US Supreme Court Upholds Affordable Health Care Act

[kandrathe]

... did make me wonder why America could not afford universal health care.

We can if "health care" is defined with some boundaries. I can't remember the exact source at this moment (I'm rushing off to a meeting in 5 minutes), but it was essentially that the bulk of our care is given to a small fraction of the population, and that most of that is in the final year of a persons life attempting to buy them a few more months. The sad result is that most often the extra care statistically shortens lifespan. We can easily afford health maintenance, and treatment of common chronic or acute illness. What we can't afford is to keep the mentality that we must "save them at any cost", especially when that persons body is all worn out already.

...I can't help but shake my head at the constitutional challenge to the Obamacare package.

The constitutional question challenged was whether the Federal government can force you to go out and buy something you don't want, or face a fine. The SCOTUS resolution was that it wasn't a fine, it was a tax. So, they ruled that yes, the government can impose a tax on you for whatever reason. The SCOTUS didn't get into the political fray to determine the fairness of a tax on not buying health insurance, that is an issue between the Congress and their electorate. Many states attorney generals challenged (and won) the Federal governments imposition of rules on pushing people onto Medicaid, which is partially funded by the states. Many states were worried that this would be a budget buster at the state level, and wanted control over their own programs. The SCOTUS ruled that the Federal government cannot impose sanctions on states. They can use carrots, but not sticks.

Also, while I support lower taxes, particularly for the low and middle classes, I also don't understand why Republican voters tend to get so upset about tax rises on those earning over $250kpa.

The issue for Republicans is that spending has drastically increased during Obama's tenure (debt has increased 6 trillion since 2008, out of our 15 trillion total public debt), while the recession has been reducing tax revenues. We could take 100% of the income for those earning over $114,000 and still not balance our deficit spending.

Say we take it up to the top 10%, or everyone with income over $114,000, including joint filers. That's five times Mr. Obama's 2% promise. The IRS data are broken down at $100,000, yet taxing all income above that level throws up only $3.4 trillion. And remember, the top 10% already pay 69% of all total income taxes, while the top 5% pay more than all of the other 95%. -- WSJ April 17, 2011

So, do we have a lack of taxes problem, or a spending problem? Mr. Buffet suggest we need to do a little of both, and I tend to agree. Our tax system needs an overhaul -- especially with regards to the disparate rates of income tax derived form work versus investments.

It's much easier to get elected by giving away free things (at tax payer expense), than to suggest fiscal discipline, and that other dirty A word - Austerity. I've said this before, I'm not against using the fiscal and organizational power of government to make permanent improvements to social infrastructures (e.g. rebuild our antiquated power grid). These types of government projects might only be possible with government involvement, and create long term economic benefits for everyone (e.g. think Roman aqueducts).

The whole argument regarding minimally adjusting taxes on the top x% is a political red herring towards solving our deficit issues (outlays far exceed tax revenue). Being neither in the R camp or the D camp, it seems to me to be pure political maneuvering to obfuscate the issue and give the Democrat base a rally cry. It would be as if we were arguing about obesity in the US, and you suggested I deal with my fat children first (they aren't actually fat, quite the opposite -- I'm having to put them on a bacon for breakfast, and steak/roast beef for dinner diet).

We have a slight correctable issue with Social Security (retirement) due to the number of baby boomers reaching age 65. They either need to adjust the tax rate, the retirement age, or raise the cap from $106K to $250K, or a combination of those three. But, our weak willed politicians are fearful of rocking the senior boat, or should I say vote.

We have a bigger issue with our government health insurance for elderly (Medicare), and slightly less of one with our health insurance for the poor (Medicaid). To me it boils down to an expanding number of possible treatments, and medications with an expanding population of people needing treatments and medications. First, we really need to separate the issues with *Health Insurance* from our issues with *Health Care*.

I claim one of the biggest problems with cost in health care (and education) is inflation (others may disagree). Our CPI masks certain areas of inflation because many areas of our economy have reducing prices, while others are increasing. The bottom line is that whenever you have a fixed expectation of say "a doctor visit", there is no way to use technology to make a 1 hour doctor visit take 5 minutes without jeopardizing the quality of care. We've squeezed about as much efficiency as we can out of doctor visits. We can pick a number (8, 16, 32), but one doctor can only do a fixed amount of patients in a day. As the prices (i.e.labor, technology, insurance, collections), go up, those prices are passed along to the consumer directly. In the US, we have the very best health care money can buy, but most of us can no longer afford it. Since most of us have our employers pay for most of it, we don't see the increases in costs as directly and instead complain about the flatness of wages since 1980. The inflation of health care prices is most certainly due to a lack of supply, and an increase in demand. A good start would be for colleges and universities to increase the output of health care workers to close the demand gap. Currently, the only stop gap we have is to import health care workers through special H1 visa recruitment.

I really don't mean to be offensive or say that our system here in Australia is better, or could even work in the USA, but there are some aspects of American political culture which seem so strange. In Australia we tend to have centrist governments which generally respect legislation enacted by previous governments (we had universal health care put through in the 70s and despite the opposition to it by many in more recent governments, the legislation largely stands).

In America there tends to be a far greater culture of appealing to the constitution to enact social change instead of changing governments.

Case law, and the SCOTUS has been an instrument of dissent over "nullification" in the US since the civil war. What is different is that we are not a true democracy. We are a representative republic unified by the Federal Constitution. Each state in the US should reserve sovereignty, and has it's own constitution that for state concerns supersedes the Federal constitution. Certain things, like the rights of citizens are guaranteed at all levels.

Roe vs Wade settled a moral issue that the authors of the constitution could never have forseen it being used for. In Australia, that issue has been settled by electoral mandate, but if new information comes to light, or the people of this country decide that they had changed their minds about it, changing the law would be relatively easy compared to what is required to change it in the US.

And, if our system were working as intended, the Feds wouldn't be able to tell Utah what to do if they didn't want it. Excepting that the original Roe V Wade case was based upon deception, there is a definite human rights dilemma on whether to support a persons ownership of their body and progeny, versus the rights of the (potential) citizen yet to be born. It's not an easy problem to resolve well either way.

Pretty much everyone in the western world knows what the second amendment is and what it means for Americans.

Really? I've been engaged in numerous debates since the Aurora tragedy, and I find many US citizens don't understand it very well.

The long and the short of it - America is a great country, but it has a strange political culture.

So true. It's designed to be run by part time farmer statesmen, but has been taken over by a political class and special interest lobbyists.

Edit: I'll add one more plank to this wall of text. I believe our bigger long term issue is the decreasing number of workers to retirees. A better solution for sustainability through 2050 would be for us to drastically increase legal immigration, and increase tax revenue through broadening the base of tax payers. It's not like we don't have the space for them, and they do want to come here to live and work.