10:25 I'm trying to figure out the deal with the health care ruling. The NYT seems to think that the health care act is constititional, but they are being wishy washy about it. What's the deal?
10:28 CNN gets the headline wrong.
10:29 "Congress had the power to impose the exaction in Section 5000A under the taxing power" Robert switched sides.
10:31 Erin Gloria Ryan @morninggloria Roberts is the Severus Snape of the Supreme Court.
10:34 "The Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," – Roberts
10:39 And here's what Nora Ephron thinks about food. (This is Scotus blogging ADD-style.)
10:42 Nate Silver @fivethirtyeight No, court's decision is NOT good news for Romney. But not hugely bad news for him either. Preserves the status quo.
10:46 Mike sends me the summary from SCOTUSblog:
The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.
10:50 Must check out SCOTUSblog live blogging the decision.
10:52 Sarah Palin @SarahPalinUSA Obama lied to the American people. Again. He said it wasn't a tax. Obama lies; freedom dies.
11:55 Romney is speaking. Will overturn it.
Apt. 11d 
My libertarian cousin on FB tried to make the broccoli argument to me. HAHAHAHA.
CNN was a train wreck this morning. SCOTUS Blog was the only legit source.
LikeLike
So anyone else think that Scalia’s erratic behavior might be symptoms of early dementia? I wonder how we’re going to deal with that issue as a society. In the past, I think physical health issues, secrecy (i.e. someone else basically taking over, hiding the mental status of the affected individual) worked. In these days, with our ability to treat health & the difficulty of secrecy, I don’t think we have good under the table ways of dealing with dementia in positions of power. And the public step of asking for someone’s removal on the grounds of their mental abilities is hugely difficult, psychologically, emotionally, ethically, and politically.
LikeLike
I didn’t see Roberts going this way, though in retrospect, maybe this case does show that Roberts tries to be apolitical in his rulings (while Scalia has clearly in his comments this week that the appearance of apolitical decision making isn’t important to him).
LikeLike
Having health care is, in the short run, a victory for liberals, but in the long run, I think the precedent this decision sets with respect to the Commerce Clause is going to be a big headache for liberal goals.
LikeLike
The Jealth care law is a huge change in the landscape; the commerse clause provision a small one — you can’t call inaction economic activity. The Medicare opt-in might change the landscape a bit, especially ’cause the liberal justices didn’t dissent on that one.
But the 5-4 decision? what it really shows is how important the election will be. The conservative dissent, if it were the law, would have been a huge block to using federal government to address economic and social needs. So an election that changes that minority to the majority is the real challenge. (and one that doesn’t change that majority can change the majority on the commerse clause — ginsburg’s dissent)
LikeLike
I was reading Reddit’s “Explain It Like I’m 5” piece on Obamacare, and I clicked on a link to a doctor’s explanation of the provision that “Doctors’ pay will be determined by the quality of their care, not how many people they treat.”
And I was ROFL because basically s/he’s concerned that s/he and other doctors will be treated the same way public school teachers are being treated in terms of assessing them in terms of performance.
Dr. Smith and Dr. Johnson are both primary care physicians. They both have 10 identical patients with diabetes, for whom each physician prescribes the exact same, evidence-based, standardized diabetes protocol. 4 of Dr. Smith’s patients are non-compliant with their insulin regimens, despite optimal counseling and the best efforts of Dr. Smith, thus their HbA1C values will be above the cutoff that qualifies them for a “good outcome.” In the end, medication compliance is a patient choice which cannot be controlled by the physician and although Dr. Smith did everything right from a medical standpoint, those patients will be red-flagged and reimbursement decreased….
It’s situations like this that are worrying physicians.
BWAHAHAHAHAHA!!!!! Suck it, doctors. You make 10 times what teachers make, too.
LikeLike
Politically, I still don’t see what Romney is going to do. He’s running a campaign against a health care plan similar to his own plan from not that many years ago. His MA plan would have been a central pillar of his 2008 campaign if he’d won the primary (which would have probably made him a better candidate against Obama than McCain was, IMO). He not only hasn’t put forth another proposal, I can’t see that there is a plausible counter proposal* other than the status quo. As near as I can tell, the status quo only benefits the elderly, employers, and people with no fear of losing a job or desire to switch jobs. There is, of course, a great deal of uncertainty about how ACA will actually work and whether or not it will make things worse. However good stoking fears of disaster is at raising campaign funds, you need to find something positive to focus on to win.
* I mean, there are other plausible ways to finance health care but not that Romney could put forth and keep the support he needs. There doesn’t appear to be any way to touch health care that won’t piss off the pro-elderly movement that the Tea Party has become.
LikeLike
A gifted, charismatic politician might be able to pull something out of that mess of conflicting signals that would hide the contradictions while keeping the focus on some other area where there is a larger consensus possible. That’s not really an option for Romney either.
LikeLike
Wendy,
Isn’t the latest in teaching value-added? I have no idea how value-added would work for doctors.
Also, wouldn’t it be easy to accidentally create a huge incentive for doctors to stay out of endocrinology and to stay far away from poor, uneducated, unmotivated, high-risk, and low-functioning patients? I’ve sat in on a lot of endocrinology appointments for a diabetic friend (a non-native English speaker who has been a long-term house guest), and once you’ve got a certain baseline of office care and diabetic supplies, 90% of success with diabetes is compliance. It’s hard being diabetic, just like it’s hard not getting fat, the difference being that a healthy person who overindulges has to buy bigger clothes, while the diabetic may lose their feet or die at an early age. Your doctor isn’t following you around 24/7 and can’t keep you from finishing that tub of ice cream.
(I think there’s some literature on socioeconomic/eductional factors in patient compliance but I can’t find what I want right now. bj? MH?)
LikeLike
“Politically, I still don’t see what Romney is going to do.”
Hey, that was the analysis offerred by my 8 year old after watching Romney’s response yesterday. He said [about Romney] “He just kept saying ‘I’m going to beat Obama’over and over again, without telling us what he was going to do.” (and then proceeded to remind us several times a day that he really didn’t like Romney’s speech).
He compared it to adults telling kids to use “better judgement” without telling them what it means, but just repeating it over and over and over again.
LikeLike
“Also, wouldn’t it be easy to accidentally create a huge incentive for doctors to stay out of endocrinology and to stay far away from poor, uneducated, unmotivated, high-risk, and low-functioning patients?”
You mean like teacher evaluation measures based on student performance cause teachers to flock to high SES schools filled with typical children and supportive parents?
LikeLike
I think there’s some literature on socioeconomic/eductional factors in patient compliance but I can’t find what I want right now. bj? MH?
Yep. Some of it concerning people with mental illness has my name on it, not that socioeconomic and educational factors played that large of a role there.
LikeLike
As far as losing weight goes, I think my doctor must get a bonus every time he gently reminds me that I’m too heavy and that losing weight is the best way for me to fix my lipids.
LikeLike
Should I try to eat more fish?
“Just losing ten pounds would have the biggest impact.”
What about red wine? Would switching from beer to red wine help?
“Not much, but (looks at nosy questionnaire) but drinking fewer than four a day certainly would.”
LikeLike
bj said,
“You mean like teacher evaluation measures based on student performance cause teachers to flock to high SES schools filled with typical children and supportive parents?”
Sure, which is why you should try to look at value-added (which I mentioned earlier) for teachers, rather than just plain test scores.
MH said,
“As far as losing weight goes, I think my doctor must get a bonus every time he gently reminds me that I’m too heavy and that losing weight is the best way for me to fix my lipids.”
How’s that working for him?
Whenever I’ve had to deal with any very involved medical thing, I wonder how well people of below-average intelligence manage the same situation. I know I’m no dummy, which gives me the confidence to ask stupid questions repeatedly until I actually understand 1) what the situation is 2) what I’m supposed to do. I often see people asking total strangers on the internet about stuff their doctor said at their last appointment that they didn’t understand. I think the medical profession should do a lot better with patient education, but there are always going to be issues with compliance, when compliance requires a high level of sacrifice or organization, which it often does.
LikeLike
How’s that working for him?
I learned that blueberries the day before and no fluids before the appointment are worth five pounds.
LikeLike
They’re developing value-added measures for hospitals, too (and doctors, perhaps), but I know of the ones for hospitals. They’re kind of like college ranking scores. Many variables go into them, so tweaking one or the other (if you can figure out what they are) can change the scores. So, in some cases, it might create incentives to recruit the equivalent of high SAT patients, or manipulate job placement statistics (for example, transferring out a dying patient before they actually die).
All quantitative scoring methods are prone to issues of different sorts. They may be useful at different times but they’re not a cure all, for evaluating doctors, hospitals, schools, colleges, or teachers.
LikeLike
Sometimes I feel like I’m in a satirical movie about health care in America.
“Hop up on the scale.”
“I’m here for a 3-day follow up. You weighed me on Tuesday.”
“Yes, well, that part of the standard procedure.”
“How many pounds would a person’s weight have to change in three days for it to require medical follow-up, because I can guarantee you that my weight is within a few pounds, either way, or what it was on Tuesday.”
“So, should I just put down ‘Patient Refused’?”
“I’m not refusing. I’m asking what the medical justification is for weighing me today when, to the best of my non-medical judgment, I look pretty-much identical, weight-wise, to how I looked three days ago.”
“We just track these things for the chart.”
“Every three days?”
“I’m going to right ‘Patient Refused’ now.”
LikeLike