J. KARL MILLER: Americans deserve better than 5-4 court decision on health care

Wednesday, June 27, 2012 | 6:00 a.m. CDT; updated 2:58 p.m. CDT, Wednesday, June 27, 2012

 Erelong, perhaps before this is published, the U. S. Supreme Court will hand down its decision on the fate of the Patient Protection and Affordable Care Act, known unlovingly in some quarters as "Obamacare."

The only bipartisanship recorded in the act's passage was the 34 Democrats who joined the Republicans in voting nay.

Unpopular from its inception and rushed through Congress by the use of sops (the Nebraska Compromise and the Louisiana Purchase), intimidation and by altering Senate procedures to reflect passage by majority vote, the Affordable Care Act remains something of an albatross. A poll taken in March by Washington Post/ABC poll shows 52 percent against and 41 percent in favor. 

The arguments were heard by the Supreme Court in March, and the consequences of the ruling on the constitutionality of all or portions of the Affordable Care Act concern Democrats and Republicans alike. The question yet to be answered is: How will it affect the November presidential election?

The court has several options  — it can declare the entire law to be constitutional, it can toss the entire statute or it can allow portions of the lawto stand. The court can also decided not to rule until after the government imposes its first penalties for noncompliance, which are due in 2015 or so, but this option is not considered to be likely.

The primary point of contention in the health care statute is the constitutionality of the individual mandate, which requires people to purchase health insurance or pay a fine.

Proponents of the health care law argue that it falls within the enumerated powers of the Commerce Clause to regulate commerce with foreign nations and among the several states. The opponents are equally adamant that forcing citizens to purchase a product cedes to the government an unlimited power of coercion — neither envisioned nor permitted by the Constitution.

Be that as it may, the real issue here should not be whether the court will overturn or sustain all or portions of the Affordable Care Act. It is also not about the attempts of the president, Senate Judiciary Chairman Patrick Leahy, D-Vt., and other left-wingers to intimidate and influence Chief Justic John Roberts' vote.

Whatever the court's decision, the most disturbing aspect is the almost certainty that the vote will be divided 5 to 4, along political and ideological lines of liberal versus conservative justices. Far too many of the court's most controversial decisions have been decided thus – a circumstance that should be cause for alarm in that politics and ideologies are being substituted for the interpretation of laws.

Biographical information discloses that of the nine current justices, five have Harvard law degrees, three have Yale law degrees and one, Ruth Bader Ginsburg, attended Harvard Law School and received her LLB from Columbia University. I don't believe anyone will deny that these Ivy League schools are the top of the line in the development of the nation's finest legal minds.

Why then do we have this division along party lines in those politically controversial issues when the chief justice and his associate justices attended the same law schools, studied under similar curricula, and, presumably, acquired identical jurisprudential training?

Regardless of the legislative majorities involved in its passage, a statute in question is either constitutional, or it is not.

I am not sure how we might correct judicial activity more reminiscent of  political football than of serious deliberation. We can decry "judicial activism" until the cows come home, but so long as presidents and political parties nominate judicial candidates of liberal or conservative bent rather than nominate candidates based on judicial integrity, this conundrum will prevail.

In reviewing the Constitution to ascertain the qualifications required of the judiciary, one finds that there are none listed. Not only is there no requirement that they be lawyers, Article III, Section 1 states, "The Judges, both of the supreme and inferior Courts, shall hold their Offices during good Behavior, and shall, at stated Times, receive for their Services, a Compensation, which shall not be diminished during their Continuance in Office."

Perhaps the Founding Fathers were trying to make a point in spelling out in considerable detail the qualifications for the members of Congress and the president while ignoring those of the judicial branch. Politics and the judiciary were never meant to share the same bed  — the people deserve that much.

J. Karl Miller retired as a colonel in the Marine Corps. He is a Columbia resident and can be reached via email at Questions? Contact news editor Laura Johnston.

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Ellis Smith June 27, 2012 | 7:20 a.m.

When the Founders established three separate branches of federal government we can only wonder whether they could envision the current situation. The judicial arm of government is supposed to INTERPRET existing laws, not to make laws.

When a local judge fines someone for speeding or drunk and disorderly conduct, the judge is "interpreting" the law for the benefit of the defendant; the judge is NOT making that law. When the Supreme Court of the United States rules on a law it is judging its Constitutionality; it is NOT making that law.

When did they stop teaching what we once called "Civics" in public (and perhaps also private) schools, or are students today encouraged to sleep through classes?

As for numerics, under our Constitution a 5-4 decision by the Court technically counts the same as a 9-0 decision, regardless of the endless "spin" that will be given to a vote that's not unanimous. Unanimous votes by the Justices are infrequent; I maintain that's a very good thing.

(Report Comment)
Steve Simmons June 27, 2012 | 8:15 a.m.

Colonel Miller-based on the title of your column and its premise that politics and the judiciary were never meant to mix, would you then prefer a 9-0 opinion in favor of "Obamacare" and, in particular, the personal mandate (an extremely unlikely proposition I admit) than a 5-4 opinion against?

(Report Comment)
Greg Allen June 27, 2012 | 9:43 a.m.

For healthcare to have become such a large political football that a legal mandate to buy insurance or pay a penalty is floated, and then even more insanely to hang onto it until the Supreme Court has to quell the shouting, something has gone very wrong indeed. And perhaps we should return the issue to its source: healthcare costs rose too much, insurance interests benefitted too much, and profit came to override patient care. Until we return an argument to its source there will be no resolution. I'm sure that those who continue to profit are smugly content to let the focus stay off of them.

(Report Comment)
Mark Foecking June 27, 2012 | 10:41 a.m.

Greg Allen wrote:

"I'm sure that those who continue to profit are smugly content to let the focus stay off of them."

Profit is a very small part of the cost of health care.

Here are four excellent, balanced articles that lay out the issues and recommends rational ways to control costs:


(Report Comment)
mike mentor June 27, 2012 | 11:23 a.m.

Your still clouded by what you want to hear. The point is that we have justices voting along party lines. It would be the hight of ignorance to think that these legal scholars who are educated in the laws of the land for many many years are coming to their conclusions independent of politics and that coincidence is to blame for party line after party line vote. There is no question that we have judicial activism present if these top legal minds are trying to pull the laws and what they say in different directions and are consistently doing it based on their political affiliation and the affiliation of those that appointed them.

So, IF the power was granted to the Federal Government to require it's citizens to purchase a product by law, then it would be better for the country that the justices would agree that owebamacare is in accordance with such laws and that even the justices who are against the law politically would still agree with what the laws meant legally.

However, no such law exists. You can change the constitution to grant the fed gov this power if you think that's what the fed should be doing. I know it won't happen because there is not the support for that right now. That is the way our system is supposed to work. The idea that we would have supreme court justices lowering themselves to the ethical level of slick Willy Clinton by raising arguments over what "is" is, is sickening! That's the point!

(Report Comment)
Steve Simmons June 27, 2012 | 11:46 a.m.

@mike-I resent being accused of "being clouded by what I want to hear", whatever that means. I asked the Colonel a simple question based on his column.

I actually agree with some of your points. Obviously the justices are voting along party lines...both ways. Does so-called "judicial activism" also go along party lines, or is it just the left-leaning justices who are guilty of that? Your final paragraph suggests that you understand the constitution better than the justices themselves, a common fault I think among those who tend to lean more right. I honestly don't know whether the "personal mandate" should be ruled unconstitional because I don't understand the consitution to anywhere near the depth that hopefully all 9 justices understand it. As far as I am concerned, if the personal mandate is thrown out, so be it. The court will have done its job.

And referring to "Owebamacare" and "Slick Willy" just lowers the dignity of your post.

(Report Comment)
mike mentor June 27, 2012 | 12:08 p.m.

Sorry if I offended. I made a stab based on a very small post. I inferred that you were of the opinion that the Col would not be so happy about a 9-0 vote if it disagreed with his politics, but agreed with the laws of the land. I have read nothing from the Col either in his pieces or comments that would make me think this. I probably should have left those first few words off.

I think we are both in agreement with the piece. We do have judges interpreting the laws through their politically tainted glasses and it is not good for the Country!

(Report Comment)
J Karl Miller June 27, 2012 | 12:18 p.m.

Mr Simmons,

In responding to your question, it goes without saying that I, like everyone else, have an opinion regarding the Affordable Care Act. And, I will admit readily that I stand with the majority in opposing the health care act, particularly as to the constutionality of the individual mandate.

Accordingly, I would prefer its 9-0 rejection to include that of the onerous individual mandate over a 9-0 approval. That being said, my opinion of the Court's responsibility to interpret the law as written remains the same. A statute is either Constitutional or it is not. I can perhaps be sympathetic to a single Justice finding reason to dissent--however, I find the division along party lines repugnant. Although not a lawyer, I understand the issue of precedent and believe a decision favoring the individual insurance mandate would be wrong.

I am prepared to live with the decsion as handed down by the court and move on--crying over spilt milk milk is hardly productive.

(Report Comment)
Ray Shapiro June 27, 2012 | 1:14 p.m.

ObamaCare will be reformed or dismantled sooner or later.
If we need to wait for our next President to expedite that, so be it.
Thank you Nancy Pelosi for telling us that it needed to be passed so that we'd
know what's in it.
Now we know. and it still doesn't smell so good.

(Report Comment)
Louis Schneebaum June 27, 2012 | 1:19 p.m.

The numbers spell ignorance. People overwhelmingly support the individual pieces of the ACA, with the exception of the individual mandate. Over 80% of people believe that, even if the ACA (or just the mandate) is struck down, the healthcare system in our country still needs to be overhauled. The most perplexing thing is Republican hatred of the individual mandate. The mandate IS the brainchild of Republicans. The people that will vote for Romney, who hate the mandate are literally delusional. Romney and other Republicans touted the mandate as THE conservative solution to healthcare reform. Romney is on record in print, video (MEET THE PRESS), etc, bragging about the mandate. Furthermore, the fine levied against someone who fails to comply with the mandate is not enforceable by garnishment, further fines, or criminal charges (i.e. there are no TEETH). So all of the crying is over nothing. The individual mandate is essentially a tax, and if the Obama administration would have been a bit more careful in wording it, we wouldn't be having this conversation right now. I'm sick of hearing Republicans cry about the mother-freaking mandate.

(Report Comment)
Gregg Bush June 27, 2012 | 3:42 p.m.

Republicans love
Their own ideas until
A Democrat does.

(Report Comment)
Steve Simmons June 27, 2012 | 3:47 p.m.

Colonel Miller,

I also find the division along party lines frustrating, yet it is inevitable.

Your point "A statute is either Constitional or it is not", I think oversimplifies the whole point. If that were so then surely all the nation would need would be a (very large) handbook stating clearly what is allowed and what is not. There would be no need to even have a Supreme Court.

As far as my understanding goes, the Supreme Court exists to INTERPRET the Constitution. That, by its very definition gives the court latitude but also makes its job extremely difficult. It also means that something deemed constitutional by a court in 1850, will quite possibly differ from something deemed constitutional in 1900, 1950, 2000, 2012.............................

Indeed I would be very surprised if different Supreme Court justices, in interpreting the Constitution, DIDN'T come up with differing opinions. That's the whole point!

(Report Comment)
Mark Foecking June 27, 2012 | 4:22 p.m.

Because a professional or academic is well educated and highly respected, that does not mean they will come to the same conclusion when asked to review, say, a patient case study or manuscript submission to a journal. This is the same thing - you have 9 very accomplished lawyers who each have their own opinions on what is maent by the Constitution. Experts disagree, and this is no different.


(Report Comment)
Ray Shapiro June 27, 2012 | 5:42 p.m.

("Why should companies continue to foot the bill for health insurance when Obamacare provides everyone the same poor, inefficient, cruel, and morally corrupt healthcare services? Hey at least everyone is covered!")

(Report Comment)
mike mentor June 27, 2012 | 7:16 p.m.

Just to play devils advocate with the above assertions that different opinions should be expected, I point out that we are talking about reading comprehension here and not a subjective case study. Anything beyond reading comprehension is activism IMHO. I would expect the 10 best doctors to agree with what the manual says, even if they don't all agree on a specific treatment!

(Report Comment)
Steve Simmons June 27, 2012 | 7:41 p.m.

Mike-you obviously see the Constitution as black and white. That's not meant as an insult, but I believe that by considering it thus you miss the true beauty of the whole thing. Since it was written over 200 years ago by men who's absolute intentions we can never hope to fully understand, it's meaning must be interpreted by whichever nine wise souls are given that task at any particular time. That doesn't preclude the layman and woman from having an opinion and arguing until they're blue in the face of course! I don't pretend to understand absolutely what the Founding Fathers intended, but I believe that they were wise enough (certainly wiser than me and, dare I say it, the vast majority of contributors to the Missourian) to understand that their Constitution, created in the 18th century, needed to have a certain flexibility to withstand the test of time. And IMHO they managed it (for the most part) beautifully.

(Report Comment)
Derrick Fogle June 27, 2012 | 8:45 p.m.

That's a really good set of reference articles, Mark. Thanks!

The author of those articles brings up the absurdly uneven distribution of healthcare in America. It distorts the industry and the economy, it drives up long-term costs, and it's just plain mean and cruel to some people. It's sad some people can't understand that the pound of cure is a real and tangible liability if the ounce of cure is not given, no matter how righteous they are about it.

The author also brings up administrative costs. I've been involved in medical record keeping for about 15 years. I've often talked about the long-escalating "Administrative Warfare" between providers and payers. It's an endless spiral of fracturing claims into more and more separate little line items that can then be billed, paid, and/or denied, and all the personnel involved in that whole fiasco. Two other studies have put the cost of this stupidity at 20-25%, and my personal experience in the industry concurs with the 25% figure.

This fact is deeply ironic, considering that the coding system was originally supposed to increase efficiency and reduce costs. Unfortunately, it took on a life of it's own, and is currently eating up a quarter of what we spend on healthcare. Counting and arguing over the beans, not taking care of people.

My experience in the medical industry has also allowed me to witness one of the first implementations of the "Bundle Payment" scheme. This is the Real Deal! It scraps the whole line-item cost control mindset. It dramatically simplifies claims processing and has the potential to reduce costs significantly.

Electronic records aren't going to save anyone any time or money. I know this, because the cost of certifying medical records systems is nearly prohibitive. We implement medical records systems to reduce errors in manual data entry, but then insist that the electronic system be so perfect that it costs insanely more to go electronic. So, people stick with paper as their official system of record.

I agree that the obvious rank partisanship of the SCOTUS is a depressing reality for America. It's not that they come to different conclusions, it's that the same ones keep coming to the same different conclusions, for the same different reasons: money and/or influence, mostly. It's sad and pathetic. It is, in a word, corrupt.

(Report Comment)
Don Milsop June 27, 2012 | 11:37 p.m.

The recent comment of Justice Ginsburg that other countries, when considering a constitution, should look to nations other than America as a better model is really terrifying. Particularly when Justice Ginsburg opined that South Africa was a better example of what other nations should seek to emulate when considering a new constitution. I have thoroughly viewed South Africa's constitution. I think most Americans would quake at the power a government under South Africa's laws would have over the ordinary citizen. Even worse, most liberals might not.

The founding fathers were clear that the final authority rests in the hands of the people. And the second amendment was specifically written after the first to allow the people the means of throwing off the yoke of a repressive government. Many liberals don't share that ideal. Nor do many other nations who have repressive governments in speech and gun control, yet have a murder rate far higher than ours. However, many Democrat legislators, who might vote liberal on every other issue, vote pro second amendment and are often NRA members. My personal belief is that this is to avoid the stigma of appearing anti-gun which can be a death knell for politicians in many parts of the county.

Colonel Miller is right that Americans deserve better than a 5-4 decision in this case. Obamacare is law that seeks to undermine the most basic fundamentals of American's right to choose the scope and extent of their health care needs, and not government bureaucrats. The 5-4 Kelo v. City of New London decision is a perfect example of what government can do to destroy the individual rights of the ordinary citizen. Hopefully we have justices who will stand up for liberty before they stand for bureaucracy. The intended good of Obamacare would be buried in a rapidly by unforeseen regulation and unforeseen costs (at least by liberals). The intended goal of welfare and food stamps are two shining examples of programs that didn’t work, and the unintended consequences of keeping people in perpetual poverty.

(Report Comment)
Don Milsop June 28, 2012 | 12:01 a.m.

I would remind some that 30 years ago few could get a MRI or CAT scan unless you were absurdly rich. Today they are commonplace. The same with medicines. 30 years ago medicines to treat AIDS were astronomical. Today there are 24 different drugs (confirmed by viewing American and European studies) with a wide variance in costs for HIV medications. The costs of these drugs have been reduced anywhere from 20% to 90% between 1996 and 2010. Show me a medical procedure, device, or drug that was new 30 years ago that costs anywhere near as much today. The cost of medical treatment is more a matter of time and innovation/improvement. Saying that the rich have better access might be true when something is new, but this disappears over time.

(Report Comment)
Louis Schneebaum June 28, 2012 | 12:15 a.m.

"Show me a medical procedure, device, or drug that was new 30 years ago that costs anywhere near as much today."

Seriously? Show us some numbers? Until you operate within the framework of facts, you're just full of crap...

(Report Comment)
Don Milsop June 28, 2012 | 5:03 a.m.

Louis, by now you should know I don't post anything without thoroughly researching it. If I make a mistake, which I do occasionally, I always say so and admit it. However, my vocabulary, while perhaps not as extensive as yours, is assuredly more accurate, more informed, and less pedantic. And again, you prove that eloquent prose is no substitute for logic and common sense, both of which your response is lacking.

(Report Comment)
Jack Hamm June 28, 2012 | 7:00 a.m.

"Louis, by now you should know I don't post anything without thoroughly researching it. If I make a mistake, which I do occasionally, I always say so and admit it. However, my vocabulary, while perhaps not as extensive as yours, is assuredly more accurate, more informed, and less pedantic. And again, you prove that eloquent prose is no substitute for logic and common sense, both of which your response is lacking."

Someone is a bit full of themselves lol (and divergent from reality!)

(Report Comment)
Ellis Smith June 28, 2012 | 7:27 a.m.

Why don't we just adopt a Constitutional amendment such that the Supreme Court has only ONE justice? Think how "efficient" that would be! No time-consuming deliberations. I can't stand Ginsburg's political philosophy, but I wouldn't lobby to remove her from the Supreme Court any more than I'd lobby to remove Justice Thomas.

[FDR proposed to increase the number of justices; FDR didn't get what he wanted, and I don't want to have any decreases.]

Speaking of efficiency, let's reduce the number of University of Missouri System Curators to just one. Saves time and expenses. Unlike the Supreme Court, such a move would make little difference in voting outcomes. Review Curator votes for the past 12 years. How many were unanimous?

Oh, silly me! They SHOULD have been unanimous. That's because all proposals brought before the Curators are well crafted, thoroughly researched for potential problems and/or hidden costs, so there cannot possibly be "no" votes.

I've previously suggested a different make-up for the Curators:

Always 4, but nerver more or less than 4, to be graduates of UMC campus.

Always 1, but never more than 1, to be graduates of MS&T campus.

Two EACH, but not more or less than 2, to be graduates UMKC and UMSL campuses.

Political affiliation would have nothing to do with appointment. My suggestion takes into account relative student populations of the campuses; it also guarantees that no single campus has a majority of the votes. Only one vote for MS&T and only two votes for UMKC and UMSL? That's more votes than they often have now.

[You're safe, Miller, the EXTREME SARCASM BUTTON has been deactivated.]

(Report Comment)
Mark Foecking June 28, 2012 | 7:58 a.m.

Don Milsop wrote:

"Show me a medical procedure, device, or drug that was new 30 years ago that costs anywhere near as much today."

But that's not the problem. I agree older tests and drugs are cheaper, especially when they go off-patent, but we have so many more of them, and they are so often used, that the net effect is to increase the cost of diagnosis and treatment.

Patient expectations play into this also. When do you pull the plug? When do you go into hospice? Do you get a second opinion about a distressing diagnosis? All of these increase the cost of health care significantly, but I don't think you would say we should set guidelines for any of these situations.

There are also a lot more people involved in patient care now than the original doctor-nurse-pharmacist triangle. It's increased specialization, which should better outcomes. It certainly increases costs. But with the difficulty in finding health care personnel today, would you insist we go back to where a GP stitched up your finger, or a nurse tended a ventilator, and then oversaw a patient's physical therapy? I don't think that's practical.

We're stuck with a lot of the cost of health care no matter what we do. It's intrinsic to its advancement. Going single payer or mandated private isn't going to change that.


(Report Comment)
Jack Hamm June 28, 2012 | 9:22 a.m.

Supreme Court upholds the individual mandate:

(Report Comment)
Ellis Smith June 28, 2012 | 9:34 a.m.

The core issue is not ObamaCare per se.

At issue is whether or not the government can FORCE its citizens to BUY something, regardless of the merits or demerits of what they are being forced to buy. This upends all past history. The federal government didn't FORCE its citizens to buy War Bonds during WWII.

Aren't we "forced" to pay taxes? We are required under penalty of law to pay taxes, including FICA withholding, which is a tax (even though some try to call it otherwise), NOT a purchase. Regardless of how we all feel about taxation, most everybody - including the federal courts - agrees it's Constitutional. It can also be argued that taxes are a necessity (although we can argue forever over how much tax should be paid, to whom, and for what purposes).

If we can be forced to purchase this program (a buy, not a tax), what's next?

(Report Comment)
Gregg Bush June 28, 2012 | 10:16 a.m.

Hospitals are FORCED
To provide stabilizing
Care to anyone.

(Report Comment)
Don Milsop June 28, 2012 | 11:02 a.m.

Mark, let's face it. Alot of tests and decisions are based on protecting doctors and hospitals from lawyers...not from what is sound medical procedure.

(Report Comment)
Don Milsop June 28, 2012 | 11:03 a.m.

Thanks Jack. I note that while you don't care for my comment about Louis, you also didn't state that any of it was inaccurate.

(Report Comment)
Ellis Smith June 28, 2012 | 11:03 a.m.

Many hospitals provide that now, where their emergency room is involved.

I believe that's one definition of an emergeny room: to provide stabilization, if possible.

Leave out the word "stabilizing" and the haiku might make better sense.

(Report Comment)
Mark Foecking June 28, 2012 | 11:38 a.m.


The CBO estimated that tort reform would save $54 billion over ten years (or $5.4 billion/year on average). That's statistical noise to a $2.5 trillion dollar/year industry.

Note they appear to address defensive medicine (I haven't read the actual report). It seems that it doesn't matter whether we enact tort reform or not. I'd rather concentrate on things that matter (see my links, and Derrick's post, above for some better suggestions).

Off topic, I think it should be illegal to report expenditures or revenues in anything but average annual dollars. All we hear, from both sides, is "x will save $Y billion over the next 10 years). People see the big number and react to it, and sometimes the "over 10 years" part get left out. If this isn't a pervasive example of misleading rhetoric, I don't know what is.


(Report Comment)
Jack Hamm June 28, 2012 | 11:43 a.m.


I don't waste time trying to reason people out of positions that they didn't reason themselves into! Come join us in reality

(Report Comment)
Don Milsop June 28, 2012 | 11:46 a.m.

Mark, put your own pen and pencil to it, and see if you think that those are reasonable numbers.

(Report Comment)
Don Milsop June 28, 2012 | 11:53 a.m.

Mark, just to prove my point to Louis and Jack, after doing my own calculations, those CBO numbers would appear to be accurate.

(Report Comment)
Don Milsop June 28, 2012 | 11:54 a.m.

I should have added though, it does not negate the position that many tests and treatments are prescribed with a view towards avoiding lawsuits.

(Report Comment)
Don Milsop June 28, 2012 | 11:55 a.m.

Jack, I'm there. Where are you?

(Report Comment)
Jack Hamm June 28, 2012 | 12:06 p.m.

Keep telling yourself that Don

(Report Comment)
Don Milsop June 28, 2012 | 1:27 p.m.

Mark, for what it's worth, thanks for the intelligent debate.

(Report Comment)
Bob Brandon July 4, 2012 | 7:24 a.m.

The United States deserve better than rightist jurists who throw a hizzy fit when they don't get their way like their GOP counterparts in Congress: all the pressure on Justice Roberts came from the dissenters. We also deserve better than delusional fellow citizens who proclaim that such is good jurisprudence.

(Report Comment)
frank christian July 4, 2012 | 8:31 a.m.

"The United States deserve better than rightist jurists who throw a hizzy fit when they don't get their way like their GOP counterparts in Congress"

And where shall we obtain these "better" jurists? From the Congressional counterparts that saddled our nation with the atrocity and dared name it "Reform"?

The "delusional fellow citizens", are those who can watch the destruction of our economy and way of life, as has been perpetrated by the progressive varlets now controlling our government, then still write and vote in their favor.

(Report Comment)
Bob Brandon July 4, 2012 | 8:52 a.m.

It's never a pretty site when Mr. Christian (can't type this without thinking of Charles Boyer) freaks out in writing.

Entertaining, however, if not pretty.

(Report Comment)
frank christian July 4, 2012 | 10:11 a.m.

With no serious answer to the truth, one must try a joke. Hard to even conceive yours as "joke", unless you meant Chas, Laughton (Capt. Bligh), rather than the Frenchman, Boyer.

(Report Comment)
Derrick Fogle July 4, 2012 | 10:47 a.m.

One very strong criticism I have of the PPACA is the limits on personal healthcare savings accounts.

One of the very fundamental problems with our healthcare system is that it's essentially a 'love triangle' or perhaps more accurately a 'hate triangle.' Insurers and providers are the ones that spend 20%-25% duking it out over actual payments for services, while the patient tries to get the most out of a semi-fixed cost for them. This is one of the things that distorts the market and drives up costs.

If I had my druthers, I would go completely the other way: health savings accounts would be permanent (not limited to year-by-year), unlimited ($100K in there? No prob), and inheritable (so your kids will kill you for it) (that's just a joke).

If I had this option, I would almost certainly switch back to Catastrophic-only insurance, and plow the difference between those premiums, and the "full coverage" plan premiums, into that health savings account. Then I would manage my own money, paying directly for basic healthcare needs. If something crazy happened, I've still got catastrophic.

Last year, I used my Health Savings Account (HSA, called a "Flex Spending" where I work) to pay for my son's braces. Under the PPACA today, I would not even be able to put the whole year-long cost of those braces into my HSA.

As it is, rules on HSA ($2,400 max per year, if you don't use it in that year, you forfeit it) make it little more than a way to cover co-pays and deductibles.

Problem is, we'd have to find some way to really encourage people to use HSAs and catastrophic, instead of going the "premium" plan route. If not enough people start brokering their own healthcare costs, we won't be able to break up the love triangle, and those that would use HSAs would end up still paying the higher costs of a distorted system.

From my perspective, one of the best ways to drive down costs is to make the healthcare consumers themselves write the check. To a certain extent, this is what co-pays and deductibles are designed to do, but the actual effect is that the whole rest of the distorted system still lurches on it's upward cost spiral, and the patient just gets stuck with an extra bill. The effect isn't big enough to drive down overall costs.

Promoting the use of HSA and catastrophic, and discouraging premium plans, would definitely be a step in the right direction.

(Report Comment)

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