So is this what the wingnuts are blabbering about when they insist healthcare isn’t “in the constitution?”

They’re actually referring to a mandate to buy health insurance?

If it’s a mandate to buy into co-ops like Massachuseutt’s: yeah, bad idea. Apparently, that has been a boon to the health insurance companies, and the premiums charged are some of the highest in the nation, and there have been no “healthcare savings” otherwise.

So yeah, mandates are scary and stupid (and unconstitutional?) if it’s Milt Romney care, without a viable public option.

So does that mean the requirement to buy auto insurance in almost all of the states in the US is also unconstitutional? 

I know that health insurance and auto insurance are not the same thing. But if the state can make you buy one type of insurance, surely, it can force to buy another type of insurance. 

Besides, private businesses require people to have insurance before purchasing products or services.  Try getting a mortgage without having applied for homeowner’s insurance.  Some landlords require their tenants to have renter’s insurance.  And try renting a car without auto insurance.  Wouldn’t that violate a constitutional right to be free from insurance?

Hmmm, it appears the authors found a new constitutional right, freedom from insurance.

phinky—that misunderstands their argument, which rests on differing powers between the Federal and State governments.  They’re very stupid, but they’re not that particular kind of stupid.

The academic literature on the commerce clause is very interesting.  The argument I find most persuasive goes as follows:

If the federal government can force Americans to buy a particular product under threat of a tax penalty, then there are essentially no limits on the federal government’s power.  The purchase and sale of any product will, in aggregate, impact interstate commerce and can therefore be compelled by the government.

Indeed, it’s hard to see the point of the non-commerce clause powers of Congress; Congress would have the power to establish a post office, create bankruptcy law, or establish patent law under the commerce clause according to modern jurisprudence.  We are thus left with the conclusion that the modern “anything goes” interpretation of the commerce clause is wrong, or the drafters put in a bunch of clauses that don’t mean anything.

The modern interpretation also leads to the rather perverse result that clauses granting power act as limitations—as noted, absent the bankruptcy clause, Congress would surely have the power to enact bankruptcy law under the commerce clause.  Yet, because the bankruptcy clause says the laws must be “uniform,” Congress is more restricted than if the clause never existed in the first place, an utterly perverse and nonsensical result.  Similarly, copyrights have to be for a “limited time” under the IP clause; yet, if that clause didn’t exist, Congress would be free to make them for unlimited duration (granted, the limited time clause is also essentially toothless).

Therefore, the correct interpretation of the commerce clause must be much more narrow than it is currently.  To the extent federalism isn’t already dead in America, giving the government to force Americans to buy a particular product is the death knell.  At least with auto insurance or growing wheat, you have a choice to not drive a car or not grow wheat.

Phinky, no state requires you to buy auto insurance.  Most (all?) states require you to either buy auto insurance or demonstrate proof of financial responsibility if you own a car.  What would the parallel with health insurance be?  I have opted out of the auto insurance regime by not owning a car (granted, that’s easy for me to do since I live in NYC), but how would I go about opting out of the health insurance market?

What IS the authority of the Federal Government to require an individual to purchase health insurance?
I understand the automobile insurance issue. Driving is a privilege, not a right. In order to use the privilege, one must purchase insurance, register the car, and keep the vehicle maintained to a certain level of safety standards. If health care is a right, then it should be funded by taxes, as opposed to individual fees, such as insurance. I’m trying to think of other rights we have that require an individual fee to exercise. I don’t recall an “unreasonable search and seizure” insurance policy being required.
However, I know that “peaceful assembly” can require a permit. So, there are mixed signal here. Is this a case of the difference between “negative” rights and “positive” rights? As has been said in Star Trek,
“Dammit Jim, I’m an engineer, not a constitutional scholar!”.

I think of it as taxation without representation.  I have no control over who’s running a health insurance company.  I don’t get to “vote the bum out” unless I’m a major shareholder.

<blockquote>of course the ever popular counseling.
2) COunsel people the higher the deductible,the lower the premium. </blockquotq>

Which is it?  Counseling or no counseling?

And, of course,  mental health is just bullshit so counseling shouldn’t ever be covered.  Tell that to our soldiers returning home from Iraq and Afghanistan.  Oops, we already have.  That’s why they’re killing themselves in record numbers.

Tort reform?  That’s your answer?  FUCK YOU, YOU SOULLESS MOTHERFUCKER.  Lawsuits are demonstrably not the cause of high health care.  More than that, when you have a state like Alaska that has every tort reform imaginable, you have the HIGHEST nursing home care costs.  And people have no recourse for malpractice.  There’s no reason to provide the best care b/c there is no consequence for failure.  It is cheaper to pay out a cheap tort case than to provide better care.

Let’s not forget a huge reason for large awards—the necessary future medical costs.  If medical costs were socialized, people wouldn’t have to sue to try to get the care they or their loved ones need.

As for chiropractic?  Works better for migraines than drugs.  Wisconsin tried to prove otherwise so they wouldn’t have to cover it, but ended up doing the study twice b/c it shows more people (95%!!!!) are helped by chiropractic.

But it’s better just to let other people die and suffer than to cut into the profits of the insurance companies.

Hey, corwin, tell me one benefit insurance companies provide.  What do they do to help medicine?  What do they do that’s worth the BILLIONS they suck out in “profits” by failing to pay for claims?

Health insurance is not like auto insurance or home owner’s insurance.  My home owner’s insurance doesn’t pay for in-network fire departments to put out fires or refuse to pay for out-of-network police to patrol the streets.

We have a centralized government and socialized services because they WORK, and when they work, they work BETTER than the free market. 

Be honest, corwin, the free market has no place in health care.  Who spends three years saving up so they can have an emergency appendectomy?  Why should the rich be allowed to live while the poor suffer and die?  That is what we are talking about.

Vaccines?  EVERYONE benefits from vaccinations.  If only the rich kids are allowed to be vaccinated, polio and worse would run rampant again.  How is that good for anyone?

Same with for profit fire departments.  If the fire department only comes out if you can pay them up front, then other houses are likely to be burnt down in the mean time.  It’s stupid.  That’s why we socialized it.  Same for the cops.

I don’t want to live in Somalia.  I’d like my country to join the rest of the industrialized world and stop fucking its citizens over so a very very few can be ridiculously wealthy while the rest of us are treated to a guilt trip for wanting to be able to STAY ALIVE WITHOUT GOING BANKRUPT or WANTING TO START A COMPANY or CHANGE JOBS but can’t b/c of the current unsustainable health care system.

Actually, corwin, the easiest way to make health insurance cheaper is to make sure only those who don’t need it are allowed to purchase it.  That way the cost for care the insurance company pays for is little to none, ideally none, and therefore the premiums can be kept low and yet the insurance company will still be profitable.

Of course, if the company guesses wrong on whether someone will have low health costs, they can always rescind the customer’s coverage, even retroactively, and abandon the customer to his/her fate.

And all of this would be Constitutionally legal!

The customer saves money, the insurance company is profitable, and all is well with the world.  Let’s face it, if you get sick, it’s your own damn fault anyway, so you don’t deserve any health care.  Just like those dirty sluts who get themselves pregnant, those Americans who are crass enough to get sick deserve to stay sick, and feel the full measure of god’s judgment against them…

I can’t imagine what any possible downsides to this might be, so there must surely not be any, right?...

As i recall, corwin, the government program that was predicted to be relatively inexpensive but led to our deficit was a program to go in and destroy a foreign country and kill a bunch of people.  That kind of deficit spending wasn’t even questioned.  But now we’re losing several times the number of people killed on 9/11/01 simply because they can’t get medical coverage, and NOW we are supposed to be worried about the cost??

I don’t know about your particular politics, and maybe you’re as anti-war as we are, but unlike the Iraq war, we have the demonstrated fact that people are dying and we have a plan that will actually prevent these people from dying.  That you would rather let them die proves that you are a sociopath.

A few days ago, a health insurance CEO was on NPR whose company was paying $5 million to lobby congress against health care reform.  It would have been nice if someone asked this exec how many major procedures they had to deny so they could afford these costs.  Medicare overhead is 4%, insurance company overhead is something like 30%.  It sounds like someone is doing the better job.

I have no problem with lying relentlessly on revenue neutrality.  The bozos who are going on and on about it had no trouble borrowing a trillion dollars to go to war in Iraq so Bush could work on his daddy issues.  Obviously, they’re lying about caring.  So we can lie about it being revenue neutral, and things can cancel out.

The insurance companies are spending $100 million plus to lobby Congress, which is a clear sign that they make way too much damn money if they have that kind of cash available.

So does that mean the requirement to buy auto insurance in almost all of the states in the US is also unconstitutional? 

I know that health insurance and auto insurance are not the same thing. But if the state can make you buy one type of insurance, surely, it can force to buy another type of insurance.

I don’t know about the constitutionality of any of this, but there’s a massive difference between a mandate to buy auto insurance and a mandate to buy health insurance.

I can choose not to own an automobile, and thus not have to purchase auto insurance.

I don’t really have a choice about having a body.

One other thing on the auto insurance deal… many states don’t require auto insurance, for example, if you are extremely wealthy.  But in those cases, you must maintain a reserve of cash that would equal at least the mandated state minimum coverages.  Basically, you act as your own insurance company.

Not that I think Corwin is someone who will care about this, but just in case others are doing some at-home head-nodding to the evaluation of the worth of counseling posted above:

The science is firmly behind mental health counseling, when practiced using empirically-validated methods, as a way to boost immune system functioning and increase treatment retention in patients having difficulty during treatment for non-psychiatric illnesses. For example, I have a practicum at a cancer center where counseling is offered to patients with the understanding, based on clinical research, that mental health support for many patients will help them to complete very difficult treatments (like chemo and radiation) that require some degree of self-motivation and that can be extremely painful and frightening without producing a positive result that a patient can immediately see. Those who are suffering from adjustment problems to having been diagnosed with a serious, life-threatening illness will have less functional immune systems and be more vulnerable to infections while weakened from symptoms of illness or side-effects of treatment, and short-term counseling interventions are an effective way to ameliorate this problem.

Moreover, and just as importantly, counseling can be very effective in treating many psychiatric symptoms, especially depression and anxiety, and time after time studies show that counseling for these problems works more efficiently than drug therapy alone. That means less time off of work and less $ spent on often-expensive medications (and more importantly, less suffering).

Of course, counseling also eats into the profits of pharmaceutical companies, so I can see why the idea is promulgated rather freely that it is a waste of time and money.

And if you think counseling is “ever-popular” you are ignorant of the general stigma against those who receive counseling, and hence the resistance in the public to seeking mental health treatment, even when it is desperately needed, and - more importantly - you have no clue how difficult it currently is to get insurance companies to pay for counseling. Inadequate mental health treatment (and, I would add, outrageous lack of coverage for substantive treatment approaches to addiction) result in a very large group of people who end up very sick, unable to work for large periods of time, prone to financially and psychologically devastating (and potentially deadly) mental health emergencies, and dependent upon charity to meet basic needs.

I should know. My family has been sent to the brink of financial ruin because my husband was unable to get the counseling he needed while he was only moderately depressed and spiraled into a severe, and so far intractable after 2 years, psychotic depression. That has, believe me, resulted in greater strain on public services such as state and federal disability. (and it makes me feel a little ill to boil a heart-wrenching human tragedy down to how much $ it costs the public to give a shit about someone whose life it should already value)

And herein lies the central part of the problem with health care debates: people who feel they ought to have their opinions taken seriously about life-or-death public policy issues, even when they have not bothered to do any real research in the process forming those opinions. Opinions that are built on fairy dust and moonbeams are taken just as seriously as the opinions of people with real knowledge of the field in question.

(sorry, I don’t usually use such clinical language about people seeking mental health counseling, I’m just using the terms one would find in the scientific literature since my point is to describe what is said in the scientific literature; nor am personally arguing against the use of treatments that are not empirically validated in all cases)

Sorry, I think I got sucked into a thread jack. I apologize.

I am worried about mandated health insurance if there is nothing to ameliorate increased costs for low-income people. The bill may not pass with any reliable controls on the cost of premiums, especially for people with pre-existing conditions, and that means a mandate could be financially devastating. Even with subsidies, I guarantee you there will be people on the cusp of whatever cut-off point they pick who are screwed by such a policy. And many people cannot afford any increase at all in their monthly budget right now.

I live in a country that mandates insurance coverage.

Some people still don’t buy insurance. 

There are no penalties as long as you don’t try to sign up later.  If you do, then you’ll incur a bill for 2 years of premiums.  That’s all.  It’s a lot—on my lowish salary it would be around $4000—but you can negotiate with the city office and try to get it reduced or get a payment plan installed to make it manageable.  Basically they just want you to pay at all rather than not pay anything. 

Of course, now the government is trying to make sure all the wascawwy fowweigners (the legal ones) sign up for insurance by holding their visas over their heads.  I wonder if they’ll figure out how to force the actual citizens to sign up for it.  I could go on some kind of ranting diatribe about the unfair treatment and xenophobia and so on, but I’ll leave it at that.

I like my mandated coverage.  I got a wisdom tooth pulled for less than $50.  In the US it was $750 because our dental insurance topped out at $1000 and I’d already needed a root canal.  And that was back when my insurance was based on my previous year’s income of 0.  So I was paying about $10 a month for health insurance.  Now I pay about $200, which slightly sucks.  But better than paying a lot for nothing, better than having nothing, and better than paying a lot for the same kind of coverage.

Here’s the thing:

On the one hand, it looks like there might actually be a point to that argument.

On the other hand, the prospect of the wingnuts wanking themselves rigid about it, sliding the constitution up and down their straining micro-penises, is really unappealling.

The answer, or course, would be to tax everyone and pay for health care through taxes - single payer.  But, apparently, that’s off the table.

I am worried about mandated health insurance if there is nothing to ameliorate increased costs for low-income people. The bill may not pass with any reliable controls on the cost of premiums, especially for people with pre-existing conditions, and that means a mandate could be financially devastating. Even with subsidies, I guarantee you there will be people on the cusp of whatever cut-off point they pick who are screwed by such a policy. And many people cannot afford any increase at all in their monthly budget right now.

That’s exactly how I feel.  It doesn’t help that a lot of people (including far too many liberals) believe that uninsured people have plenty of money for insurance but selfish spend it on cell phones and bling instead.  A mandate to buy private insurance will hurt a lot of people and not help currently insured people as much as they think.  The uninsured add 8% to the cost of the average premium.  8% isn’t nothing but it’s not cause to think that mandates will magically make insurance affordable.  Mandates are to many on the left what tort reform is to the right.

And herein lies the central part of the problem with health care debates: people who feel they ought to have their opinions taken seriously about life-or-death public policy issues, even when they have not bothered to do any real research in the process forming those opinions. Opinions that are built on fairy dust and moonbeams are taken just as seriously as the opinions of people with real knowledge of the field in question.

Not just the health care debates either.  Name any issue and you have the problem of moonbeam and fairy dust people being given equal time - shit, more time in many cases - to people who have science and facts behind them. 

I’m so sorry about what you and your husband went though.  Shameful.

I like the smell of this. 

They’ve tried lying, and that has only worked a little.  They’ve tried saying that the very concept is immoral, and that’s only worked a little.  Obama has done his best to water down his own stated vision until there’s next to nothing left, and yet the plan still breathes.  Blue dog Dems have done their usual job of pissing left and kowtowing right, but still the plan breathes.  The GOP have come out and said all they want to do is kill it, and yet the plan still breathes.

So out comes the next part of the backlash: FDR-era allegations that the very idea is not only wrong but UNCONSTITUTIONAL in the way that everything that helped the poor and only slightly burdened the rich was under the New Deal.  And we all now that they will say what the plutocrats in the 30s said: that unconstitutional is the same is illegal is the same as criminal.  And that reliable smiling whore the Post trots out the argument for them, testing the air if the public will sniff in the smell of lies and think it is roses.

This article makes me surprisingly happy.  It makes me think that despite everything going their way thus far they are worried and are having to reach into their last cartridge box early.  The rich scum of the 30s waited until it went through the system, then sandbagged it in the winner’s circle and had their bought judges proclaim the win to be forfeited loss for breaches of magic rules.  They had the patience and the strength, and they still lost.  But their inheritors are reaching early.

They’ve still got the last card, though. Will the FBI or armed services produce a new Smedly Butler?

What Caren said. Health insurers are parasites, and a mandate without a public option (or the kind of heavy, heavy regulation that exists elsewhere) is state-sanctioned extortion on behalf of parasites. Even if it’s constitutional, it would be immoral, and I’ll not pay a red cent of it.

I just went back and read my own post and pondered one uncomfortable truth:
There’s a point where anybody who isn’t of the right and who is well versed in history is tempted by the linear appeal of Leninism: It will take decades or centuries to convince people, and we don’t have that time and they won’t be convinced anyways, so why not just wipe them out and be done with it?

It doesn’t work, of course, and that way madness and murder lies.  But one is tempted.

In touring blog land, I’ve seen many discussions concerning rights. I think one doesn’t need to spend too much time to find arguments that health care should be a right. There have been proposals over the years for the idea of a “basic citizen income” or equivalent concept where a citizen would get a monthly stipend sufficient for a modest lifestyle, including food, shelter, and healthcare. This monthly stipend requires nothing in return, no work requirement, no showing up at the welfare office, no drug test, nothing. How could such a system work, with no requirement that an individual contribute back? This question came up in relation to a discussion about the Constitution, in that no where is it required that a citizen work.

What Caren said. Health insurers are parasites, and a mandate without a public option (or the kind of heavy, heavy regulation that exists elsewhere) is state-sanctioned extortion on behalf of parasites. Even if it’s constitutional, it would be immoral, and I’ll not pay a red cent of it.

It is and it’s like beating one’s head against the wall trying to get mandate-supporting liberals to see this.  They just respond with the same talking points:  “It won’t work unless everyone is covered.  People will wait until they are sick to sign up. And there will be subsidies to help people pay the premiums!”  I patiently explain them them that I understand how risk pools and adverse selection work so I don’t need that explained to me.  I’m all for taxing everyone to get universal coverage through the state.  I don’t want to be forced to subsidize the parasitic health insurance cartel, whether or not I personally get help from the government to do so.

The uninsured add 8% to the cost of the average premium.

I have to wonder what percentage of the average premium goes straight to the executives or the stockholders?  What percentage of the average premium is straight profit?

And what percentage of the average premium pays the salaries of the people who deny claims?

Kyra, I guess that all goes in the 30% figure typically touted as the cost of overhead.

I don’t know if it is constitutional to require every single person residing in the US to purchase a hamburger from large corporate hamburger chains or to require people to purchase anything from a private for profit corporation. But I know for sure, I don’t think it should be constitutional.

If you want something mandated, if it’s important that everyone have it, then we have something called “government.” They might want to check that idea out.

What’s more important is this is a mirror of the Mass plan and if our experience here in Mass is any indication, it’s not going to truly work. It may help a lot of people, but it’s not really changing anything. It may cover people on paper, but it does little to solve the reasons we want everyone covered in the first place. It doesn’t reduce costs in any way shape or form. It doesn’t protect people from bankruptcy because there’s still large deductables. And it doesn’t even cover everyone because you still get a percentage of people for whom paying the tax penalty is cheaper than obtaining insurance.

As the Congress and President have no intention of working on real health reform, they should instead abandon most of the plan and work on some basic insurance reforms to keep us staggering forward until such a time as we have real leaders who will work for a real single payer public health system.

There are a bunch of things in the current plan that will make insurance companies significantly less parasitical if they survive to enactment: no rescission, no pre-existing condition exemptions, no cherry-picking on premiums.

Of course the insurance companies will find other ways to screw people, or will just ignore the new law, but that way lies the problem of making themselves even less popular than they are today.

Funny thing is—a single payer system, financed with tax dollars would unquestionably be constitutional, becaue the federal government’s spending power is its broadest power, extending to anything that promotes the general welfare.  But the power to regulate is more closely constrained under the Constitution than the power to spend money—although the power to regulate interstate commenrce has been interpreted quite broadly over the years.

There’s such a huge difference between paying premiums/taxes for single-payer health care and paying premiums to an insurance company that they’re two completely different animals. 

With the the first, you pay a premium/tax and you get the health care you need. 

With the second, you pay your premium and a middleman decides if the company is going to uphold your contract.  If they aren’t, good luck suing to get what you paid for - if you don’t die first, that is.

We don’t need health insurance, we need health care.

I just another commercial saying that we need health care reform, just “not so fast” (it’s the one with red balloon; I think it’s put out by the National Chamber of Commerce).  It makes me crazy - if health insurance worked all that well, especially after eight years of no oversight, we wouldn’t be in this mess, now would we?  I can’t believe that argument is actually being made.

Sorry… I know I’m preachin’ to the choir here, but people like corwin make me so angry.  They either just don’t get it or are too selfish to get it, and I don’t know why the media gives opinions like that equal time, as if they were credible arguments.