Constitutional Health Care Activity

CONSTITUTIONAL HEALTH CARE

Assessing the Necessity of Health Care Reform and constitutionality of the Supreme Court's
"Affordable Health Care Act" decision

In June 2012, the Supreme Court passed Nat'l Fed. of Ind. Business v. Sebelius; Florida, et al., v. HHS; and HHS v. Florida, et al … .aka, “Obamacare”, declaring it legal and constitutional for a government to require all Americans to secure health insurance. Since then, “Obamacare” has been the subject of intense controversy. But why, in the first place, was Obamacare “necessary”?

For what main reasons is “traditional” health care in need of “reform”, and why did the Courts find “Obamacare” constitutional?

Utilizing the DBQ-concept of “presented evidence / drawn conclusion”, read through the information below to find supporting evidence and topical paragraphs...

Part I: The
"Need for Reform"

In our American system of health care, the government spends more money, but we have fewer doctors and shorter life expectancies. Additionally, if the government is spending all this money, when then is health care so darn expensive?

TIME Magazine covered this very issue in March 2013. The title of the featured article was called"The Bitter Pill: Why Medical Bills are Killing Us" and explores the problems with the current health care system. To be able to understand the need for Obamacare, we must start by understanding why health care was broken in the first place.

Read excerpts from the article below.

~ The Basic Problems ~

The article starts out by discussing some of the "basic problems" with today's health care system. And it discusses "cost" first. Read the excerpts below:

- In the U.S., people spend almost 20% of the gross domestic product (the country's "worth") on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries… We spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia.
- According to the Center for Responsive Politics, the pharmaceutical and health care product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and other health insurance programs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health care industrial complex spends more than three times what the military industrial complex spends in Washington.
- Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance.

The article continues to discuss the "basic problems" with today's health care system by defining the "victims" inside of the system. Read the excerpts below:

People fare differently according to circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may limit how much they employer will pay or which drugs and treatment they'll cover. They may or may not be old enough to be on Medicare (a health care program for senior citizens) or be poor enough to be on Medicaid, the government-assisted program that provides for low-cost health care…And if you're not protected by Medicare, the health care market is not a market at all. It’s a crapshoot…
Additionally, most Americans today have little visibility into pricing, let alone control of it. And if they do have access to the bill, they have no idea what the bill means. They have little choice of hospitals or the services they are billed for, even if they somehow know the prices before they get billed for the services.
They have no choice of the drugs that they have to buy or the lab tests or body scans that they have to get, and they would not know what to do if they did have a choice.
They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers. Since 2011, there have been more than 3.5 million personal bankruptcies filed in the U.S. Some 60%, or more than 2 million, are estimated to have involved medical debt as a key factor.

~ Government Bureaucracy ~

In the 1930s, Franklin Roosevelt created the Social Security Administration to help those in need of government support through unemployment relief, retirement savings, and basic health care services. During World War II, the federal government "froze" the profits of private businesses, but allowed these same businesses to attract and retain employees by offering certain "benefits", such as health insurance. In the 1960s, Lyndon Johnson created the Medicare system (which later expanded into Medicaid in the 1980s) to help the elderly and the poor pay for health care. And today, we find that not much has changed. Read the excerpts below:

Medicaid covers more people: 56.2 million compared with 50.2 million with Medicare.
More than 3 million bills that come into Medicare every day. The system then figures out the right payments for each person and churns out more than $1.5 billion a day in wire transfers.
However, hospital finance people argue vehemently that Medicare doesn’t pay enough and that they lose as much as 10% on an average Medicare patient.
Medicare spent more than $6.5 billion last year to pay doctors, but these payments are at a deeply discounted Medicare rates. Remember that Medicare / Medicaid is for the elderly and the poor, so "cost" to the patients is very low. The difference between what the patient pays and what the doctors charge is paid by the federal government. Depending on the discount, a Medicare patient can pay anywhere from $7.48 to $164 for a chest X-Ray reading.
One such patient we interviewed had 33 visits in one year to 11 doctors who had nothing to do with his recovery from the heart attack or his cancer. In all cases, he was routinely asked to pay almost nothing: $2.20 for a check of a sinus problem, $1.70 for an eye exam, 33¢ to deal with a bunion. “They paraded in once a day or once every other day, looked at me and poked around a bit and left,” Alan A. recalls. Other than the doctor in charge of his heart attack recovery, “I had no idea who they were until I got these bills. But for a dollar or two, so what?”

~ The Cost ~

Most Americans get their health care from their "employer", meaning that their employer "pays" most of their monthly bill, or "subscription" to health care, and just charges the employee a smaller fee. This "smaller fee" can vary: A public school teacher, for example, might pay $15 per month for health care while their school district picks up the rest of the bill. Conversely, a businessman in a private business (Starbucks, for example...) might pay $200 to $300 per month. It all depends.

Let's continue to read excerpts from the article and try to answer why health care is so expensive.

When Sean Recchi, a 42 year old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston, Texas. Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. The total cost for Sean to get his treatment plan and initial doses of chemotherapy was $83,900.
Soon after he was diagnosed with lung cancer in January 2011, a patient whom I will call Steven D. and his wife Alice knew that they were only buying time. The crushing question was, How much is time really worth? Alice had collected bills totaling $902,452. They had maxed out on the $50,000 payout limit on a UnitedHealthcare policy they had bought through a community college where Steven had briefly enrolled a year before. A "payout limit" is the maximum amount of money that a health insurance company will pay. After that, the bills are up to you! “We were in shock,” Alice recalls. “We looked at the total and couldn't deal with it. So we just started putting all the bills in a box. We couldn't bear to look at them."
There was no way the D.’s or Sean Recchi could pay those bills...so what happens?
Consider another case involving a 61-year-old bus driver named Emilia Gilbert who slipped and fell one evening in her backyard in Fairfield, Connecticut. She was taken to the emergency room at Bridgeport Hospital, where she was treated for some cuts and a broken nose. She left a few hours later with a bill for $9,418, which included $6,538 for CT scans and $239 for a routine blood test. When Gilbert, who was earning about $22,000 a year, was unable to pay, she was sued by the hospital. A judge ordered her to pay off her bill in $20 weekly payments over six years.
That's one solution: long payment plans. The D.'s were able to scrape together $3,000. With the couple’s $3,000, on top of the $50,000 paid by the UnitedHealthcare insurance, that leaves a bill of almost $850,000. Hospitals can put the D.'s or the Recchi's on a payment plan, but these plans would take hundreds of years to pay off! So hospitals just "write it off" in the form of "discounts"....
What is a "write off"? Let's look at the numbers: Of the $900,000 bill the hospital charged, they only received $53,000. Technically, that's the only revenue (profit) they collected. When it comes time to pay taxes to the government, they only pay taxes on the $53,000, completely ignoring the $850,000 debt because it's "written off"....
The government is now "missing out" on its tax money. "Write offs" are legal and normal, as the government allows them. BUT! They government is STILL NOT GETTING the taxes they're due! And that's part of the reason why we have such a high debt today...
According to a recent financial report, some hospitals apply so many discounts and write-offs that they end up with only about 18% of the revenue it bills for. That’s an average 82% discount.
When the discounts to Medicare and private insurers are applied, hospitals end up being paid a lot less overall than what is itemized on the original bills. One particular hospital studied ended up receiving about 35% of what it bills to patients. This money is left unpaid...and that's that...

Additionally, there the so-called "chargemaster"

Why exactly are the bills so high? For one, it has to do with something called a"chargemaster". The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.
No hospital’s chargemaster prices are consistent with those of any other hospital, nor do they seem to be based on anything objective — like cost — that any hospital executive I spoke with was able to explain. “They were set in cement a long time ago and just keep going up almost automatically,” says one hospital chief financial officer with a shrug… An “NM MYO REST/SPEC EJCT MOT MUL” was billed at $7,997.54. That’s a stress test using a radioactive dye that is tracked by an X-Ray computed tomography, or CT, scan. That's a very high cost for a "CT Scan". Additionally, another problem is that Medicare only pays the hospital about $550 for that test.
Dozens of mid-priced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-Ray for which one hospital is routinely paid $20.44 when it treats a patient on Medicare. Here are additional "bills" that we found alarming:

VOX.com covered the high cost of medications as well. With the provocative title, This Drug Costs $84,000, And There's Nothing the U.S. Health Care System Can Do to Fix It, we find that the drug, Sovaldi, with the power to cure the fatal disease of Hepatitis-C, costs $1,000 per pill, with a total bill of 84.000 per treatment cycle.

Why? The answer, simply, is that no one knows. To read more about this story, click here.

Additionally, VOX.com ran other story, again, provocatively-titled, A Knee Replacement Can Cost Anywhere from $16,000 to $61,000. That Makes No Sense. And it seems like they're right. Why do costs vary so much, in addition to being so high in the first place? You can see from the map below that certain parts of the country have a wider range of cost discrepancy. Read the story here.

~ Tests, Tests, Tests ~

By now, we've seen that Medicare / Medicaid covers about 90 million people, and that one of the biggest problems is that hospitals don't get PAID enough in return! Hospitals run a deficit and this deficit is passed on to the federal government. Perhaps that's why they charge so much for tests, testing strips, and alcohol pads. Another problem we see is that, quite frankly, Americans have TOO MUCH health care! Read below:

A recent report found that health care providers in the U.S. conduct far more CT tests per person than those in any other country — 71% more than in Germany, for example, where the government-run health care system offers none of those incentives for over-testing. We also pay a lot more for each test, even when it’s Medicare doing the paying.
According to a study in the Annals of Emergency Medicine, the use of CT scans in America’s emergency rooms “has more than quadrupled in recent decades.” As one former emergency-room doctor puts it, “Giving out CT scans like candy in the ER is the equivalent of putting a 90 year-old grandmother through a pat-down at the airport: Hey, you never know.”
“We use the CT scan because it’s a great defense,” says the CEO of another hospital not far from Stamford. “For example, if anyone has fallen or done anything around their head — hell, if they even say the word head — we do it to be safe. We can’t be sued for doing too much.” This is to defend against medical malpractice litigation, in other words, people "suing" the doctors because of something they did wrong.
Said one doctor, “I bet 60% of the labs are not necessary.” Said another, “They hand out blood tests and Xrays in hospitals like bottled water, and they know it.”

Part II:
A "Constitutional Decision"

In March 2012, with the Court's decision looming, many wondered if it was Constitutional to mandate that all Americans have health care coverage. Many cited the Freedoms of Speech, Religion, and Individuality as reasons against it, and the 9th Amendment that protects against the expansion of abusive government power. Joe Klein, who writes for TIME Magazine, wrote the following in an article entitled, "Is Obamacare Constitutional?" Here is an excerpt:

If Obamacare is upheld, it fundamentally changes the nature of the American social contract. It means the effective end of a government of enumerated powers — i.e., finite, delineated powers beyond which the government may not go, beyond which lies the free realm of the people and their voluntary institutions. The new post-Obamacare dispensation is a central government of unlimited power from which citizen and civil society struggle to carve out and maintain spheres of autonomy.

A majority of constitutional-law scholars predicted that the law would be struck down. And in fact, four of the court’s conservative Justices did vote to strike it down — including Anthony Kennedy, who is usually the court’s swing vote. Let's examine how the judges voted. The conservative judges (Thomas, Scalia, Roberts, Alito, Kennedy) are shown with an orange border; the liberal judges (Sotomayor, Breyer, Kagan, Ginsburg) are shown with a blue border.

Below is how each judge voted on the constitutionality of the Act. The "washed out" judges voted "unconstitutionally".

Roberts, usually a conservative, actually sided with the court liberals!!!

"The government is claiming that not only can it regulate economic activity, but also inactivity.
This substantially affects interstate commerce."

"There is government force in almost every economic decision
because the government already regulates so much."
(Sotomayor's argument in March that since Congress requires people
to buy all sorts of things, this is really nothing new!

"To say that [the Act] merely imposes a tax is not to interpret the law but to rewrite it."
(This is the central argument of the Court conservatives: this is more than just a tax!)

"Because we are human beings we all suffer from the risk of getting sick."
(Breyer's reasoning that all Americans should be considered
part of the health care market because everybody needs care eventually)

"Put simply, Congress may tax and spend."
(This is the central argument of the "majority" decision: If you don't buy health insurance,
you'll be taxed...and since Congress has the power to tax, this is completely constitutional!)

"We should be approaching this case with caution, minimalism and the understanding that

the federal government is one of limited powers."

(Alito's reminder that the government has "limited powers" and that this Ac)

"If Congress can reach out and command even those furthest removed from an interstate market to participate in the market, then the Commerce Clause becomes a font of unlimited power."
(Kennedy's belief Congress should not be able to require people to buy anything)

"We don't get insurance so that we can stare at our insurance certificate.
We get it so that we can go and access health care."
(Kagan's case that health care is different from other kinds of goods and services
and that, therefore, regulating it requires an "different" kind of solution)

"When contemplated in its extreme, almost any power looks dangerous."
(Ginsburg's argument that conservative Justices' fears about the scope of the law were unfounded)

Chief Justice John Roberts claim that Congress may tax and spend is the reason why the Act passed. But he may have voted in favor for other reasons. The following excerpt is taken from TIME Magazine on how and why Roberts voted the way he did:

Roberts may have voted with the court’s liberals because he simply believed that Congress had the constitutional power to pass the Affordable Care Act. It could be that Roberts held back out of concern about the enormous impact that striking the law down would have had. It is one thing to say that a Christmas tree must be removed from a town square [out of the Freedom of Religion, First Amendment issue] and quite another to strike down a law that provides health care to millions of people. There is another possibility: Roberts may have been responding to the mounting criticism of the Roberts court....Just 44% of Americans say they approve of [the Court and how they've handled recent issues].

And again, this is the "central argument" of the five (5) approving judges on why the Affordable Health Care Act was "constitutional". Congress has the power to tax.

Most people still don't understand how the Affordable Health Care Act got passed. According to TIME Magazine, "How can Congress' authority to regulate interstate commerce reach into the pockets of citizens who aren't a part of the commerce? If Congress can make people buy private insurance, what else can they make us buy?"

But Congress (or Obama) isn't making you buy anything! They're simply charging you a tax if you DON'T buy Health Care! Sneaky, yes. But constitutional. It gets at the same end-result, but along different avenues...

Part III:
Mandated Healthcare

OK. So we've seen how health care is in need of reform:

A lack of patient awareness into what they're being charged and how they're being cared for.
A bloated government bureaucracy that provides discounted health care for close to 100 million people
TOO MUCH health care, perhaps, seen in the sheer number of tests and procedures
Exorbitant prices that no one can quite figure out
Debt, lack of medical payment, the threat of malpractice lawsuit, and the infamous "chargemaster".

And we've seen that the Supreme Court defended the government mandate that forces people to buy health insurance, not decreeing that Congress has the power to force health insurance on people, but rather tax (fine) people for NOT buying health insurance. Tricky, tricky...

So, what does it all mean. What exactly is "Obamacare"? For any and all questions on health care reform, click on the VOX.com logo below to take you to an external site...