Health Care

[prole]

[Crux]

 

We're not finished: Medicare Part E

 

What's now in progress: WeWantMedicare.com

 

 

 

[tvashtarkatena]

Does the healthcare bill violate the 10th ammendment?

 

Probably not. The 10th Amendment states that "[t]he powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people." The federal government, however, can claim two Constitutional justifications for mandating health care. One is the right to regulate interstate commerce, which includes any business that operates across state lines. (Even if not all health insurance companies operate in more than one state, Congress can still regulate them as long as that regulation is part of a comprehensive interstate scheme, according to the Supreme Court.) Congress also has the Constitutional right to tax. Just as Congress taxes polluting companies for imposing a burden on other people, it could tax Americans who don't buy health insurance for doing the same. As if to emphasize the point, the fine for not buying insurance is levied by the IRS.

 

Suck it, half-assed constitutional "scholars".

 

Both points of this analysis are flawed. Re: point one, congress can regulate interstate businesses, but this involves individual persons, not businesses. Re: the 2nd point; congress can fine businesses for polluting, which constitutes a past and present harm. It's unclear whether or not congress can fine a person for a future harm that may or may not happen(consuming health care resources if uninsured IF the person gets sick).

 

States may force citizens to buy insurance as a requirement for using public infrastructure; driving on roads, for example, but it remains unclear whether or not the feds can force citizens to buy insurance simply to live.

 

There will undoubtedly be one or more court challenges to the mandatory health insurance requirement, which I personally think was a very bad idea. Whether the issue makes it to the supreme court remains to be seen. If it does, the defeat of such a challenge is far from a foregone conclusion. Past courts have show deference to the legislature, but the Roberts court has proven to be unusually activist.

Edited March 25, 2010 by tvashtarkatena

[tvashtarkatena]

BTW, here's a summary of what's in the New Health Care:

 

linky

 

We'll need to go to a single payer system eventually...this new law is a muddled bandaid.

 

I don't, for the life of me, know why the Dems bothered to include 400 RFuck amendments in this bill, when not a single one of the cunts voted for it. Next time they'll know not to bother.

[Mal_Con]

George Washington in 1793 approved the Militia Act which required every male to by a musket and ammo.

[tvashtarkatena]

Fast forward to the present: similar 'everybody-must-be-armed' laws have failed in the courts in recent years.

[rob]

FW just PM'd me a death threat. Maybe I should arm myself now.

[prole]

Maybe it's just ironic satire.

[tvashtarkatena]

This bill extends federal power into uncharted territory, particularly the individual mandate clause. Never before has congress mandated penalties for NOT buying something. It will certainly run into serious legal challenges, and perhaps even at the supreme court level. Personally, I find the mandated purchase of a for profit, commercial product a disturbing precedent, to say the least.

 

Is the new health care constitutional?

 

Still, in the balance, I'm very glad the bill passed. A failure here would have sent any health care reform into another decade of oblivion; we can't afford to do that anymore as a country. In addition, the passage of this bill with zero republican votes indicates that bipartisanship is over; a welcome change in my book. I believe it also signals the long term death of the Republican Party, something long overdue as far as the good of the country is concerned. At least now the country will be trying reform which can, of course, be amended along the way. And as far as the individual mandate, my main worry, is concerned; there's a significant chance it will be shot down in the courts and by the states, anyway.

 

 

[rob]

I'm penalized if I don't have kids. Some people are penalized if they don't get married. We reward people for buying houses, and allow them to deduct interest paid on the loan (VERY unusual, actually. Most countries don't allow that.)

 

So, I don't see this as that big of a deal. It's not really a penalty for not getting insurance. It's an excise tax that you have to pay, which is waived if you have insurance.

 

I'm not a legal scholar, but I doubt the individual mandate will be shot down at the SCOTUS level.

 

Incidentally, I would feel much more comfortable if insurance companies were not allowed to be for-profit. But I've been saying that for year.

[rbw1966]

Isn't social security "tax" an individual mandate?

[rob]

and Bush wanted to privatize that, which would have resulted in a federally mandated inclusion into a privatized market. Which was FINE when republicans were proposing it.

 

More and more I am finding that republicans are just a bunch of wieners. Obama could propose paying down the deficit and they'd be against it.

[KaskadskyjKozak]

Incidentally, I would feel much more comfortable if insurance companies were not allowed to be for-profit. But I've been saying that for year.

 

Yes.

[Choada_Boy]

FW just PM'd me a death threat. Maybe I should arm myself now.

 

Me too! But thankfully I have received a court injunction requiring me to wear a t-shirt in public at all time due to the fact that I do not possess a concealed weapons permit.

[prole]

[tvashtarkatena]

Well, you're not penalized if you don't have kids. You're not fined. Or jailed if you don't pay the fine. You are subsidized if you have kids. It's a big difference. Furthermore, this isn't a tax, or 'like a tax'.

 

Congress has never before mandated that you buy a commercial, for profit product. It's power to do so will now be tested in the courts. This isn't speculation: there are already legal challenges in the works.

 

The ability of congress to regulate interstate commerce seems to be a weak argument for taking this fairly significant step, in my view. Once this happens, what other commercial products will Congress see fit to force all of us to purchase for the general good?

 

The way to do this right is to tax us (which Congress clearly has the power to do), and make single payer healthcare available to all of us. That would remove an instant 12% or more out of our overall health care costs; the part consumed by the billing clusterfuck we currently enjoy.

Edited March 26, 2010 by tvashtarkatena

[rob]

well, if I don't have kids, I pay more. I'm no tax scholar, and I guess the IRS doesn't call it a "penalty," but in the real world that sounds like a penalty to me. If I don't have a kid, then I pay more. And if I refuse to pay more, I go to jail.

 

I know, that's a stretch. But still.

 

So let's take the scenario where I don't want to buy insurance. Under the new bill, now I have to pay this excise, or "penalty."

 

Now, on the other hand, let's take the scenario where there is a mandatory tax to support a single-payer, government-provided insurance. In either case, I am paying a tax/penalty. I can see how one is philosophically different than the other, but in the end, it amounts to the same thing; I'm sending the government money.

 

Edited March 26, 2010 by rob

[Crux]

This bill extends federal power into uncharted territory, particularly the individual mandate clause. Never before has congress mandated penalties for NOT buying something. It will certainly run into serious legal challenges, and perhaps even at the supreme court level. Personally, I find the mandated purchase of a for profit, commercial product a disturbing precedent, to say the least.

 

Is the new health care constitutional?

 

Still, in the balance, I'm very glad the bill passed. A failure here would have sent any health care reform into another decade of oblivion; we can't afford to do that anymore as a country. In addition, the passage of this bill with zero republican votes indicates that bipartisanship is over; a welcome change in my book. I believe it also signals the long term death of the Republican Party, something long overdue as far as the good of the country is concerned. At least now the country will be trying reform which can, of course, be amended along the way. And as far as the individual mandate, my main worry, is concerned; there's a significant chance it will be shot down in the courts and by the states, anyway.

 

 

In my thinking, for the Blessings of Liberty to be legally predicated upon the purchase of anything from a private entity would be unconstitutional. As it turns out, however, the health insurance reform bill does not do that: The bill does not provide for any fines to be imposed upon persons who do not have or fail to obtain medical insurance. What Congress has done to mandate citizen participation in the collective medical insurance pool is to enact a new tax. Under details of budgetary reconciliation, the new tax is designated to raise revenue needed to defray costs the Government incurs by paying for emergency or other medical care for persons who have no medical insurance. As the new tax is leveraged in the insurance reform bill, it comes with an exemption for citizens who have insurance, thus compelling most everybody to have insurance.

 

For those who cannot afford insurance, reconciliation has enacted means of revenue collection to provide subsidies that will make their insurance affordable. Individuals will be able to choose their insurance providers, to whatever extent choices are available by the industry cartel -- pretty much the same as now, only with government subsidies to make premiums affordable for buyers who have lower incomes. Lower incomes are those below 88K, from what I understand, and subsidies will be paid directly to the chosen insurance providers.

 

I'd like to see a public option made available, rather than deal with a predatory cartel we hope to tame with the new law, but I believe the new provisions for medical insurance will be significantly better than what we have now.

 

At any rate, once I learned the mandate that I buy insurance is to be imposed by a germane tax incentive rather than legal fines, the law seemed congruent with constitutional principles and unlikely to be viewed otherwise by federal courts, including the SCOTUS that is presently doubted by so many people after its recent decision on the Citizens United case.

[JayB]

Isn't social security "tax" an individual mandate?

 

Seems like it's hard to answer anything but "yes" to the above. Ditto for the levies imposed to fund Medicare. In one case your money will be funneled into a series of highly regulated, nominally private cartels and in the other it's going into a marginally solvent public-monopoly/intergenerational ponzi apparatus. Not sure which should be more worrisome to the principled civil libertarian.

 

I'm moderately relieved that there are people on the left like Tvash who are marginally concerned with the expansion of state power entailed in the entailed in the purchase-or-penalty scheme, but I'm not sure how diverting the funds directly into a state monopoly would be an improvement in that regard.

 

 

 

 

[JayB]

I can see how one is philosophically different than the other, but in the end, it amounts to the same thing; I'm sending the government money.

 

Uh-oh.

 

"He sees too clearly and speaks too plainly..."

 

 

 

 

[tvashtarkatena]

 

I'm moderately relieved that there are people on the left like Tvash who are marginally concerned with the expansion of state power entailed in the entailed in the purchase-or-penalty scheme, but I'm not sure how diverting the funds directly into a state monopoly would be an improvement in that regard.

 

 

You save 12% off the top in admin/billing costs. We already have the IRS...no addditional cost in collections there. As for paying the providers; everybody uses the same system (per the French model): huge economies and simplification there. I would think that would make dollars and sense to you.

[prole]

I'm moderately relieved that there are people on the left like Tvash who are marginally concerned with the expansion of state power entailed in the entailed in the purchase-or-penalty scheme...

 

Yeah, the "left" has been skeptical of this scheme all along. It was a sop to the insurance industry as a way to spread its risk across the entire population in lieu of a single payer program. As if you didn't know this already...

[tvashtarkatena]

Does the new health care cover remedies for insomnia?

[tvashtarkatena]

A single payer government monopoly is just what we need to bring health care costs down. What we don't need is a clusterfuck of competing companies merging, going out of business, scamming their customers, and generally fucking us over any way they can to please their constituency, which isn't us. Private companies are great if you want a new widget. Health care billing is certainly not that, nor should it be. Health care billing should be standardized, predictable, boring, and largely invisible to providers and patients alike. Why this is a huge industry in this country and practically no where else is utterly beyond me.

[JayB]

A single payer government monopoly is just what we need to bring health care costs down. What we don't need is a clusterfuck of competing companies merging, going out of business, scamming their customers, and generally fucking us over any way they can to please their constituency, which isn't us. Private companies are great if you want a new widget. Health care billing is certainly not that, nor should it be. Health care billing should be standardized, predictable, boring, and largely invisible to providers and patients alike. Why this is a huge industry in this country and practically no where else is utterly beyond me.

 

There's a difference between prices and costs. Government can enact legislation that puts caps on prices, but it can't control the gazillion factors beyond its control that determine what it actually costs to make things or bring services to the market. Government can cap the price of milk at 1$ a gallon, but hard as it may try, it can never control the real cost of all of the inputs that go into producing the said gallon of milk. When the real cost exceeds the price the government sets, then farmers stop producing it. If they're forced to keep delivering it they'll degrade the quality as much as possible in an effort to stay afloat you probably won't want to drink it.

 

Health care is no different. Governments can control the price of delivering healthcare, but they can't control the cost of doing so, much less the demand for it.

 

As of right now, something like 86% percent of all premiums are used to pay for goods and services, and the profit margins run around 2.2%. When you control for the real cost of Medicare, most of the efficiencies disappear.

 

Even if there is a real margin there, the notion that it holds the key to making healthcare more effective is difficult to comprehend. The right way to value the efficiency of health care is to divide the benefit to the patient over the total cost of delivering it. What really matters is the numerator, and of the components that make up the denominator, the .1 to 0.05 that's in play in the "administrative efficiency" component aren't terribly significant.

 

When you actually look at major drivers of total health costs, the obsessive parsing of marginal differences in administrative costs is even more puzzling. The nation is getting older and fatter, and the number of pills and devices at our disposal to address the health consequences of both is continuously expanding. You can scale administrative infrastructure pretty easily without spending much more money. This is not true for delivery - whether it's CT scanners or bariatric surgeons.

 

I suspect that before long the illusion that it's private sector administrative expenses that are driving up the national tab for health-care will vanish, and then the conversation about how to best contain them will start to get very interesting.