Supreme Court and Obamacare
For a long time I've been conflicted over the issue of Individual Mandates and Obamacare. Over the years I've transitioned to a view that Healthcare should be provided to all citizens, regardless of their ability to pay, but I have never been sure of the best way to provide it. But I also believe that Free Market should be a part of any solution, followed by extra money equaling better care. Single Payer in my mind is a Big Government solution that tramples on the Free Market and its implementation in countries like Canada leave a lot to be desired.
There are other options of course that provide Healthcare for all, without being Single Payer, in Civilized countries, but I do not know which route is best.
And so with good intentions I've been supporting the principles of Romneycare and Individual Mandates as the best potential solution for the problems we face.
Now, after listening to the Supreme Court arguments today I am even more conflicted over this issue, and am much more negative towards the Mandate to buy insurance. I think the arguments/questions/points Conservative Justices made were persuasive.
What were your thoughts? Which solution would you prefer? Do you think that we have a duty to provide Healthcare to all?
I was also negatively affected by the liberal justices disinterest to looking at the constitutional problems of this Law. They seem to have no problem at all with increases in government power.
Submitted by Ender on Tue, 2012-03-27 15:53
Comments :
Sorry. I didn't see your post
until after I made a blog entry. I guess my blog entry is my answer. ;-)
That's because it isn't an increase in government power
the conservative justices would have no problem if there was a tax deduction for purchasing health insurance. Same effect, different mechanism.
Why don't you guys mosey over to the forvm to discuss this, the echoes aren't quite as loud ;)
I find the forvm hostile
and nasty from too much partisan bickering, which has simply embittered people. The few of us who drop now and then are far more cordial and generally avoid the role-play bickering akin the cross-fire.
Mechanism matters
The "how" matters.
Or, in a phrase from misty musty history, the end does not justify the means.
Intelligent, rational people who support the ends can still be horrified by the means. This is indeed an attempt at an unprecedented increase in government power: the creation of an entirely new category of things the government can make a citizen do. Being unable/unwilling to acknowledge this fact is disingenuous, regardless of one's position on the problems the bill attempts to resolve.
I've registered at the forvm and browse it on occasion. You have some really good writers there, and an interesting mix of posters, but there doesn't seem to be much room for discussion. Role-play bickering is a great descriptor; exchanging talking points gets old pretty fast, and once you get past the "gotcha!" thrill it's intellectually vapid.
Not that this place is a hotbed of activity, of course :-)
Well said.
The "HOW" does indeed matter. And I agree 100% that dancing around the constitutional legality of a law simply because one supports the ends in some in way is very disingenuous and that's exactly what I see from the 4 lefties on the court.
It's easy to reason by absurdity
The mandate sucks. It will do nothing but make healthy people grumble at having to pay overpriced premiums to greedy insurance companies. You want folks to pony up for the common good, you do it through the tax code with its built-in means testing. I'm conflicted about whether I actually want the mandate struck down (not the rest).
Single-payer works. This can be proved by using any objective and comprehensive measure of performance with any other advanced country. Maybe it's the simplistic belief in American exceptionalism that drives this notion that we should ignore all the data around us.
The US government already spends more per capita on healthcare than Canada or Britain, despite providing far less coverage. "Big Government" haters who want to actually prevent poor sick people from dying prematurely have a great opportunity to shed the blinkers and kill two birds with one stone.
What problem are we trying to solve?
Do we have a duty to provide healthcare to all?
I can't help but apply my background to this kind of issue. Once a strategic project manager, always a strategic project manager I guess.
I have to make you drill down: First, what is "healthcare"? When you ask if we have a duty to provide it, what is the "it" exactly? What problem, exactly, are we trying to solve?
The problem that not enough people buy insurance? If that is the case, then you have to show a direct causality between the purchase of insurance and the "it" we think we have some duty to provide. Can we, empirically, demonstrate that having insurance *on its own* is the complete solution to the "healthcare problem"? In other words, is there data that says the mere fact of having insurance actually "provides healthcare" to such a degree that justifies the perpetual establishment of the bureaucracy and police powers needed to make sure that 300 million people are consistently and without break covered by insurance, regardless of the cost of that insurance?
If one says "the problem is not enough people have insurance" then one is really saying that there is no other structural or systemic problem within the healthcare delivery system. It's another way of saying that the current system works perfectly, just not enough people get to take advantage of it.
The only people who believe that are people who've had no experience within the system. IMHO. I just had an MRI on my slightly-separated shoulder. The billed cost for just the MRI (not the reading, nor the orthopedist) was over $3100. Given than something like 25% of the population has an annual household income of less than $25,000 per year, is it reasonable to assume that the "average citizen" could fork over more than 10% of their annual income for this kind of rather routine sort of health care?
The problem is that taking responsibility for routine healthcare issues is bankrupting average people. One heart attack, one stroke, one bad automobile accident, and you are toast, now and forever. You will be in hock to the medical system until the day you die. They will take every asset you have built up over the years and destroy any plans you had for a reasonably self-reliant future. And you cannot avoid the cost. If I were to have a stroke in a public place, and someone called an ambulance, could I refuse the care, knowing that I have no hope of paying for it? No.
Government CAN fix that. Creative thinking can fix that. Technology can fix that. Relying on antiquated paradigms for healthcare delivery will never fix that. The data is out there, but is there much analysis? No. Analysts don't have lobbyists. And the lobbyists write these bills. The Guilds are in charge, not the citizenry.
So, to circle back to your question: do we have a duty to provide healthcare to all? No. We have a duty to ensure that marketplace regulation does not actively impede the delivery of adequate healthcare to the average citizen.
Objectively,
I agree that the conservative case for the unconstitutionality of individual mandates is pretty strong.
As a practical matter however, I think that the Obamacare mandate may be effective.
If the mandate is struck down, it would not be the first time that the correct decision in the law was not the most beneficial decision for the people-- for example, Kelo and Citizens United were both cases that I think were probably correctly decided, but as a practical matter I would have liked both decisions to have gone the other way.
In many ways, the fault lies with the Constitution itself. I agree with Ruth Bader Ginsburg that if you were starting fresh, our Constitution would not be the optiomal model to use as a starting point.
skymutt: accept no substitutes!
I disagree, skymutt.
The Constitution is an important thing to start from when developing poilcies.