Should be interesting to see if they actually reach a decision.

My thought is they will punt it down the track until 2015 when individuals can file suit.

My guess is they don't punt. I also predict that the vote will be 5-4. The deciding vote will be cast by Justice Kennedy, whose opinion is the only one no one can predict with any certainty. Thus I won't say which way the majority decides.

I seriously hope they demolish it.

Jim I have a question for you, if the government can regulate say utility costs and such why don't they come up with a blueprint for medical costs. I saw that when I had surgery what was billed out by the hospital and doctors, and what was paid by the insurance was a big discrepancy. It also shows just how much the medical industry over charges if they can settle for the rates they agreed to with the insurance companies. Why not have a blue book of rates for everything across the board. They could divide the country into regions and have different prices for different regions. I think that would be a prudent step in controlling healthcare costs. when their costs go up let them have a hearing and ask for a rate increase?

Could this work?

All the Op-Ed's are saying 5-4. the 4 arguments are very well defined for constitutional discussion.

Regardless, of the outcome I don't think this will be the last word for ObamaCare.

I seriously hope they demolish it.

Jim I have a question for you, if the government can regulate say utility costs and such why don't they come up with a blueprint for medical costs. I saw that when I had surgery what was billed out by the hospital and doctors, and what was paid by the insurance was a big discrepancy. It also shows just how much the medical industry over charges if they can settle for the rates they agreed to with the insurance companies. Why not have a blue book of rates for everything across the board. They could divide the country into regions and have different prices for different regions. I think that would be a prudent step in controlling healthcare costs. when their costs go up let them have a hearing and ask for a rate increase?

Could this work?

Specialist, I'm no expert on healthcare, it is a very complicated issue, and I know very little...

States currently DO regulate the costs of health insurance. Health insurance companies need to get their rates approves by state insurance departments.

That aside, I just don't know how we control these costs. The cost of providing quality care are so high, I just don't see how you contain it. People want the best care, and that cutting-edge technoogy is very expensive.

Today, most doctors will tell you that they lose money when they treat Medicare/Medicaid patients, because the pathetic reimibursements provided by the gov't simply doesn't cover the costs of the care provided. How do you solve that problem? Beats the heck out of me.

I also know that Medicare is in the red by tens and tens of trillions of dollars (that's trillions with a "t"). And the baby boomers will make that much, much, much worse. What's the answer to that problem? Beats me. Should we bankrupt our kids and grandkids so that all the baby boomers can live an extra 6 months? But what's the alternative? To pull the plug on all these people? How do you begin to solve these problems?

"Why not have a blue book of rates for everything across the board."

I think that's how medicare works. And the rates are not sufficient to cover the costs of the care. Here's part of the problem. If you have one politician who wants to set the rates at a level that covers the costs of the care, plus a reasonable profit for the doctor. You then have another politician who promises to cut those rates in half...he knows that's stupid, but he wants to get elected. That crap works, those promises get people elected, which is why cops get to retire at age 45 with insane pensions. You simply cannot leave these decisions to politicians who care more about getting re-elected than they care about doing the right thing.

Specialist, the Baby Boomers will VERY SOON force the rest of us to figure this out. Do we literally bankrupt ourselves to extend their lives by every day possible?

Beats me.

Starting January 1, 2011, TEN THOUSAND BOOMERS A DAY started turning 65. 10,000 a day. That will continue for 15 years.

I don't pretent to know the answer. But I do know for a certainty that we are in serious, serious trouble. This could literally bankrupt us. Medicare is tens of trillions in the red, and the boomers have barely begun to turn 65. I read that today, 50% of a person's healthcare costs are incurred in the last 6 months of one's life. Think of what that means when the baby boobers really start getting old and sick by the tens of millions. We can't possibly cover that expense, but I don't even like to consider the alternative.

All I know is this. I have 3 boys. I sure as hell don't want them to have to sell their houses to keep me alive for 6 more months when I'm 80 years old.

Where do we get, say, $50 trillion more to pay for the care that the baby boomers will need? Do the math. It's not possible, it just isn't. And that's exactly what we are facing.

I saw that when I had surgery what was billed out by the hospital and doctors, and what was paid by the insurance was a big discrepancy. It also shows just how much the medical industry over charges if they can settle for the rates they agreed to with the insurance companies.
Insurance companies and hospitals agree to pricing terms before an insurance company say "yeah, we'll allow our customers to use your doctors." The insurance companies leverage the wide availability of doctors to strong-arm hospitals into agreeing on cheaper terms. In turn, the hospitals utilize the volume increase to justify taking tighter margins.

Essentially, large insurance companies are provided wholesale pricing because of the leverage they hold in their larger customer base.

Essentially, large insurance companies are provided wholesale pricing because of the leverage they hold in their larger customer base.

What he said...

What he said...

Exactly now if the Federal Government did the same thing healthcare would be significantly lower. If they can take what the insurance companies are giving and still be profitable, then they should start by using those rates.

As Jim said, it is very complicated and anyone who tells you they know how to fix it is crazy. There are some obvious areas (high RX costs, tort reform, unneeded tests, etc.) but how about lowering the cost of medical school? Anyone think of that? I never thought of that until someone mentioned it recently. We need more primary care Drs. But b/c PCPs earn so much less and they leave med. school w/so much debt, most medical school grads specialize b/c they can earn more $. Maybe a 2 tier system, subsidize the cost of a PCP educ. but if you want to spec., your last year or 2??? cost you much, much more. There is prob. a 1,000 things most of haven't heard of that that would need to change to really lower the cost.

Exactly now if the Federal Government did the same thing healthcare would be significantly lower. If they can take what the insurance companies are giving and still be profitable, then they should start by using those rates.


Are you saying that government would act as a healthcare provider (like a doctor), or are you saying the government would act as a health insurance company (taking people's money and paying doctors with that money)...

If you are talking about the government actually providing healthcare, well, I don't see that the government does many things nearly as well or efficiently as what's done in the private scetor. The government has no incentive to save money, because they are spending other people's money.

If you're talking about the government acting as an insurance company, that's how Medicare works, and (1) it doesn't pay doctors enough for services provided, and (2) it's nearly bankrupt, and will be completely bankrupt when the baby boomers are all old and sick.

I don't pretend to have any answers...

Are you saying that government would act as a healthcare provider (like a doctor), or are you saying the government would act as a health insurance company (taking people's money and paying doctors with that money)...

If you are talking about the government actually providing healthcare, well, I don't see that the government does many things nearly as well or efficiently as what's done in the private scetor. The government has no incentive to save money, because they are spending other people's money.

If you're talking about the government acting as an insurance company, that's how Medicare works, and (1) it doesn't pay doctors enough for services provided, and (2) it's nearly bankrupt, and will be completely bankrupt when the baby boomers are all old and sick.

I don't pretend to have any answers...

I am saying the government would act like a public utility commission would. They would set the rate that each procedure should be payed. The insurance companies already do this , but if you have no insurance you pay almost double for the same procedure. This way there is a flat rate across the board for any and all procedures, it could be fine tuned by geographical area based on cost of living say. If hospitals want that rate to go up they would go in front of a board, and present evidence as to why the rate they get from anyone for a particular procedure should go up, then the board would decide on the increase.

as an example I go in for surgery and the anesthesiologist charges 2900.00 for general, 350 for a nerve block, and 400 to use an ultra sound machine for 3 minutes for a total of 3650. Now the insurance company agreement allows for 989 for general, 124 for nerve block, and 89 for the ultra sound. for a total of 2003.

Now if you have to pay cash you pay full price. Obviously the doctor and hospital are not going to be bankrupt charging the lower fees to the insurance companies, because those that pay cash probably offset it a little. Why not have the government regulate the amount the can charge and set the rate at:

1200 for general
147 for the nerve block
110 for the ultra sound

Now every individual pays that amount if the pay cash, or if they have insurance the insurance company pays the same.

That is the extent of the Government involvement, they just set the price for a procedure across the board.


I think this would significantly lower health care cost, or at least control any rise in cost.

Exactly now if the Federal Government did the same thing healthcare would be significantly lower. If they can take what the insurance companies are giving and still be profitable, then they should start by using those rates.
There's a reason many private practice doctors don't accept Medicaid (some won't event accept Medicare). The government sets pricing and then pays 60-75% of that actual price, if they pay at all. Also, medical offices that accept Medicare patients are subjected to significant increases in the amount of BS they have to deal with, including how they bill, manage records, operate their office and a ton of other things that increase overhead.

It is exactly the above reason that in some states Walgreens has stopped accepting Medicaid.

Again, it comes down to matter of leverage due to volume. The government has the leverage over many providers because of the volume of elderly patients on Medicare.

Some of the most successful private practice doctors that I know of have enough patients that they do not need to accept patients with Medicare/Medicaid. Not to mention they don't get stuck dealing with nearly as many people begging for pain pills, people that play the system to get disability checks and the other dregs of society.


Personally, I'd prefer the government to stay the hell out of setting prices. Make no mistake, government regulation is a major contributor to why health care costs are so high.

There's a reason many private practice doctors don't accept Medicaid (some won't event accept Medicare). The government sets pricing and then pays 60-75% of that actual price, if they pay at all. Also, medical offices that accept Medicare patients are subjected to significant increases in the amount of BS they have to deal with, including how they bill, manage records, operate their office and a ton of other things that increase overhead.

It is exactly the above reason that in some states Walgreens has stopped accepting Medicaid.

Again, it comes down to matter of leverage due to volume. The government has the leverage over many providers because of the volume of elderly patients on Medicare.

Some of the most successful private practice doctors that I know of have enough patients that they do not need to accept patients with Medicare/Medicaid. Not to mention they don't get stuck dealing with nearly as many people begging for pain pills, people that play the system to get disability checks and the other dregs of society.


Personally, I'd prefer the government to stay the hell out of setting prices. Make no mistake, government regulation is a major contributor to why health care costs are so high.

Good points but not what I am saying.

We would not use medicare rates, and the paperwork would go to the health insurance company. Rather than 100 different insurers haggling over rates you could average the rates and that would be the max that any hospital or doctor could charge for that procedure whether the person has health insurance or pays cash. This way everyone is paying the same.

Right now if I have insurance and you do not we pay different amounts for the same quality of care:

My insurance might pay 200 for a checkup, and I pay my 10 copay

You might see the same doctor, get the same care but with no insurance and paying cash you pay 395.

That is not a good way to control or keep health care costs down.

The fed could say to the doctor you can charge 265 for the check up no matter what insurance someone has or doesn't have, because that is the average rate the 10 best insurers would pay you.

Good points but not what I am saying.

We would not use medicare rates, and the paperwork would go to the health insurance company. Rather than 100 different insurers haggling over rates you could average the rates and that would be the max that any hospital or doctor could charge for that procedure whether the person has health insurance or pays cash. This way everyone is paying the same.

Right now if I have insurance and you do not we pay different amounts for the same quality of care:

My insurance might pay 200 for a checkup, and I pay my 10 copay

You might see the same doctor, get the same care but with no insurance and paying cash you pay 395.

That is not a good way to control or keep health care costs down.

The fed could say to the doctor you can charge 265 for the check up no matter what insurance someone has or doesn't have, because that is the average rate the 10 best insurers would pay you.
I get what you're saying, but what you're suggesting is not sustainable.

Is it a matter of fairness or keeping down costs? From your description, it seems like you want Uncle Scam to further regulate things because "it's just not fair".

The strict regulation of charges that you suggesting is one baby step away from completely socialized medicine. Why not just completely nationalize health care?

Good points but not what I am saying.

We would not use medicare rates, and the paperwork would go to the health insurance company. Rather than 100 different insurers haggling over rates you could average the rates and that would be the max that any hospital or doctor could charge for that procedure whether the person has health insurance or pays cash. This way everyone is paying the same.

Right now if I have insurance and you do not we pay different amounts for the same quality of care:

My insurance might pay 200 for a checkup, and I pay my 10 copay

You might see the same doctor, get the same care but with no insurance and paying cash you pay 395.

That is not a good way to control or keep health care costs down.

The fed could say to the doctor you can charge 265 for the check up no matter what insurance someone has or doesn't have, because that is the average rate the 10 best insurers would pay you.

First, if everyone is paying the average of what we all pay today, I don't see how that lowers the cost, except for people who currently pay as they go without insurance. Second, while your idea controls the amount that doctors get paid for services, it doesn't address the costs of the care that the doctors provide.

We need to somehow address the underlying cost of the healthcare that docs provide. One way to do that is tort reform. Unfortunately, the American Trial Lawyers lobby gives big $$ to democrats, who consequently won't allow that reform.

That's just a very small piece. I don't know that there is a solution. It's a staggering problem even in a simple environment, but when you throw on top of it the looming tsunami of the baby boomers, and we are in for a real reckoning. A real reckoning.

We need to somehow address the underlying cost of the healthcare that docs provide. One way to do that is tort reform. Unfortunately, the American Trial Lawyers lobby gives big $$ to democrats, who consequently won't allow that reform.

That's just a very small piece. I don't know that there is a solution. It's a staggering problem even in a simple environment, but when you throw on top of it the looming tsunami of the baby boomers, and we are in for a real reckoning. A real reckoning.

As you said, a small piece - but a piece.

The NE journal of medicine says about 7.4% of Drs. are sued each year and by age 65, even Drs. in low risk specialties (like pediatrics and dermatology) face a 75% chance they will have been sued. In 2009, the Congressional budget office said that going to a 250K cap on noneconomic damages and 500K on punitive damages and a 1 year statute of limitation would save about 11B/year - 40% of from reduced malpractice prem. and the rest from fewer tests/procedures.

Total cost/year are about 2.6Trillion. Thus 11B, is not even 1/2 of 1% of total costs. Cost are incr. about 100B/year.



In 2010, the 5 largest medical insur. had about 11.7B in profit.

First, if everyone is paying the average of what we all pay today, I don't see how that lowers the cost, except for people who currently pay as they go without insurance. Second, while your idea controls the amount that doctors get paid for services, it doesn't address the costs of the care that the doctors provide.

We need to somehow address the underlying cost of the healthcare that docs provide. One way to do that is tort reform. Unfortunately, the American Trial Lawyers lobby gives big $$ to democrats, who consequently won't allow that reform.

That's just a very small piece. I don't know that there is a solution. It's a staggering problem even in a simple environment, but when you throw on top of it the looming tsunami of the baby boomers, and we are in for a real reckoning. A real reckoning.

Well just in time, a bill came from our Orthopedist for my wife's shoulder surgery:

$11,800.00 billed for the ortho part not including anesthesia.

Anyone care to venture a guess how much Bluecross Blue Shield payed?

$3700 ?

$3700 ?

nope...

Well just in time, a bill came from our Orthopedist for my wife's shoulder surgery:

$11,800.00 billed for the ortho part not including anesthesia.

Anyone care to venture a guess how much Bluecross Blue Shield payed?
Probably about 65-75%, so about $8500. In the end, why does it matter? It still doesn't change the whole bit about leverage I discussed above.

Even with BCBS paying a reduced rate, health care costs are still increasing. With that in mind, even enacting your "government regulated pricing", how would it decrease costs? Like I said above, it seems like you want the government to regulate pricing because you don't think it's fair.

? Like I said above, it seems like you want the government to regulate pricing because you don't think it's fair.

Bingo!...wants the govt to make it fair(er) regardless of whether or not it is the proper role of the federal government....

interesting comparisons...

Why The Supreme Court Should Uphold the Health Care Law 9-0 | TIME Ideas | TIME.com (http://ideas.time.com/2012/03/26/why-the-supreme-court-should-uphold-the-health-care-law-9-0/)

RealClearPolitics - Back to the Future? (http://www.realclearpolitics.com/articles/2012/03/27/back_to_the_future_113627.html)

also interesting that I've read proffered cause for all but Thomas* of "the 5" as having reason or potential to uphold Obamacare but on the other side there is absolutely no question apparently, that "the 4" will ignore the Constitution and vote in lock step to uphold it........

*despite his obvious distaste for Justice Thomas’s views, Jeffrey Toobin takes him seriously as a judicial thinker and pathfinder.
“In several of the most important areas of constitutional law, Thomas has emerged as an intellectual leader of the Supreme Court,” Toobin writes. “Rarely has a Supreme Court Justice enjoyed such broad or significant vindication.”

Probably about 65-75%, so about $8500. In the end, why does it matter? It still doesn't change the whole bit about leverage I discussed above.

Even with BCBS paying a reduced rate, health care costs are still increasing. With that in mind, even enacting your "government regulated pricing", how would it decrease costs? Like I said above, it seems like you want the government to regulate pricing because you don't think it's fair.

nope

It would decrease costs because the American public is being price gouged.

BCBS payed a grand total of 2159.14 The rest was written off, and they still had room for a profit.


So tell me they are not price gouging, and if there was a commission that set rates at this point healthcare cost would be no cheaper across the board?
It's not about fairness as much as about being price gouged.

It would decrease costs because the American public is being price gouged.

BCBS payed a grand total of 2159.14 The rest was written off, and they still had room for a profit.


So tell me they are not price gouging, and if there was a commission that set rates at this point healthcare cost would be no cheaper across the board?
It's not about fairness as much as about being price gouged.
The above post re-emphasizes that your position is about fairness. You keep saying "if the government set prices, health care would be cheaper". When asked How? health care would be cheaper, your reply is "because the government would be setting the prices."

If it's that easy, maybe the government should tell gas stations how much they can charge for a gallon of gas. How about having them regulate the price of a fishing reel? I'm sure Van Staal would still have room for profit if they sold their reels for half the price.

As I have said above, how about the government stay out of telling businesses what they can and cannot do and take action in the areas the government actual should have a roll in.
For instance:
- It is ridiculous that I cannot purchase medical (or vehicle) insurance from a company outside of Massachusetts. Nothing is more effective on creating competitive pricing than competition. Yet the government requires me to purchase through a company registered in Massachusetts.
- How about developing tort reform? Did you know an Obstetrician is potentially on the hook for every child they deliver until the kid turns 18? That's why many OBs have malpractice insurance rates far exceeding 6 figures. Maybe that has some effect on the cost of medical care.
- Drug companies and medical supply companies are allowed to distort the spirit of trademark laws in order to keep drug costs astronomically high. Yes, they need to earn back money and profit from their R&D but the exploitation is ridiculous.

Let's not allow for the further unnecessary expansion of the government's power and will over corporations and the people. The government holds enough power already to effect change without further regulating the free market.

Jeffrey Toobin says questioning by Supreme Court justices leads him to believe the health care reform law is in peril. He called today's session "a train wreck" for the White House

It would be interesting to hear Thomas' questions.

The above post re-emphasizes that your position is about fairness. You keep saying "if the government set prices, health care would be cheaper". When asked How? health care would be cheaper, your reply is "because the government would be setting the prices."

If it's that easy, maybe the government should tell gas stations how much they can charge for a gallon of gas. How about having them regulate the price of a fishing reel? I'm sure Van Staal would still have room for profit if they sold their reels for half the price.

As I have said above, how about the government stay out of telling businesses what they can and cannot do and take action in the areas the government actual should have a roll in.
For instance:
- It is ridiculous that I cannot purchase medical (or vehicle) insurance from a company outside of Massachusetts. Nothing is more effective on creating competitive pricing than competition. Yet the government requires me to purchase through a company registered in Massachusetts.
- How about developing tort reform? Did you know an Obstetrician is potentially on the hook for every child they deliver until the kid turns 18? That's why many OBs have malpractice insurance rates far exceeding 6 figures. Maybe that has some effect on the cost of medical care.
- Drug companies and medical supply companies are allowed to distort the spirit of trademark laws in order to keep drug costs astronomically high. Yes, they need to earn back money and profit from their R&D but the exploitation is ridiculous.

Let's not allow for the further unnecessary expansion of the government's power and will over corporations and the people. The government holds enough power already to effect change without further regulating the free market.

The government regulates Electric, telephone, and natural rates. IN Mass they regulate car insurance cost, so what difference does it make if they regulate HealthCare cost nationally.


Do you think Obamacare is going to reign in the cost of healthcare?


There were 3 specialties that were over 100,000 for average cost
of premium. Orthopedist was around 89,000 and the other 21 specialties were less than 60,000 in 2010. But Massachusetts has one of the highest in the nation rates There are other states where every specialty is under 100,000, and according to Mass Div of insurance rates seem to have stabilized.

I definitely think that tort reform is needed, drug companies need to be regulated better, but bottom line is if you are charging X dollars 20% of X dollars as payment, and making your nut, then there is something wrong with your prices.

That is price gouging at it's finest.

The government regulates Electric, telephone, and natural rates. IN Mass they regulate car insurance cost, so what difference does it make if they regulate HealthCare cost nationally.
Considering that electric, telephone and natural gas companies have government-sanctioned monopolies issued by towns, they should be regulated. My preference is to not have the government-sanctioned monopolies and allow the free market to do its thing.
Do you think Obamacare is going to reign in the cost of healthcare?
Not even a little bit - and that's not because I think it's going to be created impotent by the Supreme Court. ObamaCare, if allowed to completely materialize, will have no effect on prices while further contributing to long waiting times to see a specialist.

There were 3 specialties that were over 100,000 for average cost
of premium. Orthopedist was around 89,000 and the other 21 specialties were less than 60,000 in 2010. But Massachusetts has one of the highest in the nation rates There are other states where every specialty is under 100,000, and according to Mass Div of insurance rates seem to have stabilized.
Do these seem reasonable to you? I've read that approximately 10% of medical costs are due to malpractice insurance. According to the wikipedia (take the source for what it is) entry on "Medical Malpractice", 60% of claims against doctors are dropped (still costing an average $22k per dropped claim) and 90% of the time cases go to trial, the doctor is found to be not negligent (yet costing an average $100,000/case).

How about a situation like in the UK where the loser in these frivolous suits are held liable for all or a % of the legal expenses? How about creating a limitation of 1-year from the incident to bring up a claim? How about not allowing families to sue every time someone that needs a high-risk surgery dies?

This country has turned into such a litigious society that someone that gets injured breaking into my house could sue me for medical damages. A little bit of tort reform would do this country some good and could have a real beneficial impact, not only on medical costs, but on society as a whole. This is an area that the government actually has direct control over.

I definitely think that tort reform is needed, drug companies need to be regulated better, but bottom line is if you are charging X dollars 20% of X dollars as payment, and making your nut, then there is something wrong with your prices.

That is price gouging at it's finest.
And when Uncle Scam starts telling medical institutions how much they can charge, you know what's going to happen? Smaller practices will close down because their overhead is too high and the tight margins created by the government won't be sustainable. Also, medical institutions will be forced to cut corners and reduce the quality of care in order to be sustainable.

Name me one market that has every benefited by being over-regulated by the government. Typically, more governmental regulation results in significantly more red-tape while having little to no benefit for the consumer.

Like I said above, maybe the government should regulate the price of a gallon of gas and the price of bread. Those prices are too high too.

[QUOTE]Considering that electric, telephone and natural gas companies have government-sanctioned monopolies issued by towns, they should be regulated. My preference is to not have the government-sanctioned monopolies and allow the free market to do its thing./[QUOTE]

Technically telephone companies are no longer monopolies since cell phone, cable tv, and Clec carriers. You can also puchase your electricity from someone other than Ngrid or Nstar, and they just transport it to the end user so again not a monopoly. Not sure about the gas company though, but you could heat your house with alternative fuels like oil, propane, wood, coal or pellets.


[QUOTE]Do these seem reasonable to you? I've read that approximately 10% of medical costs are due to malpractice insurance. According to the wikipedia (take the source for what it is) entry on "Medical Malpractice", 60% of claims against doctors are dropped (still costing an average $22k per dropped claim) and 90% of the time cases go to trial, the doctor is found to be not negligent (yet costing an average $100,000/case)./[QUOTE]

Yeah considering my Ortho guy does surgery two days a week, the day of my surgery he was doing 7 or 8 surgeries that day, which the nurses say was average. So he is averaging say 14 surgeries a week or close to 700 a year which at 10000 a pop is 7 million dollars. So that 100,000 is about 1.5 percent of his operating costs. not 10 percent.



[QUOTE]Not even a little bit - and that's not because I think it's going to be created impotent by the Supreme Court. ObamaCare, if allowed to completely materialize, will have no effect on prices while further contributing to long waiting times to see a specialist./[QUOTE]


At least we finally agree on something.. :grins:

At least we finally agree on something.. :grins:
:cheers:

It would be interesting to hear Thomas' questions.

If he had any.

As I had started this, it's going to be very devisive in the decision.

I could almost see someone challenging SS contributions if they throw ACA out as being unconstitutional.

These decisions well either send us down the road of socialism or further breakdown what is perceived as American prosperity.

Btw the 7 million dollars that the ortho doc generates is just from 2 days of surgery per week, the other 3 he is also generating revenue with 10 -15 office visits per day...

I could almost see someone challenging SS contributions if they throw ACA out as being unconstitutional.

Or things like Auto insurance... I'm a good driver, I think I'll go without....

Or things like Auto insurance... I'm a good driver, I think I'll go without....
You aren't obligated to own a car. Remember, driving is a privilege, not a right. If people don't like it, there's always a bicycle.

Or things like Auto insurance... I'm a good driver, I think I'll go without....

maybe I missed something...when did the Federal Government start mandating auto insurance?

If he had any.


I could almost see someone challenging SS contributions if they throw ACA out as being unconstitutional.



Not even close. Social security contributions are a "tax" levied by the federal government, and the constitution clearly says the federal government has the authority to collect taxes. If it's explicitly in the constitution, it cannot be considered unconstitutional.

The individual mandate is completely different. It's requiring individuals to eneter into a contract with a private company. If the feds can do that, why can't they make you buy a computer from Apple? Why can't they make you buy an electric car?

I hapen to like the individual mandate on the moral grounds that healthy people should help pay the cost of people who get sick through no fault of their own. However, I don't like Obama's willingnes to ignore the constitution when it suits him. If enough people want the federal government to have the authority to force us to buy things from a private company, we have mechanisms to amend the constitution to reflect that. Until then, the individual mandate seems unconstitutional to me.

These decisions well either send us down the road of socialism or further breakdown what is perceived as American prosperity.

That is a stretch, but it certainly should raise the question, if you can't be required to have insurance, then shouldn't a hospital be able to reject the uninsured? Actually, I am not sure if the quote above is an either/or...

If it isn't unconstitutional to make taxpayers and insurance holders pay for others health care, how can it be unconstitutional to require people to be insured?

I bet most who are opposed to this already have health care. They may say they are opposed because of the government mandate for a person to have insurance is a government invasion. I don't believe that is why they oppose it. My gut feeling is the real issue for most them is they don't want to have to pay for the insurance of all the people who will be required to get insurance. Irony is, they already do pay for it. Beech is complicated.

You aren't obligated to own a car. Remember, driving is a privilege, not a right. If people don't like it, there's always a bicycle.

The tax payers are obligated to foot the bill of your medical costs if you are uninsured and get hurt.

The tax payers are obligated to foot the bill of your medical costs if you are uninsured and get hurt.

are they?

I think it was Justice Breyer that made this broad suggestion yesterday as well, but I'm not sure that it is true...

I know a few people that were either injured or became quite ill needing cance treatments etc while uninsured....and the "tax payer" did not pay for their medical costs, most were covered/treated by help from charitable trusts through the hospitals, payment arrangements worked out through the various providers and on...I don't think that hospitals that admit patients or treat them in the emergency room can simply bill the taxpayer for services not paid by the uninsured....to suggest that anyone that needs medical services and can't pay for them at that time either out of pocket or through some form of insurance instantly places a financial burden on "the taxpayers" is...... "a stretch":uhuh:

The tax payers are obligated to foot the bill of your medical costs if you are uninsured and get hurt.

are they?

I don't think that hospitals that admit patients or treat them in the emergency room can simply bill the taxpayer for services not paid by the uninsured....to suggest that anyone that needs medical services and can't pay for them at that time either out of pocket or through some form of insurance instantly places a financial burden on "the taxpayers" is...... "a stretch":uhuh:

In a few states - like NY, they have a surcharge on claims to compensate hospitals for "uncompensated care". I think it is either a per monthly head count or a % of paid claims. The insurance company pays. It is built into the rate the insured pays.

In a few states - like NY, they have a surcharge on claims to compensate hospitals for "uncompensated care". I think it is either a per monthly head count or a % of paid claims. The insurance company pays. It is built into the rate the insured pays.

"The insurance company pays."

I don't think that's true. If the patient is uninsured, how does the hospital know which insurance company to bill? You're saying that surcharge is passed on to all insurance carriers? Maybe. Anyone know for sure?

I'm guessing that hospitals write off a ton of uncollected (and never to be collected) medical bills from folks who can't pay.

This problem isn't getting solved no matter what happens. My objection ha snothing to do with paying for others, my objection is based on the unconstitutionality of it, IMHO of course...

"My objection ha snothing to do with paying for others, my objection is based on the unconstitutionality of it, IMHO of course...

So..
It's the right thing to do, but the wrong way to do it?

You aren't obligated to own a car. Remember, driving is a privilege, not a right. If people don't like it, there's always a bicycle.

auto insurance is state mandated, not federally.

auto insurance is state mandated, not federally.

Thats my fault for a bad example. I know it is state mandated and macintosh apples to green apples.
I think it is mandated in 49 of 50 states.

The point is, it is still a mandated purchase, intended to protect you AND others from your actions (or an accident).

"The insurance company pays."

I don't think that's true. If the patient is uninsured, how does the hospital know which insurance company to bill? They don't, the state govern. sends out the $ based on the total uncompensated care and the amount of surcharge collected You're saying that surcharge is passed on to all insurance carriers? Maybe. Anyone know for sure?IT is passed onto any carriers doing business in that state.

I'm guessing that hospitals write off a ton of uncollected (and never to be collected) medical bills from folks who can't pay.I would guess so.




NY also has a surcharge to subsidize teaching hospitals.

So..
It's the right thing to do, but the wrong way to do it?

In my opinion, yes. I don't think that people who get sick (through no fault of their own) should have to pay one cent more for medical costs than healthy people. None of us control who gets sick and who doesn't (for many diseases), so it seems fair that we share the costs. I just don't think you should ignore the constitution to do it.

Also, I would't apply this to people who choose to eat like pigs or smoke, they should pay the costs of their medical care.

It's a brutal problem, I don't pretend to have any brilliant insights...

In a few states - like NY, they have a surcharge on claims to compensate hospitals for "uncompensated care". I think it is either a per monthly head count or a % of paid claims. The insurance company pays. It is built into the rate the insured pays.

In all cases, the bill is somehow paid. If the hospital covers it, it is passed on to everyone in their hospital bills. If the hospital uses the losses as a write-off- the tax revenues are made up somewhere else (or put on the credit card of our kids), if the insurance companies pay a surcharge- it affects our insurance rates.

In any case, I do think the constitutionality of the health care law treads a thin line, but so does passing off the cost of the uninsured to everyone else and that is established by prior practice for decades.

In all cases, the bill is somehow paid. If the hospital covers it, it is passed on to everyone in their hospital bills. If the hospital uses the losses as a write-off- the tax revenues are made up somewhere else (or put on the credit card of our kids), if the insurance companies pay a surcharge- it affects our insurance rates.

In any case, I do think the constitutionality of the health care law treads a thin line, but so does passing off the cost of the uninsured to everyone else and that is established by prior practice for decades.
A good point made today on Morning Joe, have you every known anyone who didn't use health care in their lifetime?

David Brooks had a good opinion piece yesterday...

http://www.nytimes.com/2012/03/27/opinion/brooks-step-to-the-center.html?_r=1&ref=davidbrooks

-spence

The point is, it is still a mandated purchase, intended to protect you AND others from your actions (or an accident).
Any my point was that it's a conditionally mandated purchase. If someone doesn't agree with paying for auto insurance or cannot afford it, they can ride a bike.

On the other hand, the ACA is an mandated purchase for being a living, breathing human being. If you disagree with ACA or cannot afford it, tough crap - pay up anyway.

A good point made today on Morning Joe, have you every known anyone who didn't use health care in their lifetime?

David Brooks had a good opinion piece yesterday...

http://www.nytimes.com/2012/03/27/opinion/brooks-step-to-the-center.html?_r=1&ref=davidbrooks

-spence

no, I dont.
Nor do I know anyone who didnt use food stores, some form of transportation, eat at restaurants or buy toilet paper.

cannot afford it, tough crap - pay up anyway.

Actually, that isn't true. There is assistance to pay for it if you can't afford it. The alternative is the current system, where if you can't pay for it, you go in uninsured and everyone pays for it anyway. If you don't want to pay for it, you get hurt and everyone else pays for it. How is that a better system?

Thats my fault for a bad example. I know it is state mandated and macintosh apples to green apples.
I think it is mandated in 49 of 50 states.

The point is, it is still a mandated purchase, intended to protect you AND others from your actions (or an accident).

Should that 50th state be required to mandate it because the other 49 have? And if the Federal Gvt. can mandate health care for all of us why shouldn't it mandate auto insurance, or anything else for that that matter, for all of us? If the Federal Gvt need not be limited to its Constitutionally limited powers to mandate, but can mandate anything, are the states even necessary? Would it not be better to eliminate the mish-mash of 50 different governments, and all of us then be gathered under the mandate of one central government? Are the states necessary? Are they merely obstacles to good, uniform government?

From Brooks article -


Second, Obamacare centralizes Medicare decisions — and the power of life and death — within an unelected Independent Payment Advisory Board. Fifteen experts are charged with controlling costs from the top down.

Hmm, so he is basically agreeing its a death panel? So, Sarah Palin WAS RIGHT???

OMG!!!!!!!!!!!!!

What does the health-care law mean to me? - The Washington Post (http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/)

no, I dont.
Nor do I know anyone who didnt use food stores, some form of transportation, eat at restaurants or buy toilet paper.
Do they pay the bill when they do those other things?

Hmm, so he is basically agreeing its a death panel? So, Sarah Palin WAS RIGHT???

OMG!!!!!!!!!!!!!

I'm gonna get you one of these shirts as a going away present....:hihi:

Do they pay the bill when they do those other things?

Should all the state and local regulations, taxations, mandates, and ordinances that govern the sale and purchase of those other things be replaced by Federal mandates? Wouldn't that make it more uniform and fair, more equal, and even more affordable for all of us? Shouldn't state and local governments be eliminated and replaced by the Federal Gvt.?

:happy:

Should all the state and local regulations, taxations, mandates, and ordinances that govern the sale and purchase of those other things be replaced by Federal mandates? Wouldn't that make it more uniform and fair, more equal, and even more affordable for all of us? Shouldn't state and local governments be eliminated and replaced by the Federal Gvt.?

The constitution is a list of enumerated powers. It specifically lists powers granted to the federal government, and it specifically says that everything else is left to the states.

Having these types of things mandated by the feds might be more consistent and fair. However, the constitution doesn't say that it can be ignored to promote fairness or consistency.

Johnny D is exactly correct, the analogy of auto insurance is a terrible analogy, because no one is forced to drive a car, and many peopl are not impacted by auto insurance requirements because they don't drive (lots of folks in big cities don't drive, and thus can avoid buying auto insurance without penalty). Obamacare requires every single human being to enter into a contract with a private company. Nothing like that has ever been proposed, I don't think. That it hasn't been proposed doesn't mean it's unconstututional, that's why we have the Supreme Court.

have you every known anyone who didn't use health care in their lifetime?

-spence


Once again you miss the point entirely. It doesn't matter, as far as the constitutionality of the law is concerned, that everyone will use healthcare at some point.

Everyone will die at some point. That doesn't mean the feds can mandate how we handle our funeral arrangements.

Everyone eats food. That doesn't mean the feds can mandate a healthy diet for all of us.

Spence, you need to seperate your love of Obama from the question of constitutionality. Just because this was Obama's idea, doesn't necessarily mean it's constitutional. Obama's agenda is not a litmus test for constitutionality. The number of people impacted by healthcare is absolutely, conmpletely meaningless to the Supreme Court.

That it hasn't been proposed doesn't mean it's unconstututional, that's why we have the Supreme Court.

So, if the SCOTUS upholds it as constitional, and you agree with it in principal, would you then support 'Obamacare'?

I feel bad for the Solicitor General...must be rough being laughed at in the Supreme Court when you are trying to defend landmark legislation...

someone mentioned Justice Thomas, I don't know about questions he asked or didn't ask but I'm sure he was wondering how it is possible that this legislation was signed by a President who some claim was a Constitutional scholar of some sort and sworn to uphold and defend the Constitution....passed by a Congress(needing every trick in the book employed) made up of many people with legal backgrounds and sworn, I think, to uphold and defend the Constitution,.... and now argued by a guy who, I guess, is supposed to have some knowledge of what he is arguing with regard to the Constution....

The constitution is a list of enumerated powers. It specifically lists powers granted to the federal government, and it specifically says that everything else is left to the states.

I agree with you about what the Constitution says. But what judges say is often different than what the Constitution says. There is a famous "footnote" in the history of U.S. Constitutional jurisprudence. Footnote 4 written by Justice Harlan Stone for the 1938 U.S. vs Carolene Products which was used later to allow government to legislate against "unenumerated rights" of the People and for the non-enumerated powers of government so that Federal Government regulations would be reviewed on a "rational basis scrutiny." If government could show an even remotely rational basis for the legislation, regardless of any factual presentation or lack thereof, it would be upheld.

Having these types of things mandated by the feds might be more consistent and fair. However, the constitution doesn't say that it can be ignored to promote fairness or consistency.

You're right, the Costitution doesn't say so, but judges that have been educated in modern law schools are steeped in a progressive view of "instrumentalist" interpretation. That is, the Court is not simply a referee of Constitutional rules, but judicial decisions should be instrumental in achieving certain social goals or by treating all legal doctrines as instruments or means of serving the social objective that the judge deams appropriate. Several theories are used as a basis for such interpretation such as "realism," "monumentalism,"cognitive jurisprudence,"rule according to higher law," and "universal principal of fairness."

Johnny D is exactly correct, the analogy of auto insurance is a terrible analogy, because no one is forced to drive a car, and many peopl are not impacted by auto insurance requirements because they don't drive (lots of folks in big cities don't drive, and thus can avoid buying auto insurance without penalty). Obamacare requires every single human being to enter into a contract with a private company. Nothing like that has ever been proposed, I don't think. That it hasn't been proposed doesn't mean it's unconstututional, that's why we have the Supreme Court.

Actually, several people have been exempted from the mandate. But, when you argue with a progressive, you do so with someone who views "fairness," "equality," and equitable distribution of pain and gain through a centralized authority above any Constitutional consideration. When you point out that legislation may be unconstitutional, you will either get no response, or be led into a discussion of fairness, equity, or some contrived model of economic advantage. And usually, if not always, the instrument or means to achieve the goal is the Federal Government, which begs the question--are States necessary or are they (as well as the Constitution) an obstacle to good, efficient government?

So, if the SCOTUS upholds it as constitional, and you agree with it in principal, would you then support 'Obamacare'?

I support the notion that no one who gets sick, through no fault of their own, should have to suffer financially. I'd support a plan that solves that issue in an efficient way. I don't know if Obamacare does that. And there's a lot more to Obamacare than the individual mandate. If Obama was serious about reducing medical costs, and he is not, then he would have included tort reform as part of Obamacare. He won't do that, because his party is in the pocket of the Trial lawyers lobby.

Obama has attacked the health insurance industry, as if their whopping 6% profit margins are the problem. That's just ideological BS for the Spences of the world, just like his current war on the wealthy.

Actually, several people have been exempted from the mandate. But, when you argue with a progressive, you do so with someone who views "fairness," "equality," and equitable distribution of pain and gain through a centralized authority above any Constitutional consideration. When you point out that legislation may be unconstitutional, you will either get no response, or be led into a discussion of fairness, equity, or some contrived model of economic advantage. And usually, if not always, the instrument or means to achieve the goal is the Federal Government, which begs the question--are States necessary or are they (as well as the Constitution) an obstacle to good, efficient government?

Very well articulated, sir!

Detbuch:
I believe all judge's decisions regardless of the time period are informed by their own political beliefs and inclinations and if you look at the Supreme Court there have been periods where different ideologies have held sway with different degrees of impact.
General comment:
If in fact the idea that mandating health insurance by requiring those who do not have it to pay a penalty fee then I think that the issue becomes one of restructuring the law so that those who do not have health insurance pay a higher rate of tax or there is a deduction of the cost of that insurance for those who have paid for the insurance. One of the big problems with health care that is behind the heath insurance law is that the uninsured do not have the means to gain access to preventive medicine and over time they in turn result in larger payments for all users of the health care system in the US. While adding another deduction/credit to the tax goes against my idea that deductions should be eliminated and all rates reduced the "tax" objection to the bill seems to me one that could be worked around.

no, I dont.
Nor do I know anyone who didnt use food stores, some form of transportation, eat at restaurants or buy toilet paper.
Big difference, with all of those items there are already set costs. The argument made by the Administration is that the price of health care is heavily influenced by how one pays for it.

-spence

Once again you miss the point entirely. It doesn't matter, as far as the constitutionality of the law is concerned, that everyone will use healthcare at some point.
It matters because if people are going to use health care they are going to participate in interstate commerce regardless if they're paying for it or not. If everybody is participating then there's no real argument that someone can really opt out.

Jim, I actually read the entire transcript from yesterday...have you?

-spence

Big difference, with all of those items there are already set costs.

The price of all those items do not have a "set cost." A great portion of the costs are a result of various government regulations and taxes. The price of manufactured goods have built-in tax and regulatory costs that range all the way from the production or growth of the basic materials required to manufacture the final product including the regulations and payroll taxes and social security and medicare and local and state taxes that each of those producers pay and are part of the price of material they ship to the ultimate manufacturer, and the same costs are included in the companies that transport the materials to the ultimate manufacturer, and the same costs that the ultimate manufacturer has to pay its employees again all added to the cost of the product and often the same government costs that private shippers pay and are part of their fee to deliver to retail outlets and, finally, the retail outlet has the same types of governmental regulatory and payroll taxes, etc. that factor in to the final price of the product a great portion of which can be the accumulation of all the taxes and regulations payed along the way to manufacture and sale. It has been estimated that 50 to 60% of the price of manufactured items is in the taxes and fees paid overall. And various localities have different regulations and tax structures as well as differing levels of clientele for products so that prices of the same goods are different in different places, and there are sales and clearances and fluctuating economic conditions that affect the prices. Prices for most products have been rising lately due to multiplicities of factors, not the least of which is government intrusion

The argument made by the Administration is that the price of health care is heavily influenced by how one pays for it.

-spence

The price of health care is also very heavily influenced by government regulation and mandate. In the case of the Federal Government, much of the mandates are unfunded. It was the Federal Government, in the first place, that forced hospitals to accept emergency patients that have no insurance. It is Federal regulation and collusion that artificially raises the price of drugs to be much higher than necessary. And if the government thinks that a mandate can require uninsureds to pay for insurance, that means it believes that those people could have purchased insurance before the mandate, so it shouldn't have forced hospitals to accept them unless they payed for the uninsured health care they received just as any customer must pay for the product it buys in any other transaction. And the force of local laws would be sufficient for such transactions. As for those that cannot afford to buy insurance, won't their costs still be shifted to those who are insured, even if the government picks up the tab for them in which case the cost is shifted to the tax payer. And isn't the so-called shift in costs that occurs now overestimated--the article that I posted in the other thread relates a study that estimates the cost shift not to be $1,000 for an average policy, but an annual cost of about $80. So the government creates problems, then expands its power in order to "solve" the problems--in this case with a "solution" that is even more expensive for most, and in the same stroke changes the fundamental relation of the individual to the government. Government power expands, individual freedom contracts. But it is all for the better and is more efficient, and the power of government pervades into all aspects of our economic lives, which is virtually all aspects.

If all commerce can be "regulated" by the Federal Gvt., which this mandate would give it the power to do, I ask again, in this thread, for the fourth time, are States and the Constitution necessary? Are they not obstacles to efficient centralized government? Would it not be better to just abolish them?

Detbuch:
I believe all judge's decisions regardless of the time period are informed by their own political beliefs and inclinations and if you look at the Supreme Court there have been periods where different ideologies have held sway with different degrees of impact.


Not as much as one would conclude by how the Court has adjudicated for the past 75 years. The period between the FDR Court to now is the time when adherence to the text of the Constitution was deliberately discarded in favor of desired political outcomes. There are various reasons for that, the main being the prevalence of progressive philosophy in our universities and educational institutions and the efforts of progressive politicians which culminated in the FDR administration all-out attack on the Constitution. This is all well documented and easily researched. That only "radical" Tea Party types and conservative talk radio, and "radical right wing" politicians discuss it, is due, again, to how our elites in the media, and the rest of us for that matter, have been educated, and the gradual acceptance of generations of the status-quo. Current generations have known only this, and accept it as correct.

Though there were some differences in Constitutional interpretation before FDR, they were not major deviations from the Constitution and the greatest problem was the slavery issue. Not that there were not attempts to expand Federal power beyond Constitutional enumerations, some of which may have succeeded to some degree, but there was no great (except for slavery) disagreement on Constitutional authority between those of opposing parties. Even Grover Cleveland, a Democrat, vetoed hundreds of bills (I think it was hundreds--it was a lot) because he considered them to be unconstitutional. Judges were not forced to consider a barrage of assaults on the Constitution because there weren't that many. And when they adjudicated, there was far more faithfulness to Constitutional text and intention.

It matters because if people are going to use health care they are going to participate in interstate commerce regardless if they're paying for it or not. If everybody is participating then there's no real argument that someone can really opt out.

Jim, I actually read the entire transcript from yesterday...have you?

-spence

Spence, in your previous post, you didn't make a reference to the Commerce clause. you implied that the individual mandate was justified because of how many people participate in healthcare. I was reacting to what you posted.

It matters because if people are going to use health care they are going to participate in interstate commerce regardless if they're paying for it or not. If everybody is participating then there's no real argument that someone can really opt out.

Jim, I actually read the entire transcript from yesterday...have you?

-spence

No, most health CARE is not interstate. Some products that are used may have crossed state borders and such products can be "regulated"--whatever that means. But the actual care, unless the hospital is straddling a border, is usually intrastate, not interstate. A great deal of health care is only consultative with no products being used or exchanged. In any event, the B R O A D, expansive, "interpretation" of "commerce," "regulate,." and "interstate," is not justified in the text of the Constitution, neither was it intended according to the extant documents of ratification and explanations given in letters and statements later by the founders. But that is, apparently, not important to you. Valid arguments about what such broad interpretation and the power it grants to the Central Government, and the fundamental change in the relation between the citizen and the government also seem to be of no importance to you. What seems to matter only is a solution to a problem regardless of what precedence that solution gives to government to "regulate" every aspect of our lives. No matter even that much of the problem is created by government in the first place--the same government that presumes to fix it. Nor does it seem to matter to you that the solution, along with the train of solutions over the past 70 years, destroys the foundation, the structure of limited, representative government built specifically to ensure individual lilberty, and replaces the structure with an amorphous, unlimited administrative apparatus. An apparatus that will replace individual sovereignty and more "efficiently" solve all our "collective" problems. I ask again, of what use are 50 different State governments and an unadhered to Constitution to such an apparatus?

It matters because if people are going to use health care they are going to participate in interstate commerce

-spence

it was statements like these and other tortured definitions of convenience that found the Solicitor General being laughed at on the floor of the Supreme Court the last few days. :)

from : MOTHER JONES

Obamacare's Supreme Court Disaster
—By Adam Serwer

The White HouseSolicitor General Donald B. Verrilli Jr. should be grateful to the Supreme Court for refusing to allow cameras in the courtroom, because his defense of Obamacare on Tuesday may go down as one of the most spectacular flameouts in the history of the court.

Sounding less like a world-class lawyer and more like a teenager giving an oral presentation for the first time, Verrilli delivered a rambling, apprehensive legal defense of liberalism's biggest domestic accomplishment since the 1960s—and one that may well have doubled as its eulogy.


that's from BIG Obamacare supporters:uhuh::)

If all commerce can be "regulated" by the Federal Gvt., which this mandate would give it the power to do, I ask again, in this thread, for the fourth time, are States and the Constitution necessary? Are they not obstacles to efficient centralized government? Would it not be better to just abolish them?

clearly, based upon statements by people here, the answer is either.."no", the States and the Constution are not necessary in their minds/views ....or....."maybe", but they are so woefully uninformed on States Rights and the Constitution that these considerations never enter into any of their arguments :)

it's depressing........fortunately, it's been shown the last few days that you can try to argue around and around the Constitution and logic and common sense, but it's tough to argue through it...


Madison- Federalist #45
"The powers delegated by the proposed Constitution to the federal government, are few and defined. Those which are to remain in the State governments are numerous and indefinite. The former will be exercised principally on external objects, as war, peace, negotiation, and foreign commerce; with which last the power of taxation will, for the most part, be connected. The powers reserved to the several States will extend to all the objects which, in the ordinary course of affairs, concern the lives, liberties, and properties of the people, and the internal order, improvement, and prosperity of the State."


JUSTICE KENNEDY: "And here the government is saying that the Federal Government has a duty to tell the individual citizen that it must act, and that is different from what we have in previous cases and that changes the relationship of the Federal Government to the individual in the very fundamental way."


interesting, this would appear to represent, and I think what is really the essence of the "Fundamental Change" that we were promised by this President, which may/should be a change that he has no authority to promise

it's depressing........fortunately, it's been shown the last few days that you can try to argue around and around the Constitution and logic and common sense, but it's tough to argue through it...




Gotta luv your statement.
Common sense is not so common.
It comes from an open mind, experience and practical knowledge.

“Fathom the hypocrisy of a Government
that requires every citizen to prove
they are insured....


but not everyone must prove they are a citizen.”