Nasty as the ACA is, we will be considerably worse off without it.

Al, not so. I and many others do not want to be FORCED to buy something we do not want. If you want it, fine, whip out your wallet and pay for your own. Do not expect me to pay for you.

I read yesterday in the Eugene Register Guard there is a new type of health care service where you pay a monthly fee of like $30 to belong to a clinic and you pay a co-pay of $20 or so for each visit. This sounds like the same type private innovation Zoomcare here locally represents for urgent care. I hate to leave it to some bureaucrat under ObamaCare to determine if such health care service meets the individual mandate.

Besides, the U.S can't afford this long sought after new entitlement (ObamaCare), as it can't even afford existing medicare and social security programs as presently. So, Bojack's usual fiscal prudence tact seems somewhat tarnished by his public health care advocacy here.

We are not going to survive many centuries as a country if we are not going to foster and motivate otherwise able bodied citizens to work and endeavor to make their own decisions, provide for their own needs and wants. ObamaCare represents de-powerment of the individual in this country, and ultimate weakness.

All the folks who don't want to be "forced to buy something," need to acknowledge that government basically does this all the time, and it's the price of living in a civilized society.

Whether it's streetcars, tax credits for oil companies, wars or Medicare, the government mandates that citizens pay for these things, regardless of whether we want to.

Like Jack, I would have preferred a public option. And to quote a Nobel prize-winning economist, Paul Krugman:

Well, ObamaRomneycare is basically a somewhat klutzy way of simulating single-payer. Instead of collecting enough revenue to pay for universal health insurance, it requires that those who can afford it buy the insurance directly, then provides aid — financed with taxes — to those who can’t. The end result is much the same as if the government collected taxes from those under the mandate and bought insurance for them....It is in no sense more interventionist, more tyrannical, than Medicare; it’s just a different way of achieving the same thing.

My wife had a baby last year at Legacy Meridian Park. At 9 cm dilation, the nurse indicated the delivery wasn't progressing quickly enough, and notified the Doctor, who told us an emergency C-section was the only option.

We spent five days in the hospital, and the total charges exceeded $40,000.

When I complained that the room charge ($2,100/night billed for the mom, then another $1,900/night billed after baby's arrival) was excessive, the billing manager asked, "Did you ask how much the room cost was in advance?"

No, I didn't ask. By that same logic (caveat emptor), they might have charged $10,000/night. Since I hadn't asked, they implied I had no right to complain.

I was told that $4,000/night for mother and baby was "usual and customary".

With the exception of the Operating Room, we had the same pre-delivery room for post-delivery. The room didn't get any bigger, but they began double charging the room post delivery. The only thing that changed was the addition of a roll-in crib. The room didn't get any bigger, but the fee nearly doubled.

Time in the nursery and incidentals were billed separately. Ironically, the couple across the hall spoke very limited English and said they had recently immigrated from Mexico.

I would be very surprised if they enjoyed the same double insurance coverage that we had. I wonder if they bothered to ask what the nightly room rate was, or if they even cared?

When I complained about the double-billing, they performed an audit and reduced our bill by $1,800. After three months, they finally addressed my fundamental question: can you really bill the same room twice. They said it was perfectly legal.

The Health Insurance Companies are part of the problem: they're complicit.

I have to agree with Allan. I think many of us who comment on this blog are lucky to have fairly good health insurance through our employers or Medicare. It's easy for us left-leaning types to sulk about not getting a public option or root for the ACA's demise in hopes that something better comes along; we can afford our ideological purity. For all its considerable flaws, the ACA was an attempt to fix some of the worst facets of our market-driven health-insurance system. Sure, I'd like something more "socialist," but I also don't want to see insurance companies going back to dumping people with pre-existing medical conditions and 25-year-olds who can't get jobs in this terrible economy.

5th, so you say streetcars, wars, Medicare and what ever are the same.

Silly, silly, silly, are to fined, for not hoping in to a street car? If you do not comply with obamaCare they send a bill for payments.

I am glad you will submit, Sammy will ram some more
Whatever down you. Glad you have funds to do pay for what you want, I and 70% of Americans do not want to pay your free ride in life.

do not want to be FORCED to buy something we do not want.

I like the principle. My kids are all past school age. Can I get a pass on property taxes? Also, I'm not so keen on the Afghan war. Or the Congress.

Why shouldn't we have an individual health mandate just like we have an individual car insurance mandate? If you walk around without health insurance, you are imposing a cost on me and everyone else when you get sick or suffer an injury, just like an uninsured driver. Legally there are important differences (state vs. federal requirement) but morally it is totally justified for me to make you pay for something that you should have paid for yourself. And the subsidies are pretty significant for those who truly can't afford insurance.

I don't have sympathy for those who choose to pass along their costs to everyone else.

"Can I get a pass on property taxes?"

You realize there is a difference between a med insur premium and a tax?

If you're in your 20s now, you can get a pass on buying medical insurance, if you feel lucky.

As far as the ACA, it's better than nothing, but not much. It never addressed cost controls which drives the pricing treadmill.

Leaving aside the technical legal issues, we won't cry any tears if the health care law is struck down. With no public option, it didn't do anywhere near as much as Congress should have to change the way health care is delivered.

RIGHT ON THE MONEY---as usual....

there is a difference between a med insur premium and a tax?

So you say. And yet it seems to me that whether the government raises my income tax rate, or Increases the co-pay on some Medicare benefit, or reduces my income tax deduction for some medical expenses, the effect on my wallet is the same.

Car insurance and ACA/Mandate are NOT comparable. If I do not own a car, I do NOT have to buy car insurance. If I have a car and owe NO money on it, I only have to buy liability insurance. The liability insurance is not for me, but for somebody else that I might injure. And, it's required by the State, not the Federal government. If I owe money on the car (to a bank), I must have collision insurance. The collision insurance is not for me, it's for the title holder of the car. This is not required by the State or the Federal government, but is required by the title holder.

Again, if I have NO car, NO insurance is required or mandated.

Mike

"All the folks who don't want to be "forced to buy something," need to acknowledge that government basically does this all the time, and it's the price of living in a civilized society."

I didn't realize Metro has goombahs out there pulling people out of their cars and forcing them on to the "streetcar". I wouldn't be surprised if this is in the works but they're not willing to go there yet.

Its time that most in Oregon realize that we have a universal health insurance option system in this state. Even with a catastrophic condition you can get coverage through the Oregon Medical Insurance Pool (OMIP) which is effectively the public option. You may be declined by individual carriers because they cannnot under the law "rate you up" for the risk or for being a "smoker", but you can apply and will be accepted to OMIP.

Still 17-24% of the public decide that they cannot or will not afford the premiums and choose to go without coverage. That's an individual decision and I have talked to many people that seem to not value coverage until they actually need it. They beleive they can "game" the system and others will pay for it.

Oregon has been a great test case of what will happen with the new law and it won't solve any of the real issues in terms of affordability or cost of coverage. Health insurance is expensive and procedures are costly and thats a fact.

It seems most just want the governnment to pay for their health insurance and they believe the new law will do this. I am surprised every time I talk to somebody who believes come 2014 all will have coverage and it will be inexpensive or covered by the government. Thats the message that was sent by this administration. It wont, nothing comes for free. Oregon's experience over the past 10 years with universal access and a risk pool is a great example.

Ironically during the debate of the new law Oregon's experience like that of Washington was barely mentioned. the reason why was obvious, it didnt fit the "spin".

I'm fine with not requiring people to buy health insurance so long as they are ok with permitting ERs to exclude the uninsured. Of course, as it is now, when the uninsured gets in a bad auto accident, he'll get treated and can stiff the hospital if he chooses. Then the cost just gets passed on to the rest of us with insurance.

A health care bill that is 2000 pages and does not address cost controls speaks for itself.

And nowhere is the question of personal responsibility for one's health ever mentioned. While one cannot prevent certain genetic diseases (which include a lot of familial psychiatric conditions), immune diseases, cancer, and accidents, one CAN influence a huge amount, just by staying trim, active, and eating a good calorie-restricted diet. This starts with a human milk diet in infancy, which is a preventative against obesity, infectious disease, and respiratory illness, to name a few.

As long as the US has the lowest breastfeeding rate in the world, (with, correspondingly, a formula diet Itself directly feeding the obesity problem), and has schools which offer high calorie diets to their students, and food stamp programs which do not restrict purchases to healthier food choices, then health care costs will balloon indefinitely, and things like the ACA will prove meaningless in the long run.

if I have NO car, NO insurance

If you're on this blog and you have no car, you must be deceased. So, no health insurance either.

"Nasty as the ACA is, we will be considerably worse off without it."

That is the core of the argument in favor. Regardless of whether it is true or not, I hope SCOTUS rules strictly on constitutionality. And if the law is unconstitutional, I would disagree with you even if otherwise I would have agreed.

Which actually I wouldn't because like others here I feel it not only evaded entirely the enormity of our nearly-infamous cost-control problem, it made that, and will make it, worse.

The "public option" would or could have required tax assessments which is constitutional.

So many issues:

> This bill was written by and for those profiting from it - how can anyone defend this piece of extortion?

> Healthcare is about the only business where you have no idea how much you are paying until you get the bill- by forcing open pricing, we could cut costs considerably.

> Healthcare should be regulated just like a public utility- letting them price their services (in the dark) and then letting insurance companies decide what they will actually pay for (in the dark) is why the costs are rising by over 20% per year

> Even people that are 60 today will not get their medicare coverage with annual 20% cost inflation- this alone will put the USA into an unrecoverable debt (of course we are there now, but nobody will admit it).

The health care system we have had in the United States for most of my lifetime is broken. We spend, per capita, vastly more than other countries that have universal coverage — even twice as much — without covering some 50 million people at all, and without getting aggregate outcomes (measured, for example, by infant mortality and life expectancy) that measure up. People with employer-provided health care coverage think they are insured, but it is an illusion. They are only a layoff or merger or bankruptcy or company policy change away from having no coverage. And employer coverage has declined over the past ten years from 69% to 53%, even as employees' share of the cost has escalated. Based on current trends, health insurance premiums by 2037 will be greater than the average family's entire income.

This is the backdrop for the Supreme Court's consideration of the Affordable Care Act, which promises to significantly reduce the number of people without reasonable access to health insurance (and already has delivered on that promise for many people age 26 and under) and, if the CBO is to be believed, to "bend" the cost curve of health care in the United States downward.

The constitutional issues presented are formalistic, so much so that it is easy to lose sight of the core issue: if the law is invalidated on constitutional grounds, that means our federal government lacks the power to adopt laws it enacts to address a major systemic problem. Since 2000, it appears that the Supreme Court is, when you get right down to it, political. It has the power to take a relatively easy and basic question of constitutional law (whether the act goes beyond the powers granted to the Congress under the Constitution) and use that power to influence national politics. If they go this route, they'll give us another hefty shove down the road to oblivion.

So, Allan, you are arguing that because SCOTUS made a political rather than constitutional ruling in Bush v. Gore, they should do the same here. That is what I would consider a shove down the road to oblivion.

I cannot agree that a constitutional ruling invalidating the insurance mandate would mean "our federal government lacks the power to adopt laws it enacts to address a major systemic problem." It would mean our federal government failed to do it this time. Obama got outgunned and wanted something rather than nothing. I was sorry he did not pull back until his strategy was better ordered.

On the importance of all of this I think we would agree, if not the timing or the particulars.

I have heard a couple of political commentators say that if the court guts health care, Obama will appear such a failure that he will not be reelected. Sounds more than possible.
Not that politics would influence the decision, just as the Bush-Gore decision was decided so fairly on the basis of nonexistent law.
So the candidate backed by the super rich felons -- you won't find too many middle class people with the means to bundle $100 million iffy mortgage packages and sell them as solid gold -- will be in charge.
And the Tea Party people will be so happy not to have health care they won't notice that they just voted to screw themselves again.
Canada doesn't want immigrants, so we can't move there, but at this point maybe Greece would be a welcome change.

There were around 3000 people that died on 9/11/2001.

There are around 3000 people that die of cancer every month.

We have lost around 3.7 million people since 9/11

There has never been a bigger epidemic in our lifetime.

No healthcare system can keep up with the cost of the current methods to fight cancer because they are making huge profits to not cure you, but let you slowly die.

This is not a debate about what system works best, but about an out of control mess called modern medicine.

Car insurance and ACA/Mandate are NOT comparable. If I do not own a car, I do NOT have to buy car insurance. If I have a car and owe NO money on it, I only have to buy liability insurance. The liability insurance is not for me, but for somebody else that I might injure.

That's right -- and in the same way the health insurance mandate is not actually for you, it's for the rest of us. They're couching it in language about giving you coverage, but the reality is that we're trying to prevent you from screwing the rest of us with your unpaid medical bills.

Being on a fixed income, I had to shop around for health coverage (trail tip: apply to 3 or 4 programs at the same time - if you do it one at a time and are rejected, subsequent applications will reflect the rejection - my bride was rejected due to asthma, but other plans accepted her; they may not have, had they known that one plan rejected her).

I would not support being forced to purchase a plan that may not suit our needs - which is precisely what Obamacare does. How many promises relating to that mess have been broken already? "If you want to keep your doctor, you can" - well, no, you can't. The list of broken assurances is extensive.

Tim, this book is number one on my Amazon wish list. I was alerted to it via a medical newsletter a week ago. It's a new release (written by an oncologist) recommended as something every doctor should read.

http://www.amazon.com/How-We-Do-Harm-ebook/dp/B005LVL12O/ref=wl_it_dp_o_pC?ie=UTF8&coliid=I2DJSBTASKY37E&colid=357MF0JBRARNO

"... the health insurance mandate is not actually for you, it's for the rest of us. They're couching it in language about giving you coverage, but the reality is that we're trying to prevent you from screwing the rest of us with your unpaid medical bills."

The question is still whether it is constitutional to require the purchase of medical insurance from a private carrier. A "public option" than entailed taxes to pay for government provision for those who would or could not afford their own coverage would be constitutional.

One way or another, "we're" all going to be "screwed" by those who don't, for whatever reason, pay their own medical bills. They certainly are not bills that hardly anyone would eagerly acquire.

Eric - "For all its considerable flaws, the ACA was an attempt to fix ..." And the Yugo was an attempt to build an affordable car - both attempts failed. Would you buy a Yugo and try to convince people it really was a car? I wouldn't nor would most people. ACA is a lame, pathetic shot in the dark and it's going to cost us a ton to fund this turkey. Just like dumping money into a Yugo really doesn't help or improve that POS become a better car, so too, the amount of money that ACA will cost most of us will still provide pathetic care. Just say no to ACA - aka Obamacare.

If you think adding more government to this problem is going to fix anything, you are not a student of history.

Whether you support Universal Health Care or not, the essential question is; if the government can force you to purchase health care, is there anything that they cannot force you to buy?

A major problem with the Obamacare is that it was hashed out behind closed doors. There were various "gimmicks" used to prevent the electorate from knowing exactly what was in it and deal cut with various "Big" groups.

Contrary to Obama's election promise to have the proceeding on C-Span, there was not even the barest attempt to involve anyone but loyal Party members in crafting the legislation.

Nor was there any attempt to examine the methods used elsewhere to determine their effectiveness or problems. Congress, or at least, half of Congress decided to reinvent the wheel.

Maybe if it is overturned we can have a discussion of how to manage the problems.

If you think "competition" and the "free market" are going to fix health care, you are not a student of history.

What's really curious about all this is that the individual mandate, the object of all this conservative dudgeon and alarm, is the creation of the Heritage Foundation and was the centerpiece of the Republican health care proposal in the early 90's, drawing sponsorship of more than half the Republicans in the Senate including Grassley, who now views the individual mandate as the End of Freedom. After all, only state and local governments should be able to make you eat broccoli.

The problem with pmalach's theory is that the free market has never been fully unleashed. Insurance companies act, from state to state, like little fiefdoms and monopolies with little incentive to offer better service for lower prices.

The insurance marketplace concept (i.e., moderating the option to purchase from more than just your local carriers) should have been tried out first, before we try to overhaul the entire program and replace it with an even more complicated system.

For those who hate big insurance and think Obama's plan is so great, ask yourself who actually PROFITS from the plan. As I read it, Obama wants to bring in more insured (including the poor or those with pre-existing conditions) and wants to include the younger folks (therefore the extension of coverage to 26) to balance out risk. We aren't asking the insurance provider to act benevolently, we are lining their pockets with more premiums and using the power of the tax authority to do it.

Yes, free market competition is the answer, because when you're having a gall bladder attack, what you really need to be doing is comparison shopping. Also, I find it's good sport to go toe-to-toe with Smith-Kline-Glaxo over how much monopoly rent I'm willing to give them on their latest patented designer drug.

Jack, I agree that we would have been better off with a public option, and I think that is the next step regardless whether the ACA is upheld, struck down, or kept piecemeal. I just read all the comments, and am wondering if one of the ACA detractors can explain away Miles essential point - why should we allow someone to receive insurance (anybody gets treated upon arrival at an ER - 1986 law signed by Reagan) without paying into the system for that coverage? That is the one major benefit I see in the ACA, and that is why so many conservatives supported that concept before Obama took office.

Well Allan, even the proponents of the new law complain that one of the major causes of increased insurance costs are people who wait until after they are sick (perhaps with a gall bladder attack) to get around to getting insurance.

And you miss the point . . . when the big insurance companies become BIGGER under the new law, how do you think the government will control their special interests? For example, 80% of their premiums must be dedicated to patient costs. When the executives' 20% salary and profit margins are threatened, they'll just increase the premium. If Obama wants to "bend" the cost curve, he should be mandating a price cap. Why isn't he doing that?

For you lawyers out there, would the public option be subject to the same constitutional objection as the health care mandate currently before the Court?

I understand the mandate is objectionable -- especially, in light of questioning today by the "swing" vote on the Court, Justice Kennedy -- because the federal government forces people to buy insurance they don't want to purchase.

Whereas, the public option would avoid constitutional objection because the feds step in and pay to provide health care for the uninsured whether they want it or not?

Is that the difference?

Mike H. -- That is my understanding of the constitutional argument against the ACA. If the feds force you to pay taxes to support a federal program that they require you to participate in (see: Medicare), that's okay. But if they force you to pay for a private plan, that's unconstitutional.

The irony, of course, is that if successful the argument will limit the government's ability to use the private sector to implement public programs, which as others have pointed out is exactly what Republicans wanted to do (and did, in Romney's case), up until Obama proposed doing it. A Supreme Court ruling against the ACA is probably single payer's last hope of ever getting passed.

The constitutional issue comes about because Pelosi is an arrogant, (um what is that word that Bill Mahar uses all the time?) who thinks she can do whatever she wants.

Had someone with a little more smarts been in charge of drafting the law they could've created something that flys. Medicare for everyone for example would've been easy to implement and would pass constitutional muster. But congress tried to get cute by claiming that ACA wasn't a tax. So then they have to go drag up the wheat farmer as an example of how the feds can do anything they want and here we are.

Of course, all of these things are frauds since there won't be enough money to pay for any of them. ACA, if it survives is a ponzi scheme. It joins Social Security, Medicare, etc as another Ponzi scheme that the feds can't fund.

We can't offer better healthcare to larger numbers of people without first addressing rampant healthcare inflation.

I'm not a student of Obamacare, but I would bet they took the cowards way out: price controls if Medicare is the payor.
That only shifts the "make whole" burden to the private insurers.

We also need to bridge the gap between how much a particular input costs, and the patient's awareness of that cost.

I recently asked a Dr. (who is going to perform an elective surgery) how much the procedure costs...He blinked twice, and told me he didn't know, but he thought it ranged from $500 to $2,000 dollars. "Don't you have insurance," he asked? Of course I have insurance, but that doesn't mean the cost doesn't matter.

Would you hire an auto mechanic who had no idea how much he was going to charge? Of course not, but we do with healthcare providers more often than not.