I really enjoyed this pugnacious, belligerent, non-lawyerly response to the whole premise behind the health care lawsuits.
You may agree or disagree with the writer (I think I’ve made it clear I agree with him) but it’s wonderful to read at least one person who isn’t swallowing the conservative premise whole.
He isn’t passively and patiently answering the narrow question conservatives chose to ask, as in nearly every other editorial or analysis of health care I’ve read. He doesn’t get that far. He doesn’t accept the question as they chose to frame it.
I don’t know why Federalist Society types seem get this incredible deference from the country as a whole, no matter how insane their arguments, but it seems to me we might want to start actually listening critically to these Big Questions they’re always raising, instead of accepting the question and moving right to desperate defense.
If conservative ideas are so solid and bedrock and logical, the questions they select and frame so carefully should survive a rigorous public inquiry and debate, before we get to answering them. We really don’t have to defer to them. It’s entirely possible they’re completely wrong right from the get-go.
So far, in two of the pending lawsuits, opponents of the law have succeeded in spinning the judges, framing the lawsuits as posing the question whether (as Virginia argued) the federal government can “impose a penalty for what amounts to passive inactivity.”
But the judicial answer, it seems to me, should be two-fold.
The first, and most important, answer a judge should give is, “I dunno. Find a case where the government does that and get back to me.” Because that description of the Affordable Care Act is simply inaccurate.
Here’s how Judge Henry Hudson put it in his decision in Cuccinelli v. Sebelius: The Act “requires that every United States citizen, other than those falling within specified exceptions, maintain a minimum level of health insurance.”
This snappy apothegm is the logical equivalent of saying that the Defense Appropriations Act “requires that every United States citizen, other than those who leave the country, engage in accepting a minimum level of protection by the United States military.” The provisions of the Health Care Act provide a benefit. The majority of Americans, who already have health coverage (and seem, by and large, to regard this coverage as worth bargaining for) will simply see improvements in their existing health care benefits, such as an end to lifetime benefit limits and the right to include older adult children on their policies. A significant number of others who are currently uninsured will become eligible for government-funded health insurance.
There will remain a small but significant number of Americans who can afford health care insurance but choose not to buy it. But contrary to the sound bite above, even they are not required to “maintain a minimum level of health insurance.” If they wish to keep their uninsured status, they may do so by paying an addition to their income tax bills–ranging from as little as $695 for an individual taxpayer to $2085 for a family of six or more. The claim that the government is “forcing individuals to buy a commercial product” is worse than spin; it is simply false.
The doctrine under which the Act is being assailed quite simply constitutes a threat to most of the significant advances in federal law of the past 100 years: federal pension programs, national wildernesses and parks, consumer protection, environmental regulation, and most particularly statutory guarantees of civil rights.
It’s not coincidental that right now Ron Paul laments the Civil Rights Act and that Haley Barbour speaks fondly the segregated South, that anti-immigrant extremists target birthright citizenship, or that right-wingers seek to wreck the Constitution with an old-South style amendment letting states repeal federal laws. A decision to void the Act would furnish a powerful precedent for those who would “restore” a libertarian dreamland that never existed, and that for most of us would quickly become a nightmare.
Yutsano
And the very first act of the Republican House will be…repeal of the whole thing! Yep, including insuring kids up to 26, the donut hole patch, and the pre-existing conditions clause. I already gots my popcorn ready!
Dave
This is slightly OT, but has anyone seen what the House GOP is titling their HCA repeal bill? It’s officially the “Repeal of the Job Killing Health Care Law Act”.
We’ve given the levers of power to a bunch of fucking five-year olds….
me
I guess mandatory car insurance laws are unconstitutional too. Or is that okay because it’s a state law and they think the 14th amendment is unconstitutional.
liberty60
Good point-
Maybe we could just flip the premise-
Everyone in America is required to pay a new tax of $695; however, those who get health insurance are given a waiver on the tax.
Its like saying the government “forces” people to install solar panels since those who don’t pay higher taxes than those who do.
DBrown
So, then no State can require auto insurance in order to drive? Exact situation so how can this health care law be invalid?
Yutsano
@me: Lots of folks think the Sixteenth Amendment is unconstitutional too. Apparently everything after the first ten was passed incorrectly or something like that. And even the first ten are pretty suspect.
Kay
@me:
That’s the difference. There’s a better comparison, though, and it’s Medical Support Orders. Those came through state legislation but predicated on a federal law and a federal agency directive.
Conservatives didn’t object to those, which is a little mystifying :)
dmsilev
@Yutsano:
Except the Second, of course. That one was handed down by Moses on a stone tablet and given to Jesus for safekeeping.
dms
Triassic Sands
@Yutsano:
Because the Senate won’t go along, the Republicans may not pay any price for their action. For example, in the case of children who have continued to be covered by their parent’s insurance, they won’t lose their coverage, so it will be as if the Republicans haven’t done anything at all — except to their base who will swoon with love for the assault on health care legislation. But for the average swing voter, I doubt if this action will even register.
@Dave:
Hey, at least it’s not “The Repeal of the Soul-Sapping, Job- Killing, Tax-Raising, Freedom-Smashing, Embroyo-Murdering, Planet-Destroying Health Care Law Act.”
At least, not yet.
Davis X. Machina
I think Democrats need to get out ahead of this growing movement if they want to salvage 2012.
Pre-emptive repeal is just what the Democrats need. It’s the one issue calculated to get real progressives off the bench and into the game — they hated the bill in the first place. And it sets the table for single payer.
It’ll protect the remaining Democrats from red and purple districts who survived the mid-terms.
At the same time it’s the sort of bi-partisan, across-the-aisle issue that makes Washington insiders happy.
A grand, radical, righto-leftist coalition.
McCain’s 180º on DADT proves there’s no political downside to reversing yourself overnight on a major policy position, so there’s no price to be paid except from a few so-called ‘pragmatists’.
(OK, I’ll level with you. I got stuck with a lot of ‘Kill the Bill’ merch from ’09, that I’ll be able to unload…)
Yutsano
@Triassic Sands:
They’re saving that title for the articles of impeachment for Obama.
@Davis X. Machina:
Adjusted for reality.
azlib
@Dave:
Pretty much says it all. And Obama (and the so called independents he is trying to court) thinks reasonable people can work with this crew.
sven
Meanwhile, house Republicans are literally asking hundreds of corporations how they would like regulations to be rewritten.
Like most folks here I avoid Politico but this story is too bald-faced to ignore.
Darrell Issa asks business: Tell me what to change
LGRooney
Sounds like Billmon is back!
cleek
@liberty60:
and then Obama will have reneged on his pledge to not raise taxes on the middle class.
Michael
“Are you now or have you ever been a member of the Federalist Society” should be a question at every confirmation hearing from here on out.
An affirmative answer should be an instant disqualifier.
kay
@Michael:
How did they get so insulated and coddled? They can float the most crackpot theory and the whole country immediately engages in earnest, respectful debate.
Liberals don’t get all this worshipful deference.
ruemara
@azlib:
You know what pisses me off? People who say shite like that. Whatever the fuck Obama thinks, the reality is that he HAS to work with this crew, just like he had to work with the last disappointing set of blue dog nutters. Now, he has to try and make government function with an absolute set of crazies. If all you can get out of politics is “Obama is too naive to understand these people that I from my living room chair grok completely, ergo he is at fault”, then you need to switch to fantasy football.
Michael D.
Just an FYI, the author, in the lst paragraph, changed RON Paul to RAND Paul. He made an error.
LGRooney
@dmsilev:
Except of course, it wasn’t passed down onto a stone tablet because if one were to read it, “originalistically,” we wouldn’t be spending hundreds of billions on the Pentagon.
Triassic Sands
@Yutsano:
The articles of impeachment for Obama will have a title so long it will have to divided up into chapters. Surely, the words “socialist,” “communist,” “Nazi,” and “Muslim,” will figure prominently, as will the always catchy “America-hating traitor.”
I have really mixed feelings about the GOP impeaching Obama. On the one hand, it seems like they would make such fools of themselves that they might become discredited in the eyes of even the average American dolt. The idea of impeaching Obama (after the previous administration got off without so much as a slap on the wrist) is so preposterous that it’s tempting to believe that it would backfire horribly and cost the GOP for years to come.
As with the Clinton impeachment (but much more so) the crazies in the House could send the articles of impeachment to the Senate for trial, where Judge Roberts could pretend he was carrying out some sacred constitutional duty in ultra-solemn form, and Obama would be acquitted. (While there is no way Obama would be convicted, the final vote count would be interesting. Would it be straight party-line or would the Mainers and Scott Brown and maybe another Republican senator or two vote for acquittal?) Once again, the US would be the laughing stock of the world, and, at home, confidence in our system would fall to historically low levels.
Then, I remember who will be reporting the story and who their audience is and suddenly I’m not so sure it would work out that way.
Embroyo-murdering? WTF?
Chris
@dmsilev:
I dunno. The Second has that line about “well regulating” militias, what the hell’s all that about?
Alwhite
And herein lies my main complaint against so much of what the Dems have been (not) doing, Obama in particular. So often, even when the outcome is favorable the Dems have allowed the Republicans to frame the issue. They do not question the assumption, they do not push back at the bullshit. While some do an admirable job of stating their case it is often from a position of weakness because they allow the bogus premise to stand unchallenged.
Refuse to answer the question – instead refute the question & make them defend their framing.
Davis X. Machina
@Chris: Fiber. And lots of fruit.
Triassic Sands
@dmsilev:
Your comment makes me wonder why the Republican religious fringe in this country hasn’t discovered the “Eleventh Commandment” — Thou Shalt Possess Firearms.
Surely, there must be lost books of the New Testament in which Jesus turned slingshots into semi-automatic handguns and spears into AK-47s.
Triassic Sands
@Chris:
“Well-regulated militia” simply refers to the adequate intake of dietary fiber. Nothing more.
shargash
That’s about as stupid and dishonest piece of spin as I’ve seen in a while. By that logic, there is no mandate to file a federal tax return or honor a federal subpoena. Anyone who doesn’t is just subjected to a special “tax” if they don’t.
The fact that there is a government-enforced penalty means it is a mandate. Duh!
And for those who think that car insurance is equivalent, driving a car has been deemed to be a privilige, and those who don’t drive don’t have to have insurance. Unless you’re going to argue that being alive is a privilige, the two are not even close to equivalent.
I really don’t get why the Obamabots’ are so hyped up in favor of the mandate. Is it just that overturning it will reflect poorly on the Leader?
The mandate was put in there as a giveaway to the healthcare insurance industry so they wouldn’t oppose the bill. When I complained about the mandate before the bill’s passage, I was smugly told that we could always improve the bill in the future. Well, here we have a few judges trying to improve the bill by removing the mandate, and the same smug people are now shouting in outrage about “Republican” judges and trotting out every lameass argument imaginable in favor of it.
Of course, in the grand scheme of things, I shouldn’t mind so much. I have health insurance and will qualify for Medicare before too many years go by. Maybe I should look forward to a mandate to buy all sorts of things — cable TV, fast food, a new car or appliances, maintain a minimum balance on my credit card, or pretty much anything else any industry that can lobby Congress can dream up. Oh, sorry. That’s right. It wouldn’t be a mandate. It would be an opportunity to buy, just with a special “tax” if I declined.
kay
@Alwhite:
That’s true with liberals, though, not just Democrats. It’s some inherent eagerness to respond, or something.
I think it’s just part of the make-up. I’m guilty of it too. Every once in a while I get time to think it through and ask “WTF are they talking about, anyway?” but it’s rare.
FormerSwingVoter
The whole “individual mandate” bru-ha-ha is insane anyway. Oh noes! You may pay more in taxes if you don’t have insurance!
Yeah, well even if it’s overturned, they can accomplish the exact same thing by giving tax credits to those with insurance. I rent instead of own, and have no kids, so I pay more in taxes than many in my peer group. But I don’t shriek about the “children mandate” or the “mortgage mandate” because that would be completely batshit insane.
However, since we do give up $100 billion in revenue due to the mortgage deduction, I have no qualms with telling my more conservative friends that more of my tax money goes to them than anyone on welfare. That goes over well ;)
gypsy howell
I have a theory (please bear with me here, then flame away)
I think the republicans have worked through the numbers and determined that for a very large percentage of the voting public, the problems which HCR is supposed to fix will not have any appreciable impact on them in any given year.
What percentage of the population in any given year actually face the problem of a pre-existing condition preventing them from getting coverage for health insurance? I bet it’s pretty small. What percentage of the voting population actually goes over a lifetime payment cap in any given year? In other words, for each of the fixes in the HCR bill, how many people are actually (as opposed to theoretically) affected? I don’t know that number, but I’m certain the republicans have done that calculus.
This is one of the major problems the administration faces – the problems addressed in the bill are only theoretical problems for most people in this country at any given time. IF I lose my job and have to get health insurance on my own, then maybe I’d come face to face with the pre-existing condition situation. But as long as I don’t need to find new health insurance, the whole pre-existing thing is only an abstract problem for me. IF I have a catastrophic injury, then MAYBE I would run out my lifetime benefit cap. But as long as I’m not racking up a million dollars in medical bills, the lifetime cap repeal doesn’t actually affect me.
HCR is a bunch of fixes for a bunch of tiny pools of constituents in any given year. The fact that our congresscritters and the administration idiotically chose to phase these fixes in by dribs and drabs over the next 4 years makes this problem even worse. Tiny pools of constituents are of no consequence to any politician.
I think the Republicans are counting on the fact that for a huge percentage of the voting population, the changes in the HCR bill won’t have any ACTUAL REAL TIME impact on them personally. (Didn’t Obama pretty much tell us all that?) And we all know, that unless something directly affects the American public, they could give a shit less. Calling for repeal will have no downside for republicans, because not enough voters to matter are really going to get hurt by repeal this year. I think the republicans, and enough blue dogs to get over the hurdle, can pull this off with no blowback to them.
Yeah, they’ll need to do a few things like put forth the “Shovel Money Into The Donut Hole So Grandpa Doesn’t Face the Dimmicrat Death Panel Act”, (which will once again blow another hole in the budget by paying off Big Pharma) to make things palatable. But then they can be heroes!
It’s kind of hard to imagine Obama wouldn’t veto HCR repeal, but at this point, I think anything can happen. “Will of the People,” and all that.
Even if HCR did get repealed, I don’t think there would be any price to pay politically.
Ok, now tell me how wrong I am.
harokin
@shargash: How do you feel about the mandate to own a home if you want to avoid increased taxes? What about the mandate to donate to federally recognized charities if you want to avoid increased taxes?
kay
@shargash:
Well, no. Because you’re not guaranteed a basic cable package (or a Happy Meal) in this country if you choose not to purchase the premium package.
You are guaranteed access to emergency medical care, via a federal law that liberals put in. Insurance or no, ability to pay or not, if you’re very sick or injured, you’ll get basic medical care.
That’s the difference. I don’t think your comparison works, and relying on it is actually contra to the broader liberal argument that health care is a right, so I think it’s counterproductive, to boot.
Rick Massimo
This is what they, and our friend shargash @27, refuse to accept. Our conservative movement is like a four-year-old who is so determined to show that You’re Not the Boss Of Me that he’ll ride his bike blindfolded straight into a tree. “Don’t you DARE tell us that a ban on discriminating against pre-existing conditions is a good thing! What if I WANT to be discriminated against, huh? Did you ever think of THAT in your fancy Harvard Law classes?”
Also, shargash – as the writer of the linked piece pointed out, this is like saying that the government is compelling you to pay for the protection of the military: Well, yeah; they are.
FormerSwingVoter
@shargash:
Er, because insurance prices go up if you require them not to drop people unless healthy people also sign up. Adverse selection, dude.
kay
@shargash:
It’s funny, because conservatives tie themselves up in knots on this, too.
Their whole argument (President Bush used it) is that people can go to an emergency room for “basic health care” so we’re a great country and everything’s fine.
But that’s a unique guarantee, it doesn’t exist in food or housing or any other market, and it comes with an implied duty, that if you can pay, you should. So they’re right back to where they started.
Linkmeister
The mandate is necessary because, like all insurance pools, the healthy (or long-lived, for life insurance) pay in to cover those who are not so fortunate. If you let the healthy opt out the only people with insurance are the sick, and premiums would skyrocket (if they could even get insurance at all, and we know they have been blackballed with the current system).
Davis X. Machina
Paying our children’s college tuition — or saving up for it. Insulating our homes. Buying hybrids. Tree-farming.
Legislatures declare certain behaviors, involving the purchase of goods or services, even from private, for-profit entities, to be pro-social, and worth encouraging, by tax-advantaging them, and do so all the time.
MattR
@Linkmeister: I understand why the mandate is necessary in theory, but I have never seen anyone actually point out why it is currently necessary in practice. Being forced to cover pre-existing conditions and other aspects of the law will increase costs for the insurers, but if they are already making obscene profits then they should be able to absorb those increases.
As an example, if a company currently takes in $1 billion in premiums, spend 10% on adminstrative costs and 60% on medical care that leaves them with a $300 million profit. Under the new law, they have to spend at least 80% on medical care which is an increase of $200 million dollars. It seems like that money could be used to cover the additional costs that this law requires before it is necessary to add a mandate.
I don’t know if my scenario is close to reality because I have never seen any actual numbers/projections comparing the increased costs with their current profits while taking into account the new requirement that they spend 80-85% of premiums in medical care. I have only seen the theoretical argument for why it is necessary.
Triassic Sands
@shargash:
@MattR:
Removing the mandate doesn’t improve the bill — it makes the whole thing fall apart (regarding universal or near-universal coverage).
Since we are still committed to having for-profit health insurance companies, in order to require them to cover everyone regardless of pre-existing conditions there has to be a mandate. Otherwise, smart individuals will simply forgo health insurance until they get sick. If they do get sick, they can sign up, get treatment (maybe tens or hundreds of thousands of dollars of care), and then, healthy again, drop the insurance. That means insurance companies will be insuring people only when they are sick — insurance companies make money insuring healthy people.
Here is the difference:
Mandate: millions of people — mostly healthy — pay insurance premiums every day of every month of every year. Treatment for the sick is paid for by the total of all premiums — sick and healthy.
No Mandate: millions of people — all sick — pay premiums only when they fall ill. Since the premiums of sick people can’t possibly pay for the treatment of sick people, the insurance companies go out of business (and no one is covered) or no one’s treatment is covered.
The reason insurance works is because the number of healthy people outnumbers the number of sick people.
As health care costs continue to rise and more and more employers stop offering insurance, more and more people will be on the individual market.
Imagine this scenario: Bob spends his money having fun. Then, he begins to feel tightness in his chest. After several episodes, he realizes he may be building to a heart attack. So, he signs up for health insurance. A month later he suffers an MI. His medical bills exceed $40,000, but he has only paid two months’ premiums, let’s say $800. Feeling healthy — stent in place — Bob decides to drop his insurance until he needs it again.
Does that sound like it will work? (For Bob, shit yeah!!!)
MattR
@Triassic Sands:
My point is that if the insurance companies are currently making obscene profits (and if they now have to spend more money on medical care as a result of the law), then why can’t the insurance company eat that $40K that Bob stuck them with? I understand the fear that the entire country will become like Bob, but why not wait until that actually starts to happen instead of adding a mandate before it is really necessary?
gene108
@kay:
Liberals are too into self-flagellation to get that sort of deference. They spend more time beating each other up, than they do focused on any coherent goal.
In order to be taken seriously, you have to take yourself seriously.
You don’t take yourself seriously by pissing on someone, who agrees with you 90% of the time or up to 90% of what you want and when they give you 90% of what you want you just bitch about the 10% you didn’t get.
No one is going to take you seriously, if you aren’t in it to win it.
Reporters are competitive.
Getting national network gigs means you’ve had to push yourself ahead of a bunch of other bozos and to stay on top and get your own show means you want to compete and establish yourself as the alpha-male in your office.
Republicans want to win. Period.
Reporters can understand that because they are dealing with the pressure to come out on top and stay on top.
They take the win at all costs mentality of Republicans seriously because it is so close to their hearts.
Pondering philosophical questions and debating the “ifs” about a policy, though intellectually interesting over a cup of coffee with friends, ain’t going get you, your own prime time T.V. show.
Democrats to some extent and liberals to a large extent seem to care more about the “ifs”, than winning.
Sometimes winning is just a matter of declaring victory and hoping no one says you didn’t win.
There’s a myth out there that Republicans rammed down everything they wanted and more, when Bush, Jr. was President.
The reality is they didn’t open ANWR or the coasts up to oil exploration. The biggest domestic policy achievement, Medicare Part D, was something Democrats had wanted for a very long time.
The tax cuts were passed with razor thin margins, with Cheney casting the tie breaker in the Senate on 2003 tax cuts.
Social Security privatization was a flop.
The reason people think Republicans did what they wanted is because the Republican base never went bat shit crazy and started chewing out the Republicans because they passed a Democratic bill – Medicare Part D – for example, because they were getting what they wanted with regards to regulations and taxes.
Sure some right-wingers decried Medicare Part D, but that didn’t make them want to sit home in 2004 and let Kerry win, under the assumption Bush, Jr. and Kerry were both the same.
Many liberals have taken the view Democrats and Republicans are both the same, so they’ll vote Nader and have rebuked Democrats attempts to implement liberal policy, such as HCR.
At some point, people will just defer to you, if they feel like they can relate to you and you have a certain swagger that you’re right.
Republicans have values, like winning is the only thing that matters and a swagger their ideas are right, that gets people to defer to them.
Liberals spend too much time questioning themselves and are, at some level, indifferent to competition, so they don’t relate to the national media and instill a sense they know what they are doing.
ed drone
@shargash:
No, the mandate was put in there so the healthcare insurance industry so they wouldn’t go broke. If you require coverage, and don’t require universal participation, only those already sick (or feeling like it) will get insurance, and the companies would have to cover them. The whole point of insurance is to spread the risk, and if you leave out the healthy, all you get is sick ‘uns, and they’re the ones who cost the companies.
Now, you can say you don’t care about insurance companies, and they can all go to hell, but as a matter of fairness, you can’t require they cover people unless you require healthy people to participate. And if there’s no other option (a public one, for instance), all the companies can do is raise rates, which hits all their customers, or go broke.
The worst thing to happen to Republicans would be that they beat back the participation rule, but leave in place the ‘must cover’ rules. The companies would soon be howling for the scalps of those who turned the tables that way, and that’d be the Republicans.
A sop to the companies? Well, in that the Act didn’t provide for universal, single-payer, public-financed competition for the companies, maybe so. But as logic goes, penalizing uninsured people helps keep the existing system, whatever you think of it, afloat.
Ed
gene108
@gypsy howell:
I think that was especially true in 1994, but as insurance costs have sky rocketed and employers have scaled back coverage and shifted more costs onto employees, the average American is more acutely aware the insurance they have isn’t as rock solid as they want it to be.
There’s a lot more uncertainty for most Americans, with regards to employment and employer provided health care than there was a generation ago (and yes, the early 1990’s was a generation ago).
Republicans aren’t going to suffer any blow back by presenting a bill to repeal HCR.
There are a large percentage more Americans acutely aware of how dicey their access to health care is compared to years gone by, that removing discriminatory practices based on pre-existing conditions, will not sit well with voters and can be used against Republicans.
Also, there are plenty of middle aged, middle class Americans, with 22 year old kids out of college and because of the labor market, those kids can’t get jobs with benefits. The parents (and kids) are benefiting by being able to keep those 22 year olds on their insurance plan.
maus
@Davis X. Machina:
Oh yeah, we’re SURE going to get more progressive legislation going in the house once it’s repealed.
Are you insane?
gene108
@MattR:
When you have for-profit, publicly traded companies, those companies are answerable to their share holders. They are answerable as to why they aren’t making profits like they did 3 months ago and the incentive of those companies is rooted in returning value to the shareholders. There’s really no such thing as an obscene profit, in this scenario.
This works for most businesses.
With health care it seems to create a mess. You have for-profit, publicly traded insurance companies, yet most hospitals are not-for profit.
That to me, is a basic flaw in our delivery system. You have entities operating with basically different goals, one to provide care, the other to maximize profits.
Anyway, your point that insurance companies have to suck up and eat losses, because you don’t like the fact they are profitable isn’t a good basis to drive health care policy.
$40,000 in claims, spread across the currently 30,000,000 uninsured, with only $800 paid in premiums, will bankrupt the insurance industry. Your looking at $2.4 billion paid in premiums, with $1.2 trillion paid in claims (double check my math, I’m doing it my head and maybe off be a power of ten).
Your model of requiring insurers to suck up losses isn’t sustainable.
Doing away with private insurers and rolling out Medicare-for-all-single-payer also isn’t sustainable, because providers would have to make cuts as their reimbursements would drop substantially.
Our HC system is complicated and to think there’s on cookie-cutter super solution that will involve no problems, such as single payer or the public option, is just wishful thinking.
HCR addresses the main complaint by liberals that our health care system limits access, due to ability to by insurance or afford care. I don’t get the hostility towards it, other than outright hostility towards the insurance industry.
Mnemosyne
If the problem is that consumers will be forced to buy a commercial product, then either make all healthcare and health insurance companies become nonprofits, or nationalize the industry.
There we go, problem solved. Not that you’ll ever catch a judge making that decision.
MattR
@gene108: You cut off the second part of my statement. From what I understand, most insurance companies spend far less than 80% of their premiums on health care services. As a result of the new law they will either need to cut premiums or increase spending on medical care. So why can’t that increased spending be used to cover people like Bob (and I should note that it is virtually impossible that every single uninsured person in the USA will require tens of thousands of dollars in health care every year), before we add a mandate.
It may very well be that the numbers are such that this has to be done almost immediately. I just have never seen that case made. It would have been nice to see some actual figures quoted comparing these various factors. Instead, I have always only seen the theoretical case (which I completely agree is essential in the long run to make the market functional).
Ash Can
@maus: Psst — I’m pretty sure that was snark.
gypsy howell
@gene108:
You may be right. I’m self-employed, and so I really don’t know how people who have company-subsidized group policies are affected. For me, I’ve seen a nearly 400% increase in premiums over the last 10 years, and now, given our age and the dumb little medical issues that go along with that (high cholesterol, high blood pressure, stuff like that) trying to switch to a lower-cost high-deductible junk plan is, needless to say, very frightening. For me, I see nothing in the HCR plan that’s going to help me out for years to come — I’m just hoping that somehow my husband, who’s 5 years older than me, can hold out til Medicare. For me– shit I have 9 more years til medicare, and with insurance premiums at $1500+ a month (and increasing 15%+ each year) and consulting contracts that are going by the wayside right now… well, things look pretty bleak on the health care front for us, HCR or no HCR. As far as I can tell, there ain’t much in the HCR bill that’s going to change that for me personally. Don’t Get Sick, and If You Do….
Maybe the average American really does see what’s happening with their health insurance. I just assume that I’m not very representative of the rest of the country, and most people are actually satisfied with their insurance and care options, or at least think they are because nothing really catastrophic has happened to them yet to put it to the test. And as long as their company is subsidizing most of it and they’re in some group plan, well, things are pretty much OK. I think republicans are banking on that — they aren’t too concerned with that small percentage of us who are out there on the fringes and hanging on by our fingernails.
Maybe I’m wrong.
different church-lady
The guy’s argument doesn’t hold water.
He claims the following:
He then argues the following:
OK, if that’s not a penalty for not doing something, then nothing is. He starts by saying there’s no penalty, then claims that it’s not unconstitutional because you can just pay the penalty.
I’m not going to argue constitutionality or necessity of mandates. I’m just going to say that the guy has made a rather unimpressive defense.
As for the idea that you’re “taking part in commerce” simply by living — yeah, let’s go back to the barter system in order to pay for our shelter. Or something.
It used to be I only felt spun by conservatives. Now everyone is in on the game.
maus
@Ash Can: I DON’T EVEN KNOW ANYMORE :O
AxelFoley
@ruemara:
Thank you. It gets old repeating this to the “Obama is naive” crowd.
Hob
@different church-lady: “Penalty” is normally understood to be something whose only purpose is punitive: you must pay a fine of $X so you’ll be sorry and change your ways. That’s how Republicans are spinning this, but it’s not accurate. Under the ACA, the additional tax liability you have if you don’t carry insurance serves a purpose other than punishing you: it supports government-funded health care services that are used by the uninsured. There’s a clear need to raise revenue for this; the tax itself is not punitive. The ACA is just giving a tax break to people who do carry insurance, because they are lowering the overall cost to the system.
Hob
@MattR:
You’re assuming that (a) the number of “people like Bob” would be equal to or smaller than the number of people who are currently uninsured, and (b) the insurers would have at least as much revenue as they do now. Neither is true.
If you require insurers to take on anyone at any time regardless of pre-existing conditions, then there’s no reason for anyone to pay for health insurance when they’re healthy. Everyone who currently has a policy, and hasn’t had to use it for anything expensive lately, would have a massive incentive to just drop the policy now, because they can always re-apply if and when they get sick. Everyone becomes like Bob. Insurers don’t just have to spend more of their revenue– they lose their revenue, all of it, because now the only people who are insured are the ones who are paying less in premiums than the cost of their health care (or, I guess, the ones who just haven’t thought it through, or who like paying for nothing). Insurance and risk pooling are unsupportable in that scenario.
You can look at this as another symptom of the basic mismatch between health care and the concept of insurance. Car insurance, fire insurance, etc., all cover discrete events: clearly you can’t purchase a policy on your house the day after it burns down and expect to collect anything. But health insurance, as soon as it goes beyond catastrophic care and is used for health maintenance, has to deal with the issue of chronic disease somehow– some people are going to be sicker in predictable ways because they were sicker to start with, and that adds up. It’s like trying to insure houses that are already very slightly on fire. So in order for risk pooling to work at all, you either keep some people out (rejecting those with pre-existing conditions) or you bring more people in (adding more healthy people to the plan).
different church-lady
@Hob: So this defense is based on semantics?
Hob
@different church-lady: Not any more than your complaint is. You’re saying it’s important that X should be described as a penalty, rather than as something else. In that case, the meaning of “penalty” is relevant. If it isn’t, I have no idea what you’re complaining about.
oh really
@MattR:
The short answer would be “an ounce of prevention is worth a pound of cure.” Why wait for disaster, when you can continue to make obscene profits across the board. Obviously, the insurance companies have figured out that if they get to insure everyone, they will be able to afford to insure the sick, and still make obscene profits. The problem is the country can’t afford that. The profits — all of them — have to go.
Not everyone will behave like “Bob.” I know I didn’t years ago when insurance was a lot cheaper and the benefits much better. But enough people would act that way to cause severe distress for the for-profit insurance companies.
The profits — all of them — have to go.
The key to all our worries begins with “for-profit.” People routinely call for “single-payer” insurance, but that isn’t the key. A single-payer for-profit insurance company would still be a disaster. Obviously, when people use the single-payer shorthand they are referring to a government not-for-profit plan, but neither Germany nor Switzerland has a single-payer system, yet both have universal care using not-for-profit companies. What absolutely has to go is for-profit insurance. That was the huge flaw in Obama’s reasoning, although he may understand that the for-profit companies have to go, but we aren’t ready yet to get rid of them. His plan is not really a workable solution, but a step toward a workable system. If we were smarter (but we’re not) and not so ideologically hamstrung, we could make the move in one step. But like any baby humanoid, we have to take baby steps. The hope is that some day we’ll be smart enough to walk. (I have my doubts.)
My distrust for American corporations is such that I truly believe we will have to rid the system of all corporate entities to be able to achieve an affordable universal system. To me, that means we can’t trust American not-for-profit companies. The corporate culture in America is so corrupt that I don’t believe we will be able to do what countries like Germany and Switzerland have done. We need a government run, universal, single-payer system with no for-profit components. (Yes, doctors and nurses can still make a profit on an individual basis.) Although in socialized medicine, even the doctors and nurses work for salaries paid by the government, we are a long way from being willing to accept that kind of system.
I’ve recommended people read TR Reid’s The Healing of America several times in BJ threads. It’s really important to see and understand what other countries have done — really done, not the Fox News lying-ass version, but the real thing — in order to figure out what to do in this country. In this context , it is interesting to see how and how much doctors are paid in other health care systems — expect the AMA to have one gigantic, collective heart attack if Japan’s MD pay scale is ever offered to American doctors! Medical schools would empty overnight and law school applications would skyrocket.
Yutsano
@oh really:
Actually this is not true, at least for Switzerland. There is a level of basic care that all health insurers must offer and they cannot operate that for profit. However, you can pay to go beyond the basic system and get extra benefits and such, and that Swiss health insurers can operate on a profit basis. Also consider that health insurance is consolidated with other types of insurance there as well in one huge pot. Japan operates in a similar fashion, which is why AFLAC is a large health insurance operator over there.
Triassic Sands
Switzerland has a basic package of health care benefits — the things people NEED. This insurance must be non-profit.
Insurance companies can offer extras — private hospital rooms, elective cosmetic surgery, etc. on a for-profit basis.
My point is not false. Every Swiss citizen has access to the health care they need (that all human beings need) and the insurance companies are not allowed to make a profit on that care. Switzerland changed to their current system because 5% of its citizens couldn’t afford health care under their previous US-like system. In this country, we have at least three times that percentage of people uninsured and millions more underinsured and the Republicans think that’s fine. Today, no one in Switzerland has to declare bankruptcy because of medical bills.
Personally, I don’t care about the frills. And they are irrelevant to the health of a country’s citizens. No one died prematurely from not getting a timely boob job or having to listen to a roommate whine about the food. As long as the procedures and items deemed to be for-profit aren’t medically necessary, then the people are protected.
My point about not trusting American corporations is why I don’t want this kind of system for the US — insurance companies would probably “invest” sizable sums into lobbying to have things like coronary artery stents and chemotherapy for cancer ruled to be non-essential.
Lorne Marr
I don’t understand why they require the repeal of the whole bill. What is bad about the already existing measures that are clearly beneficial to ordinary people?