The Politics of Health Care

[JDN]

It's a pity you are not in LA or I'm not in MN.  I honestly think we would agree on most points, but somehow we seem to miscommunicate.  A game of golf, a sail, or a beer might mend fences.

I tried to point out to answer your question that most of the free world has a national health care plan (central control) AND better results than our free market plan.

I tried to indirectly point out, without going through the legal arguments again (see forum for a detailed analysis) as to why a national health care plan is constitutional.  I mean good grief,
my Dad is covered by Medicare; what is that other than a national health care plan?  And Social Security?

And I tried to point out that we have a two tiered health care system; one for the haves and one for the have nots.  The quality of care is dramatically different.  I can give you personal examples;
when they thought I didn't have insurance (I was semi conscious) after being hit by a car AND when they mixed up the paperwork and said I was "fine" but actually I had acute meningitis.  After they figured out
I had good insurance and some money, I got first class treatment.  But is that right?  IMHO the answer is a resounding NO. 

[G M]

I tried to point out to answer your question that most of the free world has a national health care plan (central control) horrific wait times, horric service and crushing debt AND better results than glides on the innovation and progress of our free market plan.

Fixed it for you!

[G M]

my Dad is covered by Medicare; what is that other than a national health care plan?  And Social Security?

They are broke. We can't afford them, much less a new "entitlement". Wishing and pretending won't make this truth go away.

[G M]

http://blogs.the-american-interest.com/wrm/2012/03/10/50-of-uk-nursing-home-patients-abused-by-government-health-care/

50% of UK Nursing Home Patients Abused By Government Health Care


Fans of government health care keep telling us that government can do the job, and they point to countries like the UK as examples where single payer, government run health care systems deliver high quality, compassionate care.
 
They are either grossly ignorant or they are lying through their teeth.
 
A recent study by a British healthcare regulator finds that half of all elderly people in Britain’s nursing homes are being denied basic health services.
 
Half.
 
Some older people were forced to wait months for a doctor or nurse to treat simple health problems. No doubt they were waiting for the Bureau of Bedsore Management to review the proper procedures before issuing a bandage-changing permit.
 
Over the polite grumbling of many advocacy groups, the British Parliament can be faintly heard tinkering away at some far overdue legislation. No doubt the grannies will get some relief just as soon as the House of Commons passes some new laws, the House of Lords (whoever they have there now that they have chased the actual, you know, Lords out of it) sagaciously tinkers with it, the Queen signs it, the bureaucrats get all the regulations nicely written, and the memos and administrative procedures get delivered to the proper offices.
 
Of course, the National Health Care service has been around since the 1940s and somehow these lingering little problems haven’t quite been cleared up yet.  It’s obviously just a question of getting the right regulations in place and any century now the system will by running like a fine tuned machine and there won’t be any problems at all.

[ccp]

"jornolister":

Here is what I mean about Fareed Zakaria who meets with Obama regularly to coordinate the framework of his shows with the agenda of the WH.   If I hear him ask one more guest, "don't you think Obama is right?",  or exclaim "you know it is true [what the wh says], give another lecture about the glories of whatever the WH policy is on whatever the topic du jour is:

http://www.forbes.com/sites/aroy/2012/03/19/fareed-zakarias-puzzling-take-on-health-care-in-britain-taiwan-and-switzerland/

[Crafty_Dog]

By RON JOHNSON
One year after the passage of ObamaCare, this paper published an op-ed I wrote ("ObamaCare and Carey's Heart") about how America's health-care system saved my daughter's life, and describing how implementing this law will limit innovation, lead to rationing, and lower the quality of care. Now, two years out, I would like to focus on the budgetary disaster.

As a candidate, Barack Obama repeatedly claimed that his health-care plan would lower annual family health-insurance premiums by $2,500 before the end of his first term as president. But the Kaiser Family Foundation recently reported that the average family premium has increased $2,200 since the start of this administration.

Then there is the higher cost to taxpayers. The CBO's initial estimate in March 2010 of ObamaCare's budget impact showed it saving money, reducing the federal deficit by $143 billion in the first 10 years. But that positive estimate was largely the product of gimmicks inserted into the bill by Democratic leaders to hide the law's true cost.

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 .Sure enough, the administration last October announced it would not implement one of those gimmicks, a long-term care program called the Class Act, because it was financially unworkable. The loss of the premiums that would be collected to finance the Class Act wiped out $70 billion of the supposed deficit reduction projected by CBO. And last month the administration's proposed fiscal 2013 budget included $111 billion in additional spending for the premium subsidies in the health law's insurance exchanges—further eroding any confidence in the original ObamaCare projections.

This would not be the first time a government program exceeded its projected cost. When Medicare was passed in 1965, for example, the federal government estimated it would cost $12 billion in 1990. Medicare actually cost $110 billion in 1990.

In the case of ObamaCare, one of the principal sources of the lowball estimate used to justify the law is related to the insurance exchanges. The CBO originally estimated that one million Americans would lose their employer-sponsored care and be forced into the exchanges.

But a McKinsey & Co. study in June 2011 showed that 30%-50% of employers plan to stop offering health insurance to their employees once the health law is implemented in 2014. Last week the CBO breezily dismissed this and other studies on the ground that "it is doubtful that any survey conducted today could provide very accurate predictions of employers' future decisions."

As someone who purchased group health insurance for over 31 years, I fully understand why the McKinsey study is more credible than the CBO.

Why? Because the decision employers face under ObamaCare is straightforward: Do they pay $20,000 per year for family coverage, or do they pay the $2,000 penalty to the government?

It is not as if dropping health coverage will expose their employees to financial risk. They will thereby make employees eligible for huge subsidies in the health-care exchanges—$10,000 if their household income is $64,000 per year. In a competitive environment, ObamaCare provides the incentive for employers to drop coverage.

According to the CBO, 154 million Americans are covered under employer-sponsored plans. What would be the cost to taxpayers if 50% of those individuals lost their coverage and became eligible for subsidies? The answer is difficult to calculate, but CBO's answer is basically: Don't worry, revenues will increase automatically to cover those costs (for example, employees' taxable incomes will increase when they lose employer-provided coverage).

In reality, as government assumes a greater share of health-care costs, pressure to cut payments to providers will be enormous. Reduced government reimbursements to providers will cause massive cost-shifting to those remaining in the private health-insurance market. More employees will lose coverage. Before long, we will have what the left has long sought—a single payer health-care system modeled after Medicaid.

In recent testimony before the Senate Appropriations Committee, Health and Human Services Secretary Kathleen Sebelius told me that America's health insurance system is in a "death spiral." She failed to acknowledge that implementation of ObamaCare will be the cause of that death spiral, and American taxpayers will be left to pick up the tab.

In a June 2009 speech to the American Medical Association, Mr. Obama promised: "If you like your health-care plan, you'll be able to keep your health-care plan. Period. No one will take it away, no matter what." I'm not sure what you would call that statement, but whatever you call it, it was a doozy.

Mr. Johnson, a Republican, is a senator from Wisconsin.

A version of this article appeared Mar. 20, 2012, on page A11 in some U.S. editions of The Wall Street Journal, with the headline: ObamaCare's Costs Are Soaring.

[Crafty_Dog]

Well, this sounds pretty inconvenient for the unconstitutional argument , , ,

http://www.forbes.com/sites/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/

[G M]

Well, this sounds pretty inconvenient for the unconstitutional argument , , ,

http://www.forbes.com/sites/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/

Obviously it's constitutional to make everyone in America work as a sailor. 

[DougMacG]

Yes, an interesting mandate.  Seems to me the distinction GM points out is noteworthy.  There is no mandate to participate in that kind of commerce, but if you do you must participate in the cost.

Obama-care mandates that if you exist, you must purchase this product.  The income tax code comes close except that a constitutional amendment specifically authorizing it was required.  Certainly without the amendment our tax code is unconstitutional.

The Obama administration argued in it's passage that Obamacare is not a tax and argued in its constitutionality that it is.

The closest precedent for the individual mandate was the internment mandate of Japanese-American imposed by the FDR administration. http://www.u-s-history.com/pages/h1662.html  By merely existing a mandate was placed on you.  As is the case now, it was really in their own best interest: http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=323&invol=214

[Crafty_Dog]

By DAVID B. RIVKIN JR. AND LEE A. CASEY
On Monday, the Supreme Court will begin an extraordinary three-day hearing on the constitutionality of ObamaCare. At stake are the Constitution's structural guarantees of individual liberty, which limit governmental power and ensure political accountability by dividing that power between federal and state authorities. Upholding ObamaCare would destroy this dual-sovereignty system, the most distinctive feature of American constitutionalism.

ObamaCare mandates that every American, with a few narrow exceptions, have a congressionally defined minimum level of health-insurance coverage. Noncompliance brings a substantial monetary penalty. The ultimate purpose of this "individual mandate" is to force young and healthy middle-class workers to subsidize those who need more coverage.

Congress could have achieved this wealth transfer in perfectly constitutional ways. It could simply have imposed new taxes to pay for a national health system. But that would have come with a huge political price tag that neither Congress nor the president was prepared to pay.

Instead, Congress adopted the individual mandate, invoking its power to regulate interstate commerce. The uninsured, it reasoned, still use health services (for which some do not pay) and therefore have an impact on commerce, which Congress can regulate.

Congress's reliance on the Commerce Clause to support the individual mandate was politically expedient but constitutionally deficient. Congress's power to regulate interstate commerce is broad but not limitless.

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 .First among the limits is the very nature of congressional authority, which is based on specifically enumerated powers. As the Supreme Court has consistently acknowledged, the Constitution denies the federal government the type of broad public health and welfare regulatory authority known as a "general police power," which is reserved exclusively to the states. The court has also repeatedly held that preservation of this division between federal and state authority is a matter for supervision by the courts, and its precedents make clear that congressional Commerce Clause regulation must be subject to some judicially enforceable limiting principle.

The defining characteristic of a general police power is the states' ability to regulate people simply as people, regardless of an individual's activities or interaction with goods or services that might themselves be subject to regulation. Thus, the Supreme Court has ruled that states, exercising their general police power, can require all resident adults to obtain a smallpox vaccination. Only this type of authority could support ObamaCare's individual mandate, which applies to all Americans as such, regardless of any goods they may buy or own, or any activities in which they might choose to engage.

Congress has crossed a fundamental constitutional line. Neither the fact that every individual has some discernible impact on the economy, nor that virtually everyone will at some point in time use health-care services, is a sufficient basis for federal regulation. Both of these arguments, advanced by ObamaCare's defenders, are flawed because they admit no judicially enforceable limiting principle marking the outer bounds of federal authority.

On the left and right, legal thinkers too often forget that Congress has no constitutional power simply to regulate the economy. Rather, that power comes from a series of discrete authorities—to regulate interstate and foreign commerce, to tax, spend and borrow, to coin money and fix its value and so forth—that together allow it broad control over the nation's economic affairs. As a result, congressional efforts to address national problems may well be less economically efficient than would a more straightforward exercise of police power. The Constitution subordinates efficiency to guarantee liberty.

The Constitution divides governmental power between federal and state governments so that one may check the other. This requires that the electorate be able to tell, especially on Election Day, which government is responsible for which policies and regulations with which we live.

As Justice Anthony Kennedy explained in one leading Commerce Clause case, United States v. Lopez (1995): "The theory that two governments accord more liberty than one [emphasis added] requires for its realization two distinct and discernible lines of political accountability: one between the citizens and the Federal Government; the second between the citizens and the States." Congress's use of its commerce power in passing ObamaCare eradicates those "discernible lines of political accountability."

Even so, Congress's enumerated powers support a vast and ever growing regulatory state, much of it based upon the Commerce Clause. Neither that Leviathan, nor the Supreme Court's precedents upholding it, is now at issue.

Justice Antonin Scalia explained in another of the Supreme Court's recent Commerce Clause cases, Gonzales v. Raich (2005), that the power to regulate interstate commerce, especially in conjunction with the power "to make all laws which shall be necessary and proper [emphasis added] for carrying into execution" its enumerated powers, gives Congress broad authority to reach even local and non-commercial activities when necessary to make legitimate regulatory schemes effective. Raich upheld federal control of purely local cultivation, sale and use of marijuana, and it is often incorrectly cited as support for the individual mandate.

Related Video
 Wisconsin Senator Ron Johnson on how ObamaCare will ratchet up health-care costs.
.
.But the Necessary and Proper Clause does not guarantee Congress whatever power it would like to reach its policy goals. That provision supports only otherwise legitimate exercises of Congress's enumerated powers. So under the Commerce Clause, Congress can try to achieve universal coverage through regulating the interstate health-care insurance market, as ObamaCare does, by requiring insurance companies operating in that market to cover pre-existing conditions. Then under the Necessary and Proper clause, Congress could also require employers to collect data on pre-existing conditions from new hires so insurers can better plan.

Requiring all Americans to have health insurance may well create a new revenue stream for insurance companies so as to lessen these new burdens on them, but it does nothing to make these new coverage requirements effective regulations of interstate commerce as the Supreme Court uses that term. In particular, the individual mandate does not prevent avoidance or evasion of these new insurance regulations. Nor does it make compliance easier to police, as was the case in Raich. There, the ability to regulate local marijuana production and use was necessary to make its interstate regulation effective because, as Justice Scalia noted, the homegrown variety "is never more than an instant from the interstate market."

Unlike the regulations at issue in Raich, the individual mandate applies regardless of anyone's interaction with a commodity, service or other activity, like the interstate sale or transport of marijuana, that Congress can legitimately regulate. Put another way, the Controlled Substances Act is about the regulation of drugs, not people. It affects individuals only to the extent that they interact with the substances it proscribes, and it can be avoided by simply avoiding those substances.

Americans cannot escape the individual mandate by any means because it regulates them as people, simply because they are alive and here. That requires police power authority. Permitting Congress to exercise that authority—however important its ultimate goal—is not constitutionally proper and would forever warp the federal-state division of authority.

Messrs. Rivkin and Casey are lawyers who served in the Justice Department during the Reagan and George H. W. Bush administrations. They represented the 26 states in their challenge to ObamaCare before the trial and appellate courts.

A version of this article appeared Mar. 22, 2012, on page A15 in some U.S. editions of The Wall Street Journal, with the headline: The Supreme Court Weighs ObamaCare.

[DougMacG]

"The individual mandate is incompatible with centuries of contract law. This is so because a compulsory contract is an oxymoron."

http://www.washingtonpost.com/opinions/obamacares-rewriting-of-contract-law/2012/03/23/gIQAVuFmWS_story.html

George F. Will
    Opinion Writer

Obamacare’s contract problem

View Photo Gallery —  Both supporters and opponents of the Affordable Care Act are organizing efforts to raise support for their respective sides when the Supreme Court hears oral arguments on the health-care law in late March.

By George F. Will,

On Monday the Supreme Court begins three days of oral arguments concerning possible — actually, probable and various — constitutional infirmities in Obamacare. The justices have received many amicus briefs, one of which merits special attention because of the elegant scholarship and logic with which it addresses an issue that has not been as central to the debate as it should be.

Hitherto, most attention has been given to whether Congress, under its constitutional power to regulate interstate commerce, may coerce individuals into engaging in commerce by buying health insurance. Now the Institute for Justice (IJ), a libertarian public interest law firm, has focused on this fact: The individual mandate is incompatible with centuries of contract law. This is so because a compulsory contract is an oxymoron.

The brief, the primary authors of which are the IJ’s Elizabeth Price Foley and Steve Simpson, says that Obamacare is the first time Congress has used its power to regulate commerce to produce a law “from which there is no escape.” And “coercing commercial transactions” — compelling individuals to sign contracts with insurance companies — “is antithetical to the foundational principle of mutual assent that permeated the common law of contracts at the time of the founding and continues to do so today.”

In 1799, South Carolina’s highest court held: “So cautiously does the law watch over all contracts, that it will not permit any to be binding but such as are made by persons perfectly free, and at full liberty to make or refuse such contracts. . . . Contracts to be binding must not be made under any restraint or fear of their persons, otherwise they are void.” Throughout the life of this nation it has been understood that for a contract to be valid, the parties to it must mutually assent to its terms — without duress.

In addition to duress, contracts are voidable for reasons of fraud upon, or the mistake or incapacity of, a party to the contract. This underscores the centrality of the concept of meaningful consent in contract law. To be meaningful, consent must be informed and must not be coerced. Under Obamacare, the government will compel individuals to enter into contractual relations with insurance companies under threat of penalty.

Also, the Supreme Court in Commerce Clause cases has repeatedly recognized, and Congress has never before ignored, the difference between the regulation and the coercion of commerce. And in its 10th Amendment cases (“The 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 court has specifically forbidden government to compel contracts.

In 1992, the court held unconstitutional a law compelling states to “take title to” radioactive waste. The court said this would be indistinguishable from “a congressionally compelled subsidy from state governments” to those who produced the radioactive waste. Such commandeering of states is, the court held, incompatible with federalism.

The IJ argues: The 10th Amendment forbids Congress from exercising its commerce power to compel states to enter into contractual relations by effectively forcing states to “buy” radioactive waste. Hence “the power to regulate commerce does not include the power to compel a party to take title to goods or services against its will.” And if it is beyond Congress’s power to commandeer the states by compelling them to enter into contracts, it must likewise be beyond Congress’s power to commandeer individuals by requiring them to purchase insurance. Again, the 10th Amendment declares that any powers not given to the federal government are reserved to the states or to the people.

Furthermore, although the Constitution permits Congress to make laws “necessary and proper” for executing its enumerated powers, such as the power to regulate interstate commerce, it cannot, IJ argues, be proper to exercise that regulatory power in ways that eviscerate “the very essence of legally binding contracts.”

More at the link.

[Crafty_Dog]

I had not seen this point articulated previously.  It seems to me quite sound and I will be adding it to my repertoire.

[G M]

Conservatives hijack #ILikeObamacare hashtag on Twitter
 

Published: 7:37 PM 03/23/2012





By Paul Conner
 
Speaker Nancy Pelosi of California holding the gavel used to pass Medicare Reform, laughs as she walks across the street and into the U.S. Capitol as the House prepares to vote on health care reform in the U.S. Capitol in Washington, Sunday, March 21, 2010. Walking with Speaker Pelosi are from left, Rep. Steny Hoyer, D-Md., Rep. John Lewis, D-Ga., and Rep. John Larson, D-Conn. (AP Photo/Charles Dharapak)
 


Conservatives on Twitter today quickly hijacked the #ILikeObamacare hashtag, which had been launched by President Barack Obama’s campaign to highlight supporters of the Democrats’ signature health care reform law.
 
The Twitter hashtag was the most popular in the world Friday afternoon, but not for reasons the Obama campaign wanted. (RELATED: Full coverage of the health care law)
 
For every tweet saying, “My son is now covered, despite his pre-existing condition,” ten tweets were dripping with sarcasm about the health care law. The Daily Caller rounded up ten funniest tweets that came across our screen.
 
10.) @jimmiebjr: #ILikeObamacare because I trust the same people who wrote the tax code to keep things simple, understandable, and transparent for me.
 
9.) @EWErickson: #ILikeObamacare because I think responsibility is giving free condoms to our kids while we bankrupt their future.
 
8.) @brostap: #ilikeobamacare because…oh wait it’s terrible…
 
7.) @joshgreenman: #ILikeObamacare because “love” is too strong a word.
 
6.) @IamJackBlack: #ILikeObamacare because anything we do to be more like Canadians is only a good thing.
 
5.) @anthropocon: #ILikeObamacare because I hate the government listening to my phone calls, but I want them to decide if I get a pacemaker.
 
4.) @iowahawkblog: #IlikeObamacare because the best things in life are free. Give or take $2 trillion.
 
3.) @karr_pe: #ilikeobamacare because my senior citizen mother is really getting on my nerves.
 
2.) @gman949: #ILikeObamacare because now my prostate exam won’t hurt as much as the higher taxes I have to pay for it.
 
1.) @voteforcantwell: #ILikeObamacare Because I’m too poor to pay for insurance – Sent from my iPad 3”


Read more: http://dailycaller.com/2012/03/23/conservatives-hijack-ilikeobamacare-hashtag-on-twitter/

[DougMacG]

Followup on contract law which is taught both in business school as well as legal training:  The elements of a valid contract always first require competent parties which I would presume to be someone capable of freely choosing whether to enter or not enter the contract.  Also required is 'consideration'.  Googling around I found this description of the validity of consideration:  "The payment doesn't need to be a fair payment. The courts will not intervene where one party has made a hard bargain unless fraud, duress or unconscionable conduct is involved."

Whoops, that link came from Australia.  http://www.smallbusiness.wa.gov.au/four-essential-elements-of-a-contract/  They aren't allowed to look at foreign law for guidance, right?

Here's another take on it: "The vitiating factors or elements are misrepresentation, duress, undue influence and certain forms of mistake."  http://wiki.answers.com/Q/What_are_the_vitiating_elements_of_valid_a_contract

There use to be an out-clause when our state auto insurance became 'mandatory' for motorists:  you could post a bond or other assets as another way to demonstrate financial responsibility up to the minimum requirements of the new law.  Speaking of auto insurance, the closest I've come to empathizing with a rape victim was when I had to Geico that I needed to change the bank account of my auto-pay.  They went through every imaginable personal question possible just short of asking me what I was wearing.  What will be your right of privacy with your new, state run health insurance company (do they get to know your first elementry school attended and your mother's maiden name?), and who will be overseeing their ability to pay?  Dodd Frank with a side payment to Newt to keep down the scrutiny?

In the case of financial responsibility pertaining to healthcare, I believe it is the loose freedom of personal bankruptcy that allows young, healthy, financially able people to avoid the risk that they may have to pay for large unforeseen healthcare costs for the rest of their lives if the don't freely choose to procure insurance.  People wipe out these debts in amounts that are only a fraction of a year's income in our court system.  Funny that many other debts cannot be wiped out in bankruptcy: tax debt, child support, and student loans are examples.  It is quite a strange web that we weave to convince ourselves that the most egregious destruction ever of our most intimate privacy rights is given up in the name of 'necessary and proper'.  What a bunch of bs.

[Crafty_Dog]

Lets put the Obamacare decision materials in this thread so as to leave room for other Constitutional issues in that thread.


www.landmarklegal.org/uploads/11-398bsacLandmarkLegalFoundation_FILED.pdf

[DougMacG]

"Lets put the Obamacare decision materials in this thread so as to leave room for other Constitutional issues in that thread."

Tomorrow starts the oral arguments of the case.  One of the strangest points in prognostication is that it is considered a mathematical certainty that all four so-called liberal justices will vote for this unprecedented, unauthorized, unconstitutional federal taking of personal privacy and liberty.

On the other side I recall that Republican appointees of intended conservative justices over the last several decades have not always turned out to be that predictable.

Assuming the universal prognostications are right, the only question in the case is what does Anthony Kennedy think and will Scalia or Roberts jump over with him.

As an optimist (and contrarian) on our constitutionally limited American government, I assume the vote will be 9-0 to strike this down.  It isn't authorized. It isn't necessary.  It isn't proper. It isn't even regulation of interstate commerce.

[DougMacG]

Subscribe at the link for excellent economic analysis!

http://scottgrannis.blogspot.com/2012/03/seven-fatal-flaws-of-obamacare.html

Scott Grannis: The seven fatal flaws of ObamaCare    March 1, 2012

Fatal flaw #1: The penalty imposed for not buying a policy is very likely to be less than the cost of insurance for a great many people. This, combined with the requirement that insurance companies may not deny coverage to anyone with a pre-existing condition, means that a large number of people will forgo signing up for a policy, knowing that they a) will save money and b) can always sign up for insurance if they turn out to develop a serious medical condition. Thus, the actual revenues will far way short of projections.


Fatal flaw #2: The government has no ability to enforce the penalty for noncompliance.

Fatal flaw #3: Mandating that people buy a health insurance policy simply because they are alive is arguably unconstitutional. The Supreme Court has already decided to take up this issue and will begin hearing oral arguments this month. I note that a recent USA/Gallup poll shows that an overwhelming 72% of Americans believe that the individual mandate is unconstitutional. The mandate is also a way of hiding the fact that young people will effectively be paying a huge new tax in order to subsidize older people.

Fatal flaw #4: Regulating the price which insurance companies must charge for policies, coupled with a requirement that companies must rebate to their customers the amount by which their loss ratios fall below 90%, effectively turns these companies into government-run enterprises and would likely result in the effective nationalization of the healthcare industry. That is a violation of the Fifth Amendment, and of a Supreme Court requirement "that any firm in a regulated market be allowed to recover a risk-adjusted competitive rate of return on its accumulated capital investment."

Fatal flaw #5: A government-imposed restructuring of the healthcare industry can't possibly improve our healthcare system, and is extremely likely to make it worse. As Don Boudreaux has noted, "Trying to restructure an industry that constitutes one-sixth of the U.S. economy is ... so complicated that it's impossible to accomplish without risking catastrophic failure." No collection of laws or government bureaucrats can achieve anything close to the efficiency that free markets can deliver; the demise of socialism is the most obvious proof of this. Government control of healthcare will inevitably result in higher prices and rationing, leaving everyone worse off. UPDATE: Acknowledging this reality, the CBO in March '12 calculated the cost of ObamaCare to be $1.76 trillion over a decade, almost double the $940 billion forecast when the bill was signed into law.

Fatal flaw #6: In cases wherein companies find that complying with the law would result in large increases in healthcare premiums that would threaten employees' access to a plan, the Dept. of Health and Human Services may grant a waiver to the company. As evidence of the first five fatal flaws accumulates, and as healthcare insurance companies continue to raise premiums to pay for the unintended consequences of government attempting to regulate an entire industry and hundreds of millions of people, more and more companies are likely to apply for waivers. To date, over 1200 companies have been granted waivers. At some point the whole edifice will come crashing down of its own weight.

Fatal flaw #7: The individual mandate violates centuries of contract law, since in order to be valid, contracts to purchase health insurance must be entered into freely.

[DougMacG]

As a media issue aside, I have started to wonder if Newsweek (Wash Post co.) is turning conservative or if Samuelson is another token conservative like Geo. Will.  This piece has excellent insight.  Extrapolating the numbers cited for health improvements gained when the uninsured get insurance, this program should spark about a 0.14% improvement in health outcomes to the American public, not counting the overall detriment the system that it will certainly cause.

http://www.realclearpolitics.com/articles/2012/03/26/obamas_ego_trip_113601.html

March 26, 2012
Obama's Ego Trip
By Robert Samuelson

WASHINGTON - As the Supreme Court hears arguments on the constitutionality of the Affordable Care Act (ACA) -- Obamacare, as many call it -- the justices will probably share at least one assumption: that their decision will have a big effect on the health of Americans. Ideally, everyone ought to have insurance, and it's popular wisdom that this would significantly improve people's health. But it's not true. The ACA's fate will dramatically affect government and the health care system; the impact on Americans' health will be far more modest.

Rarely has a program with so little potential inspired so much contention. Although millions would benefit from health insurance, the overall relationship between people's insurance status and their self-reported health is underwhelming. Consider a study of Massachusetts' universal coverage program, enacted under former Gov. Mitt Romney, by economists Charles J. Courtemanche of the University of Louisville and Daniela Zapata of the University of North Carolina at Greensboro. It estimated that about 1.4 percent of the state's adult population moved into the "very good" or "excellent" health categories.

Another study by economist Daniel Polsky of the University of Pennsylvania examined what happened to uninsured Americans who went on Medicare at age 65. Polsky found "no significant health effect for the uninsured relative to the insured upon reaching Medicare eligibility." Although other studies report somewhat larger effects, most share a weakness. They rely on people's self-reported assessment of their health. Just receiving government-subsidized insurance, worth $8,000 to $12,000, may make people feel better. It shields them from financial setbacks.

On reflection, the loose relation between health and insurance is not puzzling. Many uninsured are young and healthy; in 2010, 40 percent were between the ages of 18 and 34. Others pay their own bills or receive "uncompensated" care. Still others are too sick to be cured by any means. Finally, having insurance may not change unhealthy lifestyles or how people use the medical system. Before receiving Medicare, the uninsured used emergency rooms more than the insured; once on Medicare, they still did.

So the laudable goal of universal coverage ought to be balanced against drawbacks. At the margin, the ACA will probably discourage job creation, because mandated insurance raises the cost of hiring and the complexity of the 2,700-page law will intimidate some employers. Requiring younger workers to have expensive, comprehensive insurance (as opposed to catastrophic coverage) expands the undesirable inter-generational transfer from them to their wealthier elders. Finally, the ACA worsens the budget outlook.

The Obama administration has obscured this by arguing the program reduces budget deficits. Though technically true, this is misleading.

From 2012 to 2021, the Congressional Budget Office estimates the ACA's insurance subsidies at $1.5 trillion. But the CBO reckons these costs will be offset by revenue increases (including: a higher Medicare payroll tax, higher taxes on unearned income, penalties for individuals without insurance, taxes on drug and insurance companies) plus assumed cuts in Medicare. Still, all these tax increases and savings might have been applied to the huge projected deficits that existed pre-ACA. The administration resembled a homeowner who couldn't afford the mortgage but scraped up money for an expensive renovation. And if the renovation's costs are underestimated -- or all the new money doesn't materialize -- the ACA will increase the deficit.

To these problems is now added a possible backlash from a Supreme Court ruling. The administration argues that the ACA falls within the government's authority to regulate interstate commerce. Opponents contend that the insurance "mandate" requiring coverage would give government unprecedented power to order Americans to buy almost anything. Unless there's a lopsided decision (7-2 or better), the court may deepen public polarization over the ACA.

If the court disallows the mandate, President Obama's liberal supporters will accuse it of partisan judicial activism by usurping the role of elected leaders. If it narrowly blesses the ACA, conservatives will say constitutional liberties were sacrificed on the altar of political expediency. Either way, the court risks withering criticism that it is meddling in the election.

Considering the ACA's glaring -- and predictable -- economic and political shortcomings, why did Obama make it his first-term centerpiece? The answer seems to be his obsession with securing his legacy as the president who achieved the liberal grail of universal coverage. In his book "The Escape Artists: How Obama's Team Fumbled the Recovery," Noam Scheiber recounts a telling incident. Obama's advisers tell him he can be known for preventing a second Great Depression. "That's not enough for me," Obama replies.

The ACA is Obama's ego trip, but as a path to presidential greatness, it may disappoint no matter how the court decides. Lyndon's Johnson's creation of Medicare and Medicaid was larger, and he isn't deemed great. And then, unlike now, government seemed capable of paying for bigger programs.

[DougMacG]

"Can the Supreme Court Survive a Health-Care Decision?" (from constitutional issues)

Yes, if they get it right - one way or the other. 

This is quite an odd situation - the will of the people and the action of their representatives are pulling in two different directions.

If the law is struck down, it means there are still limits on government.  How well they define that will reflect on them and on the structuring of new programs far into the future.

Bush v. Gore stood the test of time (IMO) because it turned on a simple concept. the constitution gave an authority to the Florida legislature, not the Florida court, so the overturn of the will of the legislature by the state court was struck down.

In Roe v. Wade the right of privacy was judged paramount; the life of the unborn human being was not.  That is obscenely immoral and illogical to many but no one questions that the life status of the unborn is not covered in the words of the constitution.  All it takes is a new amendment to fix that.

What is the phrase or concept that will be paramount in the healthcare decision, in either direction?

Conservatives believe the healthcare case is symbolic of having no limits on government, but the justices would need to agree on what that limit is and how this program violates it. 

I think it is as simple as this: the federal government does not have unenermerated powers.  If the people want this new power in their federal government, they need (IMO) to go back and authorize it in an amendment like they did with the 16th amendment authorizing the power to levy a direct tax on income.  The amendment process didn't change.

On the liberal side, they believe that requiring someone to perform healthcare services on you is already a right (unenumerated) in a civilized society and the provisions in the bill were all 'necessary and proper' to 'regulate' the interstate commerce market to guarantee those services are performed and paid for.

Seems to me that "necessary" is a much stronger test in this context than just politically necessary.  There is no one in the Obama administration or Pelosi-Reid congress that did not know they had already authority to spend more on healthcare services and to raise conventional tax up to any rate they want.  The far simpler and broader alternative of single payer with universal coverage was ruled out at the time for political, not constitutional reasons.

What is the evidence and unanswerable argument that this new power is necessary?

[DougMacG]

Part one, part two transcripts.  Historic stuff, might be interesting to go through.  I imagine one could go wrong guessing their opinion by hearing their question.

http://www.politico.com/news/stories/0312/74537.html
http://www.politico.com/news/stories/0312/74543.html

Other accounts:
http://www.foxnews.com/politics/2012/03/27/swing-justice-poses-tough-questions-on-obamacare-at-supreme-court-hearing/
"Can you create commerce to regulate it?" Kennedy asked Solicitor General Don Verrilli.
-----------------------
During the debate of the Obamacare mandate at the Supreme Court Justice Kennedy says that the mandate fundamentally changes the relationship of a citizen with the government.  http://www.realclearpolitics.com/video/2012/03/27/kennedy_individual_mandate_fundamentally_changes_relationship_of_govt.html

CHIEF JUSTICE ROBERTS: The key in Lochner is that we were talking about regulation of the States, right, and the States are not limited to enumerated powers. The Federal Government is. And it seems to me it's an entirely different question when you ask yourself whether or not there are going to be limits in the Federal power, as opposed to limits on the States, which was the issue in Lochner.

SOLICITOR GENERAL VERRILLI: I agree, except, Mr. Chief Justice, that what the Court has said as I read the Court's cases is that the way in which you ensure that the Federal Government stays in its sphere and the sphere reserved for the States is protected is by policing the boundary: Is the national government regulating economic activity with a substantial effect on interstate commerce?

JUSTICE KENNEDY: But the reason, the reason this is concerning, is because it requires the individual to do an affirmative act. In the law of torts our tradition, our law, has been that you don't have the duty to rescue someone if that person is in danger. The blind man is walking in front of a car and you do not have a duty to stop him absent some relation between you. And there is some severe moral criticisms of that rule, but that's generally the rule.

[ccp]

Doug writes,
"I imagine one could go wrong guessing their opinion by hearing their question."

Jeff Toobin whom we all know, and admits his forcast appears to have been dead wrong thinks the line of questioning by the Justices is quite telling:

http://www.cnn.com/video/?hpt=hp_c1#/video/crime/2012/03/27/nr-toobin-mandate.cnn

[Crafty_Dog]

Worrisome his comments about Roberts , , ,

[DougMacG]

"not only that they're compelling us to enter into the marketplace, they're not — they're prohibiting us from buying the only economically sensible product that we would want. Catastrophic insurance."  Carvin quote from the exchange below. [not exactly necessary, not exactly proper.]



For sure Roberts and Kennedy are trying to find the limits of both sides of the argument.  I read through the day two transcripts, individual mandate day at the Court, a strange sort of 9 or 10 person highly interrupted discussion. (and now lost my post in a computer crash) 

(Now they are on severability - if they strike down part, the justices are supposed to then read, judge and re-write 2700 pages - that the lawmakers never read??)

Each has their own points they are trying to get at.  Ginsburg kept going back to how Social Security and other programs tie to this.  Each new program expanding government and shrinking liberties is used as the lever to help enable the next expansion of government.  Social security in is actual form is merely tax and spend.  In its conceptual form as a forced savings, generational transfer and long term contract binding future congresses to continue it to for everyone's lifetime, it is a constitutional farce.

Verrilli was adamant to not call anything a mandate; it is merely the minimum coverage set by congress.

Many justices were lost to find a 'limiting principle'.  If we allow this expansion, then what is the limit on government power over the individual? 
-------
Sotomayer (wise Latina) showed a sign of noticing a problem:  "...The government says, borrowing my colleague's example, you can't buy a car without emission control. I don't want a car with emission control. It's less efficient in terms of the horsepower. But I'm forced to do something I don't want to do by government regulation. [but you don't have to buy the car]  You are not forced to buy a product you don't want. And I agree with you that since the government regulates all markets, there is no limiting principle on their compelled purchase. When they put these environmental controls on the...They forced me to buy, if I need...unpasteurized goods, goods that don't have certain pesticides but have others. There is government compulsion in almost every economic decision because the government regulates so much...."

CARVIN: The difference here is the government is trying to tell you to buy the car in the first place.

And as Justice Kennedy pointed out, that's a fundamental alteration of the relationship between the national government and its citizens. Never before in our history has the government presumed to tell us, Go ahead and buy products you don't want because it's going to help other people.
-----
Can they make you buy a cell phone, buy brocolli, buy burial insurance?

Health insurance is unique because you don't know when you will need it or what you will need. (?)  Yet we have systems in place that work fine for police and fire emergency services.   Opposing attorney ripped up the catastrophic argument because the bill is a far cry from just catastrophic coverage - that is what is prohibited by the bill.  This is a brief excerpt of note, read it to the end, why framers were not afraid of 'regulating commerce':

Mr. Carvin:  ...It would be perfectly fine if they

20 allowed — you do actuarial risk for young people on the

21 basis of their risk for disease, just like you judge

22 flood insurance on the homeowner's risk of flood. One

23 of the issues here is not only that they're compelling

24 us to enter into the marketplace, they're not — they're

25 prohibiting us from buying the only economically

103

1 sensible product that we would want. Catastrophic

2 insurance.

3 Everyone agrees the only potential problem

4 that a 30-year-old, as he goes from the healthy 70

5 percent of the population to the unhealthy 5 percent.

6 And yet Congress prohibits anyone over 30 from buying

7 any kind of catastrophic health insurance. And the

8 reason they do that is because they needed this massive

9 subsidy.

10 Justice Alito, it's not our numbers. CBO

11 said that injecting my clients into the risk pool lowers

12 premiums by 15 to 20 percent. So, Justice Kennedy, even

13 if we were going to create exceptions for people that

14 are outside of commerce and inside of commerce, surely

15 we'd make Congress do a closer nexus and say look, we're

16 really addressing this problem. We want these

17 30-year-olds to get catastrophic health insurance.

18 And not only did they — they deprived them

19 of that option. And I think that illustrates the

20 dangers of giving Congress these plenary powers, because

21 they can always leverage them. They can always come up

22 with some public policy rationale that converts the

23 power to regulate commerce into the power to promote

24 commerce, which, as I was saying before, is the one that

25 I think is plenary.

104

1 JUSTICE KAGAN: Mr. Carvin, a large part of

2 this argument has concerned the question of whether

3 certain kinds of people are active participants in a

4 market or not active participants in a market. In your

5 test, which is a test that focuses on this

6 activity/inactivity distinction, would force one to

7 confront that problem all the time.

8 Now, if you look over the history of the

9 Commerce Clause, what you see is that there were sort of

10 unhappy periods when the Court used tests like this -­

11 direct versus indirect, commerce versus manufacturing.

12 I think most people would say that those things didn't

13 really work. And the question is, why should this test,

14 inactive versus active, work any better?

15 MR. CARVIN: The problem you identify is

16 exactly the problem you would create if you bought the

17 government's bogus limiting principles. You'd have to

18 draw distinctions between the insurance industry and the

19 car industry and all of that.

20 We turn you to the Commerce Clause

21 jurisprudence that bedeviled the Court before the 1930s,

22 where they were drawing all these kinds of distinctions

23 among industries; whereas our test is really very

24 simple. Are you buying the product or is Congress

25 compelling you to buy the product? I can't think of a

105

1 brighter line.

2 And again, if Congress has the power to

3 compel you to buy this product, then obviously, they

4 have got the power to provide you — to compel you to

5 buy any product, because any purchase is going to

6 benefit commerce, and this Court is never going to

7 second-guess Congress's policy judgments on how

8 important it is this product versus that product.

9 JUSTICE ALITO: Do you think they are

10 drawing a line between commerce and everything else that

11 is not commerce is drawing an artificial line, drawing a

12 line between Congress and manufacturing?

13 MR. CARVIN: The words "inactivity" and

14 "activity" are not in the Constitution. The words

15 "commerce" and "noncommerce" are. And again, it's a

16 distinction that comes, Justice Kagan, directly from the

17 text of the Constitution.

18 The Framers consciously gave Congress the

19 ability to regulate commerce, because that's not a

20 particularly threatening activity that deprives you of

21 individual freedom. If you were required, if you were

22 authorized to require A to transfer property to B, you

23 have, as the early cases put it, a monster in

24 legislation which is against all reason in justice,

25 because everyone intuitively understands that regulating

106

1 people who voluntarily enter into contracts in setting

2 changing conditions does not create the possibility of

3 Congress compelling wealth transfers among the

4 citizenry. And that is precisely why the Framers denied

5 them the power to compel commerce, and precisely why

6 they didn't give them plenary power.

[ccp]

This is off the acponline.org first page without need for a password so I think it ok to print.  I note Dr. Hood's Masters in public health is from (you guessed it)  *Harvard*.  I remember a few decades ago I once considered getting a degree in pulbic health to help shape the "future" of health care but the stuff was simply too boring.  I don't agree with the College's position on this yet I believe part of it is due to a pragmatic political approach to inevitable changes that must take place or else this country will go bust.

****The Present and Future of the Affordable Care ActMarch 26, 2012tion:
Virginia L. Hood, MBBS, MPH, FACP
President, American College of Physicians

Washington — The American College of Physicians (ACP), representing 132,000 internal medicine specialists and medical student members, is pleased to report that the Affordable Care Act (ACA) has resulted in major improvements in access and coverage for tens of millions of Americans seen by internal medicine physicians. Considering that it is just a little over two years since the ACA was enacted into law, and many of its programs are not yet fully effective, the ACA has had notable success in improving health insurance coverage. Looking to the future, the ACA will ensure that nearly all legal residents in the United States will have access to affordable coverage beginning in 2014—if the law is allowed to be fully implemented.

Interestingly, the public policy discussion of the improvements made by the ACA on its two-year anniversary is taking place in a context when the Supreme Court is hearing oral arguments this week on lawsuits challenging the law’s constitutionality. ACP did not submit an amicus brief on the constitutional questions being considered by the Supreme Court because our expertise is in evidence-based assessment of the policies required to ensure that our patients have access to health insurance, not in constitutional law. But the evidence leads us to firmly believe that the ACA’s programs to expand health insurance coverage—including subsidies, health exchanges, essential benefits packages, an individual insurance requirement, and a single national eligibility standard for Medicaid—are necessary to help protect and ensure the health of the American people.

The ACA Already is Helping Millions of PeopleAs a direct result of the ACA:

2.5 million young adults kept their health insurance coverage because they were allowed to stay on their parents’ plans. The percentage of people between ages 19 and 25 being carried as a dependent on a parent’s employment-based coverage increased from 24.7 percent in 2009 to 27.7 percent in 2010. The number of young adults with employment-based coverage as a dependent increased from 7.3 million to 8.2 million.

Through the end of July 2011, 1.28 million Americans with Medicare received discounts on brand name drugs in the Medicare Part D coverage gap — up from 899,000 through the end of June and 478,000 through the end of May. These discounts have saved seniors and people with disabilities a total of $660 million. Figures released a week ago from the Department of Health and Human Services indicate 5.1 million seniors have saved more than $3.2 billion on prescription drugs because of the ACA.

More than 18.9 million Medicare beneficiaries, or 55.6 percent, have received one or more preventive services at no out-of-pocket cost to them.

The National Health Service Corps, which receives mandatory funding under the ACA, has awarded nearly $900 million in scholarships and loan repayment to health care professionals to help expand the country’s primary care workforce and meet the health care needs of communities across the country. There are nearly three times the number of NHSC clinicians working in communities across America than there were three years ago—increasing access to health care. In 2008, approximately 3.7 million patients were provided service by 3,600 NHSC clinicians. With field strength of more than 10,000 clinicians, NHSC now provides health care services to about 10.5 million patients.

The ACA will Help Many Millions More over the Next Two YearsMany patients seen by internal medicine specialists have multiple chronic diseases (often labeled as “pre-existing conditions” by health insurers), which makes it very difficult for them to find health insurance at a premium they can afford. Under the ACA, insurers won’t be allowed to exclude them from coverage, charge them an excessive premium, or refuse to renew their coverage. These protections, already in effect for children, will become effective for adults on January 1, 2014.

Studies suggest that an individual requirement is needed for such reforms to work. Without an individual insurance requirement, some people may wait to obtain insurance until they are sick, aware that insurers will not turn them down or charge them higher premiums (except for family size and tobacco use). This will drive up premiums for everyone else, causing more persons to drop coverage, and potentially, resulting in millions more uninsured persons.

ACP also strongly supports requiring Medicaid to cover all persons with incomes up to 133 percent of the Federal Poverty Level. This change, which initially will be paid for by the federal government, is the most effective way to ensure that low-income persons have access to coverage. Some 16 million vulnerable Americans will receive coverage from this change.

When these and other programs enacted by the ACA become fully implemented by 2014, it is estimated that 94 percent of legal residents in the United States will have access to affordable health insurance coverage, with 32 million persons who now have no health insurance being able to obtain coverage. This will be a historic achievement in improving the health of the American people. Studies show that people without health insurance live sicker and die younger than people with coverage.

ACP fervently hopes that the Supreme Court will chart a course that does not derail implementation of the ACA’s key programs to expand coverage, while responsibly carrying out the court’s constitutional obligation to clarify the constitutional questions. And we hope that a day will come when Congress will be able to move beyond a partisan debate over “repeal and replace” of the ACA to discussion of bipartisan improvements that could be made in the law, without sacrificing the commitment it made to helping nearly all Americans obtain affordable health insurance coverage.

***

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 132,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.

Contact:
David Kinsman, (202) 261-4554
dkinsman@acponline.org
Jacquelyn Blase
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[Crafty_Dog]

By LAMAR ALEXANDER, MIKE JOHANNS, JOHN HOEVEN AND JIM RISCH
Two years after ObamaCare was signed into law the American people are more opposed to it than ever. It is now clear that the law will impose heavy burdens on state and family budgets and increasingly possible that its mandate that all Americans purchase health insurance or face penalties will be ruled unconstitutional. As lawmakers, we need to repeal the law and do what we should have done in the first place: go step by step to reduce costs so that more people can afford insurance.

When the Senate was voting on the health-care bill in 2010, we suggested anyone who voted for it ought to serve as a governor and actually try to implement its new mandates and costs. That's the real trick—implementing a more than $2.5 trillion bill that increases costs in a health-care system that is already too expensive, and doing so when state budgets have been roiled by recession.

The National Governors Association (NGA) reports states are facing a collective $95 billion budget shortfall this year alone. But ObamaCare's expansion of Medicaid will force an additional $118 billion in unfunded mandates onto the states through 2023.

The National Association of State Budget Officers says Medicaid now comprises nearly one quarter of states' entire budgets. Each one of us has served as governor in our state and knows that increased costs in one area means less money in another. America's families know this as well since they can't just print and borrow money when their spending goes up like the federal government does.

Yet, astonishingly, more than half of ObamaCare's newly promised health-insurance coverage was accomplished by assigning nearly 26 million more people to an already broken Medicaid program and telling governors, "Now, you find a way to help pay for it."

This will leave states with two choices, or a combination of both: either cut funding in areas such as K-12 education, public universities and colleges, veterans affairs programs, and other much-needed services; or raise sales, income or property taxes.

As Nebraska Gov. and NGA Chairman Dave Heineman said in February, "The overall fiscal condition of states has improved, but governors are very concerned about the growth of Medicaid as it consumes an increasing share of state budgets. Medicaid's rapid growth could result in less funding for education, transportation, or public safety." Indeed, in just three years the annual budget shortfall created by the new Medicaid mandate will already be greater than the entire Nebraska State Patrol's approximately $50 million budget.

Enlarge Image

CloseGetty Images
 .Tennessee's previous governor, Democrat Gov. Phil Bredesen, has called ObamaCare "the mother of all unfunded mandates," estimating that it would cost Tennessee an additional $1.1 billion from 2014 to 2019, even with the federal government covering the Medicaid expansion for the first three years.

The North Dakota Department of Human Services reported that the expansion will increase the number of beneficiaries on the state's Medicaid rolls by 50%, and is expected to cause serious access-to-care dilemmas because there aren't enough health-care providers in the state who take Medicaid to absorb the new patient load.

The same is true in Idaho, where Medicaid rolls would nearly double to include more than a quarter of the state's population. The additional enrollees would add more than $240 million in costs between 2014 and 2020. Gov. Butch Otter has repeatedly stated "big federal programs aren't the answer" and that ObamaCare "keeps states and the marketplace from making health care more affordable."

College students in nearly all states will be hit with a triple whammy. First of all, tuitions are increasing at public universities and colleges in large part because ObamaCare restricts governors from making changes to Medicaid eligibility that would reduce their state's health-care costs. Consequently, higher education is one of the first places they can cut.

College students are being hit again because the federal government took over the student-loan business in 2010, eliminating the competition. This allows the Education Department to borrow money from Treasury at an interest rate of 2.8% and lend it to college students at a rate of 6.8%. A portion of the profits from overcharging students will be used to help pay for ObamaCare.

And the third blow comes as college students graduate and enter a depressed job market where employers are creating fewer jobs as a result of the high costs associated with ObamaCare. Analysts at UBS have suggested as much when they stated in a September 2011 report that the health-care law is "arguably the biggest impediment to hiring, particularly hiring of less skilled workers."

As this week's historic debate in the Supreme Court clearly shows, the fight over ObamaCare is far from over. We and our Republican colleagues voted against the law two years ago and will continue to work toward a smarter, step-by-step solution that will make health care available to more Americans at a lower cost to the federal government, the states, and individuals seeking care.

Messrs. Alexander, Johanns, Hoeven and Risch are U.S. senators from Tennessee, Nebraska, North Dakota and Idaho, respectively. Each previously served as his state's governor.

[Crafty_Dog]

The pathetic Republican leadership ought to have a Specific Plan by now for implementing this that they can promote as the alternative to Obamacare.  Why don't they?!?  Boehner and McConnell need to go.

What to do on the Day After Obamacare
By JOHN H. COCHRANE

Last week, the Supreme Court heard arguments on the constitutionality of the administration's health law, aka ObamaCare. Opponents are giddy with the possibility that the law might be struck down.

But what then? Millions of uninsured, both those who choose not to purchase coverage and those who can't due to pre-existing conditions, will still be with us. The rising costs and inefficient delivery of health care will still be with us.

The country can have a vibrant market for individual health insurance. Insurance proper is what pays for unplanned large expenses, not for regular, predictable expenses. Insurance policies should be "guaranteed renewable": The policy should include a right to purchase insurance in the future, no matter if you get sick. And insurance should follow you from job to job, and if you move across state lines.

Why don't we have such markets? Because the government has regulated them out of existence.
Most pathologies in the current system are creatures of previous laws and regulations. Solicitor General Donald Verrilli explained as much in his opening statement to the Supreme Court: "The individual market does not provide affordable health insurance," he noted, "because the multibillion dollar subsidies that are available" for the "employer market are not available in the individual market."

Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.

Continue with the endless mandates (both state and federal) on insurance companies to provide all sorts of benefits people would otherwise not choose to buy. It sounds great to "make insurance companies pay" for acupuncture. But that raises the premiums, and then people choose not to buy the insurance. Instead of these mandates, at least allow people to buy insurance that only covers the big expenses.

What about Medicare and Medicaid? Two words: premium support. The underlying point of premium support is simple. If insurance costs $5,000 and the government gives an individual a $4,500 voucher, that individual will still feel the correct economic signal to shop for cost-efficient health insurance and health care.

The main argument for a mandate before the Supreme Court was that people of modest means can fail to buy insurance, and then rely on charity care in emergency rooms, shifting the cost to the rest of us. But the expenses of emergency room treatment for indigent uninsured people are not health-care's central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don't shop on price, and because regulations have salted insurance with ever more coverage for them to overuse.

If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what's offered today that we would likely not even need the mandate.

Meanwhile, staggeringly inefficient markets for health care itself need a thorough, competition-focused deregulation. Americans will know there's a healthy market when hospitals post prices on their websites, and when new hospital and health-care businesses routinely enter to challenge the old ones. Here too regulations keep competition at bay.

The number of new doctors is still restricted, thanks to Congress and the American Medical Association. Congress caps the number of residencies, the AMA has fought the expansion of medical schools, state tests make it difficult for foreign doctors to work here, and on and on.

There are hundreds of government impediments to competition. New hospitals? In my home state of Illinois, every new hospital, expansion of an existing facility or major equipment purchase must obtain a "certificate of need" from the Illinois Health Facilities Planning Board. The board does a great job of insulating existing hospitals from competition if they are well connected politically. Imagine the joy United Airlines would feel if Southwest had to get a "certificate of need" before moving in to a new city—or the pleasure Sears would have if Wal-Mart had to do so—and all it took was a small contribution to a well-connected official.

The result is a monstrous system in which insurance patients are gouged to subsidize Medicare, and cash patients are gouged most of all. Here's Mr. Verrilli again: "Insurance has become the predominant means of paying for health care in this country." Yes, the cash market has been badly damaged. Whose fault is that? Shouldn't we bring it back?
Group health plans in today's system may appear reasonable enough—they seem to resemble "buyers' clubs," where people pool together to get good deals from providers. But in a real buyer's club, each buyer still pays his own bill—you don't go into a Sam's Club and haul off whatever you can with only a fixed $20 copayment. And real buyer's clubs don't depend on where you work. Real buyers' clubs for health services could be a useful way to get competition going and revive the cash-and-carry market for individuals.

A deregulated health-care and health-insurance market can work. We can at least start by removing the obvious elephants in the room: all the legislation, regulation and interventions that needlessly keep prices up, keep competition and innovation out, shelter people from the economic consequences of their decisions, and prevent the emergence of real insurance that follows you from job to job and from health to illness and back.

Mr. Cochrane is a professor of finance at the University of Chicago Booth School of Business and an adjunct scholar at the Cato Institute.

A version of this article appeared April 3, 2012, on page A15 in some U.S. editions of The Wall Street Journal, with the headline: What to Do on the Day After ObamaCare.

[bigdog]

http://www.cbsnews.com/8301-504564_162-57408827-504564/appeals-court-fires-back-at-obamas-comments-on-health-care-case/

Appeals court fires back at Obama's comments on health care case

In the escalating battle between the administration and the judiciary, a federal appeals court apparently is calling the president's bluff -- ordering the Justice Department to answer by Thursday whether the Obama Administration believes that the courts have the right to strike down a federal law, according to a lawyer who was in the courtroom.

The order, by a three-judge panel of the U.S. Court of Appeals for the 5th Circuit, appears to be in direct response to the president's comments yesterday about the Supreme Court's review of the health care law. Mr. Obama all but threw down the gauntlet with the justices, saying he was "confident" the Court would not "take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress."

Overturning a law of course would not be unprecedented -- since the Supreme Court since 1803 has asserted the power to strike down laws it interprets as unconstitutional. The three-judge appellate court appears to be asking the administration to admit that basic premise -- despite the president's remarks that implied the contrary. The panel ordered the Justice Department to submit a three-page, single-spaced letter by noon Thursday addressing whether the Executive Branch believes courts have such power, the lawyer said.

The panel is hearing a separate challenge to the health care law by physician-owned hospitals. The issue arose when a lawyer for the Justice Department began arguing before the judges. Appeals Court Judge Jerry Smith immediately interrupted, asking if DOJ agreed that the judiciary could strike down an unconstitutional law.

The DOJ lawyer, Dana Lydia Kaersvang, answered yes -- and mentioned Marbury v. Madison, the landmark case that firmly established the principle of judicial review more than 200 years ago, according to the lawyer in the courtroom.

Smith then became "very stern," the source said, telling the lawyers arguing the case it was not clear to "many of us" whether the president believes such a right exists. The other two judges on the panel, Emilio Garza and Leslie Southwick--both Republican appointees--remained silent, the source said.

Smith, a Reagan appointee, went on to say that comments from the president and others in the Executive Branch indicate they believe judges don't have the power to review laws and strike those that are unconstitutional, specifically referencing Mr. Obama's comments yesterday about judges being an "unelected group of people."

I've reached out to the White House for comment, and will update when we have more information.

CBSNews.com Special Report: Health Care Reform

[G M]

But we were told the president was a constitutional scholar! 

[Crafty_Dog]

BD:  Would you please post this on the Legal Issues/Legal Matters thread as well? TIA.

[DougMacG]

I am out traveling with limited access, but would otherwise want some of these points discussed in addition to the ones on Legal Issues.
----------------
http://www.powerlineblog.com/archives/2012/03/justice-breyer-flunks-con-law.php
Justice Breyer flunks Con law    Scott Johnson, Powerline

Reading the transcript and listening to the audio of day 2 of the Obamacare argument, I was struck by the sheer intellectual laziness and complacency of Justice Breyer. To liken him to a rodeo clown would be to credit him with too much energy. Referring to the key New Deal Commerce Clause case of Wickard v. Filburn, Breyer asked, for example: “Didn’t they make that man growing his own wheat go into the market and buy other wheat for his — for his cows?”

Well, actually, no, Justice Breyer, they didn’t. “They” — Congress in an amendment to the Agricultural Adjustment Act of 1938 — limited the amount of wheat farmer Filburn could grow on his farm under a quota set for him by the geniuses in Washington (or penalized him for exceeding the quota). “They” didn’t make him go into the market and buy wheat for his cows. That’s the point — the point Randy Barnett has argued for the past few years.

The distinction between the case vaguely recalled by Justice Breyer and the one decided by the Supreme Court in the Wickard case might be the difference between a pass or a fail on a fairly graded Con law exam in law school. It goes to the heart of the Obamacare case. Justice Breyer has apparently been pursuing other intersts over the past few months.

As Jeffrey Anderson and Conn Carroll have observed, this wasn’t necessarily Justice Breyer’s only laugh-out-loud moment during day 2 of the oral argument. And if Justice Breyer were not a party-line liberal, you would have heard about it.
--------------------
http://www.powerlineblog.com/archives/2012/04/barack-obama-constitutional-ignoramus.php
Barack Obama, Constitutional Ignoramus    Steven Hayward, Powerline

I’m grateful for the favor Obama did for us yesterday of exposing his extreme constitutional ignorance, with his comments on how it would be “unprecedented” for the Court to strike down a law passed by a “strong majority” in Congress.  (As if a House margin of seven votes is a “strong” majority.)  True, he walked back the comment today, but surely because his statement was not merely indefensible but outright embarrassing to his media defenders.

I’ve been growing weary of hearing people mention that he’s a “constitutional scholar,” since he never published a single thing on the subject either as editor of the Harvard Law Review or as a member of the faculty at the University of Chicago Law School.  But hey—he taught constitutional law, didn’t he?

Not really.

His course on constitutional law, one of several constitutional law courses on the U of C curriculum, dealt exclusively with the equal protection clause of the 14th Amendment—the favorite, all-purpose clause for liberal jurists to use to right wrongs and make us more equal by judicial fiat.  There is no evidence that Obama ever taught courses that considered other aspects of constitutionalism, such as executive power, the separation of powers, the Commerce Clause, or judicial review itself.

I have a copy of one of his final exams.  It is a long hypothetical involving civil rights, which begins thus:

    In part, Hardsville’s racial isolation is the result of white flight and the limited economic means at the disposal of the black community.  It is also well documented, however, that Hardsville’s racial isolation arose in part due to decisions by a white-controlled city government prior to the seventies that were purposely discriminatory.

So you can see what kind of “narrative” this exam question promotes, and hence the kind of answers likely to get an A from Professor Obama.  One of the questions students are asked is, “What is the likelihood that the city will be held liable for violating the constitutional rights of blacks under the Equal Protection Clause. . .”  There’s a second hypothetical involving potential gender discrimination under the Equal Protection Clause.

A law student in Professor Obama’s class would learn virtually nothing about the constitutionalism of the Founding, or even of John Marshall or Joseph Story.

Now, clearly Obama is hoping to intimidate the Court in the same way FDR did in 1937 with his court-packing scheme.  Some time later I’ll discuss FDR’s extraordinary rhetoric attacking the Court that year, but suffice it to say for now that Obama already showed his hand with his inaccurate attack on the Citizens United decision in the State of the Union speech two years ago. As John Steele Gordon put it well, “It seems there is simply no lie President Obama will not tell in pursuit of his agenda.”

Notwithstanding the fact that Justice Alito could be seen mouthing the words, “Not true,” the Supreme Court by its traditions does not hit back at the President or Congress in these kind of brawls.  But thank goodness for the Fifth Circuit Court of Appeals, which today rather tartly demanded that the Justice Department please explain, in at least three pages, within 48 hours, its understanding of judicial review.  This should be interesting.  Here’s a copy of the follow-up letter from the court... more at link
-------------------
http://www.powerlineblog.com/archives/2012/04/obama-walks-back-supreme-court-threat-still-gets-it-wrong.php
Obama Walks Back Supreme Court Threat, Still Gets It Wrong
------------------
http://www.powerlineblog.com/archives/2012/04/does-the-commerce-clause-negate-the-rest-of-the-constitution.php
Does the Commerce Clause Negate the Rest of the Constitution?
----------------
http://online.wsj.com/article/SB10001424052702303816504577321844137787970.html?mod=WSJ_Opinion_MIDDLETopOpinion
The Man Who Knew Too Little
President Obama's stunning ignorance of constitutional law.
James Tarranto WSJ, at the link

[ccp]

"I’ve been growing weary of hearing people mention that he’s a “constitutional scholar,” since he never published a single thing on the subject either as editor of the Harvard Law Review or as a member of the faculty at the University of Chicago Law School.  But hey—he taught constitutional law, didn’t he?"

Doug,
Excellent point.   I remember at least one faculty colleague of Brock in Chicago state on the Marc Levin show how he never knew Brock show any real interest in Constitutional law.

On Fox they had a former student of Brock come on the show and state how he was literally shocked by Brock's essentially a threat to the Supreme Court concerning their review of the Health Care law and that if they vote against that he will do everything he can to undermine their legitimacy and integrity and paint them as "activist" etc.  He said this was unprecedented and Obama clearly knows this.   What he was not asked was what he thought of Brock as a Consititutional Law professor.  I was hoping they would ask him this.

The evidence I read is the whole "professor thing" was more of a way station while he was honing his political connections.

[G M]

http://www.dailymail.co.uk/health/article-2126379/Sentenced-death-old-The-NHS-denies-life-saving-treatment-elderly-mans-chilling-story-reveals.html?ITO=1490

Sentenced to death for being old: The NHS denies life-saving treatment to the elderly, as one man's chilling story reveals
By John Naish
PUBLISHED: 19:30 EST, 6 April 2012 | UPDATED: 21:23 EST, 6 April 2012



When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat.
Even the palliative surgery or chemotherapy that could have eased his distressing symptoms were declared off-limits because of his age.

His distraught daughter Michele Halligan accepted the sad prognosis but was determined her father would spend his last months in comfort. So she paid for him to seen privately by a second doctor to discover what could be done to ease his symptoms.

 Sentenced to death: Michele Halligan fought to get treatment for her father Kenneth Warden after a specialist told her nothing could be done
Thanks to her tenacity, Kenneth got the drugs and surgery he needed — and as a result his cancer was actually cured. Four years on, he is a sprightly 82-year-old who works out at the gym, drives a sports car and competes in a rowing team.

‘You could call his recovery amazing,’ says Michele, 51. ‘It is certainly a gift. But the fact is that he was written off because of his age. He was left to suffer so much, and so unnecessarily.’
 More...Women over 40 told: 'Don't take IVF success for granted'
Little boy's life-threatening brain tumour discovered after routine eye check-up

Sadly, Kenneth’s story is symptomatic of a dreadful truth. According to shocking new research by Macmillan Cancer Support, every year many thousands of older people are routinely denied life-saving NHS treatments because their doctors write them off as too old to treat.

It is often left to close family members to fight for their rights. But although it is now British law that patients must never be discriminated against on the basis of age, such battles often prove futile.


Read more: http://www.dailymail.co.uk/health/article-2126379/Sentenced-death-old-The-NHS-denies-life-saving-treatment-elderly-mans-chilling-story-reveals.html

[DougMacG]

Excerpted from transcript:

Justice Alito: “...it appears to me that the [Congressional Budget Office] has estimated that the average premium for a single insurance policy in the non-group market would be roughly $5,800 in—in 2016.

Respondents—the economists have supported—the Respondents estimate that a young, healthy individual targeted by the mandate on average consumes about $854 in health services each year.

So the mandate is forcing these people to provide a huge subsidy to the insurance companies for other purposes that the act wishes to serve, but isn't—if those figures are right, isn't it the case that what this mandate is really doing is not requiring the people who are subject to it to pay for the services that they are going to consume? It is requiring them to subsidize services that will be received by somebody else.”

[Crafty_Dog]

Herewith a response by an intelligent progressive friend:
=======
The alternative, in the completely free market, is to allow that discrimination to happen "naturally" as a Darwinian consequence of who has attained sufficient wealth and who has not.  This alleviates anyone from being responsible for the plight of another.  But the effect is the same.  The event described below, ascribed to government in this case, will still happen with regularity.   Possibly even more so given where the poverty line is.

So it is bad when government decides but it is acceptable when it "just happens" without anyone to blame (apart from the individual in question for not having been sufficiently financially successful)?  I think you would say yes.

Seems like the issue then is not that someone might be denied care as described here - but rather that anyt choices in someone's life are decided by another.  Which means this story can be replaced with any other of less dire consequence (such as being told where you will spend your vacation - similarly appalling but much less persuasive).

So chilling?  Perhaps.  But still a diversion from the real issue.
======
Over to you GM , , , and the rest of us.  What is the answer to this?

[G M]

There are those who choose freedom and those who wish to be wards of the state. Funny how the "progressives" are only generous with other people's money, in our case, the money of generations yet unborn yet leave the vast majority of actual charity work/donations to the ignorant bitter clingers to do.

How did the poor ever get medical care before the invention of the nanny state? Things like Catholic hospitals, which may get out of the business due to the birth control mandate.

"So it is bad when government decides but it is acceptable when it "just happens" without anyone to blame (apart from the individual in question for not having been sufficiently financially successful)?  I think you would say yes."

Yes. Why, because freedom is important and a free people get to make their own choices and live and die with the consequences. Do you want to live or die based on the whims of a gov't employee? Why is that something to be preferred?

[ccp]

"78 he was too old to treat"

Ironic as I don't even think 78 is that old at all anymore.

Indeed this is roughly the average lifes span for a man in the US now.

[Crafty_Dog]

My sense of things is that Obamacare is intended to have, and will have, the effect of driving us to monopsony (single payer). 

I remember how because I had my own insurance, when my knee was broken I was able to elect to have three extraordinary knee surgeries that replaced the snapped ligaments with tendons from cadavers.  IMO (not IMHO!) the expertise to perform such operations would not have existed, nor will exist under single payer.  Indeed the "excess of specialists" was one of the rallying cries for Hillarycare in the early 90s.  Without these surgeries, I would be a quasi-cripple, reduced to walking with a crutch, or perhaps a cane on level ground.  Certainly my life in martial arts would have ended right then and there.

Even if I qualified for the first surgery and the expertise to perform it existed, would I, at 40 years of age, have been green lighted for three surgeries?

The surgeries cost $50k in 1992 dollars.  I paid $8 of them.  I got a pretty good version of my knee back.  THE SYSTEM WORKED AS INTENDED.

My intelligent progressive friend posits the question as "What does it matter who decides?"

Even now, or in the future, with my insurance I decide, regardless of my age.  My answer is that it matters nearly everything. 

[ccp]

You will NEVER see any "quality" measures come out of ivy academia for a result such as you describe.

Such superb world class orthopedic care does not show up on any Harvard outcomes study.

We are lumped together into population studies and statistical measures.

[DougMacG]

My first post ever (half) agreeing with Barney Frank:

http://www.nationaljournal.com/congress/barney-frank-obama-made-mistake-with-health-care-push-20120416

Barney Frank: Obama Made 'Mistake' With Health Care Push

By Jonathan Miller
Updated: April 16, 2012 | 6:35 p.m.

Rep. Barney Frank, D-Mass., said he advised President Obama against taking up health care reform following a special election in 2010 that changed Democrats' fortunes in the Senate, saying that he should have instead turned his focus to financial reform.  (No, that was a disaster too!)

Frank referenced former President Bill Clinton and his failed health care plan from the 1990s. “Obama made the same mistake Clinton made,” Frank said in a wide-ranging interview with New York magazine. “When you try to extend health care to people who don’t have it, people who have it and are on the whole satisfied with it get nervous.”

The outgoing representative from Massachusetts added that after Republican Scott Brown won former Sen. Edward M. Kennedy’s seat, breaking Democrats’ filibuster-proof majority, Obama should have backed down: “I think we paid a terrible price for health care. I would not have pushed it as hard. As a matter of fact, after Scott Brown won, I suggested going back. I would have started with financial reform but certainly not health care," Frank said.

He said that if the president had followed his advice, “you could have gotten some pieces of it.”
------
Frank is right on this last part.  In the heat of the debate, Obama could have gotten the 'popular' parts of Obamacare passed with bipartisan support - if that was what he wanted and he could have avoided the fiascos of the Cornhusker kickback, deemed passed, broken promises about open debate and time to read the bills and all the rest.  He chose not to and paid a heavy price in 2010 and likely became a one-termer. 

Jumping the gun here on the upcoming Supreme Court decision, he also could have avoided the fiasco of having his signature achievement ruled to be unconstitutional.  His second term election theme then could be to do more instead of creating the need to go back and undo what he got wrong.

[G M]

http://washingtonexaminer.com/opinion/editorials/2012/04/examiner-editorial-why-democrats-wont-vote-budget/504281?utm_source=Washington%20Examiner%20Opinion%20Digest%20-%2004/19/2012&utm_medium=email&utm_campaign=Washington%20Examiner:%20Opinion%20Digest

Examiner editorial: Why Democrats won't vote on a budget

April 18, 2012 -- 6:00 PM


Households make budgets. So do businesses and nonprofits. There was also a time when Congress made them, but those days are long gone -- 1,086 days gone, to be precise. That's the last time Democrats, who have controlled one or both houses of Congress this whole time, passed a budget resolution through either the House or the Senate.

On April 15, 2010, both houses failed to meet the statutory deadline for passing a budget for the first time ever. Although the Senate Budget Committee would later pass a plan out of committee, Senate Majority Leader Harry Reid, D-Nev., blocked it from the floor, going so far as to prevent even a debate about the budget.
 
Asked to explain this bicameral failure in the face of trillion-dollar deficits, House Majority Leader Steny Hoyer said, "It's difficult to pass budgets in election years." Turns out, it is also difficult to get re-elected when you don't pass budgets. Later that same year, House Democrats lost 63 seats.
 
Senate Democrats lost six seats in 2010 but managed to retain control of the upper chamber. Surely, in the nonelection year of 2011 they would bring a budget to the floor, right? Wrong. Reid told reporters at the time, "There's no need to have a Democratic budget," adding, "It would be foolish for us to do a budget at this stage." In July 2011, Reid's assistant leader, Dick Durbin, D-Ill., went so far as to claim on national television that Republican filibusters prevented a budget from passing. He must have known he was fibbing -- under Senate rules, budget resolutions can pass with a simple majority.
 
In fact, Democrats just wanted to focus on attacking the "Path to Prosperity" budget proposed by House Budget Chairman Paul Ryan, R-Wis. Sen. Chuck Schumer, D-N.Y., said, "To put other budgets out there is not the point." As Treasury Secretary Timothy Geithner would later say, "We don't have a definitive solution ... We just don't like yours."
 
Fast forward to this past Monday, when Senate Budget Chairman Kent Conrad, D-N.D., announced he would attempt to pass a Democratic budget out of his committee for the first time since 2009. Conrad even held a press conference Tuesday during which he released a budget document nearly identical to the Bowles-Simpson deficit reduction plan that President Obama rejected in 2010.

But Reid quickly moved to quash this plan, and Conrad, who is retiring after this year, backed off at the eleventh hour. "This is the wrong time to vote in committee; this is the wrong time to vote on the floor," Conrad told reporters late yesterday afternoon.

It is no coincidence that the Democrats' failure to pass a budget began immediately after Obamacare became law. In order to hide its $1.7 trillion price tag and $500 billion in tax increases through 2022, Democrats had already exhausted every last budgeting gimmick. As a result, they had no further tricks up their sleeve to pay for the rest of their spending priorities without voting on the massive tax increases that Conrad's new budget contained -- $2.6 trillion, and not just on the rich.

Put yourself in the shoes of the half-dozen vulnerable Democratic senators who are up for re-election this year. Would you want to vote for that?
 
That is why Reid forced Conrad to pull his budget, even knowing that such a move would create an embarrassing spectacle. To paraphrase another politician, "We're running for office, for Pete's sake!"

[Hello Kitty]

Obama and California's waste of tax dollars on things that I don't cotton to absolutely had everything to do with me quitting a 100k a year job and moving out of country.
I'll still vote Libertarian or Republican, but they can fund Obummer care, Pelosi field trips, the Dream act, and every other stupid thing on their dime. When enough of the hackers start following suit, the problems and waste will have to be dealt with. America doesn't make herself rich, the efforts of hard working people do, and I'm done being ripped off. They can fund that crap on their Liberal constituent's dimed and see how far/long they go. Slackers. F em n feed em dog st. My two cents.

[Crafty_Dog]

GM, I get that there is some sort of connection to Health Care, but that really is a Budget piece, not a Health Care piece.  Sorry to be so anal on thread coherency but , , , there it is.

[Crafty_Dog]

By ALAN S. BLINDER

Health-care reform, the impossible dream that seemed to become a reality in 2010, is now in mortal danger. Republicans want to repeal it even though the federal law is patterned after a Massachusetts law that their apparent presidential nominee signed in 2006. They can't do that, of course, unless they sweep the next election. So the clear and present danger comes from the Supreme Court, where a majority of justices seemed to snarl at the law in open session last month. Health-care reform is clearly in legal peril.

This is no small matter. Over one-sixth of our economy is at stake. Beyond the economics, our country was founded on the idea that the rights to life, liberty and the pursuit of happiness are inalienable. Access to affordable health care is surely essential to two of these three rights, maybe to all three.

Rights are nice, but someone has to pay the bills. Looking around the world reveals a wide range of health-care payment systems. On a spectrum ranging from 100% payment by the state to 100% payment by private parties, many advanced countries cluster near the 100%-government pole. None is near the 100%-private pole. The United States probably comes closest, with about half the bills paid privately.

Though we Americans spend a much larger share of our GDP than any other nation on health care, we are not healthier. We are also the only rich country that fails to insure all its citizens. The Patient Protection and Affordable Care Act of 2010 seeks to end that. It would be a shame—and I mean that literally—if Republicans repealed the law or if the Supreme Court voided it.

The U.S. health-care payment system has a few oddities we'd be better off without. For one, the tax code incents employers to pay part of workers' wages in the form of health insurance, which is why insurance became tied to employment in the first place. For another, we have somehow decided that the state should provide anyone age 65 or older with health insurance, while everyone younger should fend for themselves. I'd hate to have to explain either of those choices to the proverbial man from Mars.

Now the big question: Does anyone think it is sensible to have nine lawyers decide what sort of health-care payment system the nation should have? Yet that's what may happen when the Supreme Court hands down its ruling.

Those three memorable days in March dealt with many issues, but the Court's main focus was on the individual mandate. Before considering the legalities, let's think about the economics. Why does the law require people to purchase health insurance?

Enlarge Image
blinder
blinder
Chad Crowe

Like most forms of insurance, health insurance is plagued by potential adverse selection. Pick any price, and riskier customers—the people more likely to file claims—will find the insurance policy more attractive than less-risky customers. So in health insurance, in particular, insurance companies expend huge resources trying to screen the bad risks out and the good risks in. One obvious way is to exclude people with pre-existing conditions, but there are others. All this effort adds to national health expenditures, improves insurers' profits, and hurts the bad risks (e.g. sick people).

The essential bargain made in 2010 starts by using the individual mandate to create a huge pool consisting of (almost) all Americans under age 65—just as Medicare now does for the 65-and-over population. With that pool created, the law can then require private insurers to cover (almost) everyone, including those with pre-existing conditions. In return, insurers get a lot more customers and a lot less adverse selection. They also save a ton of money on screening.

The Supreme Court's ruling could unravel this bargain. If the justices void the individual mandate, the adverse selection problem comes roaring back. Then, if the other insurance reforms remain in place, it will be the insurance companies that get sick. They will have to take on the bad risks while some of the good risks opt out, as they do now.

That's where economics and law collide. Economically, the individual mandate and insurance reforms form an unbreakable pair. Legally, they are separate. So the mandate could be ruled unconstitutional while the insurance reforms are not. After all, there is no question that health insurance is interstate commerce, and no question that the federal government can regulate interstate commerce.

So what happens if the justices void the mandate but leave the insurance reforms in place? The answer is: We get incoherence. Which, of course, is why you don't want judges making economic policy.

You could hear the justices grappling with this problem in the hearings. At one point, Justice Antonin Scalia even mused about declaring the entire law—which runs well over 2,000 pages—unconstitutional rather than deciding what stays and what goes. As a citizen untrained in the finer points of jurisprudence, I found that idea rather odd. Wasn't there something about a baby and some bathwater? How in the world can things like health-care quality measurement and disease prevention be unconstitutional?

So what will the Court decide? I claim no special expertise in constitutional law or Supreme Court psychology, but you could also hear hostility toward the mandate emanating from Chief Justice John Roberts, Justice Samuel Alito, and even Justice Anthony Kennedy. I have a simple model of Supreme Court decision making which rarely errs. In cases in which there are clear Democratic and Republican positions on an issue—which certainly includes this case—the Court will vote 5-to-4 Republican. Think Bush v. Gore or Citizens United, for example.

This is another real shame. If we are going to have political decision-making, at least elected politicians should do the deciding. Come to think of it, they already have.

Mr. Blinder, a professor of economics and public affairs at Princeton University, is a former vice chairman of the Federal Reserve.

[Hello Kitty]

Not to be a thorn Guro, but I just walked away from healthcare that I paid for through the company when I left and am now responsible for my own care 100%. Why shouldn't everyone be responsible for themselves? The greatest thing about being truly free is that there is no safety net. We are free to succeed, but we're also free to fail. This is an axiom that exists. If we take that away, we do away with our freedom. Is that worth it? I don't think it i

[Crafty_Dog]

GB:

Please understand that I dsagree with the piece I posted.  Read the subject and see that I am asking how to give a politically effective retort.

[DougMacG]

"Though we Americans spend a much larger share of our GDP than any other nation on health care, we are not healthier."

Do you mean healthier than every other nation?

My answer to that point is - unquantifiable.

a) Remove all American treatments, equipment, medicines and innovations from their systems and let's do a comparison. Canadians are getting better rates on American meds than Americans do, for example.  But what do they need those for if their system is superior, lol.

b) Compare SURVIVAL RATES for the afflictions most likely to hit you such as prostate cancer, breast cancer, colon cancer.  America beats European in these measures.

c) Remove genetic and cultural factors if you are comparing health care delivery systems.  The USA is a melting pot.  To compare healthcare systems with a homogenous society like Japan or Norway compare healthcare outcomes of Japanese Americans with the Japanese, Norwegian Americans with the Norwegians, and compare Mexican Americans with Mexicans and African Americans with Africans.

d) The measure the statists always follow with is the percent or number of uninsured which is a healthcare finance outcome, not a healthcare outcome.


"It would be a shame—and I mean that literally—if Republicans repealed the law or if the Supreme Court voided it."

No matter if it violates the constitution?  People like that shouldn't be allowed to vote in a constitutional republic, MHO.


"The U.S. health-care payment system has a few oddities we'd be better off without. For one, the tax code incents employers to pay part of workers' wages in the form of health insurance, which is why insurance became tied to employment in the first place."

Repairable without Obamacare.


"For another, we have somehow decided that the state should provide anyone age 65 or older with health insurance, while everyone younger should fend for themselves."

No one is denied healthcare.  The argument is over payment systems.


"Now the big question: Does anyone think it is sensible to have nine lawyers decide what sort of health-care payment system the nation should have?"

It wouldn't be before the US Supreme Court if Congress hadn't passed and the President hadn't signed a bill that ELECTED officials in 26 states found to be UNCONSTITUTIONAL. That would be a large number of states opposing even if we did have government by majority rule - AND WE DON'T.


"Why does the law require people to purchase health insurance?"

Do you mean why would they do that when they have no power like that authorized to them in the constitution?


"...no question that the federal government can regulate interstate commerce."

And no question Americans have a COMPETING right of privacy in their affairs. Or is there?


"So what happens if the justices void the mandate but leave the insurance reforms in place?"

Why would they.  There is an unseverability clause in the final version. (?) http://www.thepublicinsuranceoption.com/tag/healthcare-reform-legislation  If not, as Justice Scalia suggested, they won't be inclined to go back through 2700 pages not even read by the people who passed it and re-write it.  That is the legislative branch's job.  Looking forward to an improved legislative branch next year.


"I [Alan Blinder] claim no special expertise in constitutional law"

Finally got something right!


"In cases in which there are clear Democratic and Republican positions on an issue—which certainly includes this case—the Court will vote 5-to-4 Republican."

Does that reflect badly on the 5 or on the 4?


"This is another real shame. If we are going to have political decision-making, at least elected politicians should do the deciding."

With no constitutional restraints?  He isn't the first or highest up to regret living in a country where we place constitutional limits on governmental powers.  

[JDN]

One of the individual mandate keys as pointed out in the article is adverse selection.  It's the elephant in the room, but no one talks about it. Actuaries and Underwriters spend millions of dollars devising ways not to cover sick people.  We will never have a "fair" system until this issue is resolved.  If you are young and healthy, you can get insurance relatively cheaply, but oddly enough, this group often doesn't buy insurance.  If you are truly rich, you don't need it; you can self insure or pay any premium asked.  But for the majority out there, people under 65 and not yet eligible for Medicare (isn't that a mandated system?) people who have some medical problem, but were insured at a company for example, if they are laid off, they have no option after COBRA.  Many times, coverage can't be found.  Or if it can be found, the price is prohibitive.  "No one is denied healthcare."  True, after you have depleted your savings, sold your house, maybe declared bankruptcy, no one is denied.  But without money or insurance, you are a second class citizen receiving second class health care.  Good luck. 

Is that right?  Is that fair?

[DougMacG]

The elephant in the room is that they could have written and passed a bill to cover catastrophic injuries and unexpected illnesses in a constitutionally authorized way instead of cradle to grave governing and they would not now be faced with starting completely over - with a new group in power.

[JDN]

The elephant in the room is that they could have written and passed a bill to cover catastrophic injuries and unexpected illnesses in a constitutionally authorized way instead of cradle to grave governing and they would not now be faced with starting completely over - with a new group in power.

Well, if they can find a way to cover catastrophic injuries and unexpected illnesses plus eliminate all pre existing clauses, in an affordable manner for all Americans, why don't the Republicans propose just that?  But they don't...... 

As for the constitutionality of it, what is Medicare other than a a mandated government plan for all people over age 65? 

[G M]

Is that right?  Is that fair?

Is it right and fair to confiscate money from the young to partially subsidize the care for the older population? Is it right and fair to run up a debt that will crush generations yet unborn? Is it right and fair to flood the world with dollars, resulting in crushing inflation that literally takes food from the mouths of the poorest and most vulnerable people on the globe so Buraq can engage in his insane spending?