Op-ed: Hobby Lobby and the Constitutional Right to Be Stupid

[Cindy]

Can someone explain to me (a none USA) what all this means? I thought that 'Obamacare' was going to give universal health care to Americans, now there is this. How do you guys actually get and pay for health care?

As an Aussie I pay 1.something of my income for 'free' health care, in addition I can take out private insurance that gives me freedom of choice.

Yes there are problems but it seems to me a good system that protects those who cannot afford health care, the majority pay for the poor and everyone gets free access with no restrictions.

So what do you get and why not have a similar system?

[dalebert]

Allowing healthcare to be a commercial privatized market has major moral conflicts, in my view it removes the care from healthcare, because noone cares, they just want your money.

I really don't understand why healthcare is somehow in a special category of things that should be provided for free from governments versus any other need a person has. I understand wanting a safety net and I was heavily involved in voluntary efforts to provide one in the form of a privately-run overflow homeless shelter. I spent several nights a month as a volunteer staying up all night at it. For several years I spent one night a week helping prepare food at the local soup kitchen. The idea was the efforts of volunteers who could afford the time was given up for people who were in desperate (though usually temporary) need. But it's this idea that certain things should automatically be provided to everyone because we need them that I just don't get. It's very inconsistent. There are SO many things we need to survive. Why don't we say the same about shelter, food, or even shoes? Those needs are even more key to our survival than healthcare.

Can someone explain to me (a none USA) what all this means? I thought that 'Obamacare' was going to give universal health care to Americans, now there is this. How do you guys actually get and pay for health care?

I'm sure that's the ultimate goal and that's what it was sold as to plenty of people who didn't read the fine print or at least failed to put effort into fully grokking it. It established standards for commercial companies that provide insurance as to what it must provide, standards for companies, like whether they must provide health insurance as a benefit depending on number of employees and how many hours an employee works, and it established penalties for failure to obtain health insurance depending on whether the Federal government thinks you can afford it based on math formulas.

My sister, for instance, who recently lost her house to foreclosure and is now renting and who's husband is now unemployed, is paying over $300/month in addition to her normal taxes as a fine for not having health insurance which she says she can't afford. In the interest of full disclosure, I have to admit that I don't think my sister is particularly responsible with money. Maybe she really should be renting a tiny apartment and making the kids share a room so they can afford health insurance. All I know is her family made a decision that affects them alone and they're being punished by the U.S. government for their "bad" decision.

[kira21 ♡♡♡]

I really don't understand why healthcare is somehow in a special category of things that should be provided for free from governments versus any other need a person has.

Erm, because its morally wrong to let people die and suffer from curable stuff just because they are poor maybe? :-)

[dalebert]

Erm, because its morally wrong to let people die and suffer from curable stuff just because they are poor maybe? :-)

I'll repeat myself. Then based on that reasoning, why aren't you arguing that all housing and food be completely provided by governments instead of by businesses? People will suffer and die if they don't have those things.

[Misato]

Where I was two employers ago was self insured so they got to build whatever plan they wanted. They artfully cut out all trans care coverages. They denied coverage to same sex domestic partners and lied to myself and another colleague about it by saying they couldn't cover same sex domestic partners at the time because of ERISA. I know it was a lie because General Mills was operating under the same law and did offer insurance to same sex couples.

I can't prove that company was operating under religious descrimination, but it felt like it and not just to me. The two gay guys who started with me: one mounted an in your face resistance, the other went back into the closet while at work.

The people I worked with there were great. But HR and management made it an intolerable place to work. I totally get the importance of religion to many people. I would not call their faith "stupid". I do demand however, that those of faith follow George Carlin's second commandment, "Keep thy religion to thy self." After that employer, after listening to those advocating for faith based discrimination no, we cannot allow this country's laws to be used to protect only those who use their faith as a proxy/justification for their own hatred of something.

[Dee Marshall]

Except when the law requires that it be provided by all companies. Claiming a religious justification should not exempt any company from following the law. This is a bad decision made by conservative members of the Supreme court to support their individual political agendas in violation of their solemn oaths as judges. They should all be impeached.

Spot on, Susan. Unfortunately, Supreme Court Justices are selected by the president and confirmed by congress and then serve for life. There is no way to remove one from the bench. It's supposed to give us a measure of stability, which it does unless a president is allowed to "pack" the panel, as Bush was, then it gives us a measure of instability.

[Eris]

The top priorities of any private business are to survive and to make a profit. Whilst individuals within a private healthcare company may genuinely care about helping others at the end of the day the agenda for the business will be set by management who's job is to make money and to keep the company running.

In a market where viable alternatives to private care exist a reasonably high standard must be maintained in order to ensure repeat business. However where the only access to health care is from private providers (particularly large monopolies or oligopolies) then they are able to give you less bang for your buck (provided they are united in their shoddy service) and you have little alternative but to take what you can get.

This is particularly obvious where Phone and Internet monopolies which use the fact that they are often your only option in a geographical area to provide you with terrible service which lags behind Estonia.

The US private health care system is on average more than twice as expensive for you the customer than it is in countries where you receive universal health care paid for though taxation.
Particularly outpatient care where private healthcare companies take the opportunity to gouge you for additional fees.

What I can't understand is why Americans continue to pay far more in premiums for health insurance than they would for universal healthcare.
Whilst it tends to be slow and bureaucratic for non emergency procedures no one will refuse you treatment in an emergency or ask for money for emergency aid.
In Scotland prescriptions for existing conditions are also paid for by the taxpayer.
If they weren't then I'm not sure my mother could continue to obtain the drugs required for her to keep her sight.

Is it ingrained in the cultural psyche of America that any form of tax increase is unacceptable?

Here's a recent comparison by Forbes which may comparing the US health care system to 10 other countries showing that not only does private health care cost you more money, but that it's also worse...

http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/

[Olivia P]

I'll repeat myself. Then based on that reasoning, why aren't you arguing that all housing and food be completely provided by governments instead of by businesses? People will suffer and die if they don't have those things.

Yes homelessness and extreme poverty is terrible and it is indeed morally wrong to collect insane amounts of money you will never spend while there are people experiencing homelessness and extreme poverty.

Fortunately there are charities that plug the gaps, although as my dad says, if the system worked there would be no need for charity.

[SarahM777]

Can someone explain to me (a none USA) what all this means? I thought that 'Obamacare' was going to give universal health care to Americans, now there is this. How do you guys actually get and pay for health care?

As an Aussie I pay 1.something of my income for 'free' health care, in addition I can take out private insurance that gives me freedom of choice.

Yes there are problems but it seems to me a good system that protects those who cannot afford health care, the majority pay for the poor and everyone gets free access with no restrictions.

So what do you get and why not have a similar system?

To put it as simply as possible Obama care is NOT universal health care but it is mandated insurance. So basically everyone is to buy health insurance. They set it up that if one fell under a certain percentage of the poverty level then the feds would help subside the insurance payments,or if eligible one could qualify for medicare. But there is a catch with that,some of the states accepting the federal funding to expand the medicare coverage to about 140% of the poverty level so those who fall under that would be covered by medicare. However other states did NOT accept the federal funding (The state I live in did NOT) In the state I live in if you go over 100% of the poverty level,you're up a creek without a paddle so to speak. You don't qualify to be on medicare nor do you qualify to GET THE federal subsidy towards your health insurance.

Basically what we have is far less health care for our money then you do because what we really have is a system that is a glorified bill paying service that charges a huge sum of money to do so. Why is that you may ask? It's the great paper chase. Our biggest problem is all the paper work to get the bills paid.

[Colleen M]

Yes homelessness and extreme poverty is terrible and it is indeed morally wrong to collect insane amounts of money you will never spend while there are people experiencing homelessness and extreme poverty.

Fortunately there are charities that plug the gaps, although as my dad says, if the system worked there would be no need for charity.

I'd actually say he's got it backwards:

If the public funds charity well enough to meet requirements, government largesse is not required.
If the public refuses to fund charity well enough to meet requirements, government largesse has no mandate.

It's actually moot in the United States, as in either case the government is simply not authorized.   

[kira21 ♡♡♡]

I'll repeat myself. Then based on that reasoning, why aren't you arguing that all housing and food be completely provided by governments instead of by businesses? People will suffer and die if they don't have those things.

Actually in the UK, if you are not able to feed and house yourself, for example through being made redundant or becoming disabled, you will be supported in that too. So yes, I think that, in a civilised society, we do not allow people to suffer in pain, starve or become homeless, so I would prefer that actually.

The fact is though, that most people can feed and house themselves, though it does become somewhat tricky to perform your own triple heart bypass, so healthcare is pretty much always a collective provision.

[Colleen M]

To put it as simply as possible Obama care is NOT universal health care but it is mandated insurance. So basically everyone is to buy health insurance. They set it up that if one fell under a certain percentage of the poverty level then the feds would help subside the insurance payments,or if eligible one could qualify for medicare. But there is a catch with that,some of the states accepting the federal funding to expand the medicare coverage to about 140% of the poverty level so those who fall under that would be covered by medicare. However other states did NOT accept the federal funding (The state I live in did NOT) In the state I live in if you go over 100% of the poverty level,you're up a creek without a paddle so to speak. You don't qualify to be on medicare nor do you qualify to GET THE federal subsidy towards your health insurance.

Basically what we have is far less health care for our money then you do because what we really have is a system that is a glorified bill paying service that charges a huge sum of money to do so. Why is that you may ask? It's the great paper chase. Our biggest problem is all the paper work to get the bills paid.

Without disagreeing with you, I'd like to add that the law authorized subsidies only to low-income residents of states which set up "exchanges" which are what it calls the marketplaces.  Most states elected not to set up these marketplaces for the regulated sale of private insurance, and the few that did generally showcased an inability to put together a website.  The federal government had an absolutely disastrous exchange roll-out and the executive is now claiming that the law which explicitly refers to exchanges in "states" allows the federal government to offer the subsidies instead.  Our legal system requires someone to at least pretend they're being hurt by this interpretation before they can sue to have a court (eventually Supreme) actually clarify that one way or the other and we're a little short on people who feel harmed by subsidies.

It is such an overcomplicated disaster that there's a belief from parts of both left and right here that the whole thing was actually deliberately set up as a flaming catastrophe which would set the stage for single-payer so we could get something which works as well as the healthcare we provide our veterans, which has long been the yardstick of how the U.S. government makes single-payer work.     

[suzifrommd]

So what do you get and why not have a similar system?

I'll speak only for myself.

It's very important to me that if I don't like the game I be able to take my bat and ball elsewhere.

I'd like my medical provider to know that if they don't satisfy me, I can fire them and bring in someone else. That's why I don't favor a single government system.

Again, this is just my personal viewpoint. I have no economic evidence that it's any better.

[dalebert]

Actually in the UK, if you are not able to feed and house yourself, for example through being made redundant or becoming disabled, you will be supported in that too. So yes, I think that, in a civilised society, we do not allow people to suffer in pain, starve or become homeless, so I would prefer that actually.

We have safety nets for people in the U.S. and have for some time. We have food stamp programs, welfare, medicaid. There are clinics that are funded at various levels of government. There are things like Planned Parenthood clinics that are charitably funded and I imagine get some government funding and they actually provide all kinds of healthcare (not just reproductive care; that's a misunderstanding) and the price is adjusted for the customer's income, potentially free. Emergency care cannot legally be denied in the U.S. You just might get a big bill later, many of which go unpaid and just end up being a huge blemish on your credit record, though that's a far cry better than the alternative.

All of that is very different from saying that governments should COMPLETELY TAKE OVER providing everything that is considered a basic human need.

The fact is though, that most people can feed and house themselves, though it does become somewhat tricky to perform your own triple heart bypass, so healthcare is pretty much always a collective provision.

I can't make my own shoes. That doesn't mean the government has to. I pay someone else to make them. I don't grow food or raise pigs. I wouldn't be very good at it unless I spent a lot of time learning it, just like heart surgery. I pay someone else to do that. We live in a world where we all benefit by specializing on certain things and exchanging our services for the services of others. None of that mandates that choices be taken away from everyone and have governments take it over completely, e.g. food, shelter, shoes, or healthcare.

[Cindy]

It is obviously complicated and some how ingrained into the USA psych that there should not be government driven tax to support those who cannot support themselves, some fear of socialism perhaps. But I cannot see taking some good ideas from other models of societies to improve rather than be fearful of compromise leading into a society you do not want.

[Colleen M]

The top priorities of any private business are to survive and to make a profit. Whilst individuals within a private healthcare company may genuinely care about helping others at the end of the day the agenda for the business will be set by management who's job is to make money and to keep the company running.

In a market where viable alternatives to private care exist a reasonably high standard must be maintained in order to ensure repeat business. However where the only access to health care is from private providers (particularly large monopolies or oligopolies) then they are able to give you less bang for your buck (provided they are united in their shoddy service) and you have little alternative but to take what you can get.

This is particularly obvious where Phone and Internet monopolies which use the fact that they are often your only option in a geographical area to provide you with terrible service which lags behind Estonia.

The US private health care system is on average more than twice as expensive for you the customer than it is in countries where you receive universal health care paid for though taxation.
Particularly outpatient care where private healthcare companies take the opportunity to gouge you for additional fees.

What I can't understand is why Americans continue to pay far more in premiums for health insurance than they would for universal healthcare.
Whilst it tends to be slow and bureaucratic for non emergency procedures no one will refuse you treatment in an emergency or ask for money for emergency aid.
In Scotland prescriptions for existing conditions are also paid for by the taxpayer.
If they weren't then I'm not sure my mother could continue to obtain the drugs required for her to keep her sight.

Is it ingrained in the cultural psyche of America that any form of tax increase is unacceptable?

Here's a recent comparison by Forbes which may comparing the US health care system to 10 other countries showing that not only does private health care cost you more money, but that it's also worse...

http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/

Put another way:  Wow, that free market sure produces lousy, expensive televisions. 

Of course, if you made Sony pay absurd lawsuit damages every time a television broke because trial lawyers are a huge political constituency, that would be true of televisions like it is in medicine in the United States.  If you made LG produce a different model of television for every state in the union, it would be true of televisions like it is of medicine here.  After all, Toshiba's love of profit has clearly led to televisions inferior to nationalized television production around the world. 

Then again, a truly, genuinely free market may not be the problem...

[kira21 ♡♡♡]

I can't make my own shoes. That doesn't mean the government has to. I pay someone else to make them. I don't grow food or raise pigs. I wouldn't be very good at it unless I spent a lot of time learning it, just like heart surgery. I pay someone else to do that. We live in a world where we all benefit by specializing on certain things and exchanging our services for the services of others. None of that mandates that choices be taken away from everyone and have governments take it over completely, e.g. food, shelter, shoes, or healthcare.

I knew that would get said.

Yes, but you can buy your own shoes. You can anticipate the need, save a little money and walk to a shop and buy them.

You cannot however anticipate needing open heart surgery, pay for an MRI machine, a hospital, surgeons, nurses, blah blah blah. It is an service, often an emergency service, that needs to be provided collectively and therefore paid for collectively, as and when it is needed. That is a big difference, between shoes, burgers and medical care.

I have to agree with you Cindy. When you have a service that is collectively paid for and collectively accessed, particularly one that is an emergency service, a life or death service, I don't understand how you can justify taking that service and having individualised access based on ability to pay. 

[dalebert]

It's very important to me that if I don't like the game I be able to take my bat and ball elsewhere.

You want choices? You fascist!

[Cindy]

You want choices? You fascist!

Hee Hee, but I have choices, I can choose what Dr treatment etc. what hospital, public or private care.

[kira21 ♡♡♡]

I'd like my medical provider to know that if they don't satisfy me, I can fire them and bring in someone else.

That is an incredibly strange thing for me to hear regarding healthcare. So can I ask why you might 'fire' them?

Actually, you can pay to go privately here too, like Cindy said. There are more options :-p It just means if your house burns down and you don't have enough money to pay for you or your kids diabetes shots you wont die from it. However if you want to pay to go private and get your own room when you go into hospital and quicker access to treatment, you can go to private hospital/dr/physio/endo/whatever.