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Thread: Obama Care Wins Supreme Court Decision!

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    Obama Care Wins Supreme Court Decision!

    Supreme Court Health Care Decision: Individual Mandate Survives

    WASHINGTON -- The individual health insurance mandate is constitutional, the Supreme Court ruled Thursday, upholding the central provision of President Barack Obama's signature Affordable Care Act.

    The controlling opinion, written by Chief Justice John Roberts, upheld the mandate as a tax, although concluded it was not valid as an exercise of Congress' commerce clause power. Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan joined in the outcome.

    The decision in National Federation of Independent Business v. Sebelius comes as something of a surprise after the generally hostile reception the law received during the six hours of oral arguments held over three days in March. But by siding with the court's four Democratic appointees, Chief Justice Roberts avoided the delegitimizing taint of politics that surrounds a party-line vote while passing Obamacare's fate back to the elected branches. GOP candidates and incumbents will surely spend the rest of the 2012 campaign season running against the Supreme Court and for repeal of the law.

    Five justices concluded that the mandate, which requires virtually all Americans to obtain minimum health insurance coverage or pay a penalty, falls within Congress' power under the Constitution to "lay and collect taxes."

    "The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause," Roberts wrote. "That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress's power to tax."

    Ginsburg, writing separately for the four liberals, said they would have upheld the mandate under the commerce clause too. "Unlike the market for almost any other product or service, the market for medical care is one in which all individuals inevitably participate," she wrote. "Virtually every person residing in the United States, sooner or later, will visit a doctor or other health care professional."

    Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito joined in a dissent. Together, Roberts' controlling opinion, Ginsburg's concurrence, the four-justice dissent and Thomas' own dissent add up to 187 pages.


    In a section of his opinion joined by the liberal justices, Roberts noted that the conservative dissenters contend that the mandate cannot be upheld as a tax "because Congress did not 'frame' it as such. In effect, they contend that even if the Constitution permits Congress to do exactly what we interpret this statute to do, the law must be struck down because Congress used the wrong labels."

    But the majority was not persuaded by that argument. Roberts wrote that the mandate provision "need not be read to do more than impose a tax. That is sufficient to sustain it."

    On Medicaid expansion, the court upheld the expansion but with a critical caveat: The federal government may not threaten the states that don't comply with the loss of their existing funding. Essentially, the Medicaid expansion is now optional for the states.

    "As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding," Roberts wrote. "Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer. The States are given no such choice in this case: They must either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding. The remedy for that constitutional violation is to preclude the Federal Government from imposing such a sanction."

    For their part, the dissenters were not impressed with Roberts' parsing of the law. "The Court regards its strained statutory interpretation as judicial modesty. It is not. It amounts instead to a vast judicial overreaching," wrote the four other conservatives.

    They then looked to the political future: The majority's decision, they argued, "creates a debilitated, inoperable version of health-care regulation that Congress did not enact and the public does not expect. It makes enactment of sensible health-care regulation more difficult, since Congress cannot start afresh but must take as its point of departure a jumble of now senseless provisions, provisions that certain interests favored under the Courtís new design will struggle to retain. And it leaves the public and the States to expend vast sums of money on requirements that may or may not survive the necessary congressional revision."

    Careful legal parsing aside, the bottom line is: The Affordable Care Act has survived.

    Erin Mershon contributed to this report.

    This is a developing story. Please check back for updates.

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    Re: Obama Care Wins Supreme Court Decision!

    Health Care Law: All Hail The Failure Of Conventional Wisdom

    WASHINGTON -- Is this a great country or what? Not because the U.S. Supreme Court upheld the overall scheme of the president's health care law. That is an ordinary question, no matter how much money was at stake. It is a great country because the workings of our carefully wrought system of government are not predicated on punditry, predictions or polls.

    Defying the expectations, Justice John Roberts -- said to be a relentless conservative activist -- joined the court's "liberal wing" in saving the law by grounding the "individual mandate" not in the power of Congress to regulate commerce, but in its taxing power. As I suggested yesterday, the court essentially said that Congress could not require people to buy something in the private economy, but they could fine them if they didn't. The court found that power to fine, in the taxing power of Article I. Now the president will have to figure out a way to make the fines in the law -- which are weak and toothless -- real.

    The idea to require all Americans to buy private health insurance was hatched in a conservative think tank, first deployed by a Republican governor (Mitt Romney) and at first opposed in the Democratic 2008 presidential primaries by candidate Barack Obama. But as soon as he had he vanquished Hillary Clinton - a proponent of the mandate -- he privately decided to support it. "I kind of think Hillary was right," he told an aide in the summer of 2008, according to Princeton professor Paul Starr. There were those -- including Starr -- who had publicly and privately warned that the mandate was a risk, but once in the White House Obama and his aides (many, ironically, Clinton veterans) ignored the warnings.

    The obvious big political winner, at least initially, is President Obama. Had the court thrown out the core mechanics of the law, his signature accomplishment would have been in shambles. He can take to the campaign trail with the backing of none other than George W. Bush appointee Roberts. His polls were on the upswing and may get a boost. There are troubles down the road. He has to make the fines real. Most people don't like the mandate, no matter what it is grounded on. Republicans and Romney, their presumptive nominee, will make overturning the law their crusade for the campaign, and they will have the polls on their side.

    Beyond the political back-and-forth, the 5-4 ruling is an example of the durability of our system, and of Roberts' desires to protect the reputation of the institution as the one place in the country that is above politics. The court is the most essential part of our system of government by the rule of law. It takes the place in our system of faith or royalty as the ultimate arbiter of Truth in the public realm. Roberts understood that, and protected it.

    Now it is clear why Justice Scalia went on his rampage yesterday. He doesn't like Roberts' institutional vision of the court.

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    Re: Obama Care Wins Supreme Court Decision!

    Health Care Ruling: What It Means For You
    By Matt Negrin | ABC OTUS News
    Health Care Ruling: What It Means …

    The Supreme Court ruling on President Obama's health care law is complicated, just like the law itself. Today the court said the law is mostly constitutional. Here is what it means for you:
    - You have to buy health insurance or be subject to a tax
    - If you are under 26, you can get health insurance from the plan your parents use.
    - If you're on Medicare, you can get free mammograms.
    - If you have what's called a pre-existing condition, you can get health insurance.
    - Insurance companies can't deny you coverage even if you get sick and make a mistake on your health insurance application.

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    Re: Obama Care Wins Supreme Court Decision!

    Thrilled and relieved, sick patients cheer court ruling

    By JoNel Aleccia
    Jerry Fielder and Beth Ann Levendoski breathed separate sighs of relief Thursday -- one in Texas, the other in California -- on the news that the U.S. Supreme Court had largely upheld President Obama's signature health care law, preserving the guarantees that the seriously ill women will have health insurance.
    Fielder, a 64-year-old cancer patient from Universal City, Texas, and Levendoski, a 57-year-old San Diego woman with a history of complicated spinal surgeries, were among those with the most to lose from the long-awaited ruling on the Obama Administration’s Affordable Care Act: people with pre-existing health conditions.
    "I am thrilled. I can't tell you what this means," said Levendoski, who is still recovering from two 10-hour surgeries in 2011 to correct spinal fractures and a compressed spinal cord, which left her virtually paralyzed. "I hardly slept all night."
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    On a 5 to 4 vote, the nation’s top court on Thursday upheld the provisions of the Affordable Care Act, including the controversial proposal that requires all Americans to have health insurance, or face financial penalties. The court interpreted the so-called "individual mandate" as a tax, however.
    "I was on pins and needles. I was dreading the results," said Fielder. "Then I was like, Oh my God, they upheld it? I can't believe it."


    For Fielder, the ruling means she won’t have to count the months until Medicare kicks in next spring to continue treatment for lymphoma and a fist-sized malignant tumor in her abdomen.
    Fielder spent most of the past decade struggling to acquire and maintain health insurance after giving up employer-sponsored care when the family decided to start a small business. They assumed they'd be able to buy private insurance, but when Fielder and her husband, Charles, now 65, went looking for coverage, they were stunned to be turned down by 16 different providers because of his history of heart problems.
    They paid $73,000 out of pocket for Charles' heart surgery in 2003, but then, in 2009, came Jerry’s diagnosis.
    “You can pay for a broken leg, you can pay for a broken arm, but you cannot pay for cancer,” she said.
    Without insurance, Fielder received no treatment for months, growing sicker and weaker as the cancer spread. Only after she gained access to a stop-gap program through the ACA did Fielder get care that has slowed her disease and allowed her to return to work. Charles became old enough to qualify for Medicare last year.
    Fielder said she has met many families, including single mothers with young children, struggling to find coverage for existing illnesses.

    Courtesy Beth Ann Levendoski
    Beth Ann Levendoski, 57, of San Diego, is enrolled in a PCIP, a health insurance plan provided under the Affordable Care Act for people with pre-existing conditions.

    "Everybody is just a blink away from needing insurance," Fielder said.
    Between 36 million and 122 million adults under age 65 in the United States have a pre-existing health condition and as many as 17 million do not have health insurance, according to the Government Accountability Office. The estimates vary widely because of the type and number of ailments used to define pre-existing conditions in each of five estimates. In the lowest estimate, adults reported whether they had ever been told they had one or more of eight specific conditions. The highest estimate included any individual reporting a chronic condition in 2009.

    Fielder and Levendoski are among more than 67,000 people nationwide who enrolled in Pre-existing Condition Insurance Plans, or PCIPs, which were created to provide insurance for people too sick to get coverage on the private market. Both women were among the first to join in October 2010.
    The PCIPs are temporary programs aimed at bridging the insurance gap until 2014, when the health reform law requires insurers to accept all comers, including those with previously identified health issues.
    For Levendoski, being able to maintain her insurance coverage is the key to her future.
    A former director of a nonprofit agency, she lost her insurance in 2004 after being laid off. She exhausted benefits through the state COBRA health benefits program and then learned that she couldn't get private insurance because of a history of kidney problems and the degenerative effects of childhood scoliosis, which required repeated surgeries. Her condition grew so dire, she suffered spinal fractures and a compressed spinal cord that left her unable to walk.
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    She exhausted about $55,000 in savings paying for care out of pocket before the ACA was enacted. She eventually lost her home and had to declare bankruptcy because of the medical bills. Levendoski was able to buy insurance and resume her treatment in 2010 after enrolling in the PCIP.
    The two surgeries last year helped relieve the paralysis in her legs, but left her with lasting, debilitating weakness in her arms. Unable to work now, she lives for free with her 80-year-old mother, which allows her to use state disability payments to cover the monthly premium of $467 for the PCIP program.
    Regaining strength in her arms and re-learning to walk mean Levendoski has a long road ahead, including another major surgery planned in just a few weeks.
    She was in an agony of anticipation most of this week. When the high court didn't rule on the law as expected Monday, Levedoski was in tears. On Thursday, as early reports appeared mixed, she was worried, then elated.
    "I am going to be so relieved," she said.

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    Re: Obama Care Wins Supreme Court Decision!

    President Obama Responds To Supreme Court Ruling - Article/Video


    http://www.huffingtonpost.com/2012/0...#slide=1156972

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    Re: Obama Care Wins Supreme Court Decision!

    Roberts Based Ruling on Judicial Restraint
    Bloomberg News

    If the U.S. Supreme Court had wanted to make history, it could have: Striking down the individual mandate in the health-care law would have been the most weighty Supreme Court ruling since Franklin Roosevelt’s first New Deal was ruled unconstitutional three-quarters of a century ago.
    By upholding the individual mandate -- after honestly acknowledging that making people buy insurance is a tax -- the court chose the more cautious course.

    In the spirit of Justices Oliver Wendell Holmes and Felix Frankfurter, the court adopted the strategy of judicial restraint. The man most responsible for this comes as a surprise: Chief Justice John Roberts, a tried and tested conservative appointed by George W. Bush to the near-universal plaudits of the right. Roberts said in his confirmation hearings that he believed in judicial restraint. That has become a cliche, repeated by every would-be judge raising a right hand before a Senate committee. When the chips were down, Roberts did exactly what he had sworn to do under oath. He stayed the court’s hand and rejected activism.

    The court’s explanations were sufficiently complex that CNN briefly reported the mandate had been struck down. But the core logic of the holding was a model of analytic clarity. To require people to buy insurance or else pay a penalty is a tax. The Constitution gives Congress the power to tax in order to accomplish its legitimate goals. Calling the mandate what it in fact is makes this result crystal-clear.

    Word Choice

    These words sent a direct message to Democratic politicians who refused to call the mandate a tax: You should have told us the truth in the first place. Had the mandate been called a tax from the beginning, all this legal wrangling might never have occurred. It would have been essentially impossible to argue that the mandate was unconstitutional if the bill had directly relied upon the taxing power.

    Of course, politicians are unlikely to take this object lesson seriously. Calling the mandate a tax might have stopped it from passing. Now, the mandate has been upheld. The Democrats’ game of bait-and-switch worked -- after a fashion. Now the drama of the last several months, and the serious worry about the court striking down the president’s signature domestic policy achievement, can be conveniently forgotten.

    What is most shocking about the outcome is who brought it about: Roberts, not Justice Anthony Kennedy, cast the deciding fifth vote to uphold the law. When Roberts was up for confirmation, many liberal insiders to the world of the Supreme Court bar were optimistic that he would be a reasonable and evenhanded chief: a conservative, of course, but one who played by the rules. He had little written record to go on, so no detail was too small to escape comment. While still a lawyer, Roberts had occasionally participated alongside liberals in the private, informal moot courts that are part of the preparation for a Supreme Court argument.

    Once he became chief justice, however, Roberts seemed to many liberals to have reverted to his origins as a clerk for former Chief Justice William H. Rehnquist and a longtime supporter of the Federalist Society, a powerful conservative legal organization. His decisions have for the most part been consistent with those of Justices Samuel Alito, Antonin Scalia and Clarence Thomas, the conservative bloc. Together these four conservatives have won when Kennedy joined them and lost when he defected to the liberal side.

    Historically Important

    In the health-care case, Kennedy joined the conservative dissent. This is itself worthy of comment, because Kennedy has become a historically important liberal justice through his opinions on gay rights and on habeas corpus rights for detainees at Guantanamo Bay, Cuba. But Kennedy has remained a conservative on issues of the government’s power to regulate; and in the end, after all the guessing about his views, he stuck with that position here. One can only speculate on what Kennedy might have done had Roberts not given him the option of joining the conservatives in dissent.

    Roberts did wave the conservative standard on the question of Congress’s power to regulate commerce, squarely stating that the regulation of inaction would have been too great an extension of the Commerce Clause power. Yet he balked at stopping Congress from imposing a tax. Conservatives who want to make the health-care plan into a central campaign issue can take some small solace in that the court has called the individual mandate a tax. But there will surely be major shock among those who counted on Roberts to toe the party line, as there is shock among those liberals who had given up on the vision of Roberts as a lawyer’s lawyer.

    What explains this result? One possibility is that John Roberts, former law clerk, former high-powered Supreme Court litigator and now chief justice, loves the Supreme Court more than he loves political conservatism. A student of the history of the court -- and as a participant in history -- Roberts knew the consequences of striking down the individual mandate: He would have been attacked by the president and the news media as the chief of the most activist conservative court since the 1930s. For “the Roberts Court” to become a title of infamy would have been a sadly negative culmination of a highly successful career.

    Then there is that most old-fashioned of motivations: principle. Frankfurter, who did more than anyone to popularize the idea of judicial restraint, was a liberal New Dealer who became a judicial conservative because he stuck with the principle of restraint even when liberals had five votes.

    Roberts now enters the pantheon of true judicial conservatives, judges who hold back from activist results no matter how it affects presidential politics. By helping the court avoid making history, Roberts’s place in history is assured.

    (Noah Feldman, a law professor at Harvard University and the author of “Scorpions: The Battles and Triumphs of FDR’s Great Supreme Court Justices,” is a Bloomberg View columnist. The opinions expressed are his own.)

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    Re: Obama Care Wins Supreme Court Decision!

    Its a bad day for the reality of what this means. It great to have the view of what we hope this means, or what the plan is for this to do. However, i work in the field, i speak daily with administrators that have already had to cut back non essential staff in hospitals. I have spoken with Doctors who want to help medicaid patients, but due to business reasons, no longer can take medicaid patients, thus these patients are getting door after door closed on them. Therefore these patients now will see doctors less and less.

    The quality of care will be reduced dramatically. Even the administration knows this and addressed this today, when Obama said he was saddened by the recent events that have occurred recently, but it was his hopes that this would change. "Hopes" that is horrific. Hopes. Offices will make sound business decisions everyday, and if they lose money seeing patients they will not accept them.

    Small business will now be faced with a choice. Pay this additional tax (that is what it is per the supreme court) or pay the penalty. It will be cheaper to pay the penalty so many business will drop people from their coverage, so now we have more people in the entitlement group, needing those of us who have coverage and a job to pay for them...President did not plan for this. So we pay more and more.....

    We can go on and on...The point is..It is a great thought, but this plan is doing nothing but adding to our debt, giving those with out coverage coverage at the additional cost to the rest of everyone, plus we have issues with many that are underinsured, and those are the ones that currently struggle more than others, as those totally with out can get covered.

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by wpink View Post
    Its a bad day for the reality of what this means. It great to have the view of what we hope this means, or what the plan is for this to do. However, i work in the field, i speak daily with administrators that have already had to cut back non essential staff in hospitals. I have spoken with Doctors who want to help medicaid patients, but due to business reasons, no longer can take medicaid patients, thus these patients are getting door after door closed on them. Therefore these patients now will see doctors less and less.

    The quality of care will be reduced dramatically. Even the administration knows this and addressed this today, when Obama said he was saddened by the recent events that have occurred recently, but it was his hopes that this would change. "Hopes" that is horrific. Hopes. Offices will make sound business decisions everyday, and if they lose money seeing patients they will not accept them.

    Small business will now be faced with a choice. Pay this additional tax (that is what it is per the supreme court) or pay the penalty. It will be cheaper to pay the penalty so many business will drop people from their coverage, so now we have more people in the entitlement group, needing those of us who have coverage and a job to pay for them...President did not plan for this. So we pay more and more.....

    We can go on and on...The point is..It is a great thought, but this plan is doing nothing but adding to our debt, giving those with out coverage coverage at the additional cost to the rest of everyone, plus we have issues with many that are underinsured, and those are the ones that currently struggle more than others, as those totally with out can get covered.
    Great. So the previous system in the US was better? For whom? The insurance companies. And yet now, they got 20-30 million more people. And still millions more will be uncovered.

    Pink, doctors ALREADY turn away Medicaid patients. And, how costs can go up any MORE than they have under the previous system is beyond me. 15-20% insurance premium increases year after year in some cases. Recission. Claim denial and coverage denial due to pre-existing conditions. Businesses ALREADY overburdened by health care costs. And we're STILL unhealthier as a nation, with worse health care outcomes and shorter lifespans, than many other countries in the industrialized world-- all of whom have single-payer and costs that average HALF of ours as a nation.

    I don't think the health care administrators you are speaking with are the all-knowing word on this.

    Pink, Obama never would have attempted a health care overhaul, that's right, even knowing the 40 million were uninsured, if THE REST of the system was working anywhere close to acceptably. Unfortunately, it's been bringing the US economy to a near-halt, with projected costs that were unsustainable. THAT's why he felt he had the support of the people two years ago going into this.

    I have spoken with numerous doctors and administrators, and for all of them, their feelings about the new health care law are mixed. But one thing they all agree on is that the old system was f__ked-- both for them and for patients.

    I'd like to know your solution. Just go back to the old way??

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by wpink View Post
    Small business will now be faced with a choice. Pay this additional tax (that is what it is per the supreme court) or pay the penalty. It will be cheaper to pay the penalty so many business will drop people from their coverage, so now we have more people in the entitlement group, needing those of us who have coverage and a job to pay for them...President did not plan for this. So we pay more and more.....

    .
    This is a VERY good thing. The number 1 albatross around the necks of US business is healthcare costs . . .not taxes, not 'regulation' . . but increasing healthcare costs they have to pay their employees. We are the only nation that still has the completly a$$-backwards idea of coupling healthcare to employment. It's stupid. More people on the exchanges is only a good thing. And this isn't more people on "welfare" . . people with jobs whose employer drops healthcare coverage won't suddenly get free healthcare . . they'll have to buy their insurance like everyone else.

    The Right makes out so-called 'Obamacare' to be either government-run healthcare (an absolute lie) or now a suddeny free expansion of healthcare to lazy people ie the poor (I heard the latter directly from tea-party inclined coworkers of mine). Yes Medicaid expansion is one piece of the puzzle (and more poor people on insurance and not going to emergency rooms is ultimately a cost saver) but the largest parts of the bill are the consumer protections for people already on insurance. It should really be called the Healthcare Consumer Protection Act b/c that is the main gist of the law.

    And it's funny that all of the nurses I know are in favor of this and some doctors I know aren't . . doctors overcharging and doing superflous tests are one of the big reasons our system is crushed by rising costs. 70%, at least, of medical care can be done safely and soundly by nurse practictioners and that is the dirty little secret many doctors are worried will get out with greater consumer protections on healthcare costs.

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    Re: Obama Care Wins Supreme Court Decision!

    What the Supreme Court's Ruling Means for Consumers
    By Louise Radnofsky | The Wall Street Journal

    The Supreme court said Congress was acting within its powers under the Constitution when it required most Americans to carry health insurance or pay a penalty. It upheld the mandate as a tax, in an opinion by Chief Justice John Roberts.

    But the justices found fault with part of the health-care law's expansion of Medicaid, a joint federal-state insurance program for the poor. The justices made some changes to the Medicaid portion of the law.

    Q: Does this mean the health overhaul law is in place for good?

    A: The decision effectively upholds the law for now, but its future depends on which party controls the White House and Congress after elections in November. President Barack Obama and most Democrats consider the law a signature achievement and want to move forward implementing it. Republicans, including presumptive presidential nominee Mitt Romney, have pledged to overturn it. They say they would offer an alternative proposal but haven't been specific about what it would include.

    Q: What happens to any benefits I already get because of the law?

    A: They will stay in place for now. Parents will still be able to keep their children on their insurance plans up to age 26, and Medicare recipients will keep getting discounts on prescription drugs to close a gap in coverage known as the "doughnut hole." New levies under the law, such as the 10% tax on tanning services, also stay put.

    [Related: Supreme Court's Obamacare decision: live coverage from SCOTUSblog]

    Q: When will I see the big changes from the law?

    A: Most of the mandates don't start until 2014. That is when most Americans will be required to carry insurance or pay the penalty at issue in the Supreme Court case. The penalty will start at $95 a year or up to 1% of a person's income, whichever is greater.

    [More from WSJ.com: Health Ruling Won't Cure States' Ills]

    Tens of millions of Americans are expected to get insurance coverage under the system that starts in 2014. Some of the poorest Americans will become newly qualified to enroll in the federal-state Medicaid program—although the court appeared to make some changes to how that program will work. Another batch of people who earn more but still have low incomes will get tax credits to offset their insurance costs. Consumers will be able to comparison shop for policies in newly created exchanges that will operate like popular online travel websites.

    [Related: Hospital stocks jump after health care ruling]

    Insurance companies will have to sell coverage to everyone, regardless of their medical history, and will have to restrict how much they vary premiums based on age. Companies with 50 workers or more will be required to offer insurance to their workers or pay a penalty.

    Q: What if I already have insurance?

    A: You may see changes to your plan. Unless your employer has "grandfathered" your insurance benefits' structure, your plan will have to meet new regulations under the law, such as covering more preventive services without out-of-pocket costs. There has been speculation that some employers will stop offering coverage and funnel workers toward exchanges once they open, but most companies say they have no immediate plans to do that.

    [More from WSJ.com: Ruling Underscores Hospitals' Strategy]

    Q: What will happen to my insurance premiums?

    A: Most consumers can expect to keep seeing increases in premiums and co-payments because the underlying cost of health care is expected to rise. The law contains a few mechanisms to curb premiums, but it also requires that many insurance providers make their benefits more generous, which will raise their cost. Older people could see their premiums go down because of the new age rating rules insurers will face. People who buy policies without the help of an employer could get a better deal by being able to shop on the exchanges, where comparing plans will be easier than before.

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    Re: Obama Care Wins Supreme Court Decision!

    Obamacare Lives: What You Need to Know
    By Morgan Housel/Motley Fool

    That was the tweet heard 'round the world this morning from the widely followed SCOTUS Blog.

    We'll probably be parsing the words of the Supreme Court's decision for weeks, but it looks like the individual mandate of the Affordable Care Act, also known as Obamacare, has survived.

    What's it mean?

    Very few expected this outcome. Intrade, an online betting site, put the odds of the mandate being struck down at around 70%. Even staunch supporters of the mandate seemed resigned in recent days to the likelihood that it would likely be repealed.

    Simplified, the bill does a few big things:

    Prevents insurance companies from denying customers for pre-existing conditions.
    Allows young adults to stay on their parent's insurance until age 26.
    Limits age-rating, or charging premiums several times higher for older customers.
    Eliminates lifetime insurance caps and restricts annual limits.
    Restricts how much insurance companies can spend on non-medical costs (overhead).
    Mandates that everyone acquire health insurance by 2014 or face a tax, offering subsidies or Medicaid for those who can't afford it.
    Here's what's important: According to the Census Bureau, 49.9 million Americans didn't have health insurance in 2009. Part of that is due to the weak economy; most of those without health insurance have a very low or nonexistent income. But a lot is due to soaring costs that have put insurance out of reach for the gainfully employed. According to the Kaiser Family Foundation, 69% of businesses offered workers health insurance in 2000. By 2009, that number had dropped to 60%. It's almost certainly lower today. Our health-care system doesn't work for far too many Americans, which likely explains why most of the policies outlined above are pretty popular. Most, that is, except the mandate to buy insurance:


    Source: Kaiser Family Foundation, April 2012.

    But there's a problem here. Without a mandate, most of the popular provisions of ACA wouldn't work. Last week, health-care reporter Sarah Kliff wrote in The Washington Post about what happened when Washington state made it illegal for health insurers to deny customers for pre-existing conditions (popular) but didn't make it mandatory to buy health insurance (unpopular):

    In 1993, Washington state passed a law guaranteeing all residents access to private health-care insurance, regardless of their health, and requiring them to purchase coverage. The state legislature, however, repealed that last provision two years later. With the guaranteed-access provisions still standing, the state saw premiums rise and enrollment drop, as residents purchased coverage only when they needed it. Health insurers fled the state and, by 1999, it was impossible to buy an individual plan in Washington -- no company was selling.
    Kliff mentioned one customer who told her insurance company that she "very much appreciated our excellent service [and] that she would certainly pick our plan again when she became pregnant." That doesn't work. A mandate gets around the problem by forcing healthy people to pay into the system, not just the sick.

    So, who wins here?

    The measuring of political wins and losses misses the point altogether. The winners here are the nearly 50 million Americans who don't have health insurance. They're the majority of personal bankruptcy cases linked to medical bills, and those who couldn't quit their job because they can't afford to lose employer-provided coverage.

    Health insurers might be seen as losers -- shares of UnitedHealth (NYSE: UNH ) , WellPoint (NYSE: WLP ) , and Cigna (NYSE: CI ) were all down big this morning -- but it's still entirely unclear how the bill will affect their business over the long haul. On one hand, there are a raft of new rules to comply with. On the other, they'll eventually see a flood of new customers effectively mandated to buy their product. First-day knee-jerk reactions rarely reflect the true impacts of big events.

    This isn't the end of the story, of course. Mitt Romney has vowed to repeal the ACA if elected president. One of the biggest complaints about the ACA is that it causes uncertainty. No one knows what might happen next, or what health-care costs will be a year or two from now. Alas, that hasn't gone away.

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by hagler04 View Post
    This is a VERY good thing. The number 1 albatross around the necks of US business is healthcare costs . . .not taxes, not 'regulation' . . but increasing healthcare costs they have to pay their employees. We are the only nation that still has the completly a$$-backwards idea of coupling healthcare to employment. It's stupid. More people on the exchanges is only a good thing. And this isn't more people on "welfare" . . people with jobs whose employer drops healthcare coverage won't suddenly get free healthcare . . they'll have to buy their insurance like everyone else.

    The Right makes out so-called 'Obamacare' to be either government-run healthcare (an absolute lie) or now a suddeny free expansion of healthcare to lazy people ie the poor (I heard the latter directly from tea-party inclined coworkers of mine). Yes Medicaid expansion is one piece of the puzzle (and more poor people on insurance and not going to emergency rooms is ultimately a cost saver) but the largest parts of the bill are the consumer protections for people already on insurance. It should really be called the Healthcare Consumer Protection Act b/c that is the main gist of the law.

    And it's funny that all of the nurses I know are in favor of this and some doctors I know aren't . . doctors overcharging and doing superflous tests are one of the big reasons our system is crushed by rising costs. 70%, at least, of medical care can be done safely and soundly by nurse practictioners and that is the dirty little secret many doctors are worried will get out with greater consumer protections on healthcare costs.
    hagler. On the surface it is a very good thing. And there are some very good features about it. However, what people do not understand is no one will see these patients, and the quality of care is going to suffer.

    I work for the nations well the worlds largest medical device company in Houston now. I sell Insulin pumps. We have patients that have seriousl glycemic excursions and hypoglycemic events that need to get on our pump immediately or could develop retinopathy, the need for dialysis and for every 1% point their sugars are above target, they increase their risk of dying due to a diabetes induced complication by 25%. To properly manage your diabetes once it has reached the state where you need insulin a patient needs to see a Endocrinologist. However, as of 8/1/2012 due to planning to deal with Obamacare, not one endocrinologist in Houston will see this patient, they have get their diabetes managed by a primary care office, that will take their insurance. So now this patient has to see a primary care physicians that is not equipped to treat her, provide the diabetic education etc.

    Hagler your way off on this one, and I hate the right wing idiots. this is an expansion of Medicaid. That is state run insurance. and that is exactly what Obamacare is, having the state have to provide insurance paid for by the taxes taken out of the taxpayer at the federal level. Medicaid is run by the state. In houston Medicaid patients are seen at two hospitals and they get subpar treatment. Many advanced treatments that do bring marginal benefits to many times life saving treatments are not paid for by medicaid. Many times Medicaid will require a step -edit process before ultimately providing the treatment the customer needed at first.

    Nurses by nature are the type that care for people. Many are not wired to think business. Many doctors are like the also. However, if you get a physician that runs his own office, he has to think business and he understands that everytime they see a medicaid patient it actually loses him $150 to $250 in opportunity costs ( what they could have gotten from a commercial plan) and in raw dollars they lose money when you factor in the cost associated with treating this patient and what they get from the government. Make no mistake about it Hagler, what is being offered, is a expansion of Medicaid. The quality of the service given is greatly reduced.

    Will there be parts of the plan that are good Yes. I have many patients that need a pump, that when we verify insurance, it some back they have a pre-existing illness (diabetes) and have to wait until the have the insurance plan for a year. Things like that. Ultimately some will benefit, but most will suffer, as you will see your cost go up, and more small business will opt out of covering their employees forcing more people onto this plan, increasing our costs.

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    Re: Obama Care Wins Supreme Court Decision!

    The problem with the ENTIRE thing-- both the old system and the Affordable Healthcare Act-- is that nobody needs health insurance. That's only an additional slice of the pie which goes to insurance company costs for pushing paper and denying claims, and for huge bonuses to their executives for NOT paying benefits.

    What we all need is health care.

    Insurance is the problem that has crippled this nation the old way, and under Obamacare will still not get us out from under. Yet Obama caved to the Right and to insurance companies, and the Right wing in Congress voted against him in the end.

    Cut out the health insurers, they do NOTHING good for people who need health care nor for those who pay for it (whether business, the gov't, or the patients themselves). Health insurance companies are indeed the death panels Stupid Sarah feared would come, or at least which that lying woman claimed to fear would come . . . they've been here for decades already. They already DO ration health care, every day, and have for decades.

    We need single-payer-- Medicare for all. Seems to work everywhere in the industrial world except the "freedom-loving" US. Free to drop dead and not be treated, as per Ron Paul and cheered by the Republican debate crowd.

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by Michael Frank View Post
    The problem with the ENTIRE thing-- both the old system and the Affordable Healthcare Act-- is that nobody needs health insurance. That's only an additional slice of the pie which goes to insurance company costs for pushing paper and denying claims, and for huge bonuses to their executives for NOT paying benefits.

    What we all need is health care.

    Insurance is the problem that has crippled this nation the old way, and under Obamacare will still not get us out from under. Yet Obama caved to the Right and to insurance companies, and the Right wing in Congress voted against him in the end.

    Cut out the health insurers, they do NOTHING good for people who need health care nor for those who pay for it (whether business, the gov't, or the patients themselves). Health insurance companies are indeed the death panels Stupid Sarah feared would come, or at least which that lying woman claimed to fear would come . . . they've been here for decades already. They already DO ration health care, every day, and have for decades.

    We need single-payer-- Medicare for all. Seems to work everywhere in the industrial world except the "freedom-loving" US. Free to drop dead and not be treated, as per Ron Paul and cheered by the Republican debate crowd.

    Insurance by definition only works if the event being insured against is not likely to happen/is not need regularly. Therefore, catastrophic health coverage of some kind "could" work but for healthcare for everything we need on a regular basis, insurance makes zero sense. The rest of the world has realized this, but we are still stuck in the mud.

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by hagler04 View Post
    Insurance by definition only works if the event being insured against is not likely to happen/is not need regularly. Therefore, catastrophic health coverage of some kind "could" work but for healthcare for everything we need on a regular basis, insurance makes zero sense. The rest of the world has realized this, but we are still stuck in the mud.
    Well put, hagler04. Yes, catastrophic health insurance makes sense.

    But for comprehensive health care needs, including basic check-up appointments, insurance is an added cost and simply a waste of money to pay a health insurance company so they'll then MAYBE pay a doctor-- with that insurance company BOTH cutting what they'll pay the doctor AND telling the patient what they will and won't pay for!

    The systrem is so f__ked up that doctors wanting a full roster of patients need to affiliate with health insurers because the insurers control so many patients-- i.e., so many potential customers of that doctor, and for the privilege of the doctor having access to these potential customers, he has to agree to take much lower fees from the insurance companies.

    Guess who makes up the difference? Answer: OTHER, non-insured patients. That's right, when someone goes into a doctor's office with the temerity to actually pay cash, she is charged FULL PRICE, receiving no discount, unlike the insurance company.

    Indeed, the insurance companies not only ration care AND avoid paying benefits whenever possible, but they truly control the market-- they control the doctors/providers plus the demand side, the patients. AND they determine the prices paid.

    Doctors who refuse to deal with insurance companies and who might charge an intermediate-level price are probably non-existent-- as there are few cash customers around; most people in the US have private insurance, Medicaire or Medicaid.

    One of my many beefs with the Republicans is, why were they all in favor of gov't insurance under Nixon, who proposed it himself, also under Clinton ONLY IF mandated coverage was included in the bill, but somehow under Obama, the same damn thing is now "socialism"? "Killing freedom."

    See, that's their problem-- they have no loyalty to the US at all, only to the Republican party, which decided it will flush the country down the toilet rather than do anything bipartisan with Obama. At no time in US history have so many bills been voted against by their own sponsors! Yup, often when a Repub Congressman drafts a bill and then Obama later supports it, the Repub sponsor votes against it! THAT should be something they send you to prison for, as it's totally jerking around the Congress and President of the US. ONLY for self-serving, political purposes.

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    Re: Obama Care Wins Supreme Court Decision!

    THE REAL WINNERS
    By PAUL KRUGMAN/NY TIMES

    So the Supreme Court — defying many expectations — upheld the Affordable Care Act, a k a Obamacare. There will, no doubt, be many headlines declaring this a big victory for President Obama, which it is. But the real winners are ordinary Americans — people like you.

    How many people are we talking about? You might say 30 million, the number of additional people the Congressional Budget Office says will have health insurance thanks to Obamacare. But that vastly understates the true number of winners because millions of other Americans — including many who oppose the act — would have been at risk of being one of those 30 million.

    So add in every American who currently works for a company that offers good health insurance but is at risk of losing that job (and who isn’t in this world of outsourcing and private equity buyouts?); every American who would have found health insurance unaffordable but will now receive crucial financial help; every American with a pre-existing condition who would have been flatly denied coverage in many states.

    In short, unless you belong to that tiny class of wealthy Americans who are insulated and isolated from the realities of most people’s lives, the winners from that Supreme Court decision are your friends, your relatives, the people you work with — and, very likely, you. For almost all of us stand to benefit from making America a kinder and more decent society.

    But what about the cost? Put it this way: the budget office’s estimate of the cost over the next decade of Obamacare’s “coverage provisions” — basically, the subsidies needed to make insurance affordable for all — is about only a third of the cost of the tax cuts, overwhelmingly favoring the wealthy, that Mitt Romney is proposing over the same period. True, Mr. Romney says that he would offset that cost, but he has failed to provide any plausible explanation of how he’d do that. The Affordable Care Act, by contrast, is fully paid for, with an explicit combination of tax increases and spending cuts elsewhere.

    So the law that the Supreme Court upheld is an act of human decency that is also fiscally responsible. It’s not perfect, by a long shot — it is, after all, originally a Republican plan, devised long ago as a way to forestall the obvious alternative of extending Medicare to cover everyone. As a result, it’s an awkward hybrid of public and private insurance that isn’t the way anyone would have designed a system from scratch. And there will be a long struggle to make it better, just as there was for Social Security. (Bring back the public option!) But it’s still a big step toward a better — and by that I mean morally better — society.

    Which brings us to the nature of the people who tried to kill health reform — and who will, of course, continue their efforts despite this unexpected defeat.

    At one level, the most striking thing about the campaign against reform was its dishonesty. Remember “death panels”? Remember how reform’s opponents would, in the same breath, accuse Mr. Obama of promoting big government and denounce him for cutting Medicare? Politics ain’t beanbag, but, even in these partisan times, the unscrupulous nature of the campaign against reform was exceptional. And, rest assured, all the old lies and probably a bunch of new ones will be rolled out again in the wake of the Supreme Court’s decision. Let’s hope the Democrats are ready.

    But what was and is really striking about the anti-reformers is their cruelty. It would be one thing if, at any point, they had offered any hint of an alternative proposal to help Americans with pre-existing conditions, Americans who simply can’t afford expensive individual insurance, Americans who lose coverage along with their jobs. But it has long been obvious that the opposition’s goal is simply to kill reform, never mind the human consequences. We should all be thankful that, for the moment at least, that effort has failed.

    Let me add a final word on the Supreme Court.

    Before the arguments began, the overwhelming consensus among legal experts who aren’t hard-core conservatives — and even among some who are — was that Obamacare was clearly constitutional. And, in the end, thanks to Chief Justice John Roberts Jr., the court upheld that view. But four justices dissented, and did so in extreme terms, proclaiming not just the much-disputed individual mandate but the whole act unconstitutional. Given prevailing legal opinion, it’s hard to see that position as anything but naked partisanship.

    The point is that this isn’t over — not on health care, not on the broader shape of American society. The cruelty and ruthlessness that made this court decision such a nail-biter aren’t going away.

    But, for now, let’s celebrate. This was a big day, a victory for due process, decency and the American people.

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    Re: Obama Care Wins Supreme Court Decision!

    Why ObamaCare is Not Enough: It’s the Health Care Costs, Stupid!
    by Mark Hyman, MD

    In the run-up to the presidential election, the political debate is heating up around ObamaCare. This week the Supreme Court upheld ObamaCare and the individual mandate, but the single biggest question is hauntingly absent from the campaign discourse.

    How do we stop and turn back the tsunami of chronic disease, in particular, diabesity – the continuum of obesity, pre-diabetes, and diabetes that is the major driver of 21st century suffering and costs?

    Diabesity is the hidden cause of most heart disease, hypertension, high cholesterol, stroke, dementia, many cancers (breast, colon, prostate, pancreas, liver, and kidney), and even depression. Yet is it almost never treated directly because there is no good drug for it.

    Over the next 20 years $47 trillion will be spent around the world to address chronic diseases caused by diabesity.

    How our next president addresses this will determine whether or not we bequeath a bankrupt, desperately sick nation to our children; the first generation of Americans who will live sicker and die younger than their parents.

    The good news is while we cannot solve problems like war or natural disasters, we can solve diabesity. We haven’t been able to win the war in Afghanistan, but we can win this war on chronic disease.

    Diabesity is nearly 100% preventable, treatable, and very often curable. As Donald Rumsfeld said, this is a “known, known.” The science is clear, the strategies well documented (if little applied.) Democrats, Republicans, Libertarians, and Tea Partiers alike all have the potential to get sick and must face this problem square on.

    Diabesity affects one in two Americans, yet is not diagnosed in 90% of those who have it. In fact, there are no national screening recommendations for pre-diabetes or for persons at high risk for diabetes. The implications of this medical blind spot are staggering – the single biggest cause of chronic disease is overlooked and not treated 90% of the time.

    Twenty-five percent of those over sixty-five, one in five African-Americans, and one in ten across the whole population have diabetes. One in three children born today will have diabetes in their lifetime.

    And pre-diabetes affects up to 150 million Americans. Diabetes alone accounts for one in three Medicare dollars spent. Diabetics cost health plans five times more than non-diabetics ($20,000 versus $4,000.) By 2014, when sixteen million more citizens are eligible for Medicaid, the burden of costs will be even greater.

    Seventy percent of the federal budget is for Medicare, Medicaid, and Social Security. By 2042, 100% of the federal budget will be required to pay for Medicare and Medicaid, leaving nothing for defense, transportation, education, agriculture, environment, or any of the government’s other basic services.

    This is unsustainable. We need a collective, bipartisan national campaign with the passion and vision of President Kennedy’s call to action, of “putting on a man on the moon by the end of this decade.”

    The insurance reform at the heart of the Affordable Care Act allows for better access to medical care, including medication and surgery. It laudably promotes improved efficiencies, reduction in medical errors, better care coordination, and implementation of best practices.

    But what if we are coordinating the wrong kind of care? What if our best practices are the wrong practices?

    Our toxic industrial diet, our sedentary lifestyle, chronic stress, and environmental toxins cause diabesity and its attendant downstream ills (often mislabeled as something else such as hypertension, cancer, heart disease, and dementia.)

    Drugs and surgery are feeble, ineffective, costly, and often harmful treatments for lifestyle-induced illness. They are misguided efforts at best, dangerous at worst. Mounting evidence proves that the solution to lifestyle and diet-driven obesity-related illnesses won’t be found at the bottom of a prescription bottle; they will be found at the end of our fork.

    Prescription medication for lifestyle disease has failed to bend the obesity, disease and cost curves. Statins have been recently found to increase the risk of diabetes in women by 48%.

    And factoring in the increased risk of diabetes when statins are used to prevent first heart attacks, there is no net benefit, and significant potential harm from statin use in the over 20 million Americans who take them.

    Avandia, for example, the number one blockbuster drug for type-2 diabetes, has caused nearly 200,000 deaths from heart attacks since it was introduced in 1999. The large ACCORD trial found in over 10,000 diabetics that intensive blood sugar- lowering with medication and insulin actually led to more heart attacks and deaths.

    This is Pharmageddon.

    A recent study found that over 75% of stent placements for heart disease don’t help at all to reduce heart attacks and deaths, are harmful, and unnecessarily increase health care expenditures. Yet the number of angioplasties and stent placements performed has increased, not decreased.

    We don’t have “evidence-based” medicine. We have “reimbursement-based” medicine. Doctors do what they get paid to do, not what the science shows they should do.

    That’s the bad news. The good news is that there is an extensively studied, scientifically validated set of strategies that work better, faster, and cheaper than medication and surgery and can be implemented at scale with little cost by lay people in local communities and in medical practices.

    Intensive lifestyle therapy, not wellness counseling or prevention, but lifestyle treatment of existing chronic disease focusing on pre-diabetes, diabetes, and heart disease has been proven to work better than medication or surgery.

    Currently this is not implemented in our health care delivery system or in community-based programs in any meaningful way. But it can and should be.

    Intensive lifestyle treatments – simple, proven behavioral change strategies, peer and online support, appropriate financial incentives, and partnerships within communities can be used to address the social, behavioral, and biomedical roots of diabesity.

    While individual mandate and insurance reform are the main focus of the debate surrounding ObamaCare, little known but potentially transformative provisions of the Affordable Care Act provide the seeds of change for our entire health care system.

    These provisions, the National Diabetes Prevention Program (section 10501), Prevention and Public Health Fund (section 4002), creation of community health teams (section 3502), and incentives for states to prevent chronic illness among Medicaid beneficiaries (section 4108), could stem the tide of chronic disease.

    There is no lack of pilot programs, demonstration projects, and examples of the success of intensive, community-based lifestyle programs to improve health care outcomes and reduce costs. Current provisions for payment and innovation within the health reform bill set the stage for expansion of these programs.

    The Diabetes Prevention Program showed that a structured lifestyle-change program could reduce the progression to diabetes by 58%, working better than any other known treatment.

    The study published in 2002 in the New England Journal of Medicine, was based on outdated and contraindicated nutritional advice from the old Food Pyramid recommending a low-fat diet for diabetes prevention.

    The study was performed when bread and pasta was king, and our government encouraged us to eat 8-10 servings a day of bread and cereals, which are now known to directly drive the risk of diabetes. And yet still, it was more effective than any medication.

    This model has been scaled in communities and organizations across America, including a partnership with the Center for Disease Control, YMCA of America, and United Health Group using lay health coaches to implement the program.

    While the dietary recommendations are still less than ideal, these programs are working. Imagine what a program based on 21st century nutritional science could do. And these programs have been conservatively documented to save billions.

    Over the last few years a number of examples of the power of community-based peer-support models have emerged. At Saddleback Church, Rick Warren, Dr. Mehmet Oz, Dr. Daniel Amen, and I enrolled more than 15,000 congregants in a lifestyle change program delivered with online support in small peer-support groups.

    The church lost 250,000 pounds in one year, and many reversed diabetes, reduced or eliminated medication, and avoided hospitalization. We changed the culture of the church, and changed what was served at bible breakfasts, at work, and at home.

    Participants learned to create health together — to shop, cook, eat, exercise, and play together. We didn’t treat disease. We didn’t create a weight-loss program.

    We taught people self-care and how to care for one another, and together they created a miracle – something health care or health care reform has not been able to achieve.

    Innovative community-based models also can change our default choices for how we live, move, eat, and play. If the things that create health are easy to access and things that create disease are hard to get to, extraordinary change occurs.

    In Albert Lea, Minnesota, a pilot project was designed to create healthy choices and limit bad ones. Kids who weren’t allowed to eat in hallways and classrooms, for example, lost 10% of their weight.

    In Thailand, one community garden is irrigated by an old bike hooked up to a generator run by patients with diabetes. They get exercise and grow healthy food at the same time.

    This model has been replicated across the world – including Peers for Progress that created pilot programs to treat diabetes in Cameroon, Uganda, Thailand, and South Africa based on peer support.

    The peer support group models were more effective than conventional medical intervention for improving the health of diabetics and healthcare costs decreased tenfold.

    Health, it seems, happens outside the clinic, where people live, work, play, and pray. We need to rethink how we treat chronic disease. It is not only better medical management, which often just barely, if at all, staves off complications and death, but with high-science, low-cost, and high-touch innovations.

    A comprehensive integrated strategy can solve this problem. Start with revised screening guidelines to identify the 90% of pre-diabetics and the 25% of diabetics never diagnosed.

    Build new practice models and reimbursement for group visits to deliver lifestyle medicine in more effective and cost efficient ways. Support and scale proven community based peer-supported models of lifestyle change.

    Over 20% of Americans are out of work. Train a new army of 1 million community health workers, like the barefoot doctors of China, who can support their peers in creating health. Set a national goal for America of losing 1 billion pounds a year.

    Retool medical education to train future doctors in lifestyle and food treatment. Support private-public partnerships to create community environments that foster a healthier lifestyle.

    Fully fund programs that work (lifestyle change), and stop paying for what doesn’t work (most angioplasties and stents and statin use.) Implement little-known provisions from the Affordable Care Act that can effect change.

    Prioritize the work of the newly formed National Council on Prevention, Health Promotion and Public Health Council, an inter-agency council focused on creating a healthy America outside of the clinic and hospital. Fund these programs, test them, implement them, measure them, and then let the good ones flourish.

    We can’t win the war in Afghanistan, and we have been losing the war on cancer, but this is one war we can win. We just need to mobilize.

    To your good health,

    Mark Hyman, MD

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    Re: Obama Care Wins Supreme Court Decision!

    To those who want Obamacare for the right reasons, enjoy your victory, b/c its on a grandscale. But as the old saying goes, be very careful what you wish for. This will fundamentally change healthcare decision making in ways many aren't looking at down the line. And imo, there will be no turning back as we go down this tunnel.

    For me, the initial disgust with this court decision is rawest as I watch the sanctimony & dishonesty of the President, Pelosi and Newt (more on him in a sec.) who orchestrated it.

    I would respect them more, if they were honest, that what this is really about is a pure & naked power grab wh/ has nothing to do w/ feeling good about the healthcare of the citizenary. No, when I see the gleam in their eyes & the licking of their chops, I see their acknowledgement that they've just harpooned the largest whale in the sea. Roberts greenlighting this, will give the admin the largest entrenchment of domestic power of any legislation of the 20th century. This will be a State pandora box on steroids. A sad day for those who endorse liberty. The entangling & frankly dangerous ramifications of this natl healthcare system will give the State encompassing powers over individuals wh/ its never had.

    The GOP, for the most part, is just as culpable, and in many cases, are fine w/ this. It's only the principled libetarian leaning wing of the party that truely doesnt want this, and there arent enough of them to turn this back. The obstuctors of this who are mad simply b/c Obama pushed it thru (like Rush/hannity water carriers) are part of the problem also. They failed to admit the past system was broke & frankly left too many fair minded citizens out to dangle.

    This problem has enemies on both sides and goes back some 25 years. Its part of a growing encroachment of big State in colloboration w/ big healthcare that has grown exponentially in both parties for some time.

    If the many in the GOP had really wanted to stop this, they wouldve done this from newt's reign as house speaker thru 2003 before the gulf war went to hell and they had the leverage to get a compromising bill that couldve served the citizenery fairly.

    Instead, they sold out to big insurance and trial lawyers who didnt want the system changed (this is why I didnt believe the recent Newt, even though on paper he was right). They allowed both to create a private sector system that was wasnt a real free market, but rather a colluding oligopoly wh/ was aided by law and big govt itself (in allowing it to occur via pac $). Interstate insurance competition was never allowed wh/ wouldve broke the oligopoly squeeze. Furthermore, no tort reform was brought in to also lower costs. The end result has been disasterous and profoundly left people out in the cold to suffer. Neither party pushed for reform that would address problems w/o overarching state control. It made the GOP look insensitive & has allowed the Statist elements of the democratic party to be able to soon entrench a command system. It has essentially opened the door for this approaching slouching beast wh/ imo will make the last 25 years seem tame.

    It didnt have to be this way. Thru '03, a doable private sector solution was for the making. One that wouldve had strong govt regulations & safety nets in place, but wouldve still left automony with the citizen, not the state. If reforms had been put in place, it wouldve been a viable system that both sides couldve lived with. More importantly it wouldve been more efficient, less costly, covered all & left decision making still w/ the citizen.

    sadly, the power brokers in both parties, didnt want that to happen. the common denominator greed & power. You will hear a lot of lip service from a good % in the gop about belly aching, but in reality its crocodile tears. They knew this would happen & they frankly profited from it.

    the system we will have, sold sanctimonously as noble and altruistic, starting in '13, will quickly chip away at quality and freedom. what many citizens haven't looked at closely (b/c its been couched in complexity & media clouding) is the round-about way their quality, taxes and freedom will be curtailed. sure you will have choice, but your doc will NOT. Doctors will be COMPELLED via obamacare to follow the rules of the STATE. It will be a headfake command system. That is the power of the litigation arm in this. Plus it will become too expensive for small business, they will opt out & thus govt will have increasing leverage.

    The winners will be the State; lawywers and large insurance corporations (same culprits as before); & big pharm.

    Losers will be: small & mid sized healthcare businesses; healthcare practioners; the debt; healthcare innovation; middle class tax payers; & finally patient service quality.

    This will also grow in control & be so entrenched as to never be repealed enough to allow a viable free market solution. It unconstitionality will come in further focus for citizens as they start to see how many businesses opt out. Decision making falls into elite hands. Large govt will outsource that to big insur and pharm that are in the tent w/ big govt. It will curtail innovation and make seing your family doc more like a McMart doc in the box clinic.

    Practioners will be overworked w/ less profit motive potential. the upper tier open to the rich and elites in govt will have access to the best, the rest will be shifted to a State funded system wh/ will be over debted, inefficient & will have to inpose some form of quotos and waiting lists to deal w/ the overload. It will be free and b/c of it many at first wont complain. Yet, they will see quality slip, personal choice curtailied & govt debt increase. Of course they will realize that nothing indeed is free as they see hidden taxes increase to absorb the cost. Big players who have been outsourced the contracts (think pfizer, large Insur, & large healthcare living corps.) will consolidate and lock in their markets in ologopolies cutting out new innovative competition. They win, but the quality will certainly suffer. It will essentially work like a modern East india company control over tea in collusion w/ the crown.

    problem is tea is a choice, your health isnt. furthermore, the only way the citizenary can change is thru repeal. w/ the supreme court ruling and the entreching nature of healthcare, that will be highly unlikely. As I said before, be careful what you wished for.
    Last edited by HandToMouth; 07-03-2012 at 05:01 PM.

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    Re: Obama Care Wins Supreme Court Decision!

    well said Hand to mouth.

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by HandToMouth View Post
    It didnt have to be this way. Thru '03, a doable private sector solution was for the making. One that wouldve had strong govt regulations & safety nets in place, but wouldve still left automony with the citizen, not the state. If reforms had been put in place, it wouldve been a viable system that both sides couldve lived with. More importantly it wouldve been more efficient, less costly, covered all & left decision making still w/ the citizen.

    .
    I'm assuming you are talking about some sort of 'private-sector based solution' without an individual mandate . . which would be impossible. If you want consumer protections under our current system, you need everyone in the system. The GOP realized this in 94, Romney did in 02, and Obama in 09.

    Also, any 'private sector-based solution' with insurance companies at the helm doesn't leave intact consumer choice . . a healthcare system based on private, employer-provided health insurance (which as I stated before, is a horrible system and we are the only backwards country using such a system designed for the 1930s) leaves the consumer at the whim of a) Their employer and b) The health insurance company. This is an industry who hired people whose sole job was to fund ways to deny people coverage. Beyond the admin costs of that which distort the market, that IMO is purely morally reprehensible.

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by hagler04 View Post
    I'm assuming you are talking about some sort of 'private-sector based solution' without an individual mandate . . which would be impossible. If you want consumer protections under our current system, you need everyone in the system. The GOP realized this in 94, Romney did in 02, and Obama in 09.

    Also, any 'private sector-based solution' with insurance companies at the helm doesn't leave intact consumer choice . . a healthcare system based on private, employer-provided health insurance (which as I stated before, is a horrible system and we are the only backwards country using such a system designed for the 1930s) leaves the consumer at the whim of a) Their employer and b) The health insurance company. This is an industry who hired people whose sole job was to fund ways to deny people coverage. Beyond the admin costs of that which distort the market, that IMO is purely morally reprehensible.
    Agree totally, Hags. With every word.

    Also liked and mostly agreed with HTM's post, though I don't think either the president or Pelosi lied about a thing. The Right, yes, I think they've been lying about this and everything else for years now. Their only consistency is that however Obama feels about anything, they then feel the opposite. Wonderful. Why was national health care, with a mandate, fine for Repubs Nixon, Dole, and Gingrich in prior years, but NOW with a black, Democratic president, it's "socialism"? Someone just please explain the 180-degree turn on this by Repubs, most notably Gingrich and Romney, as in the slightest way "principled".

    My other disagreement with HTM would be, respectfully as always, that if we should be careful what we wish for, then should that also be said about Medicare (about which the populace is overwhelmingly pleased)?

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    Re: Obama Care Wins Supreme Court Decision!

    I do find it a bit troubling that there is a for-profit motive with insurance companies. Seems to me a bit icky and rife with conflicts/problems when the insco's incentive is not for you to be healthy, but to make sure it pays as little as possible for your health care. That is why I lean towards the government providing the insurance, or some form of it as an alternative option, using non-profit methodology, and charge a rate at which everyone can have full coverage, and without having a bunch of profits left over to pay boards of directors and investors, or where we have folks at the company looking for ways not to cover you or to get you to pay more money. I think the movie Sicko effectively made that point.

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    Re: Obama Care Wins Supreme Court Decision!

    Quote Originally Posted by apollack View Post
    I do find it a bit troubling that there is a for-profit motive with insurance companies. Seems to me a bit icky and rife with conflicts/problems when the insco's incentive is not for you to be healthy, but to make sure it pays as little as possible for your health care. That is why I lean towards the government providing the insurance, or some form of it as an alternative option, using non-profit methodology, and charge a rate at which everyone can have full coverage, and without having a bunch of profits left over to pay boards of directors and investors, or where we have folks at the company looking for ways not to cover you or to get you to pay more money. I think the movie Sicko effectively made that point.
    Agree on all counts, apollack.

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