Obamacare and the Supreme Court

[All-American]

http://www.cnn.com/2012/03/23/politi...iew/index.html

SCOTUS will begin hearings on the constitutionality of the Patient Protection and Affordable Care Act, aka Obamacare, on Monday. There will be six hours of hearings spread over three days. Who ever said law wasn't exciting.

The key issue, of course, is whether the commerce clause allows Congress to mandate a purchase. My guess is it will end up with a 5-4 split, with Roberts, Alito, Scalia, and Thomas on one side, and Ginsburg, Sotomayor, Kagan, and Breyer on the other. I'm not sure on which side Kennedy will vote.

It will also be interesting to see how the outcome affects the political landscape. It's obviously a black eye for the democrats if their signature piece of legislation is shot down. It might not be much better for them if it's upheld and a republican base is infuriated.

[Color Me Badd Fan]

http://www.cnn.com/2012/03/23/politi...iew/index.html

SCOTUS will begin hearings on the constitutionality of the Patient Protection and Affordable Care Act, aka Obamacare, on Monday. There will be six hours of hearings spread over three days. Who ever said law wasn't exciting.

The key issue, of course, is whether the commerce clause allows Congress to mandate a purchase. My guess is it will end up with a 5-4 split, with Roberts, Alito, Scalia, and Thomas on one side, and Ginsburg, Sotomayor, Kagan, and Breyer on the other. I'm not sure on which side Kennedy will vote.

It will also be interesting to see how the outcome affects the political landscape. It's obviously a black eye for the democrats if their signature piece of legislation is shot down. It might not be much better for them if it's upheld and a republican base is infuriated.

My recollection on these kinds of matters is that Kennedy is a conservative. It's the social
issues where's he kind of squishy.

[UtahDan]

Interesting. Kennedy is the new O'connor isn't he? He went with the liberal justices just this week on one of the most important criminal cases to come along in a very long time.

[RobinFinderson]

http://www.cnn.com/2012/03/23/politi...iew/index.html

SCOTUS will begin hearings on the constitutionality of the Patient Protection and Affordable Care Act, aka Obamacare, on Monday. There will be six hours of hearings spread over three days. Who ever said law wasn't exciting.

The key issue, of course, is whether the commerce clause allows Congress to mandate a purchase. My guess is it will end up with a 5-4 split, with Roberts, Alito, Scalia, and Thomas on one side, and Ginsburg, Sotomayor, Kagan, and Breyer on the other. I'm not sure on which side Kennedy will vote.

It will also be interesting to see how the outcome affects the political landscape. It's obviously a black eye for the democrats if their signature piece of legislation is shot down. It might not be much better for them if it's upheld and a republican base is infuriated.

A couple of points:

First, if the SCOTUS rejects Obamacare, we will be back at square one with regard to the country's progress toward universal health coverage. There will be very few options remaining, except for single-payer. Before conservatives get too excited about this 'win,' they should recall that Obamacare represented an attempt to achieve the goal of universal care WITHOUT upending our whole private health care system.

Second, while Obamacare is definitely unpopular now, should it both survive this scrutiny AND be effective, I don't think that its unpopularity will last.

[All-American]

A couple of points:

First, if the SCOTUS rejects Obamacare, we will be back at square one with regard to the country's progress toward universal health coverage. There will be very few options remaining, except for single-payer. Before conservatives get too excited about this 'win,' they should recall that Obamacare represented an attempt to achieve the goal of universal care WITHOUT upending our whole private health care system.

Second, while Obamacare is definitely unpopular now, should it both survive this scrutiny AND be effective, I don't think that its unpopularity will last.

Since Obamacare does nothing to actually reign in the rising costs of health care, square one may be better.

[RobinFinderson]

Since Obamacare does nothing to actually reign in the rising costs of health care, square one may be better.

It might be. But once taxpayers are on the hook for the subsidizing health insurance for a significant number of Americans, I think we might be able to find the political will to control costs better. Getting to national coverage, no matter how it is done, will happen piecemeal, and effective cost control is a piece that hasn't been fit into the bigger puzzle.

[All-American]

It might be. But once taxpayers are on the hook for the subsidizing health insurance for a significant number of Americans, I think we might be able to find the political will to control costs better. Getting to national coverage, no matter how it is done, will happen piecemeal, and effective cost control is a piece that hasn't been fit into the bigger puzzle.

So once we make it so we really can't afford not to make changes, then we will make changes; ergo, accelerate the deterioration. What could possibly go wrong?

Taxpayers were already on the hood for "subsidizing" health insurance when they had to purchase their own. That didn't do the trick. Besides, if the federal government is providing it, 47% of Americans are not subsidizing it. How is THAT going to muster political will?

[ERCougar]

I don't understand the conservative objection to the insurance mandate. Well, on the surface I do, but if you dig a little deeper, it seems to me to be the cost-control measure out there. Once you mandate insurance (and give the penalty some actual teeth), people will migrate to the high-deductible plans that are much cheaper and put cost burdens onto the consumer. The alternative is much worse--single payer with no cost-sharing, leaving all of us (well, the half of us that pay taxes) with "mandatory insurance" where we cover both ourselves and everyone else.. You're fooling yourself if you think the current system can last.

SIDENOTE: Personally, I still really like the idea of medical "disaster coverage" by the government--very high sliding-scale deductible based on income, and leave the rest to the private market.

[Utah ma'am am I]

I don't understand the conservative objection to the insurance mandate. Well, on the surface I do, but if you dig a little deeper, it seems to me to be the cost-control measure out there. Once you mandate insurance (and give the penalty some actual teeth), people will migrate to the high-deductible plans that are much cheaper and put cost burdens onto the consumer. The alternative is much worse--single payer with no cost-sharing, leaving all of us (well, the half of us that pay taxes) with "mandatory insurance" where we cover both ourselves and everyone else.. You're fooling yourself if you think the current system can last.

SIDENOTE: Personally, I still really like the idea of medical "disaster coverage" by the government--very high sliding-scale deductible based on income, and leave the rest to the private market.

Once the government can mandate that the public buy anything, be it insurance or anything else, what's to stop it from mandating the public buy anything else?

The only thing the government should have done to reform health care is to allow insurance companies to sell across state lines and allow the market to work.

[RobinFinderson]

So once we make it so we really can't afford not to make changes, then we will make changes; ergo, accelerate the deterioration. What could possibly go wrong?

Taxpayers were already on the hood for "subsidizing" health insurance when they had to purchase their own. That didn't do the trick. Besides, if the federal government is providing it, 47% of Americans are not subsidizing it. How is THAT going to muster political will?

I just don't think that it is too much of a stretch to think that the half of all Americans who pay taxes (and votes) isn't going to want to control the cost of the health insurance it is buying for the other half of Americans.

[ERCougar]

Once the government can mandate that the public buy anything, be it insurance or anything else, what's to stop it from mandating the public buy anything else?

The only thing the government should have done to reform health care is to allow insurance companies to sell across state lines and allow the market to work.

Um...we are?

The problem with no mandate, as I'm sure you know, is that we've decided as a society not to let people die in the streets. Someone has to pay for that--not requiring people to make their own arrangements is the equivalent of requiring the responsible among us to do it.

[Omaha 680]

Second, while Obamacare is definitely unpopular now, should it both survive this scrutiny AND be effective, I don't think that its unpopularity will last.

[RobinFinderson]

The ultimate cost of Obamacare is hard to quantify. As ER just pointed out, the public already pays a huge cost to subsidize the care of the indigent, who receive most of their primary care in the ER (perhaps the most expensive place to be treated), because that is their only option. We might find out, if Obamacare survives the SCOTUS, that it costs less to provide care for the indigent by treating them through traditional primary care facilities.

[Color Me Badd Fan]

I don't understand the conservative objection to the insurance mandate. Well, on the surface I do, but if you dig a little deeper, it seems to me to be the cost-control measure out there. Once you mandate insurance (and give the penalty some actual teeth), people will migrate to the high-deductible plans that are much cheaper and put cost burdens onto the consumer. The alternative is much worse--single payer with no cost-sharing, leaving all of us (well, the half of us that pay taxes) with "mandatory insurance" where we cover both ourselves and everyone else.. You're fooling yourself if you think the current system can last.

SIDENOTE: Personally, I still really like the idea of medical "disaster coverage" by the government--very high sliding-scale deductible based on income, and leave the rest to the private market.

The irony of it is that conservatives (AEI) in the past did advocate the mandate, but it's the part of Obamacare that may very well get the entire piece of legislation deemed unconstitutional. Mitt Romney pinned Newt Gingrich down on this in one of the debates because Newt himself was one of these advocates before Romney got a version of the law pushed through in Massachusetts.

But the mandate is now a conservative pet issue now for three reasons:

1. It's an easily explainable concept and something that can be trashed by conservatives when it's done enough times, now everyone on the Republican side hates mandates but I've never heard a very good argument why they hate them at least at the state level;

2. It, quite possibly, is unconstitutional because the federal government is forcing people to buy insurance under the clause that allows the Congress to pass laws regulating interstate commerce -- basically affirming the constitutionality of this law under the commerce clause gives Congress some incredibly extensive powers.

3. There's no severability clause in the legislation, therefore if one part of the legislation is unconstitutional, it's all unconstitutional.

You pointed out why the individual mandate is probably the best part of Obamacare. Everyone should get health insurance and it prevents these no insurance, don't pay their medical bill assholes (the ones that voluntarily don't get insurance -- I'm not talking about the people with preexisting conditions) from raising the costs on everyone else. Are conservatives also against the states mandating that people buy auto insurance?

The mandate is the least of Obamacare's problems. The bigger problem is the premium subsidizing for everyone that is 400% of the poverty level and under. But the premium subsidy is constitutional while the mandate is quite possibly not constitutional.

[Omaha 680]

Um...we are?

The problem with no mandate, as I'm sure you know, is that we've decided as a society not to let people die in the streets. Someone has to pay for that--not requiring people to make their own arrangements is the equivalent of requiring the responsible among us to do it.

On a philosophical level I disagree with the mandate for similar reasons as the Il Pad family. On a practical level I disagree with it because the relatively low penalty for not carrying insurance combined with requirement of covering preexisting conditions will lead many to continue to forgoe health insurance until they have a large expense they need covered.