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Tie game. Bottom of the 9th. Bases loaded. Two outs. Three balls. Two strikes. And the pitch...
June 28, 2012 6:02 AM   Subscribe

In less than an hour, the Supreme Court will hand down its final judgment in what has become one of the most crucial legal battles of our time: the constitutionality of President Obama's landmark health care reform law. The product of a strict party line vote following a year century of debate, disinformation, and tense legislative wrangling, the Affordable Care Act would (among other popular reforms) require all Americans to buy insurance coverage by 2014, broadening the risk pool for the benefit of those with pre-existing conditions. The fate of this "individual mandate," bitterly opposed by Republicans despite its similarity to past plans touted by conservatives (including presidential contender Mitt Romney) is the central question facing the justices today. If the conservative majority takes the dramatic step of striking down the mandate, the law will be toothless, and in danger of wholesale reversal, rendering millions uninsured, dealing a crippling blow to the president's re-election hopes, and possibly endangering the federal regulatory state. But despite the pessimism of bettors, some believe the Court will demur, wary of damaging its already-fragile reputation with another partisan 5-4 decision. But those who know don't talk, and those who talk don't know. Watch the SCOTUSblog liveblog for updates, Q&A, and analysis as the truth finally comes out shortly after 10 a.m. EST.
posted by Rhaomi (1173 comments total) 46 users marked this as a favorite

 
.
posted by drezdn at 6:06 AM on June 28, 2012


Well, fuck.
posted by swift at 6:07 AM on June 28, 2012


SCOTUSblog is going to "officially" announce the result on their Twitter account, where they've already said they expect more traffic to their webside today than in their first 5 years TOTAL, and that they spent $25,000 on server hardware, support, and additional writers today.
posted by Plutor at 6:07 AM on June 28, 2012 [7 favorites]


Regardless of how this goes:

MEDICARE-FOR-ALL, PLEASE.
posted by tivalasvegas at 6:07 AM on June 28, 2012 [38 favorites]


"Because", wrote Scalia in a scathing dissent, "negroes."
posted by mhoye at 6:08 AM on June 28, 2012 [104 favorites]


C'mon Supreme Court; Please don't fuck us on this one.
posted by furnace.heart at 6:10 AM on June 28, 2012 [1 favorite]


Didn't know they have tickets for supreme court rulings. Hey look, SCOTUS is just like Louis C.K. - they both do their own ticketing!
posted by joecacti at 6:12 AM on June 28, 2012 [2 favorites]


Heh. As if there is any doubt which way they'll go - it was doomed the moment it got in front of them.
posted by Artw at 6:14 AM on June 28, 2012 [3 favorites]


Hey look, SCOTUS is just like Louis C.K. - they both do their own ticketing!

I'll wait for the DVD.
posted by ZenMasterThis at 6:15 AM on June 28, 2012 [2 favorites]


I had a nightmare about this last night. I suppose that's what happens when you have serious medical issues in your household AND your employer will be affected by today's decision, but it still felt like a distinctly 2012 problem to have.
posted by MCMikeNamara at 6:16 AM on June 28, 2012 [7 favorites]


It's going to be this kind of a day, isn't it?
posted by mazola at 6:18 AM on June 28, 2012 [1 favorite]


I am willing to believe in (a) god if only Scalia will be immediately raptured away.
posted by elizardbits at 6:19 AM on June 28, 2012 [8 favorites]


I know I was a little link-happy there, but the "past plans" one -- a direct copy of a 1993 Reason magazine essay about conservative alternatives to Hillarycare -- is particularly rich:
In a nutshell, Heritage proposes that consumers be able to choose from among a host of health-care options ranging from traditional insurers to health maintenance organizations (HMOs). Using refundable tax credits that decrease as income grows, Heritage would empower families to choose plans on the basis of coverage, service, and price. As part of the "healthcare social contract" thus formed, Butler says, heads of households would be required by law to buy basic health-care coverage "to protect society from citizens who would try to exploit the good nature of ordinary Americans" by free-riding on the system.

[...]

While this regulation will underprice coverage for some individuals, Haislmaier says that the alternative is politically impossible. He says that the Heritage plan is designed to be "purely political"--to accomplish as much as possible in market-oriented reform without dooming the package to failure.

[...]

The Heritage plan lets consumers choose among approved insurance plans. It doesn't let them make choices about medical care itself. Indeed, Butler himself discounted the ability of consumers to make informed choices about medical procedures and other care in revealing congressional testimony before the Senate Finance Committee last year. "Let me draw a distinction between two ways in which consumer choice can operate," he said in answer to a senator's question. "One...is that individuals would shop around between doctors, ask for price lists, and so forth. I don't think that is a reality that is ever going to come and I think it mistakes the way consumer choice can and should operate. The other type of consumer choice is...to choose a health insurance plan....I tend to feel that the ordinary American can probably do that."
posted by Rhaomi at 6:21 AM on June 28, 2012 [10 favorites]


Crying for my the state of my country
posted by 200burritos at 6:22 AM on June 28, 2012


Nothing on the previously unsung hero of SCOTUS(blog) reporting known as Lyle Dennison? Us #teamlyle fans am disappoint.
posted by zombieflanders at 6:23 AM on June 28, 2012 [1 favorite]


Another day of getting laughed at by countries who can't understand why we don't give our citizens health care.
posted by cashman at 6:28 AM on June 28, 2012 [18 favorites]


Guys if it doesn't work out you're totally welcome in Canada. Water's a little cold but it's only June. Also we made tea.
posted by saturday_morning at 6:33 AM on June 28, 2012 [25 favorites]


Another day of getting laughed at by countries who can't understand why we don't give our citizens health care.

They can laugh all they want, but they love our bread and circuses!


Er, wait.
posted by Atreides at 6:33 AM on June 28, 2012 [6 favorites]


/shrugs. The NHS won't last long.
posted by Artw at 6:34 AM on June 28, 2012


Wait, why y'all despondent already? No decision yet, right? If it's struck down I'll be ready to join whatever mob forms in the streets, but 'til then, here's my happy in-denial dance (dances)
posted by IwishIwasFordMaddoxFord at 6:34 AM on June 28, 2012 [1 favorite]


dealing a crippling blow to the president's re-election hopes

Cite? If anything, the court striking it down would help Obama, inmyveryhumbleopinion.
posted by (Arsenio) Hall and (Warren) Oates at 6:35 AM on June 28, 2012 [2 favorites]


Meanwhile, insurance companies have been raising their rates by double digit percentages for the last couple of years, citing "increased healcare costs." So they win either way.
posted by zarq at 6:35 AM on June 28, 2012 [3 favorites]


Men at SCOTUS steps currently chanting: "real women buy their own birth control!"

Fucking despicable.
posted by zombieflanders at 6:36 AM on June 28, 2012 [25 favorites]


Artw: *sigh* sad but true.

Never fear residents of the US, you need not feel alone for much longer!
The UK will be joining you in healthcare for the wealthy soon enough.
posted by lith at 6:38 AM on June 28, 2012


Here's hoping Scalia quotes the Code of Hammurabi and a Kids Court ruling.
posted by drezdn at 6:38 AM on June 28, 2012 [5 favorites]


Wait, why y'all despondent already? No decision yet, right?

The decision is being made by Republicans and fucks over Obama, what do you think will happen?
posted by Artw at 6:38 AM on June 28, 2012 [2 favorites]


Another day of getting laughed at by countries who can't understand why we don't give our citizens health care.

Wait til they hear what we're teaching kids about cryptozoology.
posted by elizardbits at 6:38 AM on June 28, 2012 [5 favorites]


Rhaomi: “But those who know don't talk, and those who talk don't know.”

Well, you can say that, but I happen to think that Orin Kerr's thoughtful prediction of the decision over at Volokh Conspiracy was intelligent and almost certainly accurate.
posted by koeselitz at 6:38 AM on June 28, 2012 [2 favorites]


Fingers crossed from across the pond.

As a casual observer watching from the UK I am more grateful than ever before for the NHS(for all its problems and there are many undoubtedly).
posted by numberstation at 6:39 AM on June 28, 2012 [1 favorite]


what do you think will happen?

I think there will be a big party with free cake and sparkly balloons and everyone will be happy cause they get what they want. (In this scenario "everyone" = "rich old white men".)
posted by elizardbits at 6:40 AM on June 28, 2012 [4 favorites]


Some dude outside SCOTUS protesting that nobody's buying his t-shirts
posted by IwishIwasFordMaddoxFord at 6:43 AM on June 28, 2012 [2 favorites]


How do these SCOTUS decisions not leak? I mean, aren't there interns helping with the photocopies and stuff? I am amazed.
posted by secretseasons at 6:44 AM on June 28, 2012


How do these SCOTUS decisions not leak? I mean, aren't there interns helping with the photocopies and stuff? I am amazed.

Probably a good way to lose your career, if you leak a SCOTUS decision.
posted by roomthreeseventeen at 6:45 AM on June 28, 2012 [4 favorites]


Toothless? The MA plan, AKA RomneyCare provides for fines for individuals who do not purchase health insurance. Unless of course you do not earn enough to afford it. The cost to employers who don't offer the plan? only $295.00 per employee per year. Well below the cost of providing a subsidized plan. Oh, and that fine for non-conforming individuals? $1100.00 per year. So in a nutshell the results of RomneyCare is hundreds of employers dropping their subsidized plans, Individuals being forced to buy their own plan or face penalties, and indigent and illegals still able to get free care. This so far has cost Massachusetts $350,000.00.
posted by Gungho at 6:45 AM on June 28, 2012 [5 favorites]


How do these SCOTUS decisions not leak?

There was an ex-law clerk on NPR yesterday morning that mentioned that folks working at the Supreme Court tend to be very conservative about their jobs and don't want to risk damaging their reputations by leaking information. So, probably a cultural thing.
posted by backseatpilot at 6:45 AM on June 28, 2012 [1 favorite]


How do these SCOTUS decisions not leak? I mean, aren't there interns helping with the photocopies and stuff? I am amazed.

Well you've got law clerks, who while they are only employed for a short period of time are in a very prestigious position with no incentive to fuck it up. You've also probably got some other staff who would lose their very good jobs.

Not sure why anyone would do that when the return is "Reporter thinks I'm cool."
posted by Bulgaroktonos at 6:47 AM on June 28, 2012 [3 favorites]


SCOTUSblog liveblog getting "five questions per second" now.
posted by Rhaomi at 6:48 AM on June 28, 2012


I think there will be a big party with free cake and sparkly balloons and everyone will be happy cause they get what they want. (In this scenario "everyone" = "rich old white men".)

The good guys are always stalwart and true, the bad guys are easily distinguished by their pointy horns or black hats, and, uh, we always defeat them and save the day. No one ever dies, and everybody lives happily ever after.
posted by kmz at 6:48 AM on June 28, 2012 [5 favorites]


That's a lot of reading in to get done in 1 hour.
posted by laconic skeuomorph at 6:49 AM on June 28, 2012


BTW, there's two cases that will almost undoubtedly be announced first: the Stolen Valor Act and how Congress can regulate injury law. The big one isn't expected until after 10:15 EST.
posted by zombieflanders at 6:49 AM on June 28, 2012


For some interesting (read: depressing) context wrt how long this debate has been going on in this country, check out the "Town Hall Meeting of the Air" radio show on "Does America Need Compulsory Health Insurance?", from January, 1940. Exactly the same arguments that we're rehashing today, with exactly the same ridiculous fears -- seventy years ago.

(And I recommend the other episodes as well; this was one of the smartest shows of its time on American radio. And it's full of other telling moments -- for example, the "Should We Ignore Racial Differences" show from 1939 features a bunch of white Ivy League professors discussing whether African-Americans should be fully integrated citizens -- interrupted towards the end by an impassioned, angry black man who is immediately dismissed by the lecturers, who don't even begin to take him seriously. Chilling.)
posted by ariel_caliban at 6:49 AM on June 28, 2012 [45 favorites]


I'm trying not to be pessimistic about this outcome, it's going to stir up so much rancor and misinformation either way. Instead, I'm pinning my hopes on the fact that I live in one of the liberal states that did not protest the law. If it's struck down, I expect that I'll be seeing a plan put in place for my state at least. Another reason to stay here and never, never, never live in a Red state again.
posted by saffry at 6:49 AM on June 28, 2012 [1 favorite]


Libertarian author and George Mason University Economics Professor Tyler Cowen comments on health care this week:
We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree. We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.
posted by octothorpe at 6:50 AM on June 28, 2012 [7 favorites]


I don't think it's only conservatives who don't like a huge giveaway to private insurance companies with little in return.
posted by DU at 6:50 AM on June 28, 2012 [5 favorites]


I don't think it's only conservatives who don't like a huge giveaway to private insurance companies with little in return.

True. And, as a matter of (pretty gosh darn certifiable) fact, until about three years ago, they loved it and liberals didn't.

GO MY TEAM WHATEVER IT IS MY TEAM SAYS WITH NO REGARD FOR WHAT I BELIEVED TEN SECONDS AGO!!!
posted by (Arsenio) Hall and (Warren) Oates at 6:52 AM on June 28, 2012 [3 favorites]


Man, we Americans sure hate our poor and sick people, don't we?
posted by tommasz at 6:52 AM on June 28, 2012 [10 favorites]


Libertarian author and George Mason University Economics Professor Tyler Cowen comments on health care this week

Christ, what an asshole.
posted by zombieflanders at 6:53 AM on June 28, 2012 [21 favorites]


Man, we Americans sure hate our poor and sick people, don't we?

GOP Jesus has his OWN bible...
posted by mikelieman at 6:53 AM on June 28, 2012 [4 favorites]


I live in Washington, home of liberal Seattle. Our Attorney General protested the law off his own back simply because he's a partisan asshole.
posted by Artw at 6:53 AM on June 28, 2012 [2 favorites]


We need to accept the principle that sometimes poor people will die just because they are poor.

Basically, "if you're poor, fuck you you can go die." I think Cowen should stick to food writing.
posted by windbox at 6:53 AM on June 28, 2012 [1 favorite]


From liveblog:

When the Justices take the bench, the Marshal -- Pamela Talkin -- will pound the gavel and with an "Oyez, oyez," announce that the Court is in session. [...] To answer another question, I have no idea what "Oyez" means. It's just what they say. Readers?

Yiiiiiiiikes
posted by jinjo at 6:53 AM on June 28, 2012 [9 favorites]


Man, we Americans sure hate our poor and sick people, don't we?

and the uneducated and unemployed! can't forget about them
posted by zombieApoc at 6:55 AM on June 28, 2012 [2 favorites]


Amy Howe: You all are the greatest. Apparently Oyez means "listen" or "hear" or "pay attention." Thanks!

Lawyered.
posted by zombieflanders at 6:55 AM on June 28, 2012


I think Cowen should be commended for stating the actual conservative opinion on healthcare rather than hiding it behind bullshit about individual freedom or whatever
posted by theodolite at 6:55 AM on June 28, 2012 [21 favorites]


as a " old white man", who is depending on this bill to continue to provide insurance for kids who are not yet 26 and can NOT find jobs in this fucked economy. Could we avoid going to the "old white men" place again? Please
posted by HuronBob at 6:56 AM on June 28, 2012 [12 favorites]


The full Tyler Cowen post from which the above quote was pulled is here. The two sentences directly preceding the above pull quote are:
A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence.
posted by Perplexity at 6:57 AM on June 28, 2012 [1 favorite]


To be fair, the comment was "rich old white men"
posted by zombieflanders at 6:57 AM on June 28, 2012 [4 favorites]


Yeah I was surprised she didn't know what "Oyez" meant either. I'm not even a lawyer and I knew it was "Hear ye" in archaic French.
posted by tivalasvegas at 6:57 AM on June 28, 2012 [5 favorites]


Republicans, for the right to die except in cases of euthanasia.
posted by drezdn at 6:57 AM on June 28, 2012 [14 favorites]


i'm actually not able to really do anything else right now because i'm all anxious about the decision.
posted by sio42 at 6:57 AM on June 28, 2012


Facebook has recently purchased $25,000 of new server equipment to accommodate all of the "SUCK IT, LIBTARDS" status updates soon to follow
posted by Sticherbeast at 6:58 AM on June 28, 2012 [5 favorites]


I sincerely wish that instead of the French "Oyez, oyez" ("Hear ye, hear ye"), you had French-style health care.

I don't know anyone who laughs at US lack of decent health coverage for everyone. Quite on the contrary, people's faces usually bear looks of shock and then sorrow once it sinks in that it's true.
posted by fraula at 6:58 AM on June 28, 2012 [11 favorites]


Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor.

These two sentences are simply incredible. Trying to equalize health care consumption hurts the poor because it costs money, so we need to just let them die. To avoid hurting them
posted by crayz at 6:58 AM on June 28, 2012 [19 favorites]


To be fair, the comment was "rich old white men"

Do we need to stereotype ANYONE, really. I know wealthy people who support this, I know blacks who don't, I know women who are out protesting with the tea party. Can we just call them "the people who don't support the law"?
posted by HuronBob at 6:59 AM on June 28, 2012 [18 favorites]


jinjo: Yiiiiiiiikes

I commend her for her admission of not knowing something, all too often people would muddle through, pretend, or ignore the question entirely.
posted by lith at 7:00 AM on June 28, 2012 [3 favorites]


Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence.

Wait, only most feasible policies? Well, then let's pick from the ones that don't. Solved.
posted by jedicus at 7:00 AM on June 28, 2012 [1 favorite]


WASHINGTON, DC—In a landmark decision Monday, the United States Supreme Court ruled 8-1 that it rules.
posted by (Arsenio) Hall and (Warren) Oates at 7:00 AM on June 28, 2012 [2 favorites]


We need to accept the principle that sometimes poor people will die just because they are poor.
We do?
posted by Flunkie at 7:01 AM on June 28, 2012 [4 favorites]


Can we just call them "the people who don't support the law"?

Or "massive pricks" for short.
posted by howfar at 7:01 AM on June 28, 2012 [2 favorites]


Yeah, I work in the insurance industry. Pretty tense round here.
posted by emjaybee at 7:01 AM on June 28, 2012


SUCH A NAILBITER
posted by triggerfinger at 7:02 AM on June 28, 2012


SCOTUS rules in favor of challenger to "Stolen Valor" act, affirming First Amendment right to lie about one's own military honors.
posted by Rhaomi at 7:03 AM on June 28, 2012 [1 favorite]


Same here, emjaybee.
posted by NationalKato at 7:03 AM on June 28, 2012


Stolen Valor Act unconstitutional in case anyone cares.
posted by zombieflanders at 7:03 AM on June 28, 2012


Stolen Valor Act could be a good band name.
posted by IwishIwasFordMaddoxFord at 7:03 AM on June 28, 2012 [5 favorites]


I just wanted to tell you both good luck. We're all counting on you.
posted by joecacti at 7:04 AM on June 28, 2012 [17 favorites]


How is that freedom of speech? I didn't think freedom of speech covered lying?
posted by maryr at 7:04 AM on June 28, 2012 [1 favorite]


Sincerely hoping that the conservatives live to deeply regret branding this all "Obamacare".

That only works as an insulting label if it fails. If it works, they have to see people happily benefiting from a plan indelibly associated with Obama's name.
posted by caution live frogs at 7:04 AM on June 28, 2012 [14 favorites]


CNN.com not coming up...any good video links?
posted by pointystick at 7:04 AM on June 28, 2012


damn you (A)H and (W)O. i got all emotional there for a moment and my faith in the country was reaffirmed.

then i realized my faith in my own literacy was sadly misplaced.
posted by sio42 at 7:04 AM on June 28, 2012


"large box" for HCA ruling. Gonna take forever to read
posted by IwishIwasFordMaddoxFord at 7:05 AM on June 28, 2012


A rejection of roadway egalitarianism, namely a recognition that the wealthy will purchase more and better roadway usage than the poor. Trying to equalize roadway usage hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will be unable to travel just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly bridges — which increase their ability to travel and which the poor enjoy to a much lesser degree. We shouldn’t screw up our roadways by being determined to fight inegalitarian principles for one very select set of factors which determine travel possibilities.
posted by Sticherbeast at 7:05 AM on June 28, 2012 [3 favorites]


These two sentences are simply incredible. Trying to equalize health care consumption hurts the poor because it costs money, so we need to just let them die. To avoid hurting them.

Just another example of why Libertarianism is BATSHIT CRAZY.
posted by Benny Andajetz at 7:05 AM on June 28, 2012 [27 favorites]


How many people do you think will simultaneously post with a comment containing nothing but the vote on the health care decision? Let's put the over/under on 15, and I'm taking the over.
posted by andoatnp at 7:05 AM on June 28, 2012


I commend her for her admission of not knowing something, all too often people would muddle through, pretend, or ignore the question entirely.

The internet is right there- presumably her google works.
posted by winna at 7:05 AM on June 28, 2012 [1 favorite]


Stolen Valor Act unconstitutional in case anyone cares.

YEEAAAAAHHH!!!! Suck it, Liberals! USA! USA! USA! WOOHOOO!!!
posted by gauche at 7:05 AM on June 28, 2012 [2 favorites]


Criminal liability for lying about a medal of honor anyone? The Alvarez opinion was just issued.
posted by Jurbano at 7:06 AM on June 28, 2012


How is that freedom of speech? I didn't think freedom of speech covered lying?

Only certain categories of lying are beyond protection, such as perjury and fraud. Simply walking around with medals you haven't earned is neither perjury nor fraud.
posted by Sticherbeast at 7:06 AM on June 28, 2012 [4 favorites]


maryr: I'm the Prince of Nigeria. Telling you a lie isn't a crime. If I go further and defraud you that's a separate crime.
posted by floam at 7:06 AM on June 28, 2012 [2 favorites]


My charitable guess on what Cowan was trying to say: trying to provide poor people with the same level of coverage as the rich depletes a limited pool of money for providing the poor with other services with limited results. Everyone should be guaranteed a certain basket of health services but not equal services to the rich, because the rich are willing to spend large amounts of money for minimal length or quality of life returns.
posted by ghharr at 7:07 AM on June 28, 2012 [1 favorite]


520,000 contemporaneous readers on the SCOTUS liveblog.

lots of people not doing anything work-related at work, including me!
posted by sio42 at 7:07 AM on June 28, 2012


I wonder what the average period is between people realizing their government doesn't work for them and deciding to do something about it. If I remember my history, it can be depressingly long.
posted by Mooski at 7:07 AM on June 28, 2012


Why does Thomas get to read anything. I mean he should just always be the silent brooding menace he always is.
posted by IwishIwasFordMaddoxFord at 7:07 AM on June 28, 2012 [3 favorites]


I didn't think freedom of speech covered lying?

Read Citizens United.

I keed, I keed, but seriously, non-fraudulent lying is totally free speech.
posted by gauche at 7:07 AM on June 28, 2012 [7 favorites]


When the Justices take the bench, the Marshal -- Pamela Talkin -- will pound the gavel and with an "Oyez, oyez," announce that the Court is in session. [...] To answer another question, I have no idea what "Oyez" means. It's just what they say. Readers?
It would be far cooler if they opened with "Hwæt!"

posted by Jehan at 7:07 AM on June 28, 2012 [12 favorites]


We have HCR opinion coming now
posted by zombieflanders at 7:07 AM on June 28, 2012


Individual mandate fails. Fuck.
posted by Rhaomi at 7:07 AM on June 28, 2012


> Stolen Valor Act unconstitutional in case anyone cares.

YEEAAAAAHHH!!!! Suck it, Liberals! USA! USA! USA! WOOHOOO!!!


....That was a Bush era thing.

The people around me at work are saying it was upheld.
posted by EmpressCallipygos at 7:08 AM on June 28, 2012 [1 favorite]


Stolen Valor Act unconstitutional in case anyone cares.

YEEAAAAAHHH!!!! Suck it, Liberals! USA! USA! USA! WOOHOOO!!!


Huh?
posted by kmz at 7:08 AM on June 28, 2012


ooooo!
posted by joecacti at 7:08 AM on June 28, 2012


ZOMG here it is
posted by IwishIwasFordMaddoxFord at 7:08 AM on June 28, 2012


Where do you see that Rhaomi?
posted by zombieflanders at 7:08 AM on June 28, 2012


Lies are people too, my friend.
posted by Benny Andajetz at 7:08 AM on June 28, 2012 [5 favorites]


I work in a psych hospital. Many of my patients are covered by Medicaid or are totally uninsured.

I am so worried right now.
posted by catlet at 7:08 AM on June 28, 2012


FOX news: Struck down!
posted by joecacti at 7:08 AM on June 28, 2012


The individual mandate survives as a tax.

!!!!!!!
posted by zombieflanders at 7:08 AM on June 28, 2012 [8 favorites]


Amy Howe:
The individual mandate survives as a tax.
posted by XQUZYPHYR at 7:08 AM on June 28, 2012


It's being reported on CNN by Wolf Blitzer
posted by triggerfinger at 7:09 AM on June 28, 2012


individual mandate survives as tax
posted by IwishIwasFordMaddoxFord at 7:09 AM on June 28, 2012 [1 favorite]


"The individual mandate survives as a tax." - SCOTUSblog
posted by saturday_morning at 7:09 AM on June 28, 2012 [1 favorite]


Live blog says "Amy Howe: The individual mandate survives as a tax."
posted by mkb at 7:09 AM on June 28, 2012 [1 favorite]


Wait. SCOTUSblog just said the Individual mandate survived, but as a tax.
posted by schmod at 7:09 AM on June 28, 2012 [1 favorite]


Amy Howe: The individual mandate survives as a tax.
posted by WinnipegDragon at 7:09 AM on June 28, 2012


...that it was struck down
posted by triggerfinger at 7:09 AM on June 28, 2012


But it constitutional as a tax. Howabout that.
posted by [expletive deleted] at 7:09 AM on June 28, 2012


Haha, what? SCOTUSblog is contradicting CNN live report?
posted by Rhaomi at 7:09 AM on June 28, 2012 [1 favorite]


WTF is going on here?
posted by zombieflanders at 7:09 AM on June 28, 2012


The individual mandate survives as a tax.

Can someone who knows how anything works explain this to stupid ol' me?
posted by shakespeherian at 7:09 AM on June 28, 2012 [5 favorites]


Well ok wait what does that mean though
posted by showbiz_liz at 7:10 AM on June 28, 2012


very complicated....you don't say?
posted by SomaSoda at 7:10 AM on June 28, 2012


How can it "survive" as something else? Did SCOTUS do that? Can they do that? CONFUSED also the auto-update alert box stopped working, boo
posted by jinjo at 7:10 AM on June 28, 2012


CNN says the mandate was "struck down". I don't get it.
posted by DWRoelands at 7:10 AM on June 28, 2012


Can someone who knows how anything works explain this to stupid ol' me?

Me too?
posted by EmpressCallipygos at 7:10 AM on June 28, 2012


MANDATE LIVES. EAT SHIT GOP!
posted by Ironmouth at 7:10 AM on June 28, 2012 [50 favorites]


individual mandate survives as tax

AHAHAHAHA

I KEPT SAYING THIS WOULD HAPPEN, AND PEOPLE KEPT TELLING ME I WAS SO TOTALLY WRONG

THERE IS NO WAY FOR ME TO PROVE THIS MEANINGLESS ASSERTION

AND YET HERE I AM

ASSERTING
posted by Sticherbeast at 7:10 AM on June 28, 2012 [51 favorites]


What does...huh?
posted by middleclasstool at 7:10 AM on June 28, 2012


SCHROEDINGER'S TAX
posted by Rhaomi at 7:10 AM on June 28, 2012 [49 favorites]


WTF does that mean, Amy Howe?
posted by pointystick at 7:10 AM on June 28, 2012


Amy Howe: It's very complicated, so we're still figuring it out.

That would seem to say the rest stays though, right?
posted by zombieflanders at 7:10 AM on June 28, 2012


How is that freedom of speech? I didn't think freedom of speech covered lying?

The question is "Are we far enough down the road to Fascism that anything even remotely disrespectful of our flag-wearing trigger pullers deserves legal sanction?"

Negging the SVA = no to that question. And I think that's a good thing.
posted by Pirate-Bartender-Zombie-Monkey at 7:10 AM on June 28, 2012 [8 favorites]


Do they mean that it would have survived had it been implemented as a tax?
posted by Perplexity at 7:10 AM on June 28, 2012


Tom: So the mandate is constitutional. Chief Justice Roberts joins the left of the Court.


HOLY SHIT
posted by zombieflanders at 7:10 AM on June 28, 2012 [11 favorites]


wowzer. Roberts joins left.
posted by SomaSoda at 7:10 AM on June 28, 2012 [1 favorite]


WTF does that mean "survives as a tax"???
posted by Thorzdad at 7:11 AM on June 28, 2012


and also...Roberts?
posted by middleclasstool at 7:11 AM on June 28, 2012 [2 favorites]


The individual mandate survives as a tax.

So "single payer", right? RIGHT?
posted by pashdown at 7:11 AM on June 28, 2012 [5 favorites]


Roberts voted for it!
posted by WinnipegDragon at 7:11 AM on June 28, 2012 [1 favorite]


I believe it means something a little bit like Singer Payer, no? We all pay in, we all get insurance.
posted by (Arsenio) Hall and (Warren) Oates at 7:11 AM on June 28, 2012 [2 favorites]


Hooray for the CPA lobby! With extra healthcare tax credits!
posted by mikelieman at 7:11 AM on June 28, 2012


SCOTUSblog says the mandate is constitutional. Other people say it's struck down. Whaaaaaa
posted by shakespeherian at 7:11 AM on June 28, 2012


I just heard someone "woo hoo" from about 100 feet away
posted by theodolite at 7:11 AM on June 28, 2012 [7 favorites]


...and SCOTUS BLOG says "The Mandate is constitutional". ???!?!?!
posted by DWRoelands at 7:11 AM on June 28, 2012


CNN and Reuters headlines are directly contradicting each other about the mandate right now.
posted by crackingdes at 7:11 AM on June 28, 2012


SHOULD I BE THRILLED OR OUTRAGED PLEASE EXPLAIN
posted by elizardbits at 7:11 AM on June 28, 2012 [86 favorites]


Augh! Explanations! I need them! Use small words! Am too freaked out to process anything with more than 3 syllables!
posted by shiu mai baby at 7:11 AM on June 28, 2012 [1 favorite]


NYT blog says "The Supreme Court has ruled on President Obama’s health-care overhaul, and Times reporters and editors are analyzing the decision. Once we are comfortable with its basic meaning, you can expect a torrent of coverage."
posted by catlet at 7:11 AM on June 28, 2012 [4 favorites]


Scotusblog: So the mandate is constitutional.
posted by winna at 7:11 AM on June 28, 2012


Tom: So the mandate is constitutional. Chief Justice Roberts joins the left of the Court.

What
The
Fuck
John!
posted by TedW at 7:11 AM on June 28, 2012 [8 favorites]


^ is why you need to hire an attorney.
posted by Jurbano at 7:11 AM on June 28, 2012 [1 favorite]


Amy Howe: The Medicaid provision is limited but not invalidated.

This shit is getting cray cray
posted by zombieflanders at 7:11 AM on June 28, 2012 [7 favorites]


Do they mean that it would have survived had it been implemented as a tax?

I thought it was a tax already. If you refuse to get insurance, you pay a special tax to make up for it.
posted by floam at 7:11 AM on June 28, 2012 [1 favorite]


Not surprised that Roberts joined the left. He knew this would have been on him had it been struck down with no basis or precedence.
posted by (Arsenio) Hall and (Warren) Oates at 7:12 AM on June 28, 2012


Medicaid provision limited. That's bad for the poor.
posted by IwishIwasFordMaddoxFord at 7:12 AM on June 28, 2012


CNN saying the mandate is unconstitutional. What's going on here?
posted by item at 7:12 AM on June 28, 2012


Are they saying the mandate is unconstitutional but that it's okay to do as a tax?
posted by triggerfinger at 7:12 AM on June 28, 2012


NBC is reporting health care law is upheld, not under the commerce clause but under taxing power of Congress (as a penalty).
posted by NationalKato at 7:12 AM on June 28, 2012 [2 favorites]


Can someone who knows how anything works explain this to stupid ol' me?

Not without reading the opinion. At this point I don't even know who wrote it.
posted by gauche at 7:12 AM on June 28, 2012


Ooh donuts.
posted by seanmpuckett at 7:12 AM on June 28, 2012 [2 favorites]


gov't argued multiple bases for mandate. that's why survives as a tax.
posted by Ironmouth at 7:12 AM on June 28, 2012 [4 favorites]


Chief Justice Roberts joins the left of the Court.

I hope this means he thinks Scalia is a great big bag of dicks.
posted by elizardbits at 7:13 AM on June 28, 2012 [48 favorites]


So I'm assuming the decision is worded with like thirteen nested quadruple negatives and that's why no one can figure out what the fuck it says right
posted by shakespeherian at 7:13 AM on June 28, 2012 [8 favorites]


I wish the world was black and white...just like I know it never was
posted by kenaldo at 7:13 AM on June 28, 2012 [1 favorite]


"The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read."

There ya go folks. See you at the party.
posted by saturday_morning at 7:13 AM on June 28, 2012 [4 favorites]


As the Chief, Roberts has every incentive to join the liberals, so that the opinion can be crafted in as conservative a way as possible. (Chiefs get to assign opinions.)
posted by Yesterday's camel at 7:13 AM on June 28, 2012 [3 favorites]


The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read.
posted by IwishIwasFordMaddoxFord at 7:13 AM on June 28, 2012


Tom: The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read.

Damn
posted by zombieflanders at 7:13 AM on June 28, 2012


Can someone who knows how anything works explain this to stupid ol' me?

From CNN:
The first question the high court tackled in its seven-hour marathon argument in March was something few observers had expected: It boiled down to whether the law's individual mandate is a "tax" that could prevent the court from considering the broader constitutional questions.

A little-known federal law -- the Anti-Injunction Act, dating back to 1867-- bars claimants from asking for a refund on a tax until it has been paid.

This "gateway" issue could render moot all the other pending health care questions if the justices think the minimum coverage requirement amounts to a tax.

Most justices seemed reluctant to take that route at the public argument session; they appeared eager to move on and address the broader, more vital constitutional questions. But citing the Anti-Injunction Act might give cautious justices a way out of deciding the explosive issue in an election year.

The majority might conclude that the political branches can best resolve the conflicts, at least for now, or that the matter can be handled after the November elections.

Some court watchers have called this the health care "sleeper issue" that could delay a decision on the constitutionality of the individual mandate for at least four years.
posted by Rock Steady at 7:13 AM on June 28, 2012 [1 favorite]


John Roberta probably wrote the decision
posted by JKevinKing at 7:13 AM on June 28, 2012


On a tangent - the people around me, including my boss, are all saying that "so this is a bad thing because it's a 'yes' vote for Obama and he will get re-elected."

I have got to find a new job because these clearly are not my people.
posted by EmpressCallipygos at 7:13 AM on June 28, 2012 [90 favorites]


There is a very angry lady on CSPAN3 right now.
posted by schmod at 7:14 AM on June 28, 2012 [3 favorites]


Good damn
posted by zombieflanders at 7:14 AM on June 28, 2012 [1 favorite]


Unnamed CNN producer is sooooooooooo fucked. At least Roberts has someone to take the heat off his inauguration misread as most embarrassing high profile SCOTUS-related gaffe.
posted by Rhaomi at 7:14 AM on June 28, 2012 [3 favorites]


.
posted by caclwmr4 at 7:14 AM on June 28, 2012


Tom: The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read.

i can haz insurance?!?!?!??!!!!
posted by sio42 at 7:14 AM on June 28, 2012 [17 favorites]


It's a first step for health care sanity for my southern neighbours. CONGRATS!
posted by WinnipegDragon at 7:14 AM on June 28, 2012 [4 favorites]


In all the permutations I imagined, I never thought SCOTUS would uphold the individual mandate under the taxing power. I assumed that would have been rejected 9-0 and that the individual mandate would have been upheld under the Commerce Clause 6-3 or rejected 5-4 (with Roberts going to whatever side had the votes). I am totally stunned by the taxing power aspect.
posted by Falconetti at 7:14 AM on June 28, 2012 [5 favorites]


what did kennedy say?
oh, "5-4 w/ roberts joining liberals..."
posted by pjenks at 7:14 AM on June 28, 2012


It sounds like they're saying the court went ahead on its own and declared the mandate a "tax" for the purpose of making it Constitutional.
posted by XQUZYPHYR at 7:14 AM on June 28, 2012


Spending this morning at a hospital and then at an customer-owned insurance company (both groups that were hoping for the decision we got except for the Medicare issue) has been ridiculously weird.
posted by MCMikeNamara at 7:14 AM on June 28, 2012


BREAKING: JEFF TOOBIN IS AN IDIOT.
posted by Ironmouth at 7:15 AM on June 28, 2012 [5 favorites]


So this is a good thing, right?
posted by sperose at 7:15 AM on June 28, 2012


ABC said it's like Flood Insurance. They can't make you buy it, but they can tax you differently if you don't. They can't mandate Health Insurance and fine you if you don't comply, but they can tax you if you don't comply, or give you break if you do. I think...
posted by zengargoyle at 7:15 AM on June 28, 2012 [13 favorites]


CNN still says "Health Care struck down"
posted by pjenks at 7:15 AM on June 28, 2012


I have got to find a new job because these clearly are not my people.

When I got out of the Insurance Business I was a much happier man. Until I got into the Banking Business....
posted by mikelieman at 7:15 AM on June 28, 2012


I love that this is so complex that it's completely unclear what happened. It's a perfect microcosm of the vicissitudes of our system.
posted by Plutor at 7:16 AM on June 28, 2012 [13 favorites]


The best part of this decision is how many news outlets are saying WE DON'T REALLY KNOW WHAT THIS MEANS BUT WHEN WE DO WE WILL TELL YOU. I feel slightly better about the American media today.
posted by elizardbits at 7:16 AM on June 28, 2012 [20 favorites]


pjenks, why are you watching CNN's site for the news? Go somewhere dependable.
posted by NationalKato at 7:16 AM on June 28, 2012 [2 favorites]


ABC said it's like Flood Insurance. They can't make you buy it, but they can tax you differently if you don't.

If this is accurate, it's the best explanation I've heard so far, and....seems to be a fair compromise, no?
posted by EmpressCallipygos at 7:17 AM on June 28, 2012 [5 favorites]


What the hell CNN? The entire law has been upheld now? When 5 seconds ago everything was struck down?!?!
posted by cashman at 7:17 AM on June 28, 2012


wow @ cnn
posted by Perplexity at 7:17 AM on June 28, 2012 [1 favorite]


CNN still says it was struck down - what the hell? Why didn't they wait to get confirmation before running with the fox news line?
posted by winna at 7:17 AM on June 28, 2012


Metafilter: microcosm of the vicissitudes of our system.
Also: Not a good band name.
posted by joecacti at 7:17 AM on June 28, 2012 [1 favorite]


The Tea Party's gonna flip its shit.
posted by triggerfinger at 7:17 AM on June 28, 2012 [3 favorites]


Upheld!

Also, 'Wolf Blitzer' - if that is your real name - needs to be put out to pasture. He regularly jumps the gun on live reports like this.
posted by item at 7:17 AM on June 28, 2012 [3 favorites]


words i never thought i'd see: (from the SCOTUS live blog) - Tom: Chief Justice Roberts' vote saved the ACA.
posted by sio42 at 7:17 AM on June 28, 2012 [1 favorite]


EmpressCallipygos: "On a tangent - the people around me, including my boss, are all saying that "so this is a bad thing because it's a 'yes' vote for Obama and he will get re-elected." "

My coworkers know I'm the token liberal in the office, and taunt me by referring to "President Romney," and pointing to photos of him and saying "Take a look at your future president."

I work in a "non-partisan" office in Congress. FML.
posted by schmod at 7:17 AM on June 28, 2012 [29 favorites]


CNN got it laughably wrong, posting in giant type "Mandate Struck Down" on its homepage. Then it changed it.
posted by shivohum at 7:17 AM on June 28, 2012 [1 favorite]


The best part of this decision is how many news outlets are saying WE DON'T REALLY KNOW WHAT THIS MEANS BUT WHEN WE DO WE WILL TELL YOU

I liked all the news outlets saying MANDATE UNCONSTITUTIONAL and then when you refresh they say ENTIRE ACA UPHELD because lol, the name even changed
posted by shakespeherian at 7:17 AM on June 28, 2012 [5 favorites]


It sounds like they're saying the court went ahead on its own and declared the mandate a "tax" for the purpose of making it Constitutional.

My reading is that, if it's a tax, it can't be challenged until it's enforced. So this may not be definitive, but rather passing the buck? It looks like no one really knows yet.

Still, passing the buck until the law is actually in effect is a HUGE win. The status quo is a powerful argument for future courts to continue to uphold the law.
posted by muddgirl at 7:17 AM on June 28, 2012 [1 favorite]


no, I just went there (for the first time in months) cause I heard they were saying that...
posted by pjenks at 7:17 AM on June 28, 2012


CNN has 'Mandate struck down' on it's ticker, while the main page says the ACA is upheld. Way to go guys.
posted by WinnipegDragon at 7:18 AM on June 28, 2012


So I'm assuming the decision is worded with like thirteen nested quadruple negatives and that's why no one can figure out what the fuck it says right

Our Supreme Opinion is: We do not undeclare that the law is not not not never not going to be not un-upheld. Not.
posted by Rock Steady at 7:18 AM on June 28, 2012 [18 favorites]


When I got out of the Insurance Business I was a much happier man. Until I got into the Banking Business....

I am in the banking business. As a secretary, but yeah.

(No, these seriously aren't my people; one of my bosses yesterday wanted a hotel for an upcoming trip and was trying to decide between 4 of them and asked me "which one is nicest?" And I just blurted out, "dude, when I travel I stay in youth hostels," and he looked at me like I was a freak.)
posted by EmpressCallipygos at 7:18 AM on June 28, 2012 [24 favorites]


Moneu quote: Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.
posted by gauche at 7:18 AM on June 28, 2012 [1 favorite]


Oh, CNN:

Correction: The Supreme Court backs all parts of President Obama’s signature health care law.
posted by kmz at 7:19 AM on June 28, 2012 [1 favorite]


Wow. Remember when CNN revolutionized the news industry?
posted by XQUZYPHYR at 7:19 AM on June 28, 2012 [14 favorites]


9:!7, CNN FINALLY got around to changing it's headline from "Mandate struck down" to the more neutral "Court rules on Obamacare". 10 full minutes after the decision was first reported.
posted by triggerfinger at 7:19 AM on June 28, 2012


The Tea Party's gonna flip its shit.

Judging by the audio on C-SPAN3, they started doing so about ten minutes ago.
posted by one more dead town's last parade at 7:19 AM on June 28, 2012 [6 favorites]


This is a big fucking deal.
posted by schmod at 7:19 AM on June 28, 2012 [33 favorites]


CNN has 'Mandate struck down' on it's ticker, while the main page says the ACA is upheld. Way to go guys.

CNN, or as my dad used to call it, The Keystone News Network.
posted by gauche at 7:20 AM on June 28, 2012 [8 favorites]


Man, I wish I was a fly on the wall of the backroom negotiations which convinced Roberts to vote for the tax argument, and Kennedy to vote against it!
posted by muddgirl at 7:20 AM on June 28, 2012 [6 favorites]


CNN: DEWEY STRUCK DOWN
posted by localroger at 7:20 AM on June 28, 2012 [70 favorites]


The crowd of people on scene don't know what the fuck to do! Now they're just milling around.
posted by cashman at 7:20 AM on June 28, 2012 [1 favorite]


Next on CNN: Dewey defeats Truman!
posted by goethean at 7:20 AM on June 28, 2012 [5 favorites]


Liveblog again:

The court reinforces that individuals can simply refuse to pay the tax and not comply with the mandate.

Wait then uh
posted by jinjo at 7:20 AM on June 28, 2012 [1 favorite]


"The court reinforces that individuals can simply refuse to pay the tax and not comply with the mandate." -- Buh???
posted by schmod at 7:20 AM on June 28, 2012


"The court reinforces that individuals can simply refuse to pay the tax and not comply with the mandate. " - SCOTUS blog
posted by pointystick at 7:20 AM on June 28, 2012


SCOTUS website getting hammered. This is the page for slip opinions (where the full opinion will be uploaded).
posted by catlet at 7:20 AM on June 28, 2012 [1 favorite]


Amy Howe: The court reinforces that individuals can simply refuse to pay the tax and not comply with the mandate.

Wha?
posted by jpdoane at 7:20 AM on June 28, 2012


Scouring the internet for the first sincere usage of 'activist judges'
posted by shakespeherian at 7:20 AM on June 28, 2012 [1 favorite]


So this means I can go get in line for my free shot of gov't-sponsored heroin, right?
posted by item at 7:20 AM on June 28, 2012 [2 favorites]


Amy Howe: The money quote from the section on the mandate: Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.

I kind of want to kiss Roberts and Kennedy right now. You don't want to know what I'm thinking about the liberal justices.
posted by zombieflanders at 7:21 AM on June 28, 2012 [4 favorites]


CSPAN3 for pleasure or for pain, depending on your disposition.
posted by (Arsenio) Hall and (Warren) Oates at 7:21 AM on June 28, 2012


The creepy thing is that they completely scrubbed their breaking news blog of the fuck up, not even mentioning that they'd made it.
posted by winna at 7:21 AM on June 28, 2012


This just in, American conservatives forced by law to aid the sick and poor, just like God had been telling them to for 2000 years.
posted by seanmpuckett at 7:21 AM on June 28, 2012 [172 favorites]


So does it remain the same? The headlines imply that it survives, but with some changes. The SC can't make changes, can they?
posted by Think_Long at 7:21 AM on June 28, 2012


JOHN ROBERTS. JOHN ROBERTS? WHAT? WHAT?

This is... um... I'm going to go wander around for a while, maybe bumping into things.

WHAT?
posted by davidjmcgee at 7:21 AM on June 28, 2012 [7 favorites]


Upheld as a tax so the Commerce Clause doesn't become an unlimited source of federal power. Pretty much the best possible outcome.
posted by stopgap at 7:21 AM on June 28, 2012 [12 favorites]


You want to know how "working poor" I am?
I have tears streaming down my face.
posted by NorthernLite at 7:21 AM on June 28, 2012 [39 favorites]


Bulworth: Yo, everybody gonna get sick someday / But nobody knows how they gonna pay / Health care, managed care, HMOs / Ain't gonna work, no sir, not those / 'Cause the thing that's the same in every one of these / Is these motherfuckers there, the insurance companies!

Cheryl and Tanya: Insurance! Insurance!

Bulworth: Yeah, yeah / You can call it single-payer or Canadian way / Only socialized medicine will ever save the day! Come on now, lemme hear that dirty word - SOCIALISM!

-Bulworth

posted by Pirate-Bartender-Zombie-Monkey at 7:22 AM on June 28, 2012 [21 favorites]


Wow, our "news" sucks.
posted by odinsdream at 7:22 AM on June 28, 2012 [1 favorite]


NYT has finally put up a breaking news ticker: "Supreme Court Allows Health Care Law to Largely Stand"

06/28/12: the day everything was so crazy, the NYT split an infinitive
posted by saturday_morning at 7:22 AM on June 28, 2012 [144 favorites]


As they say in the land of Socialist medicare:

Слава Богу!
posted by mazola at 7:22 AM on June 28, 2012 [8 favorites]


FRACK. For want of a backslash...
posted by Pirate-Bartender-Zombie-Monkey at 7:22 AM on June 28, 2012


No, Roberts has not had some change of heart, as some people seem to be asking; again, he was acting strategically by joining the majority. His heart has not grown three sizes today.
posted by Yesterday's camel at 7:22 AM on June 28, 2012 [11 favorites]


"Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."
posted by ShawnStruck at 7:23 AM on June 28, 2012 [4 favorites]


Amy Howe: The money quote from the section on the mandate: Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.

Lyle: The key comment on salvaging the Medicaid expansion is this (from Roberts): "Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding." (p. 55)

Nice.
posted by zombieflanders at 7:23 AM on June 28, 2012


Roberts is also more interested in preserving federal government power than the other conservatives on the court.
posted by Jurbano at 7:23 AM on June 28, 2012 [1 favorite]


Stolen from Twitter: Roberts is the Severus Snape of the Supreme Court.
posted by shiu mai baby at 7:23 AM on June 28, 2012 [81 favorites]


The majority here decided that they are judges, not a political council of Supreme Leaders for Life.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 7:23 AM on June 28, 2012 [10 favorites]


15 minutes in, Fox News: SUPREME COURT ABOUT TO RULE ON OBAMACARE.
posted by Mapes at 7:24 AM on June 28, 2012 [2 favorites]


The court reinforces that individuals can simply refuse to pay the tax and not comply with the mandate.

...and then go to jail, I assume.
posted by DWRoelands at 7:24 AM on June 28, 2012


so what happens now? can I go to the doctor for the first time in like 6 years?
posted by ninjew at 7:24 AM on June 28, 2012 [5 favorites]


Well, people could refuse to pay the tax, but they would face the same repercussions as refusing to pay any other tax........ right?
posted by starman at 7:24 AM on June 28, 2012


oh shit dudes i just saw a black van with DEATH PANEL cruise down the street im gonna call my grammaw
posted by robocop is bleeding at 7:24 AM on June 28, 2012 [23 favorites]


CSPAN3 for pleasure or for pain, depending on your disposition.

Give me those delicious, delicious tears.
posted by atrazine at 7:24 AM on June 28, 2012 [6 favorites]


I wonder how much of CNN's woes are bad Content Caching? Stale servers still serving the "Struck Down" headline while the updates propagate?

They wouldn't, would they?
posted by mikelieman at 7:24 AM on June 28, 2012


His heart has not grown three sizes today.

But if it had, he'd at least be required to have insurance to cover the bills.
posted by Think_Long at 7:24 AM on June 28, 2012 [13 favorites]


This is good for . . . John McCain!
posted by Ironmouth at 7:24 AM on June 28, 2012 [3 favorites]


EmpressCallipygos: "On a tangent - the people around me, including my boss, are all saying that "so this is a bad thing because it's a 'yes' vote for Obama and he will get re-elected." "

My coworkers know I'm the token liberal in the office, and taunt me by referring to "President Romney," and pointing to photos of him and saying "Take a look at your future president."

I work in a "non-partisan" office in Congress. FML.


I work for a healthcare non-profit whose mission is to improve public health, and a stunningly huge chunk of my coworkers are opposed to the ACA. Which is like being tasked to get people to fuck more while being anti-nudity.
posted by middleclasstool at 7:24 AM on June 28, 2012 [20 favorites]


Well, that's all a bit of a suprise.
posted by Artw at 7:24 AM on June 28, 2012 [1 favorite]


From the liveblog: Tom: Apologies - you can't refuse to pay the tax; typo. The only effect of not complying with the mandate is that you pay the tax.
posted by codacorolla at 7:24 AM on June 28, 2012 [3 favorites]


Tom: Apologies - you can't refuse to pay the tax; typo. The only effect of not complying with the mandate is that you pay the tax.
posted by shakespeherian at 7:25 AM on June 28, 2012


ninjew, where do you live? MeFi can probably direct you to a doctor you can afford.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 7:25 AM on June 28, 2012


You can't refuse to pay the tax, that was a typo according to SCOTUSblog.
posted by Falconetti at 7:25 AM on June 28, 2012 [1 favorite]


"Apologies - you can't refuse to pay the tax; typo. The only effect of not complying with the mandate is that you pay the tax." -- SCOTUSBlog
posted by schmod at 7:25 AM on June 28, 2012 [1 favorite]


In all the permutations I imagined, I never thought SCOTUS would uphold the individual mandate under the taxing power.

Interesting. I thought the taxing power was the obvious solution. For example, suppose Congress passes a law that raises taxes slightly across the board and also creates a tax credit for people with children (supposing such a credit did not already exist). This is obviously not a government-imposed mandate to have children, just a way to subsidize the cost of having children and, in that way, encourage population growth.

The 'insurance mandate' effectively operates in the same way and should have been described as a tax (and accompanying tax credit) to begin with, but then of course Congress would have been raising taxes and we can't have that. Luckily the Supreme Court can look past the form to the substance, which is that the 'mandate' was just an everyday application of the taxing power.
posted by jedicus at 7:25 AM on June 28, 2012 [17 favorites]


From the SCOTUS liveblog: "Apologies - you can't refuse to pay the tax; typo. The only effect of not complying with the mandate is that you pay the tax."
posted by tivalasvegas at 7:25 AM on June 28, 2012


I'm thisclose to digging out my "Yes We Can" button from 2008 and wearing it to work tomorrow...
posted by EmpressCallipygos at 7:25 AM on June 28, 2012 [23 favorites]


That was quite a typo.
posted by jinjo at 7:25 AM on June 28, 2012 [5 favorites]


Boy howdy, big day for important typos and miswritten headlines!
posted by pointystick at 7:25 AM on June 28, 2012 [2 favorites]


So anyway, I guess you can all go back to bitching about how this law is terrible and worse than nothing.
posted by Artw at 7:25 AM on June 28, 2012 [20 favorites]


Guys, everyone who's in this thread still is already reading the scotusblog live blog.
posted by Plutor at 7:26 AM on June 28, 2012 [6 favorites]


So anyway, I guess you can all go back to bitching about how this law is terrible and worse than nothing.

Don't be ridiculous, it's almost time for the football.
posted by elizardbits at 7:26 AM on June 28, 2012 [7 favorites]


Fox News still trying to figure out how to spin this and not reporting the decision. Hilarious.
posted by zeoslap at 7:26 AM on June 28, 2012 [2 favorites]


very q+d, but I could not resist.
posted by SomaSoda at 7:26 AM on June 28, 2012 [1 favorite]


The individual mandate was upheld 5-4 with Roberts voting in favor and Kennedy against.

Suck it, Kennedy.
posted by zombieflanders at 7:27 AM on June 28, 2012 [3 favorites]


Yay I was wrong!:
The Court holds that the Anti-Injunction Act doesn't apply because the label "tax" is not controlling.
posted by muddgirl at 7:27 AM on June 28, 2012 [1 favorite]


John Roberts is going to be remembered as the biggest damn troll in U.S. history.
posted by lootie777 at 7:27 AM on June 28, 2012 [10 favorites]


I'm worried that Roberts is trying to open the door to future challenges -- i.e., someone challenging the tax as being unconstitutional as applied, even if the law is constitutional on its face.
posted by Yesterday's camel at 7:27 AM on June 28, 2012 [1 favorite]


Knock me over with a feather. I was sure this was toast!
posted by madamjujujive at 7:28 AM on June 28, 2012 [2 favorites]


on CSPAN-3 father of four says he doesn't have insurance and this is a terrible decision because he doesn't want to buy it. Logic is that it will be harder to pay for his insurance too.

didn't really think of what happens if he gets sick.
posted by Ironmouth at 7:28 AM on June 28, 2012 [3 favorites]


Fox News still trying to figure out how to spin this and not reporting the decision. Hilarious.

COURT RULES POOR PEOPLE MUST PAY OWN WAY; FORCES INDOLENT BUMS TO COVER MEDICAL COSTS
posted by (Arsenio) Hall and (Warren) Oates at 7:28 AM on June 28, 2012 [4 favorites]


which is that the 'mandate' was just an everyday application of the taxing power.

Which is going to be the Fox Industrial Complex spin on all this.

SCOTUS CALLS OBAMACARE HUGE TAX HIKE
posted by stupidsexyFlanders at 7:28 AM on June 28, 2012 [9 favorites]


CNN says the president will speak about this in the next several hours.
posted by cashman at 7:28 AM on June 28, 2012


After the oral arguments, the legal experts remained confident that the individual mandate would be upheld, because, duh.

Then the dreams came. Dark dreams of great cruelty. The legal experts got scared. Up until a few minutes ago, the mainstream prediction for this case was that Scalia would consume the earth into non-Euclidean eldritch horror
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 7:28 AM on June 28, 2012 [28 favorites]


John Roberts is going to be remembered as the biggest damn troll in U.S. history.

JUSTICE JOHN ROBERTS, TROLLFACE
posted by shakespeherian at 7:28 AM on June 28, 2012 [2 favorites]


Saying Roberts joined this to push the ruling more conservative would only work if it was a 6-3. With a 5-4, Roberts was effectively the one carrying this over the line for Obama and all of us. A lot more sanity than I expected out of him. Very heartfelt thanks to SCOTUS today
posted by crayz at 7:29 AM on June 28, 2012 [20 favorites]


I'm worried that Roberts is trying to open the door to future challenges -- i.e., someone challenging the tax as being unconstitutional as applied, even if the law is constitutional on its face.

I too, look forward to which Republican Attorney General tries to sue to have it overturned again in 2014, AFTER several hundred thousands of his/her voters start getting health care.
posted by XQUZYPHYR at 7:29 AM on June 28, 2012 [8 favorites]


Hah. This was amusing. I saw this thread ("one hour to go for the ruling") and noticed that almost an hour twenty had passed, and thought "ooh ooh what happened what happened I better go to CNN". And on CNN.com: fucking NOTHING! Blank, empty, no coverage. I was so terribly confused. Then I read this thread and I was sad and then cautiously happy and then a little confused and now I think pretty really happy? And when I go to CNN.com now they say "Supreme Court upholds entire health care law". So, yay, happy!!!! ...? ... !!
posted by PercussivePaul at 7:30 AM on June 28, 2012


I'm worried that Roberts is trying to open the door to future challenges

How does that even make sense given he could have just voted no and made it unconstitutional?
posted by smackfu at 7:30 AM on June 28, 2012 [6 favorites]


on CSPAN-3 father of four says he doesn't have insurance and this is a terrible decision because he doesn't want to buy it. Logic is that it will be harder to pay for his insurance too.

didn't really think of what happens if he gets sick.


Or any of those kids of his. If we could export magical thinking we'd not have such a huge trade deficit.
posted by winna at 7:30 AM on June 28, 2012 [9 favorites]


Lol, oh Kennedy. Okay.
posted by shakespeherian at 7:30 AM on June 28, 2012


father of four... Without insurance

Jesus, that's got to be so expensive, or Maybe he's just relying on outright neglect.
posted by Artw at 7:30 AM on June 28, 2012 [3 favorites]


Pete Williams on MSNBC saying that there is no penalty for not paying the "tax". I'm confused.
posted by pjenks at 7:31 AM on June 28, 2012


Damn, saw just localroger and goethean beat me to the punch.
posted by SomaSoda at 7:31 AM on June 28, 2012


Lyle: In opening his statement in dissent, Kennedy says: "In our view, the entire Act before us is invalid in its entirety."

Wow, an extra special fuck you to Kennedy.
posted by zombieflanders at 7:32 AM on June 28, 2012 [18 favorites]


Scalia would consume the earth into non-Euclidean eldritch horror

this can still happen at virtually any moment regardless of official decisions being made though
posted by elizardbits at 7:32 AM on June 28, 2012 [15 favorites]


Sounds like Pete Williams got sucked in by the same typo discussed above.
posted by howfar at 7:32 AM on June 28, 2012


Pete Williams on MSNBC saying that there is no penalty for not paying the "tax". I'm confused.

I think we've shifted into the dimension where major news networks report blog typos as fact
posted by theodolite at 7:32 AM on June 28, 2012 [24 favorites]


Does anybody know why CNN has been choosing to use what looks like a cellphone camera for their live feed outside the Court?
posted by item at 7:32 AM on June 28, 2012


Weird day. Roberts with the "liberals", Kennedy with the dissenters.
posted by Thorzdad at 7:32 AM on June 28, 2012 [2 favorites]


CNN says the president will speak about this in the next several hours.

I'll believe that when I see it happen, based on the source.
posted by theredpen at 7:33 AM on June 28, 2012 [6 favorites]


Yeah, I'm going to ignore the news people in favor of the ScotusBlog.

Also, LOLCNN.

I am absolutely flabbergasted. Still afraid to celebrate until the lawyers assure me there is no buried turd in this decision.
posted by emjaybee at 7:33 AM on June 28, 2012


My favorite thing I learned today is just how much of the news media is getting their information directly from SCOTUSblog.
posted by shakespeherian at 7:33 AM on June 28, 2012 [22 favorites]


Wow, that was a roller coaster of a ride.
posted by Forktine at 7:33 AM on June 28, 2012 [1 favorite]


Romney--I was always for mandate. Supreme Court has upheld my position.
posted by Ironmouth at 7:33 AM on June 28, 2012 [36 favorites]


Pete Williams on MSNBC saying that there is no penalty for not paying the "tax". I'm confused.

LOL MSNBC producers are reading the same liveblog as the rest of us. What a sterling example of modern television 'journalism'.
posted by muddgirl at 7:33 AM on June 28, 2012 [5 favorites]


!

(What crayz said. Thanks for making me feel a little less cynical today, SC. It can't have been easy, but it was the right call.)
posted by saulgoodman at 7:33 AM on June 28, 2012


Or any of those kids of his. If we could export magical thinking we'd not have such a huge trade deficit.

His children are probably on medicaid.
posted by ephemerista at 7:33 AM on June 28, 2012 [4 favorites]


"In Plain English: 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."
posted by reductiondesign at 7:34 AM on June 28, 2012 [18 favorites]


Seems like the teeth have been pulled. The philosophy of the law has been upheld (Congress can implement a tax and can propose expansion to Medicaid) but there is nothing to enforce it (who cares if you don't pay the "tax" and states really don't have to comply if they don't want to).

Luckily the insurance companies still must insure w/o regard to pre-existing conditions.

Seems like this might bring down the whole for-profit insurance system...
posted by pjenks at 7:34 AM on June 28, 2012 [1 favorite]


Question: so, my stupid state has resisted any planning for the health insurance exchanges because our governor believed the mandate would be struck down. Does this mean they have to set them up now?
posted by wittgenstein at 7:34 AM on June 28, 2012


"In our view, the entire Act before us is invalid in its entirety."

I cannot wait to read Kennedy's reasons for finding that Federal regulation of the already-highly-regulated insurance industry (not the mandate, the regulation) is somehow constitutionally invalid.
posted by gauche at 7:34 AM on June 28, 2012 [1 favorite]


This, ladies and gentleman, is now known as dancing day.
posted by Brandon Blatcher at 7:34 AM on June 28, 2012 [6 favorites]


Yes, to answer a common question, the whole ACA is constitutional, so the provision requiring insurers to cover young adults until they are 26 survives as well.
posted by IvoShandor at 7:35 AM on June 28, 2012 [1 favorite]


[We don't do that "gleefully wishing for people's deaths" thing here. Act like you like it here.]
posted by jessamyn at 7:35 AM on June 28, 2012 [8 favorites]


yeah I'm really looking forward to hearing Mr. Romney try to spin this. especially the part about how he's never tried to push something like this himself
posted by ninjew at 7:35 AM on June 28, 2012 [2 favorites]


who cares if you don't pay the "tax"

That's based on a typo in the SCOTUSBlog liveblog. If you don't buy the insurance you have to pay the penalty, which is a tax.
posted by muddgirl at 7:36 AM on June 28, 2012


CNN: Obama will make a statement shorty, followed by blasting Hulk Hogan's theme music out all White House windows
posted by XQUZYPHYR at 7:36 AM on June 28, 2012 [48 favorites]


Seems like this might bring down the whole for-profit insurance system...

I'm OK with that.
posted by zombieflanders at 7:36 AM on June 28, 2012 [10 favorites]


And if you don't pay the tax, the IRS cares. They care quite deeply.
posted by muddgirl at 7:36 AM on June 28, 2012 [10 favorites]


who cares if you don't pay the "tax"

That typo was corrected. You do have to pay the tax.

states really don't have to comply if they don't want to

They do if they want new Medicaid funds.
posted by Sticherbeast at 7:36 AM on June 28, 2012


I'm generally opposed to life tenure for Supreme Court justices. But I wonder whether it gave Roberts the last bit of courage he needed to ignore the political pressures and do the right thing.
posted by brain_drain at 7:36 AM on June 28, 2012 [4 favorites]


gauche: "I cannot wait to read Kennedy's reasons for finding that Federal regulation of the already-highly-regulated insurance industry (not the mandate, the regulation) is somehow constitutionally invalid."

I'm guessing it's because (in his opinion) the mandate was unconstitutional, and the Congressional Idiots forgot the "if any part of this is unconstitiutional it doesn't mean the whole thing is" severability magic incantation.
posted by Plutor at 7:37 AM on June 28, 2012 [2 favorites]


Someone better shake Romney.
posted by Artw at 7:37 AM on June 28, 2012 [1 favorite]


who cares if you don't pay the "tax"

Ask Wesley Snipes.
posted by audi alteram partem at 7:37 AM on June 28, 2012 [9 favorites]


*tosses Obama football*

*spikes it*
posted by leotrotsky at 7:37 AM on June 28, 2012 [1 favorite]


Won't some think how this affects intrade?
posted by drezdn at 7:37 AM on June 28, 2012


Luckily the insurance companies still must insure w/o regard to pre-existing conditions.

Just pointing this out because yeah, this was hella important.
posted by EmpressCallipygos at 7:37 AM on June 28, 2012 [9 favorites]


As the Chief, Roberts has every incentive to join the liberals, so that the opinion can be crafted in as conservative a way as possible. (Chiefs get to assign opinions.)
posted by Yesterday's camel at 10:13 AM on June 28 [1 favorite +] [!]


No, Roberts has not had some change of heart, as some people seem to be asking; again, he was acting strategically by joining the majority. His heart has not grown three sizes today.
posted by Yesterday's camel at 10:22 AM on June 28 [2 favorites +] [!]


I'm sorry, but this makes no sense. He could have been the fifth vote the other way and still assigned himself the opinion.
posted by pardonyou? at 7:37 AM on June 28, 2012 [7 favorites]


I just wanted to tell you both good luck. We're all counting on you.
posted by CaseyB at 7:38 AM on June 28, 2012 [27 favorites]


I wonder if this doesn't actually help Romney by giving something to rile up his base.
posted by shivohum at 7:38 AM on June 28, 2012 [3 favorites]


The decision [PDF]
posted by shakespeherian at 7:38 AM on June 28, 2012 [7 favorites]


I'm worried that Roberts is trying to open the door to future challenges -- i.e., someone challenging the tax as being unconstitutional as applied, even if the law is constitutional on its face.

In all the euphoria here, this isn't getting mentioned as much as it should. The Supreme Court just ruled that the mandate is not a mandate, but a tax. And under the Anti-Injunction Act of 1867, a tax can only be challenged in court by someone who has already paid the tax. Since nobody will be paying the tax until 2014, the Supreme Court cannot rule on the constitutionality of the tax until someone pays the tax in 2014 and then sues the government for a refund.

By calling it a tax, they are essentially putting off the day of reckoning for 2-3 years. The mandate still may be struck down as an unconstitutional tax then.
posted by notswedish at 7:38 AM on June 28, 2012 [19 favorites]


But I wonder whether it gave Roberts the last bit of courage he needed to ignore the political pressures and do the right thing.

I personally like to imagine Ginsberg holding a knife to his groin and staring him down with a threatening hiss.
posted by elizardbits at 7:38 AM on June 28, 2012 [22 favorites]


Er, here
posted by shakespeherian at 7:39 AM on June 28, 2012


Wittgenstein: Each state may choose to participate in the Federal Exchange, rather than set up their own. Source: I work in that exact niche.
posted by joecacti at 7:39 AM on June 28, 2012 [2 favorites]


I like to think SCOTUSBlog put that typo in just to catch the other media reading from other peoples' reporting. Well played.
posted by stupidsexyFlanders at 7:39 AM on June 28, 2012 [14 favorites]


That typo was corrected. You do have to pay the tax.

Oh, sorry I thought that --- since I heard the NBC chief legal correspondant say it on air after a correction to a blog typo --- it was an actual fact.
posted by pjenks at 7:39 AM on June 28, 2012


CNN: Opinion 1 is out. Court rules in favor of man who lied about receiving the medal of honor. Court says lies protected by 1st amendment.

A huge victory for members of both parties!
posted by mediated self at 7:39 AM on June 28, 2012 [29 favorites]


pardonyou? , please see notswedish's comment above. Also, it's not clear that Roberts could have corralled enough justices to get the properly conservative opinion he would have wanted.
posted by Yesterday's camel at 7:39 AM on June 28, 2012


My read is that Roberts actually is a strict constitutionalist and there is nothing unconstitutional going on here and Scalia, et al. believe that the constitution is 220-some years old, so the only way to honor it is to be reactionary by whatever justification necessary.
posted by dances_with_sneetches at 7:39 AM on June 28, 2012 [1 favorite]


shakespeherian: "The decision [PDF]"

Wait. Does SCOTUS use LaTeX to format its documents?
posted by schmod at 7:40 AM on June 28, 2012 [9 favorites]


And everyone in my generation instantly thought "Oh my god, Roberts has been Snape the WHOLE TIME"
posted by Chipmazing at 7:40 AM on June 28, 2012 [14 favorites]


I wonder if this doesn't actually help Romney by giving something to rile up his base.

I'd think it would energize Obama's base as much if not more, but I guess we'll see.
posted by zombieflanders at 7:40 AM on June 28, 2012 [1 favorite]


I wonder if this doesn't actually help Romney by giving something to rile up his base.

Pretty much. If SCOTUS had struck ACA down, that would have taken-away a powerful piece of Mitt's platform.
posted by Thorzdad at 7:40 AM on June 28, 2012


There are 200 pages of opinions. Some light summer beach reading!
posted by brain_drain at 7:40 AM on June 28, 2012


That was mean, shakes.
posted by gauche at 7:41 AM on June 28, 2012


I love the Reddit comment: "I could sit on the Internet all day today, thinking, 'Yes, let the hate flow through you...'"
posted by Mooski at 7:41 AM on June 28, 2012 [14 favorites]


Like I said, it's just a tax.
posted by spaltavian at 7:41 AM on June 28, 2012 [6 favorites]


Oh, god....now some people here at work are saying, "no, now this is still gonna make Obama look bad because he was trying to be all 'no this isn't a tax' and the supreme court is now making him admit that yes it was all along."

*digs out resume*

So, anyone in the New York area have work for an admin with 20+ years experience?
posted by EmpressCallipygos at 7:41 AM on June 28, 2012 [11 favorites]


Wait. Does SCOTUS use LaTeX to format its documents?

Doubt it. It was created with Acrobat Distiller.
posted by PenDevil at 7:41 AM on June 28, 2012


Wait. Does SCOTUS use LaTeX to format its documents?

I don't think so, but Century Schoolbook looks a heck of a lot like Computer Modern, doesn't it?
posted by theodolite at 7:42 AM on June 28, 2012 [3 favorites]


Won't some think how this affects intrade?

Haha, the thread over there is bananas.

The price for "ACA unconstitutional" actually rose by 0.2% as I was typing this.
posted by saturday_morning at 7:42 AM on June 28, 2012 [1 favorite]


That was mean, shakes.

Apologies; typo.
posted by shakespeherian at 7:42 AM on June 28, 2012 [1 favorite]


So there are five votes for weakening the interpretation of the Commerce Clause of the constitution. It will be interesting to see what the implications of that are for existing federal regulations as well as proposed new regulations.
posted by alms at 7:42 AM on June 28, 2012 [6 favorites]


Let's sneak on right-wing blogs and start a whole "impeach Roberts" meme.
posted by dances_with_sneetches at 7:42 AM on June 28, 2012 [25 favorites]


pardonyou? , please see notswedish's comment above. Also, it's not clear that Roberts could have corralled enough justices to get the properly conservative opinion he would have wanted.

I wasn't questioning the part about preserving an argument against the tax as applied, I was questioning the argument that Roberts joined the liberals so he could "conservatize" the opinion. That still makes no sense since Roberts could have joined the four dissenters who believed the entire law should be struck down immediately.
posted by pardonyou? at 7:43 AM on June 28, 2012 [1 favorite]


By calling it a tax, they are essentially putting off the day of reckoning for 2-3 years. The mandate still may be struck down as an unconstitutional tax then

I don't understand. If they were planning on striking it down as unconstitutional, why wouldn't they just do that now? Especially in an election year.
posted by Think_Long at 7:43 AM on June 28, 2012 [1 favorite]


Muting the TV. CSPAN3 callers making me want to pour bleach down my ears....
posted by schmod at 7:43 AM on June 28, 2012 [2 favorites]


This is the most political decision that ever politicaled since they let FDR push through the New Deal. The only reason I can come up with for Roberts supporting this is that he didn't want people to have a reason to take power away from the Supreme Court.

At least they didn't uphold it on the clearly unconstitutional " it's the commerce clause, yo" bullshit.

Does this ruling let people re-challenge once the first penalties for not paying the tax come through? (Also, I wonder how exactly they are going to enforce this - how will people prove they have healthcare or not when it comes to their tax forms?)

I am still really angry about the Stolen Valor ruling though - so it's not okay to lie about being a lawyer, or doctor, but totally cool to lie about having the Medal of Honor and having other people buy you shit or elect you on its basis?
posted by corb at 7:43 AM on June 28, 2012 [1 favorite]


Let's sneak on right-wing blogs and start a whole "impeach Roberts" meme.
I doubt they'll need any help with that.
posted by Thorzdad at 7:43 AM on June 28, 2012 [2 favorites]


FoxNews is still calling it ObamaCare, anyway, but they're maybe beginning to transition to calling it the ACA?

Current headline:
ObamaCare SURVIVES Court Lets Stand Affordable Care Act, Individual Mandate
posted by tivalasvegas at 7:44 AM on June 28, 2012


So striking it down would hurt Obama but not striking it down helps Romney? Heads, I win, tails you lose?

Or more likely, people had their opinions on Obama and Romney already and this will just confirm them. The only real question is whether it affects the number that bother to get out and vote on that opinion.

I'm not sure anyone could make the case that a Romney presidency would have much impact on this law, unless you knew for sure a) he'd get to appoint another judge and b) that judge was bound and determined to strike it down. Two big ifs. If I were a Republican who hated this law, I'd not feel like electing him was likely to help much.
posted by emjaybee at 7:44 AM on June 28, 2012 [3 favorites]


(Also, I wonder how exactly they are going to enforce this - how will people prove they have healthcare or not when it comes to their tax forms?)

In Massachusetts, we receive tax forms from our health insurance providers that state which months of the year we were covered. That has to be recorded on our state tax returns - I assume something similar could be rolled out nationwide.
posted by backseatpilot at 7:45 AM on June 28, 2012


And under the Anti-Injunction Act of 1867, a tax can only be challenged in court by someone who has already paid the tax. Since nobody will be paying the tax until 2014, the Supreme Court cannot rule on the constitutionality of the tax until someone pays the tax in 2014 and then sues the government for a refund.

No - the Court dismisses this problem. Because Congress labeled it a penalty and not a tax, the Court ruled it does not fall under the AIA.
posted by shivohum at 7:45 AM on June 28, 2012 [2 favorites]


I should mention this happened opn the first day my marriage-related health insurance became active, take from that what you will....
posted by The Whelk at 7:45 AM on June 28, 2012 [16 favorites]


The only reason I can come up with for Roberts supporting this is that he didn't want people to have a reason to take power away from the Supreme Court.

What... people would do this? What?
posted by shakespeherian at 7:45 AM on June 28, 2012


By calling it a tax, they are essentially putting off the day of reckoning for 2-3 years. The mandate still may be struck down as an unconstitutional tax then.

That was my initial thought - I haven't read the opinion yet, of course, but according to SCOTUSBlog:
The Court holds that the Anti-Injunction Act doesn't apply because the label "tax" is not controlling.
So there are five votes for weakening the interpretation of the Commerce Clause of the constitution.

No, there were 4 votes that the Commerce clause and the tax clause applied, 1 vote that only the tax clause applied, and 4 votes dissenting.
posted by muddgirl at 7:45 AM on June 28, 2012


Liberalism in the USA: celebrating a 5-4 decision upholding a health care law that throws some table scraps our way. I mean, juicy ones, but scraps all the same.

*sigh*
posted by Dr.Enormous at 7:45 AM on June 28, 2012 [13 favorites]


SCOTUSBlog now explaining that "the tax is a tax" to Pete Williams on air... PW still not buying it, since there was no explicit provision to penalize you for not paying the "tax" built into the law.
posted by pjenks at 7:45 AM on June 28, 2012


So striking it down would hurt Obama but not striking it down helps Romney? Heads, I win, tails you lose?

Some had speculated that striking it down could help Obama by giving him a rallying cry.
posted by goethean at 7:45 AM on June 28, 2012 [1 favorite]


FoxNews is still calling it ObamaCare, anyway, but they're maybe beginning to transition to calling it the ACA?

Well, now that it's not going to be struck down and hang as an embarrassment around his neck, they can't have him getting credit for it...
posted by mightygodking at 7:46 AM on June 28, 2012 [3 favorites]


Kaiser Health News will be hosting a live webcast discussion about the decision at 1 pm Eastern. Yes, I work for the Kaiser Family Foundation. No, we are not affiliated with Kaiser Permanente or Kaiser Industries. KHN is editorially independent.
posted by rtha at 7:46 AM on June 28, 2012 [5 favorites]


Looks like I can finish medical school knowing that I'll be practicing in a country that gives a damn. Today is a good day to study.
posted by The White Hat at 7:46 AM on June 28, 2012 [25 favorites]


It might give something for the Republican House and Senate candidates to rally around, but Romney arguing about it can be quashed pretty easily. Why was it right for Mass. but not the whole country?
posted by drezdn at 7:46 AM on June 28, 2012 [1 favorite]


Congratulations, The Whelk!
posted by muddgirl at 7:46 AM on June 28, 2012


Romney spent yesterday and the day before parading up and down telling everyone what a failure Obama was because this would obviously be struck down. Hard to see this as a win for him unless his supporters can be etch-a-sketched as well - not unlikely I guess.
posted by Artw at 7:47 AM on June 28, 2012 [2 favorites]


> Won't some think how this affects intrade?

http://i.imgur.com/rnd3A.png

price -95.8%
posted by egor83 at 7:47 AM on June 28, 2012 [2 favorites]


Liberalism in the USA: celebrating a 5-4 decision upholding a health care law that throws some table scraps our way. I mean, juicy ones, but scraps all the same.

IT HAS BEGUN
posted by shakespeherian at 7:47 AM on June 28, 2012 [11 favorites]


pardonyou?, I think that Roberts -- correctly -- thinks the dissenters' arguments for the unconstitutionality of the ACA are bullshit. I imagine he wants, in his heart of hearts, for the mandate to be struck down but much of the rest upheld.
posted by Yesterday's camel at 7:47 AM on June 28, 2012 [1 favorite]


Dissent of Scalia, Thomas, Alito, & Thomas: The values that should have determined our course today are caution, minimalism, and the understanding that the Federal Government is one of limited powers. But the Court’s ruling undermines those values at every turn. In the name of restraint, it overreaches. In the name of constitutional avoidance, it creates new constitutional questions. In the name of cooperative federalism, it undermines state sovereignty. . . . The fragmentation of power produced by the structure of our Government is central to liberty, and when we destroy it, we place liberty at peril. Today’s decision should have vindicated, should have taught, this truth; instead, our judgment today has disregarded it.

Plain English: WAAAAAAAAHHHHHHHH
posted by brain_drain at 7:47 AM on June 28, 2012 [22 favorites]


Re: the tax thing. What does "controlling" means in this context exactly? It sounds like "the mandate is really a tax" isn't accurate; the mandate seems to be allowed on the understanding that it has no actual force in itself, and the tax associated with it is totally separate. But then the tax doesn't count as a tax either for legal purposes? Brain hurt.
posted by jinjo at 7:47 AM on June 28, 2012


Because Congress labeled it a penalty and not a tax, the Court ruled it does not fall under the AIA.

But does the same thing apply in terms of standing? No one can sue until they actually have the penalties?

The only reason I can come up with for Roberts supporting this is that he didn't want people to have a reason to take power away from the Supreme Court.

What... people would do this? What?


This was what was threatened to happen over the New Deal. Supreme Court planned to strike provisions down on the grounds it was an unconstitutional expansion of the commerce clause, FDR threatened to give them term limits and pack the court with his people if they didn't do what he said.
posted by corb at 7:48 AM on June 28, 2012 [1 favorite]


totally cool to lie about having the Medal of Honor and having other people buy you shit or elect you on its basis?

No, because receiving shit as a result of that lie falls under fraud, which is already illegal. Simply saying that you've won a Medal of Honor is just a lie, and lying is not in and of itself against the law.
posted by Sticherbeast at 7:48 AM on June 28, 2012 [6 favorites]


TEAM TABLE SCRAPS
posted by The Whelk at 7:48 AM on June 28, 2012 [19 favorites]


Yes, Thomas dissented so hard he signed it twice. Should have said Kennedy.
posted by brain_drain at 7:48 AM on June 28, 2012 [4 favorites]


LiberaRealism in the USA: do the best you can now even if its not perfect and keep fighting to make things better in the future.
posted by ND¢ at 7:48 AM on June 28, 2012 [29 favorites]


I wonder if this doesn't actually help Romney by giving something to rile up his base.

His base has been so effective at getting riled up apoplectic about absolutely imaginary shit for so long, I can't imagine this is going to have all that much effect. I mean what the hell is Obamacare when you already believe the UN black helicopters are running concentration camps in Detroit?
posted by Kid Charlemagne at 7:48 AM on June 28, 2012 [5 favorites]


Is this like in wrestling where Roberts turns heel and the announcers are all "OH MY GOD!!! WHAT'S HAPPENING?!?!?! THIS IS IMPOSSIBLE!!!"

Cause that part in wrestling is awesome.
posted by NoRelationToLea at 7:48 AM on June 28, 2012 [51 favorites]


I'm not sure anyone could make the case that a Romney presidency would have much impact on this law, unless you knew for sure a) he'd get to appoint another judge and b) that judge was bound and determined to strike it down. Two big ifs.

You're forgetting that Congress can just outright repeal the law and that whoever is president will have to either sign off on it or veto it.
posted by ultraviolet catastrophe at 7:48 AM on June 28, 2012 [2 favorites]


Liberalism in the USA: celebrating a 5-4 decision upholding a health care law that throws some table scraps our way. I mean, juicy ones, but scraps all the same.

All that could happen today was upholding the law, so why not celebrate it? It's not like the Court could come out and say "The law is struck down, free healthcare for all!" This is like bitching about celebrating the first win of the season because you still haven't won the Super Bowl.
posted by Bulgaroktonos at 7:48 AM on June 28, 2012 [28 favorites]


FDR threatened to give them term limits and pack the court with his people if they didn't do what he said.

Yeahhhhh, we're not getting court-packing again in our lifetime.

Fun fact: the skeleton of the court-packing scheme had actually come from archconservative Justice McReynolds. He had pitched a very similar idea when he was Attorney General.
posted by Sticherbeast at 7:49 AM on June 28, 2012


By calling it a tax, they are essentially putting off the day of reckoning for 2-3 years. The mandate still may be struck down as an unconstitutional tax then.

In some sense, I suppose, but the tax power is pretty broad. The usual limits would not seem to apply (e.g. tax as a form of regulation when the regulation would have been impermissible, such as a tax on paper and ink being an impermissible regulation of free speech). If the insurance tax credit scheme is unconstitutional, then so is virtually every other tax credit, since they all work the same way: there is a tax, then there is a way to reduce that tax by engaging in some voluntary activity that the government wishes to subsidize or encourage.
posted by jedicus at 7:50 AM on June 28, 2012 [7 favorites]


Liberalism in the USA: celebrating a 5-4 decision upholding a health care law that throws some table scraps our way. I mean, juicy ones, but scraps all the same.

--Veruca Salt
posted by zombieflanders at 7:50 AM on June 28, 2012 [4 favorites]


Is this like in wrestling where Roberts turns heel face

Except without the spandex, please.
posted by catlet at 7:51 AM on June 28, 2012 [5 favorites]


Sarah Palin : "Obama lied to the American people. Again. He said it wasn't a tax. Obama lies; freedom dies."
posted by crunchland at 7:51 AM on June 28, 2012 [3 favorites]


Cause that part in wrestling is awesome.

I quite like the notion that the entire US govt is predicated upon kayfabe.
posted by elizardbits at 7:51 AM on June 28, 2012 [19 favorites]


photoshop skills y'all
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 7:51 AM on June 28, 2012 [16 favorites]


how will people prove they have healthcare or not when it comes to their tax forms?

Here in Massachusetts, your insurer is required to provide you with a document that they also submit to the state, with your SSN and the fact that you were enrolled in their coverage. It's sort of like a W-2, which is the answer to the question 'how will people prove they had income and withholding taxes during the year?'

Ironically, I'll have to pay the Massachusetts penalty this year--I have health insurance (through Obamacare! I'm 25 and am insured through my dad who lives out of state), but it's out of state so my insurance doesn't submit the W-2 like form to Massachusetts. In order to prove I'm insured, I'd have to prove like 200 line items about what my out of state insurance does or doesn't cover in order to determine whether it qualifies as 'good' health insurance under MA regulations. Since my income this year is only going to be barely over the exempt limit (below a certain level of income the mandate here in MA is waived), the extra tax will most likely be less of a pain to pay than trying to prove that my insurance is certified.

Of course, this is a way better option than having no insurance at all, which is what would have happened to me if the Court had struck down Obamacare.
posted by notswedish at 7:52 AM on June 28, 2012 [1 favorite]


In Massachusetts, we receive tax forms from our health insurance providers that state which months of the year we were covered. That has to be recorded on our state tax returns - I assume something similar could be rolled out nationwide.

Wow, I'd never thought about that aspect of it. Would something like this have been necessary prior to this decision?

Is this like in wrestling where Roberts turns heel and the announcers are all "OH MY GOD!!! WHAT'S HAPPENING?!?!?! THIS IS IMPOSSIBLE!!!"

Cause that part in wrestling is awesome.


Just when I thought this day couldn't get any better, this caused me to imagine Elena Kagan hitting Scalia with a folding chair.
posted by MCMikeNamara at 7:52 AM on June 28, 2012 [54 favorites]



"as a " old white man", who is depending on this bill to continue to provide insurance for kids who are not yet 26 and can NOT find jobs in this fucked economy. Could we avoid going to the "old white men" place again? Please"


NO!
posted by QueerAngel28 at 7:52 AM on June 28, 2012 [2 favorites]


But does the same thing apply in terms of standing? No one can sue until they actually have the penalties?

No, the plaintiffs in this case were ruled to have standing to sue -- without any penalties having been exacted -- and lost. I don't see why individuals would have any kind of a case to sue separately.
posted by shivohum at 7:52 AM on June 28, 2012 [1 favorite]


There's a lot of pissed-off amateur Constitutional scholars out there right now.
posted by entropicamericana at 7:52 AM on June 28, 2012 [8 favorites]


I should mention this happened opn the first day my marriage-related health insurance became active, take from that what you will....

Conclusive proof: Gay marriage causes healthcare reform.
posted by jedicus at 7:53 AM on June 28, 2012 [34 favorites]


IT HAS BEGUN

Come now, we're all human beings here. We are actually capable of holding complex and contradictory emotions simultaneously, including being genuinely happy about a court ruling that was, according to nearly all legal experts, decided rightly -- and ALSO being sad that we will still have a health care system that leaks like a sieve in a monsoon.
posted by tivalasvegas at 7:53 AM on June 28, 2012 [11 favorites]


I wonder how tempted Obama is to yank the tiger's tail and joke about CNN and MSNBC getting it wrong when he makes his speech.
posted by zombieflanders at 7:53 AM on June 28, 2012 [1 favorite]


There's a lot of pissed-off amateur Constitutional scholars out there right now.

And a lot of vindicated professional Constitutional scholars.
posted by gauche at 7:53 AM on June 28, 2012 [22 favorites]


oh god my desk is way too close to the CEO's office and i don't want to sit here listen to them screaming all day oh god
posted by shakespeherian at 7:54 AM on June 28, 2012 [12 favorites]


Obama lies; freedom dies.

Palin replies; America sighs.
posted by brain_drain at 7:54 AM on June 28, 2012 [49 favorites]


Holy shit. I'm stunned. Thought there was no way in hell they'd let it stand.

Yay!
posted by zarq at 7:54 AM on June 28, 2012


Glad Palin has weighed in. Now what does Snooki think?
posted by ND¢ at 7:55 AM on June 28, 2012 [37 favorites]


Sorry I messed up...
posted by madamjujujive at 7:55 AM on June 28, 2012 [27 favorites]


You have a boat. The boat is unfit for purpose

while designed well 200 years ago, it is unfit for current conditions and the boat is riddled with deliberately planted woodworm - the lower decks are sinking, and their denizens are slowly drowning

a request by the woodworm planters was made to drill holes in the 3rd from bottom deck. instead, a couple of expensive, slowly leaking inflatable buoys were attached to the outside.

the boat will still sink, and the crime of its destruction and corruption will go unanswered but thousands of people every year will be saved from fast or slow deaths from drowning

it is a good day to be on a bad boat
posted by lalochezia at 7:55 AM on June 28, 2012 [19 favorites]


So will there be a new federal tax form (1040-obamacare) where you prove you paid for healthcare, and if you didn't, you get a negative credit? I feel like I need another ACA primer...
posted by joecacti at 7:55 AM on June 28, 2012 [1 favorite]


Welp, that didn't take long.The Dow's dropped, so it's an ECONOMIC MELTDOWN because of the ACA ruling.

Right-wing blogs are apoplectic over the market's stunning plummet to 4,000 points higher than when Bush left office.
posted by XQUZYPHYR at 7:56 AM on June 28, 2012 [22 favorites]


Mitch McConnell speaking now. Lie, followed by lie, followed by purposely misleading statement. What a bloviating bag of shit this man is.
posted by Benny Andajetz at 7:56 AM on June 28, 2012 [13 favorites]


Hey, I feel your pain. I mean, I spent 10 minutes photoshopping Scalia's face onto MODOK's body for nothing. Nothing!
posted by robocop is bleeding at 7:56 AM on June 28, 2012 [12 favorites]


oh god my desk is way too close to the CEO's office and i don't want to sit here listen to them screaming all day oh god

At my old job I had to walk out of the room on a vp who was ranting about hcr because it was that or start shouting myself.

Can you wear headphones to block it out?
posted by winna at 7:56 AM on June 28, 2012


Pleased as punch that the ACA was upheld, but this comment from Lyle at SCOTUSBlog is chilling:

The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress's authority to pass social welfare laws. Using the tax code -- especially in the current political environment -- to promote social welfare is going to be a very chancy proposition.
posted by Cash4Lead at 7:56 AM on June 28, 2012 [8 favorites]


I'm waiting for Richard Mourdock to re-upload the appropriate pre-sponse video
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 7:56 AM on June 28, 2012 [2 favorites]


Supreme Court planned to strike provisions down on the grounds it was an unconstitutional expansion of the commerce clause, FDR threatened to give them term limits and pack the court with his people if they didn't do what he said.

That is... so far from what happened. Shrinking and growing the size of the court for political reasons was pretty common up until FDR. The New Deal was not one bill. Many, many parts of the New Deal were struck down. FDR's plan to pack the courts had to go through Congress, where it died. If Obama wanted to fuck with the Supreme court in any way, he would have to get it through a House committee who would probably laugh him out of the chamber.
posted by muddgirl at 7:56 AM on June 28, 2012


Does anyone have any photos of despondent ACA opponents on SCOTUS steps? I'm serious here.
posted by oneironaut at 7:57 AM on June 28, 2012 [1 favorite]


I don't have time to read the whole thing. Will elective circumcision be covered?
posted by ColdChef at 7:57 AM on June 28, 2012 [9 favorites]


There's certainly precedent for Republican-appointed Chief Justices disappointing "their" party on decisions of primary significance. Earl Warren was nominated by Eisenhower and eventually became the leader of the most liberal faction the court has ever seen (Eisenhower said the nomination was "the biggest damned-fool mistake I ever made"). One decision does not a liberal make, obviously, but you better believe Republicans are having Earl Warren flashbacks.

Plain English: WAAAAAAAAHHHHHHHH

True, but not a point to be taken lightly. There are a lot of people out there who believe strongly in "states rights" and limited federalism. I think the language of the dissent was designed to -- and will -- inflame those beliefs. I think we'll see a resurgence in animosity directed at the court.
posted by pardonyou? at 7:57 AM on June 28, 2012 [2 favorites]


oh god my desk is way too close to the CEO's office and i don't want to sit here listen to them screaming all day oh god

See if you can arrange for him to be visited by three ghosts
posted by The Whelk at 7:57 AM on June 28, 2012 [53 favorites]


According to Mitt Romney, Obama's first three and a half years have officially NOT been a waste of time.
posted by Curious Artificer at 7:58 AM on June 28, 2012 [27 favorites]


I predict that the "you're allowed to not pay the tax" misinformation will persist in the depths of the right wing's fever swamp for years to come.
posted by Flunkie at 7:58 AM on June 28, 2012 [24 favorites]


Tom: I dissent from Lyle's view that the Commerce Clause ruling is a major blow to social welfare legislation. I think that piece of the decision will be read pretty narrowly.
posted by Holy Zarquon's Singing Fish at 7:58 AM on June 28, 2012 [2 favorites]


What a bloviating bag of shit this man is.

And the worst part was he actually sounded like it. Like every word bubbled up and oozed out of his jowls.
posted by cashman at 7:59 AM on June 28, 2012


So... Kennedy.

That's interesting. He said he wanted to strike down the entire law.

He's a "moderate"? We're counting on his vote to preserve Roe?

It's a weird day when John Roberts is to the left of Kennedy.

Still, yay!
posted by sotonohito at 7:59 AM on June 28, 2012 [1 favorite]


Cash4Lead is right to point out that this could well be a poisoned chalice. Congress's (obvious) Commerce Clause power to improve social welfare nationwide is being restricted further.
posted by Yesterday's camel at 7:59 AM on June 28, 2012 [1 favorite]


Will elective circumcision be covered?

I THOUGHT WE WERE FRIENDS
posted by jessamyn at 7:59 AM on June 28, 2012 [98 favorites]


Chief Justice Roberts saving Obamacare is like The Joker changing the tire on the Batmobile. Unexpected, but very a very welcome outcome.
posted by inturnaround at 7:59 AM on June 28, 2012 [5 favorites]


Looks like I can finish medical school knowing that I'll be practicing in a country that gives a damn. Today is a good day to study.

Yeah, I'm sitting in Cornell Medical College today for a summer internship, and I feel the same way.

Woohoo!
posted by ocherdraco at 7:59 AM on June 28, 2012 [5 favorites]


The ACA was upheld, but the opinions also show 5 votes to dramatically weaken the Commerce Clause. From ScotusBlog:
The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress's authority to pass social welfare laws. Using the tax code -- especially in the current political environment -- to promote social welfare is going to be a very chancy proposition.
It will be very interesting to see how this plays out.
posted by alms at 8:00 AM on June 28, 2012 [3 favorites]


sotonohito: "It's a weird day when John Roberts is to the left of Kennedy."

With the exception of Scalia (and possibly Thomas), the Supreme Court does not operate on the traditional left/right axis, nor should it.
posted by schmod at 8:00 AM on June 28, 2012 [8 favorites]


@schmod: Bush v Gore says you are wrong.
posted by sotonohito at 8:01 AM on June 28, 2012 [6 favorites]


So now I have to marry my cat AND provide it health insurance! This administration has certainly turned this country topsy-turvy.
posted by backseatpilot at 8:01 AM on June 28, 2012 [15 favorites]


somewhere else in NY, some slightly less rich old white men are quietly celebrating this day, if only for the fact that no one will pay any attention to their misplacement of 9 BILLION DOLLARS.
posted by ninjew at 8:01 AM on June 28, 2012 [8 favorites]


Maybe not so bad. Follow up from someone else at ScotusBlog:
I dissent from Lyle's view that the Commerce Clause ruling is a major blow to social welfare legislation. I think that piece of the decision will be read pretty narrowly.
posted by alms at 8:01 AM on June 28, 2012 [2 favorites]


House Republicans quickly pass a pre-written bill to strike-down the entire ACA in 5-4-3-2...
posted by Thorzdad at 8:01 AM on June 28, 2012 [2 favorites]


From reading Kennedy's opinion, I think it's clear that Roberts joined the liberals because he could only get votes to overturn by allowing opinions to be written that would eviscerate lots of current doctrine and precedent. It seems the extemism of his colleagues forced him into the uphold-the-mandate camp.
posted by Yesterday's camel at 8:01 AM on June 28, 2012 [7 favorites]


From SCOTUSblog, in reply to the "very chancy proposition" bit:

Tom:
I dissent from Lyle's view that the Commerce Clause ruling is a major blow to social welfare legislation. I think that piece of the decision will be read pretty narrowly.

posted by jbickers at 8:02 AM on June 28, 2012


Okay so just to keep us all sane and safe no one go on Facebook until next April okay
posted by shakespeherian at 8:02 AM on June 28, 2012 [6 favorites]


With the exception of Scalia (and possibly Thomas), the Supreme Court does not operate on the traditional left/right axis, nor should it.

Gah. My administrative law tutor loved Scalia. His personal skills and viewpoints did not hugely diverge from the image this has probably set up in your head.
posted by jaduncan at 8:02 AM on June 28, 2012 [3 favorites]


Some guy I know "but what does it mean to someone like me who cant afford it?" I really don't know because I'm not sure what the mechanisms are, anyone able to help me on this?
posted by showbiz_liz at 8:02 AM on June 28, 2012


The ACA was upheld, but the opinions also show 5 votes to dramatically weaken the Commerce Clause.

Yeah, but we've been see-sawing around about the Commerce Clause for a long time now. The Rehnquist Court was supposed to be a big meany about Commerce Clause power but they kind of really petered out towards the end. It's not set in stone.
posted by gauche at 8:03 AM on June 28, 2012


oh god my desk is way too close to the CEO's office and i don't want to sit here listen to them screaming all day oh god

My own bosses seem to have calmed down. there is hope.
posted by EmpressCallipygos at 8:03 AM on June 28, 2012


Ironically, I'll have to pay the Massachusetts penalty this year--I have health insurance (through Obamacare! I'm 25 and am insured through my dad who lives out of state), but it's out of state so my insurance doesn't submit the W-2 like form to Massachusetts

notswedish, for what it's worth, I've had out-of-state insurance in Massachusetts for a long time. My current employer's insurance is from an out-of-state BCBS affiliate, and when I was away at grad school I had student health insurance from Ohio State while maintaining my Massachusetts residency. Both providers supplied me with a 1099-HC despite not being based in MA, which I filed with my state return and had no problems. So they may give you something anyway.
posted by Kosh at 8:03 AM on June 28, 2012 [1 favorite]


Intrade at 1.7% that ACA will be struck down this year. Thems some true believers.
posted by drezdn at 8:03 AM on June 28, 2012


Amy Howe: Take a quick look at Footnote 11, which is on page 44 of the slip opinion: Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing that they may not lawfully do is buy health insurance and not pay the resulting tax.

Tom: In Amy's 10:56 -- typo: The only thing that they may not lawfully do is not buy health insurance and not pay the resulting tax.


Get it together, Amy!
posted by jinjo at 8:03 AM on June 28, 2012 [2 favorites]


The ACA was upheld, but the opinions also show 5 votes to dramatically weaken the Commerce Clause.

Eh, that really depends on how courts parse this in the future. None of the opinions cites any other ruling or act of Congress which would be unconstitutional under this view of the clause; the entire argument was that the mandate is an unprecedented expansion of CC powers, and if you buy that, then it can be struck down without overturning past precedent.

posted by Holy Zarquon's Singing Fish at 8:04 AM on June 28, 2012 [1 favorite]


Simply saying that you've won a Medal of Honor is just a lie, and lying is not in and of itself against the law.

Well, yeah, but a lot of these have come about because people vying for election have claimed false decorations. Since you can't prove people voted for them or not based on those decorations, is that still fraud, or is that now not illegal?

The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress's authority to pass social welfare laws. Using the tax code -- especially in the current political environment -- to promote social welfare is going to be a very chancy proposition.

So is this decision actually a limit of Commerce? Might that possibly be why Roberts did a switch?

Also, seeing some discussion in Veteran circles - what does this mean to people whose only "healthcare" is provided by the VA for VA-only treatment?
posted by corb at 8:04 AM on June 28, 2012


oh god my desk is way too close to the CEO's office and i don't want to sit here listen to them screaming all day oh god

Any way you could stream the audio? They could be the next internet stars!
posted by Thorzdad at 8:04 AM on June 28, 2012 [4 favorites]


My boss: "Time to go home and clean my guns and load the magazines"
His son: "That's what you said when it was passed."

They're nice people, I promise.
posted by azarbayejani at 8:04 AM on June 28, 2012 [4 favorites]


so it's not okay to lie about being a lawyer, or doctor, but totally cool to lie about having the Medal of Honor and having other people buy you shit or elect you on its basis?

It's not *illegal* to lie about being a lawyer or doctor -- unless in doing so, you also commit fraud. I think we can all agree that it's not *okay* to lie about any of these things, but that doesn't mean it should be (or can be) illegal.
posted by Slothrup at 8:05 AM on June 28, 2012 [5 favorites]


Living in a country that has universal health care, I'm happy for Americans today but really this should never have been an issue to begin with.

It's one thing if a country is too poor to provide health care to it's people. America is not such a country.
posted by gen at 8:05 AM on June 28, 2012 [17 favorites]


Gah. My administrative law tutor loved Scalia. His personal skills and viewpoints did not hugely diverge from the image this has probably set up in your head.

The biggest Scalia fan among my law school classmates was the guy who ordered an examination gown from England in which to take his exams, despite being an American whose undergraduate degree was from Brandeis.
posted by Bulgaroktonos at 8:06 AM on June 28, 2012 [9 favorites]


From reading Kennedy's opinion, I think it's clear that Roberts joined the liberals because he could only get votes to overturn by allowing opinions to be written that would eviscerate lots of current doctrine and precedent. It seems the extemism of his colleagues forced him into the uphold-the-mandate camp.

But this doesn't really make sense, either, since in that case Roberts' fifth vote would still be controlling and thus absolutely any part of the others' statements he refused to join on wouldn't be considered a binding, precedent-setting part of the ruling, no?
posted by nobody at 8:07 AM on June 28, 2012 [1 favorite]


Any way you could stream the audio? They could be the next internet stars!

just imagine the wailing of a thousand damned souls from out the fiery depths of the inferno

Maybe I'll run upstairs to the trading floor, see how those guys are getting on!
posted by shakespeherian at 8:07 AM on June 28, 2012 [4 favorites]


The biggest Scalia fan among my law school classmates was the guy who ordered an examination gown from England in which to take his exams, despite being an American whose undergraduate degree was from Brandeis.

Does he now style himself "Esq."?
posted by jedicus at 8:08 AM on June 28, 2012 [4 favorites]


From reading Kennedy's opinion, I think it's clear that Roberts joined the liberals because he could only get votes to overturn by allowing opinions to be written that would eviscerate lots of current doctrine and precedent. It seems the extemism of his colleagues forced him into the uphold-the-mandate camp.

This doesn't really make sense. The conservatives wanted the law struck down. Roberts could have negotiated a narrower ground for decision in exchange for his vote to strike down the law.
posted by brain_drain at 8:08 AM on June 28, 2012 [1 favorite]


Well, yeah, but a lot of these have come about because people vying for election have claimed false decorations. Since you can't prove people voted for them or not based on those decorations, is that still fraud, or is that now not illegal?

There are so many worse things that politicians lie about every day. Every minute. Why is that lie so deserving of criminal penalties?
posted by Holy Zarquon's Singing Fish at 8:08 AM on June 28, 2012 [2 favorites]


"but what does it mean to someone like me who cant afford it?"

I think the best-case outcome of this is that the insurance exchanges would get set up with lower-cost options -- and they would be able to offer lower-cost options because everyone is buying insurance. And between the lower-cost options on the insurance exchanges, and the subsidies for lower-income people, everybody should be able to afford insurance.

The worst-case outcome is that people who already can't afford to buy health insurance will be forced to pay extra while not even getting any health care out of it.

Based on the way things turned out in Massachusetts it seems like we may be headed for something closer to the best-case outcome than the worst-case outcome, but... I feel like this Supreme Court decision may be the best we could have hoped for, and the ACA a step in the right direction, but I'm legit worried about freelancers/contractors who don't have the option to get cheaper health care through their jobs. (Individual plans can be ridiculously pricey.)
posted by Jeanne at 8:09 AM on June 28, 2012 [1 favorite]


We are actually capable of holding complex and contradictory emotions simultaneously, including being genuinely happy about a court ruling ...and ALSO being sad that we will still have a health care system that leaks like a sieve in a monsoon.

Thank you. Lord some people are incapable of nuance. I'm happy the decision was upheld, and that's the best outcome that could have come out of today.

But I live and work in Massachusetts, and while the health care situation is a lot better here than elsewhere, we're still in the "screwed" category; just in the "somewhat less screwed" subheading (I say "we" here to mean both the state government and its residents). The ACA is like an Internet Explorer security patch: it's good to fix some holes and make things better, but at the end of the day you're still using Internet Explorer, and that's a little sad.

So yeah, bittersweet.
posted by Dr.Enormous at 8:09 AM on June 28, 2012 [15 favorites]


"but what does it mean to someone like me who cant afford it?"

Medicaid.
posted by Houstonian at 8:09 AM on June 28, 2012


Has the percentage of 5-4 decisions gone up in recent years, or am I just imagining things?
posted by LastOfHisKind at 8:09 AM on June 28, 2012


The biggest Scalia fan among my law school classmates was the guy who ordered an examination gown from England in which to take his exams, despite being an American whose undergraduate degree was from Brandeis.

I hear you. I went to 800 year old Cambridge to read law and even we no longer wear examination gowns.
posted by jaduncan at 8:09 AM on June 28, 2012 [5 favorites]


Has FOX called to impeach Roberts yet? He might as well flip sides completly, he's going to be worse than Obama himself to the teahadist crowd after this.
posted by T.D. Strange at 8:10 AM on June 28, 2012


Why is that lie so deserving of criminal penalties?

Omg hzsf why do u hate the troops.
posted by winna at 8:11 AM on June 28, 2012 [2 favorites]


LastOfHisKind, see this.
posted by Yesterday's camel at 8:11 AM on June 28, 2012


He might as well flip sides completly, he's going to be worse than Obama himself to the teahadist crowd after this.

Right, except why on earth should he care? He's appointed for life. He doesn't need to monitor public opinion. It's a little weird to assume that he'll need to find a new political "base" just for ego-gratification purposes.
posted by nebulawindphone at 8:11 AM on June 28, 2012 [2 favorites]


Three balls. Two strikes. And the pitch...

Braves win! Braves win!
posted by octobersurprise at 8:11 AM on June 28, 2012 [4 favorites]


Has FOX called to impeach Roberts yet?

Impeach a Republican judge under a Democratic president? I suppose it's possible that Fox would ask for it, but it's not like the Republican party is quite that stupid.
posted by jaduncan at 8:11 AM on June 28, 2012 [2 favorites]


he's going to be worse than Obama himself to the teahadist crowd after this.

Yup, apostates are always far worse than infidels.
posted by shivohum at 8:12 AM on June 28, 2012 [2 favorites]


Lotta tea leaf reading:

Two things that come to mind regarding the Roberts ruling.

- Sotomayor was nominated, in part, because of her persuasion skills. I wonder if that played any part in the final outcome

- I would not be shocked if Roberts was more for upholding parts and striking parts, but the battled lines firmed up into either a yea or nay duality and he had to pick a side

- Even though she was wrong int he final count Pelosi was predicting a "win" by 6-3. I think everyone is befuddled by Kennedy/Roberts switcharoo but obviously Pelsosi was counting on Roberts. Which is interesting in that iirc Justices tend to drift liberalward over time. I wonder if Roberts will turn out to be another conservative disappointment
posted by edgeways at 8:12 AM on June 28, 2012 [2 favorites]


Does ACA provide a definition of what heath insurance means? Because I have a nightmare vision of a bunch of unscrupulous "insurance" companies offering coverage that will "get you legal for less" and cover next to nothing.

At least that's what's happened in every state I've lived that has mandated car insurance.
posted by teleri025 at 8:13 AM on June 28, 2012 [3 favorites]


Braves win! Braves win!

No, no, no. Evil lost.
posted by Holy Zarquon's Singing Fish at 8:13 AM on June 28, 2012 [6 favorites]


Mitch McConnell speaking now. Lie, followed by lie, followed by purposely misleading statement. What a bloviating bag of shit this man is.

Still, impressively eloquent for a turtle in a suit.
posted by jason_steakums at 8:14 AM on June 28, 2012 [13 favorites]


It's one thing if a country is too poor to provide health care to it's people. America is not such a country.

But we can't pay for those others! Ew! Then those people who don't look like us or work as hard as us or are just not as us as us will just have a free ride and skate by while we do everything.
posted by cashman at 8:14 AM on June 28, 2012


Red State: It’s a big win for the President and a bad day for freedom. But we can deal with it. It is not the end of the world, the republic, or freedom. It just means we have to fight harder.

In the meantime, following Obama’s lead on illegal aliens, I think Mitt Romney should declare that if he is President he’ll seek “prosecutorial discretion” to not go after people who don’t pay their individual mandate tax.


Yeah, the insurance companies would love that!
posted by furiousxgeorge at 8:14 AM on June 28, 2012


This is the best baseball-related response to the FPP.
posted by gilrain at 8:15 AM on June 28, 2012 [2 favorites]


And bam, here come the anti-ACA ads. Obama is still going to need a world of help unless we want President Romney.
posted by cashman at 8:16 AM on June 28, 2012 [1 favorite]


teleri025, here's a link on what insurance plans must cover.
posted by Jeanne at 8:16 AM on June 28, 2012 [5 favorites]


Does ACA provide a definition of what heath insurance means? Because I have a nightmare vision of a bunch of unscrupulous "insurance" companies offering coverage that will "get you legal for less" and cover next to nothing.

Yes, of course it does. Visit the Kaiser Family Foundation to learn all about ACA. It's the go to resource on this stuff.
posted by notyou at 8:16 AM on June 28, 2012 [2 favorites]


This is happily almost impossible under ACA (or hell, Obamacare (ah ha ha)) regulations.
The ACA creates four benefit categories of plans plus a separate catastrophic plan to be offered through the Exchange, and in the individual and small group markets:

– Bronze plan represents minimum creditable coverage and provides the essential health benefits, cover 60% of the benefit costs of the plan, with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for families in 2010);
The Silver (70%), Gold (80%) and Platinum (90%) plans utilize the same out-of-pocket expense rules as the Bronze plan but with higher coverage (70%, 80%, 90%, respectively).

The ACA also excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through an HRA or health FSA and from being reimbursed on a tax-free basis through an HSA or Archer Medical Savings Account. (Effective January 1, 2011)
The ACA does increase the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% (from 10% for HSAs and from 15% for Archer MSAs) of the disbursed amount. (Effective January 1, 2011)
The ACA also creates an essential health benefits package that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan. Require the Secretary to define and annually update the benefit package through a transparent and public process. (Effective January 1, 2014)
posted by jaduncan at 8:17 AM on June 28, 2012 [7 favorites]


So now I have to marry my cat AND provide it health insurance! This administration has certainly turned this country topsy-turvy.

No no, you have to GAY marry your cat. If your cat is a different gender from you, then subsection b(12) says you must get another cat of a different gender and gay-marry that one, while ALSO finding someone who is no more than a third-degree blood relation to you to gay-marry the first cat.

And then you all have to get health insurance, or be sent off to the camp in Detroit for re-education. Later, after three serious healthcare issues, you go up before a Death Panel to see if you get to keep getting better on the govt dime or get turned into Soylent Green and fed to the needy.
posted by emjaybee at 8:17 AM on June 28, 2012 [26 favorites]


It just means we have to fight harder.

Yes, we must fight harder to make sure that poor people and illegal aliens suffer horribly and then die of curable ailments! THAT IS WHAT FREEDOM MEANS.
posted by elizardbits at 8:18 AM on June 28, 2012 [7 favorites]


Later, after three serious healthcare issues, you go up before a Death Panel to see if you get to keep getting better on the govt dime or get turned into Soylent Green and fed to the needy.

I'm not going. I've got an exemption due to my liberal conspiracy ID card. SO LONG WITH THE DEATH PANELS, SUCKERS.
posted by jaduncan at 8:19 AM on June 28, 2012 [1 favorite]


From SCOTUSblog:
Here is the money quote on the fifth vote to hold that the mandate is not justified under the Commerce Clause (recognizing that doesn't matter because there were five votes under the Tax Power): "The power to regulate commerce presupposes the existence of commercial activity to be regulated." That will not affect a lot of statutes going forward.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:19 AM on June 28, 2012


edgeways: "Which is interesting in that iirc Justices tend to drift liberalward over time. I wonder if Roberts will turn out to be another conservative disappointment"

You remember incorrectly. This has been true for some Justices, but some don't drift and many others drift rightward or erratically. In fact, for the past 20 years or so, pretty much all of the sitting Justices have been drifting to the right.
posted by Plutor at 8:20 AM on June 28, 2012 [3 favorites]


or be sent off to the camp in Detroit for re-education

Is anyone else thinking about how forced labor and reeducation camps could very well revitalize the economy of Detroit?
posted by elizardbits at 8:20 AM on June 28, 2012 [3 favorites]


Right, except why on earth should he care? He's appointed for life. He doesn't need to monitor public opinion. It's a little weird to assume that he'll need to find a new political "base" just for ego-gratification purposes.

They won't be inviting him to speak at the Federalist Society daddy-daughter dance anymore.
posted by T.D. Strange at 8:21 AM on June 28, 2012 [1 favorite]


CNN just aired an anti-health care law commercial ("President Obama promised my patients that they could keep me, but what if because of this new health care law, I can't keep them?") a little too late. Since I have absolutely no idea how commercials are queued, I like to think that some intern purposely delayed its airing until now. Looks like the Concerned Women for America Legislative Action Committee just flushed that money down the can.
posted by item at 8:21 AM on June 28, 2012



Impeach a Republican judge under a Democratic president? I suppose it's possible that Fox would ask for it, but it's not like the Republican party is quite that stupid.


Though I wouldn't put the stupidity past some of the personalities on Fox News. Rational thought isn't exactly a job requirement.

Does ACA provide a definition of what heath insurance means? Because I have a nightmare vision of a bunch of unscrupulous "insurance" companies offering coverage that will "get you legal for less" and cover next to nothing.

Short answer: yes. Long answer: the health insurance exchange will require a lot -- and it looks like Jeanne's link above has covers most of it. It also requires that a certain % of what the insurer brings in goes directly to patient care -- requiring refunds to the policy holders if this doesn't happen. (This is actually already happening; some insurers have refund checks all ready to comply with the rules but were awaiting today's decision to see what happened.)
posted by MCMikeNamara at 8:21 AM on June 28, 2012 [3 favorites]


The Silver (70%), Gold (80%) and Platinum (90%) plans utilize the same out-of-pocket expense rules as the Bronze plan but with higher coverage (70%, 80%, 90%, respectively).

Does this mean that healthcare plans with 100% of coverage will have to dial it back to 90? Or will they just be rolled into Platinum?

Also, the Cato Institute is now saying that states can still avoid this by just refusing to set up a healthcare exchange.
posted by corb at 8:22 AM on June 28, 2012


Is anyone else thinking about how forced labor and reeducation camps could very well revitalize the economy of Detroit?

This message brought to you by Snyder 2013: because Freedom won't wait.
posted by jaduncan at 8:23 AM on June 28, 2012 [1 favorite]


item: “CNN just aired an anti-health care law commercial ("President Obama promised my patients that they could keep me, but what if because of this new health care law, I can't keep them?") a little too late. Since I have absolutely no idea how commercials are queued, I like to think that some intern purposely delayed its airing until now. Looks like the Concerned Women for America Legislative Action Committee just flushed that money down the can.”

Sadly, that seems right on time to me – that's a campaign commercial. Anyway, I have a feeling it wasn't aimed at convincing Supreme Court justices.
posted by koeselitz at 8:23 AM on June 28, 2012 [2 favorites]


just stopping in to say I'll be danged, didn't think the Supremes had it in 'em. Whooopieeeee!!!!
posted by theora55 at 8:23 AM on June 28, 2012


House will vote on complete repeal of ACA on July 11.

And I thought I was kidding earlier...
posted by Thorzdad at 8:23 AM on June 28, 2012 [1 favorite]


Yay from Canada
posted by Artful Codger at 8:24 AM on June 28, 2012 [1 favorite]


Does this mean that healthcare plans with 100% of coverage will have to dial it back to 90? Or will they just be rolled into Platinum?

...no, it's regulatory minimums. Nobody's going to complain about insurance companies offering better cover than required.

Example: "fuck you waiter, why did you also help my wife out to the car?"
posted by jaduncan at 8:24 AM on June 28, 2012 [1 favorite]


didn't think the Supremes had it in 'em

you can't hurry laws
no you'll just have to wait
they say laws dont come easy
it's a game of give and take
posted by elizardbits at 8:25 AM on June 28, 2012 [35 favorites]


This is likely to be a boon for single-person small businesses in states that regulate access to business group insurance. For example, in Georgia, a business is not eligible to purchase group insurance unless the business will insure at least two employees; in other states, anyone with a legally formed business can buy into group plans. This puts sole proprietors and individuals without employees in a bind, because single-person insurance is ridiculously expensive, but so is hiring an employee you might not actually need just to get insurance.
posted by catlet at 8:25 AM on June 28, 2012 [3 favorites]


And I thought I was kidding earlier...

We really didn't.
posted by Holy Zarquon's Singing Fish at 8:25 AM on June 28, 2012 [2 favorites]


House will vote on complete repeal of ACA on July 11.

This is pretty irrelevant, though, since they can't possibly pass the Senate...
posted by corb at 8:26 AM on June 28, 2012


Thorzdad: “House will vote on complete repeal of ACA on July 11. And I thought I was kidding earlier...”

Well, gosh, I wish them the best of luck with that.
posted by koeselitz at 8:27 AM on June 28, 2012 [3 favorites]


House will vote on complete repeal of ACA on July 11.

That's funny because they already voted to repeal the ACA this session. Maybe they think that if they do it twice it won't have to go through the Senate.
posted by ultraviolet catastrophe at 8:27 AM on June 28, 2012 [18 favorites]


Well, they get to waste time and avoid doing anything that might help the economy, plus they get to bitch and grandstand about Obama, so that's all wins.
posted by Artw at 8:28 AM on June 28, 2012 [3 favorites]



shakespeherian: "oh god my desk is way too close to the CEO's office and i don't want to sit here listen to them screaming all day oh god"

C'mon man, wheres your sense of schadenfreude?
posted by Reverend John at 8:29 AM on June 28, 2012 [3 favorites]


House will sit on the floor of the toy aisle crying and refusing to move because some other kid got a toy too on July 11.
posted by jason_steakums at 8:29 AM on June 28, 2012 [5 favorites]


They are getting the podium ready for Mitt Romney's comments over on CNN. There's a sign directly below the microphones: "Repeal & Replace ObamaCare".
posted by Houstonian at 8:29 AM on June 28, 2012


Maybe they think that if they do it twice it won't have to go through the Senate.

Or, you know, dodge a veto.
posted by entropicamericana at 8:29 AM on June 28, 2012


"Isn’t there a International Court or UN that we could go to and appeal this? Or can the States demand they reconsider this (sorry not a lawyer but I’ve heard of appeals). Please, what can we do to stop this?" --Redstate commenter

I absolutely cannot wait to get in the car today and turn on conservative talk radio. OH MAN I am giddy with excitement.
posted by jake at 8:30 AM on June 28, 2012 [17 favorites]


Just decided to start calling it Obamacare, like its a mark of pride. Eat hot victory righty-losers!
posted by Potomac Avenue at 8:30 AM on June 28, 2012


hey so when you try to drive an unregistered, uninsured car with no license plates to WalMart without a license.. nothing bad happens right? no you get fined and/or arrested. even if you're white; that's how serious they are about it.

why healthcare in this country isn't like that, I will never understand. like others have said, this should never have been a debate.
posted by ninjew at 8:31 AM on June 28, 2012


Thorzdad, thanks for the link. I grinned at this comment in particular:

"The police state is now complete now that the government can force us to purchase services we don't want they can mandate everything. I want to thank the cowards of the supreme court for throwing us to the wolves and thank you to obama and the rest of the communists."

Wait till this guy hears about house insurance!
posted by jaduncan at 8:31 AM on June 28, 2012 [6 favorites]


Isn’t there a International Court or UN that we could go to and appeal this?

HAHA YES TAKE IT TO THE HAGUE

"WE'RE NOT ALLOWED TO LET PEOPLE DIE NEEDLESSLY ANYMORE AND THIS IS AS BAD AS HITLER"

surely that will convince everyone of the righteous goodness of your position, crazy conservative jackasses. yes. do it.
posted by elizardbits at 8:32 AM on June 28, 2012 [32 favorites]


If it becomes properly established it will become the Affordable Care Act as Invented by Mitt Romney, and Obama will be out to destroy it.
posted by Artw at 8:32 AM on June 28, 2012 [1 favorite]


When Romney complains about the individual mandate in the debates, Obama should say "I learned it by watching YOU, MITT"
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:32 AM on June 28, 2012 [29 favorites]


Obama is scheduled to speak on the ruling at 12:15. Catch it at Whitehouse.gov/live
posted by ultraviolet catastrophe at 8:32 AM on June 28, 2012


why healthcare in this country isn't like that, I will never understand. like others have said, this should never have been a debate.

Completely and seriously, the answer is State powers vs. Federal powers. They believe that states can compell you to purchase whatever they want (well, as long as it's a Republican-controlled state), but the federal government can't.
posted by muddgirl at 8:33 AM on June 28, 2012 [2 favorites]


Patrick Gaspard, Executive Director of the Democratic National Committee: it's constitutional. Bitches.
posted by furiousxgeorge at 8:36 AM on June 28, 2012 [4 favorites]


why healthcare in this country isn't like that, I will never understand. like others have said, this should never have been a debate.

Completely and seriously, the answer is State powers vs. Federal powers. They believe that states can compell you to purchase whatever they want (well, as long as it's a Republican-controlled state), but the federal government can't.


Not to rehash ancient arguments, but the other answer is that you can choose whether or not you want to drive a car. You can't choose whether or not you want to drive a body.
posted by Think_Long at 8:36 AM on June 28, 2012 [6 favorites]


They've believed that since 2009. Previously they believed it was hunky-dory and a great way to avoid single payer.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:36 AM on June 28, 2012 [1 favorite]


Isn’t there a International Court or UN that we could go to and appeal this?

Quick, get them to demand the US recognises the jurisdiction of the International Criminal Court.

It would mean that they could take the US government to court if the black helecopters take people, after all.
posted by jaduncan at 8:37 AM on June 28, 2012 [3 favorites]


The cynic in me sees this as Roberts trying to undercut Kennedy's role as the swing vote - think how much more negotiating power Roberts has with Kennedy after this. Instead of Kennedy being the key justice both camps have to lobby, Roberts has a totally credible case that he could go either way at any time and make Kennedy irrelevant.

Best inadvertent Twitter joke (the party involved was definitely against ACA): "I'm moving to Canada"
posted by yarrow at 8:39 AM on June 28, 2012 [8 favorites]


Not to rehash ancient arguments, but the other answer is that you can choose whether or not you want to drive a car. You can't choose whether or not you want to drive a body.

of course. but you can choose whether or not to drag that body into a hospital. or a doctor's office.
posted by ninjew at 8:39 AM on June 28, 2012 [2 favorites]


Hmmm. Jonathan Adler at the Volokh Conspiracy:

"Holding that it would be unconstitutional to terminate existing Medicaid funds to states that refuse to go along with the Medicaid expansion is quite significant, particularly as seven justices joined this result. While the holding here may not go beyond the limits articulated in South Dakota v. Dole, the Supreme Court has not limited the exercise of the spending power to impose conditions on states since the New Deal and, again, seven justices endorsed this result. Going forward, I expect this portion of the opinion to have the greatest practical impact. In fact, I can think of some federal laws, including portions of the Clean Air Act, that are likely to be challenged on these grounds."
posted by Holy Zarquon's Singing Fish at 8:40 AM on June 28, 2012 [3 favorites]


Best inadvertent Twitter joke (the party involved was definitely against ACA): "I'm moving to Canada"

Please tell me you dropped all pretensions of courtesy and just called them a fucking moron.
posted by Think_Long at 8:40 AM on June 28, 2012 [1 favorite]


Through Mitt Romney’s prism, health care ruling is political victory for Barack Obama
posted by Artw at 8:41 AM on June 28, 2012 [1 favorite]


Obama: Death Panels open tomorrow, surnames starting with A
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:41 AM on June 28, 2012 [20 favorites]


ok, so getting back to our well-established skepticism of the possibility that the ACA will ameliorate escalating insurance costs: what happens several years from now when it becomes apparent that a mandated market provides no basis for cost control?
posted by mwhybark at 8:41 AM on June 28, 2012 [4 favorites]


Yeah, but you have to pay regardless of your choice to drag the body into a hospital or not. So it's not really about choice at all.
posted by corb at 8:42 AM on June 28, 2012


Not to rehash ancient arguments, but the other answer is that you can choose whether or not you want to drive a car. You can't choose whether or not you want to drive a body.

Only if you live in a major city with public transportation.
posted by Melismata at 8:42 AM on June 28, 2012 [3 favorites]


I really hope Obama goes out of his way to thank Romney in his speech this afternoon. "This wouldn't have been possible without the brave leadership of the former governor of MA."
posted by (Arsenio) Hall and (Warren) Oates at 8:43 AM on June 28, 2012 [23 favorites]


Only if you live in a major city with public transportation.

Or, to be fair, have a bicycle.
posted by jaduncan at 8:43 AM on June 28, 2012 [1 favorite]


Obama: Death Panels open tomorrow, surnames starting with A

CNN: Huge upswing in deed poll name changes to Ziegfeld across the red states.
posted by elizardbits at 8:44 AM on June 28, 2012 [3 favorites]


Yeah, but you have to pay regardless of your choice to drag the body into a hospital or not. So it's not really about choice at all.

No, you don't have to comply with the mandate. You can instead choose not to recieve the tax exemption and the pay the small fee to the IRS.

It's a tax.
posted by spaltavian at 8:44 AM on June 28, 2012 [1 favorite]


I really am worried that this case will serve as the doctrinal foundation for a lot of really regressive/reactionary decisions to pare back the welfare state in the future.
posted by Yesterday's camel at 8:45 AM on June 28, 2012 [1 favorite]


Yeah, but you have to pay regardless of your choice to drag the body into a hospital or not. So it's not really about choice at all.

You also can't choose to not shoulder the burden of all people who don't have health insurance.
posted by ultraviolet catastrophe at 8:45 AM on June 28, 2012 [4 favorites]


"Small fee" being a minimum of $2,000-plus once the program hits maturity.
posted by Holy Zarquon's Singing Fish at 8:45 AM on June 28, 2012 [1 favorite]


Obama: Death Panels open tomorrow, surnames starting with A R.

Apologies - People with names beginning with A may remain calm; typo. Obama: Death Panels open tomorrow, surnames starting with A R.
posted by jaduncan at 8:45 AM on June 28, 2012 [7 favorites]


Humiliation: Nancy Pelosi's office still equipped with CRT televisions.
posted by pjenks at 8:46 AM on June 28, 2012


It's a tax.

No, it's a cookbook!!!
posted by Danf at 8:46 AM on June 28, 2012 [10 favorites]


Exactly. It's not like before this law, the care of people who don't have health insurance was paid for by the Health Care Fairy--it was paid for by everybody else.
posted by Sidhedevil at 8:47 AM on June 28, 2012 [7 favorites]


Yeah, 2,000 isn't small in my book. In fact, 2,000 a year is also currently /more/ than I pay for my family's healthcare.
posted by corb at 8:47 AM on June 28, 2012


ultraviolet catastrophe: “Maybe they think that if they do it twice it won't have to go through the Senate.”

entropicamericana: “Or, you know, dodge a veto.”

That's not really how it works. The House has no way to bypass the Senate and a veto. They can only bypass a veto if both the House and Senate collectively vote to override; and both must do so by a large (2/3) majority. That hasn't happened since July of 2008, when House and Senate were in the hands of the Democrats and the President had an insanely low approval rating.
posted by koeselitz at 8:47 AM on June 28, 2012 [1 favorite]


I really am worried that this case will serve as the doctrinal foundation for a lot of really regressive/reactionary decisions to pare back the welfare state in the future.

There's always going to be an unlimited source of "the ultimate betrayal" to these people. Even when they win.
posted by spaltavian at 8:47 AM on June 28, 2012


but this is kind of my point.. in this country, do you think you somehow avoid paying for things that people with cars use even if you don't yourself own or drive one? not really.. and it's the same with healthcare, with or without this reform.
posted by ninjew at 8:47 AM on June 28, 2012 [1 favorite]


internet reacts
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:47 AM on June 28, 2012 [17 favorites]


TIL that Nancy Pelosi has lucky lavender pumps. ♥___♥
posted by elizardbits at 8:48 AM on June 28, 2012 [2 favorites]


East Manitoba Regional Junior Kabaddi Champion '94: "photoshop skills y'all"

I took the liberty of sprucing this up -- couldn't find the face you used, but the "laughing at that Seth Meyers Bin Laden joke knowing you just had him fragged" one is so choice.
posted by Rhaomi at 8:49 AM on June 28, 2012 [5 favorites]


Everyone seems really excited, which I hope means that we got some kind of public option, which would be way more cool than mandated payments to private companies.
posted by Greg Nog at 8:49 AM on June 28, 2012 [4 favorites]


Humiliation: Nancy Pelosi's office still equipped with CRT televisions.

In the most beautiful four-television entertainment center I've ever seen. Where the hell do you get those?
posted by griphus at 8:50 AM on June 28, 2012 [1 favorite]


Scarface estate sale
posted by 2bucksplus at 8:50 AM on June 28, 2012 [8 favorites]


Where the hell do you get those?

Quick guess: a carpenter.
posted by jaduncan at 8:50 AM on June 28, 2012 [1 favorite]


People Who Say They're Moving To Canada Because Of ObamaCare
posted by one more dead town's last parade at 8:51 AM on June 28, 2012 [22 favorites]


"Small fee" being a minimum of $2,000-plus once the program hits maturity.

If you can't afford getting coverage, the law also makes the government help you pay for it. You might insist on paying the fee out of principle then, but I doubt you will refuse to go the ER for lifesaving treatment out of principle. So the $2k really just makes already existing costs visible.
posted by spaltavian at 8:51 AM on June 28, 2012 [3 favorites]


http://www.popehat.com/2012/06/28/in-the-name-of-science-a-contest/

A compilation of the best agonized, panicked or whiny reactions to the ruling. For SCIENCE!
posted by Holy Zarquon's Singing Fish at 8:51 AM on June 28, 2012 [1 favorite]


People Who Say They're Moving To Canada Because Of ObamaCare
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:52 AM on June 28, 2012 [13 favorites]


I'd like to imagine that Washington D.C. has this one Gepetto-esque carpenter of advanced years whose specialty is fitting an above-average amount of televisions into furniture.
posted by griphus at 8:53 AM on June 28, 2012 [3 favorites]


It still won't stiffle the haters.

A former coworker always posts anti-Obama stuff on his FB. He was ranting and raving about how the law is unconstitutional. Asked him if he had a heart attack when the decision came in.

"No. I feel really good. At least Roberts called it what it is--a tax."

Can't please some people.
posted by stormpooper at 8:54 AM on June 28, 2012


(One day, you'll be a real boy, eight-screen credenza.)
posted by griphus at 8:54 AM on June 28, 2012 [4 favorites]


My link is just fine, but East Manitoba Regional Junior Kabaddi Champion '94's link is an attack on FREEDOM.
posted by one more dead town's last parade at 8:54 AM on June 28, 2012 [3 favorites]


Can't please some people.

That's just what Jesus said, sir!
posted by shakespeherian at 8:55 AM on June 28, 2012 [3 favorites]


"Of course, nobody builds to the same quality these days what with these new-fangled light LCD screens."
posted by jaduncan at 8:55 AM on June 28, 2012


"Roberts is playing a long game."
posted by Yesterday's camel at 8:55 AM on June 28, 2012


Oh, hey, everyone on Facebook should use this moment as a litmus test to see whom to remove from your feed. I've got nothing but YAY HEALTHCARE on mine.

WILL TRIM FACEBOOK FEED 4 FAVORITES.
posted by griphus at 8:56 AM on June 28, 2012 [4 favorites]


WILL TRIM FACEBOOK FEED 4 FAVORITES.

Is that what the kids are calling it now?
posted by jaduncan at 8:57 AM on June 28, 2012


Yeah, 2,000 isn't small in my book. In fact, 2,000 a year is also currently /more/ than I pay for my family's healthcare.

You're good though, since you've already got insurance. And, if you make under 400% of the poverty level, you'll be paying even less because of the subsidies. Aaand, if this thing works like it's supposed to (fingers crossed), insurance prices will go down anyways, especially once the exchanges are up and running.
posted by jason_steakums at 8:58 AM on June 28, 2012 [3 favorites]


"Roberts is playing a long game."

Apparently the most realistic forecast of Star Trek is that we'll all be playing Tri-D Chess.
posted by Copronymus at 8:59 AM on June 28, 2012 [1 favorite]


Oh, and 400% of the poverty level is "$43,560 for an individual and $89,400 for a family of four in 2011": source
posted by jason_steakums at 9:00 AM on June 28, 2012 [5 favorites]


What is the overlap between people who mocked Obama's supporters with "oh yeah, he's playing 12-dimensional chess" and people who believe Roberts just supported the biggest social program since Medicare as some sort of Machiavellian tactic to destroy the New Deal?
posted by spaltavian at 9:00 AM on June 28, 2012 [4 favorites]


> Best inadvertent Twitter joke (the party involved was definitely against ACA): "I'm moving to Canada"

Please tell me you dropped all pretensions of courtesy and just called them a fucking moron.


Hell, I'd instead tell them "go ahead, we're better off without ya."
posted by EmpressCallipygos at 9:01 AM on June 28, 2012 [1 favorite]


Um. Don't do that. 'k?
posted by mazola at 9:01 AM on June 28, 2012 [6 favorites]


Yeah, 2,000 isn't small in my book. In fact, 2,000 a year is also currently /more/ than I pay for my family's healthcare.

I'm guessing this is an employer-provided coverage? $2000 doesn't cover two months of my family's private policy.
posted by Thorzdad at 9:01 AM on June 28, 2012 [3 favorites]


I'm not sure it's fair to inflict the nation's most cretinous people on poor innocent Canada.
posted by elizardbits at 9:02 AM on June 28, 2012 [9 favorites]


Tie game. Bottom of the 9th. Bases loaded. Two outs. Three balls. Two strikes.

Just wondering—how often has that scenario come up in Major League Baseball?
posted by grouse at 9:02 AM on June 28, 2012 [2 favorites]


We are fucked. Its official. We all get to buy shitty health insurance. Whether we can afford it or not.
posted by jake1 at 9:03 AM on June 28, 2012 [1 favorite]


Just break it down: Can I or can't I drop my grandfather off at a death panel?!
posted by glaucon at 9:05 AM on June 28, 2012 [10 favorites]


Everybody needs to stop what they are doing and look at this image: link. (Found from Rhaomi's image link)
posted by xorry at 9:05 AM on June 28, 2012 [18 favorites]


Tie game. Bottom of the 9th. Bases loaded. Two outs. Three balls. Two strikes.

Just wondering—how often has that scenario come up in Major League Baseball?


I AM SO CURIOUS NOW
posted by saturday_morning at 9:07 AM on June 28, 2012


Just wondering—how often has that scenario come up in Major League Baseball?

Every single goddam time someone makes a baseball movie.
posted by shakespeherian at 9:09 AM on June 28, 2012 [16 favorites]


What is the overlap between people who mocked Obama's supporters with "oh yeah, he's playing 12-dimensional chess" and people who believe Roberts just supported the biggest social program since Medicare as some sort of Machiavellian tactic to destroy the New Deal?

What if I think it's a Machiavellian tactic to get Obama voted out of office for raisin' all our taxes?

If there's anything Americans (in general) hate, it's having to pay for the services they want to use.
posted by muddgirl at 9:09 AM on June 28, 2012 [1 favorite]


Can I or can't I drop my grandfather off at a death panel?!

This is a misconception about the administration's policy. The "death panels" are actually a kind of faux-wood applique siding that gets attached to government-approved station wagons. You would need to hail one of the murdermobiles as it drives by and shove your grandfather in the backseat.
posted by cortex at 9:09 AM on June 28, 2012 [22 favorites]


Just wondering—how often has that scenario come up in Major League Baseball?

A lot more often than people would probably imagine, because as soon as a runner reaches third in that situation the pitcher will walk guys until the bases are loaded and there's a forceout at home plate.
posted by Holy Zarquon's Singing Fish at 9:09 AM on June 28, 2012 [2 favorites]


Got all your gloating out of the way? Yes?

Good.

Because this ruling doesn't strike me as the unparalleled victory that the tone of the room seems to think that it is.

First of all, there were enough votes to overturn the mandate-which-is-actually-a-tax on Commerce Clause grounds. The upshot of the ruling seems to be that yes, Congress can do this, but only because it can levy taxes on things. The only way the Democrats were able to pass this bill was on the promise that it wouldn't raise taxes. No one ever really seemed to believe this, but it's now been publicly refuted by the Court. Indeed, it's pretty clear that if the Court hadn't decided to construe it as a tax that it would have struck the entire thing down.

This means that the next time Congress wants to do something regarding social welfare, it's probably going to have to be a lot more explicit about the fact that it's raising taxes to do it. No more of this "Do this or pay money but we're not raising taxes!" bullshit. And you all know how popular tax increases are with the American public. Calling this a victory for progressive causes seems disastrously short-sighted.

Second, the Medicaid expansion has basically been gutted. Any state that doesn't want to participate doesn't have to, and their existing Medicaid funding--inadequate as it is--will remain intact. And since the expansion would blow absolutely gaping holes in state budgets, this effectively means that Medicaid expansion just isn't going to happen. That was a big part of the way we were supposed to increase coverage, especially for the poor, and I can see a majority of the states deciding they've got bit enough problems without trying to manage this one too.

Third, and this is why I was never going to be all that upset about a ruling upholding the law, we haven't really started to see this thing work. Most of the provisions in the Act haven't become effective yet. But we're already finding that it's way, way more expensive than it was supposed to be. Almost all of the revenue raising measures have failed, some before they even raised a dime. Most of the spending cuts aren't going to happen. So instead of the Supreme Court putting the bloody thing out of its misery, we're going to get to watch this thing implode over a period of years. We'll get to see the sheer gimmickry involved in selling this to the American public in exquisite detail. This promises to be far, far more damaging to the Cause than a defeat today would have been.
posted by valkyryn at 9:11 AM on June 28, 2012 [20 favorites]


Tie game. Bottom of the 9th. Bases loaded. Two outs. Three balls. Two strikes.

Just wondering—how often has that scenario come up in Major League Baseball?


Really, it would be much more interesting if you were down by three, no? I mean, you strike out with the bases loaded in a tied game and you just go to extra innings. Down by three you better make sure you don't strike out. Of course there's still a lot of outcomes there other than striking out or hitting a grand slam, but oh well.
posted by kmz at 9:11 AM on June 28, 2012 [2 favorites]


people you all heard wrong it's DEPP Panels, in which Johnny Depp decides if you live or die
posted by The Whelk at 9:12 AM on June 28, 2012 [4 favorites]


YOUR ROLE OPPOSITE HELENA BONHAM CARTER IN TIM BURTON CALLS IN A FAVOR PT. VII WAS VISIONARY, SIR.
posted by griphus at 9:14 AM on June 28, 2012 [10 favorites]


grouse: “Just wondering—how often has that scenario come up in Major League Baseball?”

Wikipedia: “As of September 27, 2011, on 27 occasions in major league history – all during the regular season – a player has hit a game-winning grand slam for a 1-run victory; 15 of those occasions came with two outs.[1][2] [3][4] Roberto Clemente hit the only walk-off inside-the-park grand slam in baseball history. Clemente's 3rd base coach instructed him to stop at 3rd, but Clemente ran through to score the winning run. Chris Hoiles' grand slam occurred with the cliché situation: bases loaded, two outs, full count, bottom of the ninth inning, and down by three runs. This was later referred to as the ultimate, ultimate grand slam. The most recent "ultimate grand slam" was by Ryan Roberts, who performed the feat in the 10th inning as the Arizona Diamondbacks beat the Los Angeles Dodgers 7-6 on September 27, 2011. This was the third ultimate slam of the 2011 season, the most ever in a single season.[5]”

Well, that's part of an answer. "Tie game. Bottom of the 9th. Bases loaded. Two outs." – and then resulting in a grand slam that wins the game – has happened 15 times in major-league history. Somehow I doubt that many of those happened with two strikes and three balls. Also, there are probably a lot more (but not that many more) where the game wasn't won.
posted by koeselitz at 9:14 AM on June 28, 2012 [3 favorites]


Really, it would be much more interesting if you were down by three, no? I mean, you strike out with the bases loaded in a tied game and you just go to extra innings. Down by three you better make sure you don't strike out. Of course there's still a lot of outcomes there other than striking out or hitting a grand slam, but oh well.

It depends on whether you're identifying with the pitcher or the batter. For the pitcher, the higher-pressure situation is one where any movement around the bases loses you the game.
posted by nebulawindphone at 9:14 AM on June 28, 2012


valkyryn, I don't see many commenters here claiming that this is a "victory for progressive causes." Many of us are simply relieved that Roberts resisted the temptation to repeal the New Deal and dismantle the modern regulatory state.
posted by Yesterday's camel at 9:15 AM on June 28, 2012 [7 favorites]


people you all heard wrong it's DEPP Panels, in which Johnny Depp decides if you live or die

While wearing pancake makeup and adopting a preposterous accent
posted by shakespeherian at 9:15 AM on June 28, 2012 [1 favorite]


As long as he is dressed as Jack Sparrow during deliberations I am totally okay with that.
posted by elizardbits at 9:15 AM on June 28, 2012 [1 favorite]


Johnny Depp decides if you live or die

How is that different from regular life?
posted by Holy Zarquon's Singing Fish at 9:15 AM on June 28, 2012 [4 favorites]


Obama speaking now.
posted by XQUZYPHYR at 9:15 AM on June 28, 2012 [1 favorite]


I agree with Valkyryn above that this is in some ways a disturbing decision even for those of us who favor health reform. The Commerce Clause part upholds a legal theory that did not appear plausible to anyone but far-right libertarians just a year or so ago and may signal intent to limit the Commerce Clause in the future. Most of all, it is amazing that if Roberts had voted with the conservatives the Court would have overturned such an important law, and furthermore a law that is in policy details rather moderate in comparison with Medicare and Social Security. That would have been an incredible exercise of judicial activism.

Second, the Medicaid expansion has basically been gutted. Any state that doesn't want to participate doesn't have to, and their existing Medicaid funding--inadequate as it is--will remain intact. And since the expansion would blow absolutely gaping holes in state budgets, this effectively means that Medicaid expansion just isn't going to happen.

I don't believe this is true. The Federal government will be picking up most of the Medicaid expansion costs through the end of the decade at least. States will get a major coverage bang for the buck by expanding Medicaid even if penalties don't make them do it.
posted by zipadee at 9:16 AM on June 28, 2012 [5 favorites]


I just got finished reading through the opinions. Fascinating and suprising result. This wasn't even on the list of possible results I would have foreseen.

Ginsburg, Breyer, Sotomayor, and Kagan voted to uphold it against every challenge. That was to be exected.

Scalia, Thomas and Alito voted to find it unconstituional in its entirety under very proffered justification. That was also to be expected.

Based on the oral argument, it appeared the decision would come down to whether Kennedy could adduce a limiting principle that would have permitted a valid exercise of Commerce Clause authority that would permit this to survive judicial scrutiny (and possibly come up with a new standard of review). He did not find such a principle and decided that the whole thing must fall as an over-step of legislative power. Which way he would go on that was the big question mark in my mind, and I am not surprised he decided that.

So it was 4 completely for it; 4 completely against it.

If you gave me those odds and said Roberts was the last to decide, I would have bet the house on it being a 5-4 ruling against ACA.

What Roberts did was interesting. As, what would be expected of him, he said this was an unconstitutional use of the commerce clause power and unconstitutional under the necessary and proper clause. But, as a good jurist, he applied the long-established principle that if there is any constitutional basis to uphold a statute, then a court should do so on that basis. Here he decided this could be upheld under the taxing power--a constitutional basis to uphold the statute. He did that despite the fact that the taxing argument was the 3rd fallback argument of the Solicitor General who offered it as almost an afterthought. It was almost an abandoned argument from the administration. It was not briefed as fully and given little time or emphasis in oral argument. It seemed to me that it would almost be unanimous against the taxing argument as the SG barely appeared to buy it himself. But Roberts went that way.

So from a judicial decision-making model, good for Roberts for applying the rule that a statute should be upheld if it can be under any argument. I am shocked he found the taxing argument persuasive, but at least he used the right canons in reaching his decision--that's what judges should do.

So we ended up with 4 totally for, 4 totally against, and 1 who was against all justifications except Argument C.

Truly a fascinating result.

I don't know how it will play politically insofar as the argument about the propriety of ACA must be about whether it is a wise tax to enforce, and, to be honest, I don't really much care for the political argument. But fro a legal perspective, this was an enjoyable thing to follow and see where they ended up and why.
posted by dios at 9:16 AM on June 28, 2012 [62 favorites]


The most amazing thing that has happened so far today is that the Prez's 12:15 address started at 12:15.
posted by damehex at 9:16 AM on June 28, 2012 [3 favorites]


From the (mostly negative) comments on my local paper's website:


Too soon to begin shadow impeachment campaign against socialist Kenyan Manchurian justice John Roberts?
posted by TedW at 9:16 AM on June 28, 2012 [2 favorites]


Just break it down: Can I or can't I drop my grandfather off at a death panel?!

Relevant
posted by Mister Fabulous at 9:17 AM on June 28, 2012


Congress can do this, but only because it can levy taxes on things. The only way the Democrats were able to pass this bill was on the promise that it wouldn't raise taxes. No one ever really seemed to believe this, but it's now been publicly refuted by the Court.

You're overestimating how much people listen to the court. Yesterday a poll showed that 25% of Americans thought the law had already been repealed.

The sole political message out of this rulling is: Obama Wins.

This means that the next time Congress wants to do something regarding social welfare, it's probably going to have to be a lot more explicit about the fact that it's raising taxes to do it. No more of this "Do this or pay money but we're not raising taxes!"

Since when have lawmakers ever been explicit about exactly what a law does? It's not like the Right didn't use the taxes/socialism line of attack before this ruling. We're already at a point where "death panels" is in the mainstream debate; you really think the Court removed restraints on what Congress tells the people?
posted by spaltavian at 9:17 AM on June 28, 2012


But Valkyryn expecting a full agreement with the Administration on Commerce Clause grounds was exceedingly unlikely to happen (which is why everyone though it would struck down). Having it be a tax makes it much less assailable in the courts and in the short term means that people have insurance.

Yes this could be seen as a weakening of the commerce clause as a useful tool for expanding the role of the federal government but let's face it that's already been under siege for decades. Yes it could mean that the current court is willing to attack other entitlements but it's really not certain.

What I do think it indicates is that the current court is going to continue to be hostile to expanded federal powers in many cases and that we need to work hard to ensure that Romney doesn't get to select a couple more jackasses for the court.
posted by vuron at 9:18 AM on June 28, 2012


Got all your gloating out of the way? Yes?

Good.

Because this ruling doesn't strike me as the unparalleled victory that the tone of the room seems to think that it is.

Thanks for the concern there.
posted by jaduncan at 9:19 AM on June 28, 2012 [5 favorites]


OH SHIT ROMNEY SNAAAAP
posted by saturday_morning at 9:20 AM on June 28, 2012


Also, let's not forget that the precedents this decisions may or may not set for future Commerce Clause cases matter far less than the ideological proclivities of whomever is next nominated to the Court. The justices are constrained by precedent until they decide that they're not.
posted by Yesterday's camel at 9:20 AM on June 28, 2012 [2 favorites]


He's giving good oratory now.
posted by The Whelk at 9:20 AM on June 28, 2012


Got all your gloating out of the way? Yes?

No wait not yet noooooooo
posted by shakespeherian at 9:20 AM on June 28, 2012 [15 favorites]


Hahaha, Obama totally just pointed out that Romney supports the idea that people who can afford insurance should be responsible and get insurance.
posted by shiu mai baby at 9:20 AM on June 28, 2012


Cite? If anything, the court striking it down would help Obama, inmyveryhumbleopinion.

Obama was in a win-win situation here. Struck down, it gives him a mandate from the people to get re-elected and "fix it." Upheld, it gives him a (slight?) boost in political capital.

Yes this could be seen as a weakening of the commerce clause as a useful tool for expanding the role of the federal government but let's face it that's already been under siege for decades.

And I'm not sure that's such a bad thing.
posted by mrgrimm at 9:21 AM on June 28, 2012 [3 favorites]


But we're already finding that it's way, way more expensive than it was supposed to be.


Nice trick there.
In 2011 alone more than 85 million people—32.5 million Medicare beneficiaries and 54 million Americans with private insurance—including seniors, women, and persons with disabilities, accessed these critical preventive services for free.

Seniors and persons with disabilities enrolled in Medicare saw significant savings thanks to the law. The Affordable Care Act works to close the Medicare Part D prescription drug coverage gap, also known as the “donut hole.” In 2011 alone, nearly 4 million seniors saved more than $2.1 billion on prescription drugs—an average of $604 per person—and will save even more in the years ahead. The average Medicare patient will save $4,200 from 2011 to 2021 while those with higher prescription drug costs will save as much as $16,000 over the same period. (via)
There is more. It all would have gone away if the decision went the other way.

"If at two years the Affordable Care Act is already helping millions of Americans access quality, affordable health care, we have a lot more to look forward to."
posted by Hypnotic Chick at 9:21 AM on June 28, 2012 [6 favorites]


"People who can afford to buy health insurance should take the responsibility to do so. In fact, this idea has enjoyed support from both parties, including the current Republican nominee for president."

I love him.
posted by shiu mai baby at 9:22 AM on June 28, 2012 [16 favorites]


Really, it would be much more interesting if you were down by three, no? I mean, you strike out with the bases loaded in a tied game and you just go to extra innings. Down by three you better make sure you don't strike out. Of course there's still a lot of outcomes there other than striking out or hitting a grand slam, but oh well.

According to TV Tropes, which actually has a wealth of information about all major sports, this has happened exactly once in the Majors. (Seriously, if you don't understand a sport well, read the TV Tropes page about it. Strange but true.)

Incidentally, what are the major court cases for next year? How does Roberts' sudden swing change the expected outcomes? I've heard claims that he's hedging on this decision so that he can be conservative on other political decisions without hurting his credibility.
posted by vogon_poet at 9:22 AM on June 28, 2012


Got all your gloating out of the way? Yes?

Jesus, no.
posted by XQUZYPHYR at 9:22 AM on June 28, 2012 [19 favorites]


valkyryn: " This means that the next time Congress wants to do something regarding social welfare, it's probably going to have to be a lot more explicit about the fact that it's raising taxes to do it. No more of this "Do this or pay money but we're not raising taxes!" bullshit. And you all know how popular tax increases are with the American public. Calling this a victory for progressive causes seems disastrously short-sighted."

How is this a bad thing? These Rube Goldberg machines that lawmakers have created to conceal the appearance of a tax hinder progressivism in the long run. I'm optimistic that this ruling will force lawmakers to be more honest about the funding mechanisms, which builds a constituency for the programs because people realize their money is going toward something tangible that benefits them.

Grover Norquist's tax pledge is not a constitutional amendment.
posted by tonycpsu at 9:22 AM on June 28, 2012 [11 favorites]


Jesus people we're losing sight of the bigger story here
posted by COBRA! at 9:22 AM on June 28, 2012 [1 favorite]


I loved listening to the Breaking News SCOTUS journalism this morning, which basically amounted to "We haven't read it yet, but we think it says x." It's just like being called on in law school!
posted by Dr. Zira at 9:22 AM on June 28, 2012 [4 favorites]


Watching Obama live it looks like he's on a green screen and I can't help but feel he's going to shake his head really fast and turn into John Simm's incarnation of the Master.
posted by MCMikeNamara at 9:23 AM on June 28, 2012 [5 favorites]


Grover Norquist's tax pledge is not yet a constitutional amendment."

FTFM.
posted by tonycpsu at 9:23 AM on June 28, 2012


Senator Jim DeMint proposes committing treason.
posted by XQUZYPHYR at 9:23 AM on June 28, 2012 [2 favorites]


CNN says the president will speak about this in the next several hours.

I'll believe that when I see it happen, based on the source.

ps. I won the Medal of Honor!
posted by theredpen at 9:24 AM on June 28, 2012 [2 favorites]


I propose Jim DeMint should stop acting like a child.
posted by jason_steakums at 9:25 AM on June 28, 2012 [8 favorites]


I'm optimistic that this ruling will force lawmakers to be more honest about the funding mechanisms, which builds a constituency for the programs because people realize their money is going toward something tangible that benefits them.

I rather think it'll serve to diminish support for those things, because people realize "Holy shit, these tangible benefits are really expensive."
posted by valkyryn at 9:25 AM on June 28, 2012


In fairness XQUZYPHYR, I'm almost entirely sure that DeMint is still in favour of anti-slavery law nullification too.
posted by jaduncan at 9:26 AM on June 28, 2012 [1 favorite]


This gives me a mild amount of hope for the future of America.
posted by thehmsbeagle at 9:26 AM on June 28, 2012


Jim DeMint is a well and true dick.
posted by Benny Andajetz at 9:28 AM on June 28, 2012


White House Blog: "I'm Here Because of Natoma"
posted by zarq at 9:28 AM on June 28, 2012


This gives me a mild amount of hope for the future of America.

Don't worry, soon enough something appallingly stupid will happen to disabuse you of this silly notion.
posted by elizardbits at 9:28 AM on June 28, 2012 [5 favorites]


XQUZYPHYR: "Senator Jim DeMint proposes committing treason."

Here's the Wikipedia article on of the concept of nullification he (and I'm sure others before the day is over) appears to be advocating.
posted by Dr. Zira at 9:28 AM on June 28, 2012


Well, now it's what we've had here in Massachusetts since 2006. Romneycare for all! I'm all for it.
posted by ericb at 9:29 AM on June 28, 2012


This means that the next time Congress wants to do something regarding social welfare, it's probably going to have to be a lot more explicit about the fact that it's raising taxes to do it. No more of this "Do this or pay money but we're not raising taxes!" bullshit. And you all know how popular tax increases are with the American public. Calling this a victory for progressive causes seems disastrously short-sighted.

Tom over at SCOTUSblog disagrees. He thinks it will be narrowly read. I think so too.

Third, and this is why I was never going to be all that upset about a ruling upholding the law, we haven't really started to see this thing work. Most of the provisions in the Act haven't become effective yet. But we're already finding that it's way, way more expensive than it was supposed to be. Almost all of the revenue raising measures have failed, some before they even raised a dime. Most of the spending cuts aren't going to happen. So instead of the Supreme Court putting the bloody thing out of its misery, we're going to get to watch this thing implode over a period of years. We'll get to see the sheer gimmickry involved in selling this to the American public in exquisite detail. This promises to be far, far more damaging to the Cause than a defeat today would have been.

And yet it is still far cheaper than the way we do it now, which is the biggest drain on our budget. This had to happen.

Your boys got whipped.

and now, Romney will get whipped. He's got to go up there and defend a position which is the opposite of the one he took at the beginning of the process. Dude wrote a letter to Obama saying the mandate needed to be in there. Now he's gonna say that's bad?
posted by Ironmouth at 9:29 AM on June 28, 2012 [9 favorites]


We are fucked. Its official. We all get to buy shitty health insurance. Whether we can afford it or not.

Is joke? I'm not an American health care expert, but I looked on Google and the first hit told me this isn't right. See.
posted by Winnemac at 9:29 AM on June 28, 2012


Obama's "Dewey Defeats Truman" Moment

Explanation for those who missed it: CNN initially misreported the outcome.
posted by beagle at 9:30 AM on June 28, 2012 [11 favorites]


Roberts the Swing Vote: Court Upholds Most of Health Care
posted by homunculus at 9:32 AM on June 28, 2012


@benshapiro: This is the greatest destruction of individual liberty since Dred Scott. This is the end of America as we know it. No exaggeration.

@AdamSerwer: I just love that some people think Judge Dredd was involved in a landmark Supreme Court ruling.

Heh.
posted by zombieflanders at 9:32 AM on June 28, 2012 [3 favorites]


valkyryn: " I rather think it'll serve to diminish support for those things, because people realize "Holy shit, these tangible benefits are really expensive.""

Yeah, but these daft schemes to conceal the cost never work. Might as well put all the cards on the table and decide as a society what we'll pay for and what we won't.
posted by tonycpsu at 9:32 AM on June 28, 2012 [3 favorites]


Buzzfeed: CNN News Staffers Revolt Over Blown Coverage
“Embarrassing.” “Fucking humiliating.” “Shameful.” A veteran producer jumps the gun, a young correspondent goes too far, and the network's crisis deepens.
posted by zarq at 9:32 AM on June 28, 2012 [7 favorites]


This is the end of America as we know it. No exaggeration.

Good.
posted by Benny Andajetz at 9:33 AM on June 28, 2012 [29 favorites]


By the way, in case your interested, there were dozens of legal briefs, unprecedented amount of oral argument and public comment on the issue, and the entire case down to one single concept: whether this tax was a "shared responsibility" tax.

The entire ball of wax is when Roberts writes:

A tax on going without health insurance does not fall within any recognized category of direct tax. It is not a capitation. Capitations are taxes paid by every person, “without regard to property, profession, or any other circumstance.” Hylton, supra, at 175 (opinion of Chase, J.) (emphasis altered). The whole point of the shared responsibility payment is that it is triggered by specific circumstances—earning a certain amount of income but not obtaining health insurance. The payment is also plainly not a tax on the ownership of land or personal property. The shared responsibility payment is thus not a direct tax that must be apportioned among the several States.

Folks, it all came down to the simple issue of the limitation that it is not triggered until an income threshold. If they would have required everyone, even the poor, to get this, presumably Roberts would have found it to be an un-apportioned direct tax and struck it down.

The dissent stridently criticizes the majority opinion for addressing this largely un-briefed issue and using it as a basis for deciding this whole thing.

Again, it's a fascinating legal decision by Roberts. Right or wrong, it's fascinating.
posted by dios at 9:34 AM on June 28, 2012 [11 favorites]


THAT'S GREAT IT STARTS WITH SOME HEALTHCARE
posted by griphus at 9:34 AM on June 28, 2012 [22 favorites]


I'll take the shitty health insurance that's more affordable and covers more than what I can get on the current open market, thanks!

pre-existing conditions, how I do not love thee
posted by catlet at 9:34 AM on June 28, 2012 [2 favorites]


Wikipedia: “As of September 27, 2011, on 27 occasions in major league history – all during the regular season – a player has hit a game-winning grand slam for a 1-run victory; 15 of those occasions came with two outs.

Well, that's part of an answer. "Tie game. Bottom of the 9th. Bases loaded. Two outs." – and then resulting in a grand slam that wins the game – has happened 15 times in major-league history.
Those 15 times were "down by 3 runs", not "tie game". The four runs from the grand slam resulted in a one-run victory.

I bet "tie game, bottom of the 9th, bases loaded, two outs, full count" happens at least a dozen times a year. (More if you accept bottom of the 10th etc.) There are a lot of games played in a season of major league baseball.
posted by dfan at 9:36 AM on June 28, 2012 [3 favorites]


LETS ALL GO TO THE ER FOR FUN
posted by The Whelk at 9:36 AM on June 28, 2012 [9 favorites]


Medicaid expansion has basically been gutted. Any state that doesn't want to participate doesn't have to, and their existing Medicaid funding--inadequate as it is--will remain intact. And since the expansion would blow absolutely gaping holes in state budgets, this effectively means that Medicaid expansion just isn't going to happen. That was a big part of the way we were supposed to increase coverage, especially for the poor, and I can see a majority of the states deciding they've got bit enough problems without trying to manage this one too.

Kevin Drum, Mother Jones: How Big a Deal is the Court's Medicaid Decision?
In practice, what's likely to happen here is pretty sad: Southern states, the very ones whose residents would gain the most from the new Medicaid provisions, are the most likely to opt out. The question is, how long will this last? Here, I'll go out on a limb and suggest that they won't hold out very long. There are a few reasons for this:
*Federal funding is 100% for the first three years. That's going to be hard to resist.

* That 100% funding runs through 2016. Right now emotions are running high, but if Obama is reelected and it becomes obvious that Obamacare is here to stay, things will probably cool down. By 2014 or 2015, as the specter of jack-booted federal tyranny recedes, wiser heads may prevail.

* There's going to be a lot of pressure from various interest groups to accept the funding. That includes pressure from within government agencies as well as from outside groups. After all, state and local governments are already on the hook for indigent healthcare, and that includes caring for those who fall in between the current Medicaid cutoff and the new one (roughly speaking, those who are between 50% and 133% of the poverty level). Even the stingy states may discover that they're already spending enough money on that group that they'd be better off simply enrolling them all in Medicaid and paying their small share of the new benefits instead.
So we'll see what happens. For now, I wouldn't pay too much attention to whatever crowd-pleasing bluster we start hearing from (primarily) Southern governors. It's election season, after all. Instead, wait until next year. If Romney wins, it's probably moot. If Obama wins, expect opposition to the new rules to cool down over time. By the time Obamacare kicks in in 2014, the blusterers may be having second thoughts.
posted by zombieflanders at 9:37 AM on June 28, 2012 [6 favorites]


Senator Rand Paul:

"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."

That is a real quote. That is an actual thing he just said.
posted by XQUZYPHYR at 9:38 AM on June 28, 2012 [129 favorites]


Yeah, 2,000 isn't small in my book. In fact, 2,000 a year is also currently /more/ than I pay for my family's healthcare.

When I was quoted for my individual policy (I stopped being covered under the group plan because of some over the top rigging of the system by my insurance provider and they cancelled my policy) the premium was $1972.00. Per month. For just me. This amount (I'm assuming) is because I have a pre-existing condition. This condition would not be covered for the first year of this ridiculously overpriced policy.

The saddest part of this whole ordeal was that I had talked myself into being okay with paying around $1000.00 a month, the amount that I was guessing they would charge me for the mostly useless individual policy. I really needed to have insurance in the future because my condition is not going away, and I was willing to eat the $12,000 in premiums for that year just to bide my time in the system.
When I learned it was going to be almost $24,000 is when I flipped the **** out.
I mean, there is greedy, and then there is EVIL.

System needs fixing is what I'm saying, and this is a step towards that.
posted by newpotato at 9:38 AM on June 28, 2012 [25 favorites]


LETS ALL GO TO THE ER FOR FUN

To the tune of Robin Sparkles' masterpiece!
posted by Holy Zarquon's Singing Fish at 9:38 AM on June 28, 2012 [9 favorites]


Personal story time: my girlfriend was diagnosed with a mixed Oligodendroglioma/Astrocytoma (read: brain tumor) last April. Thankfully, the surgeries went well, and now we're in a "keep an eye on it with MRIs every 3 months/hope to god that advances in treatment come faster than potential regrowth" (luckily it's a very slow growing kind of thing in a fairly accessible area for future resections if need be).

Anyways, she lost her job juuust before she had a seizure and they found the tumor (due to performance issues that were clearly, in retrospect, due to the tumor). So during her whole recovery, she's been on disability without proper insurance. We keep talking about getting married eventually, but if we did that it would royally screw her disability because my income would be taken into consideration. And she wouldn't be able to get on my insurance because of a preexisting condition.

This changes that. In 2014, she can get insurance just like anybody else, AND she'll be covered for clinical trials if any treatments with real potential start showing up. And we won't have to worry about her losing her disability if we get married.

Fuck yes.
posted by jason_steakums at 9:38 AM on June 28, 2012 [108 favorites]


Tie game. Bottom of the 9th. Bases loaded. Two outs. Three balls. Two strikes.
Really, it would be much more interesting if you were down by three, no? I mean, you strike out with the bases loaded in a tied game and you just go to extra innings. Down by three you better make sure you don't strike out.
There are two outs. Striking out is no worse than any out, and in fact could be better (if the catcher doesn't cleanly catch the ball, it's still a "strikeout", but it's not an "out", and conceivably the lead runner could score).
posted by Flunkie at 9:39 AM on June 28, 2012 [1 favorite]


From the first sentence of the buzzfeed link posted by zarq.

News staffers at the cable network CNN, long the gold standard in television news, were on the verge of open revolt Tuesday after CNN blew the coverage on the most consequential news event of the year.

Mistakes, they happen...
posted by bswinburn at 9:39 AM on June 28, 2012 [7 favorites]


"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."


That's a definition of "Strict Constitutionalist" I'm not very conversant with.
posted by Pogo_Fuzzybutt at 9:41 AM on June 28, 2012


"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."

That is a real quote. That is an actual thing he just said.


There's a trope that fans of the West Wing like to point out and that is whenever one of the good guys wants to be presented on the moral high ground, their adversaries always make a really stupid mistake that Josh/Sam/Toby/Cj can immediately correct them on. This makes them appear smarter and that they care more. I've always thought that it was pretty manipulative and one of the hackier aspects of Sorkin's writing. But, it appears these moments must actually happen, at least judging by this peculiar statement.
posted by Think_Long at 9:42 AM on June 28, 2012 [6 favorites]


Is there a place to get a non-live video of the President's live-stream?
posted by oddman at 9:42 AM on June 28, 2012


Twitter: #CNNHeadlines
posted by zarq at 9:43 AM on June 28, 2012


"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."

Just another example of why Libertarianism is BATSHIT CRAZY. ™
posted by Benny Andajetz at 9:43 AM on June 28, 2012 [13 favorites]


Chicago Mayor Rahm Emanuel, Obama's former White House chief of staff, called it a "historic day . The president had the courage to bend the needle of history and did something presidents have tried to do for 60 years," Emanuel said of broadening health care accessibility.

No he didn't, he just made it mandatory to have insurance. See the difference?
posted by Gungho at 9:43 AM on June 28, 2012 [1 favorite]


Might as well put all the cards on the table and decide as a society what we'll pay for and what we won't.

I'm all for that. This whole mess largely got where it was because we weren't willing to do that. If the Democrats had just called the thing a tax and had done with it, I highly doubt this part of the lawsuit would have gotten as far as it did. Then again, they probably might not have been able to pass the bill to begin with, and if they had, 2010 might have been an even bigger bloodbath than it was already.

Who can say? All's I know is that politicians of every stripe generally have zero interest in telling us how much things are actually going to cost, so any restriction on their ability to dissemble can only be a good thing.
posted by valkyryn at 9:43 AM on June 28, 2012 [2 favorites]


valkyryn: “This means that the next time Congress wants to do something regarding social welfare, it's probably going to have to be a lot more explicit about the fact that it's raising taxes to do it. No more of this ‘Do this or pay money but we're not raising taxes!’ bullshit. And you all know how popular tax increases are with the American public. Calling this a victory for progressive causes seems disastrously short-sighted.”

I'm not really being partisan here, honestly – that actually sounds like a victory for the Democrats to me. It's the Republican base that loaths taxes most; and it's Republicans who generally hide actual taxes behind "this-is-not-a-tax" fees. Democrats only did so in this case, as far as I can tell, because they're somewhat cowardly, and because they wanted to be absolutely certain this would pass with Republicans. Rest assured, however: Republicans love raising taxes as much as Democrats, usually more so, and this will limit severely their ability to do so.

That's assuming that this sets some kind of precedent that Congress has to follow. Which I am not sure it does. The Court didn't demand that all taxes be called taxes henceforth; it just ruled on the case with the interpretation that it was a tax. There is some sense in which Congresscritters who wish to avoid Supreme Court challenges might adjust their language, but it doesn't seem to me that that's a big thing on the minds of the people who pass laws in this country, at least not in a way that takes precedence over elections.

“Most of the provisions in the Act haven't become effective yet. But we're already finding that it's way, way more expensive than it was supposed to be. Almost all of the revenue raising measures have failed, some before they even raised a dime. Most of the spending cuts aren't going to happen. So instead of the Supreme Court putting the bloody thing out of its misery, we're going to get to watch this thing implode over a period of years. We'll get to see the sheer gimmickry involved in selling this to the American public in exquisite detail. This promises to be far, far more damaging to the Cause than a defeat today would have been.”

I do disagree, of course, that the ACA will end in fire and pain; we're already wasting billions upon billions of dollars per year on this problem, and I see no way that this will make it worse. That would be an almost impossible task as it is. The only people who have the privilege of believing the current system isn't a disaster which is destroying our economy are people who don't really have to care about our economy at all.

However, I don't think this is really a pertinent statement about this ruling. The point is that, even if this is a disastrous law that will harm this nation economically in a deep way, Congress has the power to make such laws. Justice John Roberts did the right thing; the Court has a long-standing precedent whereby they rule in favor of laws by any possible interpretation, and to say that this is viable as a tax is a correct interpretation. It is a good thing for the Court to uphold powers that Congress properly has according to the Constitution.

“Got all your gloating out of the way? Yes? Good.”

I'm not at all sure about anyone else here, but if I am happy today, it has nothing to do with gloating. It has to do with the fact that this is the most important Supreme Court ruling in my lifetime; it has more impact on my life and the life of those around me than anything they've said since Roe v Wade, and that was before I was born.

And, to be specific, if I am happy today, it is on behalf of the six people I know who have been hospitalized within the past four months, and who are waiting anxiously and desperately to see this law upheld and to see it take effect. They need this personally. It is vital to them. So yes, I take this decision rather personally. It's an important decision.
posted by koeselitz at 9:44 AM on June 28, 2012 [46 favorites]


"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."

That is a real quote. That is an actual thing he just said.


This is a sentiment expressed by a variety of people in a variety of ideological contexts. Opposing judicial supremacy does not necessarily make one a Rand Paul-style wingnut.

The "popular constitutionalist" school of constitutional theory, for example, is made up largely of left/liberal academics. They, too, deny the Court's final interpretive authority.
posted by Yesterday's camel at 9:44 AM on June 28, 2012 [3 favorites]


There is but one judge Rand Paul will accept a declaration of constitutionality from, and that is the judge of the most Supreme court of all: Anubis.
posted by griphus at 9:45 AM on June 28, 2012 [21 favorites]


Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so.

Interesting. This would appear to be a talking point making the rounds this morning. I've heard it repeated on call-in shows (Diane Rehm, for instance)
posted by Thorzdad at 9:45 AM on June 28, 2012


No he didn't, he just made it mandatory to have insurance. See the difference?

We made it mandatory to have insurance, and in exchange we're going to make that insurance better. Ending denial of coverage for pre-existing conditions is a huge win for all Americans. Regulating insurance coverage in general is a huge win.
posted by muddgirl at 9:46 AM on June 28, 2012 [12 favorites]


I wonder if this doesn't actually help Romney by giving something to rile up his base.

Appealing to the Republican base was only important during primaries. Romney needs the independents now.

If anything this may cost him the poorest parts of his base, who are virulently anti-Obama but also know what side their bread is buttered on.
posted by Tell Me No Lies at 9:47 AM on June 28, 2012


There is but one judge Rand Paul will accept a declaration of constitutionality from, and that is the judge of the most Supreme court of all: Anubis.
How soon we forget: Rand Paul does not worship Egyptian gods. Rand Paul worships Aqua Buddha.
posted by Flunkie at 9:47 AM on June 28, 2012 [11 favorites]


Interesting. This would appear to be a talking point making the rounds this morning.

It probably focus groups better than 'yeah, I guess I was full of shit for the preceding couple of years and many of the things I told you are not demonstrably false".
posted by jaduncan at 9:48 AM on June 28, 2012


Obama's "Dewey Defeats Truman" Moment

Explanation for those who missed it: CNN initially misreported the outcome.


So did Fox.
posted by homunculus at 9:48 AM on June 28, 2012 [1 favorite]


Interesting. This would appear to be a talking point making the rounds this morning. I've heard it repeated on call-in shows (Diane Rehm, for instance)

I'm listening to the podcast of the first hour now. Will any objects within my reach remain unsmashed?
posted by one more dead town's last parade at 9:49 AM on June 28, 2012


Aqua Buddha

Thank you so much for making me google this.
posted by en forme de poire at 9:49 AM on June 28, 2012 [3 favorites]


Apologies - not should be 'now'; typo.

This was actually a genuine typo. #needstoworkatCNN
posted by jaduncan at 9:49 AM on June 28, 2012


There is but one judge Rand Paul will accept a declaration of constitutionality from, and that is the judge of the most Supreme court of all: Anubis.

His heart is so much heavier than a feather - not even Big Bird can save him.
posted by The Whelk at 9:49 AM on June 28, 2012 [16 favorites]


Yesterday's camel: “The ‘popular constitutionalist’ school of constitutional theory, for example, is made up largely of left/liberal academics. They, too, deny the Court's final interpretive authority.”

To maybe underline your larger point a little – saying a Supreme Court decision is wrong about the constitution is not the same thing as 'denying the Court's final interpretive authority,' exactly. I believe the Court does have such authority, but that doesn't mean I always agree with how it uses that authority. To take the most egregious example I can think of, I disagree with the Court's rulings on voter ID laws. That doesn't mean I think those rulings shouldn't be followed; only that I disagree with them in principle, and hope to see them overturned.
posted by koeselitz at 9:50 AM on June 28, 2012 [6 favorites]


His heart is so much heavier than a feather

what if the feather comes from an eagle crying a single perfect tear for FREEDOM
posted by elizardbits at 9:52 AM on June 28, 2012 [7 favorites]


Senator Rand Paul:

"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."

That is a real quote. That is an actual thing he just said.


That's not hard to believe considering his recent wingnut antics: Paul: No Flood Insurance Until Senate Votes On Life Beginning At Conception
posted by homunculus at 9:52 AM on June 28, 2012


No he didn't, he just made it mandatory to have insurance. See the difference?

Sure don't.
posted by spaltavian at 9:53 AM on June 28, 2012


> There's a lot of pissed-off amateur Constitutional scholars out there right now.

And a lot of vindicated professional Constitutional scholars.


I don't know. A lot of professional Constitutional scholars were convinced that Wickard v. Filburn provided a clear Commerce Clause basis for the health care act. Roberts's opinion does a good job of distinguishing this case from Wickard and explaining that "The power to regulate commerce presupposes the existence of commercial activity to be regulated." That will be the big take-away from this case, but note that it doesn't affect or limit Wickard in any way. The article on Wickard I linked above does a good job of putting the case in context beyond the "regulating wheat for home consumption" simplifications.

To be honest, I am disheartened that so many analysts (and four of the justices!) were willing to demolish all limits on the Commerce Clause in support of a political goal. I'm all in favor of universal health care, but I don't want to shit on the Constitution to get it.

The taxing power argument always seemed so much stronger to me, but I admit that this outcome seemed pretty unlikely. The Administration really hung their hat on the Commerce Clause and because of the Anti-Injunction Act seemed to provide too much complication.
posted by stopgap at 9:53 AM on June 28, 2012 [4 favorites]


We made it mandatory to have insurance, and in exchange we're going to make that insurance better. Ending denial of coverage for pre-existing conditions is a huge win for all Americans.

A little while ago, over on Consumerist (I can't link unfortunately, as it seems the site is down) one opf the readers commenting on this just whined: "So I have to buy insurance now -- but how is that going to help me since the premiums will be really high because of my pre-existing condition?"

Fortunately, about ten people all responded saying, "uh, yeah, about that...."
posted by EmpressCallipygos at 9:53 AM on June 28, 2012 [3 favorites]


You heard it here first, folks: Rand Paul punches eagles until they cry and then defeathers them.
posted by griphus at 9:53 AM on June 28, 2012 [6 favorites]


No he didn't, he just made it mandatory to have insurance. See the difference?

Having health insurance means you have access to health care. That is part of the definition of health insurance. So yeah, there's a difference, in the sense that making it mandatory to buy insurance is a strategy, whereas broadening health care availability is the effect that the strategy achieves.
posted by LogicalDash at 9:54 AM on June 28, 2012 [1 favorite]


OBAMA: In an election season, it's always expected that two opposing candidates will do what they can to tear each other down and will never acknowledge one another's accomplishments. Today, Mitt Romney reminded America of his continued and indefatigable support of the Healthcare bill upheld today, and I believe it behooves me to thank him for that valued support. Let's take a moment to recall INSERT DATE when Mitt bravely stated INSERT ROMNEY SUPPORT STATEMENT... wait, what?

Aside to speech writers backstage

Do I have the wrong copy of this speech? Guys, hang on, one second. Hey! Where's the finished version of the script? We didn't insert the romney support statements. No, the things he said in support of the healthcare bill. ... ... Uh huh... Ok...

back to audience

Ok, I guess we didn't find them. No matter, I'm sure we'll find them eventually. Moving on.
posted by shmegegge at 9:54 AM on June 28, 2012 [1 favorite]


I feel like I've slipped into Happy Opposite Reality World, where hurricanes are a sudden and delightful attack of sunshine and rainbows and cupcake frosting.

Related: my dog bodychecked me a bit after ten all HEY HEY HEY SOMETHING'S GOING ON. 'Cos she knew. She's awesome.
posted by cmyk at 9:55 AM on June 28, 2012 [1 favorite]


The fact we all came within a hair's breadth of having ACA struck down on spurious grounds ought to give us pause -- enough to consider whether or not reining in the Court's interpretive authority, whether through term limits, packing, or what have you, might not be worthwhile.

As someone is who far to the left of the liberals on the Court I'm mainly relieved by today's ruling, but I find it funny that so many people think that (a) the conservatives on the Court are scary, BUT at the same time that (b) we must always respect the legitimacy of the justices' interpretations of the Constitution. Even though there are justices who, like Scalia, seem to think that some parts of the Constitution (like the 14th Amendment, apparently, to judge by his immigration rant on Monday) matter less than other parts.

No less a liberal luminary than FDR thought that the Court's ability to overturn acts of Congress should be cabined or limited somehow. He clumsily botched his own court-curbing (packing) plan, but that doesn't mean that we should forever be committed to letting the Roberts and the Alitos on the Court (and there will be more of them, count on it) tell us what our own basic norms and principles are.

On preview: I largely agree with koselitz.
posted by Yesterday's camel at 9:55 AM on June 28, 2012 [3 favorites]


I can see why CNN made the mistake it did.

In the Syllabus (which is the opening summary of the opinion) you usually race straight to the holding. The first holding was that the Anti-Injunction Act does not bar the suit. The second holding was:

CHIEF JUSTICE ROBERTS concluded in Part III–A that the individual mandate is not a valid exercise of Congress’s power under the Commerce Clause and the Necessary and Proper Clause. Pp. 16–30.

Based on what almost everyone was thinking, that was the big question. So there it was that the mandate is unconstitutional under the two big issues that were being fought over. I can see why someone would see that and in a rush say they struck down the mandate. No one was seriously saying that this was going to be decided on taxing power grounds. It was completely unexpected. So I can almost understand seeing that and immediately thinking "mandate is gone!"

There are a couple problems with this. First, as we know, Roberts did a couple pages later in the 4th holding in the syllabus that it was constitutional under the taxing power. So sloppy for not reading the whole syllabus. Second, the language should have been a clue. It says "CHIEF JUSTICE ROBERTS concluded in Part III-A" which suggests he was writing for himself, not the majority. If you look at other parts which are the majority opinion "CHIEF JUSTICE ROBERTS delivered the opinion of the Court with respect to Part III–C." So a careful reading would have signaled from the syllabus that the rest of the majority had not agreed to part III-A. Finally, the affirmed in part and reversed in part should have been some signal that it was affirmed somehow which necessarily required a ruling upholding the mandate somewhere. I cannot grasp how it could have been affirmed in any part of the mandate was not upheld.

So sloppy reporting wherein the source of the mistake is traceable.
posted by dios at 9:56 AM on June 28, 2012 [8 favorites]


I feel like I've slipped into Happy Opposite Reality World, where hurricanes are a sudden and delightful attack of sunshine and rainbows and cupcake frosting.

are you the pyro?
posted by robocop is bleeding at 9:58 AM on June 28, 2012 [8 favorites]


I need to send John Roberts a thank you card for the best birthday present ever!
posted by hwyengr at 10:00 AM on June 28, 2012 [2 favorites]


Obama Wins the Battle, Roberts Wins the War: The chief justice’s canny move to uphold the Affordable Care Act while gutting the Commerce Clause.
posted by homunculus at 10:01 AM on June 28, 2012 [6 favorites]


However, I don't think this is really a pertinent statement about this ruling. The point is that, even if this is a disastrous law that will harm this nation economically in a deep way, Congress has the power to make such laws. Justice John Roberts did the right thing; the Court has a long-standing precedent whereby they rule in favor of laws by any possible interpretation, and to say that this is viable as a tax is a correct interpretation. It is a good thing for the Court to uphold powers that Congress properly has according to the Constitution.

Yeah, I'm on board with that. I don't like the outcome--I do genuinely believe that this will make things worse--but legally, it's the right one. My option is to vote for people who will change the law, for all the good that'll do me.
posted by valkyryn at 10:02 AM on June 28, 2012 [3 favorites]


"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."


That is a 100% true statement. Now if at least 5 people on the Supreme Court declares something to be 'constitutional' than it is.

likewise just because 3 people on the supreme court says something is not constitutional as they did with ObamaCare that doesn't make it so.
posted by 2manyusernames at 10:02 AM on June 28, 2012 [5 favorites]


I sure as hell am today!

Do you believe in maaaaaaa-gic? And no pre-existing conditions?
posted by cmyk at 10:03 AM on June 28, 2012


If they would have required everyone, even the poor, to get this, presumably Roberts would have found it to be an un-apportioned direct tax and struck it down.

If, if if. If a frog had wings, he wouldn't bump his ass a'hoppin'. The Court had the ACA before, not a straw man of the ACA.

The dissent stridently criticizes the majority opinion for addressing this largely un-briefed issue and using it as a basis for deciding this whole thing.

Largely un-briefed = briefed.
Almost abandoned argument = not an abandoned argument.

The Court doesn't (and shouldn't) take an argument more seriously just because more trees were felled to produce it.

...

...Well, yeah, but a lot of these have come about because people vying for election have claimed false decorations. Since you can't prove people voted for them or not based on those decorations, is that still fraud, or is that now not illegal?

Fraud is still very much illegal.

Regardless, if someone got into office through these kinds of lies, then they'd be recalled in a New York minute.

...

My favorite insane update from my Facebook feed:

"Its the end of "OUR" American freedoms. See you all in jail in 2014. I refuse to have anything to do with this. I won't subscribe and I won't be paying any mandated "Tax Fine" either. Such cowards these justices are. Afraid to loose there jobs if they didn't pass this deal. PEOPLE. Obama is a nobody. A loser. A rabbit in a field of pretty flowers is more frieghtening. STOP boing down to this MUSLIM....

John Roberts is a traitor and needs to be Executed..."

Not a joke. Yipes.
posted by Sticherbeast at 10:04 AM on June 28, 2012 [1 favorite]


Romney: ObamaCare is bad law, bad policy.

Romney: Not aware that laws and policies are written and approved by Congress.
posted by Blue_Villain at 10:04 AM on June 28, 2012 [5 favorites]


Here's a comment on the tax/not a tax argument from earlier.

The ACA states that you must by health insurance if you are able to. If you are NOT able to you get support to do so. If you ARE able to and choose not to you subsidize those who are not able to.

And since this is insurance everyone in the pool supports everyone else.

It's not really a tax, but it is. Ya dig?
posted by Severian at 10:05 AM on June 28, 2012 [1 favorite]


So basically the result was the one originally stated.

It was said in the beginning that the mandate was only legal if it was a tax but the administration didn't want to call it a tax.
posted by 2manyusernames at 10:05 AM on June 28, 2012 [2 favorites]


This means that the next time Congress wants to do something regarding social welfare, it's probably going to have to be a lot more explicit about the fact that it's raising taxes to do it.

Well, first off, lots of social welfare regulations don't involve wealth redistribution via the government as an intermediary (i.e. taxation, effectively). Just to pick an example, price controls. If the government says "you can't charge more than a dollar for a tomato", that's not a tax on tomato farmers or grocers. I mean, it may hurt their income and help tomato buyers' income stretch further, but the government doesn't touch any of the money. Price controls are mostly a bad idea, but it's just the first example that sprang to mind.

Second, I disagree that if Congress tried the same approach in the future that the Court would strike it down. The courts routinely look past form to substance and engage in post hoc analysis in order to preserve laws. Rational basis is a great example. Even if the explicitly stated motivation for a law wouldn't pass rational basis review, the courts will accept any rational basis that the legislature had or could have had, even if it clearly didn't. I think the courts will take a similar approach when deciding whether something is a tax and, if so, whether it's a valid one.

And this is how it should be. Laws should be judged based on what they do, not on the labels that the legislature puts on them.
posted by jedicus at 10:05 AM on June 28, 2012 [5 favorites]


I'm listening to the podcast of the first hour now. Will any objects within my reach remain unsmashed?

Her guests were fine. Some of the callers, though, especially in the second hour.
posted by Thorzdad at 10:05 AM on June 28, 2012


I boing down to Muslims regularly, but that's mainly because I give exercise ball lessons at the local mosque.
posted by griphus at 10:06 AM on June 28, 2012 [11 favorites]


shakespeherian: "Any way you could stream the audio? They could be the next internet stars!

just imagine the wailing of a thousand damned souls from out the fiery depths of the inferno

Maybe I'll run upstairs to the trading floor, see how those guys are getting on!
"

You should say "Are you guys ok? Do you need a cookie?"
posted by symbioid at 10:09 AM on June 28, 2012 [1 favorite]


Chicago Mayor Rahm Emanuel, Obama's former White House chief of staff, called it a "historic day . The president had the courage to bend the needle of history and did something presidents have tried to do for 60 years," Emanuel said of broadening health care accessibility.

It is historic.
Timeline: History of U.S. Health Care Reform Effort (1912 - 2012)

History of Health Care Reform in The United States.
posted by ericb at 10:10 AM on June 28, 2012 [5 favorites]


It was completely unexpected.

So, in the future, expect more things.
posted by Sticherbeast at 10:11 AM on June 28, 2012 [3 favorites]


Obama Wins the Battle, Roberts Wins the War: The chief justice’s canny move to uphold the Affordable Care Act while gutting the Commerce Clause.

I am not buying this argument. Roberts wanted to set up a future fight to gut the Commerce Clause, he could have joined the dissent and authored that gutting opinion now. But he upheld it as a tax, and his opinion on the Commerce Clause was joined by no one. So there was no opinion signed by 5 justices that enforced Commerce Clause limitations. Reading his opinion together with Kennedy's dissent suggests there are 5 votes that could have limited the Commerce Clause, but I cannot grasp why the Judge would prefer to send a signal about that instead of just going ahead and doing it--if that was in fact the game he was playing.

Without a majority signing on to it, it does not appear to me that his opinion on the Commerce Clause has any precedential effect; it's just dicta from him. I struggle to buy the argument that the Chief Justice preferred to gut the Commerce Clause but made a conscious decision to vote this way to make it seem less political (while actually not doing any gutting of the Commerce Clause).

I think the simplest answer is the easiest: he did what he was supposed to do and uphold a statute if he finds any grounds to make it constitutional. He applied long-standing precedent in that regard.
posted by dios at 10:13 AM on June 28, 2012 [27 favorites]


A little while ago, over on Consumerist (I can't link unfortunately, as it seems the site is down) one opf the readers commenting on this just whined: "So I have to buy insurance now -- but how is that going to help me since the premiums will be really high because of my pre-existing condition?"

Fortunately, about ten people all responded saying, "uh, yeah, about that...."


That's the thing I just really don't get about a lot of this. Even though I (and by association, my partner) have health insurance, as someone with pre-existing conditions (and a partner with more serious pre-existing conditions), I can't imagine not knowing that. It's one thing to be selfish, but to be selfish AND against your own best interests takes a special type of willed ignorance.
posted by MCMikeNamara at 10:13 AM on June 28, 2012 [1 favorite]


"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so."

That is a 100% true statement. Now if at least 5 people on the Supreme Court declares something to be 'constitutional' than it is.

likewise just because 3 people on the supreme court says something is not constitutional as they did with ObamaCare that doesn't make it so.



"We are not final because we are infallible, we are infallible because we are final."
-- Supreme Court Justice Robert Jackson (1892 – 1954)
 
posted by Herodios at 10:14 AM on June 28, 2012 [13 favorites]


homunculus: "Obama Wins the Battle, Roberts Wins the War: The chief justice’s canny move to uphold the Affordable Care Act while gutting the Commerce Clause."

Oh - and to put that article's opener in the wrestling terms, Roberts and Kennedy tagged each other (high-fived?) to switch spots...
posted by symbioid at 10:16 AM on June 28, 2012


"Affordable care cat is upheld."
posted by OverlappingElvis at 10:16 AM on June 28, 2012 [21 favorites]


With the exception of Scalia (and possibly Thomas), the Supreme Court does not operate on the traditional left/right axis, nor should it.

Alito?
posted by Golden Eternity at 10:17 AM on June 28, 2012 [2 favorites]


That's the thing I just really don't get about a lot of this. Even though I (and by association, my partner) have health insurance, as someone with pre-existing conditions (and a partner with more serious pre-existing conditions), I can't imagine not knowing that. It's one thing to be selfish, but to be selfish AND against your own best interests takes a special type of willed ignorance.

I got the sense that they genuinely didn't know about the change regarding pre-existing conditions.

Which makes them still ignorant, but the garden-variety type of ignorant.
posted by EmpressCallipygos at 10:17 AM on June 28, 2012 [1 favorite]


It's OBSMAcare. That's all they need to know.
posted by Artw at 10:21 AM on June 28, 2012


Obama Wins the Battle, Roberts Wins the War: The chief justice’s canny move to uphold the Affordable Care Act while gutting the Commerce Clause.

I think it's more like gutting many analysts' faulty interpretation of the Commerce Clause. Roberts's opinion doesn't actually change the scope of the Commerce Clause at all. At most, it makes explicit a limit on regulatory power to only "activity" instead of "inactivity," but that limit was effectively already there (i.e. there was no precedent for regulating inactivity).
posted by stopgap at 10:21 AM on June 28, 2012 [5 favorites]


Which makes them still ignorant, but the garden-variety type of ignorant.

That's the problem, though - most of these people frothing at the mouth are just garden-variety ignorant, spun up to apoplexy by people who are not ignorant, but malicious.

It's so damned hard to be understanding of the malicious ones.
posted by Mooski at 10:21 AM on June 28, 2012 [1 favorite]


Obama Wins the Battle, Roberts Wins the War: The chief justice’s canny move to uphold the Affordable Care Act while gutting the Commerce Clause.

This is stupid. He could have struck down the law and still gutted the Commerce Clause; in fact it would have been a far more effective attack upon it.
posted by spaltavian at 10:22 AM on June 28, 2012


As it turns out, I'm getting married today.

Today is all kinds of awesome.
posted by nicething at 10:22 AM on June 28, 2012 [35 favorites]


OBSMA being so close to OSAMA.
posted by Artw at 10:23 AM on June 28, 2012


MORE LIKE OBUSSRMA
posted by griphus at 10:24 AM on June 28, 2012


Da, 'Bomrade!
posted by cmyk at 10:24 AM on June 28, 2012 [1 favorite]


a special type of willed ignorance.

I got the sense that they genuinely didn't know about the change regarding pre-existing conditions.

Which makes them still ignorant, but the garden-variety type of ignorant.


Yes, I agree - and I didn't finish my thought so was unclear what I meant. I just truly don't understand how you can have a pre-existing condition, one you worry about enough to know how it affects your potential health insurance premiums and not follow health care reform discussions from the perspective "How is this going to affect me?"

I want health care for all. But even if I wasn't I'd still want health care for me.
posted by MCMikeNamara at 10:27 AM on June 28, 2012 [2 favorites]


Brad Plummer has more about this decision's effect on the Commerce Clause over at Wonkblog. My key takeaway:
This distinction between regulating activity and inactivity is one that libertarian legal scholar Randy Barnett had developed and pushed into the mainstream. Yet for the purposes of the Affordable Care Act it ended up not mattering...

Still, the distinction is technically a new constraint on Congress’ regulatory powers. And some observers think that could prove quite significant...

Other legal scholars, however, aren’t so sure that this curtails Congress’ power...Congress, after all, has never needed to write a law regulating inactivity before.
posted by Hypnotic Chick at 10:27 AM on June 28, 2012 [1 favorite]


MORE LIKE OBCOMMUNISMzOMGWTFBBQMA
posted by mazola at 10:27 AM on June 28, 2012


lets SPIN THE WHEEL OF CRAZY TALKING POINTS to see what will turn up on Sadly, No this week:

*ding*

"Obama will force everyone to undergo medical checkups in order to implant RFID chips into every Christian baby!"
posted by The Whelk at 10:27 AM on June 28, 2012 [6 favorites]


People are trying to rope Roberts into the whole 12-dimensional chess game, but that's silly. The reality is that he's just a human being and an actual professional, and not some predictably evil robot who marches lockstep to Republican talking points. Roberts will no doubt do something we'll dislike at some point in the future, but today, in this case, he sided with us. Welcome to world of law-talkin'.
posted by Sticherbeast at 10:28 AM on June 28, 2012 [9 favorites]


implant RFID chips into every Christian baby!

Whatevs, dude, you can go ahead and use paper money if you want, but its way more convenient to just pay by scanning the RFID chip in my forehead or hand.
posted by Greg Nog at 10:29 AM on June 28, 2012 [3 favorites]


I'm not at all sure about anyone else here, but if I am happy today, it has nothing to do with gloating. It has to do with the fact that this is the most important Supreme Court ruling in my lifetime; it has more impact on my life and the life of those around me than anything they've said since Roe v Wade, and that was before I was born.
(double ++ to Koselitz)

I can't believe I scanned this whole thread.

When the glow fades and the work of cleaning up the confetti begins, I will join those who see this as the beginning, not the end. It is time for all who care to work harder. There will be major work ahead - never doubt the resolve of those who feel anger and hurt today.

To every action there is always an equal and opposite reaction
posted by Surfurrus at 10:29 AM on June 28, 2012 [15 favorites]


Other legal scholars, however, aren’t so sure that this curtails Congress’ power...Congress, after all, has never needed to write a law regulating inactivity before.

Yes, exactly. Thanks for providing that quote.
posted by stopgap at 10:30 AM on June 28, 2012


As per pre-existing conditions what's to prevent people jumping on and off various health care plans because, well they can. Since no one can deny insurance people will tend to buy it on an as-needed basis for a month or two and then drop it until they have another need to see a Dr.
posted by Gungho at 10:30 AM on June 28, 2012 [1 favorite]


implant RFID chips into every Christian baby!

Which is completely useless to me as I have no room in my wallet for a baby, no matter what religion it is.
posted by Holy Zarquon's Singing Fish at 10:31 AM on June 28, 2012 [17 favorites]


Whatevs, dude, you can go ahead and use paper money if you want, but its way more convenient to just pay by scanning the RFID chip in my forehead or hand.

Damn head chips! I once bought an entire Ford dealership by thinking about cars too hard.
posted by The Whelk at 10:31 AM on June 28, 2012 [3 favorites]


I think the best-case outcome of this is that the insurance exchanges would get set up with lower-cost options -- and they would be able to offer lower-cost options because everyone is buying insurance. And between the lower-cost options on the insurance exchanges, and the subsidies for lower-income people, everybody should be able to afford insurance.

That's how it works here in Massachusetts.
Commonwealth Health Insurance Connector Authority
The Health Connector is designed as a clearinghouse for insurance plans and payments. It performs
the following functions:

It administers the Commonwealth Care program for low-income residents (up to 300% of the FPL) who do not qualify for MassHealth and who meet certain eligibility guidelines.

It offers for purchase health insurance plans for individuals who:
-- are not working.

-- are employed by a small business (less than 50 employees) that uses the Connector to offer health insurance. These residents will purchase insurance with pre-tax income.

-- are not qualified under their large employer plan.

-- are self-employed, part-time workers, or work for multiple employers.
It sets premium subsidy levels for Commonwealth Care.

It defines "affordability" for purposes of the individual mandate.

Commonwealth Care Health Insurance Program
Commonwealth Care is one of the newest subsidized health insurance programs offered by the Commonwealth, and is a key part of Health Care Insurance Reform in Massachusetts. It is designed primarily for income-eligible Massachusetts adult residents who are not otherwise eligible for MassHealth (Medicaid), who either do not work or who work for employers that do not offer health insurance. Specifically, it allows eligible residents access to certain subsidized private insurance health plans – currently a choice of five plans – for individuals without health insurance who make below 300% of the federal poverty level. There are no deductibles. For individuals below 150% of the federal poverty level, no premiums will be charged; for those below the poverty level, dental insurance is also provided. For those above 150% of the federal poverty level, a sliding scale premium schedule based on income is used to determine the amount of money a person contributes to their policy. Commonwealth Care for those below poverty has been available through the Connector since October 1, 2006. Plans for those between 100% and 300% of the poverty line have been available since January 1, 2007. As of June 2009, 177,000 people had enrolled in Commonwealth Care according to the Massachusetts Department of Healthcare Finance and Policy. The five Massachusetts health plans contracted with the state to serve the Commonwealth Care population as of April 2010 include: Boston Medical Center HealthNet Plan, CeltiCare, Fallon Community Health Plan, Neighborhood Health Plan, and Network Health. Celticare is offered by a for-profit insurance company, Centene, of St. Louis, MO and the rest are offered by Massachusetts-based non-profits.

Young Adult Coverage
In July 2007, the Connector started to offer reduced benefit plans for young adults up to age 26 who do not have access to employer-based coverage.
posted by ericb at 10:35 AM on June 28, 2012 [4 favorites]


As per pre-existing conditions what's to prevent people jumping on and off various health care plans because, well they can. Since no one can deny insurance people will tend to buy it on an as-needed basis for a month or two and then drop it until they have another need to see a Dr.

There's this "mandate" thing you might have heard of.
posted by Holy Zarquon's Singing Fish at 10:35 AM on June 28, 2012 [9 favorites]


Gungho: “As per pre-existing conditions what's to prevent people jumping on and off various health care plans because, well they can. Since no one can deny insurance people will tend to buy it on an as-needed basis for a month or two and then drop it until they have another need to see a Dr.”

Yes, to prevent this I think the government should enact some sort of fee to penalize people who don't have health insurance. Or maybe call it a "tax." No, never mind – nobody'd ever vote for something called a "tax."
posted by koeselitz at 10:36 AM on June 28, 2012 [5 favorites]


Ginsburg's concurrence shows up Scalia for the hypocritical, partisan sack of shit that he is:

The Necessary and Proper Clause “empowers Congress to enact laws in effectuation of its [commerce] powe[r] that are not within its authority to enact in isolation.” Raich, 545 U. S., at 39 (Scalia, J., concurring in judgment). Hence, “[a] complex regulatory program . . . can survive a Commerce Clause challenge without a showing that every single facet of the program is independently and directly related to a valid congressional goal.” Indiana, 452 U. S., at 329, n. 17. “It is enough that the challenged provisions are an integral part of the regulatory program and that the regulatory scheme when considered as a whole satisfies this test.” Ibid. (collecting cases). See also Raich, 545 U. S., at 24–25 (A challenged statutory provision fits within Congress’ commerce authority if it is an “essential par[t] of a larger regulation of economic activity,” such that, in the absence of the provision, “the regulatory scheme could be undercut.” (quoting Lopez, 514 U. S., at 561)); Raich, 545 U. S., at 37 (Scalia, J., concurring in judgment) (“Congress may regulate even noneconomic local activity if that regulation is a necessary part of a more general regulation of interstate commerce. The relevant question is simply whether the means chosen are ‘reasonably adapted’ to the attainment of a legitimate end under the commerce power.” (citation omitted)).
posted by Jakey at 10:40 AM on June 28, 2012 [18 favorites]


Damn head chips! I once bought an entire Ford dealership by thinking about cars too hard.

Wow, that's embarrassing! You'd think the chip could tell the difference between the two.
posted by shakespeherian at 10:42 AM on June 28, 2012 [4 favorites]


Sick burn.

(Raich is horseshit, mind you, but that doesn't mean Scalia isn't a hypocrite.)
posted by Holy Zarquon's Singing Fish at 10:42 AM on June 28, 2012 [1 favorite]


but what does it mean to someone like me who cant afford it?"

Medicaid.


It's actually really hard for a single adult to get onto Medicaid. I had a total income of less than $5000 last year and I was still rejected. I happen to live in MA, so I was eligible for "CommonWealth Care," which is the state subsidized health insurance for people not poor enough for Medicaid and not rich enough to buy individual insurance on the health exchange. CommonWealth Care is really good insurance but I suspect that if I made a little more money I would have been screwed.

The devil is in the details here: if there is a brown "bronze" plan for indiduals with $6K in deductible costs, there will be a whole lot of young single people paying for insurance which has no practical benefits for them unless they suffer catastrophic injury.... and even then $6K is going to bankrupt most people. But again, it depends entirely on what the regulations for the bronze plan are, and I'm not sure those have even been determined yet.

Factor in the differeing implementations between states and the general political hysteria and I'm not convinced the implementation of ACA isn't going to be a huge clusterfuck with "donut holes" aplenty.

But I don't think anyone really knows the details of the implementation yet because so much was actually not specified in the bill.
posted by ennui.bz at 10:45 AM on June 28, 2012 [3 favorites]


It's actually really hard for a single adult to get onto Medicaid.

One section of the law was supposed to compel states to increase their Medicare coverage, but that definitely got weakened today.
posted by muddgirl at 10:48 AM on June 28, 2012


POLITICO: What does the health care decision mean? A guide.
posted by ericb at 10:52 AM on June 28, 2012 [3 favorites]


An interesting twist:
Scalia’s dissent, at least on first quick perusal, reads like it was originally written as a majority opinion (in particular, he consistently refers to Justice Ginsburg’s opinion as “The Dissent”). Back in May, there were rumors floating around relevant legal circles that a key vote was taking place, and that Roberts was feeling tremendous pressure from unidentified circles to vote to uphold the mandate. Did Roberts originally vote to invalidate the mandate on commerce clause grounds, and to invalidate the Medicaid expansion, and then decide later to accept the tax argument and essentially rewrite the Medicaid expansion (which, as I noted, citing Jonathan Cohn, was the sleeper issue in this case) to preserve it? If so, was he responding to the heat from President Obama and others, preemptively threatening to delegitimize the Court if it invalidated the ACA? The dissent, along with the surprising way that Roberts chose to uphold both the mandate and the Medicaid expansion, will inevitably feed the rumor mill.
posted by zombieflanders at 10:53 AM on June 28, 2012 [7 favorites]



One section of the law was supposed to compel states to increase their Medicare coverage, but that definitely got weakened today.

And some shithead governors are just going to be shitheaded about it anyway.
posted by Pogo_Fuzzybutt at 10:53 AM on June 28, 2012


///...there will be a whole lot of young single people paying for insurance which has no practical benefits for them unless they suffer catastrophic injury....//

That is actually how insurance is supposed to work. I've been paying homeowners insurance for almost 20 years and I have never made a claim. Our healthcare system is so screwed up that only the rich can afford to go to the doctor for even simple stuff, if they are paying retail. Personally, I think ACA is attacking the symptoms more than the problems, but it's a start, and it's a start I'm happy we have.
posted by COD at 10:55 AM on June 28, 2012 [15 favorites]


"It's outrageous and embarrassing,” a third CNN staffer vented. “...

It took CNN seven minutes to correct the error, from Bolduan's initial report at 10:07 am, a warning from Wolf Blitzer at 10:11 am, and finally an on air correction at approximately 10:14 am.


Idk, I see this and I think about the long-tail of human history and information/communication and I think: pretty cool.
posted by Reasonably Everything Happens at 10:55 AM on June 28, 2012 [3 favorites]


Scalia only refers to “the dissent” when he's talking about the Commerce Clause, which makes me think it's just him thumbing his nose at the liberals by rubbing in the fact that Roberts agreed with Scalia's wing on that part of the case, which puts Ginsburg/Kagan/Sotomayor/Breyer in the minority for that question.
posted by Holy Zarquon's Singing Fish at 10:58 AM on June 28, 2012 [6 favorites]


If so, was he responding to the heat from President Obama and others, preemptively threatening to delegitimize the Court if it invalidated the ACA?

Uh-huh. And how would Obama delegitimize the Court? Would he say mean things about the Court? Would that hurt John Roberts' feelings?

I know it's the Volokh Conspiracy and all, but this is just silly.
posted by Sticherbeast at 10:59 AM on June 28, 2012 [6 favorites]


there will be a whole lot of young single people paying for insurance which has no practical benefits for them unless they suffer catastrophic injury

As has been said, that's what insurance is about. We don't actually have health insurance in this country. We have pre-paid services plans masquerading as insurance products.

Of course, there are a whole lot of young single people whose only real actuarial health risk is catastrophic injury. Young people don't generally get sick or consume a lot of health care. They do, however, get hit by busses or shot. "Unintentional injury" is the leading cause of death for every age group between the ages of 1 and 44, and deaths in infancy are overwhelmingly due to either congenital abnormality or prematurity. Since the vast majority of any given person's health care dollars are spent in their last six months of life, it's pretty safe to say that most young people don't really consume all that much health care anyway.

Frankly, as a relatively healthy thirty-year-old, I'd be perfectly happy with a health insurance policy that had a much higher deductible. I get coverage through my employer, which is good, but it means that a big chunk of my compensation goes to health benefits I don't strictly need. I'd rather have the money. But under the ACA, catastrophic policies like the one I'd probably want are basically illegal, or, at least, they won't satisfy the requirement to let me get out of paying extra taxes.
posted by valkyryn at 10:59 AM on June 28, 2012 [4 favorites]


Scalia is a nut!
posted by OmieWise at 10:59 AM on June 28, 2012


If so, was he responding to the heat from President Obama and others, preemptively threatening to delegitimize the Court if it invalidated the ACA?

Ridiculous.
posted by notyou at 11:00 AM on June 28, 2012


Scalia only refers to “the dissent” when he's talking about the Commerce Clause, which makes me think it's just him thumbing his nose at the liberals

Actually, it's been suggested that this is a hint that this was originally the majority opinion, but back-room dealing led to it being a dissent, of sorts.
posted by valkyryn at 11:01 AM on June 28, 2012


That's what HZSF was responding to, valkyryn.
posted by koeselitz at 11:04 AM on June 28, 2012


The ending to this article about the crowd's response is so awesome.
posted by zombieflanders at 11:06 AM on June 28, 2012 [19 favorites]


Exactly. It's not like before this law, the care of people who don't have health insurance was paid for by the Health Care Fairy--it was paid for by everybody else.

Well, in some cases it was paid in cash by the beneficiary of that care. Which I think is the issue with taxing people who can afford to buy insurance. Sometimes, if they can afford to buy insurance, they can also afford to pay for their own medical treatment without it.

Which is the other shitty thing about the upholding. Now, even if your medical costs only cost a few hundred a year, you're going to have to pay thousands.
posted by corb at 11:06 AM on June 28, 2012


I so, so want to tell the Facebook friend (real life friend from long ago) who suggested that we might as well go to the Library of Congress and burn the Constitution that that's not where the Constitution is kept.
posted by Flunkie at 11:06 AM on June 28, 2012 [6 favorites]


from Iron_Spike's twitter

Feel free to now boycott healthcare in general, universal health care opponents! We won't mind! Honest!
posted by The Whelk at 11:06 AM on June 28, 2012 [1 favorite]


valkyryn, see HZSF's comment.
posted by Yesterday's camel at 11:07 AM on June 28, 2012


From the comments on the Volokh Conspiracy: "Scalia quotes from "the Dissent", stating "The dissent claims that we 'fai[l] to explain why the individual mandate threatens our constitutional order.'” That quote is from Ginsburg's dissent/concurrence, not the opinion of court. Thus, I think he is just referring to Ginsburg's opinion, not a dissent that became the majority."
posted by Sticherbeast at 11:09 AM on June 28, 2012 [2 favorites]


I don't buy that Scalia writing a majority opinion angle.

I'll buy completely that the initial conference vote was to strike down the whole thing. And if I had to guess, Breyer sold Roberts on the tax angle as a constitutional method to uphold the statute.

But the idea that Scalia had written a majority opinion responding to a dissent by Ginsburg that later became the dissent makes no sense: no opinions would have been started that early, and even if they were, Roberts would have been writing the majority opinion and Scalia would have been writing nothing. So if Roberts was with Kennedy, Scalia, Thomas and Alito and then changed, either no opinion would have been started before the change or it would have been Roberts' opinion that was abandoned. The premise of the argument for a Scalia majority opinion is majorly flawed.
posted by dios at 11:09 AM on June 28, 2012 [4 favorites]


With the exception of Scalia (and possibly Thomas), the Supreme Court does not operate on the traditional left/right axis, nor should it.

Eh, Scalia doesn't really fit on the left/right axis, either, at least in some cases. Witness some of his votes and opinions in Fourth Amendment cases and Confrontation Clause cases in which he has voted in favor of the rights of criminal defendants.

But under the ACA, catastrophic policies like the one I'd probably want are basically illegal, or, at least, they won't satisfy the requirement to let me get out of paying extra taxes.

Nope. The ACA leaves high deductible plans intact. The maximum deductible for a single person is $5,950. In fact, it's been criticized for not doing enough to bring maximum deductibles down.
posted by jedicus at 11:10 AM on June 28, 2012 [4 favorites]


The premise of the argument for a Scalia majority opinion is majorly flawed.

Also, it's a joint dissent. It's not necessarily written by Scalia, at least not necessarily the whole thing.
posted by Sticherbeast at 11:12 AM on June 28, 2012


It's possible that Scalia was originally writing a concurrence and copy+pasted that text into a larger dissenting opinion. But as much as I can't stand the guy, he isn't that sloppy.
posted by Holy Zarquon's Singing Fish at 11:12 AM on June 28, 2012


As per pre-existing conditions what's to prevent people jumping on and off various health care plans because, well they can. Since no one can deny insurance people will tend to buy it on an as-needed basis for a month or two and then drop it until they have another need to see a Dr.

There's this "mandate" thing you might have heard of.


I think that what is meant here is that I could find the cheapest plan available to me and be on that plan until I know I'm going to need some kind of major medical procedure. Then I can upgrade to the platinum plan for a month to pay for my surgery to get the lower out-pocket-costs and go back to the cheap plan after.
posted by VTX at 11:13 AM on June 28, 2012 [1 favorite]



Which is the other shitty thing about the upholding. Now, even if your medical costs only cost a few hundred a year, you're going to have to pay thousands.

And if by some accident, your medical costs end up costing tens or hundreds of thousands, you are going to only have to pay thousands.
posted by Pogo_Fuzzybutt at 11:14 AM on June 28, 2012 [30 favorites]


"It's outrageous and embarrassing,” a third CNN staffer vented. “...

It took CNN seven minutes to correct the error, from Bolduan's initial report at 10:07 am, a warning from Wolf Blitzer at 10:11 am, and finally an on air correction at approximately 10:14 am.


I wish I had taken a screenshot, but as of at least 10:42, the top of CNN's homepage was still showing "Supreme Court strikes down individual mandate portion of health care law" thanks to their decision to place recent contents from their twitter feed above even the top headlines.

Checking out CNN.com now shows they've completely removed any mention of Twitter -- let alone a live feed -- from their front page.
posted by nobody at 11:16 AM on June 28, 2012 [1 favorite]


even if your medical costs only cost a few hundred a year

If you know of a way to ensure that your medical costs are only a few hundred a year, I know some people who would love to subscribe to your newsletter.
posted by Rock Steady at 11:16 AM on June 28, 2012 [8 favorites]


I think that what is meant here is that I could find the cheapest plan available to me and be on that plan until I know I'm going to need some kind of major medical procedure. Then I can upgrade to the platinum plan for a month to pay for my surgery to get the lower out-pocket-costs and go back to the cheap plan after.

Sort of like buying a bigscreen TV for superbowl weekend and then returning it on Monday ? Or buying a bunch of life insurance before offing your dipshit spouse ?

I suspect the market will respond with various contract terms and conditions to dissuade that sort of behavior. Or they'll recommend people doing that be prosecuted for fraud.

Or they won't and they'll get swindled.

For a change.
posted by Pogo_Fuzzybutt at 11:17 AM on June 28, 2012 [1 favorite]


It would be pretty simple to write in a clause that states any claims paid within 90 days of changing plans can be processed under the terms of the previous plan. Or something like that.
posted by COD at 11:19 AM on June 28, 2012


Obamacare Decision Has Critical Effects On Women's Health.
posted by ericb at 11:19 AM on June 28, 2012 [2 favorites]


Nope. The ACA leaves high deductible plans intact. The maximum deductible for a single person is $5,950. In fact, it's been criticized for not doing enough to bring maximum deductibles down.

Leaves high deductible plans intact, but not high deductible catastrophe-only insurance plans intact.

The other thing that it doesn't address is people who get their needs met through arrangement rather than insurance. So, veterans using the VA for their healthcare, but not actually having "health insurance", how does this affect them? Individuals with arrangements to use their own clinics for free, how does this affect them? People who are medical professionals and don't need as much primary care, how does this affect them?
posted by corb at 11:22 AM on June 28, 2012


And as I look at those mortality numbers, I see that in 2009, about 35,000 people under the age of 45 died of cancer and heart disease, combined. Compare that to 261,000 dying of those causes between 45-64 and 870,000 after age 65, and one gets the impression that most young people are, on average, pretty healthy. By comparison, over 75,000 people under the age of 45 died from unintentional injury (e.g., getting hit by a bus), homicide (e.g., getting shot), or suicide (i.e., doing it on purpose), suggesting that until you hit 45, the risk of violent trauma of some sort is far greater than the risk of any kind of ongoing serious illness.

In other words, catastrophic policies were designed for healthy, single young people, because they're twice as likely to die from something sudden and unexpected as they are from an ongoing health care issue. Only we're not allowed to buy catastrophic policies anymore, because that we we can't afford to pay for the old people.

>But under the ACA, catastrophic policies like the one I'd probably want are basically illegal, or, at least, they won't satisfy the requirement to let me get out of paying extra taxes.

Nope. The ACA leaves high deductible plans intact.


True, but that's not my point. A catastrophic policy isn't the same thing as a high deductible policy. The latter is just a regular health insurance policy with a high deductible. The former doesn't generally offer much in the way of benefits until you get to the $10k+ range or even higher. Heck, I'm annoyed that the ACA didn't raise permissible deductibles.

Ideally, what I'd do for myself is have a cheap, bare-bones policy with a low annual cap combined with a catastrophic policy that doesn't kick in until there's a huge problem. Both policies would be cheap, because the former has a fixed amount it will ever pay out while the latter is cheap because the policy line on average won't see many claims. Right now, high deductible plans are just a way of making traditional health "insurance" slightly cheaper by mucking with the deductibles a bit. A true catastrophic policy would offer much less generous coverage on the low end with more generous coverage on the high end, but that's basically off the table now. We're all required to get very generous health insurance at all levels when most of us don't need it.

But really, my biggest gripe with the ACA isn't the mandate/tax/whatever, it's the fact that health insurance is still coupled to employment. This is a deeply silly way of going about things and it hides all sorts of pernicious effects. I'm okay with some constraints on the market for health insurance--P&C insurance is regulated, and that's a Very, Very Good Thing, so why not L&H?--but right now we have not so much a "market" as a game of three-card monte when not even the huckster knows where the money card is.
posted by valkyryn at 11:22 AM on June 28, 2012 [6 favorites]


but back-room dealing led to it being a dissent, of sorts.

"I've got this thing and it's f------ golden....you just don't give it away for nothing" --Rod Blagojevich

More than anything though, I would think Roberts was concerned about his legacy. If he had overturned the entire law, it could have created chaos and who knows what would have happened. If the ACA turns out badly, it will Obama's doing. If overturning it created a mess, it would have been primarily Robert's doing.
posted by Golden Eternity at 11:22 AM on June 28, 2012


dios> I'll buy completely that the initial conference vote was to strike down the whole thing. And if I had to guess, Breyer sold Roberts on the tax angle as a constitutional method to uphold the statute.

Based on observations during oral arguments back in March, it doesn't seem that Breyer convinced Roberts of this, at least not during an initial conference vote:
In a little-noticed exchange Monday, conservative Supreme Court Chief Justice John Roberts may have tipped his hand that he’s entertaining the possibility that the health care law’s individual mandate can be upheld on a constitutional basis that’s different from the one supporters and opponents have made central to their arguments.

For over a year now, observers and experts have assumed that the court’s final decision will hinge on the extent of Congress’ power to regulate interstate commerce. But the justices could also upend that conventional wisdom, and in a worrying sign for the plaintiffs on Monday, Roberts unexpectedly highlighted one way they could do that.

In an exchange with a plaintiffs attorney, Roberts suggested he’s skeptical that the mandate and its penalties can be treated separately and may have opened the door to finding that Congress’ power to impose the mandate springs from its broad taxing power.
-- Brian Beutler, Talking Points Memo
posted by UrineSoakedRube at 11:23 AM on June 28, 2012 [6 favorites]


I suspect the market will respond with various contract terms and conditions to dissuade that sort of behavior.

Oh, but it did! It's called the "pre-existing condition exclusion." Except it's now illegal. Hmm...
posted by valkyryn at 11:23 AM on June 28, 2012 [1 favorite]


I think that what is meant here is that I could find the cheapest plan available to me and be on that plan until I know I'm going to need some kind of major medical procedure. Then I can upgrade to the platinum plan for a month to pay for my surgery to get the lower out-pocket-costs and go back to the cheap plan after.


I get my insurance through my employer. Under the law prior to ACA, there is a limited time to make a choice, either through open enrollment period, or as a new employee. Thereafter, I am locked into that choice for a year, untill the next enrollment period, unless certain pre-defined events occur (i.e. if someone new comes into my family through birth, adoption, marriage, I can add that person, but I can't change the underlying policy choice). I understand its the same for Medicare, and I presume it will be the same for this. You can only change once a year, and you are locked into that choice for the year, so choose wisely.
posted by pbrim at 11:24 AM on June 28, 2012 [3 favorites]


But really, my biggest gripe with the ACA isn't the mandate/tax/whatever, it's the fact that health insurance is still coupled to employment.

Oh yeah, this part still sucks.

But at least now, hopefully, there will be some viable alternatives on the market to allow people to buy their own insurance and break the tie to an employer.

Because few things suck worse than turning down a job offer because you don't want to lose access to that really great doctor your found.
posted by Pogo_Fuzzybutt at 11:28 AM on June 28, 2012 [4 favorites]


We're all required to get very generous health insurance at all levels when most of us don't need it.

'Very generous' is being, well, generous. I wouldn't call a ~$6000 deductible (twice that for a family) generous for anyone who isn't a healthy young male.

But really, my biggest gripe with the ACA isn't the mandate/tax/whatever, it's the fact that health insurance is still coupled to employment

I agree. But apart from single player, how was it supposed to address that? Forbid employers from offering health insurance benefits? Employers would love it, but it would have been a killer talking point for the right.

Oh, but it did! It's called the "pre-existing condition exclusion." Except it's now illegal. Hmm...

Yeah but it used to do much, much more than curb strategic behavior by consumers, which is why it was made illegal. Anyway, since everyone should in theory now be covered continuously, the point of the exclusion is moot.
posted by jedicus at 11:29 AM on June 28, 2012 [2 favorites]


BEST PHOTO OF PELOSI AND BOEHNER EVAR
posted by zombieflanders at 11:31 AM on June 28, 2012 [62 favorites]


I agree. But apart from single player, how was it supposed to address that? Forbid employers from offering health insurance benefits? Employers would love it, but it would have been a killer talking point for the right.

Easy. Either make all health insurance tax deductible or make none of it. This would either let me buy a product on the private market using pre-tax dollars or convince my employer to just fork over what they were going to spend on my health benefits and let me buy as much coverage as I want for myself and my family. HR overhead would certainly go down quite a bit...
posted by valkyryn at 11:32 AM on June 28, 2012 [2 favorites]


Oh my god that is the greatest photograph ever taken.
posted by Holy Zarquon's Singing Fish at 11:34 AM on June 28, 2012



Oh, but it did! It's called the "pre-existing condition exclusion." Except it's now illegal. Hmm...

Truth told, that's the insurance company's own damn fault. Maybe if they were less gleefully mercenary about it.
posted by Pogo_Fuzzybutt at 11:34 AM on June 28, 2012 [5 favorites]


Individuals with arrangements to use their own clinics for free, how does this affect them? People who are medical professionals and don't need as much primary care, how does this affect them?

Seriously, who are these lucky souls? For example, I'm related to at least three nurses, and let me tell you, they don't get care for free. One of them is uninsured at the moment because her COBRA ran out from her old job and Medicare doesn't kick in till November for her. She can't afford any private insurance, nor can she call up her old friends at the hospital for free drugs and/or care. Because that's illegal.

If there are people such as you describe, they are the rare, rare minority. But they sound like unicorns to me.
posted by emjaybee at 11:35 AM on June 28, 2012 [7 favorites]


Congratulations America on getting some of the crumbs that fell from the table. Perhaps you'll set your sights higher next time and find a politician with the political guts to at least try for Single-Payer.
posted by blue_beetle at 11:35 AM on June 28, 2012 [1 favorite]


Maybe, instead of some sort of 11-dimensional chess type of strategy on Robert's part, he finished shaving one day and spent a few minutes taking a long hard look at himself in the mirror.
posted by double block and bleed at 11:36 AM on June 28, 2012


//Oh, but it did! It's called the "pre-existing condition exclusion."//

Prior to the HiPPA reforms in the early 90s, this meant that once you had a job with good insurance, you literally could never leave, unless you moved to a company big enough to waive the per-existing clause. The reforms are where the 63 day exclusion and COBRA came into being, which allowed a bit more portability for employees.

Imagine how much job portability might exist when you don't have to give a damn at all about your job as it relates to insurance. People with chronic diseases won't be handcuffed to big company jobs just for the insurance. They can freelance or do a start up because they can buy reasonable insurance on their own. How many cool things might result from the wave of entrepreneurial spirit that could be unleashed if we weren't shackled to our jobs for the insurance? How many jobs might ultimately be created?

Is it any wonder big business is opposed to health care reform? They don't want to lose those healthcare shackles.
posted by COD at 11:38 AM on June 28, 2012 [56 favorites]


Robert's

Roberts's

Doh!
posted by Golden Eternity at 11:38 AM on June 28, 2012


If the ACA doesn't what it's supposed to and makes premiums reasonable, or at least comparable to what employers have access to, I'd love to be able to renegotiate my salary with my employer so that instead of them contributing 75% of the cost of my health insurance premium, they just pay that money to me and I'll buy my own.

Even better, I'd like to see a mandate that says, "Employers can offer health benefits as part of their compensation package but if the employee chooses not to participate then the employer must pay those benefits to the employee in cash."

That way, if I think my employer is better at buying insurance than I am, they can keep doing it. If I think I can get a better value on my own, I get a raise and I'll buy it myself.
posted by VTX at 11:39 AM on June 28, 2012


The other thing that it doesn't address is people who get their needs met through arrangement rather than insurance. So, veterans using the VA for their healthcare, but not actually having "health insurance", how does this affect them? Individuals with arrangements to use their own clinics for free, how does this affect them? People who are medical professionals and don't need as much primary care, how does this affect them?

Hospitals and I clinics are employers just like banks and grocery stores; the medical professionals I'm related to get insurance through their work like anyone else. And as with lawyers, for the most part I think they use it like other people too (sure, they can prescribe certain things to themselves and diagnose within their speciality, but if their own blood has to be tested that's handled through their insurance same as everyone else).

If you're getting care from the VA, then you already qualify and ate receiving pure uncut socialist medicine, 100% government funded and provided. (it's why the VA has had better success in combating some chronic illnesses; they've had the same patient in the same system since boot camp, unlike civilians who often switch providers several times over their careers, meaning different set of records, etc.) nothing changes for them.
posted by Diablevert at 11:39 AM on June 28, 2012 [7 favorites]


EXCUSE ME SIR BUT ARE YOU IMPLYING THAT VETERANS RECEIVE SOCIALIST HEALTH CARE?

THAT'S TREASON AND I'M AFRAID YOU'RE GOING TO HAVE TO EAT THIS POISONED EAGLE
posted by Sticherbeast at 11:41 AM on June 28, 2012 [25 favorites]


This would either let me buy a product on the private market using pre-tax dollars or convince my employer to just fork over what they were going to spend on my health benefits and let me buy as much coverage as I want for myself and my family. HR overhead would certainly go down quite a bit...

Actually I think HR overhead would go up because now the employer has to keep track of which employees are in the plan and which aren't. And your buying power isn't necessarily the same, since the employer gets a group plan whereas you get an individual one. And everyone who defects to the individual market takes away from the buying power of the group, which kinda sucks for those would prefer the group plan or even just the simplicity of letting the employer deal with the hassle of shopping around. So you have this weird iterative game where employees decide whether to defect, which affects the plan the employer can offer, which affects whether employees defect, etc.

Now, companies could be required to offer all employees a choice: the company health plan or $X (tax free), where X is what they were going to spend per person. But that's the kind of meddlesome government regulation that the right would vehemently oppose.
posted by jedicus at 11:41 AM on June 28, 2012


People who are medical professionals and don't need as much primary care, how does this affect them?

I just had a discussion with my internist/GP about HIS primary care physician. I wondered if it wouldn't be better for me to go to my doctor's doctor. We both have unspecified hypothyroidism, and he has to get a physical and blood check every year just like I do.
posted by muddgirl at 11:46 AM on June 28, 2012


How does one arrive at X, the payment to the employee? I suspect that would be extremely complicated, based on pool size, markets in their state & industry, etc... Hard to establish, particularly if that company has been doing the "Pay X' for a few years and gotten out of step with market rates. Better, and simple to just have a regulatory penalty/tax.
posted by bonehead at 11:47 AM on June 28, 2012


Seriously, what is going to stop people now from going out and getting pre-existing conditions, like even two or three big ones? Like, diabetes, leukemia, cancer, leopardsy? Heck, the taxpayers are on the hook to pay for it all now anyway. With MY TAX MONEY!
posted by newdaddy at 11:52 AM on June 28, 2012 [25 favorites]


I'm getting a pre-existing condition right now...and loving it!
posted by zombieflanders at 11:53 AM on June 28, 2012 [9 favorites]


Actually I think HR overhead would go up because now the employer has to keep track of which employees are in the plan and which aren't.

Except they already do that, so this would not represent a net increase in effort expended.

And your buying power isn't necessarily the same, since the employer gets a group plan whereas you get an individual one.

Perhaps, perhaps not. The employer-based benefits model has so distorted the market that it's hard to tell what an actual private-market plan would look like. I'm all for guaranteed issue, by the way, as various states have developed very efficient ways of handling this in the auto insurance market. One I most favor is a sort of indirect tax on insurers. They basically say to the insurance companies, "Look, we've got X number of people who aren't really insurable. They've got DUIs, etc. Here's the deal: you're all taking Y% of them, where Y equals your market share, and you can't charge them more than Z, where Z is some number we made up. In exchange, we'll allow you to do business here. Got it?" Everyone else's premiums go up a bit, but because auto insurance is mandatory, there's enough risk to make that work. I say we do the same thing for health insurance.

What's that you say? Isn't that a mandate? Well, yeah. The states have always been allowed to do that. They mandate auto insurance, and that seems to work pretty well. I'd actually strongly prefer such a model over high risk pools, as those are chronically underfunded. See, e.g., the wind pools along the Gulf Coast and southern Atlantic states. But generally speaking, state departments of insurance do a remarkable job with P&C and a very good job with life, but health is largely a disaster, due in no small part to the fact that the feds keep mucking with it. This was true before the ACA, and it's just as true now.

My favored option is to just say that we're not deducting health insurance anymore, partly because of this question:

How does one arrive at X, the payment to the employee?

I say screw it. Year one, the employer just gives everyone a raise equal to their health insurance package. They then never have to think about it again.
posted by valkyryn at 11:55 AM on June 28, 2012 [2 favorites]


After all is said and done, what the US next needs is to get a handle on the other horn of the affordable healthcare bull...Actual medical costs.

Sure, insurance is blindingly expensive. You'll get no debate from me on that. However, one of the reasons insurance is so expensive (beyond simple avarice and greed) is that healthcare itself is crazy expensive in this country. So far, none of the debate has focused on bringing down real expenses...medications, equipment, fees, etc. etc. Until this brought under control, and we only focus on insurance, this will very much be a forever war.
posted by Thorzdad at 11:57 AM on June 28, 2012 [2 favorites]


Congratulations America on getting some of the crumbs that fell from the table. Perhaps you'll set your sights higher next time and find a politician with the political guts to at least try for Single-Payer.

Maybe one day I'll get the guts to jump off a cliff; I know I can fly if I just had the will to do so!
posted by spaltavian at 11:57 AM on June 28, 2012 [1 favorite]


John Roberts's Political Decision from Douthat's NYT blog.
posted by Golden Eternity at 11:58 AM on June 28, 2012 [1 favorite]


Not only am I heading out to get some cancer, I dropped granny off at the death panels and got my mandatory gay marriage along the way. Thanks, Obama!
posted by Ghostride The Whip at 11:58 AM on June 28, 2012 [6 favorites]


Here's the NYTimes video of President Obama's response. The smile that's juuuuust under the surface is maintained for the entire seven and a half minutes. Love it!
posted by funkiwan at 11:59 AM on June 28, 2012 [3 favorites]


veterans using the VA for their healthcare, but not actually having "health insurance", how does this affect them?

From the Federal Benefits for Veterans booklet:
All veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset “dollar for dollar” a veteran’s VA copay responsibility.
In some cases this is Tricare, in some cases this is through a spouse's employer, and in some cases veterans are eligible for Medicaid or Medicare.
posted by catlet at 12:00 PM on June 28, 2012 [3 favorites]


How does one arrive at X, the payment to the employee?

I say screw it. Year one, the employer just gives everyone a raise equal to their health insurance package. They then never have to think about it again.


Right. That also has the policy effect of setting the minimum insurance rate at X-$0.01.
posted by bonehead at 12:00 PM on June 28, 2012


TERRORIST FIST JABS FOR ALL!
posted by Ironmouth at 12:04 PM on June 28, 2012 [5 favorites]


However, one of the reasons insurance is so expensive (beyond simple avarice and greed) is that healthcare itself is crazy expensive in this country.

It's pretty damn expensive everywhere. But you know one of the ways single-payer actually saves money? Aside from rationing care, which it does every effectively? It's that single-payer plans frequently involve state-owned hospitals which don't pay rent or property taxes. So that asset bubble we saw? Drove up health care costs, it did, because doctors had to pay more in rent and property taxes than they otherwise would have.

But there's just no real way healthcare can be cheap. It's already about as cheap as it realistically can be. Medical equipment is expensive. Physicians and nurses are highly trained, highly skilled, highly educated people. Greed don't enter into it: there's few of them and lots of us, and unless you're going to conscript them, they get to charge market prices for their labors. We can save some money by shifting more things to outpatient care--inpatient care is extravagantly expensive--but we've already done a lot of that. There is no such thing as "bending the cost curve." There's only "consuming less health care."

Other countries spend less on health care than we do, not because it's necessarily cheaper there, but because they simply use less of it. The tragedy isn't that health care is expensive per se, it's that we spend so much on so little. Sure, it's cheaper in places like India and Latin America, but everything is cheaper there, including real estate and wages. Same reason oursourcing happens.
posted by valkyryn at 12:12 PM on June 28, 2012 [5 favorites]


I rather think it'll serve to diminish support for those things, because people realize "Holy shit, these tangible benefits are really expensive."

So is a car, but I live in the wealthiest country in the world, which allows me to own one. Universal health coverage, which is about as common in first world countries as running water and indoor plumbing should is pretty much in line with what we can expect for an economy of about our size.

What will happen as time goes on is that people will realize, "Holy shit, I am so screwed if I lose these benefits!"
posted by deanc at 12:12 PM on June 28, 2012 [2 favorites]


OBSMA being so close to OSAMA

I have an acquaintance who won't utter the President's name because it's close to saying 'Osama', and he's a Terrorist.

She also believes that the Catholic Church is a cult, Amway is a really good idea, and that skim milk is poison because it contains plastic.

We...talk about sports a lot when we hang out.
posted by spinifex23 at 12:13 PM on June 28, 2012 [4 favorites]


However, one of the reasons insurance is so expensive (beyond simple avarice and greed) is that healthcare itself is crazy expensive in this country.

I can't help wondering if this is tautological, or maybe even reversing the cart and the horse; kind of like "college debt is so high because tuition is so expensive", when it seems clear that tuition inflation is due to the ready availability of guaranteed credit. Is it possible that our private insurance system is itself to blame for the healthcare prices?

On preview, valkyryn's observations are probably more on point.
posted by George_Spiggott at 12:13 PM on June 28, 2012


Physicians and nurses are highly trained, highly skilled, highly educated people.

Hmm. What else is insanely expensive in the US right now? I wonder...
posted by Rock Steady at 12:15 PM on June 28, 2012


But there's just no real way healthcare can be cheap. It's already about as cheap as it realistically can be

In other countries, yes. In the USA, no. We pay substantially more than our peer countries on health care. Some of that is just part of the territory: on a per capita basis, we are a richer country than France, and so salaries are higher, and expenses are higher. But in other senses, we simply spend a lot of money on stuff that is unnecessary (armies of "billing specialists") and procedures and care that does not pay off in the form of tangible results, compared to other protocols, in part because we have, until now, had few backstops to determine what was worth our time and money and what isn't.
posted by deanc at 12:16 PM on June 28, 2012 [8 favorites]


leopardsy?

*mrroawr!*
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 12:16 PM on June 28, 2012 [2 favorites]


I'm British, so I'm lucky enough to have the National Health Service.

Given that, may I express some skepticism for the frequent claim I read on MetaFilter that if only your healthcare costs weren't a worry (1) you'd all move jobs! (2) you'd all become entrepreneurs!

That is, that some kind of national healthcare would result in huge economic benefits because people would be free to move/set up companies.

Because that's not how it works here. And we also have a fairly open economy, good finance, rule of law etc.

So I wouldn't expect that to happen in the USA. But, who knows?
posted by alasdair at 12:16 PM on June 28, 2012 [1 favorite]


Oh, please, oh, please, oh, please!

Limbaugh in 2010: I'll Leave US If Health Care Reform Passes.
posted by ericb at 12:17 PM on June 28, 2012 [16 favorites]


People Who Say They're Moving To Canada Because Of ObamaCare -- "I'm sure they'll like the healthcare just fine there."
posted by ericb at 12:20 PM on June 28, 2012


I will personally fund the construction of a trebuchet to launch him from the border.
posted by elizardbits at 12:20 PM on June 28, 2012 [16 favorites]


All veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset “dollar for dollar” a veteran’s VA copay responsibility.

Yes, but this doesn't mean that the veterans won't get care if they don't have private insurance, or that they have to have private insurance, or even that they do.

So what I'm asking is: veterans who receive care through VA, but do not possess "health insurance" - are these people going to be forced to acquire "health insurance" or pay 2,000 a year extra in taxes?
posted by corb at 12:21 PM on June 28, 2012


valkyryn: Ideally, what I'd do for myself is have a cheap, bare-bones policy with a low annual cap combined with a catastrophic policy that doesn't kick in until there's a huge problem.

That is just about what you get if you buy insurance from the exchange. You get a high deductible plan plus a few hundred dollars of free annual preventive care.
posted by JackFlash at 12:21 PM on June 28, 2012


But there's just no real way healthcare can be cheap. It's already about as cheap as it realistically can be. Medical equipment is expensive. Physicians and nurses are highly trained, highly skilled, highly educated people. Greed don't enter into it: there's few of them and lots of us, and unless you're going to conscript them, they get to charge market prices for their labors. We can save some money by shifting more things to outpatient care--inpatient care is extravagantly expensive--but we've already done a lot of that. There is no such thing as "bending the cost curve." There's only "consuming less health care."

Fee for service is actually one of the biggest problems. The more the dr. does, the more they get paid. That and fear of being sued lead to lots of extra tests and procedures.

But those are problems that could be resolved with sensible policies. If only we could get to that point and get past the screaming.
posted by emjaybee at 12:22 PM on June 28, 2012 [1 favorite]


I will personally fund the construction of a trebuchet to launch him from the border.

Rushin Chunkin?
posted by SomaSoda at 12:23 PM on June 28, 2012 [2 favorites]


It's pretty damn expensive everywhere. ...

But there's just no real way healthcare can be cheap. It's already about as cheap as it realistically can be.


Nope. The US pays over twice the OECD median per capita and 50% more than the next most expensive country (Norway), yet our life expectancy is actually lower than many other OECD nations (all of which spend less than us). Health care is significantly cheaper everywhere, not just in 'Latin America and India.'

Why is it cheaper? Because those countries pay less. That's it. They get essentially the same care, they just pay less for it. There's less profit: pharma companies make less on drugs, device companies make less on devices, and doctors and nurses are paid less. Health care can be vastly cheaper without sacrificing quality, there just has to be the will to make it so.
posted by jedicus at 12:24 PM on June 28, 2012 [20 favorites]


Someone else has to fund the huge open cesspit for him to land in, though.
posted by elizardbits at 12:24 PM on June 28, 2012 [3 favorites]


And thus the Great Concavity was formed.
posted by feloniousmonk at 12:27 PM on June 28, 2012 [5 favorites]


I think the argument could be made that wherever he lands automatically becomes a huge open cesspit.
posted by jason_steakums at 12:29 PM on June 28, 2012 [6 favorites]


Careful now, that's pretty much what killed the dinosaurs.
posted by WinnipegDragon at 12:29 PM on June 28, 2012 [2 favorites]


leopardsy?

*mrroawr!*


It's when your spots fall off.


And you thought CNN's mistake was hell on you:

President Obama Initially Heard Mandate Had Been Overturned

The president remained calm in the face of what would have been devastating news for his signature legislation, according to senior White House officials. One to two minutes passed before White House Counsel Kathryn Ruemmler entered the room flashing two thumbs to signal that the law had, in fact, survived almost entirely intact.
posted by MCMikeNamara at 12:30 PM on June 28, 2012 [7 favorites]


On an impulse I decided to google a certain phrase in the context of health and see what comes up. It's interesting to browse the results.
posted by George_Spiggott at 12:31 PM on June 28, 2012


valkyryn: Other countries spend less on health care than we do, not because it's necessarily cheaper there, but because they simply use less of it.

This is false. Health care and procedures in virtually every other developed country in the world is cheaper. The U.S. pays doctors twice as much, pays much more for prescription drugs, three to five times as much for MRIs and CATs, three times as much for each procedure or surgery such as balloon arthroplasty, etc. Health care is not more expensive because the U.S. uses more of it. Health outcomes are equivalent. Health care is more expensive in the U.S. because it pays 100% to 300% more for each unit of care received. U.S. hospitals even pay three to five times as much for new medical equipment such as MRI machines as in other countries.
posted by JackFlash at 12:31 PM on June 28, 2012 [27 favorites]


We'll be seeing your grandparents soon, America!
posted by deathpanels at 12:31 PM on June 28, 2012 [19 favorites]


So what I'm asking is: veterans who receive care through VA, but do not possess "health insurance" - are these people going to be forced to acquire "health insurance" or pay 2,000 a year extra in taxes?

They will have to pay quadruple that, then they get no health care anyway, and no law may ever be passed to fix this, ever.
posted by fleacircus at 12:33 PM on June 28, 2012 [3 favorites]


We'll be seeing your grandparents soon, America!

mine are already dead. pre-existing condition, you know.
posted by quonsar II: smock fishpants and the temple of foon at 12:33 PM on June 28, 2012 [3 favorites]


Thanks, Bush.
posted by Apocryphon at 12:34 PM on June 28, 2012 [1 favorite]



So what I'm asking is: veterans who receive care through VA, but do not possess "health insurance" - are these people going to be forced to acquire "health insurance" or pay 2,000 a year extra in taxes?

No
posted by yarrow at 12:35 PM on June 28, 2012 [7 favorites]


Why is it cheaper? Because those countries pay less. That's it. They get essentially the same care, they just pay less for it. There's less profit: pharma companies make less on drugs, device companies make less on devices, and doctors and nurses are paid less. Health care can be vastly cheaper without sacrificing quality, there just has to be the will to make it so.
posted by jedicus at 3:24 PM on June 28 [+] [!]
One problem, which I'm seeing firsthand is the incredible cost of a medical school education. You simply cannot pay this debt back without incredible levels of sacrifice or fees for service that look ridiculous on paper.

As doctors say, the problem is multifactorial. You can't fix the whole problem without addressing many problems, some that look large and others that are still invisible.
posted by bilabial at 12:39 PM on June 28, 2012 [6 favorites]


"Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so." Interview with Rand Paul, Jun. 28, 2012. But see Marbury v. Madison, 5 U.S. 137 (1803)
posted by Dr. Zira at 12:40 PM on June 28, 2012 [5 favorites]


Strictly speaking, Rand Paul is right. It takes five people, not two.
posted by entropicamericana at 12:44 PM on June 28, 2012 [2 favorites]


One problem, which I'm seeing firsthand is the incredible cost of a medical school education.

Which is why medical school education needs to go to an entirely free model (same for nurses). The government should say "alright, we'll pay for med school at the current median price and we'll increase it in lockstep with inflation." We should be trying to churn out as many qualified, debt-free doctors and nurses as possible in order to drive down prices.

Now, it's possible that some day we might end up with a glut of doctors. I think this is unlikely because of barriers to entry and the large unmet need for medical care. But even if we had a glut, free tuition means that it won't be the same situation as the current glut of lawyers, who come out of law school saddled with horrific debt and no job. The doctors in this scenario would only have the opportunity cost of going to medical school. Plus, their education is much more portable to other countries, as I understand it.

If we end up with such a situation then we can dial things back. But right now we're quite far from that.
posted by jedicus at 12:49 PM on June 28, 2012 [10 favorites]


Here are what I think are some major contributing factors

Providers having to "eat it" on bills that are never going to get paid. This happens A LOT.
An unbelievable amount of staff working in billing and claims. Seriously, you would not believe it, and this is a direct consequence of our private insurance system.
A disconnect between costs and the pain of those costs. Since almost nobody actually writes a check for their care, the price is ultimately concealed in the form of lower pay for workers because more of the available compensation goes to providing health insurance. I submit that this is too indirect to constitute a restraining "market force".
posted by George_Spiggott at 12:51 PM on June 28, 2012 [2 favorites]


TERRORIST FIST JABS FOR ALL!

I think it's fist pumps, actually. You sir are not ready for this it seems! Some friendly advice from a Canadian socialist.

posted by bquarters at 12:51 PM on June 28, 2012


One problem, which I'm seeing firsthand is the incredible cost of a medical school education. You simply cannot pay this debt back without incredible levels of sacrifice or fees for service that look ridiculous on paper.

The primary reason for this is that the AMA is the most powerful union in the country. They limit the supply of doctors to keep doctor income high. They limit the number of medical schools and the number of students in each school. They also restrict the number of foreign doctors to practice in the U.S. There are hundreds of thousands of highly skilled doctors from Asia, Europe and South America, the cream of the crop, the top 1% in the world, who would gladly provide care in the U.S. for a fraction of the salary of American doctors. The AMA has no interest in allowing them to do so.

Big business has no problem allowing foreign engineers to work in the U.S and compete with U.S engineers, but the AMA does not allow this for doctors.
posted by JackFlash at 12:51 PM on June 28, 2012 [5 favorites]


How does this effect those with death wishes, they don't want health care. Now they have to pay anyway.

How does it effect cyborgs, they don't need doctors.

Sorry, but this pretty much sucks. Thanks Obama!
posted by Ad hominem at 12:51 PM on June 28, 2012 [4 favorites]


Two major reasons that US healthcare costs are much higher for worse outcomes than in other countries:
1) In many cases healthcare companies expend money in order to limit access to healthcare. For example, when my ex-boyfriend required a particular sort of medication, he was first denied it -- this took a year -- and then after his doctor found a workaround which required him to go in once a month for a shot (which was actually more expensive than the pills) he was allowed the medication. So let's see what extra costs we've incurred here -- there are the administrative costs of the people who are figuring out under what loophole they can prevent him from getting the medicine, and then there is the extra cost incurred by giving him the shots instead of the pills because of a particular clause in the insurance plan. If we had the entire system working for one simple goal -- the best healthcare possible for the most number of people for the least cost -- he'd have gotten the pills, and probably earlier as well.
2) Insurance companies have no incentive to pay for preventive care under a non-single-payer system. Under a single payer system there is a large incentive to prevent people from getting terribly sick so as to limit costs to the system down the road. But if you can just make the very sick people somebody else's problem (or the government's problem) there is no incentive to ensure that people receive adequate preventive care. That's why Obama's requirement for one free physical every year on every insurance plan is so important. Otherwise the costs are tremendously large when people finally have to receive care, particularly emergency room care.
posted by peacheater at 12:52 PM on June 28, 2012 [2 favorites]


DU: "I don't think it's only conservatives who don't like a huge giveaway to private insurance companies with little in return."

I hear this regularly, but nonprofit health insurers still exist. This despite the best efforts of many people of questionable morals taking a lot of them private in deals that make them tens to hundreds of millions of dollars by undervaluing the nonprofit's assets. Most all of the large private insurers that were formerly not-for-profit were used as get rich schemes by unscrupulous people who gamed their way into the organization, packed the board with sycophants and slow people who let them get away with valuing organizations worth tens to hundreds of millions of dollars for less than a penny on the dollar in some cases.

And people wonder why it is health insurers are particularly corrupt.

If only the big insurers were the only sleazebags in health care.
posted by wierdo at 12:53 PM on June 28, 2012


Health care is not more expensive because the U.S. uses more of it. Health outcomes are equivalent.

For all the people disagreeing with me on the cost structure, it's because you're assuming this right here.

This is not true.

Health outcomes are equivalent. But health care consumption is not. We do a lot more than other countries do, we just don't have as much to show for the excess. Our cancer interventions are, on average, far, far more aggressive than elsewhere. Our outcomes are slightly better. We do a lot more cardiac interventions and orthopedic surgeries. People still get arthritis and die of heart failure. Just in general, we do more tests. We take more images. Some of this is fear of litigation, because they'll get sued if they don't. Some is a perverse incentive, though the disconnect between procedures and payment is such that this is hard to credit for mattering as much as it seems it might. Regardless, we do a lot more things but don't get much out of it.

So yes, it's true that our outcomes are about the same. We're just doing a lot more to get equivalent results. In other words, health care on a per-procedure basis isn't that much more expensive here than in other first world countries, but we do so many more of them that we wind up spending a lot more in total.
posted by valkyryn at 12:56 PM on June 28, 2012 [3 favorites]


They limit the supply of doctors to keep doctor income high. They limit the number of medical schools and the number of students in each school.

I just don't believe this is true.
posted by valkyryn at 12:56 PM on June 28, 2012


2) Insurance companies have no incentive to pay for preventive care under a non-single-payer system.

This isn't going to matter all that much in the long run. Because, to paraphrase the Keynesians, in the long run, we're all going to get old and sick. Preventative care isn't going to stop you from getting heart disease or cancer eventually, it might just put it off for a few years. Most Americans die of one of those two things, and no amount of preventative care is going to change that.

Preventative care might shave some things off around the edges, but it's not going to put a dent in the real drivers of health care expenditure: heart disease, cancer, stroke, and dementia. Things that you're almost 100% likely to get at least one of by the time you're 90, even if it hasn't killed you by then.
posted by valkyryn at 1:01 PM on June 28, 2012


How does it effect cyborgs, they don't need doctors.

Cyborgs need doctors more than most, rejection is a huge problem. Plus health care didn't include 'routine maintenance' like oil changes until the AHA. Thanks Robama!
posted by Garm at 1:02 PM on June 28, 2012 [7 favorites]


Strictly speaking, Rand Paul is right. It takes five people, not two.

Either that, or I'd like to know which three Rand Paul doesn't consider 'people'...
posted by Mad_Carew at 1:02 PM on June 28, 2012 [2 favorites]


> TERRORIST FIST JABS FOR ALL!

I think it's fist pumps, actually. You sir are not ready for this it seems! Some friendly advice from a Canadian socialist.


"Terrorist fist jab" was the term that ex-Fox host E. D. Hill used. Her show was cancelled almost immediately, so the net effect of the incident was to give one hope for the world.
posted by George_Spiggott at 1:02 PM on June 28, 2012


You sure?
posted by triggerfinger at 1:03 PM on June 28, 2012


(Darn it, meant only to link the phrase.)
posted by George_Spiggott at 1:03 PM on June 28, 2012


SCOTUSBlog (and others) on Kaiser Health News roundtable going on now.
posted by zombieflanders at 1:03 PM on June 28, 2012


TERRORIST FIST JABS FOR ALL!

I think it's fist pumps, actually. You sir are not ready for this it seems! Some friendly advice from a Canadian socialist.


Ahem. Terrorist Fist Jab.
posted by Ironmouth at 1:06 PM on June 28, 2012


Thanks for the concern there.

Daily Kos: A dark cloud on this sunny day

Slate: Roberts wins the war
posted by Apocryphon at 1:06 PM on June 28, 2012


... health care on a per-procedure basis isn't that much more expensive here than in other first world countries ...

You keep saying this but it is simply not true.

Just as an example, the U.S. pays five times as much for a routine office visit, five times as much for a CT scan procedure, and five times as much for prescription drugs as other developed countries.

The overuse excuse is just a phony conservative talking point to justify cutting care benefits. End of life expenses may be small part of the problem, but the root is still the fact that the U.S. pays exorbitantly high fees for each procedure or service compared to the rest of the world.
posted by JackFlash at 1:06 PM on June 28, 2012 [9 favorites]


You could knock me over with a feather. My pessimism has not been so completely proven wrong since the 2004 ALCS, to continue the baseball analogy.

This was perfect, but it is a move in the correct direction. Or, rather, the elimination of the last major roadblock in that direction. Let's get him reelected and push for something even better.

Also, you folks in states with teabag wielding Republican representatives? Do whatever you can to get them replaced.
posted by Joey Michaels at 1:07 PM on June 28, 2012


Insurance companies have no incentive to pay for preventive care under a non-single-payer system.

Huh? Of course they do, they don't want to pay for your sick ass down the road. My (employer-based) insurance company offers free or almost-free preventative care. They would much rather pay for my CPAP than pay for my heart attack.
posted by desjardins at 1:07 PM on June 28, 2012 [1 favorite]


I just don't believe this is true.

It's not. Congress controls the budget for residencies, which determines class sizes and the numbers of accredited med schools. This budget was slashed in 1997 at the urging of the AMA, which claimed there was an impending doctor glut, and the AMA still won't own up to there being a shortage.
posted by Slap*Happy at 1:07 PM on June 28, 2012 [3 favorites]


Preventative care isn't going to stop you from getting heart disease or cancer eventually, it might just put it off for a few years.

This would be the entire purpose of health care. To prolong life and increase its quality while doing so.
posted by Ironmouth at 1:08 PM on June 28, 2012 [27 favorites]


In other words, health care on a per-procedure basis isn't that much more expensive here than in other first world countries, but we do so many more of them that we wind up spending a lot more in total.

Nope, also false. We pay vastly more per-procedure. For example, an appendectomy in the US costs $12k - $26k. In Canada it's ~$2500. In France $2700. In Germany $2500. Netherlands $2700. UK $2600. Spain $3000. See here for the full report [pdf].
posted by jedicus at 1:08 PM on June 28, 2012 [23 favorites]


Of course they do, they don't want to pay for your sick ass down the road.

They probably won't, because by that point, the employee will probably be working for another company, or his employer will have switched to a different health care plan.
posted by deanc at 1:09 PM on June 28, 2012


"As president, Mitt will nominate judges in the mold of Chief Justice Roberts" -- MittRomney.com
posted by schmod at 1:11 PM on June 28, 2012 [37 favorites]


Huh? Of course they do, they don't want to pay for your sick ass down the road. My (employer-based) insurance company offers free or almost-free preventative care. They would much rather pay for my CPAP than pay for my heart attack.
If the assumption is that you'll be staying with the company for the long-run then the insurance companies do have an incentive. But for example, my student health insurance offered no physicals every year until Obamacare was passed. Here the assumption is that I will graduate and then become someone else's problem. Under a single payer health care system, it is always that single payer's problem. I guess I should reword -- in many cases, insurance companies have no incentive to pay for preventative care, particularly in situations where the assumption is that you will be moving on to a different insurance company eventually (which is often the case).
posted by peacheater at 1:12 PM on June 28, 2012


"Of course they do, they don't want to pay for your sick ass down the road."

The plan was to never pay for it anyway.

Pre ACA there were entire departments in insurers looking for inconsistencies and omissions from your medical history so that at the time when you require insurance they can shout 'PRE EXISTING CONDITION!' and cancel your coverage. Thanks for those years of payments though.
posted by PenDevil at 1:14 PM on June 28, 2012 [5 favorites]


Huh? Of course they do, they don't want to pay for your sick ass down the road. My (employer-based) insurance company offers free or almost-free preventative care. They would much rather pay for my CPAP than pay for my heart attack.

My expensive insurance does not currently offer free preventative care. My mother, who is on the same plan in a different state, was told that her thyroid-replacement-hormones were not necessary and therefore would not be covered. She no longer has a thyroid. They are a daily necessity. They're covered now, but trust me, your plan may be closer to singular in that than you think.
posted by jetlagaddict at 1:16 PM on June 28, 2012 [1 favorite]


I'm convinced this was Roberts inverse Pyro moment, due to some sort medication misapplication. While he thought he was laying down repub hate fire and death, he was actually handing out lollipops and gumdrops. Serendipitous.
posted by Purposeful Grimace at 1:21 PM on June 28, 2012 [1 favorite]


Preventative care isn't going to stop you from getting heart disease or cancer eventually, it might just put it off for a few years. ...

Medicine has not yet cured death, therefore it should be abandoned. Got it
posted by crayz at 1:24 PM on June 28, 2012 [4 favorites]


Preventative care isn't going to stop you from getting heart disease or cancer eventually, it might just put it off for a few years.

DID YOU KNOW THAT THE ENTIRE CONCEPT OF MEDICINE IS A SCAM
posted by Sticherbeast at 1:27 PM on June 28, 2012 [5 favorites]


Nope, also false. We pay vastly more per-procedure. For example, an appendectomy in the US costs $12k - $26k. In Canada it's ~$2500. In France $2700. In Germany $2500. Netherlands $2700. UK $2600. Spain $3000. See here for the full report [pdf].

I'd need to see the methodology behind those numbers before I'd be willing to take them at face value.

I mean, have you read a health care bill recently? There's like four different "prices" on there. There's the retail price, but no one actually pays that. There's the amount the health insurance company has paid, which is usually less than half of that. There's the amount that they say you owe, which could be anything, really. Then there's the amount you'll actually wind up paying, which could be anything from the full amount to nothing.

So yeah, if you just look at US retail prices, they're gonna be drastically higher than anywhere else. That's because no one actually pays those prices.

Further, there's no way of telling if any of that is an apples-to-apples comparison anyway. They could actually support my theory. For instance, take the "appendectomy" item. How many days are you staying in the hospital afterward? One? More? None? I dunno, and looking at that data, no one else does either.

But on an even more granular level, medical device patents are an enormous driver of costs, but people gotta have the latest and best. So we do the same procedures other countries do with more expensive equipment where the extra cost is entirely accounted for with patent rents and advertising budgets. So again, even on a procedure basis, we're using more health care than other countries, even if there's no real difference in outcome.

That's what I'm getting at. You can't just say "Hey, this procedure costs X here but Y there, therefore they have lower health care costs than we do on a per-unit basis." If we're using last year's machine and they're using last decade's, the outcome is likely to be almost the same, but ours is going to cost a buttload more. You think Turkey has the latest and greatest MRI machines? I certainly don't. But I'm confident that their machines are almost as good as ours in any way that matters. So of course it's going to cost more here. We're paying an enormous premium for a slight advantage.
posted by valkyryn at 1:30 PM on June 28, 2012 [2 favorites]


Well, if I'm going to get heart disease or cancer anyway, screw this preventative shit. I'm going back to smoking, drinking whiskey and snarfing chocolate cake.
posted by desjardins at 1:31 PM on June 28, 2012 [3 favorites]


valkyryn: I'd need to see the methodology behind those numbers before I'd be willing to take them at face value.

As opposed to your numbers, which...?
posted by gilrain at 1:34 PM on June 28, 2012 [18 favorites]


Further, there's no way of telling if any of that is an apples-to-apples comparison anyway.

Then I don't understand how you can say: In other words, health care on a per-procedure basis isn't that much more expensive here than in other first world countries,

I mean, if you disagree that there's an apples-to-apples comparison being made by those refuting your position, what are you basing your position on?
posted by rtha at 1:35 PM on June 28, 2012 [5 favorites]


I'm going back to smoking, drinking whiskey and snarfing chocolate cake.

Never stopped. I've got my San Pellegrino Limonata and gin ready to go for 5 o'clock but tonight I may go with whiskey to celebrate Obama's victory.
posted by Ad hominem at 1:35 PM on June 28, 2012


I just don't believe this is true.

Google "dermatologist shortage".
posted by elsietheeel at 1:36 PM on June 28, 2012


Did anyone catch whether anything happened in connection with the Militia Act of 1792 or the 1790/1798 laws requiring insurance for seamen? Those seemed kinda relevant but I got the impression that they weren't even mentioned in arguments to the court.
posted by XMLicious at 1:36 PM on June 28, 2012


If your current expensive insurance doesn't pay for preventative care, the company is foolish and probably worried more about profits than cost-per-insured-member (and probably not worried about costs in the same way that all insurance companies who wish to be a part of the consumer health exchange will need to be); pushing the industry to a more wellness-based model is one of the bigger-yet-not-really-publicized 'wins' of the health care reform known as Obamacare.

(if you define 'win' as 'actually making people healthier' or 'taking care of the customer')
posted by MCMikeNamara at 1:36 PM on June 28, 2012


Relax guys, valkyryn is just doing epic bong rips and basing his posts on the lyrics of "Do You Realize??"
posted by theodolite at 1:37 PM on June 28, 2012 [3 favorites]


Wait, I can get my semen insured?
posted by zombieflanders at 1:39 PM on June 28, 2012 [1 favorite]


I'd need to see the methodology behind those numbers before I'd be willing to take them at face value.

The methodology is explained in the report. They also correlate with the figures that my father (an ER doctor) gave for such procedures. And by 'figures' I mean the actual amount of money that ends up in accounts receivable at the end of the day.

They could actually support my theory. For instance, take the "appendectomy" item. How many days are you staying in the hospital afterward? One? More? None? I dunno, and looking at that data, no one else does either.

Okay, then just look at the procedures that don't involve a hospital stay (e.g. imaging and office visits). Or, if you're concerned about hospital stays driving up the numbers, then look at the cost per hospital day and per hospital stay. It's all more expensive, vastly so.

You think Turkey has the latest and greatest MRI machines? I certainly don't.

That's why I purposely gave the figures for rich European countries.
posted by jedicus at 1:44 PM on June 28, 2012 [10 favorites]


(Emphasis mine in both excerpts.)

Here's the one part that absolutely amazes me:
The Anti-Injunction Act provides that “no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person,” 26 U. S. C. §7421(a), so that those subject to a tax must first pay it and then sue for a refund. The present challenge seeks to restrain the collection of the shared responsibility payment from those who do not comply with the individual mandate. But 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.” That label cannot control whether the payment is a tax for purposes of the Constitution, but it does determine the application of the Anti-Injunction Act. The Anti-Injunction Act therefore does not bar this suit.
I'm surprised that this worked. Roberts is saying that Congress can't call a tax a "penalty" in order to fool the Constituion, but they can call it a penalty in order to fool themselves.
Amicus argues that even though Congress did not label the shared responsibility payment a tax, we should treat it as such under the Anti-Injunction Act because it functions like a tax. It is true that Congress cannot change whether an exaction is a tax or a penalty for constitutional purposes simply by describing it as one or the other. Congress may not, for example, expand its power under the Taxing Clause, or escape the Double Jeopardy Clause’s constraint on criminal sanctions, by labeling a severe financial punishment a “tax.” [...] The Anti-Injunction Act and the Affordable Care Act, however, are creatures of Congress’s own creation. How they relate to each other is up to Congress, and the best evidence of Congress’s intent is the statutory text. We have thus applied the Anti-Injunction Act to statutorily described “taxes” even where that label was inaccurate. See Bailey v. George, 259 U. S. 16 (1922) (Anti-Injunction Act applies to “Child Labor Tax” struck down as exceeding Congress’s taxing power in Drexel Furniture).
He also says that the ACA creates other things that it calls taxes, but it still refers to the mandate as a "penalty," and the Court can only assume that was intentional. Of course, that's remarkably charitable to say about a Congress that forgot to give the law a fucking severability clause (which would've torpedoed the whole law had Roberts not been on the liberal side).

So, yes, what muddgirl and shivohum say is correct. We're not going to have a legal challenge of the tax in 2014 because the Court says that the relevant law doesn't apply.

Implementing the mandate as a tax but calling it a penalty — likely done so that they could avoid GOP anti-tax rhetoric — had a magical, slapstick effect that accidentally guaranteed its affirmation by the Supreme Court and magically precluded any future challenges.

Just one more example of Democrats doing the right thing by complete fucking accident.
posted by savetheclocktower at 1:44 PM on June 28, 2012 [24 favorites]


Perhaps you'll set your sights higher next time and find a politician with the political guts to at least try for Single-Payer.

Because that would have passed the Senate without any problem at all.
posted by one more dead town's last parade at 1:49 PM on June 28, 2012 [2 favorites]


Google "dermatologist shortage".

Jesus H. Christ did it suck to be melanoma-prone and living in rural Delaware. 50 mile round trip for a mole check, and I was lucky to find anybody that close taking new patients.
posted by Holy Zarquon's Singing Fish at 1:50 PM on June 28, 2012


which would've torpedoed the whole law had Roberts not been on the liberal side

That's not necessarily how severability or severability clauses work, especially as far as the Supreme Court is concerned.
posted by Sticherbeast at 1:50 PM on June 28, 2012


End of life expenses may be small part of the problem, but the root is still the fact that the U.S. pays exorbitantly high fees for each procedure or service compared to the rest of the world.

End of life expenses are a huge part of the problem.
From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages. Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures.
(emphasis added)

Americans are less calm about dying than most of the rest of the world, so we're willing to throw billions and billions of dollars at one more year of life at the end.
posted by Etrigan at 1:50 PM on June 28, 2012 [6 favorites]


Just one more example of Democrats doing the right thing by complete fucking accident.

Or, to borrow from Community, they totally Biden'd it.
posted by zombieflanders at 1:51 PM on June 28, 2012 [11 favorites]


That's not necessarily how severability or severability clauses work, especially as far as the Supreme Court is concerned.

Not in general, but the four justices on the conservative side here did in fact write a dissenting opinion to strike down the entire law because the mandate was non-severable.
posted by Holy Zarquon's Singing Fish at 1:52 PM on June 28, 2012


Could someone explain: Under the ACA are all employers with more than 50 workers required to offer a health-care plan for *all* workers, whether part- or full-time.

I work for an educational institution with more than 50 full-timers and many hundreds of “part time” workers. As far as I know most of the part-timers on campus, from foodworkers to instructors to misc. professional staff like my dept. (whose hours often range up to 39/week!) don’t have employer healthcare benefits.

Based on previous behavior (the stories I could tell about other illegal actions), I’m sure the administration would drag its heels and look for loopholes before offering health benefit options. But I’d be curious what the standing *should* be.
posted by NorthernLite at 1:52 PM on June 28, 2012 [1 favorite]


So yeah, if you just look at US retail prices, they're gonna be drastically higher than anywhere else. That's because no one actually pays those prices.

Unless you have no insurance. I'm completely serious. The sticker price is what people without insurance are charged.

You are seeing different prices because YOU HAVE INSURANCE. Your group plan has negotiated a lower price per procedure (and for other charges).
posted by jeanmari at 1:54 PM on June 28, 2012 [21 favorites]


> That's not necessarily how severability or severability clauses work, especially as far as the Supreme Court is concerned.

I said that because all four of the dissenters say they would've struck the whole law down. But, yes, whether the whole thing was severable would likely have fallen to Roberts to decide, and it's not clear which way he would have gone.
posted by savetheclocktower at 1:55 PM on June 28, 2012


http://twitter.com/BenjySarlin/status/218447263750565888
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 1:57 PM on June 28, 2012 [1 favorite]


There's a really good "Explain It Like I'm Five" post on the ACA on Reddit.
posted by jason_steakums at 2:00 PM on June 28, 2012 [10 favorites]


I mean, have you read a health care bill recently? There's like four different "prices" on there. There's the retail price, but no one actually pays that. There's the amount the health insurance company has paid, which is usually less than half of that. There's the amount that they say you owe, which could be anything, really. Then there's the amount you'll actually wind up paying, which could be anything from the full amount to nothing.

So yeah, if you just look at US retail prices, they're gonna be drastically higher than anywhere else. That's because no one actually pays those prices.


...and I was going to respond, but jeanmari did first, with...

Unless you have no insurance. I'm completely serious. The sticker price is what people without insurance are charged.

You are seeing different prices because YOU HAVE INSURANCE. Your group plan has negotiated a lower price per procedure (and for other charges).


And now I can say, yes, what jeanmari said, exactly. I have great insurance and just received a bill for lab services related to surgery recently completed. The bill itself ("US retail prices", presumably) was a smidge over $1,100. The "Insurance Discount" (that's the phrase on the bill) was over $900. My total outlay was $24. If I did not have insurance, how exactly would I have been able to get them to lower their price from $1,100+ to the few hundred dollars the insurance company and I actually paid?
posted by davejay at 2:02 PM on June 28, 2012 [1 favorite]


"...laws requiring insurance for seamen?"

Jesus, now life begins before conception? When will this madness end?



Oh, seamen. Never mind.
posted by mr_crash_davis at 2:02 PM on June 28, 2012 [1 favorite]


Reaction to ruling, in text-based adventure format.
posted by UrineSoakedRube at 2:04 PM on June 28, 2012 [6 favorites]


The Affordable Care Act works to close the Medicare Part D prescription drug coverage gap

Nothing comes without compromise: "In addition, the Affordable Care Act cut Medicare reimbursement for laboratory services by an additional 19% over the next 10 years.” That "in addition" refers to a 40% cut in lab reimbursements enacted for 2012.

I am on Medicare, and because of lab fees, my total out-of-pocket medical expenses halfway through 2012 are already over what I paid for the entirety of 2010. The reason I don't yet count 2011 one way or the other is because my implanted defibrillator was replaced last year and Medicare has not decided yet whether or not they will pay for that.
posted by Ardiril at 2:05 PM on June 28, 2012 [2 favorites]


Mike Pence likens health care ruling to 9/11
posted by octothorpe at 2:07 PM on June 28, 2012 [1 favorite]


Unless you have no insurance. I'm completely serious. The sticker price is what people without insurance are charged.

Well, yes and no. The uninsured can sometimes negotiate a 'cash discount.' The sticker price is set artificially high for reasons related to the doctor/clinic/hospital's negotiations with insurance companies.
posted by jedicus at 2:07 PM on June 28, 2012 [1 favorite]


End of life expenses are a huge part of the problem

Well of course end of life expenses are high. Because near the end of life is when you are most likely sick.

But consider the fact that you could cut those expenses to one-half or one-third if we simply paid the lower cost for each service that every other developed country in the world spends.

Again, it isn't the amount of care. For what we spend now, we could have two to three times as much care if we didn't pay such exorbitant prices. We could give out free gold plated enemas. We could have rolling vans on the streets like ice cream trucks looking for MRI customers.

Alternatively we could have exactly the same amount of care as we do now for one-half to one-third the cost and have 100% health care coverage while at the same time a balanced budget for the next century.

The canard about end of life costs is a conservative talking point (just like the bankruptcy of Social Security) that they have successfully gotten liberals to parrot. It not the amount of care, its the expensive price we pay for that care.
posted by JackFlash at 2:09 PM on June 28, 2012 [4 favorites]


Mike Pence likens health care ruling to 9/11

This ruling will surely lead to thousands more people receiving affordable life-saving healthcare. It's more like an inverse 9/11.

11/9
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 2:09 PM on June 28, 2012 [3 favorites]


There's a really good "Explain It Like I'm Five" post on the ACA on Reddit.
Counterpoint: DEATH PANELS
posted by Flunkie at 2:12 PM on June 28, 2012 [2 favorites]


Well, yes and no. The uninsured can sometimes negotiate a 'cash discount.' The sticker price is set artificially high for reasons related to the doctor/clinic/hospital's negotiations with insurance companies.

I only know I can do this because I read Metafilter. I mean, it certainly doesn't say at the bottom of the bill "call us to negotiate a lower rate." I wonder how many people struggle but manage to pay what the bill says because every other bill you get in the mail works that way, not knowing they could be paying less.
posted by misskaz at 2:13 PM on June 28, 2012 [3 favorites]


valkyryn, it kind of sounds like you're trying to have it both ways here. If nominal prices (what you're calling "retail") are over-inflated because insurance companies have negotiated discounts, then surely, a dramatic increase in the percentage of population having insurance will reduce, if not effectively eliminate, this nominal price inflation.

If, on the other hand, U.S. healthcare costs relative to costs elsewhere are higher for reasons not having to do with nominal price inflation, then it's simply not the case that health care is equally as expensive everywhere, and there are at least in theory things we could do to "bend the cost curve", which is something you dismiss as a myth.
posted by gauche at 2:14 PM on June 28, 2012


And here come the conspiracies... Some right wing blogs suggesting that Obama threatened Robert's family.
posted by drezdn at 2:18 PM on June 28, 2012


it certainly doesn't say at the bottom of the bill "call us to negotiate a lower rate."

That is why you negotiate the rates before the procedure, not after.
posted by Ardiril at 2:18 PM on June 28, 2012


And here come the conspiracies... Some right wing blogs suggesting that Obama threatened Robert's family.
Links, please? Thanks.
posted by Flunkie at 2:20 PM on June 28, 2012


Wonkette has all your wingnut conspiracy theory needs, as usual.
posted by no regrets, coyote at 2:22 PM on June 28, 2012 [2 favorites]


The uninsured can sometimes negotiate a 'cash discount.'

This, of course, depends on a few variables:

1) whether or not the health care provider allows for this (some do, some don't)
2) the patient has to have the knowledge of being able to do this, as well as the time to do it (negotiating these things with a hospital after an ER visit is not as easy as you are making it sound generally), and the patience and the health (hey!) to tackle all of the paperwork, phone calls, etc.
3) you have to have enough cash on hand to pay the portion that the provider is requiring, unless they will accept a payment plan (dependent upon provider, your credit history, etc.)

Is there some price inflation to push up the benefits providers can negotiate with insurers a bit? Likely in many cases. So that is also something that needs to be addressed.

But saying, "Let them pay cash! They'll get a discount!" is not a reflection of the real situation.
posted by jeanmari at 2:22 PM on June 28, 2012 [5 favorites]


Some right wing blogs suggesting that Obama threatened Robert's family.

...with good health and long life!

Seriously, though. "Some right wing blogs" is right up there with "crazy guy in a dumpster". Anything you can imagine and plenty you wouldn't, they will say. Now if Limbaugh said it, then there's a chance that, say, the Missouri state legislature will give it credence and maybe it's worth mentioning. Otherwise? Pffffft, whatevs.
posted by George_Spiggott at 2:22 PM on June 28, 2012 [2 favorites]


I only know I can do this because I read Metafilter. I mean, it certainly doesn't say at the bottom of the bill "call us to negotiate a lower rate." I wonder how many people struggle but manage to pay what the bill says because every other bill you get in the mail works that way, not knowing they could be paying less.

Well, if you call up the hospital and explain that you have no insurance they'll probably tell you. This may depend on what part o the country you're in, but in California most providers seem to offer a sliding scale for the uninsured. I'm not sure what the point of the high sticker price is, probably for tax reasons.
posted by anigbrowl at 2:24 PM on June 28, 2012


The only reason I can come up with for Roberts supporting this is that he didn't want people to have a reason to take power away from the Supreme Court.

I think it was more that he didn't want to go down in history as, "the Chief Justice who was a tool of right wing hacks." His whole shtick depends on his ability to portray himself as the "impartial arbiter of the law," and casting his lot with Scalia and Thomas would have ruined that image for future generations.

Plus, he was not nominated for "Constitutional minimalism." He was nominated based on his likelihood of siding with the government in War on Terror cases.
posted by deanc at 2:26 PM on June 28, 2012 [2 favorites]


I'm going back to smoking...

Oh no your not, our insurance will go up by $200+ month, and I was planning on keeping you around for a while.
posted by empty vessel at 2:29 PM on June 28, 2012 [6 favorites]


The canard about end of life costs is a conservative talking point (just like the bankruptcy of Social Security) that they have successfully gotten liberals to parrot. It not the amount of care, its the expensive price we pay for that care.

Palliative care costs tremendously less than keeping someone alive and barely cognizant hooked up to machines. If someone offers you a Honda Civic for $30K or a Porsche 911 for $150K, and all you really needed the car for was going to your parents' house on the weekends, you'd be a fool to buy the Porsche. If someone else were to offer you the Porsche for $75K (much closer to the sticker price), you'd still be a fool to buy it, even though the Civic was double sticker as well.

Yes, costs are too high because the health-care market is broken. But that doesn't mean there aren't other reasons that we spend too much money.
posted by Etrigan at 2:30 PM on June 28, 2012 [2 favorites]


I find this pretty hilarious:

Shortly afterward, heading to a hastily called Democratic caucus meeting to discuss the decision, Pelosi ran into a longtime friend, Rep. George Miller (D-Martinez), and they hugged, according to an aide.

“What a great victory!” Pelosi said.

“You bet your ass,” Miller responded.

“I did,” she said, as they laughed.

posted by MCMikeNamara at 2:36 PM on June 28, 2012 [7 favorites]


Last year I found myself uninsured for the first time in a decade or more. My Cobra insurance had expired just days before I needed emergency surgery. I freaked out at the urgent care center and told them that there was NO WAY I could afford surgery. The kind nurse told me that I needed to get to the ER NOW. Through my gasping tears she told me that the minute that I get the hospital bill in the mail I was to call the hospital's billing department and explain my situation. Billing department sent me a form and I answered questions about my income and lack thereof. I ended up not having to pay one penny for a $22k hospital bill. I may not have had to pay but somebody did. You guys paid. Thanks guys. Everyone's policy goes up because of people like me. That is why it is fucking awesome that we all have the chance to get insurance. My story is also just one of thousands and thousands why it doesn't matter if you think you are healthy; unexpected shit happens all the time.
posted by futz at 2:36 PM on June 28, 2012 [39 favorites]


2,000 a year is also currently /more/ than I pay for my family's healthcare.

Until it isn't. At which point I'll be picking up your bill. Or you'll be left dying in the street, which I consider a morally unacceptable outcome for The Best Country In The World™.

I didn't have any pre-existing conditions, and then I did, and people I know have them, too. So as you can imagine, I'm ready to man a barricade against anyone who's going to take health insurance away from my friends and me. And I think that Roberts realized that, too, while at the same time no one is going to die on the hill of not buying health insurance, especially when the interest groups opposing it are either insured or on Medicare.

In short, there was no interest group being harmed by the mandate. Opponents found a few straw clients to fight it, but for the most part, those who would be mandated to buy insurance and didn't otherwise have it were those who supported the law. Those opposing the law were upset at the idea that having insurance no longer "distinguished" them from the unwashed masses, anymore.

Roberts pretty much figured that the best way to split the baby was just to accept the mandate, since no anti-ACA interest group was being harmed by the existence of the mandate, and it was the pro-ACA interest groups who were the ones affected by it.
posted by deanc at 2:38 PM on June 28, 2012 [4 favorites]


There's a lot of pissed-off amateur Constitutional scholars out there right now.

And a lot of vindicated professional Constitutional scholars.
posted by gauche at 9:53 AM on June 28


I'm not so sure of this. I do not recall anyone saying that they anticipated the result that occurred and that it was the appropriate constitutional resolution. Did you have someone in mind? If there are a lot of them, then I'm surprised I missed the ones who called this correctly.

I assume if you look at it from the simply binary view of "ACA upheld" v. "ACA Struck Down", then maybe that is the case. But real constitutional scholars and court-watchers are smart enough to not view the situation that way.

The overwhelming majority of scholarly constitutional treatment of these cases focused on commerce clause jurisprudence. There was vanishingly little treatment of the prevailing tax issue other than in the context of claiming it should be completely upheld or struck down on very theory including the the tax issue. I doubt you would find any scholars who argued that the ACA would be upheld solely on the taxing issue but is otherwise unconstitutional under the commerce clause and necessary and proper clause. And I likewise doubt you find any scholar who thinks "I told you so" if they were wrong on what grounds it was upheld. So I think your point is faulty, absent evidence to the contrary of the lot of scholars.
posted by dios at 2:41 PM on June 28, 2012 [1 favorite]


I (broccoli) C.J. Roberts
posted by Xalf at 2:46 PM on June 28, 2012 [1 favorite]


That is why you negotiate the rates before the procedure, not after.

So we're supposed to haggle while we're being brought into the emergency room?
posted by ook at 2:46 PM on June 28, 2012 [3 favorites]


I didn't specifically have anybody in mind, but Jack Balkin definitely called it.
posted by gauche at 2:47 PM on June 28, 2012 [4 favorites]


I'm not sure what the point of the high sticker price is, probably for tax reasons.

My understanding is that the high sticker price is because doctors can't charge someone more than they charge medicare. So if you have medicare, the procedure is listed at $2k, you can't then charge a cash customer $5k for the same thing (although you can 'discount' the list price for any number of reasons, including it being medicare). That's one reason for the high list prices, it's like the msrp on a car lot. Only suckers pay that.

An accountant friend of mine says the medical offices he's worked with routinely write off 70-80% of their list prices, and only get full payment once or twice a year from well-to-do cash customers.
posted by gofargogo at 2:48 PM on June 28, 2012 [1 favorite]


This, of course, depends on a few variables: ...

That's why I said 'sometimes.'

But saying, "Let them pay cash! They'll get a discount!" is not a reflection of the real situation.

I said no such thing and disagree strongly with the invented statement. My point was only that the statement "The sticker price is what people without insurance are charged" is not completely accurate.
posted by jedicus at 2:51 PM on June 28, 2012


doctors can't charge someone more than they charge medicare

I think you've got that backwards. My understanding is they can't bill someone less than they bill Medicare for a procedure. So they bill everybody a massive amount per procedure, but then the insurance companies tell them that they will only pay $.10 on the dollar or whatever.

That's the theory, anyway.
posted by gauche at 2:53 PM on June 28, 2012


valkyryn: " I mean, have you read a health care bill recently? There's like four different "prices" on there. There's the retail price, but no one actually pays that. There's the amount the health insurance company has paid, which is usually less than half of that. There's the amount that they say you owe, which could be anything, really. Then there's the amount you'll actually wind up paying, which could be anything from the full amount to nothing. "

The original report says that the numbers recorded are what providers are paid by governments or other insurers, not what the patient pays, which would invalidate that whole retail-vs.-paid-prices thing. Here are more visual representations of the costs.

Moreover, this is a report from The International Federation of Health Plans, which to my untrained eye certainly seems more objective than anything you'll get from any news media right now.
posted by Phire at 2:53 PM on June 28, 2012 [1 favorite]


So we're supposed to haggle while we're being brought into the emergency room?

If you are are able. Every time I go to the ER (and with my heart, that is quite often), I ask what is not covered by Medicare and my insurance, whether those procedures are optional, and whatever other questions, including those of a financial nature, that I feel are important.
posted by Ardiril at 2:57 PM on June 28, 2012


I didn't specifically have anybody in mind, but Jack Balkin definitely called it.

Wow, he pretty much did:

Chief Justice Roberts, and especially Justice Anthony Kennedy, seemed to worry whether there will be any limiting principle if they uphold the mandate on Commerce Clause grounds. . . . At the same time, both Roberts and Kennedy are no doubt aware of the political meaning of a 5-4 vote along party lines that gives Republicans what they could not get through the democratic political process. That concern, and the long history of deference to Congress on economic legislation, give the justices strong reasons to uphold the act. . . . if Roberts and Kennedy want a easy path out of their current quandary, the tax power argument, which has gotten so little attention to this point, may get a lot more attention in the future.
posted by brain_drain at 2:57 PM on June 28, 2012 [1 favorite]


Ah thanks Gauche! You are likely right, it was a hazily remembered conversation from last week....
posted by gofargogo at 2:57 PM on June 28, 2012


... and if you are unable, that is why establishing medical power of attorney is such a wise precaution.
posted by Ardiril at 3:02 PM on June 28, 2012


Also, this image sums up my thoughts succinctly about the GOP reaction to this.
posted by Phire at 3:08 PM on June 28, 2012 [2 favorites]


Balkin did call it in that article. I recall other articles from him talking about why it should be upheld under the commerce clause as well, which is why I mentioned that most of them seemed to say it can be upheld under each theory. I don't recall anyone saying "this is clearly not allowed under the commerce clause but is ok under the taxing party"--that is a very unique position that I've only seen John Roberts take.

But Balkin's article there was prescient in many regards, so cheers to him for that one. I bet he was surprised by the Commerce Clause ruling though.
posted by dios at 3:11 PM on June 28, 2012


That image would be just as valid if labelled "Liberals".
posted by Ardiril at 3:11 PM on June 28, 2012


Gosh, if I ever lack insurance and get in an accident, I will make sure that my husband is fully aware that he should negotiate the cost of my ER trip before they put me in the ambulance. Maybe call around and get the best rate.
posted by muddgirl at 3:13 PM on June 28, 2012 [12 favorites]


One thing seems clear to me: what our political debates need are more self-satisfied people saying self-satisfiedly that both sides are exactly the same.
posted by glhaynes at 3:14 PM on June 28, 2012 [6 favorites]


(Note that I don't have a problem with the fact that some people can negotiate a lower price for health care - my problem is that we are expected to negotiate a lower price for health care. This is so atypical for any product or service in the US economy - even a major car dealership advertises the fact that you don't have to negotiate for cars. Because Americans aren't raised to do so.)
posted by muddgirl at 3:16 PM on June 28, 2012 [2 favorites]


Know Your Crew: Supreme Court or Wu Tang Clan?
posted by Artw at 3:18 PM on June 28, 2012 [1 favorite]


We'll be seeing your grandparents soon, America!

Actually, under Romney it will be AMERCIA!
posted by ericb at 3:18 PM on June 28, 2012 [1 favorite]


That image would be just as valid if labelled "Liberals" is what conservatives tell themselves to avoid facing reality.
posted by Aquaman at 3:18 PM on June 28, 2012 [2 favorites]


I don't recall anyone saying "this is clearly not allowed under the commerce clause but is ok under the taxing party"--that is a very unique position that I've only seen John Roberts take.

I think the government's lawyers have been revealed as a pretty savvy bunch.

Back when the arguments were being made, many commenters (iirc), criticized the shotgun approach the lawyers followed to defend the law (first CC, then N&S, then taxing authority). But they didn't need five votes for any particular argument. They just needed five votes in favor of upholding the law.

Idealists can worry about constitutional implications of this or that; realists get things done.
posted by notyou at 3:24 PM on June 28, 2012 [1 favorite]


Healthcare Reform: Why today’s Supreme Court ruling is great news for startups
posted by Artw at 3:27 PM on June 28, 2012 [2 favorites]


This is so atypical for any product or service in the US economy - even a major car dealership advertises the fact that you don't have to negotiate for cars. Because Americans aren't raised to do so.

Speaking as a European, it seems to me that Americans haggle all the time, and that this is entirely typical for anything other than a big-box store or supermarket. If you've ever been int he business of selling stuff, people ask for discounts all the time. Really, I'd say I learned to haggle from being in the US.

Not that I think it's great for healthcare, since between stress, lack of medical expertise and other factors, it's much less practical and efficient than it is for consumer goods.
posted by anigbrowl at 3:28 PM on June 28, 2012


Commenters might have. I can't see why lawyers would. It's standard argument tactic - "My opponents say A, but they're wrong because X. And even if A is true, they're still wrong because you have to consider Y. If the court finds that Y doesn't hold, Z controls anyway." And so on up to AE at the least.
posted by Holy Zarquon's Singing Fish at 3:29 PM on June 28, 2012 [1 favorite]


I couldn't see it linked yet, so here is Ryan Gosling on the news.
posted by jacalata at 3:29 PM on June 28, 2012 [3 favorites]


DID YOU KNOW THAT THE ENTIRE CONCEPT OF MEDICINE IS A SCAM?

So very true. All one needs to rely on is PRAYER!
posted by ericb at 3:36 PM on June 28, 2012 [3 favorites]


Again speaking from experience, ambulance drivers generally do ask which hospital you want. If I were still in Atlanta, the last place I would want to go is Grady.

[ That image would be most accurate if simply titled: Americans ]
posted by Ardiril at 3:42 PM on June 28, 2012 [1 favorite]


Speaking as a European, it seems to me that Americans haggle all the time

(Speaking as an American), I haggled when I bought my car (and I was pretty uncomfortable with it but it was expected). I suppose people haggle over house prices. Literally every other time I've asked for a discount in my personal life, I've been turned down. I've been offered payment plans, but those aren't the same thing. Am I missing out on a whole world of lower prices somehow? Is this a regional thing?

and that this is entirely typical for anything other than a big-box store or supermarket

Isn't a hospital more like a big box store than a small business (which might be more willing to haggle?)
posted by muddgirl at 3:42 PM on June 28, 2012 [1 favorite]


Again speaking from experience, ambulance drivers generally do ask which hospital you want. If I were still in Atlanta, the last place I would want to go is Grady.

Ardiril you are missing my point. If I get in a car accident and I'm uninsured, should I call each hospital to haggle the lowest rate before I get there? Is this really an ideal and functional system that we should be arguing for?
posted by muddgirl at 3:43 PM on June 28, 2012 [4 favorites]


OK, people haggle on Craigslist, but again, obtaining medical services is not the same thing as buying a used coffee table.
posted by muddgirl at 3:45 PM on June 28, 2012 [2 favorites]


Are you telling me that you currently, at this very moment, have no idea which hospital you would want? Is your situation truly such that you have made no planning in that regard whatsoever?
posted by Ardiril at 3:47 PM on June 28, 2012 [1 favorite]


I give it no thought whatsoever. But I'm from the UK.
posted by Artw at 3:49 PM on June 28, 2012 [1 favorite]


I just can't wrap my head around the idea that there are such idiots out there:

Matthew Davis, an attorney in Lansing, Michigan—and the former spokesperson for the Michigan Republican Party—sent out an email this morning that posed the question “Is Armed Rebellion Now Justified?” now that the Supreme Court has ruled to uphold Obamacare.
posted by 2manyusernames at 3:50 PM on June 28, 2012 [1 favorite]


Are you telling me that you currently, at this very moment, have no idea which hospital you would want? Is your situation truly such that you have made no planning in that regard whatsoever?

I know what hospital my doctor prefers. That doesn't mean it's going to offer me the best deal. Are we talking past each other?
posted by muddgirl at 3:50 PM on June 28, 2012


Most likely. The choice (or inability) to carry insurance still bears the responsibility to make some minimal amount of advance planning.
posted by Ardiril at 3:51 PM on June 28, 2012


If I don't have insurance and go on a trip, is it my responsibility to pre-locate the cheapest hospital in each region I visit? Perhaps people who are denied affordable insurance should forgoe any sort of travel outside the radius of their pre-research hospital.

(Seriously, this sort of research is the point of health insurance. It's one of the reasons why the fact that people are denied access to these resources is a travesty.)
posted by muddgirl at 3:55 PM on June 28, 2012 [6 favorites]


Ardiril, what do you do if you're in a small town or rural area with no real options? What do you do if your case is specialized and "normal" hospitals cannot treat you?
posted by desjardins at 3:57 PM on June 28, 2012 [1 favorite]


By the way, not to derail the discussion, despite anyone's personal experiences, the ability to choose your hospital in ambulance is definitely dependent on where you are and the policies of the EMS system you are in.

For example, Illinois law states that:

"a person shall not be transported to a facility other than the nearest hospital, regional trauma center or trauma center unless the medical benefits to the patient reasonably expected from the provision of appropriate medical treatment at a more distant facility outweigh the increased risks to the patient from transport to the more distant facility..."

(There are aspects of patient choice, but only if the EMS system has taken that into consideration when setting up their policies, which most of them here -- and in many locations with multiple hospitals who would prefer not to be driving all over the city -- do not.)
posted by MCMikeNamara at 4:01 PM on June 28, 2012 [4 favorites]


Story time - when I was 23 I was living in Montana in a small-ish town with one hospital. I was working a retail job with no benefits. I had a toboggan accident that left me with stitches and a concussion. Due to a pre-existing condition I didn't find out about until later, I'm damned lucky that's all I ended up with. I'm also damned lucky that my boss' homeowner's insurance paid for the ER visit, follow-up care, and a new hearing aid or I'd probably still be paying that shit off.
posted by desjardins at 4:01 PM on June 28, 2012 [3 favorites]


A perfect Randian superman would always make the correct choice, then disable the EMTs and drive the ambulance himself if required.
posted by Artw at 4:02 PM on June 28, 2012 [16 favorites]



Matthew Davis, an attorney in Lansing, Michigan—and the former spokesperson for the Michigan Republican Party—sent out an email this morning that posed the question “Is Armed Rebellion Now Justified?” now that the Supreme Court has ruled to uphold Obamacare.


Supreme Court upholds individual mandate created by the Heritage Foundation which was the centerpiece of the 1996 Dole campaign.

And this has nothing to do with Obama's race.
posted by Ironmouth at 4:04 PM on June 28, 2012 [5 favorites]


[Go to MetaTalk if you want to continue doing that thing that looks like trolling or getting into a fight with everyone. You can't do it here. Sorry.]
posted by jessamyn at 4:05 PM on June 28, 2012 [1 favorite]


Can't wait till the Republicans start realising the US public actually might favour the ACA and they start trying to get it rebranded as Romneycare 'cos it was his idea first dammit!
posted by PenDevil at 4:07 PM on June 28, 2012 [4 favorites]


notyou: I think the government's lawyers have been revealed as a pretty savvy bunch. [...] Back when the arguments were being made, many commenters (iirc), criticized the shotgun approach the lawyers followed to defend the law (first CC, then N&S, then taxing authority).

I believe that argument in the alternative is a well-established practice in law; it has a standard joke:
What did the lawyer say when accused of breaking a vase?
It's my vase, it was broken when you gave it to me, it was in perfect shape when I gave it back, and I've never seen that vase before in my life.
So, I'd bet not on savvy but on just doing the job the way they were trained to do it.
posted by stebulus at 4:24 PM on June 28, 2012 [9 favorites]


Huh. The next thing you know, Roberts is going to be telling us that he isn't the Dread Justice Roberts, and that his name is Ryan, and that he just inherited this court from the previous Dread Justice Roberts...
posted by A dead Quaker at 4:48 PM on June 28, 2012 [15 favorites]


Am I missing out on a whole world of lower prices somehow? Is this a regional thing?

Every year my apartment complex sends out a rent increase for an absurd amount, and every year I ask if nothing can be done, so they cut the rent increase in half. It makes me angry because it's exactly like blaming people for paying full price for health care: it's not the fault of customers not to know they can ask for a discount.
posted by winna at 4:52 PM on June 28, 2012 [2 favorites]


Are you telling me that you currently, at this very moment, have no idea which hospital you would want? Is your situation truly such that you have made no planning in that regard whatsoever?

Being Canadian, the first thing I thought on reading this was: Jesus, is this a thing people have to do? Really? At this moment, I know the hospital closest to me. If I have to go there, I'm confident that the people there are competent, it'll be clean, I'll be fine.

If you have to do that kind of calculation, I don't know where you are but you are definitely not on the inside edge of civilization.
posted by mhoye at 5:03 PM on June 28, 2012 [33 favorites]


Meet Gary He, creator of the Obama-as-Truman meme
posted by homunculus at 5:12 PM on June 28, 2012


Adam Serwer: No, Roberts' Ruling Didn't Doom Liberalism
posted by zombieflanders at 5:22 PM on June 28, 2012


So my extremely Republican mom asked me about this because she heard she MIGHT HAVE TO PAY MORE TAXES and I sent her a bunch of nonpartisan (or as nonpartisan as I could find) info. My also-extremely Republican sister has a couple pre-existing conditions that require ongoing treatment and has been paying through the nose for her health insurance. She discovered that not only would this benefit my sister tremendously, if my sister got insurance through one of the policies they got linked to on health.gov, she could save about half what she's been paying for similar coverage.

They both just locked up. I think the cognitive dissonance between THAT KENYAN MUSLIM SOCIALIST OBUMMER AIN'T DOIN' NOTHIN' FOR US and him actually doing quite a lot got to them. I'm sure it'll all be explained away in time, but for now I'll just laugh.
posted by Ghostride The Whip at 5:26 PM on June 28, 2012 [19 favorites]


Yeah, there's this myth that -- if you go to the hospital, they will make things better. I'm not sure where that one comes from (one assumes all the countries with decent health care) but it's bullshit here.

If you're uninsured in the US you have to be aware, well in advance, of which local hospital(s) will treat you. I won't tell the story again, it's long, but here is how I learned that non-life-threatening problems will earn you a "Fuck yourself off home" from certain hospitals -- though they won't let you leave until you sign the paper promising you won't sue because they refused to treat you.

It's demoralizing, it's degrading, and it's completely legal. So I am heavily in favor, not only of this act, but of single-payer health care and anything else that takes the fuckers who came up with this nonsense and puts their backs to the wall.

(Meanwhile, a friend of mine was told today by a Good Ol' Ohio Republican relative that she basically deserves to die because her pre-existing medical condition is too expensive to treat. So help me, if I ever meet that person....)
posted by cmyk at 5:28 PM on June 28, 2012 [10 favorites]


I was once sent a bill, which took some dickering between my employer and insurer and the lab to get cleared, for $715. It was cleared by the insurer paying the agreed-upon contract rate of $25. That is not a discount, that is theft.
posted by localroger at 5:33 PM on June 28, 2012 [8 favorites]


Artw: "Healthcare Reform: Why today’s Supreme Court ruling is great news for startups"

I've thought that for years. I and a lot of friends are in software and you can't get three programmers in a room together without the topic of starting your own company coming up but the idea of trying to figure out how to get any kind of affordable health insurance for a three person company is way too daunting to let those ideas go much farther.
posted by octothorpe at 5:34 PM on June 28, 2012 [5 favorites]


Just finally read the opinions after work. I have to say, Justice Ginsberg's os the best of the bunch. Great analysis. Nobody's talking about it, but it's spot on. And, I have agree with the notion that the so-called lmitation on the Commerce Clause is overblown. It's almost, dicta.
posted by JKevinKing at 5:42 PM on June 28, 2012


We have private (self-pay) insurance, and my husband was just diagnosed with a crippling autoimmune disease. Thanks to the ACA, our insurance company already can't drop him just for having the gall to get sick, and starting in 2014, they'll have to actually cover the drugs that might actually put him into remission. (Non insurance cost: $2,000/mo.) Thank fuck it was upheld.
posted by KathrynT at 5:54 PM on June 28, 2012 [32 favorites]


Romney: "It's not a tax hike. It is a fee, an assessment."
posted by furiousxgeorge at 5:55 PM on June 28, 2012 [1 favorite]


The Romney campaign announced it has raised $2 million as of around 5 p.m. Thursday after the Supreme Court upheld “Obamacare.”

Yeah, this is still a massive political victory for Obama. Romney is incoherent on healthcare and he won't be able to nail home his attacks outside of the people already convinced so he isn't going to make any real gains off this.

Having it overturned is one of the few game changers that could have actually given Romney a shot by delegitimizing Obama's key legislative accomplishment.
posted by furiousxgeorge at 6:03 PM on June 28, 2012 [3 favorites]


Matthew Davis, an attorney in Lansing, Michigan—and the former spokesperson for the Michigan Republican Party—sent out an email this morning that posed the question “Is Armed Rebellion Now Justified?” now that the Supreme Court has ruled to uphold Obamacare.

Supreme Court upholds individual mandate created by the Heritage Foundation which was the centerpiece of the 1996 Dole campaign.

And this has nothing to do with Obama's race.



If you want to whittle down the Neo-Con mindset to one idea: "Those who forget history are doomed to repeat it." and they seem to have a selective/idealized memory. It's like they will settle for nostalgia over reality. I can see the draw, no matter how badly they screw things up a few months/years later they remember how great it was and they can feel good about it. Admitting that it's broken means copping to the real issues and problems, much easier to let some time pass and remember the "good ol' days."

This whole "armed revolution" thing is classic we'll go back an reference the Revolutionary War but skip over the whole Civil War, cause that didn't work out so well for those who thought it was time for armed rebellion and really that was about states rights and not enslaving human beings)

Better yet lets go invade Iraq, we'll be liberators like back in WWII, never mind how that whole Vietnam thing went.

Gay marriage - lets go back to Old Testament its much more "black and white" as far as the New Testament goes seems like the only thing they remember is that the part where everyone like them goes to heaven.

and on and on...
posted by empty vessel at 6:05 PM on June 28, 2012 [2 favorites]


If you want to whittle down the Neo-Con mindset to one idea: "Those who forget history are doomed to repeat it."
I tend to think "BE AFRAID" would be better.
posted by Flunkie at 6:07 PM on June 28, 2012 [1 favorite]


mhoye, I know in Newfoundland, the ambulance has to take you to the nearest hospital to where you were picked up. No second guessing required or wanted on the patient's part.
posted by peppermind at 6:07 PM on June 28, 2012


I tend to think "BE AFRAID" would be better.

That too.
posted by empty vessel at 6:09 PM on June 28, 2012


Ex-Militia Blogger Who Spawned Fast And Furious Scandal Predicts Armed Insurrection Over Health Care Decision
posted by homunculus at 6:11 PM on June 28, 2012


a little tangential, but related: the White House released a photo of Obama on the phone after hearing the news but with very restrictive usage notes. Is that notice worth anything in practice?
posted by jacalata at 6:36 PM on June 28, 2012 [1 favorite]


Is that notice worth anything in practice?

It looks like that's just the boilerplate language underneath all Whitehouse Flickr photos. The key part is probably the prohibition against use in such a way that might suggest "approval or endorsement of the President, the First Family, or the White House."
posted by nobody at 6:46 PM on June 28, 2012


I'll let you know if anything happens.
posted by furiousxgeorge at 6:51 PM on June 28, 2012 [3 favorites]


Is that notice worth anything in practice?

The "License" field says it is a "United States Government Work" which means it is in the public domain, and any additional restrictions cannot be enforced through copyright means.
posted by grouse at 6:59 PM on June 28, 2012


Being Canadian, the first thing I thought on reading this was: Jesus, is this a thing people have to do? Really? At this moment, I know the hospital closest to me. If I have to go there, I'm confident that the people there are competent, it'll be clean, I'll be fine.

It's even worse than that.

If you have insurance, you need to stay within their approved providers. That means if you go to the wrong hospital, or the wrong doctor, or even use the wrong ambulance - you are on the hook for the total.

There are exceptions for life threatening events; but if the event is deemed non life threatening afterwards you're still on the hook.

Pre-approvals for non-network care aren't hard to get. You'll spend 30-45 minutes on hold, and have to make 3-7 phone calls; usually to that one person who only works from 1030-130 on Thursday. And then once you get that pre-approval, the generally won't honor it the first 2-3 times the bill comes. The billing department is even less interested in helping you, and, in fact, generally, it will have to go to collections before you can get anyone on the phone with the power to do anything.

Lord help you if the actual procedure is different any small way whatsoever - did they set the bone with plaster ? Only fiberglass bone settings are covered...

I know all of this from personal experience.

So yeah, the big problem now is that government bureaucrats are going to interfere in your health care destroying all of the efficiencies of the private, for-profit, insurance companies.

We're ruined.
posted by Pogo_Fuzzybutt at 7:04 PM on June 28, 2012 [15 favorites]


The Romney campaign announced it has raised $2 million as of around 5 p.m. Thursday after the Supreme Court upheld “Obamacare.”

You don't say.
posted by Combustible Edison Lighthouse at 7:15 PM on June 28, 2012 [4 favorites]


Yeah, this is still a massive political victory for Obama. Romney is incoherent on healthcare and he won't be able to nail home his attacks outside of the people already convinced so he isn't going to make any real gains off this.

He's totally painted into a corner now. ObamaCare is basically the same as RomneyCare but implemented nationally. His only weasel out of the fact that he's running against a program that he helped design was that he maintained that it was unconstitutional for the federal government to do it and only the states could do it. The Roberts' court just blasted that talking point out of the water, leaving him with not much left to say.
posted by octothorpe at 7:18 PM on June 28, 2012 [1 favorite]


The 9 p.m. numbers came to $3.2 million. He averaged $2.5 million a day in May but that was mostly from large donors, this was more grassroots.

Obama's campaign would not reveal their fund-raising totals from Thursday when asked.
posted by furiousxgeorge at 7:20 PM on June 28, 2012


Sen Marco Rubio: The Individual Mandate For Massachusetts Was Good, Because If You Didn't Want To Participate You Could Leave Massachusetts, Whereas The Federal One Is Bad, Because If You Don't Want To Participate You Need To Leave The Country, And That's Just Silly
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 7:20 PM on June 28, 2012 [1 favorite]


He's totally painted into a corner now. ObamaCare is basically the same as RomneyCare but implemented nationally.

It's even better than that. One of the memes trying to get off the ground is that Obama lied about the mandate being a tax.

Ooops.
posted by Pogo_Fuzzybutt at 7:21 PM on June 28, 2012


Remember during the debates when Romney explicitly said that he was proud of the individual mandate for Massachusetts, but it wouldn't work federally because it's unconstitutional?

Turns out it's constitutional.

He's changed his mind though. It's now bad for other reasons or something, uh, freedom... I just need to get something from my car... *squealing tires*
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 7:23 PM on June 28, 2012 [2 favorites]


Barack, Hillary, Joe and Michelle drove by Boehner’s house all…
posted by madamjujujive at 7:26 PM on June 28, 2012 [2 favorites]


no regrets, coyote: "Wonkette has all your wingnut conspiracy theory needs, as usual."

Oh oh oh! It's like the Michelle Obama "Whitey tape!"
posted by symbioid at 7:28 PM on June 28, 2012


After several image searches, I can't find "Death Panel" done as a metal logo in blackletter gothic (preferably with an umlaut over a completely incorrect letter, even more preferably the n). Now I know we have talented graphic designers here. I wonder if someone might consider...
posted by George_Spiggott at 7:31 PM on June 28, 2012 [1 favorite]


Just out of idle curiosity, what is the longest MeFi thread?
posted by newdaddy at 7:31 PM on June 28, 2012


Infodumpster says "Palin selected as McCain's running mate"
posted by jessamyn at 7:34 PM on June 28, 2012


5555 comments.
posted by rtha at 7:37 PM on June 28, 2012


newdaddy: that's a hole you don't want to go down in to, sir or madam.
posted by lazaruslong at 7:37 PM on June 28, 2012 [3 favorites]


Someone better shake Romney.

Borowitz Report is on it: "Romney Blasts Supreme Court, Calling Healthcare Act ‘Worst Idea I Ever Had"
posted by fuse theorem at 7:41 PM on June 28, 2012 [1 favorite]


Red State: It’s a big win for the President and a bad day for freedom. But we can deal with it.
posted by blueberry at 7:42 PM on June 28, 2012 [1 favorite]


Speaking as a European, it seems to me that Americans haggle all the time, and that this is entirely typical for anything other than a big-box store or supermarket.

Wait, what? Speaking as an American, I think of haggling as something you do in China or the Middle East. In a store in the United States, from big box to corner drug, you pay the price it says on the tag.
posted by escabeche at 7:43 PM on June 28, 2012 [4 favorites]


Seriously, that Palin threads is like TVTropes without even leaving mefi. Proceed with caution.
posted by cortex at 7:45 PM on June 28, 2012


5555 comments.

The mark of the beast.
posted by Brandon Blatcher at 7:48 PM on June 28, 2012



5555 comments.

The mark of the beast.


Hail ERIS!
posted by Pogo_Fuzzybutt at 7:51 PM on June 28, 2012 [5 favorites]


Eh, I never liked the individual mandate, in fact if you recall the primary Obama was against it, while Clinton was for it. Reformulating it as a tax is probably the best outcome.
posted by delmoi at 7:55 PM on June 28, 2012 [1 favorite]


There's a lot of chatter on the topic of armed insurrection on the far right... more than usual. It may be a long summer for the FBI - no chance of an actual widespread rebellion, but I can see a few militia groups getting out of hand.
posted by Slap*Happy at 7:56 PM on June 28, 2012 [1 favorite]


I'm surprised that this worked. Roberts is saying that Congress can't call a tax a "penalty" in order to fool the Constituion, but they can call it a penalty in order to fool themselves.

So if it walks like a duck, and quacks like a duck, we'll all just agree to call it cake so we can have our cake and eat it too?
posted by Hello, I'm David McGahan at 8:00 PM on June 28, 2012 [1 favorite]


Lawrence O'Donnell's Rewrite from the other night quotes the section of the A.C.A. that specifically forbids the IRS from punishing people for not paying the tax penalty:
(A) Waiver of criminal penalties
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.

(B) Limitations on liens and levies
The Secretary shall not—
(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
(ii) levy on any such property with respect to such failure.
posted by ob1quixote at 8:24 PM on June 28, 2012 [4 favorites]


> So if it walks like a duck, and quacks like a duck, we'll all just agree to call it cake so we can have our cake and eat it too?

No, it's a bit more principled than that. Roberts is saying that what the Anti-Injunction Act calls a "tax" is not necessarily the same as what the Court deems to fall under the Constitutional authority to tax. And, as precedent, he cites a case where the court took something that was called a tax in legislation (but actually wasn't a tax) and considered it in the context of the Anti-Injunction Act. Goose/gander and all that.

The concurring opinion (Ginsburg, Sotomayor, Breyer, Kagan) briefly mentions that they agree with this reasoning, but it's sort of a moot point for them because they think the Commerce Clause authorizes the mandate in the first place.

For more on this, grab the decision (PDF) and start on page 33 (using the numbering on the pages themsevles).
posted by savetheclocktower at 8:25 PM on June 28, 2012 [1 favorite]


Eh, I never liked the individual mandate, in fact if you recall the primary Obama was against it, while Clinton was for it. Reformulating it as a tax is probably the best outcome.


I was pleased to see him be very honest about how he changed his opinion and why.

As for it being reformulated, it was not. The provisions are the same. The effect is the same.its only a legal question of the government's ability to implement it.
posted by Ironmouth at 8:32 PM on June 28, 2012


Sir, you'll be happy to learn that we've upheld your health care reform law!
posted by furiousxgeorge at 8:44 PM on June 28, 2012


Doing a for "democrat" vs. "Obama" in this thread reminds me of the fact that pretty much everyone on both sides wants to make this about Obama.

However it was voted for by 219 congresspeople and 60 senators, and while the administration definitely had a hand in creating the legislation they weren't alone by any means. It's funny how credit/blame collapses this way...
posted by Tell Me No Lies at 8:56 PM on June 28, 2012 [1 favorite]


And this is where I remind Firebaggers and PUMAs and Naderites that it really fucking matters who gets to nominate the next one or two SC judges.

Scalia and Alito and Thomas have gone rogue.
posted by bardic at 9:03 PM on June 28, 2012


We can't afford another Roberts!
posted by furiousxgeorge at 9:04 PM on June 28, 2012 [1 favorite]


We can't afford another Roberts!

Yeah, one Citizens United decision was enough.
posted by maudlin at 9:06 PM on June 28, 2012 [1 favorite]


Whatever, if you want to hump the Supremes talking point the day after a Bush appointed Chief Justice endorsed Obamacare, be my guest.
posted by furiousxgeorge at 9:08 PM on June 28, 2012 [2 favorites]


Tell Me No Lies: " It's funny how credit/blame collapses this way..."

I don't think it's that funny. Yes, there are many veto points in our system that make Presidentin' difficult, and it's surely the case that Obama didn't get everything he wanted in the bill (though figuring out exactly what he really would have wanted if he could have written and signed it himself would be difficult.) Still, absent pressure from the President, Congress would basically show up one day a year, pass the "Congresspeople Gots To Get Paid Act of [year]", and spend the rest of the year golfing and doing interviews on Sunday talk shows about how awesome/horrible the President is.

I'm not a believer in the unlimited power of the bully pulpit, but I think we can all agree that the chief executive can do some level of agenda setting. Democrats in vulnerable districts wanted nothing to do with healthcare, but it was the Democratic President's priority, so a lot of them hopped on board the PPACA Express (and many of them got bludgeoned in the 2010 mid-terms.)

Because of this, and because of the veto pen that can kill bills he doesn't like, the President gets credit and blame, despite the fact that he doesn't write a single word of the bills themselves. I see nothing wrong with this.
posted by tonycpsu at 9:09 PM on June 28, 2012 [1 favorite]


I'd like to remind everyone: PeePee Acka.
posted by dirigibleman at 9:15 PM on June 28, 2012 [1 favorite]


And with that, we've reached 1,000 comments in this discussion.

That's numberwang!
posted by Joey Michaels at 9:18 PM on June 28, 2012 [3 favorites]


The Economist:
JUNE 28th was a day of reckoning for the most important law of Barack Obama’s presidency, and for the president himself. The Supreme Court was to decide the fate of Mr Obama’s 2,700-page health reform. Oral arguments in March had not proceeded as Democrats had hoped. Mr Obama’s lawyer choked on his water, faltered in his opening statement, then endured a battery of hostile questioning. Suddenly it dawned on Democrats that their most treasured achievement might die.
posted by asuprenant at 9:27 PM on June 28, 2012


[quit calling people stupid, act decently towards each other or go to MetaTalk.]
posted by jessamyn at 9:30 PM on June 28, 2012 [3 favorites]


This is the first time in Roberts' 7 years on the court that he has sided with the liberal justices in a 5-4 decision. Talk about better late than never!
posted by brain_drain at 9:35 PM on June 28, 2012 [1 favorite]


This decision wouldn't have happened if Sotomayor and Kagan hadn't been there.

But please, by all means vote Nader.
posted by bardic at 9:35 PM on June 28, 2012 [10 favorites]


I don't think Nader would have nominated anyone to their right.
posted by furiousxgeorge at 9:38 PM on June 28, 2012


No, he wouldn't have. Because you have to be the President to nominate Supreme Court justices, not just be a guy who pulls votes away from someone who's got a chance in hell.
posted by Etrigan at 9:47 PM on June 28, 2012 [11 favorites]


That's a good point, the real folks to blame for Alito are the folks who voted for likely Presidential winner George W. Bush, specifically the Democrats in Florida who voted for him in much greater numbers than for Nader.
posted by furiousxgeorge at 9:52 PM on June 28, 2012


If you have to do that kind of calculation, I don't know where you are but you are definitely not on the inside edge of civilization.

The US is not actually a first-world country, it is the world's largest banana republic.
posted by adamdschneider at 9:58 PM on June 28, 2012 [1 favorite]


What? The USA is a first world nation by definition.
posted by Justinian at 10:04 PM on June 28, 2012


it is the world's largest banana republic

And everything is on sale!
posted by The Whelk at 10:05 PM on June 28, 2012 [3 favorites]


re: the earlier angle of people hopping on and off insurance plans when they want them, just to avoid the tax. In Australia, it's standard to have a waiting period before you can claim benefits. You can't just waltz into an insurance office 8 months pregnant and expect to pay a two-month fee for full maternity cover, for example. You can see an example here: health insurance policy, basic level (my plan falls under this policy) (pdf, sorry)

Once you are over 30 years of age and earn over a specific household income threshold, then you get a rebate on your tax if you have health insurance, even just a bare-minimum policy that only covers ambulance journeys. Everyone else gets Medicare.

It boggles my mind that even now people in the USA are scared of what this very limited improvement to health insurance might mean. I can't imagine my employer having anything to do with something so personal as my healthcare decisions, or having to choose which hospital I'd want an ambulance driver to take me to if I had a heart attack. It's just one more shitty life detail I don't have to spend time worrying about.
posted by harriet vane at 10:16 PM on June 28, 2012 [4 favorites]


for the love of dog, please I implore you folks to not devolve into another fucking Nader is/isnot responsible for Bush winning "discussion".
posted by edgeways at 10:18 PM on June 28, 2012 [4 favorites]


What? The USA is a first world nation by definition.

I am altering the definition. Pray I don't alter it any further.

More seriously, people don't use those terms per their Cold War definitions, and haven't for as long as I remember. When they say Third World they mean developing nations with what we would generally consider less than adequate standards of living and care for the majority. When they say First World, they mean to contrast with that. As far as I'm concerned, the positively Dickensian state of health care in the US means it doesn't warrant that contrast.
posted by adamdschneider at 10:38 PM on June 28, 2012 [2 favorites]


Come to think of it, I've always sort of wondered who exactly Lando was supposed to pray to.
posted by adamdschneider at 10:47 PM on June 28, 2012


And everything is on sale!

Only if you've got insurance. Otherwise you pay full price instead of the 80%+ discount.
posted by immlass at 10:50 PM on June 28, 2012


And why does Han have a concept of Hell?

Han Solo: [after Leia blasts a vent] What the hell are you doing?
Princess Leia: Well somebody has to save our skins. Into the garbage, fly-boy!


[Han has decided to go searching for Luke]
Echo Base Officer: Your Tauntaun will freeze before you reach the first marker!
Han Solo: Then I'll see you in Hell!

posted by furiousxgeorge at 10:51 PM on June 28, 2012


furiousxgeorge: Because all this is set after the prequels.
posted by dumbland at 10:56 PM on June 28, 2012 [2 favorites]


Hell is a really divey bar in South Central Coruscant. Han's got a pretty hefty tab running there.
posted by cortex at 11:26 PM on June 28, 2012 [2 favorites]


Somewhere in the 1018 posts is a point where some sort of Universal Law was triggered, and this switched into a Star Wars discussion, but I'm afraid to try to find it.

So, I'm just going to ponder the implications of the Obamacare law on the formation of the Blue Sun Corp. And Reavers as Death Panels.

[Save Firefly!]
posted by Mezentian at 11:41 PM on June 28, 2012 [3 favorites]


So I just recently got back from partying with my friends in front of the SCOTUS steps. Was kind of sad that no one else was there. (well, okay, there was a prayer circle there, which we at first assumed to be wingnuts praying for the socialism to go away, but it turns out it was an anti-death-penalty group that does this every year.)

Chatted for a while with a member of the Capitol Police, who explained that they go through the exact same training as the Secret Service and U.S. Marshalls, which I didn't know. He asked what we were celebrating, and we told him it was the health care decision, and he (at after midnight, on the SCOTUS steps) asked how it came down. We explained the unusual composition of the majority and how nobody was expecting that. His response:

"Okay, actually, that kind of is what I expected. We drive the justices home a lot. We learn things."

Which was great.
posted by Navelgazer at 12:08 AM on June 29, 2012 [28 favorites]


Justinian: What? The USA is a first world nation by definition.

...where 'first world' is defined primarily by the US?

That's a little like the definition of 'civilised' - from the little I know it used to relate to a way of behaving (not torturing people, holding yourself to a high standard, being a nice culture to live in, being primarily christian, etc.); now it seems to mean, 'the latest technology is available to at least 50% of the population' (and being primarily either christian or atheist, probably).
posted by lith at 12:46 AM on June 29, 2012 [1 favorite]


Wait, what? Speaking as an American, I think of haggling as something you do in China or the Middle East. In a store in the United States, from big box to corner drug, you pay the price it says on the tag.

Oh, furniture, appliances, musical instruments (eg guitar center), even some kinds of clothing...all sorts of consumer durables. The trick is not necessarily to ask for a discount (although that's one approach that works for a lot of people), it's to show that you willing to spend a decent amount of money but also to walk away. If a store employs sales staff those sales staff are empowered to deal, and will do so over a certain threshold, like a couple hundred (perhaps even less).

On the other hand, I think being asked to make any kind of financial or administrative decision in a situations of medical need borders on duress.

posted by anigbrowl at 1:12 AM on June 29, 2012 [2 favorites]


it is the world's largest banana republic

We are a totally bananas republic.
posted by aubilenon at 1:26 AM on June 29, 2012 [2 favorites]


I think the problem with everyone complaining that health care costs are high in the US are ignoring two things: first, that it is impossible to drive them down without interrupting people's livelihoods. Yes, doctors charge more, yes, pharmacies charge more. Yes, lots of people charge more, and that is how they make their living. And they justly enjoy a high standard of living, and I'm happy for them that they do.

How exactly would you expect to rein in health care costs, without placing some sort of maximum amount things can cost? And how would said maximum amount affect doctors, and particularly high-quality doctors, who can afford to charge premium prices? Do you really think I should pay the same price to go to the premier cancer surgeon in the US, as the person who barely qualified on their exams and has an at-best-moderate success rate?

(thanks for the details on VA stuff, folks)

The second thing is that yes, we are paying on Medicare enormous sums for things like nursing homes to extend a terrible quality of life for twenty years. We are bankrupting the young for the sake of the aged: not just people who can afford to treat their elderly with a stern refusal to die, but also those who can't, and the costs are passed on to us the taxpayer.
posted by corb at 2:03 AM on June 29, 2012


we are paying on Medicare enormous sums for things like nursing homes to extend a terrible quality of life for twenty years. We are bankrupting the young for the sake of the aged: not just people who can afford to treat their elderly with a stern refusal to die, but also those who can't, and the costs are passed on to us the taxpayer.

That's a bit harsh, you're generalising that all old people have a terrible quality of life for the last 20 years and suggesting that because they can't afford to pay their own way they should be allowed to die?
Surely they paid their way when they worked, and now they're retired?
Children don't pay their way either and never have, darned sponging kids living off our tax dollars - we should refuse them health care too, right?
posted by lith at 2:19 AM on June 29, 2012 [3 favorites]


Hm, worked out what gets me about that - it's the idea that people who aren't moving money around the economy are a burden.
As far as I'm concerned people are the point of the system, the above suggests that the system is the point and people just cogs. The old people, they're someone's mother/father or other relative, they have friends, they mean something to someone, that doesn't count for nothing just because there's no cash value on friend/family relationships.

And if this is all about the economy, well old people are a business too - take them away and think of all the jobs around them that will go. So there's the appeal to selfishness.
posted by lith at 2:33 AM on June 29, 2012 [8 favorites]


How exactly would you expect to rein in health care costs, without placing some sort of maximum amount things can cost? And how would said maximum amount affect doctors, and particularly high-quality doctors, who can afford to charge premium prices? Do you really think I should pay the same price to go to the premier cancer surgeon in the US, as the person who barely qualified on their exams and has an at-best-moderate success rate?

This argument seems to imply that there is some sort of premium healthcare that is being paid for in the US. The thing is, the overall relationship between quality and cost of healthcare in the US bears no resemblance to the rest of the civilised world, including places where the cost of living is higher than the US. Take a look at this infographic for an illustration of just how out-of-whack the US is in this regard. As far as I am aware, senior medical professionals are not typically lowly paid in these countries, so remuneration does not seem to be a big issue. There are also enormous opportunities for cost savings in bureaucracy that would not have a deleterious effect on healthcare quality (perhaps even the opposite). You are not getting what you think you are paying for
posted by Jakey at 2:55 AM on June 29, 2012 [7 favorites]


The Medicaid provision seemed to have been some major legs for the bill, it was struck unfortunately: link.
posted by skepticallypleased at 3:21 AM on June 29, 2012 [1 favorite]


We are a totally bananas republic.

I'm now picturing a universe much like the Ian McKellan Richard III, except with 2006-era Gwen Stefani in the title role.
posted by Sticherbeast at 4:05 AM on June 29, 2012 [1 favorite]


furiousxgeorge: "Whatever, if you want to hump the Supremes talking point the day after a Bush appointed Chief Justice endorsed Obamacare, be my guest."

I'll just let the New York Times do it for me: Future of an Aging Court Raises Stakes of Presidential Vote
posted by octothorpe at 4:54 AM on June 29, 2012


More hints that Roberts switched his vote.
posted by nobody at 5:03 AM on June 29, 2012


I don’t find it at all illegitimate for political actors to put pressure on the Court, so long as they stay within proper legal bounds, and keep their rhetoric within the broad boundaries of decency. But it is ironic that while liberal critics were quick to accuse the Court of playing politics by taking seriously the Obamacare challenges, it may turn out that it was only politics that saved the ACA.

That's a lot of insinuation for a total lack of substance. What political actors? What pressure? Oh, it "may" turn out that it was "only politics" that saved the ACA? Do tell us when the evidence arrives.

Who accused the Court of "playing politics" by "taking seriously" the Obamacare challenges? Seriously, who? Of course Obama didn't want the Court to strike the mandate, but other than that? As far as the legal issues are concerned, the ACA was challenged in the appropriate manner in an appropriate venue.
posted by Sticherbeast at 5:14 AM on June 29, 2012 [2 favorites]


How exactly would you expect to rein in health care costs, without placing some sort of maximum amount things can cost? And how would said maximum amount affect doctors, and particularly high-quality doctors, who can afford to charge premium prices?

Change the structure of medical school so that doctors don't graduate with hundreds of thousands of dollars of loans. Reconsider the amount of expensive, unnecessary testing and procedures done at nearly all levels of care. Streamline the system so that billing and insurance coding doesn't require multiple people per doctor's office. Develop training programs to support expanded roles where appropriate for RNs.

Look, my GP is fantastic. Well, both of them are, really, one in each state. But my doctor in DC no longer participates in insurance, period. No insurance. Some insurances will reimburse you for the doctor's time and for the procedures; mine no longer does, though my family has covered that in the past. The cost per visit, including bloodwork, is multiple hundreds, sometimes close to a thousand. Just straight up-- that's what it means to look at things without insurance and to be able to pay for a sort of low-level boutique care. The GP I see up here is also fantastic-- sent me text messages to check in once when I was having problems, all that. The co-pay is $25, but only because I have the fancy version of my employer's insurance; they no longer accept patients from any of the HMO's or low-level plans. No one does, in my area. I could not see a local doctor if I could not afford the expensive plan. That we have these levels of differences in basic health care is ridiculous. That insurance should be such a huge drain on a doctor's office that they flat up refuse to deal directly with them is really ridiculous.

In contrast to all of that when I needed a head thing checked out in England, I popped into my doctor with a next day appointment, had my blood pressure checked, and was sent home. Didn't do every level of blood test or an EKG; turns out they really weren't necessary. No billing. No forms. No calls to check and see which blood tests are approved, or which doctors. (Oh, and for birth control-- no mandatory OB-GYN visits every bloody time, fewer paps, free prescription.)

I don't think the NHS is perfect, and they're obviously struggling with austerity costs and outcome as much as any government branch. But our system? Our vaunted system? It's so broken at the bottom. We get charged for tests, not for outcomes, so we get more tests and more procedures. More C-sections, for example, a particularly expensive proposition. Doctors themselves have to deal with high levels of liability insurance. Placing controls on how much things cost isn't the only way to reform this.
posted by jetlagaddict at 5:17 AM on June 29, 2012 [4 favorites]


It's adorable watching right-wing conspiracy theorists claim that Roberts switched his vote in order to succor favor with some hypothetical DC elite. This theory doesn't even have internal logic, let alone a significant relation to the outside world. Conservatives hate his guts, and liberals still don't trust him. Indeed, the conspiracy theorists call for his head, or, in more restrained moments, his mere resignation. They compare him to Abe Fortas, who had actual ethical issues, and not the mere audacity to do something that some people might not like.

The decision would have been 5-4 either way, and he could have authored the opinion either way, and it would have been just as significant either way, so the idea that he would have written this opinion only for fame makes no sense whatsoever.

When you look at an opinion like Kelo, where there are also many suggestions that the 5-4 had switched through the process, no one accuses the majority of having switched out of undue personal affection for Pfizer or pressure from outside sources. So, why the nuttiness here? The Volokh Conspiracy is typically an intelligent blog - so why has the bar abruptly fallen to the floor, with an audible clang?
posted by Sticherbeast at 5:30 AM on June 29, 2012 [8 favorites]


Sticher, it's because they don't really have anything else to talk about so they grab onto a conspiracy theory rather than confront the fact that they lost badly.
posted by octothorpe at 5:45 AM on June 29, 2012


Sticherbeast: I'm now picturing a universe much like the Ian McKellan Richard III, except with 2006-era Gwen Stefani in the title role.

I was in that! (as a nazi extra).
posted by lith at 5:45 AM on June 29, 2012 [2 favorites]


Do you really think I should pay the same price to go to the premier cancer surgeon in the US, as the person who barely qualified on their exams and has an at-best-moderate success rate?

Of course not. The person going to the premier cancer surgeon has insurance which has somehow negotiated the maximum fee said surgeon can charge down to $6.47. It only makes sense that people with no insurance should spend $800 to get three stitches from the Doc-in-a-Box that is wedged in between the Dollar General Store and a Chinese Buffet at the local strip mall.

I'm exaggerating a little, but seriously, a few years ago when I had my wisdom teeth out, the fact that I had health insurance took the price of the process from the neighborhood of $1000 to a fairly reasonable price before any money changed hands.
posted by Kid Charlemagne at 5:46 AM on June 29, 2012 [1 favorite]


I could not see a local doctor if I could not afford the expensive plan. That we have these levels of differences in basic health care is ridiculous. That insurance should be such a huge drain on a doctor's office that they flat up refuse to deal directly with them is really ridiculous.

The reason many doctors refuse to deal with insurance is not because insurance is a huge drain on a doctor's office. The reason many doctors refuse to deal with insurance is because insurance, particularly the low-level insurances, doesn't pay them. Especially things like Medicare and Medicaid. They just don't pay for those doctors.

And yes, there should be the option to have different levels of care. Why shouldn't there? Why shouldn't doctors be able to offer nicer waiting rooms, with more personalized care? Why shouldn't doctors be able to have small practices, so that they can remember their patients and their issues without reading from the file? Well, that type of care requires higher costs, because it needs to be financially worth it to people. There exist people who are willing to pay for that level of care, and there exist doctors who are willing to provide that level of care in exchange for a higher level of payment. Why shouldn't those people be able to give what they have in exchange for what they want?
posted by corb at 5:49 AM on June 29, 2012


corb, it sounds like you're talking "different levels of care" and thinking thing like "the basic level gets you a doctor, the premium level gets you a doctor with free cappucino in the waiting room" or something. But the current status quo when it comes to "different levels of care" is that "premium" gets you a doctor and "basic" gets you "a walk-in clinic three towns over where you sit in the waiting room for four hours because they're only open on Tuesdays and so everyone has shown up on that one day with flus and broken feet and migraines and an EKG they had to reschedule ten times already and you're there with a cut on your leg you got twelve hours ago but you couldn't see anyone right away".

What you say about different levels of care is empirically true, but the "basic" level right now is nigh unto non-existent.
posted by EmpressCallipygos at 6:07 AM on June 29, 2012 [11 favorites]


My point us that the level of care is the same at both places. And actually, we were told that the difficulty of dealing with the proliferation of plans and the hassle if dealing with insurance was one of their primary reasons for the change. I said nothing about destroying small practices at all, and I do not know why you leap to that bogeyman. I am well aware of the reasons why, say, Keystone HMO isn't accepted but I also feel like it is actually a sign of a broken system that you can have insurance (and not Medicare) and have no available GPs at all. None. Or dermatologists, or so on. The barrier to care shouldn't be the ability to pay for insurance and 700 dollar checkups, instead of just going to the ER.
posted by jetlagaddict at 6:10 AM on June 29, 2012


jetlagaddict

Reconsider the amount of expensive, unnecessary testing and procedures done at nearly all levels of care.

Keep your death panels away from my health care, man! What the hell is it to you if I want my podiatrist to authorize a CT scan of my ingrown tonail? There could be cancer hiding in there!

[/exaggerated conservative argument]
[/sarcasm]
posted by The Confessor at 6:11 AM on June 29, 2012 [2 favorites]


Mainly I just think about that article about the woman who had no sick leave or insurance who dealt with a festering tumor for years until she came to Grady with her breast in a towel. Is that really the best we can do?
posted by jetlagaddict at 6:22 AM on June 29, 2012 [4 favorites]


Hm, worked out what gets me about that - it's the idea that people who aren't moving money around the economy are a burden.
As far as I'm concerned people are the point of the system, the above suggests that the system is the point and people just cogs


Actually, no it doesn't when you consider that the people who aren't moving money around the economy are a burden to other people. When money isn't put back into circulation, it pools up. Most people don't take money out of circulation: they spend it, and that passes the benefits of the economic value that money represents on to others participating in the economy. People who aren't moving money around are a burden precisely because the point of the system is to provide for people, not to allow a few who manage to find a way to get more than they need to horde it excessively to the detriment of their less fortunate neighbors as a prize for "winning the game."
posted by saulgoodman at 6:35 AM on June 29, 2012 [2 favorites]


What you say about different levels of care is empirically true, but the "basic" level right now is nigh unto non-existent.

I may disagree in terms of the level of your example, but otherwise completely agree. The low levels of care right now are shameful, and I don't think that we should pretend some of them are actual care. I'm only saying that I don't think the solution is to eliminate the different levels of care - which is why I would really oppose any attempt to limit the maximum that doctors are paid, or insist they all be paid at the same level or in the same way.

My point us that the level of care is the same at both places.

The thing is, they're not. I actually notice this most with pediatrics, when I was scouting out doctor's offices for the kidlet. Going down the list of places that were in my insurance company's list, I found some really great places - with clean, uncrowded waiting rooms, where the doctors took as much time as they needed. I found some with clean but somewhat crowded waiting rooms, where the doctors were a bit brusque, but fine. And along the way, I also found one that was much like what Empress Callipygos talked about - overcrowded clinic waiting room, doctors that wanted you quickly in and out and looked down on their patients.

And even if you're just talking about outcomes of care, those are different too. The rushed doctor isn't going to take as much time to figure out precisely what your problem is, and is more likely to misdiagnose it. They're not going to do as good followup. The facial stitches stitched by a plastic surgeon are going to leave far less of a scar than that of a harried clinic worker who just wants to close the wound and move on to the next patient. Sure, the wound is closed in both cases, but there's absolutely different outcomes.
posted by corb at 6:37 AM on June 29, 2012


I'm exaggerating a little, but seriously, a few years ago when I had my wisdom teeth out, the fact that I had health insurance took the price of the process from the neighborhood of $1000 to a fairly reasonable price before any money changed hands.

I just had two out. The cost for getting the teeth removed was $24, total, after insurance, or that was the negotiated price on the statement I got, and I paid none of that. However, insurance did not cover the anesthesia, and that was $400. I thought of asking what they'd do if I didn't want to pay for the anesthesia, like would they just have me bite down on a bullet like in the old west, but didn't have the cojones.
posted by Ghostride The Whip at 6:39 AM on June 29, 2012


Here's a question for you supreme court scholars out there. Was the commerce clause portion of this opinion dicta?
posted by benbenson at 6:43 AM on June 29, 2012


A bit of news from the San Francisco Chronicle made me stagger, this morning:
Uninsured residents like Edith Gonzalez, a 26-year-old Academy of Art University student in San Francisco, hope the federal law will help them.

Gonzalez had insurance when she needed emergency surgery last fall to remove her gall bladder. But, she said, her insurer denied her claim, saying the gall bladder issue was a pre-existing condition. Until she needed surgery, she said she didn't even know she had the problem.

Gonzales now has a $120,000 medical bill and can no longer afford health insurance. She hopes the law will enable her to buy coverage again, regardless of her health history.
How on Earth can an insurer even stoop to this life-wrecking level of malignance? There is no way an art student can pay back $120,000 in debt in any reasonable frame of time. She'd have to quickly declare bankruptcy just to have a chance at a sane life.

I'm wondering if the student can hire a lawyer to negotiate with the hospitals and reduce the bill by 90%+, or if she already has.
posted by Jubal Kessler at 6:44 AM on June 29, 2012 [2 favorites]


it is impossible to drive them down without interrupting people's livelihoods

I think most people in the US who favor a sane health care system (ie single payer) are aware that it would gut an entire industry (private health insurance) and put at least hundreds of thousands of people out of work -- lots of people in health insurance and almost everyone currently working in medical billing.

Compared to that, those poor physicians who will probably be paid less aren't even an issue.

Do you really think I should pay the same price to go to the premier cancer surgeon in the US, as the person who barely qualified on their exams and has an at-best-moderate success rate?

Sure. Works fine in everywhere that's not the US.

I'm not at all sure why you think that's not the case in the US right now, anyway. I'd expect most health insurers don't pay the premier cancer surgeon in the US any more for their services than they do the barely-qualified surgeon. Rather, I'd expect they just pay whatever their going rate is for the procedure. And the number of people in the US who can afford an out of pocket Whipple procedure is too low to support more than a bare handful of cancer surgeons.
posted by ROU_Xenophobe at 6:45 AM on June 29, 2012 [4 favorites]


Going down the list of places that were in my insurance company's list, I found some really great places - with clean, uncrowded waiting rooms, where the doctors took as much time as they needed. I found some with clean but somewhat crowded waiting rooms, where the doctors were a bit brusque, but fine.

You think your insurance company pays the nicer clinics more?
posted by ROU_Xenophobe at 6:49 AM on June 29, 2012 [2 favorites]


saulgoodman: people who aren't moving money around the economy are a burden to other people.

I realise I slightly mis-stated what I was trying to say. Of course money spent on old people's care (or anyone else's) doesn't end up with them at all and therefore doesn't pool - the money goes to the carers, the doctors, the nurses etc., which means these people are employed and earning money, so how are people a 'burden' when they help create all of this employment?
We may well be talking at cross-purposes though.
posted by lith at 6:51 AM on June 29, 2012 [1 favorite]


And yes, there should be the option to have different levels of care. Why shouldn't there? Why shouldn't doctors be able to offer nicer waiting rooms, with more personalized care? Why shouldn't doctors be able to have small practices, so that they can remember their patients and their issues without reading from the file? Well, that type of care requires higher costs, because it needs to be financially worth it to people. There exist people who are willing to pay for that level of care, and there exist doctors who are willing to provide that level of care in exchange for a higher level of payment. Why shouldn't those people be able to give what they have in exchange for what they want?

There's nothing stopping them from doing that now, but you and your doctor shouldn't expect other people to share the increased cost burden through their increased insurance premiums. Pay cash.
posted by one more dead town's last parade at 6:56 AM on June 29, 2012


it is impossible to drive them down without interrupting people's livelihoods

(shrug) Going bankrupt from outstanding medical bills is an interrupting people's livelihoods. 10% unemployment was interrupting people's livelihoods. The repeated and constant increases in health insurance costs that would have otherwise gone into my pocket is interrupting MY livelihood.

One of the reasons that the push for single-payer was not as strong as it could have been was because that would have interrupted people's livelihoods on a massive scale: our economy is filled with armies of billing specialists, record-filers, insurance adjusters, compensation analysts, etc., etc., etc. Wiping out that sector of the economy overnight would have creating a massive disruption in the country.

But telling hospitals and insurance companies that they have to keep their expenses growing only at a rate of 2% a year vs. 8% a year? That seems fair.
posted by deanc at 6:57 AM on June 29, 2012


There is no way an art student can pay back $120,000 in debt in any reasonable frame of time. She'd have to quickly declare bankruptcy just to have a chance at a sane life.

Someone school me if I'm wrong, but I believe medical debt like that is like educational loans, increasingly not dischargeable under bankruptcy.

Because fuck those lazy chislers who want to deprive the Banks of their rightful monthly revenue stream, amirite? </SARCASM>

Lifetime debt-servitude to the banksters; Welcome to the 21st C., young Americans.
posted by Pirate-Bartender-Zombie-Monkey at 7:07 AM on June 29, 2012


Going down the list of places that were in my insurance company's list, I found some really great places - with clean, uncrowded waiting rooms, where the doctors took as much time as they needed. I found some with clean but somewhat crowded waiting rooms, where the doctors were a bit brusque, but fine.

You think your insurance company pays the nicer clinics more?


Hi, I work in this industry. Insurance companies negotiate with doctors or groups of doctors, and sign contracts that may vary slightly in terms of what they'll reimburse. However, insurance companies also sell their business based on how deep a discount they get from doctors, and the more doctors there are in a given area, the more likely they are to be able to play them off against each other and get deeper discounts. Doctors fight back by threatening to leave the insurer's network. The larger the group of doctors, the more clout they have with the insurer. Any given doctor's office will have several groups of insurers they contract with, that are also competing with each other, thus complicating the business further.

On top of that, your insurer has contracted with your employer for a negotiated amount of coverage that determines your copays and deductibles as well as what's covered.

So it's not as simple as "I'll pay more for nicer offices". What kind of money your doctor makes only partially depends on what they're charging you.
posted by emjaybee at 7:09 AM on June 29, 2012 [1 favorite]


You're wrong. Medical debt is actually one of the leading causes of personal bankruptcy in the US.
posted by alms at 7:09 AM on June 29, 2012 [2 favorites]


One of the reasons that the push for single-payer was not as strong as it could have been was because that would have interrupted people's livelihoods on a massive scale: our economy is filled with armies of billing specialists, record-filers, insurance adjusters, compensation analysts, etc., etc., etc.

Not wanting to be mean, but this just makes me think of B Ark
posted by lith at 7:10 AM on June 29, 2012 [2 favorites]


Was the commerce clause portion of this opinion dicta?

Sort of. Nobody joined that part of Roberts's opinion, but the Scalia/Kennedy/Thomas/Alito dissent also would have held that the mandate was unconstitutional under the Commerce Clause, and their reasoning is very similar.

Here's Roberts's argument:
The power to regulate commerce presupposes the existence of commercial activity to be regulated. If the power to “regulate” something included the power to create it, many of the provisions in the Constitution would be superfluous. ... The language of the Constitution reflects the natural understanding that the power to regulate assumes there is already something to be regulated. ... The individual mandate, however, does not regulate existing commercial activity. It instead compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce.
And here's Scalia's:
If this provision “regulates” anything, it is the failure to maintain minimum essential coverage. One might argue that it regulates that failure by requiring it to be accompanied by payment of a penalty. But that failure—that abstention from commerce—is not “Commerce.” To be sure, purchasing insurance is ”Commerce”; but one does not regulate commerce that does not exist by compelling its existence.
(emphasis in original).

Both also go on to talk about how extending the Commerce Clause in this way would open the door to essentially unlimited federal regulation.

Roberts: "Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority."

Scalia: "To go beyond that, and to say the failure to grow wheat (which is not an economic activity, or any activity at all) nonetheless affects commerce and therefore can be federally regulated, is to make mere breathing in and out the basis for federal prescription and to extend federal power to virtually all human activity."

So, strictly speaking, it is dicta in that there was not a majority of the Court that joined on a single opinion on that issue. But a majority had essentially the exact same reasoning on the issue, and I think if a simpler case presented the issue more squarely that those five would join in a single opinion.
posted by jedicus at 7:32 AM on June 29, 2012


Did anyone catch whether anything happened in connection with the Militia Act of 1792 or the 1790/1798 laws requiring insurance for seamen? Those seemed kinda relevant but I got the impression that they weren't even mentioned in arguments to the court.

Yes. Ginsburg brings them up and Roberts addresses them in a footnote:
The examples of other congressional mandates cited by JUSTICE GINSBURG, post, at 35, n. 10 (opinion concurring in part, concurring in judgment in part, and dissenting in part), are not to the contrary. Each of those mandates—to report for jury duty, to register for the draft, to purchase firearms in anticipation of militia service, to exchange gold currency for paper currency, and to file a tax return—are based on constitutional provisions other than the Commerce Clause. See Art. I, §8, cl. 9 (to “constitute Tribunals inferior to the supreme Court”); id., cl. 12 (to “raise and support Armies”); id., cl. 16 (to “provide for organiz- ing, arming, and disciplining, the Militia”); id., cl. 5 (to “coin Money”); id., cl. 1 (to “lay and collect Taxes”).
posted by jedicus at 7:34 AM on June 29, 2012


I think most people in the US who favor a sane health care system (ie single payer) are aware that it would gut an entire industry (private health insurance) and put at least hundreds of thousands of people out of work -- lots of people in health insurance and almost everyone currently working in medical billing.

And yet this is the thing I think of every time people claim that health care is just inevitably too expensive. How do they not notice how much of that expense goes towards supporting this army of unnecessary middlemen?
posted by ook at 7:37 AM on June 29, 2012 [9 favorites]


so how are people a 'burden' when they help create all of this employment?

How is a hurricane a burden when it creates so much employment and economic activity through rebuilding? It's a terrible thing to equate all economic activity with a given dollar value as equally good.

There's a few different kinds of economic activity, and they aren't equally good for society... There's activity that arises due to innovation and improves people's lives in one way or another. Let's call this 'positive' activity; it covers things ranging from inventing smartphones to finding cures for cancer.

And there's things like the hurricane example, where there's massive work done to get things back to where they were before the disaster. If the disaster were avoidable, this means a lot of work not being put into 'positive' economic activity. It's still positive in a sense, though, since it's moving things back towards where they were after a negative impact. So let's call that 'neutral' economic activity.

Finally, there's corruption, in which rent-seeking rent-seekers seek rent by skimming money off of other kinds of necessary activity. It drives up costs without providing actual improvement of anyone's life except for the person skimming the money. Let's call this 'negative' economic activity.

(And then there's the possibility of paying people to blow shit up; you simultaneously remove people's possibilities of progress by killing them and destroying their economic base, and also remove your assassins, soldiers, and weapons researchers from participating in positive activities. I count this as negative, too, but that's just me....)

Health-care in the US suffers from very high levels of corruption. Legal corruption, yes, since the rules were set up by the groups involved in the corruption schemes. The whole insurance industry is a sham, predicated on employing lots of people to deny care to people who need it. This is actively destructive to the livelihoods of the patients, and, as was discussed above, the costs of health-care due to corruption are so bad that it's a real limit on the creation of new companies: ie, innovation. Decent health care reform would indeed put a lot of people out of work by making massive departments within the insurance departments unnecessary. But then those people could get jobs int he new companies that can now come into being without the terrible burden of the health insurance problem, and in those jobs (hopefully) do work that isn't just making other people's lives hell.

Another area that seems like it could seriously use reform is malpractice insurance. Again, it's a form of insurance that drives up costs incredibly, and could easily be replaced by some laws saying that (a) people can't sue for malpractice, since it's assumed that any doctor is human and operating in good faith, and (b) empowering doctor boards to examine complaints of malpractice and possibly strip doctors of their ability to practice if they're deemed to be dangerously incompetent and/or not actually operating in good faith. (And just require further training for grey cases, perhaps.) Such reform removes the necessity of an insurance industry, reduces the cost of health care, and thus makes people on average healthier. And again forces people in a parasitic industry to go looking for work.
posted by kaibutsu at 7:40 AM on June 29, 2012 [7 favorites]


I think most people in the US who favor a sane health care system (ie single payer) are aware that it would gut an entire industry (private health insurance) and put at least hundreds of thousands of people out of work -- lots of people in health insurance and almost everyone currently working in medical billing.

I favor single payer and I'm aware of that consequence. I also favor a drastically simpler (but still progressive) tax code and the availability of pre-filled tax forms despite the fact that it would gut an entire industry (tax preparation) and significantly harm another (accounting). I don't care. Those positions are just inefficient make-work made possible by bad laws and economic structures. We'd be better off raising taxes and paying for them to be retrained.

If an instantaneous transition would be too much of a shock to the economy, then we can phase in the change. For example, the government could put a random 10% of the population into the single payer pool each year for ten years. Or it could put everyone below X times the poverty line into it and raise X each year until everyone was covered. There are ways to solve these problems in a controlled, gradual manner.
posted by jedicus at 7:46 AM on June 29, 2012 [11 favorites]


How is a hurricane a burden when it creates so much employment and economic activity through rebuilding? It's a terrible thing to equate all economic activity with a given dollar value as equally good.

Yes, specifically this is the broken window fallacy in economics.
posted by jedicus at 7:47 AM on June 29, 2012 [3 favorites]


kaibutsu: How is a hurricane a burden when it creates so much employment and economic activity through rebuilding?

I agree with everything you're saying, which makes me think I must have said something badly.

As far as I can tell care for the elderly (the original example I was referring to) isn't like the hurricane example, or am I missing something?
posted by lith at 7:57 AM on June 29, 2012


As far as I can tell care for the elderly (the original example I was referring to) isn't like the hurricane example, or am I missing something?

Care for the elderly is different. The issue is how that care is accomplished. We pay too much for what we get, often to unnecessary middlemen. Other countries have equally good or better end-of-life care (in terms of quality-adjusted life years) for far less money. The fact that we're spending more isn't getting us more, and what's worse is that a lot of the money is spent on inefficient paper-shuffling.

There are other issues with American end-of-life care as well, like the fact that doctors don't really have frank and realistic discussions with patients and families about things like whether continued therapy is preferable to palliative care and how death is going to play out, both over the course of months/weeks and right at the end.
posted by jedicus at 8:11 AM on June 29, 2012 [2 favorites]


If an instantaneous transition would be too much of a shock to the economy, then we can phase in the change.

Which is a fair argument to make. But it's certainly a reason why the change had to be gradual. Our situation would have been different if it were 1950 when health care made up a much, much smaller fraction of our GDP.

Of course, this is what I don't understand about opposition to the ACA-- it's such a minor change to the point where people like me (employed and insured through a large employer) aren't going to see much of a difference at all.
posted by deanc at 8:15 AM on June 29, 2012


lith: "Sticherbeast: I'm now picturing a universe much like the Ian McKellan Richard III, except with 2006-era Gwen Stefani in the title role.

I was in that! (as a nazi extra).
"

HALT! THE VON TRAPPS!
posted by symbioid at 8:25 AM on June 29, 2012


Jedicus, that the majority joined or didn't join a certain part of Robert's opinion doesn't determine whether it's dicta. Of course, there must be a majority for a point for it to be precedent. That's clear. But the commerce clause discussion was not necessary to reach the conclusion that the taxing authority made the law constitutional. Therefore, dicta.

Often, judges will consider numerous alternative theories as to why a law should be upheld or not, and will focus their opinions on the one that works, saying that they have no need to consider the other theories.
posted by benbenson at 8:30 AM on June 29, 2012 [1 favorite]


lith: "MCMikeNamara: "Just when I thought this day couldn't get any better, this caused me to imagine Elena Kagan hitting Scalia with a folding chair."

That would never happen. Elena Kagan is obviously a technico.
posted by Deathalicious at 8:47 AM on June 29, 2012


edgeways: "for the love of dog, please I implore you folks to not devolve into another fucking Nader is/isnot responsible for Bush winning "discussion"."

The reason Bush won in Florida was not because of Nader. He won because of bad user interface design.
posted by Deathalicious at 8:49 AM on June 29, 2012


I favor single payer and I'm aware of that consequence.

Yes, me too, and I didn't mean to imply otherwise. I certainly didn't mean to imply that putting those people out of work, until they find something else to do, is a bad thing. Putting those people out of work is in large part the point, just as putting telemarketers out of work (as telemarketers) was in large part the point of the do not call list.

My point was that we're already willing to throw this multitude of middle-class jobs into the meat grinder, because everyone would be better off if people could get health care and if those people were doing something actually useful instead of either trying to prevent people from receiving health care or engaging in combat with that first group. You think we're going to cry because physicians might earn a bit less?
posted by ROU_Xenophobe at 8:52 AM on June 29, 2012 [4 favorites]


But the commerce clause discussion was not necessary to reach the conclusion that the taxing authority made the law constitutional. Therefore, dicta.

Sounds like you had your mind made up already, so why ask the question?

There are many different kinds of dicta. You're describing one kind, I'm describing another. And I'm not the only lawyer in the room who considered it dicta for the reason I did, so it's not as though it's a particularly unusual line of reasoning.

Anyway, you're arguably wrong on your own terms:
It is only because the Commerce Clause does not authorize such a command that it is necessary to reach the taxing power question. And it is only because we have a duty to construe a statute to save it, if fairly possible, that §5000A can be interpreted as a tax. Without deciding the Commerce Clause question, I would find no basis to adopt such a saving construction.
(emphasis added)
posted by jedicus at 8:55 AM on June 29, 2012


Maryland Gov. Martin O’Malley (D) accused Republicans of hypocrisy for pairing protests against a health care mandate with demands for increasingly invasive restrictions on women’s health.

The only health care mandate they can embrace are transvaginal probes for women,” O’Malley said Friday during a press call.

posted by madamjujujive at 8:59 AM on June 29, 2012 [18 favorites]


madamjujujive: " “The only health care mandate they can embrace are transvaginal probes for women,” O’Malley said Friday during a press call."

More of this, please.
posted by tonycpsu at 9:05 AM on June 29, 2012 [1 favorite]


How do they not notice how much of that expense goes towards supporting this army of unnecessary middlemen?

How is it possible that these middlemen are unnecessary ?

The invisible hand of the free market means that the these private, non-government entities must be the most efficient at what they do or they could not survive. Therefore any men, middle or otherise, employed by these entities must be necessary for the efficient operation of the company - or they would be fired.

QED.
posted by Pogo_Fuzzybutt at 9:06 AM on June 29, 2012 [2 favorites]


The invisible hand of the free market means that the these private, non-government entities must be the most efficient at what they do or they could not survive.

The invisible hand of the free market is also ensuring that the Kardashians continue to have a career.

I wouldn't trust this invisible hand further than I could throw it.
posted by EmpressCallipygos at 9:11 AM on June 29, 2012 [9 favorites]


The reason Bush won in Florida was not because of Nader. He won because of bad user interface design.

Multiple causes propelled Bush to the Presidency for that term.

How is it possible that these middlemen are unnecessary ?

notsureifserious.jpg
posted by Sticherbeast at 9:16 AM on June 29, 2012


The invisible hand of the market, like any evolutionary system, operates based on survival criteria.

In this case, we are talking about the private insurance system. That system's evolution and success is predicated on making it very very simple for premiums to be paid in, and making it very very hard for benefits to be paid out.

The invisible hand is working perfectly; the middlemen are there to come up with reasons why benefits should not be paid, why benefits are too high, why your policy is wrong, why your policy should be canceled, why that procedure is unnecesary, why that doctor is wrong, why that clinic is not covered, thousands of reasons why benefits should NOT be paid.

This is the operation of the invisible hand of the market.

It is punching you in your inflamed appendix, over and over, while signing "fuck you! pay me!" And we pay it, because the alternative is no treatment at all.
posted by seanmpuckett at 9:22 AM on June 29, 2012 [12 favorites]


And it's helped along by the all-too-visible hand of health insurance being tied to employment, which makes it impossible to shop around for plans because you instead get whichever one your workplace decides you get, and the people making those decisions often don't have to deal with their consequences. Hell, even in the really bad situations, people who've had problems with health insurance usually don't take their complaints to their employer. They go to the insurer, who has no reason to listen because you aren't their customer.

The system is fundamentally broken.
posted by Holy Zarquon's Singing Fish at 9:31 AM on June 29, 2012 [3 favorites]


Health care in the US is a terrible example of the invisible hand, as health care is already rife with "the submerged state" of the government's intervention. Regardless, the invisible hand is a model, a construct. It is not a moral or natural imperative, and it does not always produce the best results, nor even the most efficient results.
posted by Sticherbeast at 9:31 AM on June 29, 2012 [6 favorites]


Pogo has erred only in failing to attach a graph a fifth-grader would scorn to his masterly précis!
posted by winna at 9:35 AM on June 29, 2012


Pogo_Fuzzybutt: "
The invisible hand of the free market means that the these private, non-government entities must be the most efficient at what they do or they could not survive. Therefore any men, middle or otherise, employed by these entities must be necessary for the efficient operation of the company - or they would be fired.
"

Not sure if you're taking the piss, but the problem is that the raison d'être for insurance companies is *not* the delivery of health care. It's to make money on the float between premiums paid in and healthcare paid out. Any profit from paying out less is bonus. And, at this, insurance companies are highly effective--and all those middle men and claim-deniers are useful to that goal.

OTOH, if the goal is actual health care, those middlemen and claim deniers are chaff...
posted by notsnot at 9:35 AM on June 29, 2012 [2 favorites]


Protip: The QED at the end is the key to unlock the snark!
posted by symbioid at 10:10 AM on June 29, 2012 [1 favorite]


We may well be talking at cross-purposes though.

I think I may have accidentally missed the context of your original remark; sorry about that if so.

posted by saulgoodman at 10:15 AM on June 29, 2012


the all-too-visible hand of health insurance being tied to employment, which makes it impossible to shop around for plans because you instead get whichever one your workplace decides you get

And the rise in part-time employment or use of temporary workers makes it even harder for people to get employer-based health insurance, since people get scheduled for a number of hours just shy of the magical number where they'd be eligible for employer-based coverage (or one's shifts get cancelled, or the hours change from pay period to pay period so it can never be argued that you work a "regular 20-hour week" since you might work 15 hours one week and 25 the next).
posted by catlet at 10:18 AM on June 29, 2012 [2 favorites]


Bobby Jindal unwittingly summed up Republicans' problems in attacking President Barack Obama's health care reform with one slip of the tongue.

“There’s only one candidate, Governor Romney, who’s committed that he will appeal the Obamney, the Obamacare tax increase,” Jindal told reporters on a conference call arranged by the Republican National Committee.
posted by Golden Eternity at 10:21 AM on June 29, 2012 [5 favorites]


Jedicus, I definitely lean towards the idea that it's dicta, but I wanted to solicit other opinions.

Anyway, you're arguably wrong on your own terms:

It is only because the Commerce Clause does not authorize such a command that it is necessary to reach the taxing power question. And it is only because we have a duty to construe a statute to save it, if fairly possible, that §5000A can be interpreted as a tax. Without deciding the Commerce Clause question, I would find no basis to adopt such a saving construction.


Isn't this just Roberts saying that he considered the CC to be the "first" decision? That is to say, how is it logically true that the tax authority decision couldn't have been reached without the CC decision?
posted by benbenson at 10:21 AM on June 29, 2012


That is to say, how is it logically true that the tax authority decision couldn't have been reached without the CC decision?

Because the Commerce Clause argument was the primary argument:

"Because the Commerce Clause does not support the individual mandate, it is necessary to turn to the Government’s second argument: that the mandate may be upheld as within Congress’s enumerated power to “lay and collect Taxes.”"

Here is the key question in the case:

"Does the Affordable Care Act's mandate that virtually every individual obtain health insurance exceed Congress's enumerated powers"

In order to decide that question, the Court had to consider the arguments made by the parties. The Commerce Clause argument was the primary argument briefed and argued by both sides. So the Court had to decide that argument in order to answer the question of the constitutionality of the mandate.

While the Court's decision on the Commerce Clause did not control the outcome of the case, it was still a necessary part of the decision.
posted by jedicus at 10:57 AM on June 29, 2012


So the Court had to decide that argument in order to answer the question of the constitutionality of the mandate.

No, because the tax issue had also been briefed. For all the rhetoric about it having been a backup argument, it was still an argument and it was very much in play.
posted by Sticherbeast at 11:01 AM on June 29, 2012 [1 favorite]


You think your insurance company pays the nicer clinics more?

No, but I think that the better your insurance, and the more it pays to doctors, the more likely nicer doctors are to take that insurance. All doctors will take the nice insurance, but the more expensive doctors won't take the not-awesome insurance.


Honestly though, the entire system of healthcare insurance is broken, if only because it is not really "insurance." And sometimes it tries to act like insurance (refusing to take your bets if you're a bad risk) and sometimes it acts like a pay-for-play situation. And because it's neither one nor the other, that's where it gets all messed up.
posted by corb at 11:04 AM on June 29, 2012 [1 favorite]


No, because the tax issue had also been briefed.

Well, Roberts repeatedly said it was necessary to address the Commerce Clause argument first and that the tax argument was only addressed because a) the Commerce Clause argument failed and b) the Court had an obligation to try to save the statute if it could. I suppose you can argue that the Chief Justice is wrong about that, but I'll defer to him on the issue.
posted by jedicus at 11:06 AM on June 29, 2012


I think that there's some confusion about the definition of dicta. The commerce clause discussion was dicta because while it might have been in play, discussed briefed, talked about, etc. It was not the thing that decided whether or not the ACA was upheld. So while we all thought the question was whether or not ACA was constitutional under the commerce clause, the supreme court answered a different question and arrived at the conclusions it did. Its hard, especially when there are plurality opinions to separate the wheat from the chafe, but by not answering the question of whether this was constitutional under the commerce clause, ie by not making that the deciding issue the SCOTUS relegated that question to dicta. If someone came along with something that was somehow not construed as tax now (i'm having trouble coming up with a metaphor), but asked the same specific commerce clause question the 9 judges would not be bound by this decision.

Of course arguing about what is and is not dicta is what the entire field of supreme court litigation is all!

However it does seem that there are 5 votes on the court for limiting the commerce clause - that's where i'd put my money right now; but no justices are bound by that, and whether 'limit' is the right construction is of course disputable...
posted by goneill at 11:08 AM on June 29, 2012


ArtW: Healthcare Reform: Why today’s Supreme Court ruling is great news for startups

I am amazed that amongst all the Sturm und Drang surrounding this law, how this sleek and fucking killer feature of it (I imagine it like an anti-gravity engine buried deep within the superstructure nobody seems to notice is there red lights blinking with untapped economic RPM's and turbo-charged horsepower is so often overlooked. This should be a bloody fucking BOOM for that individual who's mastered a knowledge of skill area and wants to finally go solo and be there own boss (or at least get paid as such) or has an idea, but wouldn't risk being without insurance for him/herself and family, and in turn a boom for wealth creation and small business creation and job creation.

I swear. We get an economic lift from finally, as a nation, allowing people to move more freely through the so called "free-market" and I'm going to kick the first Tea Bagger I find in the real world or online (metaphorically speaking that it) in the teeth, with that information.

Oh the irony and beauty of it, if that indeed begins to happen, will be too sweet.

In other news: Fuck. How about that John Roberts, eh?
posted by Skygazer at 11:09 AM on June 29, 2012 [8 favorites]


jetlagaddict: "The cost per visit, including bloodwork, is multiple hundreds, sometimes close to a thousand. "

Sounds like you need to find yourself a doctor in the Dominican Republic. For the price of health care here (obviously, this isn't helpful for emergency care) you can get the health care you need and a beach vacation, including airfare. The system is clearly completely broken. It costs about $75 to get the bloodwork done and get the checkup/consult from the doctor. And everybody but the doctor him/herself comes to you.

Deathalicious: "The reason Bush won in Florida was not because of Nader. He won because of bad user interface design."

Well, he won because it was decided it would be too much trouble to count all the votes, and the subset which were allowed to be counted happened to favor Bush. Later work showed that under a full statewide recount, Gore would have won by at least a thousand votes.
posted by wierdo at 11:11 AM on June 29, 2012


The commerce clause discussion was dicta because while it might have been in play, discussed briefed, talked about, etc. It was not the thing that decided whether or not the ACA was upheld.

That's true, but it is also true that the Commerce Clause issue had to be decided in order to get to the issue that did determine whether or not the ACA was upheld. Since according to the Chief Justice it was a necessary part of the decision, I think it would not have been dicta if Scalia et al. had joined that part of the opinion. It is only because they didn't that the Commerce Clause discussion (both Roberts's and Scalia's) is dicta.
posted by jedicus at 11:14 AM on June 29, 2012


You think your insurance company pays the nicer clinics more?

I actually agree with your point, but insurance companies do generally pay "nicer" providers more. Each physician/provider negotiates a rate, and part of that negotiation is customer satisfaction. If people are more satisfied with a provider, the insurance company is more prone to pay the provider a higher rate. It sucks that it stays the same for every one of the insured across the board, but that's (supposed to be) the point of having a network of providers -- keep the cost of care down AND the quality of care up.

The system is so fucked that it isn't generally the case, but (fingers crossed) the health care exchange should make health insurance the way it's been idealized by those who support it.
posted by MCMikeNamara at 11:16 AM on June 29, 2012 [1 favorite]


Thanks. [themoreyouknow.jpg]
posted by ROU_Xenophobe at 11:18 AM on June 29, 2012


notsureifserious.jpg

Yes, I was snarking. Sometimes, my humor is a little too on the nose, I think.

I giggled, though. Sorry.


What I find most interesting about this is how far behind the curve the right wing noise machine is on the decision. They were really caught flat-footed by it.

It's sort of amusing to see the various reactions. They just don't know what to do with themselves over this and hadn't really prepared for it.
posted by Pogo_Fuzzybutt at 11:48 AM on June 29, 2012 [1 favorite]


jedicus: It is only because they didn't that the Commerce Clause discussion (both Roberts's and Scalia's) is dicta
I have trouble believing any federal judge will contradict this opinion on that ground alone. If ever a court differs from this opinion in its interpretation of the Commerce Clause, the failure of a majority to join will be mentioned, but so will the fact that the law was upheld on other grounds, and that the Court really need not have decided anything about the Commerce Clause to decide that. It will be deemed "dicta" for every reason the contradicting court can marshal to call it so. And anyone briefing the issue will certainly point out the fact that this case was decided under the taxing power.
posted by dilettanti at 11:56 AM on June 29, 2012 [1 favorite]


and that the Court really need not have decided anything about the Commerce Clause to decide that

Again, the Chief Justice said otherwise.

A hypothetical: suppose, all else being the same, that the Scalia dissenters had joined Roberts on the Commerce Clause issue. Is that now a binding holding that the Commerce Clause cannot reach inactivity or is it still dicta?
posted by jedicus at 12:27 PM on June 29, 2012


jedicus, Justice Roberts said it's a tax even though the politicians didn't call it a tax. We're saying that the commerce clause argument was dicta even though Justice Roberts doesn't call it dicta. Besides Justice Roberts' say-so, what made the commerce clause argument necessary to decide before tackling the tax authority argument?
posted by benbenson at 12:48 PM on June 29, 2012


Seriously, what is going to stop people now from going out and getting pre-existing conditions, [...] diabetes, leukemia, cancer, leopardsy?

IF THERE IS A DISEASE THAT TURNS ME INTO A LEOPARD YOU TELL ME HOW TO GET IT
YOU TELL ME RIGHT NOW
posted by lholladay at 12:49 PM on June 29, 2012 [16 favorites]


I'm wondering how likely it is that all these Republican governors will follow through on their claims that they won't approve the expansion of Medicaid in their state. Link

Because my state's governor is one of them and it really freaks me out.
posted by ephemerista at 12:58 PM on June 29, 2012 [1 favorite]


Leopardsy exists, but you have to be born with it.

The rate of transmission in utero is close to 100%, though.
posted by Holy Zarquon's Singing Fish at 1:07 PM on June 29, 2012 [1 favorite]


Besides Justice Roberts' say-so, what made the commerce clause argument necessary to decide before tackling the tax authority argument?

The two sentences before my earlier quotation, together with that quotation:

"JUSTICE GINSBURG questions the necessity of rejecting the Government’s commerce power argument, given that §5000A can be upheld under the taxing power. Post, at 37. But the statute reads more naturally as a command to buy insurance than as a tax, and I would uphold it as a command if the Constitution allowed it. It is only because the Commerce Clause does not authorize such a command that it is necessary to reach the taxing power question. And it is only because we have a duty to construe a statute to save it, if fairly possible, that §5000A can be inter- preted as a tax. Without deciding the Commerce Clause question, I would find no basis to adopt such a saving construction.

In other words, you can't go straight to the tax power argument because it's not presented as a tax. You can only get to it as a tax as a last-ditch effort to save the statute, as required by long-established constitutional law principles. So before you can get to it as a tax, you first have to demonstrate that it is unconstitutional when taken at face value (i.e. as an exercise of the Commerce Clause).
posted by jedicus at 1:22 PM on June 29, 2012 [1 favorite]


It's to make money on the float between premiums paid in and healthcare paid out.

Exactly, per this earlier comment. Insurance companies are not interested in anything but protecting their investment. To believe that they have any interest in customer service or patients is to not know how insurance companies work. They are gamblers like Wall Streeters are gamblers, except that they have much more power at their disposal on how much to collect versus pay out again.

One thing that hasn't yet been discussed here is how the price of healthcare costs demonstrate the problem of cost-shifting.

Doctors and hospitals are really backed into a corner here. As a previous commenter noted, the ones who can afford to do it (and still have enough paying patients to sustain their practice) refuse to accept any insurance at all. All patients must pay out of pocket. Not all doctors can afford to do that nor feel comfortable doing that. You have to brave the weeping of many a patient who you know and have treated when you break the news, and it can be heart breaking for people who got into the profession to care for people (not just be a cog in the machine). If you can't find enough patients who can afford to pay you out of pocket, your practice goes under.

So I have a treatment, let's say a specific type of examination, that costs me $100 to administer. Over time, the negotiations with various insurance companies mean that I can sometimes collect $100 for that exam, but other times I can only collect $75 or even just $50. I don't break even, I lose money in order to keep the patients that I have through that company and I hope that I make it up the difference on other services that I negotiated payments for. Or the insurance company is horrific about paying me on time (or at all!) So even though I get paid the $100, it is months between when my patient gets the exam and when I see the money. In the meantime, I have to cover that gap myself when I pay my staff, my rent, my malpractice premiums, etc.

In order to cover more of the gap, I end up put a price tag on that exam of $200 and hope that the few times I actually get paid more than $100 makes up for the losses elsewhere. And this keeps happening. Over and over.

Each insurance company has its own set of stringent standards, software and interfaces for filing and receiving payment for claims. (And yes, they don't want to make it easy or fast for providers to get paid.) I used to have one claims administrator in my practice back in 1984. Now I have 4 of them, all who are trying to sort through these complex and confusing ways of billing providers, trying to get paid, and trying to answer patient questions/solve problems. And then escalating malpractice insurance costs. My overhead has exponentially grown.

At the not-for-profit hospital nearby, they can't turn away the indigent or uninsured. And the insured often have discounted to the bone rates. So who pays for their treatment? The insured. Perhaps the ER charges $200 or even $400 for each procedure, because only 1 in 4 patients pays close to the real cost of the procedure. The extra covers the cost of what everyone else is not paying.

The prices aren't high just because providers want to gouge people. The prices are high, in part, because this isn't a "free market". If it were a free market, any doctor or hospital would easily and without regret or liability, turn those away who can't pay. And we wouldn't even have health insurance. That doesn't happen (thank God). Medical care is not like getting the dent in your car from an accident repaired, or buying a TV. As much as the Libertarians would love to believe that Rand could have had the choice of going to see a doctor for her amputation or going at it herself with some whiskey, a saw, and some rubber tubing.

Sorry this is a bit rushed...3 year old woke up from nap. But you get the picture hopefully.
posted by jeanmari at 1:31 PM on June 29, 2012 [3 favorites]


Ugh, and when I said "I have 4 of them...", I meant the imaginary "doctor me" who I was using as an example. Not the real me. Obviously. I hate the sight of blood.
posted by jeanmari at 1:34 PM on June 29, 2012


> No, because the tax issue had also been briefed. For all the rhetoric about it having been a backup argument,
> it was still an argument and it was very much in play.
> posted by Sticherbeast at 2:01 PM on June 29 [1 favorite +] [!]

Is the court limited to considering the arguments presented to it? What's the outcome if the government's case had been "This law is constitutional because underpants, or alternatively because it's turtles all the way down" and the justices found neither of these arguments convincing?
posted by jfuller at 4:42 PM on June 29, 2012


IF THERE IS A DISEASE THAT TURNS ME INTO A LEOPARD YOU TELL ME HOW TO GET IT
YOU TELL ME RIGHT NOW


It's not transmissible, it's only hereditary. That's why Jason didn't turn into a werepanther.
posted by homunculus at 5:02 PM on June 29, 2012 [1 favorite]


Is the court limited to considering the arguments presented to it?

In the US, pretty much yes. Courts will sometimes take up an unargued position sua sponte, but it's uncommon and usually results in grumbling from dissenting judges.

It's a key part of the adversarial system. The theory is that the best result comes from having all sides put their best arguments forward. If the judge is just going to come up with their own basis for a decision, then what's the point in having the sides argue their position in the first place?

What's the outcome if the government's case had been "This law is constitutional because underpants, or alternatively because it's turtles all the way down" and the justices found neither of these arguments convincing?

Hard to say. If the challengers had given legitimate counter-arguments (e.g. about the Commerce Clause and the tax power), then the Court might have reached the same result by simply disagreeing with the challengers rather than agreeing with the government. If the challengers only argued against the underpants/turtles theories, then who knows how it would have turned out except that both sides would have been admonished and the Court would have been forced to come up with something on its own. An example of this may be found in Bradshaw v. Union Marine:
Before proceeding further, the Court notes that this case involves two extremely likable lawyers, who have together delivered some of the most amateurish pleadings ever to cross the hallowed causeway into Galveston, an effort which leads the Court to surmise but one plausible explanation. Both attorneys have obviously entered into a secret pact—complete with hats, handshakes and cryptic words—to draft their pleadings entirely in crayon on the back sides of gravy-stained paper place mats, in the hope that the Court would be so charmed by their child-like efforts that their utter dearth of legal authorities in their briefing would go unnoticed. Whatever actually occurred, the Court is now faced with the daunting task of deciphering their submissions. With Big Chief tablet readied, thick black pencil in hand, and a devil-may-care laugh in the face of death, life on the razor's edge sense of exhilaration, the Court begins.
It goes on like that for a while (I recommend reading it), and in the end the court holds:
Now, alas, the Court must return to grownup land. As vaguely alluded to by the parties, the issue in this case turns upon which law—state or maritime—applies to each of Plaintiff's potential claims versus Defendant Phillips. And despite Plaintiff's and Defendant's joint, heroic efforts to obscure it, the answer to this question is readily ascertained.
And from there the court cites to various relevant cases that neither party had cited.
posted by jedicus at 6:19 PM on June 29, 2012 [6 favorites]


IF THERE IS A DISEASE THAT TURNS ME INTO A LEOPARD YOU TELL ME HOW TO GET IT
YOU TELL ME RIGHT NOW


It's no good, you can't go changing your spots.
posted by maryr at 6:41 PM on June 29, 2012


ob1quixote - Lawrence O'Donnell's Rewrite from the other night quotes the section of the A.C.A. that specifically forbids the IRS from punishing people for not paying the tax penalty:
(A) Waiver of criminal penalties
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
(B) Limitations on liens and levies
The Secretary shall not—
(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
(ii) levy on any such property with respect to such failure.


So, uh. This is weird, right? This is a really weird thing to have in this law.
posted by jason_steakums at 6:44 PM on June 29, 2012


It would be automatically taken out of a refund if you have one though.
posted by furiousxgeorge at 6:52 PM on June 29, 2012


Yeah, and the refund thing is a big deal because lots of people treat their tax refund as a "savings" they are "forced" to do, and that windfall really drives the sales of boats and new cars. Hardly anybody structures their withdrawals so that they *pay* at tax time. Of course anybody could do that, but then if you figure wrong you have to be ready to write a check in April. Most people take the "conservative" let them pay me back course. And under ACA, if you don't have health insurance, it's taken out of your refund.

Frankly I think it's both fair and brilliant, considering the powers that were in hand.
posted by localroger at 7:16 PM on June 29, 2012 [2 favorites]


Oh, ok. That makes way more sense.
posted by jason_steakums at 7:37 PM on June 29, 2012


Koch-backed group launches $9 million ad campaign against health law
The announcement by Americans for Prosperity (AFP), which is largely funded by the conservative Koch brothers, comes one day after the Supreme Court ruled to uphold the vast majority of the law in a major coup for Obama.

"While we are deeply disappointed in the Supreme Court ruling," AFP President Tim Phillips said in a statement, "this is far from over."



Mississippi Tea Party Chairman Calls For Open Rebellion Against Federal Government After Obamacare Ruling
posted by madamjujujive at 5:15 AM on June 30, 2012 [2 favorites]


More talk of armed rebellion
posted by Flunkie at 7:27 AM on June 30, 2012 [1 favorite]


Armed rebellion from with wingnuts? Bring it on. There is little to distinguish the base ideology of the Tea Party cranks from the Christan Patriot militias of the 1990s. The militias got slowly eroded by the steady presence of snitches and informants. What ultimately capped them off was the Y2K panic.

What was previously the domain of militant white supremacists and anti-abortion terrorists has now become mainstream thanks to financial infusion of astroturfing funds.

Let them get mouthy. It's a dead end. They either end up in jail, broke, or dead in suicide-by-cop incidents.

It all looks like mouthiness to me. In the 1990s' the critical incident that served as an advance marker was vehicle stop shootings: wingnut gets pulled over for minor traffic violation and come out the car shooting.

All things considered, the amount of right-wing domestic terrorism is abnormally low. My guess is they are spending too much time overeating while watching Fox News.
posted by warbaby at 10:07 AM on June 30, 2012 [3 favorites]


I wonder how many poor Republicans facing bankruptcy from medical debt could have been helped with that $9 million.

What's Latin for "fuck you, got mine", again? Because that's what should be printed on our money.
posted by palomar at 10:49 AM on June 30, 2012 [1 favorite]


So.... how many states are going to fuck over their poor on the Medicaid thing out of sheer spite?
posted by Artw at 10:50 AM on June 30, 2012


Mississippi Tea Party Chairman Calls For Open Rebellion Against Federal Government After Obamacare Ruling

Tea Party “treason”: What powers should the president have against those who advocate open, violent revolt against the U.S. government?
posted by homunculus at 10:53 AM on June 30, 2012


The overheated rhetoric coming from the racist and reactionary right gets a blind eye from law enforcement. With the exception of the Ft. Smith trial, the sedition laws haven't been applied to white people.

Now if you aren't white, it gets used all the time.

This would probably be a good moment to reflect on Thomas Jefferson's "Tree of Liberty" letter. In this letter, Jefferson justifies the use of federal troops to violently put down Shea's Rebellion. It is in this context that he wrote:
What country before ever existed a century & a half without a rebellion? & what country can preserve it's liberties if their rulers are not warned from time to time that their people preserve the spirit of resistance? Let them take arms. The remedy is to set them right as to facts, pardon & pacify them. What signify a few lives lost in a century or two?


When the wingnuts get too far out of line, they should be reminded of the Deacons for Defense and Justice.
posted by warbaby at 12:31 PM on June 30, 2012


What signify a few lives lost in a century or two?

Wow. I was just looking up with some pride at Jefferson's statue in the memorial on the national Mall a few months ago and -- just wow.
posted by localroger at 12:48 PM on June 30, 2012


warbaby: “The overheated rhetoric coming from the racist and reactionary right gets a blind eye from law enforcement. With the exception of the Ft. Smith trial, the sedition laws haven't been applied to white people. Now if you aren't white, it gets used all the time.”

Er – do you have a citation for that? I can't stand the Alien and Sedition acts, personally, but I don't think what you've said is correct. I mean, even the Wikipedia link you give contradicts the notion that sedition laws haven't been used against white people: "On March 28, 2010, nine members of the militia Hutaree were arrested and charged with crimes including seditious conspiracy." They sure look white to me. And, while I'm inclined to believe that these laws are probably applied in a racially lopsided manner, I can't find a single instance of them being applied to people who weren't white. Even Laura Berg was white.
posted by koeselitz at 1:05 PM on June 30, 2012 [2 favorites]


(I guess you mean none of those white people were actually convicted of sedition – although I think it's clear the law was used against them, it is true no conviction for sedition came in those cases. However, I still can't find an example of sedition laws being used against non-white people. Usually the cops find other stuff to pin on non-whites, it seems to me.)
posted by koeselitz at 1:09 PM on June 30, 2012


Scott Horton: Our Politicized Judiciary
posted by homunculus at 1:12 PM on June 30, 2012 [1 favorite]


Omar Abdel-Rahman was the first use of the seditious conspiracy law after Ft. Smith. He is also one of the few ever convicted. See Two Seconds Under the World for more about the trial.

Back in the mid-1990's, when we were dealing with the militias, the sedition laws were never used. Prosecutorial discretion and all that.
posted by warbaby at 1:17 PM on June 30, 2012


Ah, here's more about the specific federal statute.
posted by warbaby at 1:23 PM on June 30, 2012


Well, I don't think it was "prosecutorial discretion," then. Or maybe I should say – it was prosecutorial discretion, but it was a good case of the right kind of discretion. Your Wiki link states that the Feds have never won a sedition case against far-right types. If I were a prosecutor, I would hesitate to bring a case I wasn't likely to win.

Also, I haven't found a list of people who have been charged with (not convicted of) sedition. I have a hard time believing that nobody was charged with sedition through the entire 1990s except Omar Abdel-Rahman, but I guess that is possible.
posted by koeselitz at 1:28 PM on June 30, 2012


I can tell you from personal experience that law enforcement will not intervene in cases of right-wing domestic terrorism until a serious crime of violence has occurred.

Sedition, conspiracy and misprision are about the only tools available to prevent (as opposed to react to) domestic terrorism. The far right gets a free pass all the time.

The same goes for right-wing subversion in the military. There are a tiny handful of people in CID who worry about this and lots and lots willing to look the other way.
posted by warbaby at 2:15 PM on June 30, 2012


U.S. healthcare is too costly for Kevin Steinman, so he's moving to Norway
posted by homunculus at 2:40 PM on June 30, 2012 [2 favorites]


Lucky man; wish I could join him.
posted by adamdschneider at 9:06 PM on June 30, 2012


There is nothing more annoying than people in power complaining about people talking about armed rebellion, while supporting other people who advocate armed rebellion.

For example: multiple commentators in threads all over the place here who argue that the rich need to pay taxes to avoid being killed by angry revolutionaries. No one advocates that those people are treasonous. Or the people during the Bush administration who kept arguing that armed rebellion would be the answer to his right-wing ways.

Advocating armed rebellion or extremism is either treasonous or it's not. It doesn't become treasonous by being either right wing or left wing.

The same goes for right-wing subversion in the military. There are a tiny handful of people in CID who worry about this and lots and lots willing to look the other way.

This also goes for left-wing subversion in the military. I can assure you, it is exactly the same. Pretty much, the military doesn't care what you're doing, as long as you don't intend to work against the military itself.
posted by corb at 9:33 AM on July 1, 2012 [1 favorite]


Legitimacy != legality
posted by fleacircus at 11:34 AM on July 1, 2012


Charts: The Supreme Court's Rightward Shift. Before the Obamacare decision, the Roberts court was on its way to becoming the most conservative in decades. (It still is.)
posted by homunculus at 11:50 AM on July 1, 2012 [3 favorites]


For example: multiple commentators in threads all over the place here who argue that the rich need to pay taxes to avoid being killed by angry revolutionaries.

The big difference is that Lefties who use this rhetoric are only very rarely advocating such revolt; they are warning that the lesson of history is ominous. Righties tend to be brandishing the pitchforks and torches themselves as they talk of insurrection. Left-wing violent extremism went out of fashion in the 1970's. But the bombing of women's clinics, sending fake anthrax to climate scientists, and non-metaphorical lynching of people who are too open about their sexuality are happening today.
posted by localroger at 12:55 PM on July 1, 2012 [7 favorites]


This is a remarkable report by Jan Crawford, crediting inside sources for information that Roberts switched his vote midway through the process. I can't remember a similar breach of the Court's confidentiality so immediately after a decision.
posted by chinston at 1:45 PM on July 1, 2012


CBS has an interesting story out with more details on the theory that Roberts switched his decision after initially siding with conservatives to strike down the mandate.

Also, re:homunculus's link to that great Mother Jones piece analyzing the data behind the Court's rightward shift -- this chart is hilarious.
posted by Rhaomi at 1:45 PM on July 1, 2012 [1 favorite]



This is the first time in Roberts' 7 years on the court that he has sided with the liberal justices in a 5-4 decision. Talk about better late than never!

It strikes me that we may indeed have Bush to thank for this, but not necessarily George W.

Till 2020 would be an awfully long time for Jeb to wait.
posted by jamjam at 2:12 PM on July 1, 2012 [1 favorite]


There is nothing more annoying than people in power complaining about people talking about armed rebellion, while supporting other people who advocate armed rebellion.

corb, one of the differences between the modern left (by which I mean mainstream liberals/center-left in the USA) and the left of the past is that the modern left, not having participated or ever wanted to be involved with unions, don't understand the simply reality that the right wants them dead. Union members understood this, knowing that they could hold a union rally and that the Pinkertons were going to come out shooting at them. Even in the Cold War, the right said that their goal was to defeat "Communism abroad and unions at home." The left was the enemy, and the left understood that they were considered the enemy The modern liberals think that conservatives are looking for a "grand bargain" to "take the best ideas of both sides™", and the like. I can tell you that this isn't true.

There are some of us, of course, who keep track of the fact that the right hasn't changed on this score.
posted by deanc at 5:42 PM on July 1, 2012 [10 favorites]


Great site Dean C. And so crucial to understanding the Right's aggressive self-righteousness.

Roberts flipping is ultimately not so interesting. He's fighting for the name of his Court and he may be a Right wing extremist, but there's no way he needs to rub it in anyone's face as Scalia and Thomas and Alito need to, indeed are encouraged to do by those on the Right who want every dismantling of the New Deal to be a spiritual disaster for the Left. Or what they see as the last vestige of the mortal enemy of the Cold War now found INSIDE the country not without.

For all those who talk about and believe the stereotype of "Union thugs" there's almost zero ZERO balance in that stereotype of the corporate thugs and hired guns and Cops and guards and Pinkerton-type companies that killed scores of workers striking on company properties.

It's like an army that disavows and discounts all its wrongdoing because it owns the people who write the history books and the new media.

It's incredibly frustrating, also just how much the working class has been destroyed by issues of race and turned against itself (Willie Horton, the lazy Welfare freeloading queen...all these elements that are code for African-Americans being violent and lazy).

It's no wonder they have to grab at straws to turn Obama into a Kenyan, Muslim, Hitler, Socialist...he's their worst nightmare, because he turns all the stereotypes about black people into dust. So they need to throw so much laughable evil in his actions it's bonkers.

Even while there are tons of nakedly aggressive Right wingers demonizing the Left and spouting eleminationist rhetoric, the minute one person on the Left makes a similar aggressive statement suddenly the Left are the violent ones...

It's egregious and terrible stuff this Eleminationist Industrial Complex, because it creates monsters out of victims and seeks to fully have them destroyed eventually (yes, as in dead), even while it takes away their voices and renders them powerless and scapegoats them and makes them out to be a sort of human sort of vermin, that needs to eradicated for the good of the nation.

It reminds me of something...hmmm...something..something...brownshirted jackbooted such and such...
posted by Skygazer at 6:52 PM on July 1, 2012


No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)
posted by homunculus at 12:35 PM on July 2, 2012 [3 favorites]


Kaiser Health Tracking Poll: Early Reaction to Supreme Court Decision on the ACA

... a majority of Americans (56 percent) now say they would like to see the law’s detractors stop their efforts to block its implementation and move on to other national problems.

Democrats overwhelmingly say opponents should move on to other issues (82 percent), as do half (51 percent) of independents and a quarter (26 percent) of Republicans. But, seven in ten Republicans (69 percent) say they want to see efforts to stop the law continue, a view shared by 41 percent of independents and 14 percent of Democrats.
posted by madamjujujive at 1:47 PM on July 2, 2012 [3 favorites]


The bomb buried in Obamacare explodes today.
posted by Sticherbeast at 2:52 PM on July 2, 2012


Oh, wait, that's an old article. Well, it's still a good read for those who haven't been paying attention to the actual contents of Obamacare.
posted by Sticherbeast at 2:53 PM on July 2, 2012 [1 favorite]


Thanks Sticherbeast. I remember that article and it's still entirely valid and important.
posted by Skygazer at 3:26 PM on July 2, 2012


When SCOTUS upheld Obamacare
posted by garlic at 3:58 PM on July 2, 2012 [1 favorite]


This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

[...]

As it turns out, HHS isn’t screwing around. They actually mean to see to it that the insurance companies spend what they should taking care of their customers.

Here’s an example: For months, health insurance brokers and salespeople have been lobbying to have the commissions they earn for selling an insurer’s program to consumers be included as a ‘medical expense’ for purposes of the rules. HHS has, today, given them the official thumbs down, as well they should have. Selling me a health insurance policy is simply not the same as providing me with the medical care I am entitled to under the policy. Sales is clearly an overhead cost in any business and had HHS included this as a medical cost, it would have signaled that they are not at all serious about enforcing the concept of the medical loss ratio.

So, can private health insurance companies manage to make a profit when they actually have to spend premium receipts taking care of their customers’ health needs as promised?

Not a chance-and they know it. Indeed, we are already seeing the parent companies who own these insurance operations fleeing into other types of investments. They know what we should all know – we are now on an inescapable path to a single-payer system for most Americans...

[...]

If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone, today is the day you begin to understand that the reality is quite the contrary.
posted by Skygazer at 4:34 PM on July 2, 2012 [3 favorites]


Wa-Po Columnist: Liberals Will Have to Acknowledge Roberts is 'Fair-Minded Statesman' When He Rules Against Voting Rights Act
posted by homunculus at 5:11 PM on July 2, 2012 [1 favorite]


Right Wing So Mad About Supreme Court Ruling It’s Just Straight-Up Appropriating Nazi Vocabulary

Previously.
posted by homunculus at 5:57 PM on July 2, 2012 [2 favorites]


Hey! Though I started the day of its posting I just finished reading this thread today, the 4th. Fitting, no? Thanks to everyone who posted informative and compelling links. Glad I did not revisit that Palin post.
posted by safetyfork at 9:03 AM on July 4, 2012 [1 favorite]


DISBELIEF!
posted by stebulus at 10:24 AM on July 6, 2012 [17 favorites]


I think I hurt myself laughing, stebulus.
posted by rtha at 10:32 AM on July 6, 2012


Excellent!
posted by OmieWise at 2:51 PM on July 6, 2012


SCOTUSblog has posted a timeline exploring how CNN and FOX got it wrong and why it took so long for CNN in particular to issue a correction. Fascinating stuff.
posted by devinemissk at 7:25 AM on July 8, 2012 [1 favorite]


Where Is the Liberal Outrage? Conservatives are pillorying John Roberts for his health care decision. Why don’t liberals get angry when their justices fail to deliver?
posted by homunculus at 12:50 PM on July 8, 2012 [2 favorites]


Where Is the Liberal Outrage?

Maybe it's because liberals are more likely to have thought-out positions and understand that genuine disagreement is possible rather than expecting en bloc tribal loyalty.
posted by localroger at 1:21 PM on July 8, 2012 [5 favorites]


Famed conservative 7th circuit federal court of appeals judge Richard Posner says he has become less conservative since the Republican party started becoming "goofy" about ten years ago and warns that current conservative lambasting of Chief Justice Roberts could cause a similar sort of crisis of faith in Roberts:
Posner, who was appointed to the appeals court by Reagan, speculated that the leaks about the deliberations over the national health care law — which are apparently designed to discredit Chief Justice John Roberts' opinion upholding the law — would backfire. "I think these right-wingers who are blasting Roberts are making a very serious mistake," he said.

"Because if you put [yourself] in his position ... what's he supposed to think? That he finds his allies to be a bunch of crackpots? Does that help the conservative movement? I mean, what would you do if you were Roberts? All the sudden you find out that the people you thought were your friends have turned against you, they despise you, they mistreat you, they leak to the press. What do you do? Do you become more conservative? Or do you say, 'What am I doing with this crowd of lunatics?' Right? Maybe you have to re-examine your position."
I still hesitate to believe this and pessimistic ally thought we deserved what we got when we allowed GWB in, but maybe Roberts will be sort of fair minded. Wow.
posted by onlyconnect at 11:29 AM on July 11, 2012 [2 favorites]


Roberts strikes this inexpert observer as a pro-business kind of jurist rather than an ideological kind of jurist.

I think his track record bears that narrative out more than it does the right wing ideologue narrative.

This ruling fits that, I think. Obamacare is a win for big sectors of the economy.

For me, the really damaging ruling this term is Knox v. SEIU (which has the potential to gut Union political activity since it paves the way toward requiring Unions to seek permission from members before spending dues on political speech, overturning about three-quarters of a century of practice and precedent).

Alito the ideologue wrote that opinion, but Roberts was right there with him.
posted by notyou at 12:17 PM on July 11, 2012 [1 favorite]


NotYou: Knox v. SEIU

Just amazing to me, but maybe I'm being slightly paranoid. That ruling says to me: Not all money is free speech, and not all organizations are "persons."

It would seem only the money that comes from corporations and wealthy individuals is "free speech." The money from the middle class and the rest of the riff raff, is just money: Stuff they're temporarily allowed to use before it goes back to it's rightful place at the very tippy top of the food chain, to either remain there or be turned once again into the "free speech" of the 1% going to their proffered servants in government...

But unions, they need controls and "permission" from all their members before they act as a "person."

That ruling seems to further underscore the idea of Citizens United, being a huge massive salvo against the Democratic party, by ALEC inspired white papers, as it freed up unlimited and secret mountains of corporate and billionaire money and now the subsequent parts of the strategy being put in place as Unions are harassed with the loss of collective bargaining, as in Wisconsin, and with the idea that every worker has to be asked EVERY YEAR, if they want to stay in the union, and now, this ruling, that also seeks to fragment the organizational power of labor.

So it looks like the Right-wing corporatists are only completely unfazed by the critique of Citizens United, but are prepared to follow through and double down.

Amazing.
posted by Skygazer at 1:36 PM on July 11, 2012 [2 favorites]


Why I sometimes love Congress: After House passes repeal for the 33rd time, Rep. Russ Carnahan (son of Mel and Jean) tweets
"My floor speech on today's repeal vote: I know I'm a Congressman, and this is crazy, but 31 times? A jobs bill maybe?"
posted by zombieflanders at 1:44 PM on July 11, 2012 [3 favorites]


Just amazing to me, but maybe I'm being slightly paranoid

Gee, you think?....

That ruling seems to further underscore the idea of Citizens United, being a huge massive salvo against the Democratic party, by ALEC inspired white papers, as it freed up unlimited and secret mountains of corporate and billionaire money


Yeah, that sounds a bit more than "slightly paranoid." Sounds more like someone who has been so consumed with cheap talking points and hyperbolic partisan claims that they actually believe everything is a political act of war.

If you actually take the time to become informed and know the law in these areas and understand the legal reasoning that they actually put forth in the legal opinions themselves, the opinions in both Citizens United and Knox are not that surprising or transformative. The Court's view on political expenditures has long been established--going back to the 1976 opinion Buckley v Valeo--and had a trajectory. And the law on how unions can spend political money is also well-developed.

At some point, you have to realize that the issue of campaign expenditures as political speech and unions political expenditures are issues of judicial doctrine and not spontaneous outgrowths of conspiracies driven by "ALEC inspired white papers"--whatever that is supposed to mean.

The Court has addressed the contours of the issue of campaign finance laws' outer boundaries in at least:
Buckley v. Valeo (1976)
Abood v. Detroit Board of Edu. (1977)
First National Bank of Boston v. Bellotti (1978)
Citizens Against Rent Control v. City of Berkeley (1981)
California Medical Association v. FEC (1981)
Brown v. Socialist Workers '74 Campaign Committee (1982)
Regan v. Taxation with Representation of Washington (1983)
FEC v. National Conservative Political Action Committee (1985)
FEC v. Massachusetts Citizens for Life (1986)
Teachers v. Hudson (1986)
Austin v. Michigan Chamber of Commerce (1990)
Keller v. State Bar of Cal (1990)
McIntyre v. Ohio Elections Commission (1995)
Colorado Republican Federal Campaign Committee v. FEC (1996)
Nixon v. Shrink Missouri Government PAC (2000)
FEC v. Colorado Republican Federal Campaign Committee (2001)
McConnell v. FEC (2003)
FEC v. Beaumont (2003)
Randall v. Sorrell (2006)
FEC v. Wisconsin Right to Life, Inc. (2007)
Davis v. FEC (2008)
Citizens United v. FEC (2010)
Arizona Free Enterprise Club’s Freedom Club PAC v. Bennett. (2011)
American Tradition Partnership v. Bullock (2012)
Knox v. SEIU Local 1000 (2012)

Knox is rationally in line with Citizens United and the rest. The only thing Knox added to the equation is the requirement that a new Hudson notice is provided before funds are taken and used for political purposes. Not exactly earth shattering.

Now, there is legal arguments to be made about why that decision is wrong--though, I would note that it was a 7-2 decision with only Breyer and Kagan dissenting on narrow grounds about the mechanisms the union must use to calculate funds before they are used for political speech. And Sotomayor agreed with the holding that " When a public-sector union imposes a special assessment intended to fund solely political lobbying efforts, the First Amendment requires that the union provide nonmembers an opportunity to opt out of the contribution of funds." So to breathlessly chalk this up as some sort of out-of-left-field attack against Democrats and unions is ignorant and--yes--paranoid.
posted by dios at 3:08 PM on July 11, 2012 [2 favorites]


Nobody, from what I've read,* was surprised by the ruling on the narrow bit of the decision concerning the need for a second Hudson notice, dios. The SEIU had even gone so far as to refund those special election surcharges prior to the ruling (perhaps as a way of heading off worse).

What was surprising was the majority's requirement for opt in rather than opt out and the indication that they might be willing to revisit the wider issue of compulsory fees:
In an opinion by Alito, the Court held that emergency funds were not exempt from the general rule requiring objectors to opt out. That’s not a huge surprise. What was a surprise—and an ominous one—is the majority’s second holding: even allowing non-members to opt out of such an assessment would not cure the First Amendment violation. Instead, it said, the Constitution requires the union to collect the assessment only from [non] members who specifically opt in, giving notice that they want their checks reduced to pay for the special political campaign.

That new rule would impose substantial administrative costs on the union, and reduce the amount it collects. But more significantly, the majority’s rationale would seem to apply to all agency payments by non-members. And indeed, language in the opinion suggests that the majority thinks the whole idea of agency fees is a violation of the First Amendment. “[C] compulsory fees constitute a form of compelled speech and association that imposes a ‘significant impingement on First Amendment rights,’” the Court said, quoting an earlier case. “Our cases to date have tolerated this ‘impingement,’ and we do not revisit today whether the Court’s former cases have given adequate recognition to the critical First Amendment rights at stake.”

If I were the National Right to Work Legal Defense Committee, these words might sound to me very much like, “Bring us a case and we will void the agency shop altogether.” That’s particularly true given language later in the opinion calling the entire “free rider” rationale into question. If workers can’t be required to join a union or to pay agency fees, then the so-called “right to work” zone will cover 50 states and Puerto Rico.

Though the result was 7-2, Justice Sonia Sotomayor, joined only by Justice Ginsburg, concurred only in the result. The union should have offered an opt-out, she said. However, “I cannot agree with the majority’s decision address unnecessarily significant constitutional issues well outside the scope of the questions presented and briefing”—meaning the new constitutional “opt in only rule,” which was not argued by the parties and contradicts a long line of precedent. In a dissent, Justice Stephen Breyer, joined by Justice Elena Kagan, made the same point. The “opt-in” rule “runs directly counter to precedent,” he wrote. “No party asked that we [impose the rule]. The matter has not been fully argued in this Court or in the Court below.”

-----------------------
*IANAL
posted by notyou at 3:56 PM on July 11, 2012


Dios: So to breathlessly chalk this up as some sort of out-of-left-field attack against Democrats and unions is ignorant and--yes--paranoid.

Dios, only someone as pompous and obtuse as you would take a bit of self-deprecation as a signal to try and go in for some sort of overboard bullying.

So, let me get this straight, are you saying ALEC isn't working for the dismantling of Union involvement in politics? Furthermore, are you saying that Citizen's United, regardless of it's precedents, doesn't give corporations the status of personhood and make a mockery of both Freedom of speech and personhood?

I...am not a lawyer, ofcourse, but, it would seem to me this idea that the SCOTUS can act like an academic think-tank with little to no basis on it's impact on reality and the real world of the country outside of their Federalist blinkered neo-aristocratic abuse and hubris and arrogance as emanates most telling from Scalia, who over and over again oversteps sound judicial attitudes and decorum and sounds like a Tea Party Fox-News pundit is a good thing or even effective?

You want to talk about breathless and paranoid, Scalia is your man. You want to see more breathless and paranoid, and plainly disrespectful and out of line, how about Alito talking back to Obama during the state of the union speech?

I may come across as "breathless" and "paranoid" and "ignorant," but I would dare you try and address my area of expertise and sounding half as cogent, as I can about SCOTUS.

But you can't. Your vision of the world is so carefully and autistically framed and limited as to make you effectively unqualified to rule on any real and full knowledge of humanity and human experiences, no matter how many precedents you list...
posted by Skygazer at 4:37 PM on July 11, 2012 [1 favorite]


[namecalling stops now. We are asking nicely. From this point forward we will not be asking.]
posted by jessamyn at 4:38 PM on July 11, 2012 [2 favorites]


House Obamacare Repeal: Thirty-Third Time’s the Charm?

After Voting To Repeal Obamacare, Republicans Turn Their Attention To Golf
posted by homunculus at 5:38 PM on July 11, 2012


Re. that American Prospect Article... If workers can’t be required to join a union or to pay agency fees, then the so-called “right to work” zone will cover 50 states and Puerto Rico.

That's simple enough - just label the fees as a work tax.

Seriously, the idea of compulsory membership is objectionable to a lot of people, including me, and I don't really think unions will be able to rely on it in the future. I've felt for some time that the future of unions may be in taking over the administrative costs and pension management responsibilities from employers, thus allowing the employer to concentrate on whatever the core business is and allowing the union to deliver value by handling the payroll, HR, and pension administration in the employees' interest.
posted by anigbrowl at 5:47 PM on July 11, 2012 [1 favorite]


What was surprising was the majority's requirement for opt in rather than opt out

My point is that such a ruling is entirely incremental at the lines of a well-established doctrine. As a legal matter, incremental decisions are not really surprising--though politically motivated people (like possibly that Prospect writer) often treat them as makeweight. I would note, that in light of the Court's view about political speech, it is even more the case that the incremental move to opt in rather than opt out is not a surprising incremental move.

Now, bear in mind that I am not arguing about the effects of the ruling or whether it is good or bad policy. I wasn't even responding to the points you made. What I was saying--and the point I try to repeatedly make in all threads that discuss constitutional rulings--is that you have to read and understand opinions and their reasoning to properly critique them as legal rulings. These opinions are written for precisely that purpose: so that judges and lawyers and even lay individuals can understand the opinion and the reasoning. If you just rely upon blog posts or opinion writers (which are alarmingly inaccurate on legal matters) and criticize rulings from a political angle, then you should not be critical of the justices or question their reasoning because you frankly are using the wrong evaluative standards.

Take the Gonzales v. Raich case. Someone can be pro-pot legalization and say why it is a bad policy to have it illegal and that we should legalize it tomorrow. But you cannot apply that critique to the opinion. Raich can only be legally addressed as an issue of commerce clause jurisprudence. It has nothing to do with pot or right wing/left wing claptrap (people almost always are confused at the breakdown of that ruling). When I hear people mention anything about pot or changing the drug policy in the context of Raich, it is very likely they haven't a clue what issue the Supreme Court was deciding.

So coming back to your point: whether or not the Knox case was surprising only makes sense in comparison to the law in this area, and I think if you look closely at it, you'll see it was a predictable incremental change and not a "out of left-field" surprise.

Furthermore, are you saying that Citizen's United, regardless of it's precedents, doesn't give corporations the status of personhood

Citizen's United is consistent with precedents. It did not "give corporations the status of personhood". Since the 1800s, the Supreme Court and the United States Code has treated corporations as persons. (Fyi- It is Article 1 Section 1 of the US Code that says it--the very first page of the 200,000 page code that is our federal statutory law).

The idea that it was Citizen's United that "gave corporations personhood" ignores 2 centuries of law in this country. You can dislike the policy effects and want to adopt different legislation all day long; this country love political opinions. But if you want to challenge the opinion on its legal merits, you have to properly know them and use that metric.

As to the rest of your post, the mix of your apparent recognition of your obviously limited knowledge with your rude efforts to stridently discredit my informed and supported statements is walking a fascinating line. But I think this discussion of law would be much better served by leaving the political sensationalism and your apparent hatred of me (or whomever you assume I am) out of the discussion.
posted by dios at 5:57 PM on July 11, 2012 [1 favorite]


If you just rely upon blog posts or opinion writers (which are alarmingly inaccurate on legal matters) and criticize rulings from a political angle, then you should not be critical of the justices or question their reasoning because you frankly are using the wrong evaluative standards.

1) I was clearly criticizing the ruling from a political angle. The decision will tilt the political playing field, however slightly, against "my side".

2) How about we rely upon Justice Sotomayor when it comes to registering surprise at the decision and dismay at the judicial method employed to reach it?

From her concurrence:
The phrase "opt in" appears not once in petitioners' briefing. The majority protests that it cannot but hold that an opt-in regime is required, seeing as the opt-out regime the petitioners advocate is, in the majority's view, unconstitutional. But if the Court was dissatisfied with the scope of the questions presented here it should not have granted certiorari in this case. Or having granted it, the Court should have asked for supplemental briefing on the question whether an opt-in regime is constitutionally required. What it should not have done— cannot do under our rules — is decide that question without having provided the parties and potential amici an opportunity to weigh in with their own considered views.
Finally, I'm not understanding the distinction you're making with "incremental".

This ruling will result in a small change to an obscure bureaucratic process, but the reasoning behind it suggests more changes are on the way. Brought along piecemeal. Ground slowly and fine.
posted by notyou at 6:50 PM on July 11, 2012


As to the rest of your post, the mix of your apparent recognition of your obviously limited knowledge with your rude efforts to stridently discredit my informed and supported statements is walking a fascinating line. But I think this discussion of law would be much better served by leaving the political sensationalism and your apparent hatred of me (or whomever you assume I am) out of the discussion.

The idea is that there is a real a proven pattern of the GOTP gaming the electorial process via various schemes. Voter ID is one, CU is another. The attack on Unions and the requirement that members Opt-in instead of Opt-out. The erratic and unprofessional behavior of the Justices themselves: Scalia's way out of bounds editorializing on various cases. Alito's inexcusable outburst at the president at the SOTU address. Thomas and Scalia attending various David H. and Charles Koch events designed to bring money to the GOTP, and work out strategy for defeating Democrats, Ginny Thomas collecting $750,000 in fees lobbying against Obamacare. The ALEC introduced generic packages of legislation that were passed by Walker, Kasich, Scott (Wisconsin, Ohio, Florida) all designed to contain unions, and dilute democratic power, the trend of Voter ID legislation that is sweeping many of the Tea Party controlled state legislatures which are clearly attempts at frightening off and adding a layer of cost and bureaucratic time/inconvenience to those that can least navigate those elements....

And yet, inspite of all these elements you dare to call me "paranoid" and "completely brainwashed etc.." and "ignorant" which you did again, in your last comment, and it's I who "hate you"? I don't hate you. I just think you're incapable of looking at the whole picture, and you're heavy-handed.

I think I've made a pretty compelling case that there is, indeed a nationwide and concerted effort by the GOP/TP to whittle back the political and voting rights of Democrats. Furthermore, they have no choice in the matter. It's either that, or they become relegated to the trash heap of history as the demographics change against them pretty dramatically in this decade and onward from there...

Sorry if that's a part of the SCOTUS you don't want to see, but it's deeply human, deeply fallible and entirely capable of corruption and partisanship, even while it hides under the guise of precedent and "deep and complex" legal theory.
posted by Skygazer at 9:58 PM on July 11, 2012 [3 favorites]


Scalia dismisses talk of internal court rancor
posted by homunculus at 10:56 AM on July 19, 2012 [1 favorite]


Top Obamacare Critic's Op-Eds Drafted by PR Firm That Reps Drug, Health Care Clients
posted by homunculus at 11:07 AM on July 19, 2012 [1 favorite]


The ALEC introduced generic packages of legislation that were passed by Walker, Kasich, Scott (Wisconsin, Ohio, Florida) all designed to contain unions, and dilute democratic power

ALEC Rock
posted by homunculus at 2:01 PM on July 26, 2012 [3 favorites]


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