Did SCOTUS Commit a Sin?

Observing the reactions on my Facebook feed to the Supreme Court’s ruling on the Affordable Care Act, I have been most intrigued by the religious responses that call upon God to have “mercy on us” in this time of apparent tyranny.

Not being a constitutional scholar, I’ve no informed commentary to give on the correctness of the ruling, but I see nothing immoral about mandating the purchase of health insurance.  As neither my wife nor my children currently have healthcare coverage, the mandate will obviously affect me, so I don’t speak abstractly or from a distance.  Universal healthcare strikes me as a social obligation, and if a mandate is necessary to achieve that and it functions within the framework of the government’s constitutional authority, then so be it.  Mandate away!

Now maybe SCOTUS got it wrong.  Maybe the mandate really is unconstitutional.  As I said, I’m not qualified to answer that question, but I’m pretty sure, constitutional or not, good politics or not, sound economics or not, whatever the mandate is, it’s not a sin, not an act that calls for the heavenly king’s justice.  None of the Ten Commandments were violated.  None of the Beatitudes were forsaken.  It’s not a sign of decadence or wickedness.  Even if it’s an overstepping of authority, it’s hardly malicious or calamitous.  Recitation of the Kyrie seems out of place, to say the least.

Kyle Cupp

Kyle Cupp is a freelance writer who blogs about culture, philosophy, politics, postmodernism, and religion. He is a contributor to the group Catholic blog Vox Nova. Kyle lives with his wife, son, and daughter in North Texas. Follow him on Facebook and Twitter.

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87 Responses

  1. Given that the deciding vote was from the Chief Justice, who has heretofore not been a hearty advocate of the Evil Liberal Agenda, I think one can safely rule out judicial malfeasance as an explanation for the decision.

  2. Kimmi says:

    unless you’re amish. in which case, why in hell are you on facebook?

  3. Teresa Rice says:

    I agree that the ruling isn’t a sin but it sure is against liberty. Do you think that individuals should have a choice whether to buy health insurance or not? Especially those college students who may want to save a few dollars. I can understand your concerns since your wife and kids don’t have health insurance. Yes, health insurance can reduce costs but simply having health insurance doesn’t necessarily mean that a person will have greater access to health care.

    • Morat20 says:

      Is it? When people don’t buy health insurance and end up stiffing the ER for tens of thousands of dollars, dollars that I pay through increased prices, doesn’t THAT infringe my liberty?

      • Teresa Rice says:

        I agree that the people should be held responsible for their ER visit. But the people still should have the choice whether to buy it or not and be able to take a risk. That is what liberty is all about. As far as the excessive taxes go that’s a matter you’ll have to take up with the progressive politicians. They’re the ones who believe in higher -excessive- taxation.

        • Morat20 says:

          Um, I’m PAYING for their risk.

          Because “being responsible” doesn’t magically give them money to pay for it. Not now, not over their lifetime.

          I do, instead.

          So once again: Their irresponsibility is impinging MY wallet. It’s THEIR bills. why am I paying for it? And why are you claiming they’re the ones suffering?

          • Teresa Rice says:

            Why do assume that most if not all people will choose to live irresponsibly and refuse to pay for their medical costs if they should happen to get into an accident? Why do assume that the person won’t or will be unable to obtain employment? Many employers offer insurance today but not all people take part in it. It is possible to have employment but not have health insurance. The medical costs in an emergency situation for these people should be based on a sliding scale according to one’s income. But all should pay something. Insurance companies haggle with what the’re going to pay for procedures and services so these people ought to be afforded the same opportunity.

            Never claimed they are the one’s suffering. Just that they shouldn’t be forced to purchase insurance. Both you and the other person’s liberty is being violated. But as citizens we do have an obligation to pay certain taxes.

          • Morat20 says:

            Why do I assume that? Because it happens? Because the actual PLAINTIFF in the case that got handed down today got sick and ended up having to declare bankruptcy and voiding her medical bills?

            Seriously, you are shoving these costs onto ME and claiming I’m restricting liberty?

            Get your hands out of my wallet, freeloader.

          • Morat20 says:

            So, in essence Theresa — you want the freedom to GAMBLE that you won’t get sicker than you can afford (or have an accident).

            But if you LOSE the gamble, you want to..pay a token and have ME pay the rest? You know, pay what you can and let the rest of the public pay off everything else.

            WHY ARE YOU GAMBLING WITH MY CASH? And calling it “freedom”?

          • joe defiant says:

            You really believe that health care costs are so high because people are visiting the ER and not paying? So you must also believe that if this were to stop, then the price of visiting the hospital will go down? Hahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahah
            It has nothing to do with Health Care/Pharmco corporations overcharging, lobbying, and forcing both democrat and republican to pass laws that increase their bottom line. If health care improves or gets worse, more expensive, or cheaper is just a consequence of whatever they dictate and whichever one happens they could care less.

            Yeah, just like when the seat belt law was passed, car insurance got cheaper. When auto theft rates dropped by more than 50% your car insurance got cheaper too right?
            As long as you keep picking either blue or red, when both are paid for by corporate lobbyists everything will go up. And they will tell you it’s because your fellow citizen isn’t paying his fair share. The guy next door is cheating you. not the Healthcare industry! hahaha if you believe that your a real idiot.

        • Kimmi says:

          So what if they “can’t pay”? What do you do about the homeless man who visits the emergency room 100 times a year?

          • Teresa Rice says:

            Help them find a job. Then make them pay something even if it is a small amount. If you don’t do that then your encouraging irresponsibility. You’d be surprised how much some homeless people collect on the street. When I worked at a fast food restaurant in MD my store manager offered a job to a homeless guy who came in to buy a coffee every day. So there are jobs out there for the homeless.

          • Morat20 says:


            Look, lady, I realize you just had a premature baby. That’s a quarter-mil. So let’s get you off that IV and start scrubbing hospital floors. You give us, oh, 5 grand, work here for a few months for free, and we’ll bill everyone else a few extra grand to cover it.

            Good lord.

          • Jesse Ewiak says:

            Hey, debt peonage has a long and fruitful history in this great nation!

    • Kimmi says:

      no, but it does mean that health care will be cheaper.
      How much does a root canal & crown cost again?
      A lot more than if the kid gets his cavities filled!

      • Teresa Rice says:

        Is dental included in health insurance costs? Dental is an extra cost out of my pocket, not included in my health insurance fee. It may be cheaper but the quality of care sure will decline with the added number of people and the number of doctors taking early retirement or leaving the medical profession due to Obamacare. And actually the costs have increased because of Obamacare. That is at least in part why Franciscan University isn’t requiring their students to purchase health insurance anymore. Why should any person be forced to purchase health care just because they are breathing if they don’t want to? Why do you want to take away their right to choose? Yes, the people should be prepared to face the consequences for their decisions but it should be their choice to make.

        • Kimmi says:

          Dental is included in health insurance–if it gets bad enough to send you to the emergency room. And antibiotics for “oh shit your face is swelling up.”

          Quality of care need not decline. How good of care do you think we give someone if they have to hit the emergency room before we can treat them?? Let alone the incidence of hospital acquired infections.

          Perhaps the quality of care for those lucky enough to be insured right now might go down. Perhaps. But if you ask me, not paying for hospital readmissions for heart attacks will lead to a dramatic increase in quality of care. (I believe that’s first on the docket).

          If we could get people to actually take responsibility for their decisions not to purchase health care insurance, I’d be Fucking Fine with it. The Mennonites already do this — to the point of leaving america if their health gets too bad. We lose businesses like that. And I don’t give a whoop. They’re doing as their conscious says.

          But you try telling someone that they can’t use an American Emergency Room, simply because they didn’t pay for it…

          • Teresa Rice says:

            Didn’t realize that. But I was referring to basic dental care such as cleanings, fillings, having teeth pulled and the like.

            Are you saying that emergency room care is horrible? Once they get seen they usually get really good care. The person may go to the free clinic in their area. And when they go to the emergency room it may actually be for an emergency.

            The incidence of hospital infections isn’t due to bad care. It’s due to too many antibiotics being handed out. Then the infection becomes stronger and is able to withstand the antibiotic which wreaks havoc for the human body.

            “But if you ask me, not paying for hospital readmissions for heart attacks will lead to a dramatic increase in quality of care. (I believe that’s first on the docket).” I’m not sure what you are referring to. Are patients being released prematurely?

            People should always be allowed to use the emergency room but they should also have to sign something being willing to pay something, a percentage of their income regardless of whether they’re on welfare, another government program or not.

        • Mark Armour says:

          I take this to mean that if someone refuses to purchase health insurance and loses the gamble (i.e. gets sick or in a serious accident) then he/she should not be treated. Just checking.

          • Teresa Rice says:

            Nope. Just saying these people would be responsible for their own medical expenses. Said somewhere else on this blog that I think the person should be able to haggle with the hospital just as the insurance companies do as well as make payments according to income. If the person doesn’t have a job they could possibly sign an IOU or a promissory note like you do for college saying that they are willing to pay at least a percentage of the costs back when the person is employed.

          • Mark Armour says:

            And who makes up the difference or covers the costs of those who simply cannot pay? Either we distribute those costs through a government program or private insurance. The costs have to be covered somehow or we simply stop treating people who cannot afford it. Pretty simple, really.

        • Hi, Teresa. I realize I’m chiming in late to what is already a lengthy discussion in progress, but this struck my eye:

          It may be cheaper but the quality of care sure will decline with the added number of people and the number of doctors taking early retirement or leaving the medical profession due to Obamacare.

          As I wrote in reaction over at my own blog, at this time I have no real idea what the concrete effects of the ACA will be on my practice. But the ACA was supported by the American Medical Association (an organization to which I do not belong), which is an immensely powerful lobby and one whose primary interest is the financial well-being of its members. I doubt it would be supported the legislation if it meant a genuine financial hit for doctors.

          I am skeptical of the notion that a mass flood of quality physicians will leave the profession because of this law.

    • MaxL says:

      As I recall, I had to buy insurance to go to class at college. But anyway, if healthy people don’t buy insurance, then there is no such thing as insurance. I mean, if the only people who bought fire insurance were those who’s house was on fire, then nobody could ever afford the premium and there would be no such thing as fire insurance. See? That is how insurance works.

      And FWIW, the tax is minimal, and can only be subtracted from a refund. by statute. It can’t be applied as a lien.

      • MikeSchilling says:

        As I recall, I had to buy insurance to go to class at college.

        My kids have to either buy insurance from their college or submit forms saying they have private insurance.

        • MaxL says:

          That sounds right. We had a large med school and hospital on campus but student health services were grim and complicated of course.

          • Will Truman says:

            My university clinic was the bomb. It’s one of those things that makes me not-entirely-unsympathetic to an NHS sort of program. My views are more complicated than that, but there’s something to be said for the sort of easy-breezy clinic we had.

          • MaxL says:

            I agree, Will, and I complain too much about the University health program. Pritzker was a huge teaching hospital and undergrad student health just sort of got lost in the labyrinth..

            Not having to worry about life, death and illness when trying to start a new business or just be self employed will be such a tremendous improvement over the current system. I can’t even describe my relief at the ruling today. It’s not the system that I would have picked, but it works OK for the Swiss.

            Everyone with diabetes can get their own gig now. A cancer veteran or the parents of a sick child can start a company. Which is the greater liberty, folks?

          • Will Truman says:

            Now, to figure out how to pay for it and determine acceptable levels of provision. That can’t be too difficult, can it?

          • MikeSchilling says:

            Let’s start by asking what happens if ome of the kids has a rare blood disorder than can only be treated by a drug that costs thousands of dollars a dose, and argue ourselves out of covering the flu and sprained wrists.

          • Morat20 says:

            Will: How is it different than NOW?

            I mean, Cigna handles my insurance easily enough — including answering all those questions. It’s only affordable (not to mention they don’t kick me off for pre-existing conditions and won’t deny me coverage if I’m sick) because I’m not an individual — I’m part of a large pool through my company.

            If Cigna can cover ME like that — because I’m part of a giant pool called “people who work for Company X”, what’s to stop them from doing the exact same thing — and for the exact same price — to an equal sized pool called “people who are self-employed or part of a business that doesn’t offer coverage”?


            In the end, that’s ALL the ACA is — with the same caveat that Cigna demands of me. i don’t get to have a heart attack and sign up at the hospital for my company coverage. I get a chance to sign-up once a year when benefits renewal rolls around.

            That’s the mandate in a nutshell.

          • Will Truman says:

            Morat, how is what different from now?

          • Morat20 says:

            um, because individuals can be pooled?

            Whereas before they were, you know, individuals. All the mandate does is basically enforce what my company does regarding insurance: You pay for it NOW for when you need it LATER. you don’t sign up at the hospital.

            Hence the mandate — you get to pool with fellow citizens, meaning a cheaper rate, no recission, and no bans on pre-existing conditions — and in return you actually pay from the get-go, not when you’ve found out you have cancer.

          • Trumwill Mobile says:

            Morat, I’m not sure which thing I’ve said that you are talking about. That was what I was asking.

          • Morat20 says:

            I think I replied to the wrong person or something. What I said doesn’t seem applicable at all. 🙂

          • Trumwill says:

            Whew. I can stop scratching my head. It’s bleeding now.

            (I’m just kidding around with you, it’s easy to get lost in threads.)

      • Teresa Rice says:

        First, are you implying that an adequate number of healthy people don’t buy insurance today? When you bought insurance from that college didn’t you make a choice whether you wanted attend that particular college or not? I’m not sure about this but I doubt that all colleges require persons to purchase insurance. But my point is you chose which college you wanted to attend. When you chose to attend this college you also agreed to the terms of “service” or attendance which was that you were required to buy insurance. But is everyone obligated to purchase fire insurance? Is their a fine/tax penalty if they don’t?

        • Kimmi says:

          well, your bank will often require you to have homeowners insurance. which turns out to mean that anyoen who isn’t richer than Adam has to have fire insurance.
          And you WILL lose your lease if you don’t have renters insurance…(it’s part of the contract)

          • Will Truman says:

            And you WILL lose your lease if you don’t have renters insurance…(it’s part of the contract)

            Uhmm… not true? I’m sure some tenants require it, but it’s never been a requirement on any of my leases.

          • Teresa Rice says:

            “And you WILL lose your lease if you don’t have renters insurance…(it’s part of the contract)” It’s not been a requirement where I rent now.

            Are you saying that all homeowners insurance includes fire insurance?

        • MaxL says:

          My point is about pooled risk and the way that insurance works. If we want a system where there is no such thing as exclusions for pre-existing conditions then EVERYONE has to have insurance. All of the well people and all of the hurt people, too. We all pool our risk against catastrophe for any specific individual. You just can’t get rid of exclusions without having everyone participate. It’s the only way that costs are reasonable for everyone. This is the way an insurance market works. But if you get rid of exclusions, then there is nothing to prevent a person who feels a little sick from buying insurance to see the doctor tomorrow. Mitt Romney called that kind of hustle a “free rider”. hence, the individual mandate.

          So, in order for the insurance market to work correctly, everyone has to be in it and it can’t be possible to just buy the insurance only when you need it.

        • Ken says:

          “First, are you implying that an adequate number of healthy people don’t buy insurance today?”

          There are today, but there probably would not be when the vast number of people are added to the pool by the ACA. That’s why the mandate is needed.

          • Teresa Rice says:

            But wouldn’t many of these same people entering the insurance pool be the same people who we paid for in emergency rooms? Wouldn’t that mean that they would be paying into the system whereas before they probably weren’t paying anything when seen at the emergency room? That would seem to mitigate the need to coerce all people to purchase health insurance.

    • Kyle Cupp says:

      You can fairly say that the ACA limits liberty, as it requires people to do what they might not otherwise do, but limiting liberty isn’t tantamount to being against liberty. Liberty isn’t absolute, morally speaking. The mandate serves a purpose. It is meant to ensure that both the healthy and the ill participate in the market. If only the ill bought health insurance, the system would collapse.

      • Teresa Rice says:

        I asked this below but I’ll ask you the same question. Are you implying that there aren’t enough healthy people buying health insurance today to support those who do get sick? Kevin is the healthy one in our family. I’m the sickie who has problems with gynecological issues on and off (although it seems to occur more often than not lately).

        • Kimmi says:

          People on health insurance are dying these days. Medical bankruptcy is a horrible problem even for the insured.

          And the worst part? if you get sick and can’t pay, then you often can’t work to get better again.

          There aren’t enough people out there without preexisting conditions. Every woman with a C-section ever has a preexisting condition. Every man woman or child who has ever been treated for major depression has a preexisting condition.

        • Kyle Cupp says:

          When you prohibit insurance companies from covering people with preexisting conditions (sicknesses, disorders, being pregnant, etc.), which the ACA does, then you need a mandate to ensure that people buy or keep paying for insurance before they have a preexisting condition. Without the mandate, you run the risk that people will opt to wait until they have a preexisting condition before entering or staying in the pool.

          • Teresa Rice says:

            Hold on… The ACA doesn’t prohibit the covering of preexisting conditions. Are you talking about the insurance companies before the ACA was voted into law? I’m pretty sure that one of the things that the ACA does is that it no longer allows insurance companies to deny you coverage because of having a preexisting condition (one of the things I like about the ACA).

          • Kyle Cupp says:

            Ack. In a hurry and I mistyped. Meant to say “when you prohibit insurance companies from denying coverage for people with preexisting conditions…”

  4. MaxL says:

    In Germany, for example, anyone who wants to can exclude themselves from the the mandate by signing a waiver BUT, if you do: you are not eligible for any subsidies, you are exempt from pre-existing condition protections (if you get sick insurance companies can charge you whatever they think is appropriate), you cannot seek bankruptcy relief for medical debt and you can’t participate in the subsidized exchanges for 5 years. After that, you can sign the waiver again for another 5 years. I think making bankruptcy law work like that in the US would be extremely difficult, though.

    • Will Truman says:

      I actually had a vaguely similar proposal. I can’t find it, but I called it Trumwill’s Alternative To The Mandate.

      Essentially, tying PEC to continuous coverage. As long as coverage is consistent, PEC’s are covered. If there is a gap in coverage, PEC’s are not covered for the first x months, with x being the number of months you went without insurance. Maximum of a year or so.

      • MaxL says:

        I don’t think the idea was ever entertained, which really did surprise me. It got rid of the “tax” part of the equation and makes the choice very clear. Liberty vs responsibility. Or, maybe more like Soshulism!!! vs “You really are going to have to pay for that if it breaks. With your own money.”

    • Teresa Rice says:

      I agree with the waiver idea. In fact IMO young people should be given that kind of an out from the Affordable Care Act. I think the person should be responsible for the medical costs if some unforeseen accident should happen. Or at least a portion of the costs, like the way the insurance companies haggle with the costs of procedures. They have adjustments and I think the same thing can be done for the patient without medical insurance.

      • Kimmi says:

        How long does it take to pay off a heart attack? I ask this because heart issues are a leading cause of sudden death in young people. $100,000, give or take. Now are you really willing to saddle a person with the equivalent of a college diploma, simply because they’re tall and like to play basketball?

        • Jaybird says:

          How long does it take to pay off a heart attack?

          I’d say that the victim probably owes the savior his life, no?

        • BlaiseP says:

          If tort law governed here, the young person in question would owe his heart surgeon a fraction of his lifetime income.

      • MaxL says:

        So, pay the tiny tax and skip the insurance. And if you get sick, sign up. The rates will be low because the rest of us are paying, so its all good for you, see? And by paying the tax you will have made some small repayment to those of us without kids who are subsidizing your education.

        Win win.

      • Mark Armour says:

        Let me appeal to the fiscal conservatives: by providing (or mandating as the case may be) health coverage are we not also making access to preventative care available thereby reducing the overall costs for all concerned? Granted, heart treatment is expensive but it is far less costly to manage if issues are caught early than to teat after-the-fact. So increasing the pool of people paying into the system means more healthy people covering the costs of the sick but ultimately means less sick people. That is why the ACA is budgeted to cost taxpayers less over the long run – less seriously I’ll folks entering the public programs in years to come.

        • Mark Armour says:

          Hah ha! I said teat instead of treat!! I’m such a boob.

        • Will Truman says:

          Though the notion that “preventative medicine saves money” is seductive, for a lot of very noble reasons (it would provide justification to take better care of people), it’s financial benefits can actually be quite dubious. There are certainly some exceptions, but if we want the benefits of preventative medicine, we’re going to have to pay for it.

  5. MichaelB says:

    I agree with Kyle, there is nothing intrinsically immoral in the decision. Now, in the details of the ACA, there are some morality problems, such as providing for abortion, contraceptives and other intrinsically evil things. Also, there is the problem that it makes it impossible for undocumented immigrants to get health insurance.

    • Kyle Cupp says:

      I understand the moral opposition of Catholics and others to aspects of the legislation, and the HHS requirements, but, as you note, these are distinct from the mandate to buy insurance, to which, if I’m not mistaken, the Catholic Church has no moral antagonism.

    • Morat20 says:

      “contraceptives are intrisically evil”.

      It boggles my mind to hear such things. Which makes me wonder — isn’t the Supreme Court like half Catholic these days?

      • MikeSchilling says:

        Two thirds, and the rest Jewish. The Jews are all Ashenazim, which the Catholics are a bit more ethnically diverse.

        • Morat20 says:

          Hmm. I wonder how that particular rather narrow religious background skews the court.

          I don’t know anything about Jewish sects, but while Protestants and Catholics do share a lot of common ground, I’d be shocked if the courts didn’t routinely hear a case wherein the different religious beliefs would alter their perceptions a bit.

          Case in point: Intrinsically evil contraceptives, as noted above, isn’t exactly a common viewpoint outside of conservative Catholics. Not that I expect any of them to vote to overturn Griswald or anything.

          More subtle influences than that. It just seems….suboptimal, in terms of getting some diverse views in. Aren’t there protestant lawyers? (I’m not naive enough to ask for atheist lawyers!)

          • Mike Schilling says:

            I don’t know anything about Jewish sects

            Not that much to know, except that we’re all circumsized.

      • Kyle Cupp says:

        Why does it boggle your mind to hear such things? Catholicism, which attributes a procreative meaning to human sexuality, a meaning it also considers normative, concludes from this that deliberate attempts to prevent procreation while engaging in sex are evil, i.e., not in accordance with the good of sexuality. Contraceptives fall under this. I assume you disagree, and many Catholics do, but the position and line of reasoning are hardly unintelligible or bewildering.

        • Morat20 says:

          Intrisically evil acts: Murder (not self-defense, not combat, murder). Rape. Genocide….wearing a rubber?


          • Kyle Cupp says:

            You seem to think “intrinsically” means “really, really bad,” like comparable to murder, rape, or genocide. It doesn’t. It simply means “in itself” contrary to the good. An intrinsic evil can be a relatively minor offense.

          • Morat20 says:

            No, I think it means “in itself”

            Sticking a condom on your dick? Not an evil act in of itself. Sorry. It harms no one and nothing. It causes no injury, it does not deprive, it does nothing but change where a small amount of fluid ends up.

            To even claim it’s intrinsically evil you have to load up the concept.

            I’m afraid I cannot take claims of “intrinsic evil” very seriously if I first have to assume your religion is true, then your specific version fo the religion is true before I can actually make a judgement.

          • Kyle Cupp says:

            There are consequences to changing where that small amount of fluid ends up, consequences that just might be morally relevant here. In any case, you raise a good point about seriously taking moral objections that seem to arise solely out of religious belief. Catholicism makes “natural law” arguments against contraceptives, but obviously few people think these arguments reveal any kind of moral norm. The Church seems to recognize this: you rarely see bishops making the case for a return to legal prohibitions of birth control. The “secular” arguments for such an action are all found wanting.

  6. Ken says:

    I’m just certainly glad, that like Massachusetts, there are sufficient mechanisms to ensure that there are more than enough primary care providers to see all these newly insured.
    /ends sarcasm
    //studies up “First Aid for the Step 1” so I can do well enough to go into a specialty after med school.

    • MaxL says:

      Since the US pays doctors about 45% more than anyone else and about 2.5x the world average, I think it will be easy enough to attract some more doctors. Of course, Canada might end up with a shortage.


      • Will Truman says:

        Attracting doctors isn’t the problem. It’s getting them through residency that’s the problem. And getting them to agree to go to the right (primary care) residency.

        • MaxL says:

          So, pretty much the same problem we have now – and have had for as long as I can remember. I have no idea how GPs became such a disrespected profession, at least by their peers, in the US. I hate to even suggest a government program to encourage what seems to me such a decent and respectable way to make a living, but maybe this would have to be part of some broader education reform legislation prioritizing loans/grants for engineers, scientists, nurse practitioners?

          • Will Truman says:

            Yeah, absolutely the same problem we have now. I don’t know how much lurking you do, so I apologize if I tell you what you already know, but my wife is a primary care physician, so this is something of rather central importance to me. This may change, but she currently plans to leave primary care clinic work sometime in the next year or so. I wrote a little bit about it here.

          • MaxL says:

            That is a bind. Good luck with the exit strategy. I grew up in a small town and miss it often.

            I gather the problem is that GPs aren’t paid enough to attract enough med students way from specializing, but are still too expensive to have more than one to serve so many people – so they are run ragged by rules requiring them to be present for every last paper shuffling detail? What a mess. There are so many moving parts to the problem that it will be nearly impossible to untangle.

            re: lurking. I’d say you can spot my breadcrumb trail from space. This is the only site I comment on regularly. Is that typical? I wonder.

      • Ken says:

        True, and you especially see lots of foriegn grads in the primary fields around here. But there are two major issues. 1) a lack of residency slots, and 2) not enough visas for them.

        But do we really want a sort of system that assumes that we’ll just import people into those jobs? What happens when they decide to stay and practice in their home countries?

        • Ken says:

          And Max, from conversations I’ve had with several GP friends, the answer to both questions is “yes”.

  7. Mark Armour says:

    Compared to programs like Social Security and Medicare/Medicaid this is small potatoes. Ten years from now we’ll wonder what all this fuss was about.

  8. Teresa Rice says:

    @Mark Armour Do you honestly think that our inefficient government can do a better job at providing access to health care, lowering costs, and offering better coverage with the same quality care as insurance companies do today? This is the same government that already denies better tests known as PET scans which diagnoses cancer more correctly than CAT scans with relation to where it is located in the body and the amount of cancer because of the cost of the test. I have never been denied by my insurance for any test or procedure.

    • Mark Armour says:

      I don’t think that at all but I also don’t believe the medical establishment has my best interests at heart. I believe they are incentivized to run tests and prescribe costly medications.

      Unfortunately, like all things in life, we have to weigh the relative benefits and drawbacks. Do you want to reduce costs? If so then everyone needs to pay into the system (via taxes or insurance requirements) and have access to preventative medicine so as not to burden the system by delaying care. either way someone will be dictating the terms of our care – either a private system that is profit driven or a cost-conscious public system.

      In a private system some people are simply going to have access to better health care than others. A public system will actually cost much less but some people will have to sacrifice the level of care they enjoy today. And yes, it will probably be inefficient. What nobody admits is that everyone, at some point or another and whether they are insured or not, will require health care. Do we treat everyone or, like rural firefighters in recent news stories, do we decide that we are going to withhold care from those that cannot afford it or have chosen not to pay?

  9. Teresa Rice says:

    To All: Sorry about the delay in responses but yesterday I had a health scare – chest pains – and they ended up admitting me to the hospital. Thankfully it wasn’t my heart but something that can cause a similar type of pain. I’m home now but am exhausted so I will try and respond tomorrow. Have a great weekend!