The Power of the SCOTUS II: "Release the Kagan!"

[GrinCDXX]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Congratulations, you've managed to miss the point entirely.

EMTALA is just fine. But the fact that Congress passed it, contra the SGs argument, does not give Congress extraconstitutional powers to find a way to pay for it.

I don't find this argument all that compelling because, from the way I see it, the provisions in EMTALA that require emergency treatment regardless of the patient's ability to pay aren't really a policy decision made by congress. It is simply a formalization of what is required by basic human decency.

[leswp1]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Les

Would you give RomneyCare a + or a -?

D. (Duck and cover) There was no planning, it was cobbled together and rammed through so that Romney could go run for Prez. They asked the med establishment what we thought and then totally ignored anything that was said. The lack of primary care providers is ridiculous. In our area the wait to get in for a primary is monthss unless they are brand new Docs. They claimed there would be affordable plans and then the insurance companies renegged before the ink was dry. Suddenly what they promised and said they could work with was unpossible. The pharma companies now won't let us use the indigent plans they have available because everyone should have insurance but many plans don't cover meds. The premise was great but like most of the medical legislation done in Mass they legislated and then thought about what would happen later.

There are a lot of folks who are not insured still but no one seems to have a mechanism to capture that unless they show up needing care. They didn't address the stuff that the Fed bill does like preventitive care which was a huge mistake. People who have the catastrophic plans (because those are the cheapest) just fell off the map because all their 'discretionary' income went to paying the premium. They couldn't pay for the preventitive stuff. The new law (the federal one) which mandates the preventitive services is the best thing that ever happened out of that law. As I posted before we have people coming out of the woodwork to do things we have been advising someof them to do for years!

No matter what the plan, until things are not tied to profit it isn't going to work. I know that gives the socialistphobes the hebeejeebees but none of this stuff is going to solve the problem. We have some of the worst healthcare in the first world if you aren't well off. In the 3rd world countries people know they are poor and won't have access. Here we have working people without access and pretend it is their fault they can't find a way to make it work. Makes my blood boil. OK, now I am going to bake bread and forget about work for a few hours.

[WeWantMore]

I don't find this argument all that compelling because, from the way I see it, the provisions in EMTALA that require emergency treatment regardless of the patient's ability to pay aren't really a policy decision made by congress. It is simply a formalization of what is required by basic human decency.

Right, that's fine. I find it more compelling, but whatever, we can disagree, as I'm sure the justices do.

All I'm saying is, it's a lot more intelligent a debate than the "Scalia wants everyone to die" line of idiocy priceless is peddling.

[Priceless]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Right, that's fine. I find it more compelling, but whatever, we can disagree, as I'm sure the justices o.

All I'm saying is, it's a lot more intelligent a debate than the "Scalia wants everyone to die" line of idiocy priceless is peddling.

Not everyone. Just the people who can't pay for care.

How else do you translate what Scalia said?

[joecct]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Les

Thanks. That pretty much sums up what oldest son is experiencing up there in the Commonwealth. He had to go to the ER, the insurance company would not pay because he did not have a primary physician, but he could not get a primary physician due to nobody was taking new patients. ClusterCluck.

[WeWantMore]

Not everyone. Just the people who can't pay for care.

How else do you translate what Scalia said?

Nope, that's exactly what he was saying. Silly me.

[Priceless]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Nope, that's exactly what he was saying. Silly me.

Yes, it's better to pretend that's not what he meant. When the SG says that "societal norms" dictate that we not allow people to die, and Scalia's answer is "Don't obligate yourselves" what do you think he means? Seriously.

[WeWantMore]

Yes, it's better to pretend that's not what he meant. When the SG says that "societal norms" dictate that we not allow people to die, and Scalia's answer is "Don't obligate yourselves" what do you think he means? Seriously.

I think it means he hates EMTALA and wants everyone to die in the street. Whatever else could he mean? Thanks for showing me the light.

[joecct]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Yes, it's better to pretend that's not what he meant. When the SG says that "societal norms" dictate that we not allow people to die, and Scalia's answer is "Don't obligate yourselves" what do you think he means? Seriously.

Everyone dies at one time or another. Nobody who has ever lived on this planet has escaped death.

However, how can I square "..."societal norms" dictate that we not allow people to die..." with assisted suicide laws?

[leswp1]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Les

Thanks. That pretty much sums up what oldest son is experiencing up there in the Commonwealth. He had to go to the ER, the insurance company would not pay because he did not have a primary physician, but he could not get a primary physician due to nobody was taking new patients. ClusterCluck.

Problem is that at this point no one is reimbursing primary care for anything but they are loading on more and more responsibility. The people who negotiate the contracts and have control over reimbursement are about 90% specialists. They have no impetus to change the current situation. Primary care is getting walloped. Some interesting tidbits- Primary care is penalized or rewarded depending on what the patients do (they withhold $ and you get it back if you 'meet the measures'). Currently we are penalized big bucks for things we don't have control over. A few examples
-If you go to the ER and could have seen the primary care office we get dinged even if we advised you to come to the office
-if you do not get your screening tests-mammo, PSA, Colonoscopy, stool test, screening bloods- even if I have ordered them and you have signed a waver saying you won't get them or if they are not covered by your insurance- ding
-if you utilize another service- pharmacy, eye or dental plan- and the measures for your diagnosis say you should have seen someone or gotten a script- ding (if they didn't bill you don't get credit even if you can prove it was done)
- If the specialist you referred to doesn't see the patient in a timely manner but the person should have been seen- ding (you are supposed to facilitate)
-if the person doesn't get a physical every yr, even if the plan doesn't cover it- ding (some plans are grandfathered not to cover prevention stuff)
-if you prescribe higher tiered drugs- ding(even when you have completed the prior auth forms showing why they can't do the cheaper stuff)
-if you order certain tests too often (even with the prior auth. They do not take into consideration the complexity of your patient panel)- ding, ding-they keep the withhold and you are rated with a higher copay.

We are also now supposed to monitor what other specialists have done and follow thru if they don't as well as monitor whether we think they should have ordered certain tests or if they could have been avoided. This was directly against what used to be the norm. We are now responsible if the patient doesn't follow thru with what the specialst recommended and are supposed to chase the patient to get all the stuff done.

Of course reimbursement has not increased with this responsibility, just financial and legal liability. No one wants to do primary care because the level of work is ridiculous and the pay isn't close to specialty pay. Loans are immense right now. WHat would you pick?

[Kepler]

Re: The Power of the SCOTUS II: "Release the Kagan!"

This is scary.

[GrinCDXX]

Re: The Power of the SCOTUS II: "Release the Kagan!"

This is scary.

I don't have any reason to doubt the integrity of any of our officers. But we'll do our due diligence and look into that. If we find that any of our officers is taking shortcuts or violating someone's civil rights, that officer will be fired.

Sure Scott, whatever you say...

[FreshFish]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Alexander Hamilton, as quoted by the New York Sun:

Hamilton, a big proponent of federal power, famously described the Court as "the weakest of the three departments of power." It argued that the people could never be endangered by the court—so long as the judiciary "remains truly distinct from both the legislature and the Executive."

It was precisely the separation of the courts from the other two branches, Hamilton argued, that gives the court its legitimacy. He asserted that "the natural feebleness of the judiciary" puts it in "continual jeopardy of being overpowered, awed, or influenced by its co-ordinate branches" and wrote it's "permanency in office"—meaning life tenure for judges—was "an indispensable ingredient in its constitution, and, in a great measure, as the citadel of the public justice and the public security." Continued he: "The complete independence of the courts of justice is peculiarly essential in a limited Constitution." Then the famous sentences:

"Some perplexity respecting the rights of the courts to pronounce legislative acts void, because contrary to the Constitution, has arisen from an imagination that the doctrine would imply a superiority of the judiciary to the legislative power. It is urged that the authority which can declare the acts of another void, must necessarily be superior to the one whose acts may be declared void. As this doctrine is of great importance inall the American constitutions, a brief discussion of the ground on which it rests cannot be unacceptable. There is no position which depends on clearer principles, than that every act of a delegated authority, contrary to the tenor of the commission under which it is exercised, is void. No legislative act, therefore, contrary to the Constitution, can be valid. . . .

"If it be said that the legislative body are themselves the constitutional judges of their own powers, and that the construction they put upon them is conclusive upon the other departments, it may be answered, that this cannot be the natural presumption, where it is not to be collected from any particular provisions in the Constitution. It is not otherwise to be supposed, that the Constitution could intend to enable the representatives of the people to substitute their will to that of their constituents. It is far more rational to suppose, that the courts were designed to be an intermediate body between the people and the legislature, in order, among other things, to keep the latter within the limits assigned to their authority." [emphasis added]

Eventually the Supreme Court itself, in the case known as Marbury v. Madison, spelled out the logic of judicial review

[joecct]

Re: The Power of the SCOTUS II: "Release the Kagan!"

Somebody's nose got out of joint: http://news.yahoo.com/federal-judge-...-politics.html

[WeWantMore]

Somebody's nose got out of joint: http://news.yahoo.com/federal-judge-...-politics.html

Funny, but probably not appropriate.

Come to think of it, that sort of describes Obama's remarks the past few days.