Delete this outrageous post, now.
Oh, how embarrassing. I seem to have gotten ahead of myself. We can talk about alpacas instead, I guess. That's close to PPACA.
La, pal alpaca! PPACA caca? Call pa!
Individual mandate gone, most of the rest of it survives. Scalia writes something insane, Roberts something that on the surface looks mostly sane but on closer examination proves to be batshittier than Scalia's regurgitated Rush Limbaugh talking points. Ginsburg writes something sensible and practical which is ignored by everybody.
I am at least hoping for a sharply worded dissent from Ginsburg, a la Bush v. Gore.
We can talk about alpacas instead...
Racist.
Decision expected around 10am.
I thought it was coming out Thursday?
Where are you getting this information?
Individual mandate gone, with some manner of further overreach aimed at eroding New Deal Commerce Clause interpretation.
If this is the prediction thread: the PPACA will be upheld by at least a 6-3 margin. 7-2 is more likely; 8-1 is possible.
There is no chance that any of Ginsburg, Breyer, Sotomayor, Kagan or Kennedy vote against the law. With those five firmly on board, I think Roberts comes along as well. With those six, I think either Alito or Scalia (or both) also vote to uphold.
I always feel so much better when someone is optimistic.
Individual mandate gone, most of the rest of it survives.
That's where I put my money (reading, for "survives," "meaningless, gutted, undead and rotting"). The cynic in me looks forward to Democrats trying to spin such a decision as a victory. Also the next two decades of liberal politicians declining even to discuss healthcare reform. It'll be the new gun control.
Maybe there is room for optimism. The mandate was a very common Republican position not very long ago.
There is no chance that any of Ginsburg, Breyer, Sotomayor, Kagan or Kennedy vote against the law.
Everybody on the internet except you is assuming that Kennedy will vote against the mandate. Show your working.
Should that have been "...no chance that any of ... votes against the law"? Or was "vote" correct? I think it should have been "votes".
(You should never trust the legal prognostications of an illiterate person.)
It'll be the new gun control.
Republicans will pass an individual mandate requiring gun ownership? Wouldn't be the first time.
Where are you getting this information?
SCOTUSblog.
Herman Cain will clinch the GOP nomination. No clue what will happen with SCOTUS. Can't we just wait 24 more hours?
18: I was thinking more of taboo unspeakability, but that will work, too.
5, 14: That seems to me like an unlikely outcome. If the Court acts lawlessly enough to strike the mandate, it won't leave the rest standing: that would potentially be bad for the conservative wing's constituency, and potentially be good for everyone else. Why would they take half measures here?
16: most of the people on the internet are ignorant blowhards.
Why would they take half measures here?
Plausible deniability?
[M]ost of the people on the internet are ignorant blowhards.
Racist.
At least the people on the internet don't take my wool.
Democrats trying to spin such a decision as a victory
Striking down the mandate *would* be a victory. It was a stupid idea when the Republicans embraced it and being shepherded into existence by Democrats didn't change that. Plus, if the rest is kept in place, it will make the insurance companies scream bloody murder and very little on earth would make me happier than that sound.
Striking down the mandate *would* be a victory.
I should have thought you hated the "give in to win" ethos of the profession liberal class, apo.
If Scalia comes along, it may be a concurring opinion. I suspect he'll still want to make sneering comments about why the majority reasoning is wrong and overreaching.
PPACA will be upheld, 6-3. (I'd be curious to hear why you think it might be 8-1, urple. Who's the 1? Thomas?)
30: I thought 12 made that clear, but yes.
Really, I said 7-2 seemed more likely than 6-3, but that's not right. Those two seem like a toss up, and either seems much more likely than any other vote.
In descending order of probability:
7-2/6-3 uphold (tie) (extremely likely)
8-1 uphold (highly possible)
5-4 uphold (possible)
9-0 uphold (slim but real chance)
5-4 strike down (highly doubtful)
9-0/8-1/7-2/6-3 strike down (tie) (zero chance).
Plus, if the rest is kept in place, it will make the insurance companies scream bloody murder and very little on earth would make me happier than that sound.
Careful about cutting off your nose to spite your face. If the mandate is struck down and the rest of the law left in place, there is a very real risk that the individual market could go the way of Washington State or New Jersey.
Personally, I think that's unlikely to happen, because all the bloody-murder screaming by the insurers will result in either Congress or (more likely) state legislatures imposing other remedies to substitute for the mandate and prod the healthy uninsured to buy coverage. And that's assuming that the mandate isn't struck down in purely symbolic fashion.
28: I've been stridently opposed to a public-option-free mandate from the get-go. It would be bad if the whole thing is struck down, but my primary interest isn't furthering the Democratic Party's fortunes. It's fucking the insurance industry.
my primary interest isn't furthering the Democratic Party's fortunes. It's fucking the insurance industry.
Perhaps the gentleman could spare a thought for the 30 million who stand to gain coverage under the law?
Is it really true that the court is allergic to 5-4 votes on striking down big legislation? I keep seeing that assertion.
Congress leaving out the standard severability clause was a gigantic FuckYouDoubleDareYou to SCOTUS. This was not a mistake or oversight. This was a "poison pill" and SCOTUS should not merely be insulted, but should establish a precedent or guideline that they will not be manipulated or intimidated in this way. Now I know some argued that severability could be implied or something, but fuck, that gives SCOTUS a line item veto not explicitly legislated. No.
I mean hell, who knows if there is something even Lemieux would find nasty buried deep in that phonebook.
5-4, whole thing gone. Maybe even 6-3. Health care privatized and made vicious under President Romney.
Obama is the worst President ever.
Many criticize Obama, with the idea that he doesn't understand, and if only he understood, he would change his mind. This is part of his false narrative of hope and change. But Obama reads Paul Krugman - he studied the left intensely and spent years as a community organizer. He understands his opposition, those crying out for justice against the powerful, and finds them laughable, finds in them weakness at best, a punchline at worst. He reads his left-wing opponents so he can absorb the talking points, and rebut them. Some think that Obama can be appealed to around the better angels of nature, that he's naturally with "the left" but must be gently praised. But again, this is more of the false hope and change narrative. Obama understands Saul Alinsky. He gets left-wing ideas. But he hates the left, with the passion of any bully towards his victims. To him, they are chumps, weak, pathetic, losers. They are such pathetic losers, in fact, that they will believe anything he tells them. And Obama has no better nature, he is what he's done in office, someone who murders children with drone strikes and then jokes about it to his rich friends.
Put not your hopes in the schemes of evil men.
I was waiting for that Matt Stoller piece to be linked. What a bunch of infantile petulance. A rational person, or even Ian Welsh, would say "When you have no leverage over a politician, he probably won't do what you want. Simple common sense." This Stoller guy says "When you put someone in power, you put all your faith in his wisdom and kingly attributes, and well, sometimes it turns out that he betrays you. We saw it with Michael Corleone and now we're seeing it with Obama."
33.last: And that's assuming that the mandate isn't struck down in purely symbolic fashion.
That certainly would be a relatively reasonable approach--but it its likelihood seems to be belied by the unreasonable circumstances which lead to it being on the table (I guess many "compromises" have that characteristic, however).
I'd like to be cautiously optimistic, but I think this is potentially Roberts'* Bush V. Gore moment and I fear his deep inner wingnut is going to rise to the bait if it has half a chance (if the chance does not arise he'll run for cover with the majority and use this decision as his "look I'm a reasonable man" loss leader for the next two decades).
*I'm tired of trying to game out Kennedy.
I agree with the frog president.
I really don't see what Francois Hollande has to do with it.
My gut says Urple is right, but it's largely professional socialization. Judges can't be that bad and nakedly partisan, can they? Well, sometimes they can be.
I wonder what Sarkozy is doing right now.
The reason the ruling has been delayed until Thursday is so the justices can get their stock portfolios lined up to maximize profit.
Also, while Kennedy could easily vote to uphold the law, saying that there's "no way" he fails to do so is much too strong. He has a total contempt for Congress and an attraction to libertarianism.
46: Contemplating his inevitable divorce?
49: Was going to add, "and whom Mrs Sarkozy is doing" but thought it might be crass and in poor taste.
I wonder what Sarkozy is doing right now
Shagging Carla with a bottle of Tokay d'Alsace in a cooler on the night table. Politics sucks.
Shagging Carla with a bottle of Tokay d'Alsace
Sick.
thought it might be crass and in poor taste
And lord knows we don't stand for that sort of thing around these parts.
Judges can't be that bad and nakedly partisan, can they?
May I remind you of Bush v. Gore?
My prediction is mandate struck down (5-4), the rest they leave alone.
Speaking of taste, how old do I have to be before I can grow out my eyebrows without fear of social censure?
My prediction is mandate struck down (5-4), the rest they leave alone.
Are people still of the opinion that that would be a desirable outcome as it would basically destroy the private insurance industry?
Or has the thinking evolved and concluded that we're just screwed in some different way?
I'm pretty sure I could get away with it at my current 43, but vanity has kept me from testing the theory.
55. I'm hoping for mid 60s, because I'm 60 and I still get it.
I've done the math and I'll need at least four years to hit "crazy old man" bushiness.
Let's try that again: I think it will be upheld because the insurance companies like the mandate, and it's an effective bogeyman for the right in the upcoming election.
Anyone who was in the majority on Bush v. Gore, I would not trust to fall downwards if I dropped them.
If Obamacare fails, it will be an accomplishment.
55: My wife will censure you no matter how old you are. She won't even give Larry Hagman a pass.
Is that surprising? Apart from banning rejections for preexisting conditions and similar issues (which aren't insignificant and are good, progressive reforms), the law basically takes the current system and cements it in place. It doesn't surprise me that people unhappy with the current system would also be unhappy with the reform. To really love the PPACA, you have to think the current system only needed marginal tweaking.
The most realistic idea I've seen (which is to say that it splits the difference between sanity and insanity in a way that comforts me more in its plausibility than hoping for a straight victory would) is a split victory - 4 votes for upholding it under the Commerce Clause, and Kennedy plus possibly Roberts for upholding it under the taxing power. (A bit like how Congress uncontroversially banned marijuana in the guise of a prohibitive tax to avoid Commerce Clause questions.) I would still do a slow burn about creeping Lochnerism, of course.
the law basically takes the current system and cements it in place. It doesn't surprise me that people unhappy with the current system would also be unhappy with the reform.
Americans are entirely unaware of what's in the new plan. They definitely don't see it as cementing the current system in place - they see it as some nebulous government takeover that won't affect them directly, because they've got X special situation, but how dare Obama overreach like that.
64: I probably don't know your wife.
To really love the PPACA, you have to think the current system only needed marginal tweaking.
No, you merely have to believe that 50 million uninsured is a national disgrace, and that something like PPACA was the solution to universal coverage most likely to be passed into law.
(One might also believe that PPACA is much more than a marginal tweak.)
Americans are entirely unaware of what's in the new plan. They definitely don't see it as cementing the current system in place
Urple and I are both Americans. Not the median American voter, certainly, but still.
I dislike the assumption that just using insurance companies means it's going to be the same poor system as before with more people covered. Just because insurers have political power doesn't mean they're going to fight tooth and nail to stay just as shitty and rapacious as always. It is in fact a reasonable business strategy for them - one they bought into in the reform process, if lukewarmly - to accept lower profit margins and less opportunity to gouge in exchange for greater business volume. They know the current system won't go on forever - they can choose profit-maximization in the short or long term, and the current reforms are decently geared toward making them better actors.
70: I'll qualify my statements more aggressively to make that clear, in the future, although one must keep in mind that Urple and Apo are Americans.
SCOTUSblog says all upheld. Who knows?!
73: (I don't have any inside information, nor does anyone else.) [from the linked piece]
There does seem to always be very good discipline in this regard for the Supreme Court. Is it simply due to massive and overwhelming social pressure (with potentially significant future employment implications) on the clerks?
70.2 was neb-level little bitchery.
Urple and Apo are Americans
The UaAaA disclaimer.
75: I didn't mean it as such. Just that I do believe we represent a significant chuck of the opposition coming from the left.
77: That might be problem, mathematically speaking.
77: I haven't heard left-wing complaints that the ACA is a net-bad from anyone that I know offline. I've heard complaints, but always that they were outweighed by the positive.
74: It is genuinely hard for me to believe that certain little Wormtongue-esque clerks aren't giving heads up to the Boehners etc. so they have their responses in order.
Just out of curiosity, is it supposed that Obama already knows the outcome? On The West Wing someone was always letting someone know something, and that show was obviously 100% based on reality.
the law basically takes the current system and cements it in place
This is fundamentally mistaken.
Before PPACA, the bulk of federal subsidies for under-65health insurance flow (through the tax code) to corporations and relatively well-off employed individuals, with the size of the subsidy increasing as a function of the generosity of the employer health benefits. After PPACA, the bulk of federal subsidies will flow to individuals, with the size of the subsidy increasing the greater the individual's financial need.
Before PPACA, if you are under 65, don't have employer group coverage, and don't qualify for Medicaid, you stand a good chance of being uninsurable. After PPACA, anyone can be insured, with premiums and out of pocket expenses capped as a % of income for most of the currently uninsured.
Before PPACA, insurance coverage in most states is full of bait-and-switch tactics that fail to cover basic medical needs and leave unlucky consumers with unlimited financial exposure. After PPACA
Before PPACA, insurance companies make money by collecting premiums, paying claims, and selecting risk. Post PPACA, insurance companies have to make money by managing population health. They can't select risk, and if all they can do is collect premiums and pay claims, they won't be in business long.
And that's before I get to the whole topic of cost control (which accounts for half the law), where PPACA takes important steps to break out of the fee-for-volume paradigm and rebalance the incentives in the system to reward quality, primary care and prevention.
is it supposed that Obama already knows the outcome
I've heard it said that the White House will get a courtesy call maybe an hour before the announcement, FWIW
83.4 should continue "...after PPACA, every health insurance policy comes with guaranteed minimum benefits and a guaranteed minimum value."
41:A rational person, or even Ian Welsh, would say
Well, as I am sure you know, or ("This Stoller guy") are in blissful ignorance, Ian Welsh was in Canada working in finance while...
...Matt Stoller was spending every day on Capital Hill trying to get a decent health care bill passed. As in lobbying the House Progressive Caucus to stand firm on a public option, and being broken by the Obama-Rahm machine.
Stoller does take it personally.
41:This Stoller guy says "When you put someone in power, you put all your faith in his wisdom and kingly attributes, and well, sometimes it turns out that he betrays you.
To expand 86 a little bit, Stoller was in the trenches talking to the most progressive Congresspersons, though mostly staffers, begging them to withhold their votes in order to maintain leverage against industry and blue dogs, and hearing their responses, what pressures they were under, why they eventually folded.
And you should read him, but he has written at length for two years about the effectiveness of Obama's image and it's influence.
He was there and saw that the "veal pen" just could not resist Obamism. Hell, the women's groups let the Stupak amendment through.
Matt Stoller was spending every day on Capital Hill trying to get a decent health care bill passed. As in lobbying the House Progressive Caucus to stand firm on a public option, and being broken by the Obama-Rahm machine.
Uh, bob, you are aware that the House passed a bill with a public option? The one that went nowhere in the Senate? Perhaps Mr. Stoller's time would have been better spent working on Joe Lieberman and Ben Nelson.
We would be living in a worker's paradise if it weren't for that dastardly Obama.
88:Oh, hell, do we to rehash all the history, the reconciliation scramble, the election of Brown, the final showdown in the House to pass the Senate Bill unchanged, Kucinich's "come-to-Obama" moment?
Whatever.
Lemieux today has, in opposition to his colleagues, predicted that the mandate will be overturned 5-4.
I am not that awful excited about this SCOTUS ruling.
Don't much care. This is like getting excited about the Wars Powers Act, or protecting Roe v Wade.
Even if 9-0 to uphold, the dread "fiscal cliff" and the six months past the election will whittle and gut a health bill that was designed to be easy to carve and change in industry-friendly ways are even more important. I mean, they gave the assholes plenty of time, and progressives not nearly enough to work with. This provision weakened, this oversight agency underfunded, that subsidy reduced...health care in America still will suck rocks, and Obama won't be blamed.
So work to get Democrats elected! Ha ha ha.
(Links to horrible devastating changes alreadt made, upon request)
Don't Expect Popular Outrage ...Jon Walker at FDL
To begin with many people want the Court to strike down all or part of the law. A Quinnipiac poll from April found 49 percent thought the Court should throw out the law, while 38 percent thought it should uphold it. A Washington Post-ABC News poll from the same month found 67 percent wanted the Court to throw out part or all of the law. The Kaiser Family Foundation tracking poll found 51 percent thought the Court should rule against the individual mandate, with just 26 percent thinking it should uphold it. If the Court does what most people want or expect it to do, it's unlikely that action will be seen as a real overreach.Perhaps more importantly, few seem heavily invested in maintaining the law, even though millions could be affected by the Court's decision. A new NBC/WSJ poll found a plurality would have simply mixed feelings if the Court strikes down the whole law. Only 17 percent would be very disappointed by this outcome, with another 5 percent somewhat disappointed. Similarly, the poll found a majority, 55 percent, thought the Court striking down the mandate would make no difference to their family.
There is only a small base of strong supporters of the Affordable Care Act.
Kermit, thanks for the links in 33. The word about what happens without a mandate are especially significant. I knew that, but it's worth being reminded.
Lurker bleg (semi OT). I have not had a primary care physician in a long time and no one regular since my pediatrician, even though I am now gainfully employed and have coverage. Idiotically, I'm suffering through an intense (but not dangerous) allergic reaction to an antibiotic my dentist prescribed (idiotic because this happened before in my youth but I forgot the offending medication--no electronic health records in 1988). I'm considering using this as an excuse to jump back in the system. Any advice on selecting a go-to doctor? I'm a mid-40s guy in Brooklyn (although not in my basement) in case that's relevant.
Many thanks. Apologies if I should be RingTFingA.
PPACA prediction: wholly upheld, Scalia and Alito resign in protest, an abashed Roberts resigns himself to searching for his vaunted comity among the actual center of the realigned center-left court. Sorry, fever dream.
I adore my GP, but he is on the UES, alas.
Downtown Family Medicine has been a pretty good experience, and isn't too inconvenient from Brooklyn.
Most likely scenario is 5-4 to strike down the mandate together with community rating and mandatory issue. Next most likely 5-4 to strike down everything. In both of those cases the ruling will be phrased narrowly so as not to tie their hands when republicans want to privatize social security.
Next most likely is 5-4 to strike down just the mandate, but with a less narrow decision so that conservatives can at least feel like they won on the constitutional issue. About as likely as that is 6-3 to uphold the law but probably in some complicated messy way.
Anything other than 5-4 or 6-3 seems pretty unlikely to me. There's no way that Scalia is going to uphold. He hates health care, mexicans, masturbation, drugs, and dirty hippies, and has no principals more important than his id.
95: Hmm, Downtown Family Medicine (132, 141 et seq.). I love how in that thread there was a brief half-hearted attempt to engage with the on-topic part of LB's analogy, but the overwhelming need to debate subtleties of Manhattan geographical nomenclature could not be denied.
93: If you're not a person who regularly visits your GP, my advice is: look for a place close to home, not to work. I ended up picking a GP whose office is convenient to work. But when I'm sick as a dog, I'm staying home from work, and I really really don't want to travel.
98 is good advice. Beyond that, my strategy is to choose an attractive woman. It increases my perception of their competence, so I have more faith in whatever they're doing, and placebos do the work from there.
Thanks for the suggestion, LB, and for the thought, oudemia.
Time to play guess who wrote this (during a discussion of the imminent health care ruling):
I had the chance to talk with Justice Kennedy recently -- no, not about that -- and found him intellectually alive, curious and informative about new findings in physics and neuroscience.(Nope, not Beefo Meaty.)
102: I'm going to go with David Brooks or Jeffrey Goldberg.
Does Jeffrey Goldberg write stuff like that?
Dear God, those Brooks-Collins "conversations" are just cringe-inducing. From the above (#107) link:
Gail, let's praise the Supreme Court! I find it an endlessly impressive institution.
All David Brooks has ever wanted to do is to hobnob with the power structure. And Gail Collins is his enabler.
Does Jeffrey Goldberg write stuff like that?
Does he ever. He speaks often enough about the people he knows and has met, and the places he's been, and so on.
"I had the chance to be at the next stall to Justice Roberts recently -- no, not about that -- and found him scatologically alive, curious and informative about new findings in pooping and peeing."
110: Everything about that Chris Christie as spurned stalker fan piece was painful. And now I'm totally envisaging Chris Christie loitering at the bottom of the water slides at Action Park for the hot hydraulic-induced wardrobe malfunction action.
109: I don't know what to make of Gail Collins. There was a very favorable review of her recent book in the NYRB. But it's paywalled after the first few paragraphs, I see.
113: In a related bit of googling, I came a cross a bit of discussion of Action Park on The Best Show on WFMU (starts about 1:39:20 here and goes for 12 minutes or so). Mostly stuff covered in the other thread but a former employee calls in for part of it (~1:42:00) with a few stories, although the host does not really let her tell her stories. She says she was an attendant on the Loop-the-loop slide (although as discussed, it was not open very much) and that they would have to bribe workers with free lunches to get anyone to be willing to do a test run in the morning.
115: Ha, it seems the former employee who called in was his wife (also a dj on WFMU)...
Everything about that Chris Christie as spurned stalker fan piece was painful.
Seriously. I had to stop reading. Chris Christie: torn between the romance of the grittily-real 'Regular Guy from New Jersey' and the utter intransigence of the mean-minded, 'no taxes, ever' GOP-Tea Party crowd. But at the end of the day, he loves money and power and influence more than he obsesses over Springsteen, obviously.
True fact: my NJ county recently (2011) honoured Christie's wife Mary Pat with an "Irishwoman of the Year" award. I have no idea why: I believe she was born in Pennsylvania.
Americans don't like actual Irish people, Mary Catherine.
Fact 1:In the past, Scalia has limited himself to reading a dissent from the bench once a term.
Fact 2: Scalia read a dissent in the Arizona case.
Over under on separate written opinions: I think there will be 5. If two liberal justices decide to read their (majority) opinions from the bench, Scalia might want to be part of the show. But my guess: one scathing dissent from Ginsburg read from the bench.
This has been getting so stressful I've been making myself feel better by thinking instead about a new huge can of worms that opened at work yesterday.
If something bad happens, that's goodbye to most of what I've been doing for the past year, and my colleagues for much longer.
I am finding it really surreal to be sitting here at the height of a presidential campaign and waiting for a key Supreme Court decision on the signature legislation of the sitting president. And add to that the probable first in history censure of a sitting AG based on basically absolutely nothing. OF course things like that happened all the time during the Bush years ...
The normalization of the asymmetrical aspects of our current politics, let me make it explicit.
122.2 being about SCOTUS, not the other can of worms.
I have a good Lincoln quote, obliquely about the Dred Scott decision, in case of disaster.
And add to that the probable first in history censure of a sitting AG based on basically absolutely nothing.
I really haven't been following this story, but Jon Stewart makes it sound like he's culpable. Spot me a link?
"John Roberts Marshall has made his decision; now let him enforce it." No, wait.
125:Kevin Drum links to a long analysis in Fortune
Of course the House and censure is insane, but I am not willing to say I know exactly what all went down in Arizone based on the Fortune article. Bunch of CYTA goin on
If this important decision had been made by the unanimous concurrence of the judges, and without any apparent partisan bias, and in accordance with legal public expectation, and with the steady practice of the departments throughout our history, and had been in no part, based on assumed historical facts which are not really true; or, if wanting in some of these, it had been before the court more than once, and had there been affirmed and re-affirmed through a course of years, it then might be, perhaps would be, factious, nay, even revolutionary, to not acquiesce in it as a precedent.
Place your bets, mesdames et messieurs. Rien ne va plus.
SCOTUSBlog says there's a very large box of opinions on the PIO's table.
For those not watching SCOTUSBlog:
Amy Howe:The individual mandate survives as a tax.
Please to differentiate predictions from news.
Scotusblog is liveblogging trying to figure out a complicated ruling. Not an easy thing to do.
134: Cue campaign ads about Obama breaking tax promise.
Holy crap. I didn't realize how pessimistic I was until noting my great surprise at the news.
SCOTUSblog again:
Tom: So the mandate is constitutional. Chief Justice Roberts joins the left of the Court.
Does this mean 5-4, I wonder? I am super curious about the vote.
I love `parsing / it is complicated'.
I bet they used to bitch in law school that for fuck's sake, in the real world I will never have to decipher a complicated appellate court ruling under extreme time pressure.
When they say "survives as a tax" does that mean it couldn't be challenged because no one has paid the tax yet, and it can be challenged in 2015? Or that it's outright constitutional?
Nevermind. Looks like the entire thing was basically upheld. Wow.
133:David Dayen
...The health care ruling is coming out presently. Keep in mind it may be complicated and may get misreported initially...."The individual mandate survives as a tax."
...There was a lot of talk that this could be the ruling, that the mandate would be struck down, in some form, but that the penalty for not purchasing insurance would be constitutional under the taxing power. But the ruling is seen as complicated, so hold on.
But certainly eliminates the worst-case scenarios for those who like the bill and Obama
I think it means they're reading the mandate as a tax, so the commerce clause isn't an issue.
139: No kidding. I actually fist-pumped when I saw that the mandate was upheld.
Dayen:
...Tom Goldstein: "The entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read."...So much for reading the tea leaves of the oral arguments.
I'll be damned.
So it was 5-4 with Roberts the swing vote?
But certainly eliminates the worst-case scenarios for those who like the bill and Obama
Or even those who dislike them marginally less than the status quo ante.
139: Likewise. I've sort of come to assume that the right has basically won the SC.
150: It looks like it (although I expect in detail it's more fractured, with partial concurrences etc.). I guess it'd be a little surprising if Roberts but not Kennedy voted to uphold, but then again Roberts is above all a Chamber ideologue, which made him far from an uncertain vote to strike from the get-go.
far from a certain vote to strike, that is.
Roberts yes, Kennedy no - did anyone at all predict that? (Don't know for sure it's true but it's what SCOTUSblog says.)
Amy Howe:
The money quote from the section on the mandate: Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.
140: Fuck urple. I'm your new king. Unless it comes out 8-1 or 7-2, of course.
150:Yeah, Roberts wrote majority, Kennedy dissenting.
The Medicaid thing may be horrible, but today is a huge win for liberals.
Via scotusblog: "Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it."
Wait, what? What happened to my pseudonym? Stupid iPad.
Am I going to have to say nice things about Roberts now?
Even the Medicaid thing isn't that bad. Looks like they can't have ALL their Medicaid funds threatened for noncompliance with ACA--just expansion-tied funds.
163: Yes, from the bits we've seen the Medicaid expansion holding is pretty shitty. I really wasn't expecting that.
165: it might not be that bad in the immediate case, but it's a big departure from previous deferential conceptions of the spending power.
And fuck them, they threw out a gratuitous holding that the mandate wouldn't be valid as an exercise of the commerce power.
164: Yes. But you get to say arbitrarily nasty things about Scalia, Thomas, and Alito.
170: yeah, that's more like what I've come to expect
Wow this is really an interesting decision.
Sounds like the Medicaid thing will result in a lot of poor people in red states still not having health insurance.
Christ, Kennedy voted for no mandate and no severability?!
Kennedy! Holy cats! His journey to the dark side is complete!
The Medicaid thing makes zero sense. Why would the federal government be able to make new funding conditional, but not existing funding? Can't they just amend the Medicaid law to make the existing funding conditional?
175: It wouldn't mean that they'd be forced to comply with the mandate? Or does the mandate only kick in once you're over 1.33 of the federal poverty line?
Good news.
And an embarrassing Dewey Defeats Truman! moment for CNN thrown in as a bonus.
Kennedy would throw out the entire act.
It's 5-4. Roberts plus the 4 liberals. Ginsburg for the four liberals concurring in part: would uphold everything. Kennedy in dissent would strike everything.
Goodbye, awesome union-fought-for health coverage, hello shitty, super-high deductible 1984-style health coverage. Sigh.
178: No sense whatsoever. Opt-out for Medicaid expansion. Hopefully it's still enough money to lure in most states, but we'll see whether partisanship outweighs rapacity.
Annoyed how every article about the SCOTUS decision seems to make the second sentence, if not the first, about the election. Like Obamacare or not, it's important on its merits, and elections really don't hinge on the media as much as they pretend.
So where can we find the damn decision text? It's not on supremecourt.gov.
If 165 is correct, I don't see how it's consistent with Dole or the other spending power cases. Whoo 18 year old drinking age! I guess we just need to wait to read the damn thing.
179: the Medicaid expansion issue is unrelated to the mandate. The question is whether Congress can condition continuing receipt of existing federal Medicaid funds on states' agreements to expand their Medicaid programs with additional federal funds. The answer appears to be no.
Kennedy says: "In our view, the entire Act before us is invalid in its entirety."
Apparently scotus has a department of redundancy department.
I would not have guessed that twitter would cope with post-ruling traffic better than unfogged.
185: It won't be posted until they finish reading whatever they're reading from the bench. Unless journalists have scanned and posted the paper copy by now.
187: Then I don't understand 175? (which was from Spike, not from you.)
Now that everyone is forced to do business with insurance companies and rates will continue to rise (albeit at slightly lower rates), and even Roberts has proved too liberal, Republicans will have a political issue for years to come. Their base loves to seethe.
191: It means the federal govt won't have as much leverage to convince states to expand their programs to cover more people, since they'll be able to turn down the new money without risking the existing money.
Can someone who can read the opinion tell me (I'm on a phone) -- does Robert's opinion reach the commerce clause issue (and decide that it's not permissible under the commerce clause) speaking only for himself? Who joins in what parts of his opinion?
192: Let 'em then. They can seethe all they want, but 27% is still 27%.
195:
There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power.
Which doesn't fully answer 195, I realize.
Roberts joins cons to say it violates commerce but joins libs to say it doesn't matter since this is a tax.
195: Looks like Roberts says not justified under commerce clause, Ginsburg and presumably the other 3 to the left say it is.
Not that I'm working from the opinion.
195: That's right, though I've only skimmed so far. He's speaking only for himself on the commerce clause, but of course the dissenters agree with that, making five justices who believe it's invalid under the commerce clause. But they didn't join that part of the opinion so it shouldn't be treated as a holding of the court.
But it is not coming up for me.
I have the text now. The mandate is a tax for purposes of constitutionality, but is not a tax for purposes of the Anti-Injunction Act allowing them to rule now! Hilarious.
Dellinger the only one who called it at the orals, Roberts affirming. Lemieux is stunned
Both men, Dellinger said, "asked [tough] questions of both sides.""The court," he said, "understood that the alternatives being offered by the challengers were really not workable," and that the most likely policy option if the mandate is struck is a more public system like single payer.
"Jerry B" comment at FDL:
Understand pups, this means single payer is dead. Won't happen. Not now, not ever. We are now captives of the oligarchy and they will never let us up.
"jodo":
This was a no-brainer prediction. There was no way that a right-wing, authoritarian Supreme Court would ever ruin a free money grabbing scam by the wealthy oligarchs at the expense of the serfs.
This also helps Obama's chances in November, thus the mandate going into effect in 2014, and the American people wearing "property of Wellpoint" collars forever and ever.
And now I will let the serfs celebrate their neo-feudalization. Party!
Goodbye, awesome union-fought-for health coverage, hello shitty, super-high deductible 1984-style health coverage.
I'm pretty sure this was on its way out with or without the ACA.
170: Roberts does seem to navigate the politics pretty well.
205: That is so weird. Why would Roberts shy away from using the Commerce Clause if he was clearly already the key person allowing ACA to stand?
I look forward to the Eat Your Broccoli Tax.
The Kennedy vote proves I was right all along: no prediction out there was worth a damn.
203: oh-that wasn't clear to me.
205: I noticed that in the scotusblog description--wtfingf?
191: What I mean is, it appears that the Medicaid expansion is something that states like Florida can now refuse to do as an ostentatious way for their governors to position themselves as opposing Obamacare. Those people who would have been covered by the Medicaid expansion will now likely remain uncovered, as, even with subsidies (which may not even kick in until they get a higher income), they will be unable to afford coverage.
209: It still serves his purpose of slowly chipping away at what the Commerce Clause can do (see US v. Lopez, US v. Morrison), with particular reference to laws the court doesn't like.
"SUPREME COURT TO LOW-INCOME SOUTHERNERS: DROP DEAD"
209: Because he doesn't care about health care, he cares about limiting the commerce clause.
214: To be explicit: you think that poor people in red states who are left in that gap will pay the tax, not buy insurance?
I would think that there would be enough people that some shitty insurance company cobbles together a rock-bottom policy and markets it to them, the way they do for auto insurance.
Why would Roberts shy away from using the Commerce Clause if he was clearly already the key person allowing ACA to stand?
Because he agrees with the anti-Commerce Clause argument for partisan reasons, but he also knows that invalidating the ACA would completely undermine the legitimacy of the court. So he went along with the tax thing as a way of not going down in history as the guy who triggered the revolution.
There's no subsidies for the sub-133% FPL not-already-Medicaid-eligible population - if the state doesn't implement the expansion, they're a new donut hole.
218: the people poor enough to qualify for Medicaid would not be subject to the tax/penalty, I don't think. I may be wrong about that.
I would think that there would be enough people that some shitty insurance company cobbles together a rock-bottom policy and markets it to them, the way they do for auto insurance.
Yeah, but what happens when they need actual medical care which their so-called insurance doesn't cover?
219: Right, that is what I meant by him navigating the politics well in 208. Per 43, his "look I'm a reasonable man" loss leader for the next two decades. But I thought he would only do it as the 6th vote. What a big fat chump Kennedy is.
214: To be explicit: you think that poor people in red states who are left in that gap will pay the tax, not buy insurance?
Yes, because a $600 tax is still far, far less than what they would have to pay for crap insurance.
222: Right, I agree that red state poor people are still screwed*. But there's at least a mechanism for legislating what the bottom-of-the-barrel policies must cover.
*In oh so many ways.
The mandate is inapplicable if insurance after subsidies would be more than a certain percentage of income. I suspect most people in the Medicaid expansion range would get that exception.
223. Yeah. If Romney replaces Ginsburg and Kennedy with sops to the Tea Party, he will in time seem ever so cuddly and reasonable that people will forget what a conniving bastard he actually is. Thus does the Overton window move.
It sounded like they were saying that the states could refuse the money and not expand Medicaid, but if they complied with the old rules they'd keep existing funding.
What I can't understand (nb I'm still on a phone and am getting this all from you guys and poorly refreshed Scotusblog updates) is why the four dissenters didn't simply join in Roberts' commerce clause discussion. Then you'd have five votes and at least arguably a controlling conservative holding on that issue. I'm probably missing something.
Seriously, what the hell happened to Kennedy over the last couple of years?
The mandate is a tax for purposes of constitutionality, but is not a tax for purposes of the Anti-Injunction Act allowing them to rule now! Hilarious.
Eh, that doesn't bother me. The AIA should be construed narrowly, and Congress shouldn't be read to have exempted the U.S. from suit without being clear about it. They limit its application to protecting the ability of the government to collect consistent revenue streams, and that seems right. And it makes sense to distinguish--as they do--between something that is a tax for consitutional purposes and something that is a tax for statutory/AIA purposes, since in the latter case Congress controls.
Oh, wait, I might have been wrong about premium subsidies being unavailable for sub-133%.
229: Still reading but that puzzles me, too.
Lyle on SCOTUSblog:
The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress's authority to pass social welfare laws. Using the tax code -- especially in the current political environment -- to promote social welfare is going to be a very chancy proposition.
Although I am still confused what was an actual holding of a court. I also assume they could have just said it was OK as a tax and leave it that, right?
229: I'm not sure they didn't join that part of it.
207: Yeah, but now it starts pretty much right away and there is a massively larger incentive for corporations and institutions to get on with it.
I guess we're going to have to default to the heavy-woo anarchist plan of having everyone get degrees in herbology. Sigh.
Somewhat surprised that it's entirely upheld, and very surprised by the Roberts/Kennedy switch, but on reflection I shouldn't be; 154 is right about Roberts.
Honestly, I was kind of hoping for the mandate to be overturned but everything else upheld. To quote the first link way back in 33, "It became pretty clear that, if you want a market to work, you need a mandate." If.
219: I'd be surprised if that was actually true. I just think business interests are a more likely reason. The insurance industry likes the mandate because it likes more customers, not because it believes revolution imminent.
234: If they're just calling balls and strikes, they should certainly have just said it was OK as a tax and leave it at that. There was no need to resolve the commerce clause question to resolve the case, and courts aren't supposed to resolve unnecessary questions. But of course the S Ct. does more than simply resolve cases, and ignoring what five justices have said they think is problematic in its own way, holding or not. Something to keep in mind in November.
It's interesting that the dissenting 4 justices would throw out the entire law. I wonder if they would have compromised on that point to get Roberts?
Some SCOTUS Kremlinologists I'm following have noted that the decision may have ended up this way at the last minute - the dissent seems to have been written as if it were the majority decision, including at one point referring to Ginsberg's part-concurrence-part-dissent as "the dissent".
Court also rules that it's totally cool now (legally, anyway) for me to claim to have been awarded the Medal of Honor.
239: My feeling is that Roberts would have been far less inclined to strike and sever the mandate than to strike the whole thing. Once again, he's a Chamber ideologue, not a libertarian ideologue.
Here's the other thing: There are about a dozen major things wrong with health care in this country, that virtually everyone agrees on, and this law addresses only a couple of them, and makes some of them much, much worse. IANAcongressional analyst, but it seems to me it would have made much more sense to pass a whole bunch of laws that were a lot harder for the fascists to rally opposition against. E.g. the Break The AMA Stranglehold On Medical School Admissions Act, or the Sane And Reasonable Malpractice Insurance Act. Things that would actually change the way the whole system works for the better, instead of just adding more shitty kludges to it.
I predict that a lot of people like you all are going to be majorly, majorly screwed in a few years time, much worse than if the status quo ante bellum had prevailed.
240: Yeah, people are saying this on the Twitters -- basically that Roberts was driven off the dissent by its lunacy.
Huh, got far enough now to see that Roberts acknowledges that his commerce clause discussion is his alone, but ends it with an "accord" cite to the Scalia/Kennedy/Thomas/Alito dissent. Very strange.
I hereby award Blume the Medal of Excellence in the field of excellence.
241: I salute your bravery and thank you for your service to America.
No, no really, I just did what anyone would do for her country.
it would have made much more sense to pass a whole bunch of laws that were a lot harder for the fascists to rally opposition against. E.g. the Break The AMA Stranglehold On Medical School Admissions Act, or the Sane And Reasonable Malpractice Insurance Act
Maybe, but there's no reason to think they could have gotten passed individually.
I got a Medal of Honor once. I keep it on the shelf next to my Heisman Trophy.
"The power to regulate commerce presupposes the existence of commercial activity to be regulated." That will not affect a lot of statutes going forward.
240, 244: Wow, yes, there is some really weird stuff going on in there. They start by refering to "Justice Ginsburg's dissent on the issue of the Mandate", which itself I wouldn't read much into. But then they quote her as saying that "we 'fai[l] to explain'" X, when in fact Ginsburg is complaining that Roberts fails to explain X. I would be really astonished if something like that simply slipped through the cracks, but I can't think of a good explanation.
I wonder if it was simply a tactic meant to suggest that there is a 5-justice holding on the commerce clause issue.
Using the tax code -- especially in the current political environment -- to promote social welfare is going to be a very chancy proposition.
This is not good for a hypothetical carbon tax, especially under the "tax and dividend" model. Its a shame, as that would be far superior to Cap'n Trade.
Honestly, I was kind of hoping for the mandate to be overturned but everything else upheld. To quote the first link way back in 33, "It became pretty clear that, if you want a market to work, you need a mandate." If.
Every state that tried to achieve universal coverage without a mandate failed, and always for the same reason, adverse selection.
251: Yes, have seen several people dissenting from the view quoted in 234.
252: So, a Double Secret Reverse Polish Double Cross late in the game from Roberts? Or on preview, probably not.
A twitter from Matt Hamlin, quoted by Andrew Sullivan: I just can't believe John Roberts ruled in favor of a policy cooked up by the Heritage Foundation.
Potchkeh is right about the Chamber of Commerce thing. I find that a little bit comforting though not as comforting as if Roberts pulled off his rubber mask to reveal that he's really Bernie Sanders.
"The power to regulate commerce presupposes the existence of commercial activity to be regulated." That will not affect a lot of statutes going forward.
It's not so much the activity/inactivity precedent that problematic, it's the precedent that when there's a law Republicans dislike, they will make up and uphold arguments out of whole cloth about why the Commerce Clause doesn't allow it.
I predict that a lot of people like you all are going to be majorly, majorly screwed in a few years time
I concur with Justice Paennim. The PPACA is a Band-Aid on the employer-based private insurance system, which will continue unraveling at a slightly slower rate. On the other hand, I'm enjoying the outrage from the right wing, who are nearly unanimous in their fevered screams that OMG LIBERTY DIED TODAY.
I find that a little bit comforting
You should not find that at all comforting.
249: My argument, which of course is very speculative, is that many important reforms could have been passed as much less controversial individual measures, with much less traction for ridiculous "death panel"-type claims, and far less scope for legal challenges. Instead, we got a GIGANTIC subsidy to insurance companies who will, regardless of any benefit that the law as passed supposedly conveys to the currently-uninsured, use these monies to elect and lobby legislators who will roll back any positive aspects of the law. Especially post-Citizens United, this is almost guaranteed to be the outcome. So whatever you can say about how great things may theoretically be in 2014, don't get too attached to whatever you like, as the insurers will have it out of the law before you can say "Jack Robinson".
I'm enjoying the outrage from the right wing, who are nearly unanimous in their fevered screams that OMG LIBERTY DIED TODAY.
Yes, I'm actually disappointed that Scalia didn't favor us with an independent screed of his very own. It would have been amusing to read his obnoxious head exploding. The actual dissent is whiny and stupid but Scalia could certainly be more of a petulant little shit about it if he'd been holding the pen.
259.2: Yes, that is always gratifying. I guess we'll just have to pray for a lot of right-wing aneurysms before 2014.
I see no reason why the employer-based system would ever unravel. Employer-based insurance means that the people who make policy have insurance.
I see no reason why the employer-based system would ever unravel. Employer-based insurance means that the people who make policy have insurance.
It's unraveling as we speak. And the people who directly make policy get free socialized health care.
261: Now that lobbyists are all powerful, wouldn't the insurance companies just find some way to take our money later? If everything is hopeless, then everything is hopeless.
I see no reason why the employer-based system would ever unravel. Employer-based insurance means that the people who make policy have insurance.
It has been for decades now.
In putting aside Raich, the dissenters make some claims about marijuana.
Intrastate marijuana could no more be distinguished from interstate marijuana than, for example, endangered-species trophies obtained before the species was federally protected can be distinguished from trophies obtained afterwards--which made it necessary and proper to prohibit the sale of all such trophies, see Andrus v. Allard, 444 U. S. 51 (1979).
My research has revealed that for any states that take their new opportunity to opt out of Medicaid expansion, childless adults 100% FPL and lower will be completely up shit creek. Premium subsidies are only available for those households 100% to 400% FPL (plus Lawful Permanent Residents less than 100%). Childless adults sub-100% FPL in any such states are currently ineligible for Medicaid, now will not become so in 2014, and while they could join the exchanges, the insurance would be unaffordable without subsidies.
But unraveling in a way that would force government action if the ACA is struck down? The people who are the most reliable voters -- the upper middle class, and senior citizens -- will still have insurance. Everyone else would be fucked, but our political system is now such that they can be fucked with no political consequences.
The PPACA is a Band-Aid on the employer-based private insurance system, which will continue unraveling at a slightly slower rate.
This is true, but I'm not convinced we could have reached a better remedy (once Obama pissed away his mandate advantage and "we won" attitude). In the meantime, they've knocked out the pre-existing condition bullshit -- which is meaningful only if you can afford insurance, I realize, but that still affects millions of people who are otherwise fucked.
245: the dissenters couldn't join in the rejection of the commerce clause because that wasn't a holding. The holding was that the mandate was constitutional (but not for the reason you thought it was) and that they couldn't join.
Intrastate marijuana could no more be distinguished from interstate marijuana than,
So, wait a minute. If we figured out some way to chemically trace marijuana to its state of origin, it would then be legal in that state? Because there has got to be some way of doing that using a chemical analysis of isotopes found in local water supplies, or some shit like that...
My argument, which of course is very speculative, is that many important reforms could have been passed as much less controversial individual measures
The last 20 years of debate about health care does not make me optimistic that this is true. If I had to argue for a mechanism I would say (1) each of those individual bills would have been filibustered and it's harder to break 10 filibusters than 1 (and, each case the Republicans would have said, "I support the basic idea behind this law but it's unacceptable to me because of [small but crucial detail]." Second, and related, to break the filibuster they needed to keep all the democratic votes together, including, "pro-business" Democrats who would prefer to vote against it. Putting everything together in one big bill allows them to say, "we are staking the party on this one; I don't care if you like it, if you have a "D" before your name you have to vote for it." With individual bills you get 2 or 3 votes peeling off for each bill and never get the necessary votes.
'Nancy Pelosi called Vicki Kennedy following SCOTUS ruling and said "Now, Teddy can rest."'
You what?
276: They threatened to throw the body into Robert's pool if he overturned.
'"It's a black cloud pragmatically speaking," says Bachmann. "This was an activist court that you saw today. This supreme court rewrote Obamacare in its own design."
'"If we want to be Greece, then follow the supreme court and vote for Barack Obama," Bachmann concludes.'
All these people who are moving to Canada in protest of Obamacare must be kidding. Right?
The Free Republic thread on John Roberts is sweet nectar.
Which is to say, "Who can tell these days?"
"This was an activist court that you saw today. This supreme court rewrote Obamacare in its own design."
?!
283: I think that's an oblique way of saying "Obama said it wasn't a tax but Roberts said it was!"
a black cloud pragmatically speaking is amazing. You know, pragmatically.
286: That is amazing. I've never known a black cloud to speak pragmatically. They never have their feet on the ground.
255
Every state that tried to achieve universal coverage without a mandate failed, and always for the same reason, adverse selection.
If the mandate was struck down but the pre-existing condition bit and all the other bits were upheld, then the insurance industry would have gone bankrupt and there would have been massive public support for the public option. (Why didn't this happen in Washington and New Jersey, like in 33?) Because the federal government is much bigger and more powerful than state governments, and both people and corporations can't leave the country the way they can leave states.)
the dissenters couldn't join in the rejection of the commerce clause because that wasn't a holding.
They could have joined in that section of Roberts' opinion, which--true--would not have turned it into a holding in the narrow sense but would have been a clear explicit statement of what a majority of the Court says that the law is. Which is not nothing, and that kind of thing happens frequently enough.
Best part so far is Ginsburg crushing in the broccoli wars ("broccoli" cited 12 times appearing in Ginsburg, Roberts and the dissent):
THE CHIEF JUSTICE cites a Government mandate to purchase green vegetables. Ante, at 22-23. One could call this concern "the broccoli horrible."...
THE CHIEF JUSTICE accepts just such specious logic when he cites the broccoli horrible as a reason to deny Congressthe power to pass the individual mandate. Cf. R. Bork, The Tempting of America 169 (1990) ("Judges and lawyers live on the slippery slope of analogies; they are not supposed to ski it to the bottom.").That's right, throw some Bork in their stupid faces.
The Broccoli Horrible is so my new band name.
Judges and lawyers live on the slippery slope of analogies
When Unfogged commenters form a majority on the SC, analogies will be banned.
Brassicas Macabre is available, JP.
then the insurance industry would have gone bankrupt and there would have been massive public support for the public option.
And THEN I want an extreme action LEGO set. And THEN I want a floating bedroom. Over my pony's stable.
And right on cue the expected quarters are already proclaiming that a "Supreme Court Majority Endorses Activity-Inactivity Distinction" and "Economic Mandates Are Unconstitutional".
(Went over there because I was really hoping to see Randy Barnett cry, but alas nothing so far.)
Ginsburg crushing in the broccoli wars
Every time I think I couldn't love her more.
275 - You'd have seen the Maine senators and Scott Brown (and probably Lieberman and Ben Nelson) doing an Alice in Wonderland dance, where they support yesterday's bill and today's bill, but never the bill that's on the floor.
It's sensible originalism when a major piece of domestic legislation is struck down on transparent Constitutional grounds. "Activist judging" only applies when a law is duly passed by a Democratic Congress and the court's ruling protects icky criminals or lady parts.
All these people who are moving to Canada in protest of Obamacare must be kidding. Right?
"#SCOTUS holds up free healthcare for everyone?! Screw this commie country, I'm moving to #Canada #whoswithme"
Some of them seem to be in earnest. Amazing and hilarious.
272: 71 is one of the more ponyesque arguments I've ever seen. "Insurance companies are rational, so they'll wisely make the choice to protect both their interests and the health of their customers."
Interrobang?!
How well did we see that principle work in 2008? The executives and major shareholders of insurance companies are like the executives and major shareholders of most companies: They're going to look out for their personal interests first, those of their friends second, the company's at a distant third, and the public sometime around the fourth of never. If they backed this plan, it was precisely because it would give them the opportunity to rewrite the plan in their favor over the next few years. What is to stop them?
I'm pretty resigned that the only way I'm going to have decent healthcare when I'm older is by going to Scandinavia and murdering a couple of people, and spending my golden years in a comfy Danish jail cell, making potholders and reading philosophy. Maybe some gardening if the weather is nice.
Interrobang?!
Start with an interrokiss.
What is to stop them?
Clap your hands if you believe in fairies!
Roberts went to the Harlan Stone playbook:
from The Roots of Social Security, speech by Frances Perkins, 1962:
"The legal committee soon broke into a row because the legal problems were so terrible. The constitutional problem was the greatest one. How could you get around this business of the State-Federal relationships? It seemed that couldn't be done."
"We continued to wrangle about it for days. But one day I went out to tea, although not because I wanted to. In Washington you don't go to parties just because you want to go, you know; you go because you have to go. I had to call upon Mrs. Harlan F. Stone, the wife of the Supreme Court Justice. She was at home on Wednesday afternoons and so about 5:45, which is nearly the end of the day, I went to her house and presented myself. There were a lot of other people there. We went up to the dining room to get a cup of tea, and there I met Mr. Justice Stone who had just come home from the Court and was getting his cup of tea. We greeted each other and sat down and had a little chat."
"He said, 'How are you getting on?' I said, 'All right.' And then I said, 'Well, you know, we are having big troubles, Mr. Justice, because we don't know in this draft of the Economic Security Act, which we are working on--we are not quite sure, you know, what will be a wise method of establishing this law. It is a very difficult constitutional problem, you know. We are guided by this, that, and the other case.' He looked around to see if anyone was listening. Then he put his hand up like this, confidentially, and he said, 'The taxing power, my dear, the taxing power. You can do anything under the taxing power.'"
"I didn't question him any further. I went back to my committee and I never told them how I got my great information. As far as they knew, I went out into the wilderness and had a vision."
305: that's excellent, thanks
The Commerce Clause is not a suicide pact...it's a death panel pact!
THE CHIEF JUSTICE accepts just such specious logic when he cites the broccoli horrible as a reason to deny Congress the power to pass the individual mandate. Cf. R. Bork
God, I love this woman.
I realize that the ACA isn't a pony and that the insurance industry will do everything it can to undermine/evade the good parts of it, but...
It's a little depressing to find so many folks around the progressive blogosphere (not referring to unfogged specifically in this instance) determined to spin this as a loss because Roberts is somehow playing 17 dimensional chess.
Does it have to be gloom and doom all the time?
I've never really understood why the broccoli analogy is supposed to be so scary. Say the government can constitutionally compel us to buy broccoli. So? The government can constitutionally compel me to do a lot worse things.
272: 71 is one of the more ponyesque arguments I've ever seen. "Insurance companies are rational, so they'll wisely make the choice to protect both their interests and the health of their customers."
I'm not saying it will necessarily happen, I'm saying it's a reasonable possibility.
305: It's a red-letter day when having been a Stone Scholar prompts a smile.
309.last: yes, I'm afraid it must.
301: If they backed this plan, it was precisely because it would give them the opportunity to rewrite the plan in their favor over the next few years.
I have no doubt that they'll attempt to do this, but it's not clear to me what they'll try to change. Is someone out there on the internets writing specific predictions about that?
I'd guess it would be about the percentage of their take they can keep for administrative costs, as well as the amount by which they can justifiably raise annual premiums. Perhaps also the ratio of premium cost between younger, middle, and older age groups (apparently older people currently pay 5x the rate of 20-somethings, and the PPACA calls for no more than a 3x ratio).
310: It only starts with broccoli... (from the dissent):
To go beyond that, and to say the failure to grow wheat (which is not an economic activity, or any activity at all) nonetheless affects commerce and therefore can be federally regulated, is to make mere breathing in and out the basis for federal prescription and to extend federal power to virtually all human activity.
I haven't read the decision yet, but while it's a win on health care, isn't the spending power/Medicaid bit floridly insane? WTF is the principled distinction between "Money the feds gave the states last year that they could take away at whim by passing a law" and "Money the feds are giving the states for the first time in this law?" Is there going to be a general property right belonging to the states applying to the current baseline of federal funding?
297: Seriously, are there any other justices (past or present) whose opinions are as enjoyable to read?*
*Not a rhetorical question.
They are basically evil, but insurance companies have felt squeezed for ages now. Rapacity doesn't preclude wanting things to be straightened out for more certain profits in the future.
310: yeah, if the government has the power to tax, then it has the power to tax you at 100%, which is a pretty big deal. What stops the government from doing this? Elections. Problem solved. Am I missing something?
And THEN I want a floating bedroom. Over my pony's stable.
Much smarter than wanting a floating stable over your bedroom.
316 - Apparently there's something in the language of the Dole highway funding ruling that says that under certain circumstances taking away funds for non-compliance could be unduly coercive, and "we're going to zero out your Medicaid grants if you don't comply with the ACA" apparently crosses that threshold.
I've just skimmed as well, but the spending clause logic seems to be that there has to be some kind of arguably conscious acceptance of the condition as a condition for accepting the funds. So e.g. annual highway appropriations would qualify, but a provision saying "we'll cut off funds that we appropriated in a past year, and that you already accepted and started to plan around, unless you accept this new condition" is arguably unconstitutional. I haven't read enough in the opinion or elsewhere, or thought enough about it, to know what I think of that, but that appears to be the logic.
Oh good lord that was badly written. Rephrase to something like "the state has to at least in some arguable way have accepted the condition when it accepts the funds" -- the spending clause logic is basically Congress can do whatever it wants to condition funds, but the State needs to have some kind of meaningful ability to decide whether or not to accept the condition as a price for the funding.
Really, as I think and read about it more over the course of the day, I feel worse about this. A week ago I would have guessed that the ACA would either be upheld in its entirety or overturned on nakedly partisan grounds. (My overturn-the-mandate-alone-and-kill-private-insurance scenario was unlikely from the start, I realize.) It seems, though, that the way they upheld it screwed up the Commerce Clause even more, and the narrow reading on the Medicaid thing might cause bigger problems. I read someone comparing it to Marbury v. Madison, and not in a good way: Obama got what he wanted on this specific issue, but in a way that hurt both his partisans and his causes in the long run. So: yay to these regulations on the insurance industry, but we'd better enjoy it, because it's not going to get any better a long time.
309: I'd say this outcome is almost definitely better than complete overturn, both for the country and for the individual politicians I like. No doom and gloom from me by comparison with that. I only see two things to complain about here. First, all the details in my previous paragraph; and second, the fact that Kennedy voted against it, which is a sign of just how far gone he is.
isn't the spending power/Medicaid bit floridly insane?
Yes.
321 is correct that the law has been, since Dole, that conditions cannot be unduly coercive. But that has always been applied to mean that the feds can't threaten unrelated things (the conditions must relate to the federal interest in the program itself; so, as everyone understood it, the feds couldn't, say, condition highway funding on a particular set of educational standards). Roberts sort of says that this amounts to threatening something unrelated because the expansion amounts to a separate, new program, different in kind rather than degree. But it's insane, and it's kind of a big deal.
The idea that Kennedy has "changed" or that he was ever a sure vote on something like this or an arguable liberal is completely wrong. He's a libertarianish guy, which means he hates Congress and is happy to write something like Lawrence, but he has never really believed in Congressional power and is a total judicial imperialist.
309: I really don't see much cause for celebration here. All of the purported positive outcomes that may accrue are substantially worse than even a mediocre improvement. That was my point about a bunch of separate laws targeted at the actual problems of the health care system -- sure some of them might not have been passed, or been filibustered, but if a few made it through, you'd have something to be really happy about. As it is, we've got a shitty, far-right quasi-solution that is likely to be undermined in such a way that it will have disastrously negative effects in the fairly short term. Why would I possibly want to be happy about that?
@324
Oh, I agree that it's not all rainbows.
It's just that some of the comments I've been reading elsewhere amount to bizarre conspiracy theories about what Roberts real plan is. Which seems to involve throwing the election to Romney while selling us all into slavery to lizard people from alpha centauri.
I know it's just leftists being leftists but still...
Note that Breyer and Kagan both joined in the spending clause portion of the opinion, at least AFAICT.
309 - So what you're saying is that the parts of the ACA targeted at the actual problems of the health care system -- something like tens of billions of dollars of Medicaid expansion, say -- would have been more likely to pass all on their own? Do you think Ben Nelson and his friends on the right half of the Democratic caucus give a shit about the working poor? Let alone the idea that there should have been a direct assault on the AMA, which almost certainly wouldn't have passed the House and might have picked up 15 votes in the Senate.
At least Apo's position, that the law was bad because it didn't kick the health insurance industry in the balls, is defensible, because Lord knows they need a healthy ball-kicking. But asserting that anything other than a Clintonian "save the children!" bill, the one Barney Frank was pushing for after Scott Brown's election, could have made it through as a series of piecemeal votes strikes me as risible.
Your principles are admirable, Natilo (obviously we disagree in what's likely to work now), so much so that I'm surprised you seem to give credit to the right-wing smokescreen about malpractice reform being an at all significant component of fixing health care.
What would you list as the biggest components of your ideal step-by-step reform?
All of the purported positive outcomes that may accrue are substantially worse than even a mediocre improvement.
People are going to be able to get coverage who couldn't before. People can, people ARE getting coverage right now who couldn't before. To say that isn't an improvement is pretty fucking shitty.
As far as I can tell this is the nut 'graph in Roberts joined by Breyer and Kagan on the Medicaid part not being a mere modification of the existing medicaid program:
The Medicaid expansion, however, accomplishes a shift in kind, not merely degree. The original program was designed to cover medical services for four particular categories of the needy: the disabled, the blind, the elderly, and needy families with dependent children. See 42 U. S. C. §1396a(a)(10). Previous amendments to Medicaid eligibility merely altered and expanded the boundaries of these categories. Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level. It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage.
331 (to 327, I'm assuming): Anecdotally, malpractice stuff is the chief criticism I've heard doctors make of the current system. And while I don't have a lot of statistics to hand, it does seem pretty absurd. Why should doctors pay ridiculous amounts of money to insurance companies for insurance that doesn't seem to protect them all that well from the financial consequences of judgments against them? If I understand this correctly, an OB-GYN can be sued anytime before a child's 18th birthday for alleged malpractice in delivering that child as an infant. How does that benefit anyone?
You're right that it would probably be politically unfeasible to directly attack AMA policies without throwing them some bones. But we now see that it was politically unfeasible to do anything except knuckle under to the insurance companies' preferred outcome. And even that just barely.
I guess I feel about this similar to the way I feel about gay marriage fights: Don't pick fights you know you can't win, especially when there seems to be a light at the end of the tunnel. That's where it seems an incremental strategy would have worked out much better. Create the social conditions whereby the outcome you want is a foregone conclusion, then worry about passing the huge, game-changing legislation.
Having said all that, obviously, philosophically, I never expected anything too dissimilar from this outcome. The oligarchy wants things a certain way, and they have the power to make it happen. We can argue all day about a better strategy, but the most important aspects of the game have been rigged all along. It is very much in the interests of the power elite to keep most people sick and unhappy, constantly striving to acquire enough wealth to buy whatever quack nostrum is in fashion.
I find sense in Natilo's prescriptions as well, but I'm a little surprised that he seems to be arguing for incrementalism. Wasn't the idea of a big all-encompassing health insurance reform act that it would put in place a New Deal style program that, once in place, would find favor amongst the public? (It doesn't find favor at the moment, but it's not in fully in place yet.) The idea was that small steps could always be repealed in little bits without anyone noticing, whereas "Keep your hands off my Medicare!" -- that being an all-encompassing plan -- has become in some quarters a rallying cry.
334: I'm really, really dubious that it will be a net increase in coverage. Now, it sounds like a bunch of Medicaid people are likely to be kicked off the rolls in some states. And there are going to be millions and millions of lower-middle class people who had decent health care who are cast down into "Bronze" level penury. This recent illness of mine was nominally a $50,000+ affair. I had to pay for a bit over $1,000 of that out-of-pocket. From what I can see, if my current health coverage disappears, which it very likely will under the new regime, I'd probably be paying closer to $20,000 for that event. I don't have $20,000 to spend on getting sick right now. So, great, somebody a bit poorer than me gets shitty health care now, and to do that, my health care is made equally shitty. How is that a benefit? Mark my words, the ultimate upshot of all of this is that upper class and upper middle class people will receive basically the same standard of care they do now, and everybody else who has some care now -- including Medicare-covered people -- will see the overall quality of their care decline precipitously, with predictable effects on their health.
Anecdotally, malpractice stuff is the chief criticism I've heard doctors make of the current system.
Anecdotally, "too much regulation" is the chief criticism I've heard capitalists make of the current system. Therefore I propose that we drastically reduce regulation, because clearly people speaking in their own self-interest are the ones you want to go to for sound policy prescriptions.
If I understand this correctly, an OB-GYN can be sued anytime before a child's 18th birthday for alleged malpractice in delivering that child as an infant. How does that benefit anyone?
I have no idea whether that's correct or not, but if so, presumably it benefits those who were injured by the malpractice?
So: yay to these regulations on the insurance industry, but we'd better enjoy it, because it's not going to get any better a long time.
Given the current court, I'm happy to take an essentially favorable ruling which includes language pointing in an unfavorable direction.
As long as there's no serious precedent being set I think the best we can hope for is that a future court will push back in the other direction. There wasn't any way that the current court was going to write an opinion which said, "yup, we love the law and everything about it." They were always going to put in rhetorical objections.
right-wing smokescreen about malpractice reform being an at all significant component of fixing health care.
The right-wing isn't wrong that the current malpractice system is shit. They are wrong about why it is shit. They think its bad because it makes doctors pay malpractice premiums. The actual reason its bad is that vast numbers of malpractice victims don't see any compensation.
it would put in place a New Deal style program
If only. What it puts in place is a subsidy system to prop up a slowly dying industry selling a badly flawed product, in exchange for some weak regulations of that industry.
I'm really, really dubious that it will be a net increase in coverage.
We disagree here.
As long as there's no serious precedent being set I think the best we can hope for is that a future court will push back in the other direction Obama is reelected and Scalia and/or Kennedy die soon.
The whole thing is looking increasingly to be nakedly political on several fronts (d'oh! I guess you could say). This was negotiated (d'oh! again) in a very calculated way. IANAL, but the "shading" of the Roberts' opinion on both the taxing and Medicaid issues are mere whiskers; the facts and arguments as marshalled in them hardly compel one conclusion over the other.
The spending clause argument seems transparently silly to me (although I havn't read the opinion) which is why it seems odd that it was 7-2. If the bill had been exactly the same but had said we're abolishing medicare and establishing smesicare (which has all the qualities of medicare plus the PPACA) then they could of witheld the entire funding, congress says it's all one program, why is the supreme court even qualified to say it's really two.
Anywho, and since it wasn't on this blog you have no reason to believe me, but this was basically what I predicted, mandate stays (because I'm with Natilo that I basically it's scam to dick people), while the medicaid expansion gets fucked up, because it was the one undeniably good part of the bill.
310: It only starts with broccoli... (from the dissent):
I understand, if disagree with, the slippery slope argument, but the broccoli thing isn't usually presented that way. It's presented as the horrible thing at the bottom of the slope, not the start of it. But, to me anyway, it just doesn't seem in any way horrible, given what the government is clearly allowed to do. I doubt Scalia would say the government can't compel me to kill a human being, through reinstating the draft. Indeed, I'm not even a US resident but I was compelled by law, as soon as I became an adult, to make it easier for the government to make me kill other human beings. That's considerably worse than making me buy broccoli, no?
"the entire nonelderly population with income below 133 percent of the poverty level. It is no longer a program to care for the neediest among us"
People making less that $15000 a year are not the neediest among us? Ok then...
"I'm really, really dubious that it will be a net increase in coverage. "
The Congressional budget office vs. the Natilo research service, who to trust?
You're obviously not aware of what broccoli does to the digestive systems of people of Italian heritage.
346: Forget 'compel', nuttin' compels nuttin'. "...hardly support one conclusion over the other".
No big "conspiracy" but:
ACA survives on narrow argument on taxing.
Roberts is a "moderate".
Fairly robust rejection of Commerce Clause argument.
Narrow but critical (given current state of politics) rejection of the Medicaid part.
Judges scores?
(Oh, and Kennedy lets his inner freak flag fly.)
348: I'm with you...the whole broccoli thing is blog-level rhetoric at best. Future archeologists will be greatly amused/horrified.
As long as there's no serious precedent being set
But there is. The ruling draws a line under expansive interpretations of the Commerce Clause like Raich and Filburn and gives courts grounds for striking down a wide range of regulations or other federal interventions. Now whether that's a good or bad thing politically will depend on the particular cases that come up and the make-up of the court at the time, but I think it's going to have a big effect regardless.
339: I don't understand many of these statements. I think I need some education.
it sounds like a bunch of Medicaid people are likely to be kicked off the rolls in some states.
How so? Have the income/qualification guidelines for Medicaid eligibility been defined up?
there are going to be millions and millions of lower-middle class people who had decent health care who are cast down into "Bronze" level penury.
if my current health coverage disappears, which it very likely will under the new regime
Because employer-provided health insurance plans will be ditched? Is that true?
349.1: But, gosh, 133 percent! That's a lot of percents!
It's presented as the horrible thing at the bottom of the slope, not the start of it. But, to me anyway, it just doesn't seem in any way horrible, given what the government is clearly allowed to do.
Not only that, but it's not about what "the government" is allowed to do, it's about what the federal government is allowed to do. "Sure, $State may be able to make me buy broccoli but goddamn no way are those jackbooted federal bureaucrats in D.C. going to make me eat my vegetables" is a very strange principle to get so worked up about.
But there is.
I think that's a matter of debate (and I don't pretend to know the answer:
Now what about for future laws? Some observers think that this new distinction between activity and inactivity could prove quite significant. "The rejection of the Commerce Clause," wrote SCOTUSblog's Lyle Denniston, "should be understood as a major blow to Congress's authority to pass social welfare laws."
Other legal scholars, however, aren't so sure that this curtails Congress' power. Douglas Laycock, a constitutional law professor at the University of Virginia, says it was unexpected that the Supreme Court made a distinction between activity and inactivity. But, he says, it's hard to think of a situation where this will matter much.
Congress, after all, has never needed to write a law regulating inactivity before. And that's because health care is a special case, a market in which not buying health insurance has adverse impacts on everyone else. "Congress has never done this for any other industry because it hasn't needed to," says Laycock. "[The ruling is] a huge win for Randy Barnett, but it's practical impact is likely to be limited."
The brocolli thing reminds me of the famous quote: "Americans did not fight
and win the wars of the 20th century to make the world safe for
green vegetables"
Ginger Yellow's belief that it is worse to be forced to kill people than to be forced to eat brocolli is fundamentally unamerican.
The activity/inactivity distinction seems extremely stupid but also extremely easy to legislate around. And it's not precedent, or even strictly speaking reasoning adopted by a majority of the Court, so the activity/inactivity distinction doesn't bind lower courts. But if this whole experience hasn't convinced you that reelecting Obama for the sake of appointing a "liberal"* SCOTUS majority is a completely sufficient reason to enthusiastically support his reelection, I don't know what would.
*Not really. But a crazy right wing Supreme Court is incredibly scary.
I believe that it is currently an article of faith among American conservatives that eating broccoli makes you gay.
The ruling draws a line under expansive interpretations of the Commerce Clause like Raich and Filburn and gives courts grounds for striking down a wide range of regulations or other federal interventions.
But that's been true since at least Lopez. My guess is that the activity/inactivity thing (which, again, is not precedent) will go the way of the language in Printz about "comandeering," which seemed like a scary restriction on federal power but in fact has not mattered much at all.
Unless, of course, you have a five vote majority for Lochner Era II, which is a very real possibility with a President Romney.
I dearly wish that they had chosen cauliflower as the example vegetable so that I could amuse myself by quoting Brecht's Arturo Ui.
339: Yeah, I suspected the decision would have some kind of bullshit snuck into it. Instead of striking the law down outright -- which would've put a millstone around Romney's neck for November -- they've essentially turned a key part of the legislation into a "states' rights" issue.
Damn. Love all y'all, but y'all's political system is some kinda fucked up.
You know the theory being linked around about how it was originally a vote to strike it down, and then Roberts changed his mind? I think that's why Kennedy dissented - he thought (for a while, at least) that he was going with the majority.
358, 360: Even spelling it correctly make give you gay cuties.
[I]f this whole experience hasn't convinced you that reelecting Obama for the sake of appointing a "liberal"* SCOTUS majority is a completely sufficient reason to enthusiastically support his reelection, I don't know what would.
Yes, very much.
I dearly wish that they had chosen cauliflower as the example vegetable
True, but there has to be some Jame Bond joke that can be made based on broccoli.
which would've put a millstone around Romney's neck for November
Who really know? I'm sure Obama didn't want it struck down. He needs to have some accomplishment to run on.
359: My characterization of "nakedly political" was not limited to just the Republican side--the Pyrrhic victories could go either way when all is said and done. The election results will be extremely important in determining which is more likely.
336/342: It's quite true that it needs reform*, but you should know that generous estimates of the impact on the health system of wholesale malpractice is that it could reduce costs by up to 1%. Doctors appear to be the closest to the problem and to have an outsized idea of its impact.
* Not in the Republican manner of denying all recourse, but preferably with something approaching a no-fault compensation system that helps everyone harmed, not just those who are prepared psychologically and financially to sue.
which would've put a millstone around Romney's neck for November
Who really know? I'm sure Obama didn't want it struck down. He needs to have some accomplishment to run on.
This is something that seems odd to me in these discussions: if ACA were struck down that would be bad for Obama, and if it's upheld that's.......bad for Obama.
It had to be a green vegetable because of the quote in 358. It had to be broccoli because George H. W. Bush famously hated broccoli and refused to eat it.
Now, it sounds like a bunch of Medicaid people are likely to be kicked off the rolls in some states.
Link? With expansion no longer tied to overall funding, there's even less likelihood of existing Medicaid enrollees getting kicked off. Compared to without this decision, sure, lots of low-income people will be worse off.
Something from Roberts:
Indeed, the Constitution did not initially include a Bill of Rights at least partly because the Framers felt the enumeration of powers sufficed to restrain the Government. As Alexander Hamilton put it, "the Constitution is itself, in every rational sense, and to every useful purpose, A BILL OF RIGHTS." ...And when the Bill of Rights was ratified, it made express what the enumeration of powers necessarily implied: "The powers not delegated to the United States by the Constitution . . . are reserved to the States respectively, or to the people."
Wasn't this argument by Hamilton bullshit even at the time? Even with the Bill of Rights, it didn't take long for the federal government to justify restrictions on freedom of speech via the military power.
Link?
Here's Sarah Kliff
The Affordable Care Act provides financial incentives to entice states into the expansion. The federal government will, for the first three years, cover the entire cost of all these new patients. Usually states have to chip in for some of the cost.
The match, however, starts to decrease in 2017, with the federal government paying 90 percent of the bill. That's still significant, but may not be enough to entice states already struggling under the weight of growing Medicaid bills.
The financial burden would be higher on states that have traditionally had less expansive Medicaid programs. Texas, for example, only covers parents up to 26 percent of the Federal Poverty Line (about $2,900). The state would end up spending an estimated $2.6 billion on the coverage expansion between 2014 and 2019.
...
It's hard to know how many people would fall into that area, largely because -- as Salo puts it -- "this was a total surprise. We weren't studying it because it didn't matter prior to today." Going forward, however, this part of the Supreme Court decision could have a big impact on the Affordable Care Act's future.
Wasn't this argument by Hamilton bullshit even at the time? Even with the Bill of Rights, it didn't take long for the federal government to justify restrictions on freedom of speech via the military power.
Is an argument I've made in the past, but only in jest. Truly, a constitution in a divided government is the ultimate in "do as I say, not as I do"
Texas, for example, only covers parents up to 26 percent of the Federal Poverty Line (about $2,900).
Jesus.
378: I'm sure Jesus is only part of the story.
Thanks for the link in 363. I'd heard various references to these ramifications. While one doesn't like Medicaid-negative states opting out even further from supporting the neediest of their citizens, many of the same states have been trying their best to drive out undocumented persons as well. It's a grim state of affairs. People should leave those states if they can.
368, 372: Oh, it's not bad for Obama that it was sort-of-upheld. But it's not exactly bad for Romney that it was sort-of-upheld in such a specific way as to give him a "states' right" ball to defend against the threat of "federalist" Obamacare (because if the White House doesn't want to see PPACA effectively gutted through the back door, it will have to oppose this angle and pledge to overcome it).
OT:
The mess I've been dealing with for the last few weeks, which has (at my client's behest) required me to act as a figurehead for private counsel while they treated me as an idiot preschooler who they were unfortunately required by statute to stick out front, is now over. God, I hate trying to work with BigLaw. As individuals, many of them are lovely. Trying to cooperate with a BigLaw team when they really don't want your input, they just want you to shut up, sign the briefs they write, and read your lines, is humiliatingly unpleasant, particularly when your client wants you to defer to them so there's no appropriate way to push back.
I'm very very glad that's over.
26% of the poverty line? WTF is wrong with... oh, right, Texas.
All this argument about whether this is precedent for yada yada is so much hot air. If there are five justices who want a certain outcome they'll get that outcome, even if it's directly reversing what they themselves have said before a la Scalia. And maybe the precedent would bind some lower courts but there are enough wingnuts there that if they know they'll be backed up by the big 5 they'll say whatever they want too.
The correct joke is, "This is excellent news for John McCain!"
382- If you were an idiot preschooler in an Amazon tribe they would have given you much more responsibility.
381: it's not exactly bad for Romney that it was sort-of-upheld in such a specific way as to give him a "states' right" ball to defend against the threat of "federalist" Obamacare
Technically, "federalist" means states' rights; the word you want is "socialist".
It's doubtful that Republicans will parse any of this very carefully, but the 'it's okay as long as it's a tax' thing doesn't really work in their favor. On one reading, the SCOTUS said that yeah, the federal government can impose a tax on all citizens, which they are, by the way, exempt from if they've bought health insurance. It's a tax increase, and it's constitutional!
384: The most important thing to remember about the Amazon is that there is a fish that can swim up your penis. The quality of their law schools is secondary.
A total federal takeover of Medicaid might be a nice next step for single-payer advocates to push for. Is there really any reason to involve the states in it, other than to complicate things?
389: Nice act you got there, what do you call yourselves?
The Framers.
387: You'll never make it as a Republican speechwriter, I tell you. Broccoli horrible.
I've given myself a giggle fit. A little late, but "broccoli horrible" is so awesome.
The only way she could have made it better would be if it was le brocoli horrible.
It's doubtful that Republicans will parse any of this very carefully, but the 'it's okay as long as it's a tax' thing doesn't really work in their favor.... It's a tax increase, and it's constitutional!
Yeah, can't imagine any way the Republicans could spin an Obama "tax increase" in their favor.
Create the social conditions whereby the outcome you want is a foregone conclusion
Oh, is that all?
Seriously, I'm with you on changing the social conditions, but I'm not willing to put off any reform while we wait for capitalism to collapse under the weight of its own contradictions. People are right now losing their insurance because they once had a hangnail and they're going bankrupt over medical bills. You're in favor of one kind of incrementalism -- single laws on specific issues -- and those of us who reluctantly support the ACA favor another kind.
As general anecdata, I report that a self-employed friend who is HIV+ gets his insurance through a state exchange and says it's quite affordable and good quality.
Maybe now that Obama's stupid tax pledge is kaput, he could break it for real.
Natilo, I'm beginning to think you just like wallowing in pessimism.
Ah, the new meme is, "Boy, Obama sure was dumb to oppose confirming Roberts in 2005!"
394: Yeah, for instance see the lead story up at TPM right now.
"To our Democratic colleagues, stand by your tax increase or stand with us to Repeal and Replace Obamacare," said Sen. Lindsey Graham (R-SC) in an emailed statement. "During the entire congressional debate over Obamacare, Democrats vehemently denied this was a tax on the American people. The Obama Administration also denied it was a tax. However, when the case went to Court, they argued, for constitutional purposes, it was a tax."
Thinking about all this on the way to work, it struck me that part of our disagreement is a confusion about what the term "health care coverage" actually denotes. If "health care coverage" means that I pay money to an insurance company, which sends me a little laminated paper card (or two!) then yes, this legislation does indeed provide many people with health care coverage. If, however, we use a definition of "health care coverage" that has a connotation along the lines of "for a non-impoverishing amount of money, individuals will be able to access the medical services and products they need, and will thus remain as healthy as possible given various other requirements" then no, this is not health care coverage.
We're going to see rapidly increasing premiums, copays and deductibles; increasingly Byzantine customer service apparatuses; vastly greater numbers of denials for coverage of specific tests and procedures; many redefinitions of various terminologies (all to the benefit of the insurance companies); and ultimately a concerted effort to roll back the few provisions of this law that pro-ACA people have advanced. This isn't based on research from the Congressional Budget Office, it's based on hundreds of years of experience of how corporations work to maximize profits.
398: How about Roberts is paying back Obama for covering for his snafu with the oath of office?
and ultimately a concerted effort to roll back the few provisions of this law that pro-ACA people have advanced
What makes you think we wouldn't have seen a concerted effort to roll back the laws you think should have been pursued instead?
400: But that argument is completely invariant to the ACA or the court case. If companies have total power, and can make the government do what they want, then they had that power before the ACA, and they have that power whether or not the Supreme Court strikes down the ACA.
Here's what's going to happen: Millions of people who now have fairly decent health insurance are going to get booted off their company plans, because it will be much cheaper for the companies. If they are upper-middle class or wealthy, then obviously this is no problem, because they'll get to buy insurance at the platinum level and have decent coverage. If they are middle-class and below, they'll be forced to buy expensive insurance with high copays, high deductibles and very, very limited approvals for necessary treatments.
I think one of the other things that's going on here is that I happen to know a lot more of the sort of people who are going to be really screwed by this. A large plurality of my friends and acquaintances are educated, raised-middle-class-but-now-slipped-several-rungs workers in non-profits, the service industry and similar low-paying jobs. Many of them don't have health insurance, they barely scrape by, and they're going to be forced into the worst of all possible worlds: buying "coverage" that does not actually keep them healthy. Imagine you're a 32 year-old employee of a small non-profit. You make around $25K/yr, have $15,000 in student loan debt, $5K in credit card debt, pay $500-900/month in rent and utilities and have all other normal expenses. You're not going to qualify for any assistance, so you'll either buy the shitty insurance or pay the penalty tax.
402: There probably would be, but there wouldn't be a gigantic wealth transfer from working people to insurance companies to pay for it.
403: Obviously the insurance companies don't have "total power", but they have a lot of power and the ACA gives them far more.
Also, everyone is going to have to work as greeters at Wal*Mart until they are 90.
400.2: Well, I saw where you were coming from with the states' rights on Medicare stuff, but now you're losing me. It's not clear to me why all these existing behaviours would suddenly increase in the presence of legislation that very explicitly prohibits them. With what effectiveness the legislation will be enforced is an open question -- a very open one in a country as endemically corrupt as the States has evidently become -- but that's different from assuming that the presence of PPACA will somehow accelerate all these evils.
(It's worth pointing out that the role Obamacare envisages for insurers is essentially comparable to the Swiss health-care model, which does not AFAIK manifest the set of ills you claim it ought to develop. OTOH the Swiss have an effective regulatory framework in place.)
404: Here's a calculator from the Kaiser Foundation indicating that the person you describe gets a pretty sizable subsidy.
408: And the trains run on time there.
400: Very few people today have union-level health coverage, so that's not a good basis for comparison. Insurance as imposed by the ACA will be better than most existing policies, because the law explicitly and uniformly regulates total copays, benefits covered, etc.
Except premiums: yes, control of that is more or less taken on faith, plus a reliance on state review processes, MLRs, and other cost containment work. But if premiums rise too much compared to income the individual mandate automatically becomes inactive, and we're back where we started - it's not designed to enslave people to ever-rising premiums. Also the Cadillac tax might kick in at a certain point.
As to whether the insurers lobby to roll back these protections, by legislation or regulation, we'll have to see. But it still looks like a step forward to me.
Also, what about all the people who today can't get insurance at any price?
All thanks to the secret Romanche speaking Neanderthal slave-race that they keep working in the secret alpine fortresses.
410: And they speak like a bunch of languages and are super-sophisticated.
412: Topless Neanderthal slave-race.
Also 411 is so obviously right and Natlio's argument so obviously wrong and I am so sick of this stupid argument, especially today, which should be henceforth known as "national we dodged a bullet day," that if I hear it in real life as opposed to on the internet (which, to be sure, I never do) I will punch whoever makes it in the face. Radical centrism!
The premiums are illustrative examples in 2014 dollars derived from estimates of average premiums for 2016 from the Congressional Budget Office. For a 40 year old single adult, the premium for a silver plan is assumed to be $4,500 for a plan with a 70% actuarial value. To the extent that actual expected enrollment in 2014 differs from what CBO assumed for 2016 -- e.g., it has a different composition of people by health status or age -- then premiums could vary from this amount.
Premium subsidies are based on a silver plan (with an actuarial value of 70%), so all premiums shown are for silver coverage. People may be able to pay a lower premium for less comprehensive coverage (i.e., a bronze plan, with an actuarial value of 60%). The tables showing results by age and income also reflect premiums for silver coverage, though the minimum insurance that people would be required to obtain would be bronze coverage.
412, 415: "Fuck, eat, or put in charge of the trains."
"national we dodged a bullet day,"
A.K.A. National Remo Williams Day.
So, basically, a lot of this is all estimated and hoped-for numbers. And none of this addresses my points about how hard it is, even now, when there's much less incentive for them, to get insurance companies to pay for needed care without spending a huge amount of time going back and forth with their evil customer service people.
You know, when I was at the stock brokerage, the insurance company we used had one of those programs where they colluded with my employer to circumvent many of the HIPAA protections by tricking people into signing away their privacy rights. For a one-time payment of $50. It was overwhelmingly effective. You think, now that they have all the reason in the world to do as much of that kind of thing as they can think of, they're suddenly, magically, out of the blue, based on their overarching altruism, going to decide to start being good guys and not trying to screw people over?
420: The legislation also prohibits the frivolous denial of care that was the pre-PPACA norm, yes?
(Another element Obamacare has in common with the functional topless-Neanderthal system of the Alpine realms.)
Basically, again, why are you rattling on about how the act is going to make worse all these HMO behaviours that it specifically prohibits, such that it would be better to have no legislation? You are not making any sense.
The paragraph quoted in 335 is one of the dumbest things I've ever seen.
I second 423. Also, more than half of current individual insurance plans are less than bronze value.
424: I guarantee you'll see in dumber in the next 48 hours, as the wingnuts register their vocal disapproval.
Natilo, why don't you just say "Everyone who runs the country is our enemy, therefore everything they do is designed to make us worse off", instead of all these granular debatable minutiae.
423: Basically, again, this changes the playing field dramatically. There is a huge transfer of wealth and power to the insurance companies. I am very, very, very dubious, based on how everything else in US society & law works, that we suddenly get free ponies every week, because the law says so. Large companies violate the law ALL THE TIME. Making them larger pretty much ensures that they will be able to violate it more often and with fewer negative consequences.
Expanding the reach of the state AND capital does not have a very good track record as far as human happiness goes. This law does both.
These counter arguments all smack of "you don't need a union coming between you and your employer and screwing things up!" How many lawyers do the insurance companies have? How many do you, personally, have?
427: Well, yeah, pretty much.
Whatever's wrong, it's probably the government's fault.
Hey, I quit with any negativity and told the peasants to festive it all-to-hell way back around 6 hours and 200+ comments ago.
But do I get any credit for good behavior? Noooo.
Always the anarchists are the furry friends, and the Trots all fall guys and scapegoats. Ok, used to it. Painting outlines on the imaginary wall.
I applaud your good behavior, Bob, and will celebrate it by spending the next 90 seconds thinking about what a good movie When a Woman Ascends the Stairs is.
Basically, again, this changes the playing field dramatically. There is a huge transfer of wealth and power to the insurance companies
Ummmm*, no. The insurance companies were basically legally empowered, as was the case pre-PPACA, to screw you over without consequences. Having laws in place that specifically prohibit them from doing so, restrict what they can charge for coverage, and requiring them by law to provide coverage regardless of pre-existing conditions is not a "huge transfer of wealth and power" to them. To be suspicious of how well the law will be implemented is one thing, but kindly do not portray it as the exact opposite of what it is.
(*Sorry man, but the "Ummmm" was called for. I may yet have to bump it up to five Ms if you keep this up.)
I'm not saying anything about unions or about whether I think Obamacare is an ideal system (in a less lunatic country, a straight-up public healthcare system would still be the better option). But you can't get so addicted to critiquing Obama from the left that you become willing to throw facts out the window.
428: But that's true now. If you have insurance, they're as free to screw you as the law allows. The only people who are plausibly worse off are the people who didn't buy insurance before, and relied on emergency room care.
I'm skeptical that companies will get rid of health insurance if the individual insurance is so much worse. Why do companies offer insurance now? Because of altruism? They do it because it's in their own interest. Under your argument, individual insurance will be even worse than it is now, which means that the self-interested benefit companies get for providing insurance will become larger.
The core regulatory limitations on insurance companies, such as coverage for pre-existing conditions, will become untouchable if they survive to come into force. That's why Boehner was flirting with the idea of introducing them separately if the ACA was struck down.
Further to what Walt says 433, PPACA, incidentally, specifically penalizes large companies that don't offer health care to their employees, and provides a tax credit to small businesses that do. So it's not just about hoping for the wonders of the invisible hand to make companies see the light.
One of the things I wonder about is how much MA will have to rejigger things to be in compliance.
Excellent piece by Richard Posner on the decision.
Second half worth quoting in full:
"The health industry is of course an interstate business; there is a continuous flow of health insurance payments, health insurance reimbursements, drugs, doctors, patients, donations to hospitals, research money, etc. across state boundaries. Congress' regulatory power under the Commerce Clause is not limited to direct control of an interstate transaction; it includes the regulation of activities that affect an interstate industry, with "activities" including inactivity. The public accommodations provisions of the Civil Right Act of 1964 were upheld on the basis of the commerce power, even though the provisions required hotels and other places of public accommodation to do something--namely serve black travelers--that they didn't want to do, to force them, in short, to engage in interstate commerce they didn't want to engage in. And so it is with requiring drivers to be licensed--they would prefer not to have to pay a license fee. Of course they can avoid the fee just by not driving, but tell Americans not to drive and you might as well tell them cut off their feet in order to escape sales tax on shoes.
The young people who refuse to buy health insurance because they don't expect to get sick and if they do go to emergency rooms--and are billed, but just try collecting!--are free riders, like draft dodgers. They increase health costs for the rest of us.
The chief justice, echoing Justice Scalia's "broccoli" comment at the oral argument, rejected (as did the four dissenters, and so that is now the view of a majority of the justices) the Commerce Clause ground for the mandate, saying that to accept that ground would mean that "Congress could address the diet problem by ordering everyone to buy vegetables." This argument, reassuring though it is to our obese population, confuses separate constitutional provisions. The Commerce Clause would empower Congress to order everyone to buy vegetables, because the market for most vegetables is interstate, but the "liberty" protected against the federal government by the Fifth Amendment would doubtless be interpreted to forbid such an imposition, just as it would be interpreted to forbid a federal law requiring everyone to be in bed with the lights out by 10 p.m. in order to economize on the use of electricity and, by doing so, reduce carbon emissions from electrical generating plants.
I am surprised, finally, by the lifelessness of the joint dissenting opinion."
...the whole broccoli thing is blog-level rhetoric at best.
As I understand it, the whole activity/inactivity thing and the broccoli example did come from a blog. Right-wing foundations then funded its development into a legal case.
A large plurality of my friends and acquaintances are educated, raised-middle-class-but-now-slipped-several-rungs workers in non-profits, the service industry and similar low-paying jobs.
A large plurality of my friends (also, me) have previously been individually uninsurable, for any amount of money. And now we won't be.
I've refrained from correcting all of Natilo's misapprehensions in the thread, because I have real work to do, and believe it or not, today is a busy day for old Mr. Roosevelt. But this one I can't let pass unremarked:
Imagine you're a 32 year-old employee of a small non-profit. You make around $25K/yr, have $15,000 in student loan debt, $5K in credit card debt, pay $500-900/month in rent and utilities and have all other normal expenses. You're not going to qualify for any assistance, so you'll either buy the shitty insurance or pay the penalty tax.
This is just wrong, wrong, wrong. A 32 year old single person in Natilo's jurisdiction will pay a maximum of $143/month health insurance premium after subsidy. Even if he has HIV or cancer! And his annual out-of-pocket expense cannot exceed $3,125. In what world is that person not better off than today?
And now I see that LB and others got there first. As you were.
Here is an answer to a question I was wondering about -- as a practical matter in this particular case, how big a deal is the spending clause ruling. It sounds like "not very, but there's a possibility that some totally wingnutty states will decide completely irrationally to screw over some of their poorest citizens for absolutely no reason even though it costs them."
In a 7-to-2 decision, with Justices Elena Kagan and Stephen G. Breyer joining the five conservatives, the court ruled that the new provisions of the act giving coverage to all Americans under 133 percent of the poverty level constituted not an expansion of the program but actually a new Medicaid program. Threatening states that did not adopt this provision with termination of all their matching federal Medicaid money, the court said, constituted "a shift in kind, not merely degree." The court viewed this Medicaid provision as coercion -- "withholding of 'existing Medicaid funds' is 'a gun to the head' " -- that would force states to acquiesce.
How are states likely to respond? For ideological reasons some states, like Texas or Florida, may decide not to expand their Medicaid programs. But for most states, the Medicaid expansion contained in the act is simply too good a deal to pass up.
Under the act, the federal government will be extremely generous in helping states pay for Medicaid expansion. Between 2014 and 2016 the federal government will pay 100 percent of the Medicaid expansion; in 2017 the federal government will cover 95 percent of the expansion of Medicaid. That will slowly decline to 90 percent by 2020 and remain there. Over all, many states may actually save money by expanding Medicaid. How?
According to a September 2009 report by the Council of Economic Advisers, states currently pay for the uninsured in two ways. First, there is the hidden cost shift. Insurance premiums are higher for state workers (and for others whose employers cover them) because of the uninsured. Second, many states pay for uncompensated care at hospitals and clinics. While states may have to pay 10 percent of the Medicaid expansion in 2020, they will save money from eliminating the cost shift and the uncompensated care.
The Council report estimated that California would pay about $195 million for expanding Medicaid when the federal government paid 90 percent in 2020, but it would save more than $210 million in reduced state employee premiums and more than $2 billion in uncompensated care for a net savings of more than $2 billion. Similarly, Wyoming would save about $1 million, and Montana would save about $9 million. Thus, if they acted rationally, most states should go along with the Medicaid expansion.
If states don't go along with it, there will be some Americans who make less than 100 percent of the federal poverty line ($11,170 for individuals and $23,050 for families of four in 2012) who will not be eligible for subsidies to buy insurance in the exchanges and yet will not be eligible for Medicaid. Exactly how many Americans might be denied access will depend on how many states refuse to expand Medicaid for ideological reasons and how many uninsured residents they have. In 2019, it is forecast that Texas could have more than 2 million people who would go into an expanded Medicaid, bringing the total number of people in the state on Medicaid to 6 million. Thus, if Texas refuses to expand Medicaid, some of those 2 million people will lack health insurance.
Over all, this is a great day for the American health care system. Millions of Americans will have access to affordable care. And it removes significant uncertainty about how the health care system will evolve, allowing everyone -- physicians, hospitals, insurers, governments, and others -- to focus on improving our health care system.
439: Thanks. I was just about to comment that I hoped our little green friend would stop by and share a bit.
I'm skeptical that companies will get rid of health insurance if the individual insurance is so much worse. Why do companies offer insurance now? Because of altruism? They do it because it's in their own interest.
Let's not go overboard there. The prestigious high-paying companies offer good health insurance (usually self-insured and barely affected by the ACA) because it's an expected perk among the class of employees they get. Smaller companies' participation is more marginal - most of them who care less have already abandoned health insurance due to rising costs, I think, but there are still some that could conceivably drop coverage due to the perception of adequate coverage on the exchange.
Also, it seems the small-business subsidies aren't being much taken advantage of.
WAWATS is medium Naruse, overrated. Takamine was tired after 30 years of acting, and the failure of her husband, although her exhaustion might actually work for the movie. She got a second wind, I like Midareru 1964 better. It is also more in Naruse's comfortable range: daylight, family, and suburbs rather than the Ginza night lights.
(Woman Ascends does have the supporting cast. God. Reiko Dan, Tatsuya Nakadai, Masayuki Mori, Daisuke Kato, Ganjiro Nakamura, Eitaro Ozawa. Keiko Awaji. Wow.)
Best Naruse is mid-50s, 2nd best early to mid 30s. But his last is a masterpiece.
the role Obamacare envisages for insurers is essentially comparable to the Swiss health-care model,
Crucially, when polled on the question "so, how do you like the health care coverage model in your country?", the Swiss rank second to the bottom, after the United States.
445: However, in terms of actual performance, Switzerland's system is ranked by the WHO as rounding out the top twenty, ten spots up from Canada and seventeen spots up from the US. (Obviously the system everyone should really be looking at is France's. But it's hard to make the case that the Swiss model is a failure.)
WHO statistics shamefully exclude the Romanche speaking Neanderthal slaves. Because the WHO has offices in Switzerland, of course.
Perhaps the Neanderthal slaves are being compelled to compile the statistics and are subtly skewing them as an act of resistance.
A Queens College law professor named Michael Krasner was just on NY1 saying Roberts' vote shows that the SC is a political institution with its own prestige (he kept saying this word) at heart. I'm not sure I get this since they're up there for life and kind of immune to everything. I can't think he's talking about plain old public opinion. Now I will read 300 comments and see if anyone addresses this.
Prestige does come up in the piece linked in 436.
Natilo's freakout is upsetting me slightly. Nat, I hope you saw 439 and the previous 409: there will be subsidies available for someone making $25k/year.
Further to 451: If (per 439) $143/month premium payment is too much, there's the $695/year tax payment, which is like half off in exchange for no health insurance.
A Queens College law professor named Michael Krasner was just on NY1 saying Roberts' vote shows that the SC is a political institution with its own prestige (he kept saying this word) at heart.
I think it's possible that Roberts was genuinely concerned about taking political hackery too far. As it is, he managed to advance the loony right's commerce clause theory without attracting much attention.
So the court is political in the sense that it recognizes a limit to how political it can get away with being.
If (per 439) $143/month premium payment is too much, there's the $695/year tax payment, which is like half off in exchange for no health insurance.
You mean half off in exchange for the option to purchase health insurance at any point should be become sick and need it. Which, if you're relatively healthy now, isn't a bad deal. Thank you, guaranteed issue.
Which, if you're relatively healthy now, isn't a bad deal. Thank you, guaranteed issue.
Yeah, there will be those who think that way. But risk aversion is a surprisingly strong motivator. Also, if you are 32, the most likely way for you to end up with extremely high medical bills is an accident that gives you no warning that you need to buy coverage. So gaming the system by going without coverage is generally a bad idea, even if it is actuarially a sound bet.
I was actually hoping the penalty/tax would be higher relative to the cost of the insurance. While I agree that risk aversion is a strong motivator, denial is also.
Course, maybe the "OMG, Mandated Socialism" screaming will have people thinking the penalty is higher.
449, 453: Anything's possible, but Roberts has sure as hell demonstrated that he's willing to go to hacktastic lengths to reach outrageous results when he has reason to. And really, if fixing an election in Bush v. Gore was not a fatal blow to the Court's institutional prestige, I don't see why Roberts would have worried too much about the lasting impact of this case. Yes, the entire non-insane legal academy and politically-aware people in general would have been in an uproar (just like after Bush v. Gore) but it would have been business as usual in the not-so-long run.
"the Swiss rank second to the bottom, after the United States"
We're moving on up!
While I agree that risk aversion is a strong motivator, denial is also
According to the re-broadcast of Diane Rehm that I was just listening to, a surprisingly small number of people in Massachusetts have been opting to pay the fine (I think they call it a "fine" there). So apparently being in denial about this issue: not that common.
N.b. I have not read the thread
And really, if fixing an election in Bush v. Gore was not a fatal blow to the Court's institutional prestige, I don't see why Roberts would have worried too much about the lasting impact of this case.
For "prestige" read "short-term social discomfort among people I kinda want to respect me." At least, that's how I'm choosing to interpret it.
I think it's really hard to overestimate how people in rarefied positions have more in common with each other than almost anyone else in society -- even when they are fundamentally at loggerheads. That's how you get a Mary Matalin/James Carville marriage, or heck, even a Schwartzenegger/Maria Kennedy Shriver marriage.
I also think -- and this is partly based on having recently run headlong through a commuter train bellowing DOES ANYONE HAVE MEDICAL EXPERIENCE? A PASSENGER IS HAVING A SEIZURE!* -- that people are really, really, really reluctant to do things that may make them stick out or be perceived as rocking the boat. I mean, the only reason I had to do that was because all of the uniformed personnel on the train were hesitantly standing around and asking one or two nearby passengers, and everybody else was just sitting there. Yes, diffusion of responsibility blah blah, but nobody was even passing the message down to one or two people in front of them.
*There were two nurses on the train and by the time the ambulance came to get her, she was conscious again and talking to her mother.
In short: I suspect John Roberts didn't want to have to deal with the social discomfort of the people his kids go to school with possibly thinking he had failed to be an adult, and instead sided with a group of petulant, dangerous kids with their hands on the kill society button.
So apparently being in denial about this issue: not that common.
While being in decharles? A little more common, but not too common.
Also, if you are 32, the most likely way for you to end up with extremely high medical bills is an accident that gives you no warning that you need to buy coverage.
That's a good point I hadn't thought of. Get cancer as a young-invincible under fully-implemented ACA, you can get community-rated insurance for no extra charge. Get in a car crash and need severe trauma care, you're on the hook.
(ATST, another nice little-known thing the ACA does is prohibit hospitals from charging the uninsured more than they do Medicare/commercial patients.)
I was actually hoping the penalty/tax would be higher relative to the cost of the insurance.
You and the whole insurance industry.
a surprisingly small number of people in Massachusetts have been opting to pay the fine
There were some breathless reports in right-wing media outlets (and even a few mainstream ones who got snookered) about how there were *literally thousands* of people in Massachusetts gaming the system and buying coverage only a few months at a time when they needed it, and how it was costing the system *literally millions* of dollars. No one thought to put it in any kind of perspective. If Obamacare succeeds in reducing adverse selection to that level, it will have succeeded beyond the wildest dreams of its creators.
For "prestige" read "short-term social discomfort among people I kinda want to respect me." At least, that's how I'm choosing to interpret it.
I totally agree that, to the extent there's a concern for prestige it's among an already restricted group. But for the non-insane segment of the people Roberts kinda wants to respect him--and even for the insane segment--this opinion was a miserable prestige failure. The non-insane segment recognizes that his commerce clause discussion is pure gratuitous, ideological hackery. And the insane segment of course is furious at the result.
And of course I can't prove it, but I have reason to believe Roberts has the wherewithal to deal with a little short-term social discomfort when it's called for in the service of his ideology. Surely his non-insane peer group must have been looking at him funny after, e.g., Citizens United.
My only regret about today -- apart from some lingering discomfort about the Medicaid ruling -- is that I was too busy to go and wallow in Schadenfreude by reading the right wing blogs. Anyone see any good examples of wailing and/or gnashing of teeth that I can enjoy?
Surely his non-insane peer group must have been looking at him funny after, e.g., Citizens United.
Now I'm really reading tea leaves, but -- the only people I know who cared at all about Citizens United were serious political junkies (ahem). Whereas virtually my entire office erupted after the ruling today.
This was a huge, high-profile, water-cooler conversation case in a way that campaign finance just wasn't.
That was a reference to JOHN ROBERTS's non-insane peer group.
No, but my Facebook feed has a picture of a tomb labeled "The Constitution." I can't figure how to hide friends on my phone.
469: ? Yes, that's what I understood it to be. Doesn't he have little kids? Probably they go to a fancy private school. Probably the parents of those kids interact with him, even on a very limited level. I really really doubt that most of those parents, even in Washington DC, were attuned to fate and fortune of Citizens United in the same ballgame way they likely were to the ACA.
466 was me, sorry. And I don't mean to be argumentative on this point, which I don't have very strong feelings about. My point, though, is that there's no need for speculation about what motivated Roberts to set aside his ideology, because I don't think he did set aside his ideology.
468: surely the people whose respect Roberts kinda wants are the kinds of people who cared about Citizens United.
472: but that wouldn't cut unequivocally in favor of upholding the mandate. I'm sure a good chunk of his kids' classmates' lower-information parents will view him with contempt for allowing the mandate to stand.
474: Agreed. And as I said, I'm aware I'm reading tea leaves, and I also don't feel super strongly about this. I was just surprised at the number of not-necessarily-liberal people in my office who seemed to see the decision as a win.
461.5 is really remarkable. Yay for Witt!
Haven"t read the opinions or the thread. Did, though, when not wandering around hoping not to meet a griz, spend significant time on two insurance issues: my daughter turned 26 today and aged out of our coverage (so we're buying her a policy) and i have to replace my malpractice coverage, because the carrier is leaving the business of insuring sole practices in my state. For reasons I do not understand, the new carrier is obsessed with the idea, gleaned from my website, that I might represent Native Americans in some sort of case, and will not insure me unless I certify, in writing, that I will not do so. I'm on vacation in a national park: ceetifying even something reasonable is a pain in the ass.
They also worry when a/r exceeds a certain percentage -- I'm just barely under, but would not even be close if another insurance company wasn't screwing a client (and me) on a pretty substantial bill.
God I hate the insurance industry.
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Japanese traditions and sensibilities.
In Golden Slumber 2010, the old fireworks maker says:"Well, you look at the summer fireworks, and think of someone you knew long go or that is far away and realize they are also looking at fireworks." Later, the hero and heroine, separated by ten years, and with little to no direct contact in the movie, help each other out with fireworks.
Someone reviews Yamakazura 2008 at IMDB
Unremarkable jidaigekiA typical samurai story, an unhappy heroine in love with a hero who broke the law to protect the people.
This movie focused a lot on the main characters with very little happening in the film
Well, yeah, standard Shuhei Fujiwara. All the same, huh?
Yamazakura is the mountain cherry blossom, and the flowering tree is all over the movie. Not to get into all the meanings of cherry blossoms, but people go out in spring and watch the blooms in drinking parties. Just like the August fireworks.
Again, we have a couple, separated by years and having very little direct contact with each other, acting on each other from a distance. Director repeatedly cuts to each looking at cherry blossoms, sharing a feeling, thinking of each other, and making a decision or coming to terms with fate.
They are connected, only indirectly by their contacts with a third family of moneylenders, very highly connected to the daimyo. This moneylender loans money to farmers to improve their lands, and then increases taxes until the pesants starve and he can foreclose. This is to the great profit of himself, but also of the han, clan, and daimyo in the improved land.
The Cherry Blossom is of course a sign of bushido, the samurai, the warrior. It was the number one symbol during the 15-year war, not a symbol of fighting, but a symbol of dying. Duty, honor, love, sacrifice.
What is to be done about the moneylender? Our hero pulls his sword on castle grounds, slashes the bad guy's throat very publicly, and turns himself in. He is a hero to the peasants. The good leaders refuse to sentence him until the daimyo returns from Edo in six months, therefore forcing everyone to think about why he did it. This embarrasses the administration to the point that they change their tax policies. Hero of course loses his head. Heroine, through his example and sincerity, finds her own sacrifice and path to happiness.
It is not really that far from the plot of Golden Slumber, which is a contemporary movie.
You know, there are people committing suicide over foreclosure every day, and nobody gives a fuck. I'm think of Cherry Blossoms, and Berkman.
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Shuhei Fujisawa. I'm always doing that. Fujiwara is of course the ancient noble family of Nara and Heian-kyo.
461 is just another day in the life of a ninja librarian.
Someone wat above preferred Ian Welsh to Stoller. Stoller has a new TV show, supported by some standup, Ryan Brandt, something like that. Just kidding.
This is more similar to TARP than anything else: it is a massive corporate giveaway, opposed by the majority of the population, and passed over their dissent.Watching so-called progressives shilling for forcing people to buy shitty insurance to subsidize health insurance companies has been another example of why I don't call myself a progressive. Yes, a few people's lives will be saved. The cost will be many lives destroyed.
For reasons I do not understand, the new carrier is obsessed with the idea, gleaned from my website, that I might represent Native Americans in some sort of case, and will not insure me unless I certify, in writing, that I will not do so.
How on earth does this not contravene some kind of equality legislation?
460: There may be cultural reasons for that too. There are people who can get out of buying the coverage or paying a fine who get an exemption saying that it's not "affordable" for them. A lot of people who would qualify here still seem to cut back on other basic things in order to get it.
We also had very high employer rates of insurance even before the legislation.
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Mental health bleg. A younger relative of mine has been hospitalised after an acute psychotic episode -- possibly drug induced, although he's at the sort of age where more chronic mental health problems begin to manifest.
The family member he lives with is quite knowledgeable and experienced in the field of mental health, but this has come as a bit of a shock and she's used to dealing with these things as a professional rather than family member, and I wondered if anyone had recommendations for decent books on mental health useful to people living with someone with mental health issues? Or a good general level up-to-date book on psychoses and related disorders? It can be reasonably technical [she's medically trained]. The up-to-date bit is important, as I know thinking on some of these things is quite fluid.
Anonymity just because I think she'd prefer it.
>
Also, if you are 32, the most likely way for you to end up with extremely high medical bills is an accident that gives you no warning that you need to buy coverage. So gaming the system by going without coverage is generally a bad idea, even if it is actuarially a sound bet.
For anyone with significant assets they wouldn't want to lose in bankruptcy, yes, you're right. But those aren't the people (generally) who I would expect to gamble with uninsurance so as to avoid the hardship of paying the premiums.
If you're a healthy young adult with no assets to speak of, or a low-income family for who the premium payments (even with subsidies) would really hurt, you're not very worried about the potential for an emergency accident that leaves you with $200,000 in ER bills. You're not going to pay them. Gambling with uninsurance in that case looks like a very sound bet. (Not that these people have nothing to lose in bankruptcy--it's a painful and disruptive process for anyone--but considering (1) it's only a risk of loss anyway--"maybe nothing bad will happen?", weighted against (2) the certainty of paying a large amount of money out of pocket each money for a shitty insurance policy (which, again, you don't expect to need)... I know what I'd do if I were in that position.)
I realize the evidence from MA is that relatively few people are taking advantage of this rational decision, but I'm not sure I expect that to continue. (Not that I especially care if people choose this route, mind you. More power to them.)
481: It may be an unpopular bill, in which case the Democrats deserve to lose in November. What it's not is unconstitutional.
Surely his non-insane peer group must have been looking at him funny after, e.g., Citizens United.
I don't think so. Citizens United may be a problem as public policy, but as law, it's not a big stretch. Roberts is a right-wing hack, sure, but in that instance, he was a right-wing hack who agreed with the ACLU.
So far, the best I can come up with is that Roberts' opinion is an exercise in having his cake and eating it. He wanted to take the nut-right view on the commerce clause, but didn't want to be ejected from the polite legal circles he comes from. So he rendered the commerce clause fanaticism in a form that didn't do any immediate damage, and didn't really even attract much attention, considering how radical it is.
476: I would have praised 461, too, but I dunno, nobody else was saying anything, and I just kind of felt uncomfortable going out on a limb.
the certainty of paying a large amount of money out of pocket each money for a shitty insurance policy
For the love of God, why do people insist on saying the coverage will be shitty? As Minivet points out above, even the lowest value post-ACA policy* will have a higher actuarial value than half of existing individual policies. The silver / gold / platinum will be substantially higher than any existing individual policy.
Every insurance policy post-ACA** will have minimum benefits substantially better than any individual policy sold today. Preventive care without cost sharing? Check. No exclusions for pregnancy? Check. No annual or lifetime limits? Check. Strict limits on out of pocket spending? Check. If you're comparing it to the premium coverage you might get from a top shelf employer or a good collective barganing agreement, it might represent a step down. But most people don't have that! And they are becoming fewer all the time! For chrissakes, people, this is the most important progressive victory in a generation, and it's time the the public know that.
*excepting the catastrophic plans available only to under 30's and people exempted from the mandate by reason of financial hardship
** excepting grandfathered and self-insured plans
How on earth does this not contravene some kind of equality legislation?
Related question: Absent some overt racist motive, why on earth would they care?
Absent some overt racist motive, why on earth would they care?
Malpractice suit could come under tribal jurisdiction?
485 was basically my thought process when I was out of graduate school and before I got a real job. The period only lasted for a year in my case.
OK. If Ginsburg (1) feels that the commerce clause decision is obiter, and the right-wing 4 disagree with the commerce clause decision, does the commerce clause ruling form part of the ratio? I mean, if this is nonsensical or stupid please say, but I am actually kinda curious here.
487: Citizens United was a huge stretch. The disposition of the actual dispute aside (and really, support from the ACLU in this area is not always great evidence of merits), the decision went far beyond what it needed to do to resolve the case. It was a pure hack move designed to tear a much bigger hole in settled law than necessary, and everyone who was not in the tank and was paying attention knew it. And "the polite legal circles he comes from" are either in the tank or appalled at the intellectual dishonesty of this opinion.
Again, I don't know why we have to postulate what forces made Roberts go against his heart of hearts here. His heart of hearts beats in a glass jar deep in the vaults of the Chamber of Commerce, and they--and the interests they represent--did not oppose the mandate.
Also, 476 and 488 get it exactly right.
493: It's not nonsensical or stupid at all, it's very important, but I think the only answer is whatever the lower courts decide to do with it. There are a number of places where Roberts appears to be sending pretty obvious signals to give cover to the notion that the commerce clause discussion is part of the ratio. (E.g., "Justice Ginsburg questions the necessity of rejecting the Government's commerce power argument, given that S5000A can be upheld under the taxing power.... It is only because the Commerce Clause does not authorize such a command that it is necessary to reach the taxing power question.") I think that's completely bogus but I'm sure plenty of lower courts will disagree. And technicalities aside, the lower courts now know what a majority of the Court thinks about the commerce clause, and flat-out ignoring that seems unlikely.
493 - I'm not sure I'm following you, but the commerce clause discussion is not in any binding sense a holding, and it's reasoning is not binding on any court. With that said, it is clear that 5 justices have adopted that reasoning and found it persuasive, which leaves the issue as a formally open one but where the court has strongly tipped its hand. So the next time a similar issue comes up we can expect tons of citations to Roberts' opinion and explanations as to why it's persuasive. Put more simply, it won't bind a reasonable court but will provide plenty of ammunition for a wingnutty one.
I finally read the (conservative) dissent late last night. Good God. First, it was clearly initially written as a majority opinion. Second, it was a strong move to kneecap progressive federal legislation basically forever and send us back into the nineteenth century. There are five votes on the SCOTUS for this stuff. I am very glad PPACA gets to stay, but good lord is this upcoming presidential election important.
I'll repeat myself from above- does anyone really believe there's such a thing as "binding precedent" any more? They can make any policy decision they want. Justices can either take a transparently phony talking point from a right wing blog to justify what they're doing; or they can just reverse themselves from their beliefs in an earlier case and say, "my bad, that case was about illegal drugs bad and this one is about social welfare bad so I'll do what I want;" or they can just make a political decision in an election and play the "get out of precedent free" card. Even at the circuit level precedent is meaningless, since their only risk of getting reversed is if they contradict the desired outcome of the SCOTUS majority, not what's in some old law book.
On the "why did Roberts switch" question there are many here who know better than I do, but my my impression is that social Washington is now almost as polarized as the politics in Washington -- that is, Republicans hang out mostly with their own and vice versa. In any event, you need go no further than potchkeh's theory to explain the result.
498:Did you think there ever was? Did saying so make it so?
Stop me before I quote Stanley Fish.
Stop bob, don't quote Stanley Fish.
498 is understandable but not actually reflective of reality. Precedent absolutely matters for the lower courts -- note that some very conservative courts upheld PPACA. At the Supreme Court, it also matters -- Rhenquist upheld Miranda, for example. One of the reasons the current court has pushed for wingnutty "rights" in the Firs Amendment area is that it is less meaningfully bound by precedent there because there isn't any such precedent. And there are lots of cases that are less obviously political (or where the politics can cut in the reverse direction from the original ruling) where precedent matters.
Kevin Drum is now suggesting that the Commerce Clause ruling makes Social Security privatization unconstitutional. That's not true at all, right? Even if the justices wouldn't just rule in accordance with their politics, Social Security privatization would be the government taxing you and then putting the money in private accounts; or at least, any proposals from now on would be. Forced savings like in Singapore might be ruled out, I suppose.
If 439 is how things actually shake out, then yes, that part would be an improvement. I guess it's still just incredible to me that y'all are so naive about the degree to which the law as written is expected to match the actual practice of the insurance companies. The insurance companies are the ones (along with Big Pharma) most responsible for screwing up the healthcare system over the past 30 years or so. Now we're giving the EXACT SAME PEOPLE who have acted so maliciously in the past an even greater amount of economic and political power, which they're supposedly going to start using for everyone's benefit. Just out of the goodness of their hearts. And they're never, ever going to challenge anything in court, and they're never, ever going to act in ways that are detrimental to people's health care and in contravention of the law.
This all feels like it's 2003 and I'm arguing with a bunch of people who want to invade Iraq, but of course more in sorrow than in anger. But it will bring democracy! But we have to stop the WMDs! But Saddam oppresses his own people! But it will improve the status of women and homosexuals!
How do we know that?
Because the President says so! Stop being so cynical! All of your objections ignore what the President and Colin Powell have said! We don't live in a perfect world!
Now we're giving the EXACT SAME PEOPLE who have acted so maliciously in the past an even greater amount of economic and political power, which they're supposedly going to start using for everyone's benefit. Just out of the goodness of their hearts.
Not just out of the goodness of their hearts. The law, too.
505.2 is why there's an analogy ban.
By the same token, it might make the Ryan Medicare plan unconstitutional -- unless the GOP wants to impose a "tax" on seniors for not buying private insurance; good luck with that. (The Wyden-Ryan plan could conceivably pass muster because it preserves traditional Medicare as a kind of "public option".)
I'll give Natilo two Yglesias links because it will make his head explode. Most people are actually happy with their health care so insurance companies are, despite screwing up the system over the last 30 years, at least deceiving people into thinking they're happy.
On the other hand, he does seem to agree that Roberts' motivation was to prevent single-payer in the long term.
I suppose knecht is right about the Native thing: they would worry about reditributionist juries in a tirbal court. In which case I would think the more sensible thing would be to exclude claims in tribal court, rather than make me make a somewhat vague promise.
(reposted from the Orientable thread)
Moderately on-topic, my very-culturally-red-state (Western NY would be a red state if it were a state) nephew-in-law (the one married to the niece who just joined the Marines) just put up a Facebook status cheering over the survival of the healthcare law. I knew I liked that boy.
With some luck, the first few Commerce Clause cases to get to the circuits where this sort of thing is tried will configure in a way that makes them unworthy of cert, and be assigned to savvy judges. Which is another reason (were one needed) that Romney must be defeated. As Justice Jackson said in another context, this thing is a loaded gun waiting around for the right person to want to use it: a differently configured court in 2020 can climb down from the tree, calling the Roberts opinion dicta.
Natilo is correct that the insurance industry is getting a big infusion of cash in the form of the 30 million or so people who are now uninsured. And it's true that they're likely going to use that money for lobbying for more tax breaks, less funding for regulators, the repeal or hollowing out of regulations, lining their own coffers, and lighting cigars with burning $100 bills. I agree that a mandate by itself would have been horrible policy. However, I don't see how a mandate combined with a whole bunch of new, good-on-their-own regulations makes things worse overall.
Hospital stocks up, insurance stocks down
Whoops, that's an FT article entitled "Health companies' reactions mixed", which you'll have to google to read.
the insurance industry is getting a big infusion of cash in the form of the 30 million or so people who are now uninsured
... which will just about but not quite make them whole for the imposition of minimum Medical Loss Ratios. Seriously, guys, the private health insurance industry survived health care reform with no mortal wounds (and frankly got a new lease on life as quasi-regulated utilities), but it was hardly a victory. The health insurance lobby fought the bill to the end, even after they got their way* on the public option. Opinions are not uniform within the industry, and AHIP was officially neutral on the ACA challenge (though not on severability, for obvious reasons), but I can assure you that the modal industry executive was rooting for the law to go down yesterday.
*In truth, it was more a case of the hospital/physician lobby getting their way on the public option; they were rightly scared of a world where 3/4 of their patients would be reimbursed at low, low Medicare rates. It was possible to win the healthcare reform fight against AHIP, but not against the united opposition of AHIP, AHA, and AMA.
I can't keep arguing with this Black Octopus of Infinite Despair, Natilo.
513:And it's true that they're likely going to use that money for...
No, you are not getting it.
The insurance companies and megabanks are going to securitize the holy fuck out of those locked-in income streams. It will be like the mortgage boom times ten. A "policy" will be sliced diced tranched risk assessed until it bleeds and screams...and then leveraged at 30-50 to one.
And at some point in the not-too-distant future, you will paying for the bailout of Citibank and Wellpoint and the healthcare they gambled away and your own healthcare.
And maybe the managers will get fired, taking binuses and golden parachutes with them. But Citibank and Wellpoint will get new management to gamble again. and this will be repeated over and over, because if the people try to nationalize healthcare, they would have to nationalize all of global finance along with it.
The insurance companies and megabanks are going to securitize the holy fuck out of those locked-in income streams. It will be like the mortgage boom times ten. A "policy" will be sliced diced tranched risk assessed until it bleeds and screams...and then leveraged at 30-50 to one.
I'm going to regret asking, but the alternative is work. Is there any evidence at all for that or have you just mashed together a bunch of stuff that falls into the category "bad" and assumed that they all fit together somehow?
Kermit! I have a question for you. Do you know anything about the insurance options for young people and who will get subsidized?
In Massachusetts, young people can buy fairly stripped down policies, and because the Commonwealth doesn't want to be subsidizing all of the students who come from out of state, anyone in school more than half time is ineligible and has to buy crappy student insurance. The Young Adult plans under the Connector can have annual benefit caps, but this seems really silly. If you are one of the few people who gets catastrophically sick, you still need full coverage.
And one of the really evil things about student insurance is that it frequently has really crappy mental health coverage. Since those are the years that people get the major mental illnesses, this also seems like bad policy.
Is there any evidence at all for that
C'mon, man. It's bob we're talking about here. Bob spits on your naive empiricism. While you fret about "evidence" and "facts", he's saving humanity -- or at least giving humanity an opportunity to save itself, if it would only heed his impassioned warnings.
461 is just another day in the life of a white ninja gangster librarian.
505: I guess it's still just incredible to me that y'all are so naive about the degree to which the law as written is expected to match the actual practice of the insurance companies.
What Kermit says in 516. Your fixed notion that the insurance companies are being handed a ton of free power and cash is stupid. The reason they fought Obamacare tooth and nail was because it imposed large amounts of costs and regulations on them.
I think you're right to say, as you did in 301 (apart from where you quite falsely claim they "backed" Obamacare) that insurance companies will continue to try to rewrite and game the system to their advantage. I think this is different from your continued attempts to claim that everything will instantly go to hell, that the legislation wasn't worth passing and makes things worse, and that the legislation and of itself hands the whole farm over to the insurance companies. All of that is bullshit, and you are bullshitting, and you should stop. You are not being the equivalent of a voice of reason crying in the wilderness about the impending disaster of Iraq. Your arguments would have to not be misrepresentations and distortions and inversions of fact for that comparison to hold.
520: Under 30's will be able to buy catastrophic only policies. Like other policies, mental health coverage will have to be at parity with other coverage -- which is to say, nonexistant* until you exceed a large deductible (equal to HSA maximum).
*That isn't 100% true: even the catastrophic policies will have to cover preventive care and three primary care visits.
484: I know very little, only that it is a really shitty position to be in.
There are some family support groups which are sometimes helpful, NAMI in the US and MIND in the UK. Unfortunately, the up to date stuff doesn't usually get out to family members.
Matcheri Keshavan is a big researcher in public psychiatry in the U.S. (read programs serving poor people with serious mental illness) focusing on psychotic illnesses in young adults. There seem to be a bunch of videos up. Here's one.
(And wow, that "y'all are so naive" line coming from someone to whom it apparently hasn't occurred to wonder which industry has been driving all the insane, balls-to-the-wall GOP nuttiness about "Obamacare"? Just... wow.)
524: Thanks. I think Massachusetts defines young adult as 18-26.
While you fret about "evidence" and "facts", he's saving humanity...
I'm not even looking for evidence. Just some kind of reasoning spelled out. I don't understand why it would benefit either banks or insurance companies to securitize the income stream from health insurance policies. The whole idea of "risk" is fundamentally different in health insurance and mortgage finance.
519:Uhh, because they are doing it now? What do you think happens to your insurance premium? Ever hear of a company called AIG? AIG was mostly Asian (etc) health, and life, casualty, business, smorgasboard, insurance, with a division that danced with derivatives.
AIG owns 19.8% of People's Insurance Company of China (PICC) Wiki
AIG - Federal Reserve Bailout ...pages
So what happens when the retirements of people in Finland and the existence of a facory in Brazil depend on 30-year-olds not getting sick, or that Wellpoint keeps enough cashed not in gamble-mode to cover an flu-outbreak in Peoria?
Understanding the bailouts of 2008-09, and for that matter the problems in Europe now, is a matter of understanding who owns the debt? Who needs the debt repaid?
That's us, we are both debtors and creditors, in a finely tuned balance that keeps us broke but ensures the middlemen get the juice.
re: 525
Thanks. She/I were aware of Mind, but will check out Keshavan.
The problem is, the literature on cannabis and psychosis seems particularly fluid, and it's hard to weed out the hysterical pro- and anti- stuff and get a sense, for example, of how much it's a real phenomena (or just early diagnosis of a more chronic psychotic disorder).
505: It's my impression that it's doctors and hospitals who are the unsung villains of American medical costs. Medicaid is the cheapest US health care because it imposes such low reimbursement rates to doctors, not just because it cuts out insurance company executives.
The Iraq analogy is stupid. As it stands now, the law makes it an improvement over the status quo. You're argument is that we are helpless to prevent Congress from screwing us. If that's true, then we were already helpless to prevent Congress from screwing us, and the ACA changes nothing.
And unlike Iraq, this isn't a bipartisan effort. If this is such a gigantic step backward for the poor, and a gigantic step forward for corporations, why are the Republicans so opposed to the bill?
CCarp--I am going to be sending you an e-mail in a little while. I have one e-mail for you, but if it's not the best one to use, please e-mail me one that's better.
530: None of that explains why anybody would divide a health insurance policy into tranches. I'm not away of how that makes sense as a concept. Health insurance companies and mortgage brokers are both middlemen, but that doesn't make them similar on all accounts.
Full pseud at gmail works fine. I'm going skiing this afternoon, but willl have reception until maybe 2 my time.
531: What I have heard on the marijuana thing is that it's (like everything else) a gene/environment interaction. So, basically nothing terribly bad will happen to most people who smoke marijuana. If you have a strong predisposition (genetic mixed with the rest of your developmental history, including possibly, trauma), then it can be the insult which pushes you in to a first episode.
535: Probably won't get sent until tomorrow.
In 534, "I'm not away" s/b "I'm not aware."
511: My boyfriend's wingnut boss from North Carolina was threatening to have a party if it was struck down. He was particularly abusive yesterday, because it passed.
The funny thing is that, if he didn't live here and didn't have employer-provided coverage, the guy would be totally uninsurable. He doesn't want Medicare either.
534:The tranches work like mortgages. They don't divide a single policy, they bundle them.
A health insurance policy on a 30-yr-old has less risk of payout than one on a 60-yr-old. Add 2 30s to 1 60 and assign it a risk and and interest rate. Divide that into super senior, senior, etc with different interest rates. the super senior gets paid first if a 30 gets sick and the security has to get cashed.
Actually the one doing it might be the bank (its computers and quants). Wellpoint deposits their premiums and the bank counts that as reserves and leverages it according to the risk of paying out. The bank can leverage it and loan to another bank. Bank 2 invests in underwater malls. Underwater malls go bad, bank 1 asks it money back. Sorry. Wellpoint asks for its money back. Sorry.
Bank One and Wellpoint go to the Fed and Congress.
And the risk goes both ways.
Medicaid is the cheapest US health care because it imposes such low reimbursement rates to doctors, not just because it cuts out insurance company executives.
Nor does it cut out insurance companies! Currently, almost all families on Medicaid (as opposed to seniors and the disabled) are enrolled in Medicaid Managed Care plans, 71.4% of enrollees nationwide. Pretty much the entire expansion population is likely to go into MMC too. (Not all plans are private - in California about 70% of enrollees are in what could accurately be described as local public options.) But the rates paid to the plans are actuarially identical to FFS rates, so the main culprit is still the state.
531: And the Commonwealth Research Center with which he involved has a special program for young adults which includes a lot of family support groups and family-focused interventions, because teaching families how to deal with a long-term psychotic spectrum illness and how to express emotion seems to be nearly as important as antipsychotic medications in preventing relapse.
That is, 70% of California MMC enrollees, not all Medi-Cal enrollees.
541 and 543: We have managed care companies for MassHealth which you don't have to take, but it can be the default, but they're all non-profit.
Medicaid rates are too low and often don't cover a hospital's cost. A lot of doctors probably make too much money, but, God, the public psychiatrists are not overpaid--partly because the clinics get a lot of no-shows. It's a hard job.
I would totally shop at an underwater mall. Imagine the cool displays the stores could do.
546: I had to do a search for "underwater" to figure out what you were responding to, since I rarely read bob's comments.
I would totally shop at an underwater mall.
With Obama off the coast of Dubai! And just by being there it would mean you would have won--on the backs of a million white working class men from the flyover states.
We have managed care companies for MassHealth which you don't have to take, but it can be the default, but they're all non-profit.
Managed care plans are mandatory for most here, and I suspect in most other states as well.
For the love of God, why do people insist on saying the coverage will be shitty? As Minivet points out above, even the lowest value post-ACA policy* will have a higher actuarial value than half of existing individual policies.
You appear to have a very significantly higher opinion than I do of currently existing individual policies, because saying that a new option will be better than half of them is not something I would ever think might imply that new option couldn't possibly be "shitty."
550: By comparison to what? Going uninsured? My point is that the ACA is substantially better than the BEST CASE situation today for someone who doesn't enjoy employer coverage and isn't eligible for a government program (N.B. there are more than 50 million such people in this land of ours, a circumstance that contributes to an estimated 45,000 deaths per year). Covered benefits under the ACA will in most cases be identical to the most common small group product in the market (i.e. what you would get if you worked for a local employer), or better. You can dream up a world of rainbow fairies and unlimited free health benefits all you like, but most people would be pleased and relieved to get what the ACA will provide for them.
BTW, the ACA doesn't just provide affordable coverage for the uninsured, it also improves the quality of insurance coverage for (almost) everyone, in very meaningful ways.
I'm picturing you saying that at a podium surrounded by red, white, and blue bunting.
By comparison to what?
That which could have been achieved in saner world.
It took me a minute to understand 540, but as I take it, your point is that:
Health insurers generally hold cash reserves to manage small fluctuations in payouts.
These reserves usually take the form of bank deposits or short-term bank debt.
Banks sometimes take inappropriate risks.
Therefore, health insurance is risky.
I also don't think that securitizing health insurance policies is feasible, because people can switch policies or drop coverage at any time, with no future liability. I guess you could have some kind of pooling arrangement, where as people exited the pool, new customers would enter - but that seems like it would be more trouble than it's worth.
And returns can easily be negative, whereas with a mortgage you can't lose more than 100% of your principal. You could rig up a security that behaved that way, but then you'd only be selling the first-loss risk and it's not clear to me why an insurer would want to do that.
Why, then, 'tis none to you; for there is nothing
either true or false, but trolling makes it so: to me
it is a prison.
O God! O God!
How weary, stale, flat, and unprofitable
Seem to me all the uses of this legislation!
Fie on't! O fie! 'tis an unweeded garden,
That grows to seed; things rank and gross in nature
Possess it merely. That it should come to this!
Alex; I have a close family member who has suffered a single acute psychotic crisis after a period of mania. This was under severe and ongoing life stress conditions (terminally ill parent, perceived love of life breaking up, problems at work) but cannabis was definitely a huge factor and probably tipped the person over the edge. Recovery has been excellent, although the medication load made it hard going for some time and it took a while to get the balance right. Still on a lesser level which may eventually be phased out.
Thanks, emir. That's good to know. I have friends who have had issues in the past, in which stress, depression, and lack of sleep have combined with cannabis (and speed) to lead to a psychotic episode. In this case, though, it was a bit more extreme than my friends' (although not completely atypical from my skim of the literature), so fingers crossed re: recovery.
have combined with cannabis (and speed)
I'm just speculating, of course, but I would be far more suspicious of the speed than the cannabis.
Oh wearisome condition of Humanity!
Born under one law, to another bound,
Vainly begot and yet forbidden vanity,
Created sick, commanded to be sound:
re: 560
FWIW, in the case of the relative, I know there was no speed involved. Just a period of mania [a bit like emir describes], lack of sleep, dope smoking, and then a sudden psychotic episode.
In the case of one of my friends, I suspect speed was a factor, although he wasn't a heavy user.
As apo is certainly aware, weed is not what it was when I was a lad or even when he was; as I understand it the shit they sell these days is far more likely to psych you out, even than ten or fifteen years ago.
In part because they shit they sell these days is a lot more likely to be very powerful hydro and/or adulterated with other substances of which the purchaser isn't aware.
559: Psychosis definitely does occur in mania, and even for the chronic conditions, the prognosis has gotten much better.
I've had personal experience myself of being completely freaked out by the strength of something recently, and I was a very heavy smoker in my teens and early twenties, so yeah.
re: 559
This person has no real history of mania. He's a bit socially withdrawn, not particularly odd, just fairly quiet and with a small circle of friends. He's got a few minor obsessions -- stoner conspiracy theory stuff -- but no real history of delusions or manic behaviour. It's quite out of character, although it's possible to see the roots of some of the details of how he acted while having this episode in his normal behaviour.
563: I always thought that that line was propaganda from the people who are opposed to legalization and decriminalization, and not actually a reflection of reality.
567: It isn't. The change in the average strength of weed is highly noticeable to anyone who was a smoker over the span between the early Nineties and today.
Isn't that a plus from a lung cancer perspective?
570: Couldn't say for sure, but that sounds (to flagrantly violate the Most Hallowed of Bans for a moment) like expecting hard liquor to be a plus from a cirrhosis perspective.
Same high for less smoke seems like it should be safer. Same smoke but bigger high is probably not.
From a theoretical perspective. I've not looked at the literature.
The literature has a centerfold spread of people's homegrown marijuana plants and ads in the back for ways to defeat drug tests.
If stronger was necessarily "better" you would all be drinking Everclear.
I've drunk Everclear. I don't recommend it.
As someone who used to smoke to pass out in the 70s, Hawaian and sense, at least it took me a few album sides.
I am sure I don't get it, but "one puff and you are stoned" sounds too much like "one sip and you are drunk." It misses some of the point and pleasures.
Anyway, they can test all they want, but I don't quite believe it. I see people smoking this superweed and walking and talking so how much better can it really be?
Shit, they ain't high.
Actually, I haven't seen much, because if I did, I'd probably ask for some.
292. Stormcrow you are Ben Zimmer and I claim my 5 pounds.
||
Management argh. I wanted to talk to one of my line att'ys about a case I'd assigned him, couldn't find him in his office, and so I emailed him at 4:30 to come talk to me about it before he left for the day (given that it's Friday in summer, I'd expect it to be normal to dodge out the door at 5, and I didn't want to miss him.)
Looks like he'd already left at 4:30. Dude, uncool -- you're supposed to be available during working hours, and tell someone if you're leaving early. I don't want to bitch at him about penny-ante shit like that, but on the other hand, he should know not to. Feh. Maybe the email indicating that he was busted is enough that I don't need to talk to him about it.
|>
re: 560
FWIW, in the case of the relative, I know there was no speed involved. Just a period of mania [a bit like emir describes], lack of sleep, dope smoking, and then a sudden psychotic episode.
Maybe ask about spice usage. Around here we're seeing a much higher freak out rate with spice than with weed.
Spice? [Googles.] Huh. Learn something new everyday.
The change in the average strength of weed is highly noticeable to anyone who was a smoker over the span between the early Nineties and today.
Good god is it ever. I'm unpleasantly high after more than about three hits of today's street stuff.
Spice? [Googles.] Huh. Learn something new everyday.
Yeah, THC analogs and often easy to get, but on the street we've definitely seen a noticeably higher number of people wigging the fuck out.
580: Excepting prior notice, that's a bit late to expect somebody on a Friday.
Yes, but for reasons totally incomprehensible to me the NY lawyer workday goes from 11 am to 9 pm.
584: I also have heard that from myself.
Management argh.
Client asked on Tuesday if we could please get a document back to them by Friday, because they wanted to get it out to their customer today. I asked associate to handle. The whole thing should take less than an hour; it could practically be done by a secretary. Associate apparently waits until mid-afternoon on Friday to look at it, finds one ambiguity in client's instructions, and rather than doing anything at all, just fires off an email to the client asking for clarification of that point. Client responds about 5:00; associate seems to be gone. I guess they thought that since client made a (minor) mistake in the instructions, getting the document back to client on Monday is fair game.
I hate managing people. I love delegating my work to competent people, but I hate the actual management. What do I say? I know what I'll say--"The client had indicated they really wanted that on Friday--we probably should have done everything we could to get something back to them, even if you had to guess what they wanted on this ambiguous point." (There were only two options, and it wouldn't have been a lot of wasted work to guess incorrectly.) Ideally looking at the damn thing before Friday afternoon would also have been a good idea, but I'm not sure I can add that without feeling hypocritical.
Gswift, is spice some weird street lingo I don't know or are you talking about actual cooking spices? I know that in large enough quantities nutmeg will make you psychotic. Is this popular among the kids these days?
On the pot issue, I have almost zero interest in getting stoned, but I'm still curious about whether inhaling from a vaporizer is significantly safer lung-wise than smoking?
Gswift, is spice some weird street lingo I don't know
Street lingo for synthetic cannabis. Even where it's banned it's often still sold from under the counter at smoke shops. Very much popular among the kids.
Bath salts are the one that make you go cannibal. That must be the real thing.
The bath salts are dangerous as hell. Had some guys on that put up the kind of struggle where you're wondering if they'll keel over and die afterwards.
Wouldn't the use of more dangerous 'spice' be a direct result of banning pot, which is likely safer?
As for the strength of today's pot, I don't think it's a serious issue. First, if pot is stronger, then people will just tend to smoke less of it at a time. Second, pot is an easy drug to habituate to...if the stuff is stronger, you will habituate to the stronger level and feel 'normal' on it after a couple of times. (See: any serious pothead you know). The personal testimonials on the strength of pot often seem to come from people who haven't smoked for a loooong time and then are surprised that they get really high off a joint.
Like any drug, pot has a set of negative side effects, but they are I think smaller than any other seriously mind-altering drug on the market including alcohol.
Wouldn't the use of more dangerous 'spice' be a direct result of banning pot, which is likely safer?
For sure. The whole point was that a lot of the synthetics being used weren't scheduled so it was an end run around drug laws.
Following 595, I remember a paper that said if you reckon it in terms of cost needed to reach intoxication, pot is on a par with alcohol, or cheaper. I suspect that hasn't changed much over the years.
I think the takeaway is what Bostoniangirl says at 536. Some small proportion of people will be more severely affected than most others. What's tricky is they don't know beforehand. It can be hard for people to accept when they have friends who smoke more with no apparent consequences (other than usual stoner habits).
My relative was prepared to accept that he could just never smoke dope again. It helped that his friends understood but it made hanging out with them kind of boring. He hasn't stopped being friends with any of the people he's been close to for years but has kind of rebalanced to spend more time with people who don't smoke much and who take a few drinks but don't drink to get hammered as quickly as possible.
You didn't mention joint pain or weight gain so I can't tell for certain.
The personal testimonials on the strength of pot often seem to come from people who haven't smoked for a loooong time and then are surprised
Yes, this. I've been smoking since the early 80s and, sure, it's stronger now (and I can afford much higher quality these days than I could as a student). Consequently, I smoke less. But I could still sit down and smoke a whopping bunch of it without any danger of freaking out or hallucinating or what have you. I don't, because it would just be a waste.
Bath salts are the one that make you go cannibal.
Turns out this guy wasn't on bath salts after all. Just weed.
Have you considered that maybe your own tolerance has gone up over time, with sustained regular use? That seems more plausible, honestly, that the idea that all the casual users have just forgotten roughly how high a few hits used to get them, and so are simply "surprised". Maybe something that someone who smokes very regularly notices is stronger, to the extent that even they smoke less at a time, is actually a whole hell of a lot stronger, considering that if the pot were of constant strength that same person probably would be smoking more and more over time just to get as high as they like?
I smoke weed about once a year to remind myself that I hate it. (The immediate reason is usually that a new friend wants me to join them and I don't want to be uncool. But sitting there on the couch unable to initiate speech and wondering if everyone else is OK is also uncool.)
Have you considered that maybe your own tolerance has gone up over time, with sustained regular use? That seems more plausible, honestly, that the idea that all the casual users have just forgotten roughly how high a few hits used to get them, and so are simply "surprised".
Gone down?
604: That (the anxiety and inability to talk) has been my experience when sitting with new friends in their apartment. But sitting with old friends in a familiar place watching a familiar movie, with $10 worth of jelly bellies... I've heard that can be pretty fun.
Once a year here, and I don't hate it at all, but I'm good with two hits, maybe three or four if over the course of several hours -- tolerance is far, far lower than it once was.
Since we're moving out of the bookshop, we're finding all sorts of hilarious things: a now-departed partner's girly magazines behind a bookshelf that's been there for 15 years. A very very old bag of pot that was apparently forgotten. Not to give the book biz a bad name or anything, but apparently those were the days.
My perception is also that pot has gotten way stronger. I feel like highs used to be all over the place - sometimes you got walloped and sometimes I barely felt much. Now - and it's true that I don't smoke often - consistently a few hits packs a punch.
Gone down?
I suspect most of us have at some point or another, at least those with significant dating histories.
Oooh! I do have some evidence! Some good friends of mine are daily+ pot-smokers, and have been since I've known them (~15 years). (We moved from together from college to Austin.)
Through the early 2000s, they'd pack more than one bowl before heading out, or sitting down to dinner, or whatever they were about to do. For the past 5 years or so, they pack one bowl and neither of them seems to want any more than that. I haven't seen them repack a bowl in years.
611: If your tolerance goes up, you'd think the pot got weaker. If your tolerance goes down, you'd think the pot got stronger. No?
605: Maybe it's reassuring? To think that some people (out there, in our nation) are batshit crazy, and it's not something anyone can buy at their local kwiki-mart that is turning them flesh-eating crazy?
Presumably there were a certain number of face-eating crimes happening all the time before now, and it's just the bath salts hype that is getting them news coverage. Reassured yet??
I would prefer to believe that bath salts aren't all THAT scary. But I haven't seen them in the field so what do I know.
614: Yes. He was talking to apo.
Presumably there were a certain number of face-eating crimes happening all the time before now...
Sure, but you always figured you were safe if you stayed away from the Food Lion.
WTF, does every single person here have some regular history of smoking pot? I've never done any illegal substance, stop peer pressuring me.
Isn't 611 exactly what Urple is saying, that Apo's tolerance has gone up such that what he perceives as somewhat stronger is perceived by others as way stronger?
I think we need a controlled experiment involving friends who don't age, and whose pot spending money has remained the same.
Or, I guess -- do the 20 year old kids these days have to repack their bowls between dinner and (whatever they do after dinner)? Does anyone know?
There's a claim that alcohol is linked to more cannibalism than any illegal drug, but it's probably biased by Jeffrey Dahmer being an alcoholic.
618: I've never smoked pot. It just wasn't around me when I was at the right age to try something.
Oh, I didn't read close enough and thought Apo was making the opposite point.
It's never too late to try something new, Moby.
Maybe my friends just don't feel like spending so much money on pot, as they get older.
My theory (based strictly on what I've heard, natch) is that the top of the line stuff in the 90's was as good as it is today, but the lower grade ditchweed stuff has disappeared from the market. Today it's all killer.
I suspect this is related to the phenomenon that there is plentiful low grade Bordeaux in France, but not in America: once you start transporting long distances, it only makes sense to ship the high value stuff. I suspect that the average supply chain length for weed has gone up a lot since the Mexican gangs got into the business in a big way.
It could also be just that PDBS is an affluent market that demands the best of everything.
the lower grade ditchweed stuff has disappeared from the market
I find that so hard to believe. Then again, I find prices these days hard to believe.
Hey, did anyone ever used to call an ounce of weed a "lid"? I heard that term recently and found it odd.
612: Ribald teo is even better than mean teo.
I associate the term "lid" with hardcore drugs for some reason. I could look this up.
579: I claim my 5 pounds.
Heh. Thanks for the link. I guess my new band name is Lobby Lud (for the record, I had to look the phrase up).
Can you even be considered an Unfogged peer if you haven't smoked weed?
629.2: Extremely common vernacular way back in the day.
I would bet more of the commentariat hasn't than has.
618
WTF, does every single person here have some regular history of smoking pot? ...
No.
WTF, does every single person here have some regular history of smoking pot? I've never done any illegal substance, stop peer pressuring me.
I haven't. But that's probably not a surprise.
I just succumbed to the peer pressure.
WTF, does every single person here have some regular history of smoking pot? I've never done any illegal substance, stop peer pressuring me.
Pfft. Looks like we found the other cop.
630: Thanks.
I've never done any illegal drugs. I'm sure you're all shocked.
I'm sure you're all surprised.
More so than 636.
I've never touched any... what were we talking about?
I misquoted teofilo. OK, maybe the stuff is stronger than in the 90's.
644: I really can't believe I didn't use that. Turns out I'm not super familiar with all your fancy drugspeak.
The only time I ever bought weed (when I was 19), the guy selling it to me wanted to smoke together so he knew I wasn't a narc, and I immediately got so stoned that I wandered out without the weed I'd paid for.
Sad story. Then I lost $20.
Boy did Posner pen an odious piece of crap in Salon today: "Chief Justice Roberts did the right thing--but it's still a bad law." His overall take is certainly arguable, but much of his reasoning is utterly reprehensible. Try unpacking this:
But the deficit cannot be allowed to grow indefinitely, and the health care law will help it to grow indefinitely. There is no way the nation can add 30 million people to the private or public health insurance rolls without experiencing higher health costs. The reason is that insured people demand and receive more health care than the uninsured. That is explicit in Professor Dellinger's reference to health costs that are "unaffordable" by the uninsured. The care they will now get may improve their health. They may live longer. But the longer people live, the more medical care they need.Why don't these poor motherfuckers just up and die anyway? Cheaper and less bother for everybody.
I know he's just channeling Robert Samuelson's crap, but my God, listen to yourself.
Honestly, I'm probably a good example for the drug warriors to use, in that I don't want to fuck up my life on the small chance that I'm one of the few upper middle class white people who gets busted by draconian drug laws or employer testing (although living in a decriminalized state and working at a place that doesn't drug test makes the chances of that about zero.) OTOH, I have been to Amsterdam twice and didn't bother to partake there so the legal implications aren't the only thing holding me back. OTTH, I'm 35 in a couple weeks and midlife try new things etc. but wife and I have agreed if we do ever try it, it wouldn't be until the kids are grown up.
649: All I hear is "quack quack quack MORE PRESSURE, PLEASE quack quack quack."
649.last: do let the Boston commentariat know if you change your mind on that.
Pfft. Looks like we found the other cop.
A friend's internet community really was infiltrated by an undercover cop, who was trying to find information about a local gang. They figured out he was a cop, and then he still hung out there afterwords. He met up with some people to take them shooting and apparently was a weird creep the whole time.
But the deficit cannot be allowed to grow indefinitely, and the health care law will help it to grow indefinitely....The care they will now get may improve their health. They may live longer. But the longer people live, the more medical care they need.
Jesus fucking jackass.
I generally interpret people who talk about smoking pot post-age-22 as sending the message "I am so cool and privileged because I don't need to worry about being arrested".
I think I somehow always inadvertently sent out signals that I disapproved of drug use even though I don't, really. I remember several times in college when discussion of drug use abruptly stopped just after I walked into the room.
And once people seemed to think I was hilariously naive for asking "oh really? where to?" when they said they were taking a trip over the weekend. But they hadn't said anything that distinguished the going-somewhere trip from the other kind.
I had also missed this tweet from the office of the VP.
Today's decision is a really big - important - deal. Find out what it means for you: http://www.whitehouse.gov/healthreform -VP
Kermit was looking for good conservative butthurt. Here via Tbogg is Ben Shapiro:
This is the greatest destruction of liberty since Dred Scott.This is the end of America as we know it. No exaggeration.
||
I had a job interview this morning that went really well, and now I'm staying late at work to make up the time I missed. (I didn't actually have to do this, but I decided it made sense for a variety of reasons.) If I stay another hour I'll be up to a full eight-hour day, but I think I'm just going to leave now. Seven hours of data entry and similarly dull tasks is enough on a beautiful Friday evening.
|>
Don't you have, like, 20 hours of daylight this time of year?
See, I show up and the subject changes.
HEY GUYS WANT TO HEAR ABOUT GAMMA-RAY ASTRONOMY?
I have never partaken of the heathen devil weed. Or any other illegal substance. I am so uptight that I used to have a little collection of prescriptions for painkillers that I never filled, received in connection with injuries sustained while getting high on life. And America.
essear we can score you some foxy if you want to transcend that particular social anxiety.
I am astounded at all the neverweeds around here. I was pretty dorky immediately post high school but it was still essentially ubiquitous.
"I am so cool and privileged because I don't need to worry about being arrested".
I don't think I'd need to worry because everybody I tried to buy from would assume I was an undercover cop and not sell me any.
667: I ran with people who were drunk from Thursday dinner until Sunday late. The police once showed up at our house with a bus. My closest friend flunked out. There was never any pot near us. It just wasn't a thing. (I was much calmer than my roommates.)
I was only actually offered some once (and I think it was hash, they had put a lump of smoldering something in a 2 liter bottle with a hole punched in the side.) But yeah, it's always been pretty obviously everywhere- I was at a Billy Joel concert and middle aged people were puffing away in the crowd. My in-laws could probably score some if I asked (they were serious pothead hippies.)
I want to hear about gamma-ray astronomy. Or maybe Higgs rumors.
"Neverweed" is such a great word. I'd never encountered it before! (Does that make me a neverneverweed?)
neverneverweed is what made Tinkerbell fly
I want to hear about gamma-ray astronomy.
These people just put their data on the web and you can download it! And play with cute little Python packages to analyze it! It's so much fun.
Or maybe Higgs rumors.
They found it, it's a Higgs, it may or may not be the Standard Model and we're probably not going to know for sure this week. A couple weeks ago rumors were pointing toward really significant deviations from SM expectations, but it's not sounding like that now.
505: First, if pot is stronger, then people will just tend to smoke less of it at a time. Second, pot is an easy drug to habituate to...if the stuff is stronger, you will habituate to the stronger level and feel 'normal' on it after a couple of times.
There is a contradiction here. I suspect point "second" is truer: people who smoke regularly enough just habituate to the stronger stuff. But because they "feel" normal doesn't mean its effects are necessarily the same. Dedicated drunks might likewise "feel" normal after drinking enough hard liquor to put someone else under the table. (I realize tolerance curves manifest differently with the two drugs -- the analogy can only be pushed so far. But still.)
The personal testimonials on the strength of pot often seem to come from people who haven't smoked for a loooong time and then are surprised that they get really high off a joint.
For my friend from whom I hear these things -- let's just call him "me" as a shorthand -- he was a once-or-twice-a-month smoker from the mid-nineties til about ought-seven, and at the latterly edge of that curve noticed that it was more and more incapacitating. This did not technically prompt him to smoke less, per se, excepting in that it finally prompted him to more or less quit, because it was more and more as un-fun as doing hash (a drug he always hated). Having said that, every once in a while he does try it again and it completely floors him.
No psychotic episodes there either though, for him or anyone else he knew or knows.
674: They found it, it's a Higgs
Every celebrity breakup headline in the news should be replaced with headlines like this one.
Bah. That one doesn't even make sense to me.
I'd come up with something better, but I'm a little stoned.
I'm not even drunk at all. It was stupid hot and then it rained, so I didn't finish my run until late and now I'm just too tired to get a drink.
That's okay, I'm not really stoned either. Just uninspired.
Don't you have, like, 20 hours of daylight this time of year?
Yes indeed we do. It's 8pm now and looks like noon.
stupid hot
Man, no kidding. Do not want.
Basically Alaska is fantastic and I never want to leave.
And because there's tons of jobs up here, I probably won't have to! Woo!
I can't remember the last time we've had a week of 100+ degree weather. Why couldn't we have destroyed our world by triggering an ice age, instead?
I wish it was cooler here. And that I had enough money to buy weed. And that I could still drink to excess without any serious problems. And that I was not depressed all the time. And that I had a better job.
Everything is just boring and stupid. I never have any fun. It's all just going through the motions. I feel very antisocial.
I wonder what it would be like to live a life where interesting, positive things actually happened on a regular basis? Maybe someday I will read about it in a book.
Everything is just boring and stupid. I never have any fun. It's all just going through the motions. I feel very antisocial.
I very much feel for you. My sympathies.
Boredom is really under-recognized as a manifestation of depression. It can be agonizing.
It always me feel better to know someone is feeling shittier, perhaps it will work for Natilo?
I live four hours away from the love of my life, who is raising two children she had (with an outrageous redneck douchebag who ditched her, no less) after aborting mine several years ago. Oh, and she posts about them on Facebook all the time, and I can't bring myself to unfriend or block her because she keeps asking me for advice about stuff and I can't bring myself to tell her that I hate her, because I still love her.
LBJ, that sounds absolutely agonizing.
Hmmm that sounds horrible. OTOH she is single with two kids so is there really no chance?
It's not optimal. On the plus side, though, I can still drink to excess.
695: I've recently had thoughts along those lines myself, but it's clear to me I'm not the love of her life. So it goes.
(And I don't hate her, or rather I only feel that way in uncharitable moments. I was a messed-up addict when we go pregnant, she made the right decision. It's just unfortunate how things worked out.
It does occur to me that I have the material for an authentic blues song or two, now. Another one in the plus column!)
Have you considered fucking and then eating a Neanderthal? Some have found comfort there.
699: Turns out archaeology departments are all prudish and shit. Who knew?
693: Yeah, that sounds pretty bad. I mean, except for the fact that my friend's dead baby weighs on my mind a lot, which really wasn't my problem to most people's way of thinking, at least there are no kids involved in any of my manifold failures and fuck-ups.
I just wish I could have made a couple of good decisions awhile ago. By the time things started to look up for me in my mid-20s, I'd already condemned myself to a lot of pain and anguish. It's stupid, really. I'm stupid, lazy, unfocused, fearful, superfluous. There's nothing but a painful decline into worse health, worse finances, worse relationships, worse everything in store for me. I'm so useless.
There is nothing good to look forward to. Everything gets worse and worse. I don't even have the comfort of my revolutionary beliefs anymore. Nobody cares. Nobody's going to do shit.
Sorry to hear you're feeling so down, Nat. I don't know if it's any consolation, but I've been meaning to tell you that that thing you wrote that comes up when searching for your name on JSTOR (which you mentioned here a while back) is really quite entertaining, even for someone who isn't versed in the academic debates it satirizes.
703: Thanks! I wish I could write that well on command. Basically, all the really good writing I've ever done is when I was ridden with anxiety, drunk, or both. Like my Sesame Street noir from last year? Drunk and feeling incredibly panicky.
Perhaps I should take a drink right now. Took a Percocet earlier to calm down, but it was just one. And my liver is probably completely fucked at this point anyway.
In a just world, I would have access to some fucking benzos for times like this.
Hey, did anyone ever used to call an ounce of weed a "lid"? I heard that term recently and found it odd.
The Firesign Theatre, all the time, usually in repeating the gag: "Hey, this door's locked, does anyone have a key?"; "No, but I've got a lid out in the car."
674. I know essear is a fine scientist, but AFAIK he's pretty much at grunt level, so if he knows this stuff, why are they putting on all this expensive theatre, when they could just write to the papers:
"To the editor,
We found it. Don't have much detail yet but we'll be in touch when we do.
Sincerely, CERN."
685 and 686: I don't think that I could make it through a winter there. If I can live in Southern Italy in the winter, I'll go to Alaska for the summer.
I would so move to Alaska for a decent job.
Saw one for Egypt not to long ago that was close to ideal and I'd love to go back there but the timing was all wrong.
I'm about to move for another short term job to another place I've never been before where I don't know anyone, and holy Jesus, the prospect is depressing. With a little luck, maybe people in New Town will be more friendly than they are here. Everyone here acts really warm and friendly until you suggest that maybe you could do something outside work together, and then they act like you just dropped your pants in the office.
I have a couple of people I hang out with, one whom I love terribly, and others who have been friends in certain very limited ways, but who don't seem to like me much. It's depressing. I am very tired of feeling like everyone just manages me.
You don't really know how they'd act if you dropped your pants in their office until you try.
Sometimes I'm like *this* close. It makes me feel crazy. Like, if everyone acts all shocked and polices me when I say X, I wonder what they would do if I actually acted like myself for once?
X is usually something about queer sexuality, or sexuality at all, which is pretty crucial to my work, and which I teach about all the time, and when I bring it up as a topic that I teach with colleagues, they stare at the floor and say, "Huh, you're braver than me" and "You know, you might be embarrassed about that. You might not just want to talk about it with people." Really? Does anyone ever tell you not to mention your spouse or baby because you might wake up tomorrow ashamed that people know about your heterosexuality?
God, I fucking hate people here.
708: That's what's bizarre about the hissy fit some bloggers threw last week about bloggers reporting that they found the Higgs. Literally several thousand people hear rumors about the outcomes of the experiments, but some people hate it that it leaks out of the physics community. I suppose it ruins the joy of being an insider.
At the same time, I think CERN is right to be cautious. The big danger is that they've somehow fucked up the experiment or the analysis in the quest to discover the Higgs, so they want to be careful. There have been several high-profile fuck-ups in high-energy physics history, so it's a definite possibility if they're not careful.
I'm sorry for the woes, LBJ and Natty. Shitty all around.
Isn't the problem that as soon as they announce they've found it, everyone has to pack up their equipment, go home, and start looking through the want ads? I'd delay too.
I know essear is a fine scientist, but AFAIK he's pretty much at grunt level
Sounds about right, but to be clear: I'm not involved with the LHC experiments in any way. I'm a theorist doing work that intimately relates to their results, but I have no access to the data itself.
That said, if you want to know more about the Higgs, I'll break down "They found it, it's a Higgs" a little more:
* In December, one of the experiments had convincing-looking hints and the other had... less convincing... hints of a particle with a mass of about 125 GeV, probably produced in gluon-gluon collisions, decaying to two photons. That was exciting, since it's one of the ways the Higgs could show up. There were also less convincing hints that the same particle could decay to two Z-bosons.
* This week, they will (I suspect) announce that the evidence for the 125 GeV particle decaying to two photons is strong enough to call it a discovery. That isn't really new information if you believed the December result, but still, it's exciting.
* The main role of the Higgs is, loosely speaking, to give mass to W and Z bosons, which means to really say that you see a Higgs you need to know the particle you see decays to two Z bosons or two W bosons. Based on December's information, you could imagine that this was something that decayed to two photons but wasn't really a Higgs, i.e. didn't play the mass-giving role the Higgs plays. At least one of the experiments will (I strongly suspect) announce this week that they have much more compelling evidence that the particle at 125 GeV decays to two Z bosons, which more-or-less clinches its status not just as a new particle at 125 GeV but as a Higgs boson at 125 GeV. This is very, very important.
* More generally, the observation of a scalar particle is a big deal. So far, all the "elementary" particles we know are either fermions (spin one-half) or gauge bosons (spin 1). ("Elementary" is a fuzzy word, since they could always be made of other things at a scale we can't probe yet. I can be more precise.) Elementary particles with spin turn out to be protected from large quantum mechanical effects; particles with spin and zero mass basically act completely differently from particles with spin and nonzero mass, which means quantum mechanics can't take a massless particle with spin and turn it into a massive one, which in turns means (and you'll probably just have to trust me on this) that if you have a particle with spin and a small mass is a sensible and stable thing. Particles, like the Higgs boson, with mass and without spin carry no such protection; quantum mechanics can come in and mess with them.
* The implication is that, if you see a particle with mass and no spin, you are usually inclined to suspect it's a bound state of other particles, i.e. not fundamental. But there is strong indirect evidence that this 125 GeV particle can't be a bound state -- we would have seen lots of other indirect evidence of the stuff it's made of. It looks elementary. And that's deeply weird, because quantum mechanics would then want it to be very heavy. It's like our universe is poised near a critical point; if the Standard Model is true and you imagine that you were free to turn various knobs that control the masses and interactions of particles, you'd have to turn one of them to the right spot with a precision of about one part in ten to the thirtieth power to get a universe like ours. That seems hard to swallow, and leads to people talking about confusing things like the Anthropic Principle.
* Because of that, we tend to expect something else kicks in to rescue the Higgs from these quantum effects. The best guess is supersymmetry. But we've seen no real evidence of that so far. Almost anything that can swoop in and rescue the Higgs from the malicious forces of quantum mechanics that want to wreck its potential will also alter the Higgs in some way -- e.g., the relative rate at which you see it decaying to two photons versus two Z bosons could change. That's why we're all waiting with bated breath to see if the measurements are consistent with a Standard Model Higgs -- if not, we have exciting times ahead and there's more physics just around the corner. But if it does look consistent with the Standard Model, we might be living in a delicately tuned universe and we'd be pretty confused about why.
* What we'll learn this week -- I'm guessing -- is that some of the Higgs properties look a little different from the Standard Model, but with error bars big enough that it's still consistent with the Standard Model. So we'll have to wait for more data to see which way the evidence tilts.
Nonetheless, the discovery of an apparently fundamental scalar particle is a big, big deal that is unlike any other particle that has been discovered before. I don't mean to downplay the amazing accomplishment of the people working on the LHC. It's just that the question I really want an answer to is going to take a while longer.
717 the hissy fit some bloggers threw
Mostly one guy, acting the way he always acts.
719. As I understand it, if they find the HIggs, that'll be a useful and not unexpected side effect of the principal experiments they're running at the LHC; but those experiments are scheduled to run for a decade or more. I may have this wrong; paging the physicists?
722: Finding a Higgs or something like it was the slam-dunk, no-lose case to build the LHC. So it's arguable the machine's primary purpose. We're all hoping for more, though. If nothing else, running for a decade will allow its properties to be measured with more precision.
In extenuation of 722, I sent it before 720 was posted, but my connection is running like molasses in January today. Thanks for 720 - great stuff.
-e+y, sorry for typos, I'm on a bus. (Wasn't when I wrote the long comment, which I see also has typos. Oh well.)
maybe people in New Town will be more friendly
Anecdata, but the person I dated who went to New Town College really seemed to like the scene there. She was super-brilliant and very creative and an outspoken liberal, and she seemed to have found a very comfortable niche there.
726: I have heard this too. I hope it's true! It's certainly a lot more liberal.
confusing things like the Anthropic Principle.
How confusing is the Anthropic principle? I realize that applications of the principle are always a bit hairy, but the concept seems relatively straightforward (and thanks for 720).
My sympathies as well to Nat, LBJ, and AWB all of whom sound like they are having lousy times for reasons which are immediately recognizable, not particularly shocking, but which now easy solutions.
720: Because I've recently listened to A Short History of Nearly Everything, I have a faint whisper of a shred of a hint of what a infinitesimally tiny piece of this means. Where's my doctorate?
Subscribing to 728.2 If I seem disconnected it's not because I don't feel for you but because I'm 3,000 miles away and waiting for an MRI.
I assume everyone else already read this confirmation of the widely suspected theory that Roberts switched his vote on the PPACA. Although, it turns out it wasn't at the last minute, it was much earlier, but the conservative dissent was deliberately written in a way that made it look like a last minute switch:
Chief Justice Roberts changed his mind with respect to his decision. ...[A]fter he changed his mind, ...Roberts then withstood a month-long, desperate campaign to bring him back to his original position, the sources said. Ironically, Justice Anthony Kennedy - believed by many conservatives to be the justice most likely to defect and vote for the law - led the effort to try to bring Roberts back to the fold.
"He was relentless," one source said of Kennedy's efforts. "He was very engaged in this."
But this time, Roberts held firm. And so the conservatives handed him their own message which, as one justice put it, essentially translated into, "You're on your own."
The conservatives refused to join any aspect of his opinion, including sections with which they agreed, such as his analysis imposing limits on Congress' power under the Commerce Clause, the sources said.
Instead, the four joined forces and crafted a highly unusual, unsigned joint dissent. They deliberately ignored Roberts' decision, the sources said, as if they were no longer even willing to engage with him in debate.
I'm working on a new album about the Robert's court. It's called "The Constitution in Exile in Guyville."
731. Interesting and plausible, but notably lacking in named sources or references. What confidence do you give it, and why?
What confidence do you give it, and why?
Confidence: reasonably high.
Why: plausible and well-sourced, just anonymously sourced. Unlikely to be fabrication (by whom and for what reason?).
