Monday, June 19, 2017

Supremes Enter Healthcare Tug-Of-War

Originally Published March 22, 2012; Last Updated June 19, 2017; Last Republished June 19, 2017:

For reasons that are not immediately apparent our Supreme Court has elected to enter the politically charged healthcare tug-of-war—perhaps as referee for divergent lower court decisions?

It's difficult to imagine a more compelling federal purpose than Congress providing for the welfare of all our citizens by ensuring they are afforded systematic, effective, and competent healthcare.

Amazingly, providing healthcare for all our citizens has proved contentious—less than when Congress established our First Bank of the United States, which promptly assumed the Revolutionary War debts owed by the individual states1.


UPDATED 03/23/2017 CDC, National Center for Health Statistics and OECD, Health Statistics 2016 
UPDATED  03/22/2017 NAM, NAM Releases Publication on How to Improve Nation's Health System; Looks Beyond Current Policy Debate to a Vision for the Future of American Health and Health Care and UCTV, Changing the Culture: How Do We Come Together as a Health System? and NAM, 2016 Annual Meeting Vital Directions Panel (Victor Dzau and Mark McClellan) (Hint: Our Judiciary will be of little or no help and in some cases a hindrance!)


UPDATED 03/10/2017 CBO, How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums and CBO, The Budget and Economic Outlook: 2017 to 2027
UPDATED 06/25/2015 SC King et al. v. Burwell, Secretary of Health and Human Services, et al. (pdf, slip opinion)
SC, Department of Health and Human Services, et al., Petitioners v. Florida, et al.


UPDATED 06/19/2017
WP, Has Senate Majority Leader Mitch McConnell changed his mind on how to pass health care reform?

It's difficult to find a politician that is not a blatant (i.e. in-your-face) liar. Guess their going to try to stick around until their credibility is approaching zero?

UPDATED 06/02/2017 Economist, Gimme Shelter, The Super-rich Are Different: They Pay Less Tax

...a lot less! These are the taxpayers, which our "new" alt-white-house's budget proposes to help at the price of healthcare coverage for an estimated 23 million of our citizens; higher premiums for insuring citizens with preëxisting conditions; and higher premiums for aging seniors...

...and these are the taxpayers, which our "new" alt-white-house OMB Director Mulvaney asserts are not getting cannot make this stuff up!

UPDATED 05/10/2017 Guardian, Journalist Arrested for Asking Trump Cabinet Member [Tom Price] About Healthcare Bill

If our "new" alt-white-house begins abusively arresting our journalists, which shout questions about their disastrous healthcare hocus-pocus arrests are likely to skyrocket!

UPDATED 05/09/2017 WP, U.S. Life Expectancy Varies by More Than 20 Years from County to County and Vox, What you need to know about the House vote to repeal Obamacare and TheHill, Sunday Shows Preview: Republicans Tout Healthcare Vote and OECD Indicators Health at a Glance 2015

Which part of the healthcare bill are you proud of Speaker Paul Ryan, the part denying millions of Americans coverage or the part placing Americans in high risk (premium) pools or reductions of Medicad, or devolution to local government to further increase a differential life expectancy of 20 years or the "best healthcare system in the world", which delivers a lower life-expectancy at a higher cost  (also OECD, Health Indicators at a Glance 2015) or treating womens' healthcare as optional or ?

Telling America that Obamacare is bad does not make the most recently proposed Trumpcare better! Speaker Ryan is beginning to sound like Kellyanne Conway and Sean Spicer. The estimated 23 million citizens, which would lose healthcare under the GOP healthcare proposal might disagree that they are getting "better policy"? Stated differently, a proposal that eliminates healthcare coverage for 23 million of our citizens IS NOT BETTER POLICY!

Secretary Tom Price, we don't want to imagine a healthcare system, we want real affordable, healthcare for ALL our citizenry, which is equal to or better than the healthcare plans given to Congress.

Also, we do not want a Secretary of Human Health and Services that preaches laissez-faire dogma in lieu of ensuring ALL our citizenry have affordable healthcare plans equal to or better than those given to Congress. Hocus–pocus is not a healthcare plan!

...and don't forget to laugh...

UPDATED 05/05/2017 AARP, House Approves Bill Slashing Health Coverage and NYT, How Every Member Voted on the House Health Care Bill and Atlantic, The GOP Health-Care Bill Is the Ultimate Reverse Robin Hood

Our "new alt-white-house and lower house, including all California Republicans flatline healthcare for much of our citizenry, calling it a "great plan"...for who?!

Shame on California's lower house members who voted in opposition to ensuring all their constituents have healthcare equal to or better than what our nation give to them!

UPDATED 03/24/2017 NYT, Trump Blames Democrats as Major Push to Repeal Health Law Fails

American exceptionalism...eliminating healthcare for a significant portion of our citizenry and charging seniors more does not seem like optimal policy...and cheaper, better, healthcare coverage for all our citizens is nowhere in that's "making America great again"!?

House Republicans on Trumpcare (03/12/2017): All our citizens will have access to Trumpcare, which they cannot afford but that's the price of freedom and conservative laissez-faire dogma!

CBO and JCT on Trumpcare (scoring 03/13/2017): "...CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law...average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law...Under the legislation, some people [poor and elderly!] would be eligible for smaller subsidies than those under current law, and others would be eligible for larger ones [bet you can't guess who?]...In 2019, the number of uninsured would grow to 16 million people because of further reductions in Medicaid and nongroup coverage..." (read entire CBO scoring report here or if you're a fans of our "new" alt-white-house CBO's fake scoring report)!!!

Sometimes congressional proposals are so absurd you just have to laugh! It's unclear why congress would define "freedom" as a significant number of our citizenry (14 M in 2018!) forgoing adequate healthcare? Or propose illusory healthcare for many of our citizens based on harmful economic dogma?

Former Speaker Pelosi on Trumpcare (03/14/2017): [AP, Democrats Respond to CBO Report on Healthcare]

"Heath Is Not Valued Till Sickness Comes",
--Thomas Fuller MD-- GNOMOLOGIA @ page 103 #2478, Circa 1732

It's unclear how this legislation will improve healthcare beyond the existing Obamacare? Reducing or eliminating healthcare for significant numbers of our citizenry in pursuit of illusory laissez-faire economic dogma is not a useful or necessary legislative goal.  Particularly, if it requires the poor to pay more of the nation's healthcare bill!

A "placeholder" in healthcare legislation is not a better and cheaper Obamacare (aka communist takeover of America) for all our citizens without gaps in coverage. Show us the numbers, healthcare policy provisions, coverage, and assumptions!

Our "new" alt-white-house thinks "...nobody knew that healthcare could be so complicated...". It's debatable whether our "new" alt-white-house's statement is more hilarious or frightening?

President Obama knows how complicated providing healthcare to all our citizenry is and he cobbled together a first plan while continuously being called a socialist and communist. Our "new" alt-white-house doesn't know how complicated providing healthcare to all our citizenry is and must ad hoc a cheaper and better plan while being investigated for coördination and coöperation with the socialists and communists!

Is there no end to irony's beauty?!

The House Republican's healthcare ad nauseam mantra of "repeal and replace" has morphed to a "repeal and redirect" mantra, which would redirect the healthcare benefits of our Affordable Care Act from our poor to our rich! Who could have predicted that!?

How is this first presidential action (ExecOrder) of our "new" alt-white-house going to provide cheaper, better healthcare, without gaps in coverage for all Americans?

Repealing healthcare for our citizenry is at cross-purpose with America's long-term economic growth expectations. These expectations are most easily understood with reference to economic productivity or real gross domestic product (GDP) per hour worked. Absent automation and robots healthy citizens of all color and creed, including immigrants will generate that GDP—the healthier, happier, longer living and productive our citizenry the better!

It's likely that providing healthcare to all our citizenry will add more to our long-term real GDP growth than any other single public-private action and perhaps all public-private actions combined (a close second will likely be mitigating the many negative impacts of the unprecedented magnitudes of our inequality metric measures4)?

Pence would do well to adopt to the objectives of his running mate with respect to healthcare for all our citizenry, "...we're not going to have a two-day period...where there's'll be great healthcare for much less money..." and former House Speaker Nancy Pelosi:

President Obama, your being very generous with your "Republican-friends'" cruelly cynical repeal-delay-replace political tactical strategy. Your "Republican-friends" are likely intending to rerun their opposition to Obamacare, which has worked for them so well to date, during the 2018 congressional elections

One might think your cruelly cynical "Republican-friends" hope to keep the House and gain a filibuster-proof Senate in 2018 so they can simply repeal healthcare (i.e. ignore their delayed promise to replace), without political penalty.

Wonder why our citizenry hold our politicians in such low regard or complete disregard, disdain, and disgust? If our citizenry had to associate with your "Republican-friends" they'd embrace their enemies—oh!, wait they just embraced one...he's now their president-elect!

Mostly reviews the case(s) reversing the religious wackos from Texas attempts to impede a women's control of their own bodies and healthcare.

The opinion is likely to be read as contributing more to the categories of fear, uncertainty and distraction than common sense construction aimed at preserving the historic purpose of our Affordable Care Act (i.e. provide every American citizen with affordable and comprehensive healthcare).

Wow, that didn't take long for our Supreme Court to generate more zaniness—not even a Court opinion.

Just a stay of a lower court decision while the Supremes figure out whether yet another religious organization person can assert that their God forbids them from submitting a government form stating that their God forbids them from providing female employees with reproductive healthcare!

Hey, on the positive side our religious organizations persons aren't dragging women to a public square for shamming, dunking, flogging or killing—how's that for speedily enlightened national progress?

Happy 238th birthday America!

More legal mischief created by the "corporation as person" fallacy3, which glides through the bizarre and sublime in to the zany.

It's unclear what impact the amazingly narrowly tailored opinion will have on providing equal healthcare to our women. Health and Human Services (HHS) and our President should accept the Court's invitation to use alternative methods to ensure all our women have unimpeded access to complete reproductive healthcare independent of any entities' public or private religious beliefs.

The Court's stated objective of judging a religious practitioner's sincerity independent of whether their religious beliefs are reasonable or mistaken will no doubt guarantee more zaniness in future court opinions.

U.S. Supreme Court rightly stretches to save the Patient Protection and Affordable Care Act—its detractors discuss their next destructive move.

More after studying this historic, necessary and fascinating decision—its most significant implications and impacts may have nothing to to with healthcare!

UPDATED 03/27/2012 ProPublica, What’s at Stake in the Supreme Court’s Health Care Decisions Provides a handy yes-no decision flowchart for the question presented.

Understandably, some of our "laissez faire" justices seemed to conflate market entry with market function and were puzzled that our government has the ability to compel entry into the healthcare market.

If you are equally puzzled query whether our government has, can and would compel individuals to enter the healthcare system (market) if they were: radioactive; carrier of Ebola or other Class IV pathogen; or even a non Class IV pathogen like tuberculosis? (Justice Breyer pursued this line of questioning)

Now assume our explosive field of biochemistry serendipitously discovers that broccoli can treat any or all of the above illnesses. Then our government can and would compel individuals to enter the food market, too—even the most religious or broccoli phobic of our sitting Supreme Court justices!

Compelling second session question from Justice Kagan @ ~1:10:00 on hearing distinction between insurance and healthcare markets:
"...Doesen't that seem a little bit, Mr. Clement, cutting the baloney thin..."?
On market function it seems useful to note that it's very difficult or impossible for individual states to establish separate healthcare markets that operate efficiently—they would need to impermissibly restrict interstate travel or face market collapse as the uninsured seeking healthcare flowed into the state.

A "laissez faire" proponent will tend to slice the baloney nanoscale thin before acknowledging the obvious, that real world markets can and do regularly fail. Often citing prior market interventions as the reason for current market failure—you need look no further than the recent catastrophic collapse of the mortgage market—the failure was caused by to those seeking to provide affordable housing, according to our laissez faire proponents.

If our states cannot individually construct and operate efficient markets then you simultaneously implicate the commerce clause and delimit the "broccoli conjecture"2 articulated and repeated by some of the justices.

UPDATED 03/25/2012 Thomson Reuters,  The Supreme Court tackles health care reform: What's at stake for U.S. businesses Summary by Skadden, Arps, Slate, Meagher & Flom


1. Had Florida et al. been states in 1790-91 they no doubt would have filed a federal complaint arguing that our Constitution prohibited the nascent central bank from assuming any Revolutionary War debt!

2. The "broccoli conjecture" guesses that if our federal government requires Americans to form a single risk pool for the purpose of diversify healthcare risks then our Supreme Court is unable to delimit a federal government requirement that Americans purchase broccoli.

Unfortunately, we have learned to accept this type of conjecture from our Sunday school teachers—must we also learn to accept it from our Supreme Court justices?

UPDATED 06/14/2012 An interesting article tracing origins of the "broccoli conjecture"—no thinking necessary.

3. A corporate container is typically utilized to insulate its beneficiaries, apparently exempting a beneficiary's religious requirements or beliefs.

 The Court does not explain how a corporate container transmogrifies a beneficiary's religious beliefs—perhaps just another fiction fallacy more typically found in Bible stories than legal opinions?

4. An added benefit of providing healthcare to all our citizenry is a reduction of our unprecedented economic inequality.

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