Upon reading it, I’m going to revise my opinion. Breyer’s dissent is rambling and pretty weak, but I think the most compelling part relates to @CanadaMatt3004’s point. It’s not just the religious status of the school, it’s what education in that school entails.
Under Maine law, an “approved” private school must be “nonsectarian.” §2951(2). A school fails to meet that requirement (and is deemed “sectarian”) only if it is both (1) “‘associated with a particular faith or belief system’” and also (2) “‘promotes the faith or belief system with which it is associated and/or presents the [academic] material taught through the lens of this faith.’”
The clearest expression of why this should have gone the other way is this statement, buried in his rambling:
Maine thus excludes schools from its tuition program not because of the schools’ religious character but because the schools will use the funds to teach and promote religious ideals.
So I think there’s a very fine line to be drawn here (that the majority didn’t draw): if the funding decision is simply based on the status of the entity–whether it’s a religious institution or not–then I think that would be inappropriately punitive and anti-religion. That’s the finding in the prior Trinity Lutheran case. But if it’s a restriction on what the funding would be used for, then it’s proper. [Yes, you then get into discussions of how money is fungible, blah blah blah.]
My only hang up is that if there’s no public school available, and you’re getting a check from the state to cover some of your education costs as a result, what’s worse? The state money going to a religious school, or the state telling you that you can’t send your kid to a religious school and get the money? In either case, your kid is going to a private school.
The part of that excerpt that I found most important was that they are teaching academic material through the lens of that faith. So some of their science courses are going to be significantly different, for example. The state definitely has an interest IMO in making sure that kids are given a proper education in the core materials.
I don’t think this is a super simple thing and I think there are probably a lot of specific cases where that outcome would be super frustrating for parents. If these are rural areas, it’s possible someone lives 5 minutes from a religious school and 45 minutes from the next closest school of any kind. At that point even if they prefer a non-religious education for their kids, the logistics alone might be an issue. I mean, I doubt they have a school bus available for the 45 minute commute.
The problem is that this is true and it’s also true that Federalist Society goons will use the edge case as evidence that’s OK to overturn the whole principle idea the next time the principle idea that they want to overturn comes up.
The days of the mega payments to davita or other dialysis centers are long, long gone. People with medicare will also frequently have private insurance on top of it.
I’m also having a hard time getting rustled about this SC dialysis decision.
This seems like the inevitable conclusion of how Medicare is set up. If Medicare covers everyone with end stage renal disease (regardless of age), then of course insurers are going to take advantage of that.
This seems like something that could be addressed by congress if there was a desire to do so. The existing law is (as dissenters note) highly exploitable.
Also seems like everyone with ESRD will still get dialysis will still get it, but cost can get shifted to Medicare, but I doubt if anyone with ESRD really gives a shit that the end result of the law is that they still get dialysis, but more tax dollars are spent.
It is not even clear to me that people without ESRD who need dialysis for a short period of time would be affected. It sounds like the ruling means that the dialysis provider just has to take the shitty reimbursement that the insurer is willing to give and they still get their dialysis too.
Only people who get fucked are dialysis providers. Not sure how rustled I should be about that. I suppose that could have some secondary effects that reduce access to dialysis. Maybe.
I didn’t actually read the decision, so I could be wrong about above. I’m sure I’ll get around to it at some point.
Yeah, as I mentioned, that could be a consequence.
I’m not sure this is a lock though. There are constantly cuts to reimbursements for all sorts of medical services. The targets of the cuts always say, “Well if you cut payments, then we’ll go out of business and can’t provide the service.” That doesn’t always happen. I’m sure it happens sometimes. Will it happen here to a significant extent? I don’t know for sure. Perhaps.
America does more dialysis than any other country IIRC. Very few other places do dialysis on 80 year olds. This is a values decision… and it’s for the worse imo ftmp.
That’s not untrue, but that’s a bit different. Lots of docs don’t take Medicaid because there are tons of higher reimbursing patients that they could take care of instead.
But in this case, ESRD is kind of single payer. So it’s not like if you refuse Medicare, you can still have a bunch of other higher paying patients ESRD patients This ruling seems to reduce those other higher paying patients dramatically.
Wasn’t there some kind of thing where big dialysis was actively discouraging or lobbying to prevent treatments that would get people off of dialysis? Seems like a 60 minutes or similar piece maybe 10-15 years ago…
Here is an article from a quick google. Bottom line is that the incentives don’t line up well with either cost control or patient care (but great for the two companies profits).