Supreme Court will hear case on health care individual mandate

[Brettmcd]

http://news.yahoo.com/supreme-court-rule-health-reform-law-151206125.html


Well looks like we will finally get the up or down on the constitutionality of the individual mandate part of Obamacare.


Personally I don't see it as being constitutional\, I see it as too far of a stretch of the powers of the federal government.

[Brian Rubin]

I predict great things for this thread. Great things.

[Enidigm]

Obama is toast if this loses, imo, whatever the merits or demerits of the constitutional argument. Voters will flee - and, probably rightly - from a candidate that spends all his political capital on a project deemed unconstitutional, and all the effort expended to accomplish it thrown out.

[Brettmcd]

I predict great things for this thread. Great things.

I am hoping the trolls will stay out this is an important news story that deserves a discussion.

[Jibble]

What is there to discuss, exactly? If they rule against it, the liberals will be shrieking like banshees about how conservative the Supreme Court is. If they rule for it, conservatives will shriek like banshees about activist judges and continue trying to find some other angle of attack. Either way, my money is on 5-4 opinions on all the related cases.

[Bluto]

Obama is toast if this loses, imo, whatever the merits or demerits of the constitutional argument. Voters will flee - and, probably rightly - from a candidate that spends all his political capital on a project deemed unconstitutional, and all the effort expended to accomplish it thrown out.


And just to whom will they flee? The moral and ethically bankrupt old guy? The lady that says we should be more like China? The pizza guy? The Texan that can't remember which federal departments he wants to cut?

[Pogo]

Personally I don't see it as being constitutional\, I see it as too far of a stretch of the powers of the federal government.

What a FRESH and UNIQUE opinion, Brettmcd! It's so nice of YOU to make a thread about HEALTH CARE because of how many FACTS you used in every other health care thread on this forum.

[Fishbreath]

The former governor of Utah who's a reasonably conservative candidate with good across-the-aisle appeal who seems not to realize that he's in the Republican primary and not the general election?

Seriously. Huntsman's the guy I feel most comfortable with when I think about pulling in moderate voters, but he's really picked the wrong time to emphasize that he'd be good at that.

[Brettmcd]

Obama is toast if this loses, imo, whatever the merits or demerits of the constitutional argument. Voters will flee - and, probably rightly - from a candidate that spends all his political capital on a project deemed unconstitutional, and all the effort expended to accomplish it thrown out.


I disagree, I think it being overturned could be a huge boost to the chances of Obama being reelected. He could then tell his supporters that the only way to get what they want done is for a dem to be appointing the next supreme court justice.

[Brian Rubin]

What a FRESH and UNIQUE opinion, Brettmcd! It's so nice of YOU to make a thread about HEALTH CARE because of how many FACTS you used in every other health care thread on this forum.
*giggle*

[malchior]

I disagree, I think it being overturned could be a huge boost to the chances of Obama being reelected. He could then tell his supporters that the only way to get what they want done is for a dem to be appointing the next supreme court justice.This post brought to you by the Council of Kindergarten Political Analysts.

[Brettmcd]

This post brought to you by the Council of Kindergarten Political Analysts.


Rather then just being a troll why not actually explain why you think what I said is incorrect. It would clearly make the point that having a person of your own party picking supreme court justices is important.

[Brian Seiler]

Really, the opinion of anybody who isn't pretty well versed in Constitutional law isn't worth much at this point. It's a truly interesting case, because it will define the bounds of the interstate commerce clause in a market that has evolved infinitely further toward globalization in all respects than I suspect any of the people who actually wrote the words down could possibly have predicted. My gut tells me that the entire case is basically going to boil down to whether Anthony Kennedy wants to be eternally identified as the guy who gave the thumbs-up to (in many people's minds) a fundamental reconception of the limits of that particular clause on federal power. That's just my gut, though, which is not particularly well qualified to render legal decisions.

[Aeon221]

The former governor of Utah who's a reasonably conservative candidate with good across-the-aisle appeal who seems not to realize that he's in the Republican primary and not the general election?

Seriously. Huntsman's the guy I feel most comfortable with when I think about pulling in moderate voters, but he's really picked the wrong time to emphasize that he'd be good at that.

He has definitely done a great job appealing to this moderate. I'm guessing he's angling to get the nod next run round. Dude is like fifty, he can afford to wait. And when he does get his shot in a real primary (not this chucklefuck) he'll be able to point back to now and say "I didn't abandon my moderate principles even when it would have been politically expedient, unlike everyone else."

I'm personally still betting on Obama to win. Of the candidates, only Romney and Huntsman could stand a chance against him in a debate -- the rest would get clobbered so bad it'd be embarrassing. Romney is open to slicker than thou charges, and Huntsman has an irritating inability to interest anyone no matter what the subject. And with the warchest he's bringing to the table, Obama should be able to organize a hell of a lot of volunteer activism and fight in every state no matter how much of a losing proposition it'll be.

[malchior]

Rather then just being a troll why not actually explain why you think what I said is incorrect. It would clearly make the point that having a person of your own party picking supreme court justices is important.HOW DARE YOU CALL ME A TROLL! OH, KING OF THE TROLLS! I DEMAND SATISFACTION! But seriously, you should just go back and look at that post and just be totally ashamed of yourself.

In a world where the the President's signature bill gets knocked down on the fundamentals, his response is going to be complaining about the refs? Sorry, but that's just childish.

The make up of the court would definitely be part of the damage control, but that is just running the culture war draw out of the old playbook. A "huge boost"? Not a chance in the world. There is exceedingly little chance that it doesn't end up being a drag on the re-election campaign.

[JeffL]

I'm gonna go out on a limb, based on some past SC rulings on the Commerce act reach, and predict a 7-2 vote supporting the bill.

[Brettmcd]

I'm gonna go out on a limb, based on some past SC rulings on the Commerce act reach, and predict a 7-2 vote supporting the bill.


Hmm I just dont see that, I can see a 5-4 split, but 7-2 seems impossible.

[Tortilla]

I'm gonna go out on a limb, based on some past SC rulings on the Commerce act reach, and predict a 7-2 vote supporting the bill.

That was my first instinct as well, but the more I think about it the more I suspect it'll be closer. I still believe the SC won't overturn the law though. As much as people don't like it the law, there's clearly a public interest in seeing that people have proper health care and don't turn every ailment into expensive emergency room treatments.

[IainC]

I will predict here and now that Scalia will write either the dissent (if it passes) or the decision (if it fails) and, will pick the weakest and least intelligible argument to hinge his case on in either case.

[Jason McCullough]

What Jeff said. As much as 5 of them would like to overturn it, I don't think they're going to pick this case to make the huge leap to pre-1930s federalism.

[JeffL]

Yeah, they have had some rulings that don't make the news that have been surprisingly 7-2 in favor of the commerce clause broader interpretations. Personally I think it is against the "spirit" of the constitution but not against the letter of the law (the commerce clause being written at a very different time, aimed at primarily maritime issues, but written in very broad strokes.)

We'll see. What would be interesting would be if they struck down the act in entirety and then watch the reactions of all the people who now have their older children covered under their insurance lose that, as well as many of the other pieces that people are enjoying.

[drewl]

How did other countries get government funded healthcare?
Was there as much backlash against it as here in the US?

[Brettmcd]

How did other countries get government funded healthcare?
Was there as much backlash against it as here in the US?


Other countries have very different limits on what they allow and don't allow their central governments to do. Not sure what information one would get from comparing how they got their health plans started.

[Tortilla]

Other countries have very different limits on what they allow and don't allow their central governments to do. Not sure what information one would get from comparing how they got their health plans started.

The legal issues are a bit of a side show though, so it's still an interesting question. If the US had just done the right thing and gone full-on single-payer socialized health care instead of this mandate half-measure it would be legally far more clear cut.

The more interesting question is why the US is so resistant to embracing a model that has worked for a lot of other countries.

[Martin Guerre]

The US is the source of practically all biomedical research for eurotrash, because SURPRISE: smart people are greedy too, and they want exposure to consumers who have the dignity to get rich and spend their money on the health of their loved ones rather than people they've never met. Also, eurotrash singlepayer is unsustainable and pretty soon the scandinavians will go back to marooning old people on ice floes (that haven't already melted yet lol). Any more questions?

[maxle]

How did other countries get government funded healthcare?
Was there as much backlash against it as here in the US?
That's less interesting than asking why the US didn't get it (http://www.newyorker.com/talk/comment/2009/12/07/091207taco_talk_lepore) a century ago.

[IainC]

The US is the source of practically all biomedical research for eurotrash, because SURPRISE: smart people are greedy too, and they want exposure to consumers who have the dignity to get rich and spend their money on the health of their loved ones rather than people they've never met. Also, eurotrash singlepayer is unsustainable and pretty soon the scandinavians will go back to marooning old people on ice floes (that haven't already melted yet lol). Any more questions?
Wow...

[yamo yamo]

Does Holder argue this?

[BennyProfane]

The vote total will depend (perhaps this is obvious) on whether certain conservatives on the court follow their partisan instincts or follow court precident.

I think we can safely put the four court "liberals" into the "yes" category.

Kennedy, as usual, is the swing vote (if such is necessary here), and given his previous record on commerce issues I see him as a yes on this as well.

Personally I suspect Alito and Roberts will vote yes as well, for fear of calling so many other "commerce" clause rulings into question., plus oddly enough a "yes" on this is a pro-business vote.

I think one could even see Scalia and Thomas voting yes on it, especially given the arguments Silberman made last week.

So it wouldn't surprise me a lot to see a 9-0 ruling, but I'm leaning toward 7-2.

[ElGuapo]

Here is a simple question. Since, to my knowledge, there is no public/federal insurance option, is this the first time the government will have told it's citizens it is required to buy somethInh from a private company? As in "You will buy BlueCross or Aetna insurance, mandated by law".

I can think of examples of optional things ... such as the insurance requirements for a car if you own a car. Owning a car, or course, is a choice. Living is not.

I have no moral problem with a public health care system, i.e. France or Canada or Cuba. What I do have a problem with is the government forcing people to buy insurance themselves. This seems like a bandaid problem to the bigger issue of spiraling health care costs.

The real solution to me would be some kind of mandated discounts via regulation to any active insurance company that gives discounts to low income citizens who can't afford it. For example, the government could come up with a $50 or $25 a month option that provide catastrophic insurance to poor citizens.

The government of every nation limits it's citizens as to what they can do. That is, you can't do X, or Y. It also incentivizes citizens to do A or B. But to require that we buy insurance from a for profit company? That seems unprecedented and dangerous to me.

If it's that important for the public good for people to have insurance, give them incentives and education as to why it's a good idea. But making us buy insurance from a for profit corporation is counterintuitive to me.

[jeffd]

It's required if you want to avoid an adverse selection death spiral.

What's really amusing about these lawsuits is that everyone expects that the mandate is severable; that is if the courts strike down the mandate the rest of the law will stand. Of course, without the mandate the health insurance system is doomed (aforementioned adverse selection death spiral), which probably just brings the day of government run health insurance that much closer. Going after the mandate is a hilariously short-sighted play by conservatives.

[AlanQ]

Since, to my knowledge, there is no public/federal insurance option, is this the first time the government will have told it's citizens it is required to buy somethInh from a private company? As in "You will buy BlueCross or Aetna insurance, mandated by law".


No, it is not the first time: the Second Militia Act of 1792 required all able-bodied male citizens to purchase various equipment and join a militia:


That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of power and ball; or with a good rifle, knapsack, shot-pouch, and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder; and shall appear so armed, accoutred and provided, when called out to exercise or into service, except, that when called out on company days to exercise only, he may appear without a knapsack.

[jeffd]

The whole "Forced to buy a private company's product" is also a red herring. The US government provides all manner of incentives for buying stuff from private sellers.

[TheTrunkDr]

It's required if you want to avoid an adverse selection death spiral.

What's really amusing about these lawsuits is that everyone expects that the mandate is severable; that is if the courts strike down the mandate the rest of the law will stand. Of course, without the mandate the health insurance system is doomed (aforementioned adverse selection death spiral), which probably just brings the day of government run health insurance that much closer. Going after the mandate is a hilariously short-sighted play by conservatives.
I think we understand the reason for it, I think Guapo's objection is more on principle about the government requiring citizens to hand over their money to a for profit company.

[TheTrunkDr]

The whole "Forced to buy a private company's product" is also a red herring. The US government provides all manner of incentives for buying stuff from private sellers.
Incentives are not the same as fining people for not buying something.

[jeffd]

Incentives are not the same as fining people for not buying something.

Really?

What if we built the mandate as follows: across the board 900 dollar tax hike for everyone, with a 900 dollar tax rebate for people who purchase health insurance? Would you find that objectionable?

[Brandon Clements]

What if we built the mandate as follows: across the board 900 dollar tax hike for everyone, with a 900 dollar tax rebate for people who purchase health insurance?
I thought that's how it is currently built?

[jeffd]

I thought that's how it is currently built?

Not quite. The mandate is a 900 dollar tax penalty for not carrying health insurance.

At the end of the day they end up being the same thing, which is sort of my point.

[Brian Seiler]

Really?

What if we built the mandate as follows: across the board 900 dollar tax hike for everyone, with a 900 dollar tax rebate for people who purchase health insurance? Would you find that objectionable?

That would be a critically important distinction, and I suspect that you'd need to decouple the credit from the new tax. Instituting a "We bought some insurance" tax credit would be non-controversial by itself, I suspect.

[Enidigm]

Among conservatives i know there is a strange antipathic relationship toward public health care spending driven by, i guess, the neurotic system itself; while they shoulder a great burden as most of these persons are self employed and are dropping 1,500$ a month or more for family insurance, this causes them deeper and deeper resentment toward society asking them to also shoulder the hypothetical tax burden to take care of others at that level. The more they pay, the more they begrudge society wanting to live at the same level, and the more unrealistic "health reform" to them seems. Instead of seeing this as evidence that health care is unsustainable and needs institutional change (to reduce their own out of pocket costs, no less) they instead see it as proof of an unsustainable system that the government is going to force them to sustain.

[Tortilla]

No, it is not the first time: the Second Militia Act of 1792 required all able-bodied male citizens to purchase various equipment and join a militia:

Also look at "An Act for the Relief of Sick and Disabled Seamen" in 1798. It required sailors to buy health insurance. Though admittedly it was more of a tax than a purchase since there were required to buy it through a federally administered program with rates set in law.

[Enidigm]

I'm not a conservative myself, but tax incentives really are not the same at all because it's unlikely the incentive will cover the whole cost. It's like a 2 for 1 deal at a local store, are you "losing" money for not taking them up on the sale? You may be better off using the incentive, but you can still opt to do without. You don't even have to claim the mortgage deduction, and no one in the government will send you a letter helpfully pointing out the money you'd save if you did.

[ElGuapo]

Good examples. However, both defense/military related, which is always a grey area when it comes to laws. I will remember those, however.

Anything in the last 200 years? :)

[jeffd]

I'm not a conservative myself, but tax incentives really are not the same at all because it's unlikely the incentive will cover the whole cost. It's like a 2 for 1 deal at a local store, are you "losing" money for not taking them up on the sale? You may be better off using the incentive, but you can still opt to do without. You don't even have to claim the mortgage deduction, and no one in the government will send you a letter helpfully pointing out the money you'd save if you did.

Covering costs has nothing to do with it. You're also sort of missing the point: In the scenario I outlined the outcome (900 dollars added onto your year-end tax bill) is the same as under current law. Nobody really seems to find that controversial at all, yet the mandate as written is tantamount to shredding the Constitution.

[Tortilla]

Good examples. However, both defense/military related, which is always a grey area when it comes to laws. I will remember those, however.

Anything in the last 200 years? :)

The one I cited wasn't for the Navy, it was for privately employed merchant sailors.

[Enidigm]

Covering costs has nothing to do with it. You're also sort of missing the point: In the scenario I outlined the outcome (900 dollars added onto your year-end tax bill) is the same as under current law. Nobody really seems to find that controversial at all, yet the mandate as written is tantamount to shredding the Constitution.

Yes, technically that would sort of be the same. But you're raising the middle class!!! (/hyberbole) taxes by 900$. Good luck with that. In essence, the way the "fine" in constructed now is that it won't be relevant to the 80% or so of Americans with insurance and so out of sight, out of mind. But there is also the issue that those tax fines are not tied to health care unless this is specified, and would/could actually be a source of revenue, perversely, for the government. And just due to the way government works and is structured, it would be easy to decouple the tax from the incentive unless you created a government department specifically to manage that tax or regulations to ensure they remained in lock step.

[jeffd]

I think you're kind of picking around the edges here regarding implementation details that are irrelevant. My point is simple: nobody disputes that the government can raise taxes, and nobody disputes that the government can use the tax code to create incentives for private economic transactions. And yet somehow the mandate is akin to pissing on the Constitution? I just don't find that to be a coherent objection.

From a high level view it seems like objections to the individual mandate come from a few directions:
- The incoherent type (what we've been talking about).
- People who really do find tax incentives to be unacceptable (tiny minority).
- People who just hate the PPACA, for them the mandate is just a proxy for the entire bill.

Properly understood the fight over the mandate isn't really over its overall constitutionality, it's a proxy for the ongoing fight over reforming our nation's healthcare system. It's one of the reasons I find the mandate rathole the discussion has gone down so frustrating; I'd much rather people just make straight up arguments against the overall structure of the PPACA or offer alternatives, rather than just endless hand-wringing over the constitutionality of the mandate.

[Enidigm]

Right, but honestly you're taking it the wrong way. You see the need for health reform, and you don't really care how it's done. There are lots of people you care how it's done, even to the point of sabotaging reform itself.

The objection on interstate commerce grounds is one of those doubled edged bullshit things where they have a point, even if they're making the point for the reasons other than the principle itself. You want to conflate incentives with fines, and get frustrated that there are people who disagree that they aren't the same. But they aren't the same, there are important, if subtle, differences in both the implementation and their eventual destination.

[jeffd]

Right, but honestly you're taking it the wrong way. You see the need for health reform, and you don't really care how it's done. There are lots of people you care how it's done, even to the point of sabotaging reform itself.

The objection on interstate commerce grounds is one of those doubled edged bullshit things where they have a point, even if they're making the point for the reasons other than the principle itself. You want to conflate incentives with fines, and get frustrated that there are people who disagree that they aren't the same. But they aren't the same, there are important, if subtle, differences in both the implementation and their eventual destination.

Here's the thing: I really, truly don't think the objection on interstate commerce grounds is coherent. I honestly don't see a difference between the mandate and the tax + subsidize alternative. There's no subtle difference between implementation, nor destination. The end result on both sides of the equation is the same: if you don't purchase health insurance, you owe the government an extra 900 dollars.

Analogy time: I feel that the commerce clause objection to the mandate is akin to arguing that 2 + 2 is not the same as 2 x 2. It's straight up incoherent, and that's why I find it so frustrating! Asserting that they really are truly different doesn't make it so, and I haven't actually seen anyone offer up a compelling argument as to why the two are fundamentally different. It's always just asserted and then taken for granted.

[Brian Seiler]

Okay. So, try it this way. When the government says "You go buy this or we'll tax you this many," what it's really doing is issuing an ultimatum: go buy this thing OR pay us some money OR men with guns. Because that's the ultimate end of all government force. That is why you have to pay your taxes, as Wesley Snipes has learned - because if you do not, large men will come and apply physical force to you.

A positive incentive, on the other hand, is the government saying, "Okay guys - if you do this, we'll totally give you this wonderful prize." You don't have to do anything, and if you don't do anything, the only consequence is you don't get a prize. While the end result might be the same in both cases if you shape the contents of the prize properly, the theoretical implications are very, very different.

[IainC]

What would be HI-larious is, if the mandate gets struck down so the insurance companies (who only agreed to the universal coverage on that basis) pitch a fit. The whole thing gets thrown out and a Republican president in 2012 has to push through an even more socialist bill than the PPACA in order to placate a populace who finally realise that for-profit universal healthcare is fundamentally unworkable.

[Scuzz]

Among conservatives i know there is a strange antipathic relationship toward public health care spending driven by, i guess, the neurotic system itself; while they shoulder a great burden as most of these persons are self employed and are dropping 1,500$ a month or more for family insurance, this causes them deeper and deeper resentment toward society asking them to also shoulder the hypothetical tax burden to take care of others at that level. The more they pay, the more they begrudge society wanting to live at the same level, and the more unrealistic "health reform" to them seems. Instead of seeing this as evidence that health care is unsustainable and needs institutional change (to reduce their own out of pocket costs, no less) they instead see it as proof of an unsustainable system that the government is going to force them to sustain.

I think that is a very accurate description. I think most however do believe that the current system is broken, it is just the repair that is debatable.

[Hazard]

First time posting, lets see how it goes.

The fundamental problem I see is how the individual mandate is structured. The Commerce Clause ("CC") has been used and abused by Congress for decades to slowly increase the scope of the federal government, and this mandate is one step too far.

The CC has never been used to punish someone for not engaging in a private stream of business. The Militia Act of 1792 was not based on the CC. Congress was providing for the general defense of the country, which is it constitutionally authorized to do. "An Act for the relief of sick and disabled seamen" was a tax. The government took the money and funded heath care and built hospitals with the money. Neither used the CC to punish an individual for not engaging in a particular business. A mouse might starve on the distinction, but it is there.

The Federal Government is meant to be limited, not an all encompassing Leviathan. Theoretically the CC could be used to allow Congress to do anything. They might tell you how much food you could grow in your own home to feed your family, because it might affect interstate prices. They may also try to use it to control where you can wear a firearm in your own state. Or they might use it to restrict access to abortions. Wait...Congress has already did that.

I also have a healthy distrust of government. If this is allowed, and Congress is able to use the formidable power of the IRS to penalize you for not purchasing a certain product, what will be next? Could it be a federal crime with possible jail time if I do not purchase a certain product? If the health insurance industry gets Congress' blessing this year, who is going to get it next year? What industry will then be deemed "too important," and anointed with oils from the government. Regardless of whether you are Liberal or Conservative, this thought should scare the hell out of you. Remember, it is not always going to be your party in power, and when they lose, do you want the special interest on the other side telling you what you must spend your money on?

Part of the genius of the founding fathers was their ability to recognize the need to put government in check. I still believe that thought holds true. Do I believe President Obama is a socialist dictator? Not at all. He is a likable guy, even if I disagree with his policies. I also do not believe the healthcare law was devised with devious intent. Yes, healthcare needs to be fixed, but this is health care law, specifically the individual mandate, is not the solution.

Now that I finished this, I bet there are probably 20 posts saying everything I just did...

[Jason McCullough]

First post in P&R, didn't read.

[Dawn Falcon]

The US is the source of practically all biomedical research for eurotrash

Mm, xenophobia, it's what the right love.


Also, eurotrash singlepayer is unsustainable

Oh yes, only half or under the US's prices, covering everybody rather than half the people.


(that haven't already melted yet lol).

And AGW denial. *ding!* Trippllllle idioticy score!


Any more questions?

Were you born with a stick up your ass, or at what age did you implant it?

[AlanQ]

Hazard, you don't appear to have a "healthy fear of government" per se, you appear to have a fear of the federal government exclusively. By pinning your objection on the commerce clause, you are saying that while the federal government shouldn't be able to jail someone for failing to purchase a product, it's fine if the states do it (because residual powers are left to the states).

So, would you be OK with states mandating purchases? Would you be OK with the state government telling you how much food you could grow to feed your family? Would you be OK with the state government telling you where you can wear a firearm? Would you be OK with the state government restricting access to abortions? If you answer to any of these questions is "no" then your objection to the individual mandate probably isn't really about a federalism/division of powers issue.

[Enidigm]

You can't beat Lenin for rabble rousing phrases.

Loot the Looters!

[Tortilla]

Hazard, you don't appear to have a "healthy fear of government" per se, you appear to have a fear of the federal government exclusively. By pinning your objection on the commerce clause, you are saying that while the federal government shouldn't be able to jail someone for failing to purchase a product, it's fine if the states do it (because residual powers are left to the states).

So, would you be OK with states mandating purchases? Would you be OK with the state government telling you how much food you could grow to feed your family? Would you be OK with the state government telling you where you can wear a firearm? Would you be OK with the state government restricting access to abortions? If you answer to any of these questions is "no" then your objection to the individual mandate probably isn't really about a federalism/division of powers issue.

Yeah, that's make take as well. All this hand-wringing over the commerce clause at this stage seems to from the same crowd that starts loudly decrying how only privatized health coverage can be truly efficient whenever the topic of single-payer health care comes up. In other words, it's a convenient pretext for those who want to complain about Obamacare, not a genuine source of concern.

[Kolonial]

Hazard, you don't appear to have a "healthy fear of government" per se, you appear to have a fear of the federal government exclusively. By pinning your objection on the commerce clause, you are saying that while the federal government shouldn't be able to jail someone for failing to purchase a product, it's fine if the states do it (because residual powers are left to the states).
I think this is a bit of a stretch, and reads a lot into Hazard's post which wasn't there. I don't think he mentions the states once, nor residual powers. I'm not even sure how stating that the federal government shouldn't have the power to mandate individuals enter the private stream implies the states should. I'll let Hazard speak for himself on this, but my assumption is that if someone objects to a mandate to purchase coming from "the government," that would include the states as well.

[jeffd]

It bears noting that as recently as a few years ago the individual mandate was not controversial. Recall that the idea sprung from, of all places, AEI's policy shop.

[Dawn Falcon]

It bears noting that as recently as a few years ago the individual mandate was not controversial. Recall that the idea sprung from, of all places, AEI's policy shop.

Well of course, it's as much about who is trying to implement the idea as much as what the idea is.

[Hazard]

Believe it or not, I would have no problem with my state requiring me to have health insurance, heck they already require me to have car insurance. Why then is it a big deal to have the federal government do it? (1) The Constitution and (2) Accountability.

To me the Constitution is a borderline sacred document. Perfect? No. If it were perfect, we would not have 27 amendments. On the other hand, people believe in the constitution and zealously support it because it is basically a contract with the people of the US. We know what our federal government can and cannot do (ideally). When our federal government has needed to change that document, for whatever reason, it was followed by vigorous public debate. You would need to be deaf blind and dumb to miss Congress passing an amendment to the constitution. People get involved because every amendment addresses how much power 535 men and women have over an entire nation. The CC has been manipulated well beyond its original meaning, and even the meaning it had 60 years ago. If Congress were more forthright, they would have amended the constitution ages ago.

I get riled up when Congress uses a Trojan horse, in this case the health care law hiding under the Commerce Clause, to expand its power beyond the constitutional limits. People are less involved in the debate, plus there is a lesser consensus required for passage. You just wake up one day to find out you have less rights than when you went to sleep the night before, with little to no input from you as a citizen.

I am less concerned about states enacting such a mandate, because they are more accountable to their citizens, plus they have constitutional authority to do so. States have general powers, not limited, meaning they could pass the mandate without violating the constitution. State legislatures are also more accountable to their citizens. If you start passing individual mandates for private commerce in most states, you will find yourself with a very short political career. What mandates you do get through will be done with widespread consensus. If I don't like the new mandate, I just move out of state. It may not be a lot of fun, but I can move to any other state in the country without a dramatic change in my lifestyle. Whether it be a mandate to purchase health insurance, or a mandate to purchase a gun, that decision should be made on a local level where representatives live amongst the represented, and interact with them on a daily basis.

[AlanQ]

I think this is a bit of a stretch, and reads a lot into Hazard's post which wasn't there. I don't think he mentions the states once, nor residual powers. I'm not even sure how stating that the federal government shouldn't have the power to mandate individuals enter the private stream implies the states should. I'll let Hazard speak for himself on this, but my assumption is that if someone objects to a mandate to purchase coming from "the government," that would include the states as well.

Well, he explicitly based his argument on the commerce clause. That implies that the mandate is not otherwise unconstitutional (not a violation of basic rights), it's just being enacted by the wrong level of government. If the federal government is not capable of enacting an otherwise valid law, that power must go to the states since they have residual jurisdiction.

[AlanQ]

Believe it or not, I would have no problem with my state requiring me to have health insurance, heck they already require me to have car insurance. Why then is it a big deal to have the federal government do it? (1) The Constitution and (2) Accountability.

Well I guess I just don't find division of powers arguments compelling, and I don't think that state governments have actually proven more responsive or more accountable in practice. State governments are often, or even usually, far more corrupt than the federal government. Nor do I ascribe to "constitution as sacred document" theories, although that's probably because I come from a country whose constitution is only slightly older than I am. Whatever floats your boat I guess; it's pretty doubtful that anyone can convince you that the constitution is a living document, or that you will convince me the constitution should be changeless or eternal.

[Robert Sharp]

I don't like it because I don't like how the focus is still on having private companies provide the healthcare with insufficient regulations. I understand why this was a politically expedient approach to take, but I still think it's nonsensical and will lead to all sorts of problems, many of which can't even be foreseen. So, if they can't be foreseen, why am I bitching about them? Why even assume they will happen? Because private industries, by their nature, are all about maximizing profits. Forcing everyone to buy from them seems to open up all sorts of potential avenues to abuse. I don't think the government will be able to stay ahead of such abuse, from a legislative perspective.

So I see this as a half-assed solution. Half and ass is better than no ass, I always say. But still, a whole ass is pretty great, amirite?

Ohio just shot it down, btw, in our election last Tuesday. So now, we get to pay for a big legal fight between Ohio and the Feds over whether our rejection of the individual mandate is constitutionally viable.

[jeffd]

I don't like it because I don't like how the focus is still on having private companies provide the healthcare with insufficient regulations. I understand why this was a politically expedient approach to take, but I still think it's nonsensical and will lead to all sorts of problems, many of which can't even be foreseen. So, if they can't be foreseen, why am I bitching about them? Why even assume they will happen? Because private industries, by their nature, are all about maximizing profits. Forcing everyone to buy from them seems to open up all sorts of potential avenues to abuse. I don't think the government will be able to stay ahead of such abuse, from a legislative perspective.

So I see this as a half-assed solution. Half and ass is better than no ass, I always say. But still, a whole ass is pretty great, amirite?

Ohio just shot it down, btw, in our election last Tuesday. So now, we get to pay for a big legal fight between Ohio and the Feds over whether our rejection of the individual mandate is constitutionally viable.

Uhh, nullification was settled as an issue a looooong time ago. Ohio has a precisely 0.0% chance of getting away with that one.

[Robert Sharp]

Agreed. But we still voted on it. It was done in a roundabout way (no citizen of Ohio can be forced to buy insurance, basically). I didn't say it would work. But it will still cost money. I know the state can't override a federal mandate. But they put that in our state-wide vote because they still plan to fight the damn thing. And it will STILL waste money.

[jeffd]

It's worth keeping in mind that our choices aren't PPACA vs. some better plan. It's PPACA vs. the status quo. Owing to political constraints this is the best we're going to have for some time. That sucks, but IMO the case for PPACA over the status quo is open & shut.

[Adam B]

I find slippery slope arguments about the commerce clause and the PPACA to be specious at best. Does anybody really think that Congress is going to use the individual mandate to force people to buy corn because the Speaker of the House is eying a presidential run and wants to plump her Iowa numbers?

Treating healthcare like any other good is a particularly damaging fallacy that I want to kill with fire.

[JeffL]

It's required if you want to avoid an adverse selection death spiral.


That, however, has absolutely nothing to do with the legality.

I think what would go over better, from a pragmatic point of view, is rather than saying everyone gets a $1000 tax hike unless you buy insurance would be no one gets a tax increase, but rather if you DO buy insurance you get a $1000 deduction. That is actually completely analogous to the incentives that have been put in place in the past and would probably have avoided this entire court situation. It's just asking for a court ruling to say that you either buy a product we tell you to buy or we fine you. I don't want the law to be struck down, but that approach does come across as over-reaching to me (i.e. your contention that the only people who have a problem with the buy what we tell you to buy or get a fine are just people using that as a cover for attacking the law is not accurate.)

[Jason McCullough]

The endless circular argument from you guys bitching about the mandate is hilarious. "The mandate was bad and should be killed. Why, if I could go back in time I'd do it this way! Because it'd be somehow more constitutional. Even though my complaints have nothing to do with constitutionality. I'm complaining for a friend, you see."

[AlanQ]

I don't see why that is over-reaching. If the government has the power to draft you, as it certainly does, then why not the power to make you buy a certain category of good? A mandate seems no more coercive than paying taxes, that's for sure.

Really, no one seems to deny that it is within the power of the states to legislate a mandate. Why is it outside the power of the federal government?

E: To clarify, if the federal government has the authority to legislate in the area of health insurance in the form of a tax deduction, I don't see why it wouldn't be able to legislate in that same area in the form of a mandate.

[ydejin]

I'm actually rather heartened that many of you don't think the Court will vote strictly on political lines. I don't follow the Court that closely, but have assumed that it had end up just as politicized as the rest of the country.

[mrmolecule88]

Complaining about the commerce clause overreach is like pissing and moaning about your neighbor's smelly new horse. Or that damn steam train. Or all those chinamen and their opium dens. Or that ridiculous looking new 2 dollar bill they just put out. Can you imagine? You could live off that kind of money for a month!

It's pretty fucking dated, is what I'm saying. That genie was let out of the battle a long, long time ago, and pretending that state power could be or should be scaled back is impossible and laughable. You say that's the power the federal government can abuse; I say that's the power the federal government has used to grow into the sort of entity that could organize, fight, and sell weapons for a war that spanned the entire globe, and in this modern age of force projection the idea that the states could wield anything like the sort of international influence we enjoy today is...well, it's dumb. People always talk about reining in the federal government - ok, right, great, what's the alternative? Because right now in Pennsylvania we're looking at multinational corporations lobbying like there's no tomorrow, and they literally swamp the state capitol. There's nothing I can do. If, perhaps, the feds gave a damn about the EPA and kept on eye on all the pollution that's sure to spring up in the next ten years, the damage might not be too bad. But I'll be damned if I think some pissyass hickville state government could possibly compete with the size of energy corporations today.

It's superpredators and prey these days. Pretending that downsizing government downsizes the issues is wishful thinking. The health care plan, which was a fucking Republican plan a decade ago, is clearly not "gubbmint socialism!" and if it is an overreach now, why was it a possible solution then? No amount of slippery slope arguments will change the fact that the actual, literal scale of the world today demands a large government.

TSA excluded, of course.

[JeffL]

The endless circular argument from you guys bitching about the mandate is hilarious. "The mandate was bad and should be killed. Why, if I could go back in time I'd do it this way! Because it'd be somehow more constitutional. Even though my complaints have nothing to do with constitutionality. I'm complaining for a friend, you see."

Sorry if you continue to be bothered that some people think there is a problem with the federal gov't having certain powers, even if what they can make you do is something you like. Well, no, I'm not sorry, I'm glad there are some areas in which I am still not as liberal as you.

Just because the courts may agree that the government could force me to buy a gym membership doesn't mean I agree it should have that power. Any more than you'd like it if the government said you have to buy war bonds.

[yamo yamo]

I will likely pay the $900 penalty rather than sign up for health insurance. If I'm gonna pay a grand to get screwed then I want fishnet stockings.

[Jason McCullough]

Any more than you'd like it if the government said you have to buy war bonds.

I hope I'd have the premise of mind to note my complaint was about the war, not some specious bullshit about the specific financing implementation being Very Bad but a-ok if it's rearranged slightly.

[JeffL]

I hope I'd have the premise of mind to note my complaint was about the war, not some specious bullshit about the specific financing implementation being Very Bad but a-ok if it's rearranged slightly.

And therein is the precise reason we will never be able to reach any kind of meeting of minds on this.

[jeffd]

And therein is the precise reason we will never be able to reach any kind of meeting of minds on this.

Could you explain? I mean, Jason's pretty clear in how he views your analogy. Objecting to the mandate is akin to objecting to a funding mechanism, rather than to the underlying policy.

[JeffL]

Could you explain? I mean, Jason's pretty clear in how he views your analogy. Objecting to the mandate is akin to objecting to a funding mechanism, rather than to the underlying policy.

Every fiber of my relaxed Sunday afternoon being says to just ignore this, but what the heck:

Jason's comment was that, if we fined everyone who didn't buy war bonds, he would be focused on his opposition to the war, not some "specious bullshit" etc. (i.e. your point of view on forms of government powers is bullshit not worthy of consideration, and the ends justifies the means.)

My point of view, which he clearly considers bullshit as opposed to a different point of view, is that the means is indeed an issue. As I have stated previously, I disagree with the government being able to fine me for not purchasing something they want me to purchase, whether it is a gym membership or whatever. Jason's argument is it doesn't matter what method they use. A rebate is the same as a fine for him. I think there is a very fundamental difference. And this is where we will never be on the same page. Jason would be fine if our paychecks just went to Washington, and then they decided how much each month Congress decided they could afford to allow us to have, as if we were on an allowance that Congress set each month depending on what they decided they wanted to spend. And he could argue that there is no difference in that and simply subtracting taxes from our checks, and he would never understand why I see a fundamental difference. It comes from our very different view of Washington and the powers of Washington (both actual and desired.)

So it is a waste of time to argue with him on this.

[Jason McCullough]

For god's sakes, it has nothing to do with a "fundamental difference / very different view of Washington"; it's that mathematically and economically the scenarios have exactly the same effect. The only difference is deep-in-the-weeds consitutional lawyering.


Jason would be fine if our paychecks just went to Washington, and then they decided how much each month Congress decided they could afford to allow us to have, as if we were on an allowance that Congress set each month depending on what they decided they wanted to spend.

You're right, I guess it is a bit of a waste of time to discuss this if you're using rhetoric from the GOP primary.

[JeffL]

And this is why I wasn't going to respond. The only way in which you surprised me is that you didn't mention Rush or Rove.

[AaronSofaer]

Your response was an ad-absurdum that demonstrated ill faith. Hell, I agree with your position (and disagree with Jason's) and I still think your response was something stupid straight out of the GOP's primary rhetoric.

[Jason Townsend]

I don't mean this in a pigeon-holing way but I know a fair number of people who are basically "centre-right" - at least as of, say, 2000 standards - but who consider themselves sort of honorary centrists or even centre-liberal because they've been orphaned by one or another conservative political party packing up and moving right, notably in the US and Canada.

Which is understandable, and indeed a good thing, but then these same folks will sometimes act as though they're the "reasonable" liberals and that actual liberals are off in excessively-liberal-land. And I feel like saying "No, actually, you're still kind of conservative with a bunch of conservative habits of thought. Which is your prerogative, but don't act like the judge of what is now 'reasonable liberalism.'"

[AlanQ]

As I have stated previously, I disagree with the government being able to fine me for not purchasing something they want me to purchase, whether it is a gym membership or whatever.

I don't get this. Do you also disagree with taxes? I can't see why the government should be able to take your money, but not be able to order a mandate. A mandate seems less intrusive than taxation, but no one questions the right of a state to tax its citizens.

And, do you disagree with state mandates as well, or just federal mandates?

[ckessel]

I don't get this.
Me either, seems like semantics. The government effectively forces me to buy healthcare for others already, forces me to put money into retirement, forces me to buy military items I vehemently oppose, forces me to buy oil/gas via tax breaks I vehemently oppose.

Complaining about the mechanism used to force people to buy healthcare seems like splitting hairs.

[Brettmcd]

Me either, seems like semantics. The government effectively forces me to buy healthcare for others already, forces me to put money into retirement, forces me to buy military items I vehemently oppose, forces me to buy oil/gas via tax breaks I vehemently oppose.

Complaining about the mechanism used to force people to buy healthcare seems like splitting hairs.


Its not splitting hairs to be opposed to the federal government forcing you to buy a product from a private company or they will fine you. That is a hell of a lot different then taxation.

[AlanQ]

It may be different, but it seems a lot less intrusive. So again, why should a government have the power to tax but not the power to enact a mandate?

[ckessel]

What's amusing is we wouldn't even be discussing this if single payer had been implemented, which could have just been funded through normal tax allocations. By being flexible, the democrats once again shoot themselves in the foot.

[Brettmcd]

It may be different, but it seems a lot less intrusive. So again, why should a government have the power to tax but not the power to enact a mandate?

Because forcing someone to by specific products from a specific group of private companies is not something the federal government should be doing. You can't compare that to the governments legitimate power of taxation.

[AlanQ]

Because forcing someone to by specific products from a specific group of private companies is not something the federal government should be doing. You can't compare that to the governments legitimate power of taxation.

Why shouldn't the federal government be doing that? I think the federal government should be able to do that. Why is taxation a legitimate power, and a mandate isn't?

I feel like you're just stating a conclusion rather than explaining your position.

[ckessel]

I feel like you're just stating a conclusion rather than explaining your position.
This is Brett. We'd all be better off if everyone blocked him.

[Brettmcd]

This is Brett. We'd all be better off if everyone blocked him.


GFY troll.

[Brettmcd]

Why shouldn't the federal government be doing that? I think the federal government should be able to do that. Why is taxation a legitimate power, and a mandate isn't?

I feel like you're just stating a conclusion rather than explaining your position.


I guess I see at the federal level that there are constitutional provisions for the government to have the power of taxation. That is the accepted way for the government to fund its activities. I don't see the same provisions for the federal government to force you to buy a product from a private company. That is why one is a legitimate power at the federal level and one isn't.

[Enidigm]

I think it's because it's like an inverse vice tax. If you choose to smoke, you will pay a higher penalty, ie, a tax, and this same sort of usage tax can be used to moderate all sorts of public behavior, from gasoline to potato chips.

Now instead of paying a penalty by partaking, you pay one for failing to partake. Instead of regulating behavior, it is mandating behavior. The closest federal program is probably Social Security, and that isn't at all a good parallel because SS at least has the pretense of getting much of what you pay into it, out of it, as you age, and because what you pay in cash, you receive back in cash. Most if not all other federal programs result in "common good" expenditures; you may never hold in your hands military hardware, or drive on Federal roads in most states, or use Medicare or Medicaid in your lifetime. In this, the government is mandating not just taxation, but participation; every person in America is going to have to "deal" with Health Care now, whether things remain as they are, whether they pay more in taxes, or whether they are forced to join an exchange. It's a compromise from single payer that has many, including those that would benefit most from the plan, questioning their additional burdens that are being asked to shoulder.

Opposition to it, on some level has, with what has to be undisguised irony, a rejection of stereotypical conservative values; the free market knows best! Ok, here's your mandated participation in the free market! Wait, wtf, this is the market that increases costs 10% a year, screw it i'm out, down with Obamacare! I mean, it's a fair criticism, broken medical system is broken (or at least, broken for those that can't afford it, which is an increasingly large share of the population), i can understand not wanting to be forced to participate.

[AlanQ]

I guess I see at the federal level that there are constitutional provisions for the government to have the power of taxation. That is the accepted way for the government to fund its activities. I don't see the same provisions for the federal government to force you to buy a product from a private company. That is why one is a legitimate power at the federal level and one isn't.

That just seems really formalistic to me. You would be fine with the federal government taxing you X dollars, then rebating that money providing you purchased health insurance. This is exactly the same effect as a mandate, it's just more complicated and more costly (due to frictional costs of administration). The essence of the activity is the same, it is only the form that is different. In general, I don't think it makes sense to focus on the form of a law rather than the substance.

[Brettmcd]

That just seems really formalistic to me. You would be fine with the federal government taxing you X dollars, then rebating that money providing you purchased health insurance. This is exactly the same effect as a mandate, it's just more complicated and more costly (due to frictional costs of administration). The essence of the activity is the same, it is only the form that is different. In general, I don't think it makes sense to focus on the form of a law rather than the substance.


No its important to look at the form also. Its not a road you want to go down giving the federal government the authority to force you to do business with a private company. With how screwed up and corrupt our federal government can be it is not a door I want to open for them.

Again taxation is a specific power of the government, forcing you to buy from a private company isn't. It is a distinction that I think should stay.

[JeffL]

That just seems really formalistic to me. You would be fine with the federal government taxing you X dollars, then rebating that money providing you purchased health insurance. This is exactly the same effect as a mandate, it's just more complicated and more costly (due to frictional costs of administration). The essence of the activity is the same, it is only the form that is different. In general, I don't think it makes sense to focus on the form of a law rather than the substance.

Alex, if the government decided it would be good for the auto industry if everyone in America bought a Ford, Chevy, or Chrysler, and therefore said "If you don't buy a new car from one of these 3 companies this year, you will be fined $10,000" would you be OK with that? Not giving you a rebate for $10,000, not raising everyone's taxes that much and then giving a break, but simply saying: you buy a Ford, Chevy, or Chrysler this year, or you pay a fine of $10,000. Would you think that was OK?

If the answer is yes, then OK, we just disagree. All the arguments of "well, you just don't like the mechanism" etc. would also apply to this.

I'm fine with people having a different opinion, I'm OK enough with that that I don't feel compelled to call people who disagree with me all kinds of names. I just feel that there is indeed a line that is indeed based on the "how."

[ckessel]

Alex, if the government decided it would be good for the auto industry if everyone in America bought a Ford, Chevy, or Chrysler
That's a misleading analogy. Everyone uses healthcare so laws around the purchasing of it isn't causing them to buy something they're not already going to use at some point. The same isn't true for a car.

We also are currently already forced to pay for healthcare for the elderly via medicare/medicaid. The mandate is achieving the same goal of having younger, healthier people pay into a system to reduce costs for older, sicker people.

[AlanQ]

Alex, if the government decided it would be good for the auto industry if everyone in America bought a Ford, Chevy, or Chrysler, and therefore said "If you don't buy a new car from one of these 3 companies this year, you will be fined $10,000" would you be OK with that? Not giving you a rebate for $10,000, not raising everyone's taxes that much and then giving a break, but simply saying: you buy a Ford, Chevy, or Chrysler this year, or you pay a fine of $10,000. Would you think that was OK?

It depends on what you mean by "OK". I would think it was a legitimate act of government, but a shitty policy and I would do my best to get that government voted out. I totally understand thinking the mandate is stupid and bad policy. I don't understand what makes it an invalid policy (one that is outside the power of government).

In other words, I would think your hypothetical policy would be legal but bad policy, and the remedy would be the ballot box rather than the courts.

[Ben Sones]

I don't see the same provisions for the federal government to force you to buy a product from a private company. That is why one is a legitimate power at the federal level and one isn't.

The Second Congress thought that it was an appropriate application of federal power (http://www.constitution.org/mil/mil_act_1792.htm), circa 1792. I figure that these guys know a bit about the Constitution, since a fair number of them helped write it.


That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of powder and ball; or with a good rifle, knapsack, shot-pouch, and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder; and shall appear so armed, accoutred and provided, when called out to exercise or into service, except, that when called out on company days to exercise only, he may appear without a knapsack.

[Valentine]

I guess I just wonder why it would be "the worpst thing EVAH" for America if it works out so well for dozens of other countries

[JeffL]

In other words, I would think your hypothetical policy would be legal but bad policy, and the remedy would be the ballot box rather than the courts.

And I have stated that I believe the SC will uphold the mandate, that I think doing it this way is something I am not comfortable with but likely legal under the virtually unlimited breadth that the Commerce Clause has become. I just don't agree with the approach, not because of this law, but because of how it could be used.

Anyway, I'm not sure any of us are saying anything we haven't said before here. Back on topic, I still predict a 7-2 affirmation based on past SC rulings relating to the Commerce Clause.

[Jason McCullough]

A couple of interesting vote projection methods (http://themonkeycage.org/blog/2011/11/21/forecasting-the-supreme-court-vote-on-obamacare/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+themonkeycagefeed+%28The+Monk ey+Cage%29). The "ideology" one has it 5-4 overturn, the "ideology plus affinity for precedent" has it 6-3/7-2 support.

This narrative of the second sounds about right:


Respect for precedent pushes Kennedy to support the law and Roberts comes along for the ride in order to keep the opinion out of Kennedy’s hands (and possibly writing an opinion that cabins the Commerce Clause more than it is now). Alito probably goes with Roberts, but seems more up for grabs. If we are wrong, expect the justices to either downplay precedent and emphasize other legal values (such as federalism) or play up the few precedents that protect state rights.

[Bill Dungsroman]

Not meaning to derail, but my company has to switch health coverage for the new year like we've had to do nearly every year for the past few years because of absurd premium increases. This time we say goodbye to Aetna because they are mandating a 40% increase in coverage premiums. FORTY FUCKING PERCENT. HOW IS THIS FUCKING LEGAL.

[TheTrunkDr]

Not meaning to derail, but my company has to switch health coverage for the new year like we've had to do nearly every year for the past few years because of absurd premium increases. This time we say goodbye to Aetna because they are mandating a 40% increase in coverage premiums. FORTY FUCKING PERCENT. HOW IS THIS FUCKING LEGAL.
Free market, you're participating fantastically. Isn't it wonderful!

[Brian Seiler]

Not to take one side or the other, but my company did the same thing last year, and the cited reason for the increase in premiums were 1) reduced competition, because middle-sized insurers (like the one we used) were being forced out by the requirements in the reform law; and 2) other regulatory costs associated with the law. I've done no deep analysis, other than to confirm that the market in general is drifting toward consolidation, but the cause the providers cite for the cost increase are specifically the impending unfreedom of the insurance market. I suspect that there is a long, confusing, and pointless debate that ultimately ends at "well, they've got kind of a point, but, you know, not THAT much of one."

[Scuzz]

Not meaning to derail, but my company has to switch health coverage for the new year like we've had to do nearly every year for the past few years because of absurd premium increases. This time we say goodbye to Aetna because they are mandating a 40% increase in coverage premiums. FORTY FUCKING PERCENT. HOW IS THIS FUCKING LEGAL.

Wow, our Blue Shield only went up 5%, probably the smallest increase in the last 5-10 years.

[JeffL]

Was there any projections of a general range of how much premiums would go up as the provisions in the health care bill kicked in? We had someone come in to our company about a year ago and try to explain things to us, but there were still gray areas on some of the new rules. But I assume everyone expected rates to go up, since the insurance companies now have to cover a lot of people they did not cover before, as well as provide coverage beyond their previous amounts (e.g. the unlimited lifetime payouts, etc.) and they obviously will just pass on the increases to us. However, I've not seen an estimate of how much the average person can expect to see their rates increase.

[AaronSofaer]

But I assume everyone expected rates to go up, since the insurance companies now have to cover a lot of people they did not cover before, as well as provide coverage beyond their previous amounts (e.g. the unlimited lifetime payouts, etc.) and they obviously will just pass on the increases to us. However, I've not seen an estimate of how much the average person can expect to see their rates increase.


What, and the effects of having people who weren't buying insurance because they were healthy and suchlike now getting insurance is... nothing? All of the 18-25 bracket joining into the pool has... no effect?

Far more likely that the insurance companies are jacking their rates because they can, finding an excuse for it that sounds plausible, and hey look, an increase in profits. That'd be good business, at least in the short term, it seems to me.

[JeffL]

What, and the effects of having people who weren't buying insurance because they were healthy and suchlike now getting insurance is... nothing? All of the 18-25 bracket joining into the pool has... no effect?

Far more likely that the insurance companies are jacking their rates because they can, finding an excuse for it that sounds plausible, and hey look, an increase in profits. That'd be good business, at least in the short term, it seems to me.

Have to see the numbers, but first, you can't assume all of the 18-25 did NOT carry insurance, nor that the wealthy didn't carry it - I could be persuaded by the numbers, but I would bet most wealthy do carry insurance, and a lot of the 18-25 who don't have insurance because they don't have jobs are now being carried on their parents' insurance.

Again, I'd like to see real numbers from unbiased sources, but if I had to bet, I'd bet the increased liabilities are quite a bit more than what is contributed by non-insured healthy people getting insured.

Personally, I think that is just what we need to accept as the cost of the insurance reform bill.

[AaronSofaer]

Again, I'd like to see real numbers from unbiased sources, but if I had to bet, I'd bet the increased liabilities are quite a bit more than what is contributed by non-insured healthy people getting insured.



I'd also like to see real numbers from an unbiased source, and until then, I remain skeptical that a set of for-profit corporations is not using an opportunity to make more profit, that being what they do.

[TheTrunkDr]

What, and the effects of having people who weren't buying insurance because they were healthy and suchlike now getting insurance is... nothing? All of the 18-25 bracket joining into the pool has... no effect?

Far more likely that the insurance companies are jacking their rates because they can, finding an excuse for it that sounds plausible, and hey look, an increase in profits. That'd be good business, at least in the short term, it seems to me.
Pretty much. All the discussion before was how insurance was so expensive because healthy people opted out causing a self-selecting death spiral of costs. With all these new, healthy, customers paying into the system costs for everyone should go down, cause companies like making less profit or passing savings on to customers or whatever crap they like to say.

Seems like it's not happening and they're using this as an excuse to raise prices, why am I not surprised.

[JeffL]

I'd also like to see real numbers from an unbiased source, and until then, I remain skeptical that a set of for-profit corporations is not using an opportunity to make more profit, that being what they do.

I wouldn't be surprised to see that as the result of the numbers either. I.e. I don't know.

What I do know, is that the health insurance companies are motivated and rewarded for making as much money as they can. They are in the business of making money, not taking care of sick and injured people. They have stock holders who demand they make as much money as possible, their CEO's are judged and paid based on how much money they make.

And you get the behavior you reward. Which is why the concept of private, for profit companies being in charge of our health care is fatally flawed and we will never have true improvements as long as they are in charge, or even have a significant role.

[AaronSofaer]

And with that, we are in full agreement, sir. *tips hat*

[Scuzz]

Have to see the numbers, but first, you can't assume all of the 18-25 did NOT carry insurance, nor that the wealthy didn't carry it - I could be persuaded by the numbers, but I would bet most wealthy do carry insurance, and a lot of the 18-25 who don't have insurance because they don't have jobs are now being carried on their parents' insurance.

Again, I'd like to see real numbers from unbiased sources, but if I had to bet, I'd bet the increased liabilities are quite a bit more than what is contributed by non-insured healthy people getting insured.

Personally, I think that is just what we need to accept as the cost of the insurance reform bill.

That is what I am seeing amongst my 50-60 year old friends. Many have their non-student kids back on their insurance.

[JeffL]

And with that, we are in full agreement, sir. *tips hat*

And to you. And shedding my Karl Rove/Talking Points from the GOP Committees skin that I appear to have to some, lol, as much as I feel some form of capitalism is good in most areas, for health care I fervently believe the government (yes, the same government in which I have so little faith and so much scorn) should nationalize all health care insurance and make it non-profit and optimized for the well being of our citizens. Would they screw some things up? Absolutely. Would it be worse in some ways? No doubt.

But the key focus could then be maximizing the treatment of patients and not maximizing profits. Those are conflicting goals. And insurance companies don't maximize profits because they are evil, they maximize profits because that is their chartered goal as a for profit private company.

[JeffL]

That is what I am seeing amongst my 50-60 year old friends. Many have their non-student kids back on their insurance.

Yep. Here at our company we have had a very significant jump in parents now covering their non-student "kids" with our company insurance. Including me: my daughter graduated in May with a teaching degree, and has been unsuccessful so far finding a permanent teaching job, so she's back on our insurance.

[Tortilla]

I'd also like to see real numbers from an unbiased source, and until then, I remain skeptical that a set of for-profit corporations is not using an opportunity to make more profit, that being what they do.

I'm skeptical of that myself. I agree the motive is there, but the health care marketplace is competitive. My insurance through my employer has changed several times in the last decade as they have tried to find ways to keep cost growth under control. Unless you are suggesting collusion between health insurers to all jack prices a certain amount in the absence of corresponding cost growth, I don't believe pure profit motive is enough explanation for rising insurance prices.

[Bill Dungsroman]

I'm skeptical of that myself. I agree the motive is there, but the health care marketplace is competitive. My insurance through my employer has changed several times in the last decade as they have tried to find ways to keep cost growth under control. Unless you are suggesting collusion between health insurers to all jack prices a certain amount in the absence of corresponding cost growth, I don't believe pure profit motive is enough explanation for rising insurance prices.

You don't? I sure do. Remember a lot of people end up tethered to their coverage because they can't risk leaving and being denied coverage for a pre-existing condition. So, really, it's extortion.

[Houngan]

You can't really discuss the "no mandate" side without coming clean on all the other provided services. I think it's a perfectly valid stance to dislike the mandate if you're also willing to cut off access to emergency rooms, health clinics, and any other "free" health service that sucks money out of the pockets of those who do pay for insurance. You literally have to take the position of letting children die outside the emergency room door in order to have a logically consistent viewpoint on this.

Gotta repeal this dude: http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

[Brandon Clements]

Wow, our Blue Shield only went up 5%, probably the smallest increase in the last 5-10 years.
The company I work for dropped BC/BS after we were going to get hit with a 15% increase in premiums, and a projected 20% next year. United Healthcare gave us a 14% decrease in premiums for the next 2 years, so we went with that.

[Tortilla]

You don't? I sure do. Remember a lot of people end up tethered to their coverage because they can't risk leaving and being denied coverage for a pre-existing condition. So, really, it's extortion.

I'm really confused by this. I thought the laws nowadays prevented that pre-existing condition loophole for health insurance as long as people switched from one plan to another without a gap in coverage?

Like I said, I've had three different plans in the last years and I don't recall anyone freaking out about it in our (small) company.

[Brandon Clements]

I'm really confused by this. I thought the laws nowadays prevented that pre-existing conditional loophole for health insurance as long as people switched from one plan to another without a gap in coverage?

Like I said, I've had three different plans in the last years and I don't recall anyone freaking out about it in our (small) company.
If you swich jobs, you almost certainly will have a gap in coverage unless you pay the COBRA premium.

[Tortilla]

If you swich jobs, you almost certainly will have a gap in coverage unless you pay the COBRA premium.

Well yes, but that's why you price paying for a month or so of COBRA into job switching plans.

[Brettmcd]

Well yes, but that's why you price paying for a month or so of COBRA into job switching plans.


No there was a law passed in the 90s where employer insurance cannot deny you for preexisting conditions. So it doesnt matter if you purchase cobra or not, as long as its insurance through your job you are covered.


http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Ac t

[Martin Guerre]

No there was a law passed in the 90s where employer insurance cannot deny you for preexisting conditions. So it doesnt matter if you purchase cobra or not, as long as its insurance through your job you are covered.

http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Ac t

Wow, thanks BIG GOVERNMENT for driving up my premiums... Though I really should blame HR for not screening out smokers and women.

[Bill Dungsroman]

No there was a law passed in the 90s where employer insurance cannot deny you for preexisting conditions. So it doesnt matter if you purchase cobra or not, as long as its insurance through your job you are covered.


http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Ac t

As long as you don't have a gap of 3 months or greater but yeah, that is a good thing.

[Bill Dungsroman]

I'm really confused by this. I thought the laws nowadays prevented that pre-existing condition loophole for health insurance as long as people switched from one plan to another without a gap in coverage?

Like I said, I've had three different plans in the last years and I don't recall anyone freaking out about it in our (small) company.

Yeah I misspoke.

[mrmolecule88]

smokers and women.

I liked your Nitram Draw alt. You should bring him back.