Good thoughts and explanation.

...is a sort of magical thinking about healthcare; we think there's a way to get universal coverage without paying for it.

The fact remains that, if we had a single-payer system, taxes would go up. A lot. Granted, paying those taxes would still be cheaper to a significant degree than paying today's taxes plus insurance costs, but it wouldn't be free. Similarly, a public option as originally proposed would cost less than the current system, but it wouldn't be as cheap as people were hoping for.

In the long run, one of the things about a public option or single-payer that made them so popular was that they gave the promise of a full solution while not yet revealing the cost. My suspicion was that, if either of them had passed, once the true cost (in premiums or new taxes) became known, there would be the same sort of outcry to "kill the bill" as we've already seen -- and then, if it did get thrown out, a return to the same complaints about how we "need to do something" about the current "unworkable" situation we had before ACA, and will likely have if the SCOTUS throws it out.

cut war machine spending by 75% and increase taxes the top 1% to 75% of their yearly income no matter the source.

and it's one of the two most popular government programs with just about everyone.

(And I understand the need to support the bill, awful as it is) It does not ever become universal hitting the poor hardest.

And it ensures that costs will always rise, not due to ever increasing treatment, but to support an endless rise in the stock price of the corporations that created and constantly inflate the already absurdly high price of health card in this nation.

The requirement that 85% of premiums be spent on patient expenses limits the amount of profit and fat-cat overhead that can be milked out of the system.

The very poorest will either qualify for Medicaid or for large tax credits to cover the cost of coverage. Someone slightly richer than that (like me) might get screwed a little by being forced to buy a minimum policy - but at least they won't be able to selectively deny coverage.

When caps (or anything) are expressed in terms of a percentage, the motivation is to increase overall costs/expenditures as that increases the actual number of dollars. IOW, this "cap" is highly inflationary. The result is inevitably higher costs for less service.

Think of those infamous cost plus contracts in Iraq. Truck gets flat tire, burn the truck rather than replace the tire.

What good does a tax credit do for a poor person?

First, there is plenty of direct evidence in accelerating cost data that the current system without an MLR limitation of 85 percent is highly inflationary. Letting them take whatever slice of money they like out of the system as profits has done nothing to control medical cost inflation. There is no imaginable scenario where the absence of this control would. If increasing total costs on a 15 percent margin improves profits, it does so even more on a 20 or 30 percent margin. The financial incentive is even larger without this control. MLR control does not in itself control costs.

What could control costs is the exchange, where coverage is standardized, and prices can be compared apples to apples. Bottom line, in the current system, you truly do not know what you have for coverage until you get sick and see what claims they deny. All plans sound pretty good until you need them. Having personally had to come up with $7,000 to pay for my "maximum $2,000 out-of-pocket" in a year, while having the "good insurance coverage" tells me this. There is no reasonable means to do cost comparison because you really don't know what you are getting until you use it.

On another front, my current employer is different than most I have worked for over the years in that there are three plans available to select from (all with the same provider). In most cases the choice was simply yes or no.

Finally, tax credits that are refundable do plenty of good for the poor.

it is basically free money from the government. Also, the only way health insurance companies could milk those percentages is to conspire with health care providers to dramatically raise their prices. I'm not saying this is impossible, but it would be extremely hard to co-ordinate on a scale large enough to matter without getting caught.

It would give health insurance companies less of an incentive to deny procedures and skimp on payments. That could be both a good thing and a bad thing, depending on your point of view.

The cure for any argued constitutional defect is too simple, and something the conservatives desire less than the current plan. The government simply taxes you at whatever level is appropriate to income, then sends you to an exchange to pick your coverage from their range of contracted private sector providers for "free". You get the choice of provider you like, and you can select to just not sign up, but you pay the taxes regardless, because they are just taxes.

The private sector providers get the same dollars and provide the same coverage, the cash is just collected as taxes instead of premiums. Mix it in with Medicare and the only way to invalidate it is to toss Medicare out as well....

This is a political issue and I can easily see the court punting this to the "political process".

The obvious fix would not be to the Republicans' liking but there is no chance of that obvious fix being enacted.

Dems would probably need 65+ in the senate and a 80-100 vote margin in the house to make levying any new tax reated to healthcare a political possibility.

If the legislation stays in place, the scale of the problem is reduced and the political momentum to deal with is further wanes for a generation. Strike it down and the problem goes to full flower and the political momentum to ultimately fix it grows larger and faster.

Recall that individual mandates are a conservative idea, most Cons would like it and would also ban employer based coverage to cost shift the entire burden onto the working class.

Strike the legislation down and a different result will eventually prevail. That result will involve progressive taxes on the wealthy and businesses.