That healthcare thing ... again...

[Trieste]

I know there have been numerous threads on this already, but I wanted to take a different angle of approach.



I'm starting to get a feel for how our overseas members feel when someone complains about something medical. I've gotten so used to everyone in MA having health coverage that I have to stop and remind myself that people in other states don't necessarily have affordable or subsidized insurance. The system we have is far from perfect. I have quite a few complaints about it. But honestly? I'd rather have the broken system that we have now than no system at all.

It means that if something terrible happens to me, I'm unlikely to have to declare bankruptcy if I live through it.

It means that when I realized the stress and pressure has been getting to me, I was able to go to my doctor and ask for help (anti-anxiety meds, in this case, but talk therapy would have been covered if I had chosen it) to stop the panic attacks and the crushing hopelessness.

It means that I have access to a licensed dietician and proper nutritional guidance to help me plan healthy meals.

It means that my quality of life has improved noticeably. I've seen my parents' quality of life and my siblings' quality of life improve. As a result, I think that opponents (regardless of party) have a very small window of opportunity to make sure everyone else doesn't feel the effects of similar legislation, because I'm not entirely sure people would give it up after getting used to it.

Putting aside the talking point of the individual mandate, what reasons would someone running for office have to 'repeal and replace' the current legislation geared toward providing health coverage to every US citizen?

[Brandon]

Well the main reason I can think of is if said politician had a better way of implimenting nationwide healthcare. Of course better is a pretty subjective term but lets say in this case it means a healthcare plan that doesnt cost the country as much and provides equal or better care then the current system.

You said it yourself, the current system is flawed. If I had a better plan and was running, you better believe I would move to replace an obsolete system. I would expect nothing less of the people running now but I dont think anyones showed a better system or even hinted at one (not that Ive been paying much attention to the republican debates)

The other thing is a lot of Americans feel like the upcoming healthcare changes were put in place against their wishes despite having gone through the proper channels to make thier wishes known. There was a town hall I attended where our representative basicly told us he didnt care what we wanted. Im sorry but thats not how our government works, they represent us, we are their boss, and he lost his job in the last election (thank god). I dont really care what the system is or how beneficial it is to our society, we live in a society where the people are supposed to have the say and if the majority wouldnt vote for it it should not be put in place. On that basis alone healthcare should be repealed (assuming that the majority feels as I do I dont actually know what the nationwide stance is on approval for the upcoming healthcare system). If a politician was working to repeal healthcare on the basis that the majority of American's (not representatives) did not want it, then I think thats also fine

In my opinion, the above reasons are fine for wishing to repeal and replace healthcare. At this time I cant really think of any other reason I would back off the top of my head

[Darkling Muse]

I am UK based lady and what really gets my goat is when people complain about the NHS (our national healthcare service). They complain the wait time in hospitals is too long and that the food sucks or whatever :P


But I know when I am ill I do not have to worry about anything other than getting better, I know that there will be someone there to take care of me and I know (like you) that I can ask for help if I need it.

Free healthcare creates its own problems. People take advantage of it, it puts a massive strain on the amount of hours and people needed to keep a whole populous healthy for free without leaving out things like ridiculously rare diseases. The cost and upkeep is never enough, there is never enough money for the NHS and there are always people that get left by the wayside, unable to get treated because the government cant cover it and no one here has medical insurance (unless you are very very rich :P) so they can't pay for themselves... (so it doesn't even completely solve some state's current 'can't afford insurance' problem!)

People argue about what should be free and what shouldn't and it is hard to tell where the line should be drawn.
Currently you can get plastic surgery on the Nhs for things like boob jobs if your body negative feelings are upsetting your life, obese people and smokers get healthcare for 'self inflicted' problems (which is a massive debate among some circles) and so on.

So to politicians who have to make these sorts of decisions free healthcare opens up a massive, massive can of worms its not just about giving free healthcare to everyone even though, imo it should be!

[Serephino]

I think right now it's all about the money.  People are frustrated that our national debt is already so high.  And the people who can afford to pay more in taxes don't want to do so just so a poor person can get an expensive, but medically necessary treatment.

I remember seeing a clip of one Republican debate, can't remember who it was, but the guy was supposed to be a doctor.  He was asked if someone got ill but couldn't afford insurance, should the guy be left to die.  The first word out of this fucker's mouth was yes, and a few people cheered!  He may have backpedaled right away and tried to explain and do damage control, but I'm sorry, the words that came out of his mouth when he wasn't thinking about it are more telling the bullshit he came up with afterward.

And I know the system gets abused.  A friend of mine was beginning to have trouble with anxiety, and was in the ER 5 times in a week for chest pain.  I have anxiety myself, and tried to tell her...  But she let it consume her, and she had Medicaid, so a trip to the ER and a few dozen expensive tests only cost her a little sleep.  That annoyed me a little.  I know first hand panic attacks suck, but I only went to the ER over one once, and half my body was numb.  That would freak anybody out. 

[Caela]

I think right now it's all about the money.  People are frustrated that our national debt is already so high.  And the people who can afford to pay more in taxes don't want to do so just so a poor person can get an expensive, but medically necessary treatment.

I remember seeing a clip of one Republican debate, can't remember who it was, but the guy was supposed to be a doctor.  He was asked if someone got ill but couldn't afford insurance, should the guy be left to die.  The first word out of this fucker's mouth was yes, and a few people cheered!  He may have backpedaled right away and tried to explain and do damage control, but I'm sorry, the words that came out of his mouth when he wasn't thinking about it are more telling the bullshit he came up with afterward.

And I know the system gets abused.  A friend of mine was beginning to have trouble with anxiety, and was in the ER 5 times in a week for chest pain.  I have anxiety myself, and tried to tell her...  But she let it consume her, and she had Medicaid, so a trip to the ER and a few dozen expensive tests only cost her a little sleep.  That annoyed me a little.  I know first hand panic attacks suck, but I only went to the ER over one once, and half my body was numb.  That would freak anybody out. 

I'd actually like a link to any politician saying a flat yes to that question. I thought it was some people in the audience who yelled yes and that Ron Paul (I believe it was him) sort of waffled on answering it in any substantive way at all.

As for why politicians would be looking to repeal this particular law I think that Brandon rather nailed it. A lot of people feel the current version of the bill was rammed down their throat despite what people in many political distracts wanted. Promising to try and repeal it (though that's really unlikely to happen) is a good way to take that dissatisfaction and get votes. Especially if you're running against the guy who did the shoving down his constituents throats. Also, I think a number of them simply feel it was rammed through too fast giving very little time to become fluent with it or debate and revise sections of it so saying they will try and have it repealed would satisfy on a personal level as well.

I personally just don't think it was a good bill. I think it got pushed through too fast and is just a poor set up. Right now, in this country, if you go to an ER they HAVE to treat you. They are not allowed to turn you away regardless of whether you have insurance or not, so to say that people aren't getting their treatment is disingenuous. Yes they can be crushingly expensive when you get the bills but most hospital are willing to work out some sort of payment plan with you and, if you can show you are truly indigent many will just write off the cost. In the end, if you can't pay them you don't actually have to declare bankruptcy. Medical debt will sit there, earning NO interest, for 7-10 years and then fall off your credit report like anything else. Having needed surgery with no insurance before, I know how this part of the system works.

To say we didn't have the time to do this RIGHT was a load of political BS, IMO. At the time the Democrats wanted to be able to say they had done something more than they wanted to be able to say they'd done it right and so they shoved through a faulty bill despite the will of the people they were supposed to be representing. Putting another broken system, on top of an already broken system is like building a shoddy house on a faultline...it's asking for the whole damned thing to come crashing down around our ears.

[Oniya]

I believe it was an audience member that shouted yes.  I remember reading about it, and should be able to track down a link shortly. *heads off into the StoreHouse.*

EDIT:  Found it - would have been back sooner, but I wanted to find one that wasn't edited all to hell.

P4 The Tea Party Republican Debate CNN 9-12-2011

[Trieste]

Here is a link to the schedule of debates, who sponsored them, where they are held and, if the date is past, a link to a Youtube video of the debate.

http://www.2012presidentialelectionnews.com/2012-debate-schedule/2011-2012-primary-debate-schedule/

[Oniya]

The one I tracked down was just the relevant question and answer, instead of listening to the whole 30+ minutes of debate.

[Trieste]

(Try 120 minutes of debate. >.>)

I linked the whole resource because it allows for viewing of whatever other answers, too, and also the question in context, just in case.

I still haven't had a chance to finish watching that particular debate.

[Caela]

Thank you both for the links!

[Zakharra]

s for why politicians would be looking to repeal this particular law I think that Brandon rather nailed it. A lot of people feel the current version of the bill was rammed down their throat despite what people in many political distracts wanted. Promising to try and repeal it (though that's really unlikely to happen) is a good way to take that dissatisfaction and get votes. Especially if you're running against the guy who did the shoving down his constituents throats. Also, I think a number of them simply feel it was rammed through too fast giving very little time to become fluent with it or debate and revise sections of it so saying they will try and have it repealed would satisfy on a personal level as well.

I personally just don't think it was a good bill. I think it got pushed through too fast and is just a poor set up.

To say we didn't have the time to do this RIGHT was a load of political BS, IMO. At the time the Democrats wanted to be able to say they had done something more than they wanted to be able to say they'd done it right and so they shoved through a faulty bill despite the will of the people they were supposed to be representing. Putting another broken system, on top of an already broken system is like building a shoddy house on a faultline...it's asking for the whole damned thing to come crashing down around our ears.

What stuck in a lot of people minds was the politicians  (I believe Nancy Pelosi said this too) that they needed to pass it so they could know what was in it. Given the size of the bill (1700 pages?) it was rammed through with very little of the debate and discussion it should have had.

[Serephino]

Okay, it was just the crowd.  I remembered wrong.  Still, that's sick.  And you're saying everything is all good because they can't turn you away in the ER?  All they do is figure out what's wrong with you.  They will admit and treat you if you're condition is life threatening, but only then.

However, when I had a gallstone I suffered for 4 months.  Why?  Because I had no insurance and the surgeon wouldn't operate until he got his fee.  Nothing vital was blocked so my life wasn't in any immediate danger.  I only threw up everything I ate with the exception of raw vegetables. 

When I had a kidney stone they gave me pain pills and wished me luck.  I had to go see a Urologist.  Thankfully, I had temporary Medicaid that paid for the office visit.  It ran out a few days before the stone got broken up though.  He didn't know that, or I probably would've been given more pain pills and told to come back when I won the lottery.

While I admit the bill did get pushed through pretty quick, there are a lot of good things about it.  It's the mandate part I don't like.  There's still room for improvement, but being sick and not being able to get insurance because of a pre-existing condition is no picnic either.   

[Trieste]

The reason I said in my original post that I'd like to put aside the mandate thing is because I know people don't like it, but it is one area where I happen to have to agree to disagree with people who don't like it. *shrugs* You're perfectly welcome, by the way, to start a different thread to discuss it. It's just not something I want to hash over again, because I've seen it dominate too many debates and I'm not interested in having that happen in this particular one.

[Caela]

Okay, it was just the crowd.  I remembered wrong.  Still, that's sick.  And you're saying everything is all good because they can't turn you away in the ER?  All they do is figure out what's wrong with you.  They will admit and treat you if you're condition is life threatening, but only then.

However, when I had a gallstone I suffered for 4 months.  Why?  Because I had no insurance and the surgeon wouldn't operate until he got his fee.  Nothing vital was blocked so my life wasn't in any immediate danger.  I only threw up everything I ate with the exception of raw vegetables. 

When I had a kidney stone they gave me pain pills and wished me luck.  I had to go see a Urologist.  Thankfully, I had temporary Medicaid that paid for the office visit.  It ran out a few days before the stone got broken up though.  He didn't know that, or I probably would've been given more pain pills and told to come back when I won the lottery.

While I admit the bill did get pushed through pretty quick, there are a lot of good things about it.  It's the mandate part I don't like.  There's still room for improvement, but being sick and not being able to get insurance because of a pre-existing condition is no picnic either.   

I know our system, as it is now, is broken...or at the very least seriously sprained...I just don't think throwing another broken system on top of it is really going to help much in the long term. Zakharra is right too, being told that a bill needs to be passed before we can know what's in it doesn't settle well with me at all, it smacks of them trying to get something through that they know they shouldn't be.

I do actually get why some docs won't take patients who don't have insurance. It sucks but a lot of them won't even try to pay PART of their bill, they just take the doctors services and walk away. If it's not life threatening I get the reason they don't want those patients. On the flip side, being the person suffering SUCKS as well. Still a doctor is providing a service and s/he deserves to be compensated for their time just like any other service. People wouldn't dream of going in to have the brakes changed on their car and not paying the mechanic, but there are plenty who seem to think that a doctor should work on them for free just because they are there.

Running a private practice isn't cheap. I talked to one of my docs about it who was in practice on his own, no partners. Before he got to actually take home dime one he had to pay his bills, including the payments on his offices, the utilities there, the machines he had in the office, staffing etc. To keep all the bills paid (before he took money home himself) he had to clear a million dollars a year. You don't make that kind of money if your patients don't pay you which means you look for patients with insurance because you know you'll get paid.

Part of the real problem though is the sheer COST of healthcare in this country. The amount hospitals charge for even the most basic tests is ridiculous and some serious research should have been put in to determine ways of making healthcare more affordable, even for people without insurance, so that even if they don't have a carrier, their bills aren't so daunting that they just walk away from them. Also, the insurance industry itself needs an overhaul. They shouldn't be able to drop people on a whim, and certainly not for a pre-existing condition, especially a condition that is genetic and in no way self inflicted.

Like I said before, my biggest issue is that there are plenty of things that could have been fixed instead of throwing a new (and faulty imo) program on top of an already faulty one.

[RubySlippers]

I am UK based lady and what really gets my goat is when people complain about the NHS (our national healthcare service). They complain the wait time in hospitals is too long and that the food sucks or whatever :P


But I know when I am ill I do not have to worry about anything other than getting better, I know that there will be someone there to take care of me and I know (like you) that I can ask for help if I need it.

Free healthcare creates its own problems. People take advantage of it, it puts a massive strain on the amount of hours and people needed to keep a whole populous healthy for free without leaving out things like ridiculously rare diseases. The cost and upkeep is never enough, there is never enough money for the NHS and there are always people that get left by the wayside, unable to get treated because the government cant cover it and no one here has medical insurance (unless you are very very rich :P) so they can't pay for themselves... (so it doesn't even completely solve some state's current 'can't afford insurance' problem!)

People argue about what should be free and what shouldn't and it is hard to tell where the line should be drawn.
Currently you can get plastic surgery on the Nhs for things like boob jobs if your body negative feelings are upsetting your life, obese people and smokers get healthcare for 'self inflicted' problems (which is a massive debate among some circles) and so on.

So to politicians who have to make these sorts of decisions free healthcare opens up a massive, massive can of worms its not just about giving free healthcare to everyone even though, imo it should be!

My main questions are would the British give up the NHS? Would you if you had a heart condition or diabetes not get basic medical care for them as examples by a qualified person? And in your country can you go bankrupt for medical bills?

If your like me with medical issues and nothing, the NHS system with its rationing at least would be preferable and paid for out of taxes I assume to what many have now.

[HockeyGod]

I think that there are a number of reasons that the health care law would be repealed. Please note that I don't support any of them.

1. There has always been a tension between a federalized government and local autonomy. Since the War of Independence there is a significant population that still holds that a strong centralized government encroaches on the very freedoms for which we fought hundreds of years ago. This is probably a fundamental argument of the Tea Party.

2. Regardless of whether it is right or wrong, the U.S. has had a very stringent individualistic approach to society. We are not particularly collectivist in nature. Add to that a capitalistic market. In general there is a pervasive belief that if you work hard enough, you can succeed and provide.

3. The diversity of the U.S. makes it difficult to develop a cookie cutter approach to solving social problems. Take for instance the Medicare Prescription Drug Benefit (Part D). Prior to Part D, my state had a Prescription Drug Program for older adults that had a generous sliding fee scale and eligibility. The minute Part D passed, our state ended that program. We now have a program that is giving trillions of dollars to drug companies over which the State has little or no influence.

4. Fourth, I would say that misinformation would cause it's repeal. I've found that people often fall into the availability heuristic. That is, people will believe information they are fed through the media. Remember President Obama's $200 million / day India trip, or what about the cause of DD being the HPV vaccine? It happens all the time. We believe falsehoods as truths because we are too dumb to question the messenger.

5. Polarized politics would probably be my last thought on why it would repealed. If a Republican gets into office they will repeal as much of what President Obama has done regardless of whether the policies are effective or efficient. Immediately I would see bringing back Don't Ask Don't Tell, repeal of as many parts of the Affordable Care Act as possible, altering immigration policies, voting, etc.

[Caela]

3. The diversity of the U.S. makes it difficult to develop a cookie cutter approach to solving social problems. Take for instance the Medicare Prescription Drug Benefit (Part D). Prior to Part D, my state had a Prescription Drug Program for older adults that had a generous sliding fee scale and eligibility. The minute Part D passed, our state ended that program. We now have a program that is giving trillions of dollars to drug companies over which the State has little or no influence.

This, I personally, think is actually an excellent reason to repeal this law. I wouldn't mind seeing the Feds putting pressure on each state to find solutions to these problems but don't think that one answer is going to work for everyone, everywhere. It sounds like your state had a good program in place, or at least a decent one, and now they have something that everyone can complain about instead. I personally think that's a sad thing.

What works well in D.C. won't necessarily work in Oklahoma, and what works well there may not work at all in California. I have a hard time listening to people comparing our system of anything to systems that work in any country in Europe. Not because those systems are bad but because they are dealing with an entirely different populace, a different culture, and are also done on a much smaller scale. Many European countries are barely the size, and population, as some of our States and what works on a smaller scale doesn't always translate well when you try to make it work on a larger one. What would be more comparable would be if the EU suddenly decided that everyone in Europe needed the same healthcare system. I think you'd see a lot of issues cropping up then that don't necessarily on a country to country, or state by state, basis.

[RubySlippers]

I'm against a repeal unless an alternative is in place that is one that will work better. I do think though states have a role to play they can pass supporting laws to improve access and work with the reforms since they license medical providers, regulate insurance and the like also.

I would have prefered this approach give states a block grant including Medicaid funds and say okay you cover everyone in your state as you see fit. Unless 100% of residents by January 1st 2012 have access to care and mandates in place you lose ALL discretionary Federal funds to your state and all parties in the state. No pell grants, no government backed loans for school or housing or businesses, no grants, no Federal contracts, no research funds for your universities, no extra education funds, no road funds, no funding for transportation etc. Then let the states opt in or not if they don't fine they get Medicaid funding and other base obligations but lose all this other money until they opt in. There perfectly constitutional and very persuasive since your just saying the Federal funding will not go to your state they can do that if they grandfather in current contracts - when renewals come up oh well.

But my feeling is the law will stand minus the mandate in the end then the government will have to do something adminstrative like a penalty for life for not getting insured say 2.5% per year not being insured tacked on to your insurance when you do get it and added to the cost of your insurance to any employer. They could do this without a law as an administrative penalty and I would think would encourage getting coverage also. I will note besides the mandate the rest of the law is well within Federal powers to do and no one is questioning that they can decide rules for Medicaid and states if they participate must follow them as an example.

[Serephino]

I do agree it would probably be easier to let the states handle things.  We used to have a program here in PA where if you made too much for Medicaid you could get at least basic coverage, and your premium was based on your income.  But then our wonderful new Republican governor cut that program because he said there wasn't enough money in the budget to pay for it.

Why couldn't all states set up something like that?  I wouldn't mind paying a premium, I just need to be able to afford it.  And yes, cost is a big issue.  Getting my kidney stone broken up was almost a thousand dollars.  That's how much the Urologist fee was, and the machine did most of the work.  Then it was another thousand to get a stuck piece removed.  On top of that was being admitted to the hospital for a night.  I don't know how much the actual bill was, but with Medicare Part A, my 'co-pay' was $1100.  A little over $3k just because one of my kidneys decided to create a huge stone.....  And why in the hell did a 15 min ambulance ride cost $500?

[Zakharra]

I'm against a repeal unless an alternative is in place that is one that will work better. I do think though states have a role to play they can pass supporting laws to improve access and work with the reforms since they license medical providers, regulate insurance and the like also.

I would have prefered this approach give states a block grant including Medicaid funds and say okay you cover everyone in your state as you see fit. Unless 100% of residents by January 1st 2012 have access to care and mandates in place you lose ALL discretionary Federal funds to your state and all parties in the state. No pell grants, no government backed loans for school or housing or businesses, no grants, no Federal contracts, no research funds for your universities, no extra education funds, no road funds, no funding for transportation etc. Then let the states opt in or not if they don't fine they get Medicaid funding and other base obligations but lose all this other money until they opt in. There perfectly constitutional and very persuasive since your just saying the Federal funding will not go to your state they can do that if they grandfather in current contracts - when renewals come up oh well

The bolded is my emphasis.  I'd say no. That is a damned big club the federal government could and would use against states.  'You don't do things our way? Well look here..  Not everyone is covered by health insurance. We'll just withhold all federal monies until you 'fix' the problem  and getting rid of that other law there *points to law the feds do not like* wouldn't hurt either.'  If the feds were able to withhold all federal funds over one thing, do you think that that power would not be abused? By either party?

[RubySlippers]

But my approach would have been fully constitutional and look I'm in Florida and they turned down money for the high speed rail and other funds offered to impliment parts of the new law you can't have it both ways. You can't opt to not want Federal funds but its okay we only don't want these funds but give us these other funds. Like the 21 year old drinking age the one way to compel states is to take away Federal money if you don't do something but you are not forcing the states to. Just you opt out of this important program them as far as we as a Federal government is concerned your state doesn't deserve our money over what we are commited to. But you chose to opt out so now pay the price with your citizens.

But the carrot is we are giving you these funds, your free from Medicaid obligations and can create any system you feel is best for your state this includes all Federal funds we give to hopsitals for indigent care and money raised from the penalties and taxes. Its a nice amount if used well will meet the needs of your people. You can do this anyway you want but we want every resident to have access to proper basic medical care and quality of life and medically needed care. You have (assuming this was the law passing at the start) until January 1, 2012 to have a plan going into place and show us how your doing it.

It would make the constitutionalists happy, would be perfectly acceptable and states can opt out or opt in no one is forcing them to participate are they?

[Trieste]

The bolded is my emphasis.  I'd say no. That is a damned big club the federal government could and would use against states.  'You don't do things our way? Well look here..  Not everyone is covered by health insurance. We'll just withhold all federal monies until you 'fix' the problem  and getting rid of that other law there *points to law the feds do not like* wouldn't hurt either.'  If the feds were able to withhold all federal funds over one thing, do you think that that power would not be abused? By either party?

It's already been used as a club by the federal government. Nevada ignored the national max speed limit before it was repealed in the 90s, and posted a higher speed limit than 65 (or maybe it was still 55 at the time). They were already concerned about having federal money withheld, so they wrote the law to be null and void if federal monies were withheld. Sure enough, the feds pulled highway funding to invalidate the state law in Nevada.

Getting back on topic:

4. Fourth, I would say that misinformation would cause it's repeal. I've found that people often fall into the availability heuristic. That is, people will believe information they are fed through the media. Remember President Obama's $200 million / day India trip, or what about the cause of DD being the HPV vaccine? It happens all the time. We believe falsehoods as truths because we are too dumb to question the messenger.

5. Polarized politics would probably be my last thought on why it would repealed. If a Republican gets into office they will repeal as much of what President Obama has done regardless of whether the policies are effective or efficient. Immediately I would see bringing back Don't Ask Don't Tell, repeal of as many parts of the Affordable Care Act as possible, altering immigration policies, voting, etc.

I would really be disappointed if #5 came to pass, but you're probably right about that one. Again, I really think that the GOP has a very narrow window in which to do this, though. I think that, while the MA system is not perfect, it's given people a good look at what it's like to actually be taken care of without being thrown into debt and possible bankruptcy. That's powerful, powerful stuff. Add to that the fact that pretty much no woman in MA (and whoever else is insured) will have to pay for things like birth control as of August of 2012, and... I mean, that's just awesome. That's a savings, for me, of $400/year. My health insurance is $2100/year - so for all intents and purposes that drops it to $1600 per year. That's not bad - and it's cheaper than many people pay even through their workplace. Add to that the fact that if I weren't a full-time student, I would be getting subsidies from the state for my insurance (my income is within $200 of the federal poverty line) and you get to a point where insurance becomes actually affordable.

Powerful stuff.

[Zakharra]

But my approach would have been fully constitutional and look I'm in Florida and they turned down money for the high speed rail and other funds offered to impliment parts of the new law you can't have it both ways. You can't opt to not want Federal funds but its okay we only don't want these funds but give us these other funds. Like the 21 year old drinking age the one way to compel states is to take away Federal money if you don't do something but you are not forcing the states to. Just you opt out of this important program them as far as we as a Federal government is concerned your state doesn't deserve our money over what we are commited to. But you chose to opt out so now pay the price with your citizens.

But the carrot is we are giving you these funds, your free from Medicaid obligations and can create any system you feel is best for your state this includes all Federal funds we give to hopsitals for indigent care and money raised from the penalties and taxes. Its a nice amount if used well will meet the needs of your people. You can do this anyway you want but we want every resident to have access to proper basic medical care and quality of life and medically needed care. You have (assuming this was the law passing at the start) until January 1, 2012 to have a plan going into place and show us how your doing it.

It would make the constitutionalists happy, would be perfectly acceptable and states can opt out or opt in no one is forcing them to participate are they?

Yes it would. It would give the federal government a massive club. It would be ridiculously easy to find someone not being covered by healthcare and use that as an excuse to withhold federal funds until the 'issue' the federal government wants, it resolved. It would be used by either party to bring in reluctant states in line with the federal doctrine. And I seriously doubt it would make constitutionalists happy because it oversteps the boundaries of the federal government.

No state can survive without federal funds and still have to abide by every federal regulation and law. It would bankrupt them even faster.

It's already been used as a club by the federal government. Nevada ignored the national max speed limit before it was repealed in the 90s, and posted a higher speed limit than 65 (or maybe it was still 55 at the time). They were already concerned about having federal money withheld, so they wrote the law to be null and void if federal monies were withheld. Sure enough, the feds pulled highway funding to invalidate the state law in Nevada.

The funds withheld were most likely just highway and road funds. Not all federal money. To withhold all federal funds over one thing is a big escalation of federal power.

[RubySlippers]

Maybe an escalation but the distribution of discretionary Federal funds is their authority to do, naturally its unlikely to be done. But they could target key funding such as medical and science research funding, Federal contracts and reduce funding for transportation projects and select enough programs to make not mandating care (under a state model)  a prefered option.

The goal is to make not setting up a in-state universal system preferable to any rational leadership.

As for the law itself like I said its mostly constitional only the mandate is not and there is the adminstrative option they use for the Medicare Drug Plan if you opt out you pay more for life if you opt in. So they could subsidize coverage etc. as planned for low income people and then tack on a 2.5% lifetime penalty per year on your insurance and to the employers costs that could not be passed on to you per year your not covered. With fair grace periods in there. It would likely work also and would not need a law to enact just the agency doing so. And there is precedent for that.

My guess is the High Court ,at most, will toss out the mandate since there are other options to compel participation and uphold the rest of the law, one judge already said that is possible. And the lifetime penalty is likely the vehicle they would use.

But what makes Obamacare and its mandate different from Medicare and Social Security taxes to fund those programs those have no constitutional merit either and are mandates, just tell the government you don't want to participate in them when working and opt out. Its also a mandate. The High Court likely will be comparing them in the debate over this.

[HockeyGod]

Getting back on topic:

I would really be disappointed if #5 came to pass, but you're probably right about that one. Again, I really think that the GOP has a very narrow window in which to do this, though. I think that, while the MA system is not perfect, it's given people a good look at what it's like to actually be taken care of without being thrown into debt and possible bankruptcy. That's powerful, powerful stuff. Add to that the fact that pretty much no woman in MA (and whoever else is insured) will have to pay for things like birth control as of August of 2012, and... I mean, that's just awesome. That's a savings, for me, of $400/year. My health insurance is $2100/year - so for all intents and purposes that drops it to $1600 per year. That's not bad - and it's cheaper than many people pay even through their workplace. Add to that the fact that if I weren't a full-time student, I would be getting subsidies from the state for my insurance (my income is within $200 of the federal poverty line) and you get to a point where insurance becomes actually affordable.

Powerful stuff.

You ain't just whistling dixie, sister. I think that the Affordable Care Act was a step in the right direction. If you look at the health outcomes of the states, those that have ripe social and health care systems have the lowest instances of infant mortality, highest life expectancy, and best overall health. If <insert delinquent state name> won't provide for it's citizens, it's up to us to do it.