The irony of course is that the Chief Justice’s opinion in reality contains two brand new limitations on federal power – namely a brand new carve out from the Commerce Clause and a limitation on the use of federal grants to states.

I knew it was too damn quiet. Now, watch for the macaroni to hit the fan. It’s refreshing, though, to watch someone, even a flaming coryphodon, use “red” in its *old* sense.

I was flabbergasted by Robert’s decision. I would have bet that he would have overturned the whole enchilada, so I was blown away and THRILLED that the law passed muster.

This country has become so polarized that I fear at times for our survival. Already, we are no longer a democracy according to what the late Justice Brandeis said. He postulated that we can either have a democracy or great wealth in the hands of a few, but we cannot have both.

So what are we now? An Oligarchy run by Plutocrats! If Rob Zerban does not unseat Paul Ryan in the first congressional district vote, we’re more than likely doomed as a nation. I pray not. If, however, the vacuous Romney and Ryan win, we’re screwed. Ryan wants to raise taxes for all making LESS than $200,000 and give his rich Tea Party friends an additional 18% DECREASE in their taxes.

I am personally going to lose out because the PPACA was approved by SCOTUS because I am on Medicare Advantage, but if it means that ALL AMERICANS will now have access to healthcare, then it is worth the financial sacrifice I will have to make. I cannot afford that sacrifice, but an more than willing to accept it; that is part of what being an American citizen is about. The “Wrong” wing has lost its bearings, I hope that someone will splash cold water on them before it is too late.

Our medical expenses have mushroomed out of control because of the UNINSURED individuals who use expensive medical care and then declare bankruptcy to escape paying their medical bills. I do not blame them for so doing! Recently, I spent three days in the hospital and was charged over $20,000 for a normal room with NO IV fluids. That is absurd.

Most people will pay far LESS for their health insurance than Medicare charges us. We pay about $1,200 a year and an individual will only pay about $675 a year. Young people think that they don’t need insurance. All it takes is an auto accident and they’ll wish they had coverage. I have had private health insurance from the day I was no longer eligible to be covered under my parent’s insurance plan. I have also had disability income protection all of my adult life. I never expected to have to use it, but a massive hemorrhagic stroke caused me to have to retire and I received 60% of my income from the age of 57 until I was 65…eight years…and people thought I was crazy all those years.

Clarification of my previous comments: Part of being an American citizen is to be willing to share our resources with others. Socialism? No. Just part of our tradition of helping others when they can’t help themselves.

That’s also what Torah teaches all of us to do: Love our neighbors as ourselves. This country seems, in part, to have lost sight of what true American values are. The so-called “Family Values” that the Wrong Wing people push includes looking out for only their family’s well-being and not their “neighbors.”

They are traitors to the values of true Americans. Selfishness is NOT part of being an American; we are too good a people to not want others to have access to what so many take for granted: Access to health care.

We are the ONLY democratic nation that has never given a royal damn about the health and well-being of all of its citizens and for that we should all hang our heads in shame.

Just your reporting on this elaborate paranoid construction has literally given me a headache. It was perverse of me to even continue, but I couldn’t help myself. I think I better head on over to Wonkette for a breath of fresh air.

Whew.

Speaking as a college student who is about to graduate into the real world…. I NEED OBAMACARE. I won’t be able to afford health insurance without it, and my health SUCKS. It makes me angry to hear all these people trying to cut it down, when frankly, it’s my only hope of GETTING legitimate care from a doctor.

Beverly, except that Roberts didn’t uphold the law at all – he found the Medicaid Expansion unconstitutional and then completely changed the law so that it will be ineffective and is now practically guaranteed to fail (assuming argumendo that Congress ever votes to fund the Medicaid expansion in the first place).

The Medicaid ruling could have disasterous effects on federally funded social (and other) programs using block grants.

That is what makes the right wing freak out so hilarious – they actually won the case and are too dishonest to admit it – or too stupid to realize it.

Wait a moment. According to Klayman, ONLY Roberts and Kagan violated their oaths of office? What about Breyer, Ginsburg and Sotomayor? Shouldn’t they be ‘indicted’ as well?

Mind you, I feel he’s just a few marbles short of a box that will only hold one marble. And I was HUGELY excited that the ACA was upheld. But if I see craziness, I refuse to stand hypocrisy. Craziness all the way, or no craziness at all.

There is no tax clause here.

Gee — can you imagine what would have happened in Justice Roberts hadn’t been appointed by a Republican?

The fact that all of these people are screaming about making it possible for people, many of whom have pre-existing conditions through no fault of their own, to be able to buy health insurance at a price they can pay–by any measure a humane and rationale act–is beyond amazing (and not in a good way).

America basically stumbled into the whole private health insurance thing by accident rather than going the direction of many other developed countries. Now that error, which has left many people uninsured and/or uninsurable is finally being rectified.

I am self-employed (for 25 years) and have always had some health problems. Thus, the private health insurance policy I had, which was just for me because I am single and don’t have kids, cost me $1,500 A MONTH with a $10,000 deductible — until the insurance company dropped me when I hit 48 years old (don’t know why–approaching menopause and all of those Lady Problems I guess). I only ever made one claim — for gallbladder surgery. After all of the deductions, they paid only about $6,000 from a $20,000 bill. (this was in 1999) But I kept up the insurance because I didn’t want to be uninsured lest something really expensive happen. I was fortunate enough at that time to have been making enough money to pay the premiums, which were higher than my mortgage and real estate taxes.

I will be very happy to be insured again.

And many of these same lunatics who are acting like this is the end of America say they are “pro-life.” Obviously, that doesn’t extend to the uninsured! What a bunch of crazies!

If anything, I am hoping that this may be the beginning of a re-birth of sound social sensibilities in this country (as long as Romney doesn’t unseat Obama; perish the thought.)

Erika — can you explain a bit more. You are scaring me.

That is true, Erika, but that opinion is not a majority opinion, only a plurality opinion. I believe that the taxing power part of it is therefore dictum.

CoralSea, one thing to remember is the opinions in this case ran to 193 pages – it is doubtful that anyone in the press has actually read all of the opinions before reporting on it – instead, they are simply reporting on the summary. It is also doubtful that many people reporting on this case have a sufficient background in health law – specifically Medicaid to really understand what happened here.

There were two major provisions of the ACA being challenged – first was the individual mandate. That won by a 5-4 vote as a tax (but the potential mischievious part is that Roberts effectively with the joint dissent created a new Constitutional rule for the Commerce clause – it seems that the substantial effects test will survive, but there is a new carve out that Congress can not use the Commerce clause to encourage action – that may well be significant).

The second provision was the Medicaid expansion which while the indvidual mandate and the penalty got all the attention was the real heart of the ACA – the Medicaid expansion was the way by which people would low incomes would get health coverage. As both Justice Ginsburg and the joint dissent (Scalia, Thomas, Alito, and Kennedy) point out, the ACA essentially collapses without the Medicaid expansion because there would still be a huge number of people who will not be able to afford health insurance. The Supreme Court struck down the Medicaid expansion using a brand new legal doctrine which they pretty much made up on the spot (as per Ginsburg, J.)

The plain English summary of what happened is that thanks to the Supreme Court, states can now opt out of the Medicaid expansion with no penalty – of which it is likely that many states will. This is a very bad development (and the new limitation on Congress’s spending power is also extremely bad) because if states start opting out of the Medicaid expansion, the goal of having near universal health coverage will be defeated – quite simply, there will still be a large number of unisured and the cost savings will evaporate.

That is essentially the short version – the long version comes from reading Justice Ginsburg concurring and dissenting opinion.

So much paranoia, so little time. These clowns need to get back on their meds, pronto.

I think what happened in layman’s terms is: It is officially labled as a tax – and that’s the last thing most American’s want. So now, they’re going to storm the poles in November and effectively vote out a lot of democrats. It will probably be repealed.

Chief Justice Roberts has officially labled it a tax, which is why it was constitutional.

They’re calling it the “largest tax on the middle class ever”.

People are going to vote against the party that instituted it just based on that alone.

Erika — Arrggghhhh! But thanks for the explanation.

Joseph — that may or may not happen (Republicans sweeping Dems in Senate). After all — didn’t you see that new study that says that 65% of Americans polled believe that Obama would do a better job of leading a defense of the U.S. than Romney in the event that space aliens attack?

Erika, methinks you do not understand that the law was NOT overturned. You said, “he found the Medicaid Expansion unconstitutional and then completely changed the law so that it will be ineffective and is now practically guaranteed to fail (assuming argumendo that Congress ever votes to fund the Medicaid expansion in the first place).”

The LAW is LAW. It did NOT fail. Only ONE part of the LAW was overturned as it should have been because it was an overreach of Federal Power. HOWEVER, the Individual Mandate and the rest of the LAW was upheld as Constitutional by the highest court in the land, SCOTUS.

As an individual who is on a Medicare Advantage plan, I’ve zero idea of what next year or two is going to bring as far as my personal out-of-pocket expenses are going to be, as I’ve already mentioned and I am actually HAPPY to make whatever sacrifice I may have to make if it means that EVERYONE in the country can have access to healthcare providers.

I survived a massive hemorrhagic stroke from which 97% of people die. Three percent go out of the hospital and only 1% thrive as I’ve been bless to do. But a stroke is FOREVER meaning that I have to see doctors more than the average person. Currently, I pay zero for doctors visits and a maximum of $300 for any hospital stay. I’ll probably have to kiss those benefits goodbye, but again, if it means that even the poorest of our American citizens and immigrants (green cards) will be able to secure health care when they need it instead of having to wait until hospitalization is the only way they can get help.

As a former anesthesia admin in a large County hospital, we averaged about 35 surgeries per day PLUS the shootings and knifings (known as the gun and knife club) that had to get into emergency surgery. I’d get the anesthesia reports, sometimes covered in dried blood, and it was truly horrifying to see the number of cases that died during surgery because they had waited WAY too long to seek medical intervention. You’ve no concept of what it is like to get ready to leave your office only to have a body on a gurney blocking your exit.

Most of those bodies could have been alive today had they not been unable to get medical attention early in their disease process.

All Americans should be behind this law because when they UNDERSTAND it. Right now good people like you undoubtedly are, are making claims that simply are not true. Try finding a copy of the law (it is available online) and read what was tossed out and what was kept. The only problem for them is that when it hits the Senate, they’re going to say, “hey, we upped our attitude, up yours!” It will NOT be repealed despite what Cantor and Ryan and the Idiot In Chief, Boehner think. It is just going to be a massive waste of time and money.

Again, Erika, I am not attacking you, I’m just trying to get you to understand that the law is still the law.

Don’t these morons realize that this bill was written by insurance companies, was originally proposed by the conservative Heritage Foundation, and implemented by Mitt Romney in his own state? Never mind, I already know the answer to that. Why bother with pesky things like facts when you can spend your time wallowing in bone-chilling fear of a socialist menace which doesn’t exist?

“Vanderboegh wrote, “If we refuse to obey, we will be fined. If we refuse to pay the fine, we will in time be jailed. If we refuse to report meekly to jail, we will be sent for by armed men. And if we refuse their violent invitation at the doorsteps of our own homes we will be killed ”

Yes, this is pretty much true about literally ANY law. Law isn’t law if it can’t be enforced.

Plurality opinions concur in the result, and that is binding. This is also true in those points of law where the majority have concurred. Where an opinion concurs with the majority on these points but with the dissent on another, the latter, though pointing in the direction a later majority opinion might go, it is, for the now, not ratio decidendi. That funds cannot be withheld for past noncompliance seems to be established, but my understanding is that future funds can be conditioned on future compliance, as such a relationship is more or less contractual. I intend to get the opinion on disk this coming week, and may change my opinion on that, but this is my best guess so far.

“unprecedented intrusion into personal decisions.”

I wonder how this guy would feel if women and gays started defending themselves against government intrusion? Forced, unnecessary transvaginal ultrasound seems a lot more brutal, tyrannical and intrusive than anything in the ACA.

“If we refuse to pay the fine, we will in time be jailed”

Unless I’m mistaken, there’s no jail penalty for refusing to pay the fine. They won’t even put a lien on your property. It’s fairly toothless. And of course, we haven’t seen an orgy of bloodshed in Massachusetts, or an explosion of healthcare-related imprisonment.

These people are astonishingly stupid.

Beverly, I’ve actually read all of the opinions because I’m a health law attorney so I have a significant professional interest in what the Supreme Court held in this case (and a significant background in Medicaid law) – and from that background, the Medicaid aspects of this opinion terrifies me.

The individual mandate got all of the attention, but it wasn’t the important part of the ACA – the Medicaid expansion was. And it survived in name only – it was essentially gutted.

Reynardine, you have to remember that there were several holdings in this case:

Individual mandate unconstitutional under commerce clause by a 5-4 vote along ideological lines

Individual mandate constitutional under the taxing power – 5-4 with Roberts writing for the court

Unconsitutional under the Tenth Amendment (Medicaid Expansion) – 7-2 (Breyer and Kagan joined Roberts and the four dissenters)

Modified to gut the Medicaid Expansion by making it optional for the states with no penalty – 5-4 (Ginsburg and Sotomayor joined Roberts, Breyer, and Kagan).

Now, its arguable (as Ginsburg did) that Roberts commerce clause opinion is dicta, since it was not needed for his opinion but with the 4 dissenters, there is clearly a 5 vote majority for the commerce clause limits here.

Of course, I might be wrong, but while the decision was not nearly as bad as I expected, I still think it will turn out to be very bad legally.

In the long term, the fact that market based healthcare solutions are likely doomed will be a very good thing – quite simply, under the Court’s holding a single payer system is pretty much the only Constitutional way (and maybe I was loopy after reading 190 pages, – maybe I’m just loopy anyway ;) – but the dissent seems to practically endorse a single payer system at the end of their opinion as the only Constitutional way to meet Congress’s objectives)

Erika, after your reading a 190- page decision, I am not advocating the following, but if insomnia and masochism should overtake you some dark and stormy night, then try reading Joint Anti-Fascist Committee v. McGrath, 341 US 123. The plurality opinion was that the Executive Branch couldn’t do that, but there was little agreement on why. One concurrence held that, though not legislative, the act in question was one of attainder. That concept is not unfounded in commonlaw jurisprudence, since baronial courts attainted people as outlaws, but whether the federal and state prohibitions against bills of attainder in our Constitution applied also to nonlegislative acts remains unanswered, to my knowledge.

Don’t read that, though. Find radiant joy in Peach Bottom for a day, or in all events, scan the horizon. Exercise your distance-focusing muscles. If you don’t, your eyes will get stalks like a lobster’s, and they’ll call you Peer Squint (like me).

Erika seems to understand ADA better than the pundits. I sure don’t. My idea would be to keep insurance costs low, the Government should cover catastrophic events and conditions. Care is expensive because it’s better, just like cars and airplanes. Problems with government healthcare could include hypochondriacs clogging the system and Government attempts at manipulating society to keep costs down, I.E. outlawing motorcycles, guns, ice cream, and criminalizing consensual unprotected sex. Jail for not buying insurance makes no sense. At least while they have to provide medical care to prisoners.

It sounds like tax refunds and OASDI payments could be garnished to collect the penalty. I’m hazy on this … doesn’t that authority stem from the Debt Collection Improvement Act, a product of the Gingrich era? Sweet irony, if so.

The Loonwatch site appears to have been knocked down. A couple of months ago, the same thing happened to Politicususa. Maybe it’s a co-incidence.

Erika, I truly hope you’re right. After I wrote about a single-payer system on Twitter, some of my conservative friends told me about ‘failed Socialist policies in Europe.’

I explained that the healthcare I received when I was in Europe was almost universally better than that which I received in Amercia. And it was free!

That pretty much shut them up.

As of this moment, you can get the Loonwatch front page, but you can’t open their articles.

At this time, the Loonwatch site is wholly down again.

CBS News reports that CJ Roberts was originally going to vote to overturn the ACA, but that he changed his opinion, thus enraging the four dissenters, but especially Kennedy, who pressured him brutally to change back.

Roberts appears to have moved center as Kennedy moved right. Though people have predicted he could be on the Court another three decades, I wonder. As someone said…mortality is a wine like no other; even as it sharpens the moment, it clears the head.

The attacks on the Supreme Court sound like echoes of the attacks on the Warren Court after Brown v. Board of Education, down to the demands to indict Roberts…which doesn’t surprise me one bit, considering the sources.

The Loonwatch site is back.

This is a much needed victory for the Obama ?Administration, but I still waiting who is going to be Romney’s VP nominee. This will answer some questions whether Obama will get re-elected in November

Condaleeza Rice is the latest name to be bandied about as Romney’s VP.

Erika — as I understand it (in my non-attorney, self-interested capacity), the only people who will be required to purchase health insurance are those who aren’t currently covered under an employer plan, their own purchased plan, or medicare. Is this correct? Because I believe that a lot of the hoopla–particularly the “tax” hoopla, is among people who actually already have insurance and seem to think that they are going to have to buy more.

Sorry to lean on you for info, but you are knowledgeable, so I thought I’d ask.

Also, Beverly’s point about the catastrophic possibilities that can befall people who don’t have insurance — and thus, no reasonable way to get health care — is very apt. My own health is awful, and I may keel over from a heart attack from all of the damage that was done previously by untreated rheumatic fever (if so, I hope it is a massive heart attack and I die outright, so I don’t have to deal with the healthcare system). But frankly, my biggest fear is that I will suffer some injury, such as a fall from a ladder while I am cleaning the gutters, and break my leg. Because of the inflated health costs passed on to “self-pays,” I would probably not have to worry about gutters anymore, because if I did manage to get my leg set, I would lose my house.

My plan? If I tumble off the ladder and break bones, I will crawl into the neighbor’s yard and say it happened there. THen I can sue their homeowner’s insurance so I can afford treatment and still have a roof over my head!

Coral Sea, I am sorry to hear about your rheumatic fever. My grandmother died of that while still in her forties; in 1920, there were no antibiotics.

I don’t know where you live. In states with good homestead protection, they can’t take your house. For my part, before I had either Medicare or Medicaid, I had an injury that diarticulated most of the meditarsal joints on the outside of my left foot. I don’t recommend everyone engage in the regime of self-cure I did, even when there are no compound fractures or broken long bones. I do recommend that everyone get some idea of first aid and that every kit/medicine chest keep a roll of *velcro horse bandage*, which can be used for everything from stabilizing dislocations to bracing weight-bearing joints to applying pressure bandages or even (with the aid of a simple turnkey made from a sturdy stick) serving as a tournequet. It is a great deal stronger than an athletic bandage, and must be used with caution, but in some cases, it can save a life or make it possible to get to a walk-in clinic instead of the much costlier emergency room.

I learned a lot about self-doctoring, much of which I won’t pass on. It’s too bad anyone has to. But even in a sane, humane society, it’s possible to be stranded by floods and hurricanes, so it’s good to know what to use, when to use it, and how to keep it on hand.

Metatarsal. Not feeling well.

CoralSea, that is correct – and more specifically it only covers people who do not have health insurance and have the financial means to afford it which is a very small group – estimated at about 4% of the population.

Reynardine, the impression I got was that the joint dissent was originally written to be a 5-4 per curium opinion striking down the law – I thought that from the beginning simply because it was a joint dissent and the tone of Ginsburg’s opinion was very much what you’d expect from a dissent. Robert’s opinion was also heavily policy based and really emphasized the reason for the policy and the need to defer to Congress on matters of policy.

Oh and between extreme heat, extreme humidity, and extremely violent stroms there was very little radiant joy to be had this weekend.

A deal of radiance here, Erika, but after 9:00 A.M., too damn hot for joy.

Reynardine –

I actually broke my arm in a horse-back riding accident when I was 15, but my mother was in one of her moods, and refused to take me to the doctor because it was my fault for cutting school and going riding. Fortunately, the vet taped it up really well, so it healed more or less okay (sort of). But then I rebroke it at college (slipped on a patch of ice and fell onto the curb). I went to the University clinic and was told, after a three-hour wait, that I would have to come back next semester, because they didn’t have an orthopoedist on staff (Really — honest to God — this was how it was handled).

Fortunately, I had Blue Cross from my father’s employer, and so I was able to go to the local hospital and they set the bone.

Thinking about it, perhaps I am just karmically damned when I comes to health care. Oh well — I’m still here, and my arm functions quite well!

Well, durn, I reckon I’m not the only one whose mother had moods.

The Republicans have had 3 plus years to come up with an alternative solution to the Orwellian health care system in the U. S. that the ACA attempts to fix. They haven’t given an alternative plan to Obamneycare, except to repeal it and complain about death panels. As if denying coverage after purchasing insurance wasn’t a de facto death panel for many.

Currently, the new GOP rallying cry is that all people should have to pay something for their health care. On the other hand they don’t like the ACA mandate making that a requirement.

Single payer here we come.

Leslie — we can hope in regard to the single payer. I know that I personally think that it would be vastly preferable to the Alice in Wonderland (without the fun) situation we have now.

apparently their preferred scam is to turn Medicare and Medicaid over to a private voucher system (similar to what they want to do with the public schools) – you know, because Medicare and Medicaid recipients would have such an easy time getting insurance on an open market at a price less than the government program starts – or any insurance at all.

Their real plan is to “don’t get sick, and if you do get sick, die quickly”

Well, it’s finally come down to the rifles. When the fall election is over and Obama wins, the lovers of liberty will have no choice but to secede and start over. Hope it works out better this time!

Olivelevel, you can join Rush Limbaugh in Costa Rica. Don’t let the door hit you on the way out.

Olivelevel must be the one the olive reaches at the bottom of the martini.

It’s finally down to the rifles? Whoa. It’s gonna take more than a few rifles.

I remember my wife comparing me to “Marvin” from Sin City, saying that I would feel right at home swinging an axe in somebody’s face on the battlefield. She says “That’s you Joe.”

What I’m trying to say is: I do enjoy a good fight.

However comma, it may be more prudent to wait 4 more years until the next election for another president than to run – by yourself – through the street with your rifle screaming dixie (but for the comedy value of course).

I am probably the most conservative person that frequents these boards as of late, or at least the one that does not “post and run”, and I can assure you that being placed in a different tax bracket will not influence any of the veterans that I know to openly revolt against our government.

But if that’s what you want to do – good luck with that. And please add lemons to your tea, and a little bit of sugar.

Joseph, I’m really liking you. And I’m really glad you decided to call our strange little family of commenters a new home.

Thanks, friend!

I hope you like drone attacks, Olie. It will be a pity that you plan to die simply because you believe that Obama is enforcing universal healthcare(he’s not), something which has been a huge boon for most industrialized nations.

Aron, thank you sir. It’s a pleasure to tell them how I really feel.

Truly, Joseph, welcome to our Stammtisch.

Sounds like everyone picks and choses what “laws” they want to follow. Citizens, non citizens, presidents, judges, etc. The rule of law was a joke long before this latest controversy. Diversity is dividing us. Are there any leaders that unite? Any Bill Clintons out there?

NAFTA Refugee: Uhhhhh-huh. We’re all listening with RAPT attention to your rant. Meanwhile, I’m gonna enjoy my new universal health care.

Supersonic, I am in the dark about what Fels NAFTA is ranting *about*.

I know of at lease one Bill Clinton out there. If I remember correctly, he’s the spouse of the current Secretary of State.

But I could be thinking of somebody else.

Another Tinfoil Hammerhattie to Olivelevel