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Supreme Court: Affordable Care Act Is Constitutional 2416

This morning the U.S. Supreme Court ruled 5-4 that the Affordable Care Act is constitutional. The health insurance mandate, also known as "Obamacare" was found to be "permissible under Congress's taxing authority." The full ruling (PDF) is now available, and the court's opinion begins on page 7. Amy Howe from SCOTUSblog summarized the ruling thus: "The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding." Further coverage is available from CNN, the NY Times, and Fox.
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Supreme Court: Affordable Care Act Is Constitutional

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  • by timeOday ( 582209 ) on Thursday June 28, 2012 @12:21PM (#40479527)
    I already have health insurance. It's expensive and overly complicated, but I do have it. So, will this actually change anything for people like me? Hopefully I won't be picking up the tab for so many others who opted not to buy insurance before getting sick. But otherwise I don't see a huge impact.
  • by Anonymous Coward on Thursday June 28, 2012 @12:27PM (#40479653)

    The whole problem with this is the insurance angle. This becomes a guaranteed income stream for private insurance companies. They have so many ways to hide their finances, people will pay ever higher costs for reduced care. There are a thousand studies saying health care costs will increase in the future, not including inflation. There are many ways the government could improve health care and reduce the cost of it, but this is not it. If the government was the insurance company that would be different, all they would have to do is add .5 % to the current medicare deduction. Simple. Let anyone that wants join a government health plan (with no existing condition clause). Simple.

  • Re:Odd reasoning (Score:2, Interesting)

    by Anonymous Coward on Thursday June 28, 2012 @12:28PM (#40479681)

    It was an "interesting" lawsuit to begin with. The entire basis of the lawsuit, that the mandate was unconstitutional, is a legal theory that was concocted and purchased in to public awareness via conservative media outlets. When the law was being written, this sort of challenge was not even on the radar and had no legal precedent whatsoever. Plenty of other insurance mandate style laws already exist. (We're compelled to buy all sorts of insurance for all sorts of reasons)

    Now, though, that the mandate-is-tax ruling is a supreme court ruling it opens the doors to more legislation of that type in the future. The repubs own that one for putting up a flimsy case to begin with.

  • Re:Public option (Score:5, Interesting)

    by Tumbleweed ( 3706 ) * on Thursday June 28, 2012 @12:29PM (#40479691)
    What, you mean the OTHER Republican-originated plan that the Republicans blocked so that Obama couldn't look good by doing his job? What the hell do you think happened to it? It went the way of other Republican-originated ideas that are now demonized by the Republicans once a Democrat signs onto it, like cap and trade, etc.
  • by icebrain ( 944107 ) on Thursday June 28, 2012 @12:30PM (#40479735)

    The best part is this... the majority opinion says

    Congress did not intend the payment to be treated as a "tax" for purposes of the Anti-Injunction Act. The Affordable Care Act describes the payment as a "penalty," not a "tax."

    Therefore, it is not a tax for purposes of the Anti-Injuction Act (which says you can't challenge taxes beforehand; you have to pay first and then sue).

    And then they go on to say Congress could have made it a tax, and that would have been ok, so we're calling it a tax and saying it's ok.

    So, it's not a tax, but it is a tax. Which one is it?

    This is the part I'm upset about. I don't really give two flying pieces of excrement about the law itself anymore; we're already doomed to Greece redux since our appetites are too big for our wallets. But the government blatantly saying "we'll just contort language however we need to so we can do anything we want" does not bode well at all.

  • Re:Public option (Score:5, Interesting)

    by JaredOfEuropa ( 526365 ) on Thursday June 28, 2012 @12:32PM (#40479777) Journal
    Big mistake to have that removed. Your health care system now looks a little like ours in the Netherlands, and we are seeing what one would expect to see with mandatory health care insurance: premiums go up every year, and not just because of a greater overall demand. The cold truth is that insurers, collectively, have zero interest in keeping healthcare cost down. On the contrary, they'd rather charge you $600/month rather than $300 to cover the same package, unless there is some real competition amongst insurers. Over here, there really isn't.

    I'm no fan of our social-democrat party, but I do agree with an idea they floated the other day: as insurance is mandatory, the insurers add no value whatsoever. They do add a considerable amount of overhead and a staggering amount of red tape and bureaucracy in health care. Cut them out of the deal, let the government handle health care payments and collect premiums (as they already do for part of the basic package).
  • by GeneralSecretary ( 1959616 ) on Thursday June 28, 2012 @12:39PM (#40479925)
    I don't think the ACA is a bad bill, but it misses many opportunities for better healthcare reform. The biggest for the Tech community in my opinion is that it keeps up the relationship between health insurance and employers. In the Tech industry we need the ability to change employers fast and to start up new companies inexpensively. It makes it harder to start a new tech statup if I have to offer employees healthcare. As an employee I'm less likely to work for a new start-up as I fear it failing and losing my health insurance. Also, in technology we have a lot of people working for themselves, these people have always had trouble getting insurance. We need to eliminate the relationship between employment and health insurance. It should be illegal for employers to give you health insurance. Everyone should buy on the open market, there should be no more "groups". In short we should buy health insurance like we buy car insurance.
  • by Anonymous Coward on Thursday June 28, 2012 @12:39PM (#40479935)

    I advise you you GET OFF OUR FUCKING ROADS and negotiate with each person between you and where you want to go for RIGHT to cross their PRIVATE PROPERTY if you want government's influence out of your life.

  • by Anonymous Coward on Thursday June 28, 2012 @12:39PM (#40479941)

    My expectation: in a short period of time, you'll pay less. A big part of the western world already has health insurance as mandatory, and because of that health insurance companies get more customers, and can improve their prices. If they don't, some other company will, and everybody will get insured from that company.

    And another thing that might change is the US no longer becoming the joke of the western world, with all the stories I've heard of Americans or tourists in America not being given the medical care they deserve or need.

    I'm not sure of the details of this law, to be honest, but why do you think so few people in Europe are complaining about similar laws?

  • Justice Roberts Gem (Score:5, Interesting)

    by chill ( 34294 ) on Thursday June 28, 2012 @12:46PM (#40480107) Journal

    Justice Roberts had this little gem hidden in his commentary.

    "The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause.That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it.

    But in the odious 1942 Wickard V Filburn [] case the Court ruled exactly the opposite. The Court decided that Filburn's wheat growing activities reduced the amount of wheat he would buy for chicken feed on the open market, and because wheat was traded nationally, Filburn's production of more wheat than he was allotted was affecting interstate commerce. Thus, Filburn's production could be regulated by the federal government.

    In essence, they ruled that he can't grow wheat for his own use he MUST BUY IT IN THE MARKET.

    I wonder if this ruling can be used as precedent to challenge Wickard v Filburn?

  • by spidercoz ( 947220 ) on Thursday June 28, 2012 @12:48PM (#40480135) Journal

    Bullshit. The tax is only on those who refuse to get insurance. That will be an infinitisimally small number of Americans.

    What about those who would like to have insurance but still can't fucking afford it? That's the question I would like answered as it pertains directly to me and yet I can find no discussion of it.

  • by sycodon ( 149926 ) on Thursday June 28, 2012 @12:48PM (#40480139)

    Those who refuse to get insurance that meets the Government's definition.

    My current coverage, which does not include services for women does not meet their standards. So I will have to pay more for services I don't use.

  • by xevioso ( 598654 ) on Thursday June 28, 2012 @12:51PM (#40480211)

    You will note that in his Ruling, Roberts said that the conservative wing made the same argument as you did, namely, that the law was labeled incorrectly.

    And as Roberts wisely stated, it's pretty silly to argue that you should strike down a law because of it being mislabeled, rather than for the effect of the law.

  • by Moheeheeko ( 1682914 ) on Thursday June 28, 2012 @12:55PM (#40480293)

    now if we could only get rid of the illegals taking an ambulance to the ER for a cold (It happens all the time) we would be in business.

  • Re:First dissent (Score:4, Interesting)

    by Score Whore ( 32328 ) on Thursday June 28, 2012 @01:16PM (#40480909)

    No you don't. If you can demonstrate that you have the ability to pay in amounts similar to liability requirements you do not have to buy liability insurance (comprehensive, collision, etc. insurances are not required by the government but by your lender if you have one.) It's called self insurance.

    Effectively what has happened here is that medical insurance has been removed from the USA and replaced with a third party administered government plan. Insurance is based upon risk and that has been eliminated by the ACA. In other words if you can buy it after you're sick/house has burned down/car has crashed it's not insurance but merely a cost shifting system.

  • by ai4px ( 1244212 ) on Thursday June 28, 2012 @01:18PM (#40480951)
    It was disconnected until 1973 (or so) when the government required large businesses to offer it. Over the years "large business" was redefined to be 50 or more employees. My employer presently has 49 employees and has no interest in increasing by even one employee... that 50th employee will be an expensive chap.
  • Re:First dissent (Score:5, Interesting)

    by jedidiah ( 1196 ) on Thursday June 28, 2012 @01:20PM (#40481003) Homepage

    Yes, and car insurance mandates are pretty worthless. You still have people ignoring the law. The mandated minimums are grossly inadequate while being a large financial burden for those that are high risk.

    I still need to have my own coverage to insure that my own interests are looked after.

    Based on the stated purpose of the mandate, it is a total failure.

    That's not even getting into the basic separation of powers issue here and the fact that I can avoid cars and car insurance entirely if I so choose.

  • by squiggleslash ( 241428 ) on Thursday June 28, 2012 @01:30PM (#40481237) Homepage Journal

    Because now, anyone can blow off getting health insurance till they have some expensive medical bills

    No, you can't. That's the entire point. That's why all the teabaggers were so upset. You can't, any more, blow off getting insurance without penalty. If you don't get insurance, you'll pay a tax used to cover the costs of your "freeloading" (to use the term used earlier in the thread.)

  • by rah1420 ( 234198 ) <> on Thursday June 28, 2012 @01:33PM (#40481313)

    Inadvertent my ass. CJ Roberts is playing the long game. He's playing chess and everyone else is playing checkers, to bastardize a quote from Erick Erickson. This is exactly what he wanted; he keeps the Supremes out of the political arena and galvanizes people to do what they should've done in the first place; repeal the freaking thing. Don't make the Court do the dirty work.

  • by Skarecrow77 ( 1714214 ) on Thursday June 28, 2012 @01:34PM (#40481339)

    No, you don't. If you're in a low enough income bracket, you don't have to pay the penalty, and in fact get a subsidy to purchase insurance.

    a subsidy for the poor? where does the subsidy come from, taxes?
    where do taxes come from? everybody else.

    so... everybody else is paying more money because some people can't afford health care. That sounds familiar... awfully familar... wait, I know where I've seen that phrase before!

    Please explain how that isn't EXACTLY the same problem that the individual mandate was supposed to fix? the only difference I see is that the money goes to the government, then to the poor, then to the health care industry, whereas before it went directly to the health care industry. also please explain how it could possibly be less expensive in the long run now that there is at least one extra level of beuracracy (that must be paid for) in the middle.

  • by uslurper ( 459546 ) on Thursday June 28, 2012 @01:36PM (#40481381)

    I am surprised and disappointed by this ruling. But not for the reasons you might expect.

    I want the US to have universal health care, but I think the mandate was a back-asswards way of getting it and I dont think it will be successful.
    It would have been far better to just make it a tax. This mandate only helps the health insurance industry slow its inevitable downward spiral.

    Accoding to a 2007 study by Kaiser Permanente, []
    Healthcare spending has risen steadily and has outpaced wages. This means that less and less people can afford healthcare, and in turn less people will be purchasing insurance. Of course this is cyclical, since with less people buying insurance, the insurance sompanies will ahve to increase their premiums.
    And so the health insurance industry is already in a downward spiral that will eventually collapse.

    I fear that the health insurance mandate will not stop this downward spiral, since it will be less expensive for healthy people to just pay the fine than to buy insurance. Eventually, the US government will have to intervene.

    Taxpayers already pay for a large percentage of the populations medical services. If you count Medicare, Medicaid, Federal, State, and Local governments, that makes up over 100 million users, or 30% of the population. As less people can afford healthcare, the government will be shouldering a higher percentage.

    Dont fool yourself. You are paying for this one way or another. Either by taxes, or by rising insurance costs. If your company is paying the premiums, you may want to ask them why you did not get a raise this year and they will tell you it was eaten up by premiums. insurance is after all a 'tax' that you pay in order for 'services' to be available when you need them. The healthy people end up paying for the sick people with chronic problems caused by obesity, diabetes, heart disease, lung and liver diseases, all could be prevented by good diet, exercise, and staying away from drugs, alcohol, tobacco, fat, and sugar. How does that make you feel when your hard earned dollars are going to pay for someones lung cancer treatment who has chain-smoked for 20 years?

    Not that I am bitter or anything. i paid more for health care in the last 5 years than I did in taxes. The last 2 years I paid more in health care than I did for my mortgage. And that is with an employer sponsored plan and a healthy family. But the good news is that this will HAVE to change. We know it and there is a clear path to where we need to go. In the next 5-10 years we will have universal healthcare whether we vote for it or not.

  • Re:Brilliant! (Score:4, Interesting)

    by gtbritishskull ( 1435843 ) on Thursday June 28, 2012 @01:48PM (#40481689)
    Over 70% of Americans were for a "public option", but Republicans did not allow that to happen. Does that make them "undemocratic". Or is it possible that it is a bad idea to govern by polls?
  • by GodWasAnAlien ( 206300 ) on Thursday June 28, 2012 @01:53PM (#40481879)

    What should concern everyone, and the reason John Roberts supported the mandate, is that it sets a precedent to allow privatization of taxation.

    The "Left" supported it because the mandate was attached to health care, but this is a step towards corporatism much bigger than Citizens United.

  • Re:First dissent (Score:5, Interesting)

    by mapkinase ( 958129 ) on Thursday June 28, 2012 @02:03PM (#40482137) Homepage Journal

    >Otherwise, it's pretty much like car insurance, so was the game already over decades ago

    No. It's not pretty much like car insurance. You can choose not to drive, use public transportation or hired private transportation. In fact, many aspects of government action are in this direction.

    You cannot choose not to have health problems.

    This legislation is making us similar to UK, where people pay tax to get care. We will get taxed too, but we will have a choice of "IRS" - insurance company, that's extra for us.

    From the other hand, obligatory giving money to a private company without public option is also quite corrupting.

    There are many factors that can sway cost of insurance both ways:

    1/ obligation can incrrease price
    2/ since now government will subsidize the poor, not hospitals, that could lead to reduction of cost

    Time will tell. Or not.

  • by thedonger ( 1317951 ) on Thursday June 28, 2012 @02:04PM (#40482169)
    Don't forget: We voted for the dicks who passed this legislation. It's our own fault.
  • by roman_mir ( 125474 ) on Thursday June 28, 2012 @02:12PM (#40482385) Homepage Journal

    "General welfare" does not equate to 'personal welfare'.

    General welfare is supposed to be achieved by ensuring that States do not create barriers to entry against each other, so one state shouldn't be able to prevent a person from driving in the State unless that person got a driver's license from that specific State.

    Unfortunately the federal gov't not only failed to uphold and protect the Constitution at least since 1900, but it also is clearly incapable of carrying out its direct duties - preventing States from erecting barriers to entry to businesses.

    So a State declaring that a lawyer or a financier or a doctor or an engineer, etc.etc., needs a professional license FROM THAT STATE even if he already has a professional license issued in any other State - well, that's a direct failure of the Federal gov't to discharge its duties.

  • by slimjim8094 ( 941042 ) <> on Thursday June 28, 2012 @02:16PM (#40482507)

    Well, the thing is Obama believed his rhetoric about working with the Republicans to move the country forward. That's why Gitmo is still open - rather than forcing a state to accept the prisoners, he tried to work with the (largely Republican) state governments to do it, and they wouldn't have it. The Republicans also kept asking for modifications to the single-payer plan, which were largely accepted, and then didn't vote for it anyway.

    He's grown some balls since then, but it took him being burned a lot. Not sure why he didn't give up on them sooner, especially when they started off with "let's not do anything at all in order to make him a one-term President". But, again, I think he actually believed what he said in the campaign... he seemed to make a pretty honest effort to cooperate when he could've just railroaded stuff through.

  • by roman_mir ( 125474 ) on Thursday June 28, 2012 @02:56PM (#40483559) Homepage Journal

    If the penalty is lower than monthly payments, only a fool would not cancel his insurance immediately. The 'no preexisting conditions' clause turned this from insurance into something else altogether, that's not insurance, and paying a fine is probably going to be cheaper than paying premiums.

  • Re:Good question (Score:4, Interesting)

    by Smidge204 ( 605297 ) on Thursday June 28, 2012 @03:34PM (#40484283) Journal

    Just because they can't deny offering you a policy based on a pre-existing condition doesn't mean they can't adjust their premiums and include wait times before paying out based on those conditions.

    What's that? You just got diagnosed with stage 4 lung cancer? Sorry to hear that. Sure, we're legally obligated to offer a policy... premiums are $10,000 a month and anything that happens within the first six months of policy signing is not covered.

  • Re:First dissent (Score:5, Interesting)

    by Anonymous Coward on Thursday June 28, 2012 @03:54PM (#40484701)

    The belief in free markets?
    In the Netherlands, they are running an experiment where dentists were allowed to set their own prices (I have no clue how this worked before). Goals were to have better care, to have more efficient care, and to reduce prices for consumers. Noticeable effects so far: prices are up about 6% (on average), and dentists are flat-out refusing "partial" jobs (if you need drilling in two teeth and setting a bridge to fix your one broken tooth, you cannot go to a cheap "driller" and a cheap "bridger").
    The intermediate results of the experiment are so egregious, that parliament called for ending the experiment prematurely.

    I think free markets work well when buyer and seller have equal power. When you're broken, and the other guy is not broke, there's no way you're at an equal power level.

  • Re:First dissent (Score:2, Interesting)

    by The Mighty Buzzard ( 878441 ) on Thursday June 28, 2012 @04:43PM (#40485505)

    Great, and what happens when you do contract some disease that will kill you within the week? Do you want us to just let you die if you don't have the cash on hand?

    Depends. If it's something I could reasonably expect to pay back, I'd probably take the debt and get a loan or otherwise work out payments. If it's not? Everyone has to die of something. Better to do it as a man than as a leech begging for a handout.

  • Re:First dissent (Score:2, Interesting)

    by UnknownSoldier ( 67820 ) on Thursday June 28, 2012 @04:59PM (#40485741)

    > Remember, driving a car is a Privilege, not a Right.

    Repeating a lie does not make it true.

    If you would actually take the time to _read_ case law & history you will quickly see your ignorance of the facts of the matter:

    "The use of the highway for the purpose of travel and transportation is not a mere privilege, but a common and fundamental right which the public and individuals cannot be rightfully deprived." Chicago Motor Coach v. Chicago, 337 IIL200,169 NE 22, 66 ALR 834. Ligare v. Chicago 139 III. 46, 28 NE 934. Booney v. dark, 214 SW 607; 25 A M JUR (I'1) Highways, Sec. 163.

    "...For while a citizen has the right to travel upon the public highways and to transport his property thereon, that right does not extend to the use of the a place for private gain. For the latter purpose, no person has a vested right to use the highways of this state, but it is a privilege...which the (state) may grant or withhold at its discretion..." State v. Johnson, 245 P 1073.

    I could continue ad nauseam but Google "Right To Travel" if you really want to learn.

  • Re:First dissent (Score:4, Interesting)

    by AvitarX ( 172628 ) <`gro.derdnuheniwydnarb' `ta' `em'> on Thursday June 28, 2012 @05:26PM (#40486111) Journal

    This is good.

    With tests for risk coming about, it destroys the effectiveness of insurance. The individual mandate is a requirement due to technology (along with the flattening of rates across people).

    Without it, either:

    1) insurance companies are allowed to look at an individuals risk, leading to people being excluded, and weakening the whole risk spreading idea of insurance for certain predictable diseases.

    2) insurance companies cannot run said tests, putting the power in the hands of the people to test themselves, and high-risk individuals to dis-proportionally get insurance. This will drive up rates for everyone, leading to a feedback loop.

    Technology pretty much requires the new law.

  • Re:First dissent (Score:0, Interesting)

    by Anonymous Coward on Thursday June 28, 2012 @06:17PM (#40486715)

    the so called "Obamacare" is not public healthcare anyway you slice it. It requires US citizens to buy private healthcare.

    Why do so many foreign dignitaries come to the US for treatment if " most of Europe, where the costs are lower and quality is higher"

    The US has the BEST healthcare available (if you can afford it).

    Why are costs higher?

    More of everything! for example the US has per-capita more MRI machines than any other country. That means if I need a MRI I don't have to wait three weeks to get one. That also means that often some of those machines are setting idle, so to amortize the cost getting a MRI is more expensive. Etc.

    More service providers, I've never had (or known someone to have) to wait a few weeks to see an orthopedic specialist to get a bone re-broken and set correctly like I have heard of from some european countries

    I've also never seen a 8+ hour wait in an ER, but I did read of such in Australia in their own government healthcare stats.

  • by modmans2ndcoming ( 929661 ) on Thursday June 28, 2012 @11:25PM (#40489785)

    that is MEDICAID..... Totally different plan.... totally different payer (the state for Medicaid)

    the more I read in this thread the more I find those against HCR have almost no understanding of how the old or new systems actually operated.

  • Re:First dissent (Score:4, Interesting)

    by BlueStrat ( 756137 ) on Friday June 29, 2012 @03:03AM (#40490983)


    Starting a post with childish condescension; Check.

    ...if all it takes to "trample" the "principles upon which the nation was based"

    "It does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in peopleâ(TM)s minds." - Samuel Adams

    "All tyranny needs to gain a foothold is for people of good conscience to remain silent." - Thomas Jefferson a law that requires people to have medical insurance,

    It is legislation that grants government a power over the citizens it was not granted in the Constitution and had never before tried to exercise; the ability to compel private citizens to purchase a product from another set of private citizens. Will we all have to buy/go into debt for a Chevy Volt next? How about when a "right-winger" is POTUS and theoretically made you buy something you found totally objectionable and a violation of your ethics & principles under the same power?

    ...then those were some weak-ass "principles" to begin with.

    Oh, I see your problem!

    Somehow, you got all turned-around on your way up from Mom's basement for more Cheetos and Mt. Dew, and wound up in a capitalism-based democratic republic, you silly!

    Wouldn't want you having to suffer with any of those "weak-ass 'principles'" like freedom of speech/press, or freedom from warrant-less searchesseizures, or arrest and imprisonment without cause/charge or due process, for any longer than you have to, you poor, poor deary!

    The DPRK is that way ===>

    The "principles" that hold this country together were never "The Constitution" or some Burkean fantasy of the Right. The principles that have always held this country together are the ones that say, "We're all in this together" and "Let's get this done" and "Things work better when people aren't selfish assholes".

    Yeah, everyone knows that the country was founded on the principles of collectivism and central government planning & control, and not religious freedom, individual liberty, and limited Federal power. Why, just the other day I thought I saw a painting of George Washington wearing a "Mao" T-shirt. Or was it Thomas Jefferson in a Che T-shirt?

    Well, thanks once again Ratzo, for illustrating my points for me in such stark manner.


  • Re:First dissent (Score:4, Interesting)

    by fearofcarpet ( 654438 ) on Friday June 29, 2012 @06:58AM (#40491927)

    The way a lot of healthcare works in the Netherlands is that the government forces everyone to buy basic health insurance. Many employers have special deals with insurance companies that make it cheaper for their employees, but you are free to buy from other companies, so long as you have health insurance. Without it you basically aren't allowed to participate in the economy at all (i.e., no job, no back account, no benefits, etc.) There is a minimum, legal annual co-pay (which is rising) and government assistance for people who can't afford insurance on their own. Your premium is calculated from your age and your co-pay; there is no such thing as preexisting conditions. Insurance companies are not allowed to deny people coverage, your GP (huisarts) acts as the gatekeeper just as with HMOs, but the costs of procedures are effectively dictated by the government.

    Dental insurance is optional and, with the big push towards privatization that seems to be everywhere, they decided to experiment in that market, essentially removing the cost controls and allowing dentists to compete with each other for prices. And, almost instantly, dentists stopped doing basic procedures and focused on high-margin stuff. In other words, it almost instantly turned into the American system in which people with money get the best treatment and the poor get the shaft.

    What I find interesting about the Dutch system, which shares a lot of features of Obamacare, it that deliberate and explicit cost controls are apparently necessary even when you force everyone to buy insurance. Obamacare seems to control costs only through the shared risk pool--or do I have that wrong? Also--but maybe this is just a cultural thing--Dutch doctors treat everyone like hypochondriacs because they go to the doctor for every little ache and pain. Anyone that has had to deal with HMOs, co-pays, and reimbursements from American insurance companies--and that values their time--knows that doctors won't do squat unless the pain/problem has persisted for more than two weeks or so. As a consequence, people can walk around with curable--though minor--ailments that have been diagnosed as "stress related" unless they are very persistent (and willing to switch doctors). For a variety of reasons--lawsuits being among them--GPs in the US generally refer you after relatively little complaining by comparison. I wonder how the American tendency to diagnose and treat everything and the lack of explicit cost controls will affect premiums, even with the individual mandate.

    I suppose the upshot is that I can now wonder now that Roberts has departed from the four lunatics that wanted to toss the whole thing out based on their apparent powers to see into the future.

"I think trash is the most important manifestation of culture we have in my lifetime." - Johnny Legend