Democracy in America

"A Chevy mandate isn't part of a scheme to keep people from suffering and dying."

How does mandating the buying of *insurance* relate to keeping people from suffering and dying? A mandate for buying or selling care might reduce suffering and death, assuming on the margin we're looking at that health care actually improves health.

This doesn't sound perfectly reasonable to me, it sounds reductio ad absurdum to me. We know, and I've blogged about, that we can't generally stop people from buying things and it stands to reason that we can't generally force people to buy things either. But, the fact this generally holds doesn't mean that it applies to everything. We already know that states are rather successful at forcing people to buy car insurance, there's no reason to think this wouldn't apply to health insurance, especially since other countries do this as well. We also happen to know that neither states, or foreign democracies, go around forcing people to buy wheat, or broccoli, or GM autos (well, some dictatorships did make people buy Yugos, I'm not aware of a democracy that has).

So we know people don't actually go around taking things to their logical extremes. So why is it at all reasonable to take things to their logical extremes when no one actually does this? It doesn't actually happen, there aren't instances that can be pointed to. We don't need to legislate against things that people don't actually do. It's like making it illegal to buy all the food in the country as a way to conquer it. We know people won't do this so we don't need to make a law about controlling the entire American food supply to prevent tyranny. We don't need to make checks against government because at some logical extreme with no historical precedent it can do something very silly.

Let the will of the people and the institutional checks and balances do the actual checking, just as the Federalist Papers say. Don't block policies decided upon through the checks and balances set up by the government be shut down because at some absurd extreme it's a bad idea. Go down this road too far and we get an ineffectual government, which is another thing there's no historical precedent for it turning out well.

(the blog post I had in mind was this:
http://tzimiskes.blogspot.com/2010/04/impossible-policies.html )

"Liberals basically have their fingers crossed that the Supreme Court will continue to rule that the commerce clause allows Congress to do more or less anything it wants since more or less anything anyone does or doesn't do has some effect or other on interstate commerce."

such a depressingly honest view of the toilet paper that the left imagines the constitution as.

"A more humiliating reversal for the Democrats is hard to imagine."

Ugh, and humiliating for America. Our government spent a year on this thing.

Does the constitution mean anything? Does the idea of a limited government (a government that has things that it cannot do) mean anything?

We're going to find out whether the idea of constitutional limits on the government is dead, or merely on life support...

forsize:

What's even more depressing is that "liberal" is supposed to mean "one who advocates freedom/liberty". How does freedom or liberty relate to the government requiring/forcing people to buy health insurance?

@Tzi

Your wasting your breath, even I have understood that actual facts and knowledge about the world counts for nothing in this debate.

Sometimes I wish people would stop using the tired old canard of auto insurance mandates, but if that's the best argument liberals can come up with then I'm not worried. Drivers carry required insurance to cover damage done to others, not themselves, for one thing. Furthermore, STATES impose the insurance requirement, not the Federal government, because states license drivers and vehicles. Driving is, after all, a voluntary activity conducted on public property or roads. There is no requirement for licensing or insurance for those who drive only on their private property. In other words, people who don’t drive on public roads aren’t required to buy a license or the insurance. There are other problems with the car insurance analogy as well. Those who do have auto insurance only file claims when significant damage occurs. Auto insurance doesn’t pay for routine maintenance, like oil changes, lube jobs, and tire rotation. That’s why auto insurance is relatively affordable. Also, auto insurance is priced to risk. If a driver lives in a high-crime area, then the premiums will rise to cover the risks associated with theft or other damage. If they drive badly and incur violations and accidents, premiums will go up or in some cases the insurer will drop the driver from coverage. Policies are priced for risk according to age as well. The youngest and oldest drivers pay more due to their propensity for causing losses. Those who drive well and present a lower risk get rewarded with lower premiums. Right now, the federal government is preventing insurers in some instances from risk-pricing health insurance to impose government-approved fairness. That means we all pay more, removing the incentive to lower risk. What if we used another analogy, that of fire insurance instead? If we forced insurers to write comprehensive policies on burning homes, we would have no insurers left in the market. However, Obama apparently wants health insurers to do just that.

If you think spreading money around by force seems like an odd definition of fairness, you're not alone. - Arthur C. Brooks

Tzimisces

The entire logic under which NOT buying healthcare affects interstate commerce is reducio ad absurdum.

I must (1) get sick (2) go to a doctor (3) be unable to pay.

Otherwise my having insurance is immaterial. Now one can argue that those conditions are fairly common. That is probably correct but it doesn't mean that the entire argument FOR the mandate is not obtuse.

Now of course the SCOTUS can just rule that Congress can do whatever they want and so it's immaterial. But if we're going to use a number of steps/conditions as justification for something than there is absolutely NO reason that it could not be done for, to use the overwrought example, broccoli.

This is a fascinating ruling that may significantly affect the course of this battle as it winds its way through the courts.

The health care industry differs from transportation, food, or any other industry in a hugely important and unique way. The providers of health care CAN NOT refuse to "sell" their product (medicine, health care, whatever you call it), even if the "customer" is penniless. We have private health insurance, medicare and medicaid in America to attempt to pay for the health care of every citizen. Medicare and medicaid obviously are paid for by tax revenue, but only available to specific demographics. Private insurance is extremely expensive for most people and insurers have historically been allowed to refuse coverage to consumers that they know will cost them profits.

Citizens outside the demographics of medicare and medicaid have no recourse if they are refused private insurance. Eventually health care costs will bankrupt them and they will be able to receive medicaid. Frankly, this is stupid.

Obama-care is a poor solution. Private insurers are required to cover people with preexisting conditions, which will cost them money, and people without insurance will be required to buy it. The basic change is that healthy people will pay for unhealthy people who were without insurance.

In a broad sense, this is like a tax. A tax that is collected private companies attempting to make a profit.

The cost of health care is generally caused by highly irregular, random accidents. It is high enough that almost any one individual would be unable to pay for their own emergency treatment without insurance, but of course low enough that with insurance mechanisms in place, it can be provided to those in need.

The problems with this system are several, but two in particular irk me: One, that the rich get by far the best deal: the "tax" of mandatory insurance is extremely regressive. Everyone generally pays the same amount for the same sort of coverage. (My open political jab: proof that the GOP care about no one without money to give their campaigns). Two, the poor will continue to receive the worst health care. The poor and working class (as much as the bottom 60% of the population given how expensive any sort of health care is) will continue to face decisions about paying for non-emergency care. Even though successfully preventing a health problem is always incredibly efficient, a huge segment of the population will suffer worse health simply for a want of care.

The sensible solution is to pay for health care for everyone with taxes. Get rid of profit-seeking insurance companies. Their profits compared to a tax-funded system are pure rent. The total cost to the economy will go down even without considering the savings from having universally affordable preventative care.

WW's argument is facile. Health care is not in the least bit equivalent to wheat or GM cars, because every American is already guaranteed a certain level of health care (via emergency rooms, Medicaid) which our society has democratically deemed necessary for its basic integrity.

So the health care mandate is philosophically equivalent to the mandates which already compel children to get a primary and secondary education, compel people to pay taxes, and compel people in times of war to join the military, all quite possibly against their will. There are certain basic services that our society has determined to be of a fundamental, communal and universal nature, in which all must therefore participate. Without these, America as we know it ceases to exist.

So this rises above the level of the commerce clause, and should not be thereby judged. This is about the social contract itself.

I agree completely with one of Io Triomphe's points: the tax deductibility of health insurance subsidizes the wealthy to buy more expensive insurance, driving up prices. Repealing the deduction would drive down prices, making insurance more affordable for all, while also severing the link between employment and insurance. After that is done, we can assess what further changes are required.

@typingmonkey

First, it’s not WW’s argument, its Judge Vinson’s. But to muddy up your analogy, while everyone is required to get an education, the level of education they desire is up to them. Some people get Ph.D’s, others stop after receiving a high school diploma.

Similarly with health insurance, some people may need expensive plans that cover all expenses above a $20 deductible, while others would be satisfied with something that covers individual expenses above $500, and annual expenses above $2,500, with everything else out of pocket. As long as you aren’t imposing your health care costs upon others by your inability to pay, you should be allowed to purchase whatever level of coverage is appropriate for you.

I think it might be worthwhile to bifurcate health insurance that covers large, catastrophic expenses from that which covers small day-to-day appointments.

I am sympathetic to the ACA's aims (though I would actually prefer the unquestionably constitutionally-sound idea of simply taxing people and providing healthcare directly from the government rather than this convoluted subsidy to private insurers), but I do find it hard to locate the authority for the individual mandate in the constitution. The metaphors this judge emnployed were clearly hyperbolic (as Io Triomphe nicely said, the health market is unique in that sellers cannot refuse to sell their services to those who cannot afford them, making the effects of the uninsured on the national health marketplace markedly stronger than in either transportation or food; just try going to a grocery store with no money), but given the direction of recent court decisions I get the feeling that the individual mandate will be stuck down.

My question is about severability then. The individual mandate is paired with the requirement that insurers accept those with preexisting conditions, but it seems periferal to the expansion of medicaid and the literally hundreds of pilot programs designed to study cost reductions. Is it possible for the judge to nullify both the individual mandate and preexisting conditions pieces of the law while leaving the rest? Thanks,

woops. my apologies for a lack of copy editing. To wit: "employed", "struck", and "peripheral".

"There are certain basic services that our society has determined to be of a fundamental, communal and universal nature, in which all must therefore participate. Without these, America as we know it ceases to exist."

Since the U.S. spent the first 233 years without a federal mandate to purchase health insurance, does that mean that America, as we know it, ceased to exist at the moment of it's founding?

I can't say I disagree with the judge. The mandate was necessary for the route that the ACA went, yet it was a sub-optimal and convulted route in the end. Part of this was the Dems fault and the Repubs deserve a fair heaping of blame as well. At the end of the day, whether or not health care is a unique market, the Federal government mandating that I purchase something appears to my layman eyes to be unconstitutional.

DoubleH,

Auto insurances use as a means to protect the other doesn't strike me as terribly different from forced pay insurance that keeps someone paying so that they don't become a public burden when they do get sick.

Io T:

Since you shared your two complaints.. Mine is that much like the financial services we have gone the route of privatizing the profitable part of the system and socializing the unprofitable part. The private system doesn't want old people, sick, or poor, they don't compute in the spreadsheets. So instead we put all those people into medicaid and medicare. The healthy people with incomes, however, we send to the private sector. It's a neat game, but not one I lay at the feet of either party. It's just something everyone seems to like.

Io Triomphe

Healthcare providers can ABSOLUTELY refuse services. It happens all the time. Emergency rooms and other certain federally subsidized facilities must treat all comers but not individual providers. Slavery in the US, unlike Europe, has been illegal since the 1800's which is what uncompensated demands for work is usually called.

Tzimisces wrote: "Let the will of the people and the institutional checks and balances do the actual checking, just as the Federalist Papers say."

The institutional checks and balances described in the Federalist Papers have been seriously eroded since the Progressives first came into power. That's ultimately what this is all about; does Congress have limits on its power or not?

You worry that if the Feds are stopped from centralizing ever greater amounts of power in Washington, that we'll end up with an ineffective government and American civilization will slide into irreversible decline.

If that's true, then how did our nation survive to become the most powerful empire the world has ever seen? Back when the Feds only concerned themselves with their *specifically enumerated powers*, if you're theory is correct, we should have been "stagnant" at best, or in rampant decline at worst.

Your underlying hypothesis is clearly incorrect, at least as far as this country's history is concerned. It's just an erudite way of framing the old progressive argument that big government is the only way to solve society's ills, despite mountains of evidence to the contrary.