Obamacare and the Supreme Court

[ERCougar]

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.

Right--it has to have teeth or it won't work.

I'm sorry, but I think the slippery slope argument is retarded and could be applied to about anything the government (or anyone else, for that matter) does.

[ERCougar]

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;

2. It, quite possibly, is unconstitutional under the commerce clause 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 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.

Well said.
It gives conservatives an easy point to attack the entire program, which is filled with a lot of counterproductive garbage. I didn't know about the lack of severability--that's certainly interesting.
From a policy perspective, I think it's one of the better ideas out there.

[Omaha 680]

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.

Right. Apart from the constitutional question, the law has huge structural problems as well. The poor will continue to have their coverage heavily subsidized as they do now. So the only real goal of this legislation is draw the young, currently healthy people who could afford insurance but choose not to buy it into the system. I don't know how many people this includes, but I have heard estimates anywere from 20 to 30 million. But the penalty is too low to force them in. They don't have insurance now because they don't want to spend the money. If they are foolish enough to take that risk under the old rules, surely they will pay the penalty (which is much less than insurance coverage and it is questionable how it will be enforced anyway) and then sign up for coverage when they have a major medical issue because the insurance companies are mandated to take them on.

The law as written seems doomed to fail in its stated goals. When you take into account the broad new power it grants to Congress and the nearly unlimited discression it gives to the HHS secretary, it gets worse.

[Color Me Badd Fan]

Right. Apart from the constitutional question, the law has huge structural problems as well. The poor will continue to have their coverage heavily subsidized as they do now. So the only real goal of this legislation is draw the young, currently healthy people who could afford insurance but choose not to buy it into the system. I don't know how many people this includes, but I have heard estimates anywere from 20 to 30 million. But the penalty is too low to force them in. They don't have insurance now because they don't want to spend the money. If they are foolish enough to take that risk under the old rules, surely they will pay the penalty (which is much less than insurance coverage and it is questionable how it will be enforced anyway) and then sign up for coverage when they have a major medical issue because the insurance companies are mandated to take them on.

The law as written seems doomed to fail in its stated goals. When you take into account the broad new power it grants to Congress and the nearly unlimited discression it gives to the HHS secretary, it gets worse.

IMO, one of the biggest problems are group plans where everyone just pays copay for doctor's visits and so forth. There should be a minimum $5,000.00 deductible on all health insurance plans. This should be paired up with tort reform that takes away the drive to engage in defensive medicine.

Oh yeah, I should be able to shop for my anesthesiologist before my wife gives birth to our next baby. I should be able to pick my anesthesiologist before we're in the hospital. It's totally ridiculous that I should pay $1,000 (and supposedly that's cheap) for 15 minutes of that guy's time. I have no bargaining power in that transaction. Sure, it's almost a necessity and of course I'll pay for it, but I'd also be willing to pay $20 for a gallon of milk and instead pay $3.00. $20 gallons of milk arise when there is no competition just like anesthesiologists who charge cash patients $4,000 an hour arise because I can't bring one with me to the hospital.

[All-American]

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.

That half doesn't want to pay for the other half's health insurance, either.

[Katy Lied]

So the only real goal of this legislation is draw the young, currently healthy people who could afford insurance but choose not to buy it into the system. I don't know how many people this includes, but I have heard estimates anywere from 20 to 30 million. But the penalty is too low to force them in. They don't have insurance now because they don't want to spend the money. If they are foolish enough to take that risk under the old rules, surely they will pay the penalty (which is much less than insurance coverage and it is questionable how it will be enforced anyway) and then sign up for coverage when they have a major medical issue because the insurance companies are mandated to take them on.

There is a reason why this young, healthy group of the population doesn't buy health insurance. They don't get sick. They know that any premiums they pay will go to covering the insurance costs of others. It won't be spent on them because they don't get sick. Thus, they will pay to cover our aging rear ends. I dont blame them for not wanting to pay.

[Portland Ute]

Are conservatives also against the states mandating that people buy auto insurance?

Except that the states don't.

There are plenty of people that do NOT own cars. As such, they do not pay auto insurance.

You have the ability to opt out of auto insurance by changing the way you live. There would be no opting out of health care. Merely existing makes you subject to the mandate.

[Color Me Badd Fan]

Except that the states don't.

There are plenty of people that do NOT own cars. As such, they do not pay auto insurance.

You have the ability to opt out of auto insurance by changing the way you live. There would be no opting out of health care. Merely existing makes you subject to the mandate.

How many people do you know that don't have an automobile? Would you support people foregoing the right to enter a hospital to receive treatment and the hospital having the right to turn away people who have opted out?

[Joe Public]

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.

Instead of mandating insurance, would the cost-control factor would be better served by mandating HSA-type contributions for everyone instead of insurance premiums? Require health services rates to be posted, too. Between cost transparency (via posting rates) and cost sensitivity (by requiring full payment from the HSA-type account instead of just a co-pay or similar), market forces should bring costs down pretty quickly. Maybe let people cash out any HSA excess over a certain amount, too, to further incentivize cost scrutiny. Then, the high-deductible government plan covers the outliers.

I'd prefer a more libertarian approach to this, but that's not in the cards. We might as well incentivize people to pay attention to and care about point-of-service costs.

[CardiacCoug]

How many people do you know that don't have an automobile? Would you support people foregoing the right to enter a hospital to receive treatment and the hospital having the right to turn away people who have opted out?

People without insurance are never going to be denied emergency care when they are dying. It's immoral for the libertarians to even contemplate that as part of the solution.

I think it is pretty clear that we either need a market-based system with health insurance used only for catastrophic problems or a single government payer system. I have no problem with an individual mandate because the fact is that anybody could have a heart attack at any moment and it will be treated regardless of their insurance status. So a mandate seems fair.

[Utah ma'am am I]

Right--it has to have teeth or it won't work.

I'm sorry, but I think the slippery slope argument is retarded and could be applied to about anything the government (or anyone else, for that matter) does.

First, I have a nephew who has Angelman Syndrome and I find your flippant use of the word retarded highly offensive.

Secondly, that the slippery slope could be applied to anything the government does is exactly my point. Do you want the government to tell you what you have to buy, be it insurance or what car to drive or how big or small your house is? I'm not sure how you feel, but I don't like government interference in my life.

And where does it stop once that door is open? Requiring birth control to be included in coverage for Catholic owned businesses is a violation of the 1st amendment and that is a part of Obamacare, though a different topic. But as long as I brought it up, is that not a problem?

As I said, the only thing the government should have done was allow insurance companies to sell across state lines. The more the competition, the better it is for consumers.

[wuapinmon]

First, I have a nephew who has Angelman Syndrome and I find your flippant use of the word retarded highly offensive.

Secondly, that the slippery slope could be applied to anything the government does is exactly my point. Do you want the government to tell you what you have to buy, be it insurance or what car to drive or how big or small your house is? I'm not sure how you feel, but I don't like government interference in my life.

And where does it stop once that door is open? Requiring birth control to be included in coverage for Catholic owned businesses is a violation of the 1st amendment and that is a part of Obamacare, though a different topic. But as long as I brought it up, is that not a problem?

As I said, the only thing the government should have done was allow insurance companies to sell across state lines. The more the competition, the better it is for consumers.

The government's been doing this for 100+ years ever since Upton Sinclair put pen to paper. The slope's not slippery.

[All-American]

Of course the slippery slope argument applies here. We are already on the slippery slope. The interpretation of the commerce clause has been broadening ever since it was written, with only a few relatively small bumps in the road (US v. Lopez, for example). It's never been interpreted to allow so much power as this bill claims it allows, and one wonders what Congress cannot do with such a power.

[ERCougar]

Of course the slippery slope argument applies here. We are already on the slippery slope. The interpretation of the commerce clause has been broadening ever since it was written, with only a few relatively small bumps in the road (US v. Lopez, for example). It's never been interpreted to allow so much power as this bill claims it allows, and one wonders what Congress cannot do with such a power.

I obviously can't argue law with you, although it doesn't surprise me the the U of Chicago would hold that view of things.

What government action could we not apply the slippery slope argument to?

[All-American]

I obviously can't argue law with you, although it doesn't surprise me the the U of Chicago would hold that view of things.

What government action could we not apply the slippery slope argument to?

Budget cuts.