How health reform controls health cost
Secretary of Health and Human Services Kathleen Sebelius wrote a letter to the Washington Post defending health reform, citing another letter recently submitted to the House Budget Committee by 272 of America’s top economists. According to the economists:
“The Affordable Care Act contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending…
…The budgetary impact of repeal also would be severe. The Congressional Budget Office concludes that repealing the Affordable Care Act would increase the cumulative federal deficit by $230 billion over the next decade, and would further increase the deficit in later years.”
UPDATE: Here is an easy-to-understand animation explaining the Affordable Care Act, written and narrated by M.I.T. health care economist Jon Gruber (who advised both Governor Romney and President Obama on health reform).
UPDATE (01/20/2012): Under health reform, most insurance will now be required to cover contraceptives as a free preventive service. Preventing unwanted pregnancies should help control medical costs as well as reduce the incidence of abortion. (02/07/2012): In a new poll, 55% of Americans (including 58% of Catholics) agree that “employers should be required to provide their employees with health care plans that cover contraception and birth control at no cost.”
UPDATE: According to a new Centers for Medicare & Medicaid Services actuarial report, health reform will save Medicare $200 billion through 2016 and will save Medicare beneficiaries another $208 billion through 2020.
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January 8th, 2012 at 7:09 am
The first sentence you quote as coming from Kathleen Sebelius is obviously incorrect (not an incorrect quote, the statement itself is wrong).
The Affordable Care Act does not contain single payer and that obviously would be effective in reducing the rate of medical spending. In fact, probably much more effective then all the steps contained in ObamaCare combined.
January 8th, 2012 at 8:21 am
The direct quotes were from the letter by 272 U.S. economists to the House Budget Committee. I have edited the original post to make that clearer.
I agree with you that single payer would be more effective in reducing the rate of medical spending, but it would also have to include most of the same steps contained in “ObamaCare” to improve the quality of medical care. However, no elected officials are even proposing a national single-payer plan and it has absolutely zero chance of being enacted any time soon. The only political choice we have right now is “ObamaCare” or repeal.
If health reform is ruled unconstitutional by the Supreme Court or if a Republican is elected president and they take control of both houses of Congress and manage to repeal health reform, nothing else will be done for at least four years. All the benefits of health reform would be lost: health insurance companies would again be allowed to deny coverage to the people who need it most and health costs would continue to skyrocket. Even the next Democratic president may be reluctant to try expending political capital on an issue that failed for both Clinton and Obama.
As I have mentioned previously, health reform may provide the best chance of a path toward single-payer. It allows individual states the ability to experiment with their own means of meeting the goals of health reform. Vermont wants to try single-payer. If their experience proves to be successful, other states may follow them and build up public support for national single-payer.
January 8th, 2012 at 10:41 am
Look, I guess I am largely on your side on this issue, however I am unwilling to sacrifice individual liberties to solve the problem.
Perhaps we can reach agreement that the letter sent by 272 economists to the House Budget Committee is factually incorrect then.
They might try to muddy the waters with they are still correct that their opinion is based on one thing or another, but I am going to claim that it impossible for 272 to sign their signature unless they are either:
1. Intelligent and ignorant.
2. Intelligent, educated and lying.
3. Stupid.
January 9th, 2012 at 7:02 am
The current political choice is to continue implementing health reform or repeal it. Single-payer is not even on the table. The subject of this letter is the economic merits of the existing law, not an evaluation of nonexistant alternative proposals. The economists (who are not ignorant, lying, or stupid) said it contains “essentially” every cost-containment provision not every conceivable cost-containment provision. Even a single-payer plan would need to include these same provisions in order to control costs.
What sacred “individual liberties” are being “sacrificed?” The right not to pay a tax penalty? The right of insurance companies to deny claims? The right to die prematurely due to lack of medical care?
January 9th, 2012 at 9:47 am
Yes, the right not to pay a penalty for refusing to purchase a service from a private, for profit, corporation. I do not think you have considered what this additional government power could mean if the wrong people were elected to office.
I think that if the individual mandate is found unconstitutional (and I still hope and think it will be) there is still going to be a strongly, universal motivation to solve the problem of rising health costs. You might view such a ruling as a setback, I’d argue that it is really an opportunity. My argument is going to be “Well, we’ve tried everything else, perhaps now you’re willing to give socialized medicine a try.”
ObamaCare will only help throttle the increases, not solve the problem. Nothing the Republicans propose are going to solve the problem. The answer is going to become clear, and the American People will then start demanding Socialized Medicine because while socialized medicine might not be perfect, it does more to solve the problem within the limitations that humans can achieve until Jesus comes back and shows us how to do it better.
I wish to provide a caveat. While I am in favor of socialized medicine, I am favor of keeping it limited to keep it affordable. How limited? Well, I need expert advice from the medical community and I would need input from the majority of citizens for just how high a price tag they are willing to pay. I think every citizen will have plenty of time to develop an informed decision once they get around to agreeing we will have to have socialized medicine.
January 9th, 2012 at 12:14 pm
I don’t see “the right not to pay a tax penalty” in the Bill of Rights.
Suppose that the Supreme Court rules health reform constitutional, as three Courts of Appeal have already decided (including conservative appointees of President Reagan and President Bush – a former clerk for Justice Scalia), conservative legal scholar Orin Kerr (former clerk for Justice Kennedy), most other constituional scholars, and I think it will.
Then it will all come down to the political arena. If Obama is reelected, the current health reform law will continue to be implemented. If Romney (or any of the other Republican candidates) is elected, health reform may be repealed and then “nothing the Republicans propose are going to solve the problem.”
Where will the groundswell of “demand” for socialized medicine come from? Are the roughly half of the public and half of Congress who are Republicans ever going to be “willing to give socialized medicine a try?” I don’t think so.
The only hope we have is for “Obamacare” to be successful, and for the Vermont experiment to prove that socialized medicine is even better.
January 9th, 2012 at 12:20 pm
God help you (and all of us) if your point of view is right. The legislation under consideration was passed by a left leaning Congress and just how happy are you going to be when you are forced to then accept legislation when the right takes over?
Stop considering how it allows you to get what you want, start imagining how it might force you to accept what you do not desire.
January 9th, 2012 at 1:31 pm
Health reform was passed by a majority of the House and a two-thirds majority of the Senate and signed into law by the President, just like every other legislation. It will most likely be ruled constitutional by the Supreme Court. What alternative do you suggest to that process? What imaginary legislation will I be forced to accept if the right takes over? I am more concerned about the very real possibility that Republicans will take over and repeal “Obamacare,” leaving us no health reform for decades.
January 14th, 2012 at 11:24 am
Off topic post please forgive me. Please forgive me while I criticize you for not opening a thread where I could speak on topic.
Paul Hirschbiel has announced he will run against Scott Rigell. Evidently he has the support of the VBDC. I say he ain’t perfect, but until Jesus comes back we have to settle for something less. My praises to the VBDC, you did pretty well. Paul is a candidate we can support.
Now let me try to help Paul out a little bit. Perhaps he can help explain why an American Jew might vote for Barack Obama if he was faced with the only other choice was Netanyahu. If he explains it right, he’ll win my endorsement. He already has my vote, but if he wants to win my endorsement, that costs extra.
Paul needs to prove why he is just that extra special voice that is going to add something additional to the office he is running for. His opponent is not easy. Paul has my vote, but he needs a majority.
I would suggest that what Paul perceives as a weakness has the potential to be his strength.
I’m hoping we have a great candidate. If I didn’t think we probably did, I would not have even commented.
January 15th, 2012 at 3:41 am
On topic:
How would I improve the process? I would suggest that Congress should pass, and the President sign into law, only those bills which are constitutional.
You fear Republicans might repeal ObamaCare? Well think about it. If the Republicans have a large enough majority to repeal ObamaCare, then think about just what else they might do with that majority if the individual mandate is found to be constitutional. Might they privatize Social Security and force every American citizen to buy a retirement annuity from a private insurance company?
Be careful what you wish for. If your side has the power when they are in majority, the other side has that same power when they are in majority.
If it can’t be done right, it shouldn’t be done at all.
By the way, we might not have to wait for decades to get single payer if the individual mandate is found unconstitutional. While traveling through Berkley Springs, WV yesterday I saw this billboard:
What would Jesus do?
Start over.
Single Payer.
You might be surprised by who will support single payer if the individual mandate is ruled unconstitutional. It might not happen immediately, but it probably will not take decades for America to adopt some form of single payer. Surely you are in agreement that single payer would be better then ObamaCare, right? In my opinion, if we have to wait a little while to get the job done right, the time spent will be worth it.
By the way, I am not in favor of a 100% single payer program, it would actually be a hybrid. Only certain affordable medical care would be covered to keep the program affordable. Every American citizen would have the choice of whether or not they wanted to purchase supplemental coverage for medical procedures not covered. We can not afford to bust the budget to provide every American the latest, greatest, unaffordably expensive medical procedure. Perhaps such procedures could be added later when, after time, the cost comes down.
I am also going to be pretty picky about how we go about paying for the program. It should be paid for with a progressive income tax. The combined middle class would pay their own way, and the upper class would pay the costs for both their own class and for the lower class. Businesses should be freed from the burden of providing health care coverage for their employees so as to increase the chances goods with the label “Made in America” are available on the shelves at Walmart.
January 15th, 2012 at 5:13 am
I have copied your off-topic comment about Rigell v. Hirschbiel to an earlier thread entitled “Rigell v. Hirschbiel?”
You “suggest that Congress should pass, and the President sign into law, only those bills which are constitutional.” I agree. The Supreme Court gets to decide what is constitutional. Most constitutional scholars believe that the current health reform law will be ruled constitutional.
I do not have to “be careful what I wish for.” It is absolutely true that “If your side has the power when they are in majority, the other side has that same power when they are in majority.” That’s how our system works, whether I wish it or not. That is an argument for re-electing President Obama and electing more Democrats to Congress.
I am afraid of what the Republicans will do with the presidency and a large majority in Congress. They very well may privatize Social Security. President Bush tried to do it before, and Republicans will try to do it again regardless of whether or not health reform is ruled constitutional. That is an even stronger argument for re-electing President Obama and electing more Democrats to Congress.
There are only two realistic possibilities in the near term:
1) The re-election of President Obama and a Congressional Democratic majority, which will result in the continued implementation of the existing health reform law; or
2) The election of a Republican president and a Congressional Republican majority, which will result in the repeal of health reform.
If the Republicans have the presidency and “a large enough majority to repeal ObamaCare” how do you imagine they will pass single payer “socialized medicine?” Absolutely nothing was done on health reform during the eight years of the Bush administration. We would have to wait until the future election of the next Democratic president and Congressional majority (however long that may take). Do you imagine that such a Democratic president would look back at the political failures of Clinton and Obama and be eager to take on that divisive issue again?
I would be extremely “surprised by who will support single payer” since very few elected officials support it now and about half the public apparently believes “ObamaCare” is a “socialist” “government takeover.”
The best chance for single payer would be the demonstrated success of the Vermont experiment allowed by health reform.
January 15th, 2012 at 6:40 pm
You keep saying “Most constitutional scholars believe that the current health reform law will be ruled constitutional.” however I keep hearing otherwise on NPR. In fact, I can only recall one expert who put their reputation on the line with a predicted outcome and that prediction was that the individual mandate would be found unconstitutional by a 5-4 decision.
“Do you imagine that such a Democratic president would look back at the political failures of Clinton and Obama and be eager to take on that divisive issue again?”
Yes I do. Obama did not seem to have a problem tackling the problem after Clinton failed, did he? Whoever is successful in getting elected will have included it in why he/she was running in the first place.
In your “realistic possibilities” you left out a third real possibility.
3. The individual mandate is found to be unconstitutional and ObamaCare is then repealed in its entirety with strong bipartisan support.
January 16th, 2012 at 7:05 am
I have previously referenced many constitutional scholars who believe health reform is constitutional and have predicted the Supreme Court ruling won’t even be close, including Orin Kerr (a conservative who formerly clerked for Justice Kennedy) and Eva Rodriguez, Washington Post legal affairs editorial writer.
You have mentioned others who feel differently, but can’t ever seem to name anyone. Perhaps in their attempts to be even-handed, NPR was able to find someone to present the opposing view.
Here is a recent analysis that deals more specifically with each of the questions the Supreme Court has decided to consider.
The two appeals courts that have already ruled health reform constitutional included conservative appointees of President Reagan and President Bush II (who had previously clerked for Justice Scalia).
Justices Scalia and Kennedy would have to reverse their own precedent in Gonzalez v. Raich (which was itself based on 70 years of expansive interpretation of the Commerce Clause) to rule against the individual mandate.
I don’t believe that “ObamaCare” will be “repealed in its entirety with strong bipartisan support” is remotely “a third real possibility.” Congressional Democrats who fought hard for it will not vote to repeal it. Repeal would only happen as a result of a highly partisan vote by a Republican majority in the House, a filibuster-proof Republican majority in the Senate, and a Republican president.
January 17th, 2012 at 4:46 am
If the individual mandate is ruled unconstitutional, I believe there will be a majority vote to repeal and I would imagine President Obama would even sign it.
I have been doing a little research, during which I have been hampered by a slow and balky internet connection. One of the things I looked into, was what were the odds being given to the issue by bookies. Couldn’t find real odds (again, slow internet connection) but I found that one gambling site had 55% chance of it being found constitutional.
I think using Gonzalez v. Raich is a poor example of justification for the individual mandate because it ruled against a citizen’s right to grow an illegal substance on his private property. If you have the right to break the law in that way, why then would it not be legal to murder someone as long as you did so on your private property?
Constitutional scholars potentially have me cornered on Wickard v. Filburn, however I think this ruling is a travesty. I am wondering if this ruling might not have only come about due to the Executive Branch’s (FDR’s) threat to pack the courts if they did not start ruling in favor of what he was trying to do or something. But, in light of this precedence, I think that there is a difference between preventing someone from doing certain things when comparing it to forcing them to do something particular. In reality, I think Wickard v. Filburn is an awful precedent and should be overruled by the Supreme Court as it grants too great a power to the federal government to infringe on individual liberties. This has happened before, otherwise we would still be living with Dred Scott v. Sandford.
I realize that what I would be asking the Supreme Court to do is take a great leap in over ruling precedence, and such action comes with risks (if that precedence is over ruled, then is Roe v. Wade safe?). However the Supreme Court need not need take that extreme a step. Wickard v. Filburn currently defines the outer limits of federal power as exercised using the Commerce Clause. A majority of the justices need only rule that the individual mandate is a step too far beyond those limits as defined by the precedence. If the Supreme Court does not thus rule, then in effect they are ruling there are essentially no limits, and that the 10th Amendment has no meaning.
I wish to explain that if the individual mandate is not ruled unconstitutional, then I am not in favor of repeal of ObamaCare. Once the decision is handed down, the damage will have been done, so we might as well stick with it (ObamaCare). I still think a hybrid single payer would be better, but I must admit that it might take some time to garner majority support for it. As imperfect as it is, ObamaCare does solve many problems with our current healthcare system, so we might as well stick with it until American society is ready to adopt socialized medicine, and that might take some time.
I can empathize with those who are suffering under the current system and unwilling to wait for single payer. I guess I am being selfish when I state that it would be better for the greater good if the individual mandate was ruled unconstitutional. While some individuals might have to endure great hardship for awhile, such a ruling would probably result in a single payer system sooner then it will with ObamaCare being available. However my selfishness only is because I do not want to pay the price of my personal liberties since I am retired military and no matter how things go, I personally have medical care coverage for the rest of my life. My selfishness is in that I think nobody (including myself) should have to pay the tremendously high price of sacrificing individual liberties when a better, cheaper, more effective solution (single payer) is available to be chosen.
Perhaps I am a little selfish in doing so, but I am going to keep hoping for and arguing towards that which I think is for the greater good.
January 17th, 2012 at 8:11 am
You imagine Obama will repeal “ObamaCare?” That’s some imagination.
The Gonzalez v. Raich case was not decided on the basis of the illegality of the activity. The constitutional question was about the Commerce Clause. The Supreme Court ruled 6-3 that even an individual growing marijuana solely for his own personal use could substantially affect interstate commerce and therefore be subject to federal regulation that overrode state law.
Health care obviously has an huge effect on interstate commerce. Even “inactivity” (the choice not to purchase health insurance) shifts $57 billion per year onto the rest of us.
Ruling health reform constitutional would not mean “there are essentially no limits, and that the 10th Amendment has no meaning.” The appeal courts that have already ruled health reform conmstitutional were very careful to define the limits of their rulings, and the Supreme Court could easily emulate them.
You say “if the individual mandate is not ruled unconstitutional, then [you are] not in favor of repeal of ObamaCare.” Once the Supreme Court settles the issue in favor of constitutionality in July, we will be in agreement.
Regardless what the Supreme Court does, it will still be a political issue throughout the presidential campaign. Mitt “the father of health reform” Romney will apparently be leading the Republican charge to repeal health reform.
As reported on NPR this morning, repeal may be politically difficult because many popular provisions have already taken effect: 2½ million dependents now have health coverage, senior citizens are paying less for prescription drugs, free preventive care, etc. Congressional Republicans would also have to come up with $230 billion that the CBO says repeal would cost. Not that any of that would stop them.
January 18th, 2012 at 4:27 am
David,
If the individual mandate is found constitutional, it is hard to imagine that Republicans would win enough Senate seats to obtain the super majority needed to overcome the filibuster, although if they have a simple majority, there might be some arguing for changing the rules of the Senate (the nuclear option). As an aside, if this comes about, I bet you will stop complaining about the injustice of the filibuster.
I do not think that it is such a leap to imagine President Obama signing the repeal if the individual mandate is found unconstitutional. There probably will be enough votes to over-ride his veto, so he might as well as jump on board. However, I do not think that would be his primary motivation for signing it. The individual mandate is the keystone that makes ObamaCare work. That is why Obama changed to supporting its inclusion it even though he campaigned against it. (If you remember, that was one of Obama’s criticisms of Hillary during the primary, she was in favor of the mandate, he was not.)
I’m going to carry this to a bit of absurdity. Under current Supreme Court precedence, the federal government can pass laws preventing citizens from growing vegetables on their private property for their personal consumption. If the individual mandate is ruled constitutional, the federal government could also mandate that every citizen must purchase a quota of red meat. Unlikely? Yes. Impossible? No.
January 18th, 2012 at 6:36 am
“Absurd?” Yes.
January 19th, 2012 at 5:01 am
But is it possible? The answer is also yes, correct? Remember, a vast majority of us Americans are meat eaters.
(I do believe that a majority of us meat eaters really do not have a problem with anyone choosing to be a vegan or vegetarian, however the preaching annoys us, so…)
January 19th, 2012 at 7:59 am
Sure, anything is “possible.”
The two appeals courts that have already ruled the individual mandate constitutional were very careful to limit their rulings to the unique circumstances of health reform.
The 4th District decision (which included a Reagan appointee):
Greg Sergeant’s summary of the 6th District decision (which included a Bush II appointee):
I’ll make a deal with you. In the extremely unlikely event that there is ever a federal law mandating the purchase of red meat, you can have mine. I am fairly confident that I will never have to deliver on that promise.
January 20th, 2012 at 6:31 am
Well, I do not think that everyone consumes health insurance at the same levels and I do not think everyone should be forced to pay for it even if they have no intention of using it.
I will use a personal example. It is not a great one, but it is the only personal example I have.
8 or 9 years ago (I’ve lost count), my wife was told she had a terminal disease and that she had only about 4 months left to live. They told her that if she underwent radiation treatments, she would add several months to her life. She reluctantly agreed to undergo them, however after the 2nd one, she came home and told me she would rather die then undergo any more. Since then she has not been seeing any of the specialists to treat her disease. She developed high blood pressure, and she does see a General Practitioner to get a prescription to treat that.
When I discuss health care with my wife, she is adamant that society should not go broke providing the latest, greatest, most expensive medical procedures for every last citizen to give them just a few more breaths. If she chooses to forgo treatment, why should she be forced to help pay the costs for those who do not?
My wife is a good example in that she has given me very specific instructions on what choices I am to make as her spouse if she ends up in the hospital on life support. I am to tell them to pull the plug. In her mind, her quality of life is already bad and it is only going to get worse, so she does not want to waste the money prolonging her life. It irritates her that she might be expected to help pay the costs for those who are afraid of death and who might decide otherwise.
Where she is a bad example is in that her medical coverage is through TRICARE, which she receives by being the spouse of a military retiree. She has the choice that others might not have, although I would argue that this is only because I earned her that choice through my years of service.
January 20th, 2012 at 7:15 am
It is true that everyone doesn’t “consume health insurance at the same levels.” The whole concept of insurance is to spread risk over a large group.
The issue is not about people who have health insurance and choose not to use it, it is about people without health insurance. “Even if they have no intention of using” health insurance, everybody needs some kind of medical care at some point. If they aren’t insured, the cost of their medical treatment is shifted onto the rest of us. They are “free riders” (as Romney put it).
Your wife’s tragic example raises a completely different issue: end of life care. About 30% of Medicare is spent in the final year of life. About 50% of Medicare is spent on patients who die within two months. The extraordinary medical efforts usually do little to improve quality of life, they just temporarily prolong it. It is medically wasteful, but reflects personal decisions that are largely based on fear of death. Eventually, our mortality rate is 100%.
An early provision of the original health reform bill would have allowed doctors to be reimbursed by Medicare for end of life counseling so that their patients could make informed decisions about options such as hospice care and advance directives (“living wills”). Health reform opponents demonized it as “death panels,” “euthanasia,” “killing granny,” etc., and the provision was quietly withdrawn from the bill.
Regarding your personal example, I hope the “very specific instructions on what choices [you are] to make as her spouse if she ends up in the hospital on life support” are documented in an advance directive. If not, you may not be legally authorized to make the decisions she has requested when the time comes. In the meantime, take good care of your wise and brave wife.
January 20th, 2012 at 6:14 pm
My point was that those who, when faced with death, say “The end is near, so let’s get it over with” should not be forced to join the pool which includes those who will demand we bankrupt society, if necessary, to prolong their life.
I am slightly arguing against myself, seeing as how what I am actually in favor of is limited socialized medicine. My wife and I would still pay the taxes which pays for limited single payer. However my wife might put what we are in favor like this: “If you have a heart attack, head to the hospital and we’ll cover that. But if the Doctor tells you that you need heart surgery, you better have your own insurance.”
We’d cover the care and treatment for the heart attack. We’d cover continuing treatment of the type available before the days of heart surgery. But heart surgery? Well that’s expensive and you’d have to pay for that yourself. Since we’d go broke trying to provide it for everyone, it would not be included in the procedures provided for anyone. If YOU think you’d want it and YOU think it is worth it, well then YOU pay the premiums for the insurance that includes it and do not expect us to pay the premiums for you.
Some people might place a high value on prolonging their life, others might prefer to keep the money while they are young and healthy and use it to improve their enjoyment of life while they can. Why should the latter be forced to buy insurance from a for profit corporation which provides coverage for the former?
January 20th, 2012 at 7:47 pm
Perhaps you can educate me on the right to end of life issue.
My wife and I both are relying on that each can speak for the other when we can no longer speak for ourselves and the issue comes up. If we were forced to define all the circumstances where a legal document needs to define the circumstances, we would have to have a legal document the size of the Encyclopedia Britannica to cover all the possibilities.
My wife and I are just trusting in the judgement of each other. Grey areas exist which were not covered in our discussions, but I understand her wishes. I feel it would be impossible for her to communicate as clearly her wishes in a legal document what she was able to communicate to me because I have lived with her all these years, and a simple phrase expressing her will to me expresses more then everything a Harvard law degree enables one to fathom.
It is our understanding that as long as we are married, we each, one for another, get to speak for each other when we are no longer able to do so. Are we wrong? If we are wrong, the laws need to be changed to make it so. I do not desire that a legal document might be argued over by lawyers in a court of law and over-rule my wife’s attempt to fulfill my wishes.
Thus far, my wife is still willing to trust my judgement. With honesty, I think her only real concern is that I might be too reluctant to pull the plug.
January 22nd, 2012 at 9:08 am
An advance directive is a standardized legal document that is accepted by many states (including Virginia). It does not require a lawyer. It may include a “do not resuscitate” clause and a medical power of attorney that would allow you to make decisions for her if she were not able to.
January 22nd, 2012 at 3:09 pm
Perhaps I need to consult a lawyer or do some research. It is my (our) understanding that we already have to the right to speak for each other without any paperwork. A “do not resuscitate” order is too limiting. It depends on the circumstances as to whether or not resuscitation is OK. Rather then have an unthinking piece of paper speaking for me, I would rather have my wife do it. My wife’s problem might be that I would be on the road and several days away at the time a judgement might have to be made.
January 22nd, 2012 at 3:34 pm
An Advance Directive lets medical providers know the types of medical care you do and do not want in the event you are unable to express your wishes on your own. No need to consult an attorney, since stabdardized forms are available. Explanation here.
January 22nd, 2012 at 5:45 pm
I do not think I can cover all the circumstances where I want the Doctor to act and when I want him/her to keep his hands in his pockets. If I can no longer speak for myself, I want my wife to speak for me. Her voice might not be a perfect representation, but it would be a whole lot better then anything I could put on paper.
January 23rd, 2012 at 6:29 am
You are missing the point. If you can no longer speak for yourself, the paper authorizes your wife to speak for you.
January 23rd, 2012 at 2:45 pm
It is my understanding that in Virginia the paper is not necessary since we are married.
January 23rd, 2012 at 5:11 pm
The previous link was from the Virginia Bar Association. You don’t need an Advance Directive, as long as your wife is able to make the decisions you want her to without letting her emotions get in the way or as long as you don’t have other family members who disagree with those decisions. It is just a way to make it clear what your wishes are if you are not able to express them.
March 10th, 2012 at 3:12 pm
UPDATE: The plaintiff in the federal health reform case went bankrupt with unpaid medical bills.
March 11th, 2012 at 9:07 am
That’s a poor example. Her medical bills were only $4,500 according to the article and I am sure that small amount was not what drove her into bankruptcy, there must have been a larger reason and if the article went into her personal financial situation in more detail I bet it would become evident just what the cause of the bankruptcy was. I am confident the cause was not $4,500 in medical bills and attempts to paint her bankruptcy with that as the cause are deceptive.
March 12th, 2012 at 3:24 pm
It is true that her medical expenses were not the sole cause of her bankruptcy. However, her case is a good example of the need for the health reform that she opposes. She chose not to have health insurance, but was unable to pay her own medical costs. Her unpaid medical bills were passed onto the rest of us — Romney would call her a “free rider.”
March 17th, 2012 at 3:43 pm
I think that is an extreme stretch to use this case as an example.
In keeping with the topic, I have heard the CBO has reported that ObamaCare will be far more costly then their original forecast. I only read the headline and not the entire article since I was pressed for time at the time (I’m back on the road… just have a layover this weekend).
March 18th, 2012 at 8:27 am
The cost of health reform has not doubled. Health reform opponents are deceptively cherry-picking cost figures from the new CBO report.
The main thing that has changed in the new CBO report is the 10-year span. Two years ago, they projected costs over the next 10 years. Last week, they projected costs over the next 10 years. The first estimate included the first two years of health reform that had little cost. The second estimate excluded those first two years. As health reform is implemented over several years, the costs naturally increase. Nobody is surprised by that (even the Republicans who are now pretending to be shocked). As the costs increase, they are also offset by revenues and cost savings that exceed those costs.
The new CBO report focused only the costs, not the revenue and cost savings that will also take effect within the same 10-year period:
The CBO still says that health reform will reduce the federal deficit by $210 billion over 10 years.
March 18th, 2012 at 9:35 am
Thanks for giving me the rebuttal. It was not my intention, but I was able to get you to do the research for me so that I could hear the other side of the argument. I do not feel too guilty though, others might benefit from reading your comment as well.
March 19th, 2012 at 5:32 pm
Here are two explanations of how the Supreme Court may reach a majority opinion that health reform is constitutional.
March 19th, 2012 at 10:34 pm
In my opinion, any ruling by the Supreme Court in favor of the individual mandate will be a travesty. There will then be no limits on the power of the federal government to dictate what a citizen must do, not just what they must not do.
You might like that power while you are in power, but what happens when the pendulum swings the other way?
Please consider the consequences. You might get what you wish for and you might live to regret it.
March 20th, 2012 at 3:02 pm
If you had read the two appeal court decisions by conservative judges that ruled health reform constitutional or if you had read the article about how the Supreme Court may rule health reform constitutional, you would have found that any decision would be tailored very narrowly to the unique nature of health care.
Bogus “domino theories” about how this would give the government unlimited power (such as forcing people to eat broccoli) are baseless fear-mongering.
March 23rd, 2012 at 5:38 pm
That is not what I am hearing from experts on NPR. I am hearing opinions there that a ruling in favor of the individual mandate would be breaking new ground and be a major alteration of the social contract between individuals and the federal government. These experts from both sides have looked at the merits of the arguments being made by both sides. Oral arguments are unlikely to be ground breaking and more likely to attempt to buttress written arguments already made.
Once the precedent is set, it will be hard to prevent favorable rulings in favor of the new, broader interpretation of federal power.
Oh, by the way, it seems that both sides are going to be in agreement in arguing that the penalty is not a tax despite your previous arguments that it was.
March 24th, 2012 at 2:06 pm
Here is a brief history of the legal argument against health reform.
When the Supreme Court hears oral arguments on health reform beginning Monday, they have multiple questions to answer.
If the Supreme Court strictly interprets it as a tax, the Anti-Injunction Act will apply and they will punt, delaying any legal challenge until 2015 when the tax takes effect. Health reform will continue to be implemented until then.
The Obama administration will argue that “the penalty for not purchasing insurance derives from the taxing power — but that its designation of the measure as a penalty, and not a tax, means the Tax Anti-Injunction Act ought not apply.”
The next question will be the individual mandate, which may actually be “good for freedom.”
So far, health reform has been remarkably successful.
To the extent there is public opposition to health reform, it is based on ignorance and misinformation. In the words of Jon Gruber (who advised both Romney and Obama):
March 27th, 2012 at 3:29 pm
According to a new survey of former Supreme Court clerks and attorneys that have argued before the court, there is a 35% chance a majority of the Supreme Court will find the individual mandate unconstitutional. We won’t find out until June or July.
Now that oral arguments have been completed, I will make my own prediction: health reform (including the individual mandate) will be ruled constitutional by the Supreme Court 6-3, with Alito, Scalia, and Thomas dissenting.
UPDATE: David Cole concurs with my prediction: 6-3.
March 28th, 2012 at 3:54 pm
Wishful thinking.
Analysis today is how the Supreme Court ruling on sever-ability of the individual mandate is important.
The only decision that matters is whether the individual mandate is constitutional. Caveat: this is dependent on the indications that the Supreme Court will consider the penalty to be a penalty and not a tax.
I am heartened by why my opinion might win the day based on one of the questions Justice Kennedy asked which seems to include my own reasoning. Justice Kennedy asked why such a robbing of personal liberty was necessary if the alternative of single payer was available which could solve the problem without the additional cost of surrendering individual liberty.
My hopes are inflated that Justice Kennedy will rule against the individual mandate. I am less familiar with how someone thinks Justice Roberts would rule that it is. Perhaps he wants his name to be written down in infamy? Infamy is a two edged sword, and it seems it is easier to become famous for bad things then it is for good, with Jesus being the obvious exception.
March 29th, 2012 at 6:51 pm
There are many possible outcomes (and consequences), but most of them are unlikely.
If the penalty is considered a tax subject to to the Anti-Injunction Act, health reform would continue to be implemented until 2015 before any of the other issues could even be litigated. The court had to address the issue just so they could overrule the Virginia appeal court.
You are correct that “the only decision that matters is whether the individual mandate is constitutional.” That depends on Justice Roberts or Justice Kennedy identifying a “limiting principle” that makes health care unique. Such a principle has already been clearly defined by the conservative Appeals Court Judges who have already ruled it constitutional.
If the individual mandate is ruled constitutional, the severability issue is moot. Anyway, the Supreme Court doesn’t want to legislate from the bench by deciding what parts of the law are too intertwined with the individual mandate. They certainly can’t legislate a single-payer system. If pieces are torn out of health reform, Congressional Republicans won’t help mend it.
They won’t touch the Medicare issue, either. None of the lower courts accepted that argument. If they rule against that, it will jeopardize all the federal aid to the states for Medicare, education, and transportation.
If health reform is ruled unconstitutional, will it lead to single-payer? “Not in my lifetime. There just isn’t the political support.” — Tim Jost, Washington and Lee University law professor. Congressional Republicans will not allow an even more “socialist” plan to pass.
April 2nd, 2012 at 9:45 am
I think Justice Kennedy is hinting that he does not see anything in a single payer system that he would find to be unconstitutional. He also seems to be giving clues that he does seem to see potential problems with the individual mandate, and that there is a way for society to solve the problem (single payer) without resorting to the individual mandate.
As for health insurance being interstate commerce, I would argue that it is rather tepid. States regulate the insurance that can be provided in their states. It is up to the states whether or not their citizens can buy health insurance across state lines. It is interesting that one of the Republican solutions to rising health care costs is to change that. They would allow health insurance to be obtained across state lines and making the market much more of an interstate market. It also is not really much of a solution either. Yeah, by going out of state, perhaps you can get lower premiums, but it is almost certainly going to be a case of your getting what you paid for. The reason the premiums will be cheaper is because the coverage is not as good because your state government forces the insurance companies to provide certain protections the other state does not.
I am in favor of single payer and it is my hope is that the individual mandate is found to be unconstitutional. Single payer will be more effective the ObamaCare and the price will not include cost of the sacrifice of individual freedom.
But we do not have to wait too much longer before the Supreme Court makes their ruling, and then we will have to live with what a majority of the justices think.
April 7th, 2012 at 2:04 pm
I’ll stand by my previous prediction of a 6-3 Supreme Court ruling in favor of the constitutionality of health reform.
Your evaluation of the Republican proposal to allow the sale of health insurance across state lines is essentially correct. Such a policy would favor insurance companies headquartered in states with lax oversight, fewest health benefits, and the least consumer protections. States would compete in a rush toward the lowest common denominator. The insurance companies would profit by cherry-picking the healthiest customers, while denying coverage to those who need medical care the most. Instead of the patchwork of regional monopolies and duopolies that we have now, the health insurance market would soon be consolidated to a few national health insurance corporations.
We have discussed this previously: Single-payer is a great solution (and easily constitutional), but it is simply not politically viable. If health reform is ruled unconstitutional (or repealed), there will be no health reform at all. It will not happen in our lifetimes. There is absolutely no way Congressional Republicans would ever allow the passage of true “government-run” “socialized medicine.”
Just as Massachusetts (under Gov. Romney) provided the model for national health reform, an experiment in a state like Vermont (as allowed under the current health reform law) may provide the model for national single-payer. That’s your best hope.
April 7th, 2012 at 4:47 pm
I do not think single payer will work on such a small scale as in Vermont. Sick citizens who need expensive health care will migrate into the state to take advantage of it and it will end up looking like a failure as a result.
You missed my point on the single payer issue as brought up my Justice Kennedy. I take it he thinks that there is a solution other then the great expansion of federal power being grabbed with the individual mandate. The problem CAN BE SOLVED without this great expansion. If society is unwilling to choose that available solution, that is not a problem the Supreme Court needs to address. What the Supreme Court needs to address is it constitutional for the federal government to mandate that an individual must purchase a product, any product, from a private, for profit entity.
I would argue that it really should not even matter if there is a constitutional alternative available, however it seems to matter to Justice Kennedy.
April 8th, 2012 at 7:30 am
California may be the next state to try single-payer. Would that be a big enough scale?
It is not up to the Supreme Court to find a solution. They cannot legislate from the bench. They usually defer to Congress, who has already crafted a solution (however imperfect it may be).
Oral arguments are not always predictive of judicial decisions. However, Justices Roberts and Kennedy both made statements that indicated agreement with the Obama administration’s legal position. I believe both of them will join with the four liberal justices in a 6-3 decision in favor of constitutionality.
April 8th, 2012 at 11:22 am
I agree that they should not legislate from the bench, however liberal appellate judges do not seem to agree since they do so all the time.
Which statements did Roberts and Kennedy make that indicated agreement with the administration’s position?
In a couple months we’ll have the court’s decision.
April 11th, 2012 at 12:02 pm
Justice Roberts recognized the uniqueness of health care in justifying federal intervention:
Justice Kennedy agreed in acknowledging the uniqueness of the subject of health care regulation:
Health reform only needs one out of those two to form a majority in favor of constitutionality. I think both of them will join in a 6-3 decision. For what its worth, David Cole (link above) and Nancy Pelosi both agree with me.
As you say, we will all find out in a few months.
April 11th, 2012 at 5:47 pm
You are cherry picking. Justice Roberts opined that if the government could require a citizen to buy health insurance, the government could use the same reasoning to require a citizen to buy a cell phone.
http://www.politico.com/politico44/2012/03/justice-roberts-can-the-government-make-you-buy-a-118820.html
On your quote from Justice Kennedy you left out the sentence he stated before that:
“And the government tells us that’s because the insurance market is unique. And in the next case, it’ll say the next market is unique.”
I’m getting tired to listening to all these conflicting opinions from constitutional experts. If they are so expert, why aren’t they serving on the Supreme Court? Their opinions and analysis were informative proor to when the arguments were made before the court, but now the arguments have been made and they should just sit back like the rest of us and wait to see how the court rules. This matter is no longer up to the experts unless that expert has a seat in the Supreme Court.
April 12th, 2012 at 6:41 am
Yes, I am cherry-picking. You asked “Which statements did Roberts and Kennedy make that indicated agreement with the administration’s position?” I answered your question. I did not claim that every statement made by Justice Roberts and Justice Kennedy during oral arguments supported health reform.
Here is a full explanation (from the article I linked to previously):
The Supreme Court has always given great deference to Congress, which is accountable to the public. If health care “substantially affects interstate commerce” (which it clearly does) then Congress has the power under the Constitution to enact laws which they deem are “necessary and proper” to effectively regulate it.
You are correct that it isn’t up to the experts — it never was. The Supreme Court has sole responsibility for determining whether or not health reform is constitutional. That doesn’t mean we can’t talk about it.
I stand by my prediction that they will rule in favor of constitutionality 6-3.
April 12th, 2012 at 7:30 pm
Well, I am not going to make my arguments again. People who make their living arguing Constitutional law put their best case in front of the Supreme Court and now the only thing left is to wait on the result.
I will state, however, if the Supreme Court shows deference towards a populist elected Congress when judging whether laws are constitutional or not, they are not living up to their responsibilities. Their job is not to stick their finger in the wind and figure out what is popular, their job is to look at the law and examine whether or not it is constitutional. What is written in the constitution should be what matters to them, period. If what is proposed is that popular, then there is a method to change the constitution so that it can become the law of the land, and that is through an amendment to the constitution.
April 15th, 2012 at 6:04 am
There is no need to amend the Constitution. Health reform is clearly constitutional under the “commerce,” “necessary and proper,” and “taxation” clauses. Only a right-wing politically-activist Supreme Court would overturn 70 years of precedent.
April 16th, 2012 at 8:33 pm
In my common man opinion, I have heard the arguments of the experts and find the precedence argument justifying the individual mandate weak. In my opinion, the best precedence sighted (a farmer can not grow wheat on his own farm for his own consumption if the government says he can’t) was wrongly decided and should be overturned. But even that precedence only stated what he was not allowed to grow it, it did not then further mandate just how much wheat he must purchase from the market after he was prevented from growing it for himself.
Not all precedence is sacred or else we would still be living with the Dred Scott.
I will note that nobody questions where the 4 liberal justices are going to be on this issue. They are going to rule ideologically pure and that is unquestioned. The original rules be damned as far as they are concerned as long as they have the power to change what the written rules mean.
April 17th, 2012 at 3:48 pm
I will note that nobody questions where the 3 ultra-conservative justices are going to be on this issue. They are going to rule ideologically pure and that is unquestioned. The original rules be damned as far as they are concerned as long as they have the power to change what the written rules mean.
Justices Alito and Scalia will have to overrule their own rulings which previously asserted broad Congressional power under the “commerce” and “necessary and proper” clauses.
According to Justice Scalia, an individual growing marijuana for his own personal use “substantially affects interstate commerce” and is therefore subject to federal regulation under the Constitution, but health care (one sixth of the economy, adversely impacting every business in the country, denying health coverage to millions of Americans, and shifting billions of dollars onto the rest of us) does not “substantially affect interstate commerce?”
April 17th, 2012 at 6:36 pm
David,
Please note you reinforce my argument. Many of the votes of these conservative justices are in play. The votes that are not in play are the liberal ones. Those liberals in the Supreme Court place no value on the individual liberties guaranteed by the Constitution.
To those liberal justices, it does not matter what is written, it only matters how they interpret it. All the liberals agree that the original intent of that which was written really doesn’t matter. I disagree. The method to change the rules is through amendments to the Constitution, not through ridiculous Supreme Court interpretations of what the Constitution allows.
April 18th, 2012 at 4:09 pm
I refute your argument. Judging by oral arguments, the only votes that are definitely not in play are the ultra-conservatives (Alito, Scalia, and Thomas). To those three justices, it does not matter what is written (even if it was written by themselves in their own prior decisions), it only matters how they interpret it for political ends.
The four liberal justices and two moderate justices will interpret the Constitution based on the enumerated powers of Congress (specifically, to regulate interstate commerce by necessary and proper means) as well as decades of Supreme Court precedent regarding those principles.
You apparently disagree with the Constitution, which gives the Supreme Court the power to interpret what the Constitution allows.
Specifically, what individual liberties guaranteed by the Constitution are threatened by the individual mandate? The right to die without adequate health care?
There is no law in effect today that requires you to have health insurance. You freely choose to obtain it. In 2014, when the individual mandate will take effect, it will have absolutely no effect on you at all. You will still have the same health insurance that you had the day before. How will the individual mandate threaten your individual liberty?
April 19th, 2012 at 11:30 am
If you can not understand how individual liberties are threatened by granting the federal government the power to mandate you must purchase a product or service from a for profit entity, then I guess I am at a loss on how to even begin to explain it to you. You are fixated on that the ends justifies the means, and because you like the result this time, fail to see how it could cause things to happen to you in the future that you will not like, but the precedent will have been made.
April 19th, 2012 at 6:34 pm
Explain it to me. How will the individual mandate affect you personally (if at all)? In 2014, will you be forced to purchase health insurance?
I’m taking this line of reasoning to the front page.
April 24th, 2012 at 3:43 pm
No, I will not be personally impacted. ObamaCare could have impacted my coverage but active duty military and retirees were given a special exemption. I will answer you front page article more fully there.
April 25th, 2012 at 5:52 am
So, the individual mandate will not affect your “individual liberties” at all.
April 28th, 2012 at 11:23 am
Not quite true, it will not affect MY individual liberties directly, but I could point to an actual example where somebody in my family would have been affected. He made the personal choice to go uninsured and take the risk. He was aware of the risks he was taking, he is not stupid, and he made the choice for the short term. I used past tense for him because if he is not already covered, he should soon have handsome health care coverage through an employer if he does not already.
However indirectly, my personal liberties are threatened. If the individual mandate is found to be constitutional, the precedent will have been established that it is legal for the government to mandate I must purchase a product or service from a for profit entity. If you do not understand why I think this would be a horrible precedent, I can go further into this, however I find it hard to understand how you fail to see this would be a horrendous outcome. I keep thinking that you value affordable health care for all you are blinded into thinking that the ends justifies the means and fail to see the true costs and the risks of what could happen as a result of the precedent if it is established.
April 29th, 2012 at 4:49 am
The health reform law will not affect your individual liberties at all, but you oppose it because you fear that some other imaginary future law might threaten your individual liberties.
Let’s delve deeper into the case of your family member. Why did he make the personal choice to go uninsured? Was he denied coverage due to a preexisting medical condition? Was it because buying health insurance on the individual market was too expensive? Would he have chosen to remain uninsured if he could select from a variety of affordable plans in a health exchange? Would he have chosen to obtain health insurance if it was partially subsidized?
April 29th, 2012 at 10:06 am
Yes, and it seems like Justice Kennedy, at least, shares my imagination. If you do not see the risk then I guess you do not have much of an imagination.
It was because in his mind it was too expensive and ObamaCare will do nothing to make it more affordable for him, he would only be forced to buy coverage whether he wanted to or not. I believe he makes too much income to qualify for proposed subsidies. He is young and healthy and preferred to pay for what little medical care he needed out of pocket. I recommended to him that he at least purchase a major medical plan which would kick in only in the event of a major medical problem, but he decided against even that.
April 29th, 2012 at 11:06 am
It remains to be seen how Justice Kennedy will rule.
Under health reform, your relative would have the opportunity to select from a variety of affordable health plans, from catastrophic plans designed specifically for young and healthy people (which would kick in only in the event of a major medical problem) or higher level plans. Under health reform, he would not be “forced to buy coverage.” He is free to choose to remain uninsured by paying a modest tax to cover the cost to the rest of us in the event that he incurs a major medical problem. As it is now, he has chosen to enroll in employer-provided coverage and will not be affected by the individual mandate.
April 29th, 2012 at 11:16 am
Yup, and the federal government also already had the power to tax me as a smoker to pay for SCHIP health care coverage for low income children as if those children smoked or something.
Once the power to PENALIZE a nonparticipant the power will be there to increase the PENALTY for not participating. How high will the penalty be in the future? Who knows? I’d bet the penalty increase will beat the rate of inflation.
April 30th, 2012 at 10:01 am
So, you are standing up for someone else’s constitutional right not to be taxed? I must have missed that one in the Bill of Rights.
Yes, the federal government already has the power to tax smokers to pay for SCHIP. At least both are health-related. Children’s health is adversely affected by second-hand smoke. Some taxes have no relationship at all to what they are funding. The power of Congress to institute taxes is very broad.
Everyone participates in the health care market eventually. It is inevitable (unless you know someone who is invincible). Under health reform, millions of Americans who would very much like to choose to be insured but were previously unable to do so will finally be given that opportunity. Those who still choose to remain uninsured (for whatever unfathonable reason) will still be free to make that choice by paying a tax to cover the cost of their uninsured medical care to the rest of us.
Under the health reform law, the amount of the tax penalty is indexed to inflation after 2016. It can’t “beat the rate of inflation.”
May 4th, 2012 at 5:52 pm
And it is easy to change laws. Look how easy it was to change the tax on tobacco.
I am standing against the federal government’s right to mandate that any individual, including myself, can be forced to purchase a private product or service from a private market. It does not matter if even a small minority is impacted by the will of the majority, or if I agree with the goal of the mandate or not, I do not trust the government with such power. States might possess such power already, but I can avoid living in states like California where I think the government is out of control. In fact, I choose to no longer even travel in California. I intentionally left California off the list of states which my trucking company has authority to operate. The way things are going, I may have to rethink that though. California is so out of control that many, many truckers are refusing to go there. When the freight rates get high enough, I will change my mind. I am to trucking what prostitutes are to sex, I’ll do anything if you pay me enough.
May 6th, 2012 at 7:28 am
Health reform will provide health coverage for millions of Americans, protect consumers from industry abuses, improve the quality of medical care, and help reduce costs. It does not force anyone to purchase a private product or service from a private market. The small minority that may be affected by the individual mandate and who choose not to be insured may choose to pay the tax penalty instead. It does not threaten anyone’s constitutional rights. You oppose some other unknown future law.
May 6th, 2012 at 8:53 am
It forces people to either purchase medical care coverage from the private market or pay a penalty. I do not just oppose the future laws, I oppose the individual mandate. I support limited single payer. All the benefits of ObamaCare can be better achieved that way without the sacrifice of individual liberties.
May 6th, 2012 at 9:22 am
Nobody is forced purchase medical care coverage from the private market. They may choose to pay a tax to offset the cost of providing medical care to uninsured people. You seem to agree with the Tea Party that that paying taxes is a “sacrifice of individual liberties.”
May 7th, 2012 at 5:49 pm
You keep insisting it is a tax. If it is a tax, then the Supreme Court can not rule on it. It is a PENALTY.
Perhaps I agree with some members of the Tea Party on this. Just because the Tea Party is in agreement does not mean I must automatically be against it. A stopped clock is right twice a day. When we look at our watches, we might disagree on just who’s clock is stopped on this issue.
May 8th, 2012 at 8:03 am
Maybe the Obama administration should have argued that it is a tax. The Constitution grants Congress very broad powers of taxation. They must have been very confident that they had a good case on all the other constitutional issues and wanted them to be resolved once and for all now instead of being accused of delaying tactics.
The Supreme Court had to appoint a third-party attorney to argue the point so that they could directly address the Virginia appeal court decision. The attorney argued that the tax penalty “falls within the ordinary meaning of ‘tax’ because it is codified in the [Tax] Code, calculated as part of the taxpayer’s federal income tax liability, assessed and collected by the IRS, and paid into the federal government’s general revenues.” That certainly sounds like a tax to me.
If his argument prevails, health reform would continue to be implemented and the legal challenges would be kicked down the road until 2015, after the tax penalty is accessed.
However, the Supreme Court is likely to rule that the primary purpose of the tax penalty is not to raise revenue and therefore it is not subject to to the Tax Anti-Injunction Act.
Almost nobody will be affected by the individual mandate. There are only two small groups of people who might voluntarily choose not to obtain health insurance:
1) Wealthy individuals who can afford to self-insure and just don’t like paying their fair share of taxes; and
2) Those who irrationally believe themselves to be invincible or are just willing to pass the cost of their inevitable medical care onto the rest of us (Romney used to call them “free riders”).
You are defending their “individual liberty” to avoid personal responsibility by not paying the tax penalty.
May 11th, 2012 at 10:29 am
The primary purpose is to penalize those who do not conform. That makes it a penalty.
I am not wanting to avoid personal responsibility at all. I am just fearful of how increasing the powers of the federal government might mushroom into something greater. The federal government already possesses the power to tax me for smoking by making me pay a buck a pack tax on cigarettes. The anti-smoking lobby is upset that I will still continue smoking despite the tax. I do not want the citizens of New England and California mandating that I must also pay a penalty for smoking over and above the tax.
We have seen what the government will do with established precedents. I am fearful of what the government will do with the new powers given to them by a precedent that the individual mandate is constitutional. With the precedent, they can not only tax, they can penalize any behavior the majority of citizens thinks needs to be penalized.
May 12th, 2012 at 2:11 pm
Congress already has the power to use tax incentives and tax penalties to achieve various public policies.
Health reform has absolutely no effect on your individual liberties, but you fear some imaginary future law which might.
May 14th, 2012 at 3:21 pm
David Campbell started out:
“Congress already has the power…”.
We’ll have to wait and see what the Supreme Court decides on that. The arguments have been made, and now we need only wait on the results. It is my hope that the Supreme Court decides the individual mandate is a step too far, however if they rule otherwise, we all will have to live with that decision. I am going to add that this will be a terrible decision if it is ruled constitutional, and I will then start arguing for the need for a Constitutional Amendment to keep the individual mandate the exception and not the new rule. There might not be a lot of chance of getting that amendment, but it is going to be our only lawful chance and that is what I am going to argue for.
May 15th, 2012 at 4:50 am
Read the rest of the sentence. I was addressing the broader issue that you raised about how taxes are often used to incentivize (ex. college education; homeownership) or penalize (ex. smoking; failure to take personal responsibility for their own health insurance and passing along $43 billion per year in health care expenses to the rest of us).
As you say, the Supreme Court will rule soon. I’m standing by my previous prediction of a 6-3 decison is favor of constitutionality. President Obama will be reelected. Health reform will be fully implemented. Most people will realize that most of the bad things that health reform opponents have been saying about it are false and they will begin appreciating the value of it. Nobody’s indvidual liberties will be taken away. Ten years from now, people will wonder what all the fuss was about.
May 15th, 2012 at 12:42 pm
My individual will be taken away in the future if the individual mandate is found to be constitutional. Just like the already existing power to tax is used to wrestle away my choice of whether or not I want to smoke.
The problem with the costs to “all of us” is a problem caused by “all of us” in that we could just as easily turn away those without health care coverage. The individual mandate is a solution to problem CAUSED. The better answer is limited socialized medicine. I am not willing to surrender my freedoms when a better alternative is available if only the majority will agree.
May 16th, 2012 at 6:10 am
You don’t have a “choice of whether or not you want to smoke?” I didn’t realize that the constitutional right to smoke enshrined in the Bill of Rights had already been taken away from you. Try taking that to the Supreme Court.
You admit that the health reform law itself doesn’t take away your individual liberties but imagine that in some unknown way they might “be taken away in the future.”
You are defending the rights of a small number of individuals to refuse to take personal responsibility for their own health insurance and to pass along the cost of their health care onto you.
Apparently, the only two alternatives that are acceptable to you are:
a) “Turn away those without health care coverage” and let them die outside the emergency room;
OR
b) “limited socialized medicine.”
Some Republicans are actually on record as favoring alternative “a” and would repeal the law signed by President Reagan.
Some Democrats (including me) agree with you that alternative “b” is a “better answer.” However, it is unrealistic to expect that “the majority will agree.” The House Republican majority has unanimously voted to dismantle the “limited socialized medicine” that we currently have (Medicare and Medicaid).
Enacting national universal “socialized medicine” would require a Democratic president, a Democratic majority in the House, and a two-thirds Democratic majority in the Senate — and most of those Democrats would need to be more liberal than most of those who currently hold office (including President Obama). (They would certainly need to be much more liberal than the Blue Dog Democrats that you support or that you even think are electable.) Although I would be quite pleased with such a progressive government, I have no illusions that it is remotely possible.
Meanwhile, each year that you are willing to wait for those impossible conditions to occur, 45,000 Americans would die due to lack of health insurance (even without turning them away from the ER).
As we have discussed previously, our best hope for the eventual adoption of “socialized medicine” may be the demonstrated success of state experiments that are encouraged by the current health reform law.
May 16th, 2012 at 3:34 pm
As for smoking, I am fearful that just as the power to tax causes the majority who do not to smoke to force minority who do smoke to alone pay for the costs of medical care for poor children that the power of the “individual mandate” will thus too be abused.
The rest of your argument is dependent upon your understanding of that concern.
If it takes time to do the job right, then I am in favor of spending the time. The time spent will be well spent because if the individual mandate is found to be unconstitutional it is a CERTAINTY that some form of socialized medicine will be the outcome in the long run. It might cost us time to get to this better result, but we will not have paid the sacrifice of individual liberties in the meantime to put a bandaid on the problem.
May 16th, 2012 at 3:48 pm
Hey, and I am going to double post. What I am in favor of is rationing. Only that amount of medical care will be provided that the majority of citizens are willing to pay for. The more they are willing to pay for, the more that will be provided. But you want better coverage? You do not want to wait in lines? Well pay for the extra costs yourself or obtain supplemental coverage that pays for the increased costs.
May 16th, 2012 at 4:42 pm
You are willing to sacrifice 45,000 American lives per year for who knows how many decades until there is a progressive government (if ever) in order to protect individual liberties that you cannot even identify.
I am not in favor of selling health care to the highest bidder.
I am in favor of “rationing” medical care on the basis of effectiveness. I am in favor of eliminating payment for redundant, ineffective, or harmful medical care. That’s one of the things health reform will do.
May 16th, 2012 at 4:54 pm
I guess I am just selfish. I am unwilling to pay the cost of the sacrifice of individual liberties when a better outcome can be obtained cheaper. As far as I know, 45,000 more lives will not be saved if my plan is adopted. I thought those 45,000 were already going to the emergency room and their costs being paid for by us anyway.
May 17th, 2012 at 4:20 am
You get to keep your taxpayer-paid government-run health insurance regardless what happens. You will not be “paying the cost of the sacrifice of individual liberties” (whatever they are) because the individual mandate will not affect you (or most people) at all. Those 45,000 lives are being lost every year despite the $43 billion per year we are spending for inefficient emergency room treatment of the uninsured. It may be true that those lives would be saved if your plan is adopted, but your plan will not be adopted.
You do understand the politics, don’t you? Single-payer “socialized medicine” is considered to be too extreme even for our Democratic president and most of the current Democratic members of Congress (particularly the moderate Blue Dog Democrats that you favor). According to you, the progressives that would pass your plan are unelectable. Republicans currently hold a majority in the House and filibuster power in the Senate. They don’t want to expand government involvement in health care, they want to eliminate it. By what possible mechanism do you imagine they would pass “socialized medicine?” It is a fantasy.
The current health reform law isn’t the best possible solution, but its the only one we’ve got. It will increase access to health care, improve medical quality, and reduce cost, without limiting anyone’s constitutional rights.
May 17th, 2012 at 1:54 pm
You keep avoiding the fact that due to ability of the federal government to tax, I as smoker am required to pay over a buck a pack taxes. The anti-smoker lobby is powerful, and I fear that once the individual mandate is found constitutional I will also be face with paying a penalty.
I might be reassured if this new found penalty power would be wielded to force all male homosexual practitioners to pay a penalty for paying a penalty. Their conduct as a majority costs society serious money. If the tyranny of weighing against individual liberty was equally used to smite down the conduct of undesirable conduct I might not have so many concerns. But male homosexual conduct is excused and smoking needs to be penalized.
Cancer from smoking does not threaten the survival of our species. Tolerance of male sex with male spread sexually transmitted diseases does. Get your priorities straight.
May 18th, 2012 at 5:31 am
You oppose health reform because you are afraid it might lead to higher cigarette taxes?
You think there should be a tax penalty for being gay?
You don’t think that would be a violation of individual liberties?
If you really believe such a law makes sense, I suggest you write your Congressman (Rep. Forbes and Rep. Rigell would probably co-sponsor it). It probably couldn’t be passed at the federal level, but I am absolutely certain there are state legislators who agree with you. For example, Del. Bob Marshall recently said “sodomy is not a civil right.”
May 18th, 2012 at 9:49 am
You want to tax my cigarettes to pay to health care for low income children while you pay nothing? Don’t you think that is violation of my civil liberties? After all, no underage low income children live in my household (nor any underaged children at all), I am not allowed to smoke in enclosed public places so if you do not want to be exposed to 2nd hand smoke just stay out of my house, so I do not understand why I and fellow smokers like me should be forced to pay for the costs of SCHIP alone. If the majority are in favor of SCHIP, then EVERYONE should chip in.
No, it does not make sense to me to tax people for being gay. I am just making the point that if you are in favor of the unreasonable tax on cigarettes, then you should be in favor of an unreasonable tax on gays. After all, under ObamaCare, health insurance companies will already be allowed to charge higher premiums on only two things: age and whether you smoke. Smokers are already going to pay more (gays will not unless they smoke or are elderly) so why are we singled out with continuing to have to pay for SCHIP by ourselves?
But you and the majority are just fine with my paying for it just as long as you do not have to pay. Well this kind of tyranny is what I fear from an expansion of federal power to where the federal government can penalize a private citizen for not purchasing a product or service from a private, for profit organization.
There is a better option available and it is called single payer. If it can not be enacted, then oh well, too bad, I am in favor of it and when the majority get around to supporting it I will be voting with them.
May 18th, 2012 at 11:39 am
No children live in your house, so why should you pay taxes for public education?
We are finally getting down to your real reason for opposing health reform. You are defending your Constitutional right to cheap cigarettes. Does that fall under freedom of speech or freedom of religion?
You still haven’t described the political process for enacting single payer. When the Tea Party becomes socialist? When pigs fly?
May 18th, 2012 at 1:04 pm
Ah, but us smokers aren’t the only ones paying for public education alone. At least not yet.
I describe the outrageous tax on cigarettes as an injustice. It is the tyranny of the majority against the minority. It is because of people like you being willing to live with such an injustice that I fear giving the federal government any more power then they already have.
May 18th, 2012 at 1:16 pm
Personally I think non-smokers should be the only ones having to pay for public education. It would make about as much sense as forcing smokers alone to pay for health care coverage for low income children. We have got to find some way to get non-smokers to pay their fair share, and this would be one way to do it.