Congress will not revisit health care reform for a generation. After the 1 1/2 year battle in 2009/2010, no one in Congress, INCLUDING DEMOCRATS, will bring it up again. We have Pres Obama to blame for his lack of leadership. No profile in courage.

The Affordable Care Act will be the healthcare insurance system in the nation for a generation. Get used to it!

Seems to me that Obama Care is a boon for the insurance & medical corporations. There was a day when it was considered morally wronf to take advantage of someone's suffering. Perhaps someone can explain to me what Obama Care does to lower the cost.

I agree 100% that it is time for a single payer universal plan like Medicare for All.

But I disagree with characterizing today's decision a "ruling that Congress does have the power to penalize Americans who don’t buy health insurance – which was how the individual mandate works." That characterization is the way that Congress framed the metaphor which today's decision has explicitly declared to be an illegal and wrong legal metaphor. Today's decision says that even though Congress and the President may have thought they were mandating the purchase of health insurance with a penalty for those who do not buy it, what Congress and the President actually enacted was legislation that creates a tax for health care and then provides several ways to be excluded from the tax such as purchasing health care, being low income, etc.. So, as much as it is in my mind a bad law, today's decision was a good decision on the Constitutional grounds of telling Congress, the President and the American people exactly what this Act does.

I have said since the day the Affordable Health Care Act was enacted that mandates are illegal and only taxation for health care is legal, and today the SCOTUS confirmed that view.

So it is now time for everyone in the media, blogosphere, and Main Street, to stop using the terminology of "mandate and penalty" and use the legal terminology affirmed by the Supreme Court of "taxation and tax exclusion".

In the first place, single payer insurance is working extremely well for a lot of modern nations, that are shown to have a quality of care equal to ours, and at far less cost than here. Single payer was desired by a majority of American citizens AND by the medical community, of which I was a part. In a nation like ours, healthcare should be a basic right!

Now, a comment on the "Its a tax" ruling by Justice Roberts:

I believe most people would agree that individuals should be responsible to pay for the personal benefits they receive in life. Those who do not take responsibility to purchase healthcare insurance for themselves, and their families, are effectively forcing the rest of us, who have paid for our healthcare insurance, to pay for theirs. Why? Because these un-insureds still call upon hospitals and other healthcare providers to care for them. And because of the moral and ethical values these facilities hold, they will not refuse to care for someone in need, insurance or not.
When society, through its laws, requires individuals to be responsible for themselves, or pay a penalty for not taking that responsibility, it is giving the individual the "option" of either paying for their own insurance, or paying a tax to the government. They can choose either one.
So, it is not a tax in the sense of other taxes, where we have no choice as to whether to pay them. It is simply a method of saying "It is not right, or fair, for you to force me to pay for your personal healthcare."
So, the Republican stance that it raises taxes, is simply a half truth, and should not be a reason for them to try to repeal a law that helps millions of Americans, of all ages and situations. Whatever else you might think of the new law, or the Obama administration, I think you would have to agree with me on this.
Personally, I'm not as happy with the Obama administration as I could have been, had they not taken single-payer off the table at the very beginning, but a Romney administration scares the bejeebers out of me, for lots of reasons.

Health Care for Everyone! That's the endgame now! If we knew more about the rest of the other world's leading countries we could understand how they have single payer health care systems and use their experience to make it work here. The book by T.R. Reid, "The Healing of America" taught me a lot about how the UK, France, Germany, Switzerland, Canada, Taiwan, Japan and others have done this before. Several of those countries used a Harward professor, William Hsaio, as a consultant to design their healthcare systems. It can happen here.

The Tea Raggers got Kicked square in the Nuts today !!!

Ha Ha Ha !!!

Baby steps. Change is hard for any culture, and health care for all is a big one. Sad to say, the very concept is un-American. We remain, only a culture in transition. Let's tell the truth about it: from our inception, we have lived the "wild west every man for himself" ethic. Let's take a hard look in the mirror and fess up.

For women who lost their husbands in the 1800's, many, if not most, had only the options of suicide or prostitution to survive. Even in the late 1800's the rates of suicide and homicide were so high in California, residents there could not buy life insurance. As a man, had I lived then, were I facing my own untimely death, I would rather my wife and daughter lived as members of an Indian tribe, where each member's life was in fact held sacred. Obviously, the history is more complicated in the particulars, but in the general, the point is made.

Today the essence of the Republican moral code, is that the free market, whatever its determinations, (even when manipulated by Republican legislators), is Just and Right. A call to civil obligation then, even to force us to pay for health care for the hardworking poor who can't afford it - this they view as "a violation of my rights." They just don't get it. These are regular and law abiding people, honest citizens, possessed of a cruel and thoughtless world view. Just like the brave soldiers in WWII, who went to church on Sunday and kissed their wives and children goodbye in the morning, and then went off and slaughtered Jewish people all day long. In the "obvious" world-view to these soldiers "it was only awful Jews after all." Similarly, conservatives say: "Oh those lazy freeloading poor people...they could all be rich if they only worked harder...so let's leave 'em without care and that'll teach 'em..." and they say: "lucky me I'm not them and theirs is not my problem..."

People think that the nature of 'evil' has something to do with fangs and capes and bizarre psychological maladies. This if a false perception. The 'simple and obvious' which remains 'simple and obvious' - just because it had always been a part of a culture - has ever in our history been the real villain. Only a little while ago, it was obvious to much of America that black people were less than human, and deservedly and rightly slaves. Today, much of America believes that the hardworking poor who can't afford health care, or the elderly who have done their part for America, or the young who can't yet work, are owed nothing. They believe the libertarian lie and falsity that no one member of society has a claim on another, not even by virtue of the sacredness of the human individual. They don't acknowledge or know or feel, the truely spriritual and Christian call and demand: that in this broader venture of our humanity, we survive and find all our happiness and fulfillment - together.

As I beleive, we are hearing today in the vociferous complaints of the tea partiers and the Republicans - the dying throes of an archaic world view. For my part, as a progressive - I am thrilled by the accomplishment, but still not quite proud. Regarding the precious and desperately necessary work of forwarding the evolotuion of our culture and politics, I ask myself...."Have I tried hard enough? Could I have done more?"

I remember I tried to tell myself "it will be alright" when Bush got elected. But then there was the Iraq war to save Cheney's Halliburton from bankruptcy and to fill the pockets of Bush's oil industry cronies: hundreds of thousands Iraqi's dead and a nation crumbled to ruins, and a trillion dollars of our money wasted. And there was the crashed world economy - by Greenspan's libertarian zealotry which let the banks do just whatever they wanted - and by Dugan's OCC lawsuit, ramming subprime down America's throats. And then the national debt driven sky high by a tax cut for rich people left unpaid for, and two wars left unpaid for as well..."

It was not "alright."

There remains, lifetimes of work in front of us....For now, we have to know that nothing is ever 'handled.' So cheers to all and lets have at it....

When the topic of expansion of Medicare is brought up, the limited coverage of Medicare is not always mentioned. When I had surgery not long ago, I had to go to the hospital ahead of time to have what ar known as pre-surgical tests. In the pre-surgery waiting room, there was a notice posted which stated that pre-surgical testing is not covered by Medicare and that the patient would be responsible for the charges. These would probably amount to over $1000. Unless a patient has other coverage such as a Medicare supplement plan or has a Medicare Advantage plan that covers this item, the patient would have to pay for the tests, which are required before having surgery. The hospital added on their notice that they try and get the physicians to limit the tests to only those which are necessary.

Many elderly and disabled people need glasses to see, but Medicare does not cover eye exams for routine vision or contacts or eyeglasses.

Recentlly, PBS Frontline did a report on the large number of Americans who have no dental coverage and cannot afford to go see a dentist. Medicare does not provide any dental coverage except in very specialized, limited circumstances as I understand it. Dental services in the U.S. are more expensive than in many other countries. The program indicated that there are children who can die from an infected tooth if it is not treated. A lady who had not been to a dentist in years was in excruciating pain. She went to a temporary free health clinic that included limited dental services. They could not put in any crowns at this event because the equipment and time were both limited, so in her case, the dentist pulled all of the teeth that were causing her pain and then promised to arrange for her to receive free dentures at an affilated dental clinic. The show then went on to report on two corporate dental chains, the first of which specializes in dentistry for children with Medicaid. Most private dentists do not accept Medicaid patients any more due to the low reimbursement rate. In two states, Frontline along with the Center for Public Integrity found that the company's clinics installed more crowns in children than was the average for all dentists in Medicaid. The reimbursement rate for crowns is about twice as much as it would be for a regular filling. One mother was dissatisfied with the dental services her daughter received. She told the dentists to stop trying to install a crown because the anesthetic had worn off and the girl was in pain. The replacement dentist who came in got the crown on, but it fell off later on. The woman's daughter was referred to another dental office. That dentist found that one of the teeth that was supposed to have been crowned only had a stain on it that was cleaned off. The dentist and the mother both questioned whether the other teeth that had been worked on even had any cavities in the first place, and if the corporate clinic was just making the whole thing up. A former employee of the dental chain said that after time went on, they had daily financial goals that had to be met. Then, the program turned to another dental chain for adults. A truck driver with a tooth ache was shown. He had not gone to the dentist for years because of the cost. The dentist said that he needed dentures. The proposed cost was $6000. The dentist advised him to select the best guarantee for the dentures that he could manage. He then spoke with the clinic manager, a non-dentist, about the different packages that they have and how much it would cost. An outside finance company offers a health credit card at a high interest rate. These companies start charging interest even before the work begins. The CEO denied that bonuses are paid, but a dentist who used to work thecompany ir said that they were paid extra on the basis of sales volume. One eldelry patient initially only wanted one tooth worked on, but she came away with a bill for thousands of dollars. The company claimed that she expressed a desire to have a completely new smile, involving work on several teeth.

I have heard of dentists who push crowns over fillings, when a filling could be replaced with a new filling if need be, and dishonest dentists who say that teeth have decay when another dentist would or did not find those problems. But most dentists I am sure do a decent job, and if someone is in pain and has an infection, not providing treatment is inhumane.

The other thing is that an expansion of Medicare should Medicaid, if it would be truly a single payer plan. Too many right-wing governors will agree to the Medicaid expansion under the Affordable Care Act. The only way to cover those people who would otherwise be eligible would be through a federal program that would cover everyone who does not have health insurance. Even if Vermont eventually gets a single=payer program, that would not help those in other, more conservative states. Many doctors do not take Medicaid, and some also do not take Medicare patients because of the reimbusement schedule. All of these improvements would cost money, money which the federal government does not currently have.