Breaking: Florida Federal Judge Rules That Obamacare is Unconstitutional
[Guest post by Aaron Worthing; if you have tips, please send them here.]
Update: My promised analysis of the opinion is here.
And if David Weigel is right, it was the issue of severability that bit them in the keister. That means the entire law is declared unconstitutional, at least in that court.
I have written before where the failure to read the law caused them to pass a law without a normal severability provision. And I have written in the past where Judge Vinson has punished congress (intentionally or not) for their failure to carefully read and craft this legislation. That should be a useful backgrounder.
But I haven’t read a word of the decision. I will post analysis when I do.
And by my count, two other district courts upheld it. So, so far the score is 2-2. And the other case that struck it down, only struck down the mandate, and severed the rest. So bluntly, I think this is well on its way to the Supreme Court. And when it gets there, I have previously argued that Justice Kennedy will see Obamacare as the end of the right to privacy and strike this law down. (Warning: Coarse language the last link.)
Anyway, you can read the opinion at Weigel’s link. And regardless of all that, this is a very hopeful sign.
(Hat Tip: JD)
Update: Here’s another link to old analysis while I read it explaining why I think the mandate is unconstitutional under the First Amendment.
Update (II): Still reading, but this analysis is relevant, too. As in, the judge is employing logic very similar to this post.
Update (III): And this post on Kagan is directly relevant.
[Posted and authored by Aaron Worthing.]
btw, left wing smear of judge vinson will come in 3… 2… 1…
Aaron Worthing (e7d72e) — 1/31/2011 @ 12:58 pm[fitb moonbat] hardest hit!
vote for pedro (e7577d) — 1/31/2011 @ 1:03 pmBut, you should see the comments at Slate. My god, they let those people vote? Crazy, stupid people, it’s all about politics, getting results, no concern at all about being legal, no concern about losing freedom to choose to buy or not buy whatever you want or don’t want. They really, really don’t get it.
sarc_dan (7f8155) — 1/31/2011 @ 1:04 pmAre these lower court decisions (especially since they conflict) being put on hold until the case gets to SCOTUS? Or does the HCR law automatically get put completely on hold until SCOTUS hears it because of this decision? I’m only confused about the actual process.
JEA (2a1ff2) — 1/31/2011 @ 1:13 pmA big effin’ deal, eh, Joe?
gary gulrud (790d43) — 1/31/2011 @ 1:14 pmI don’t find much in the opinion to be convincing, particularly when dealing with the most salient question: whether or not Congress can regulate “inactivity” under the Commerce Clause.
But it’s not Vinson’s fault that he has nothing (legally speaking) to hang his hat on. This is (as he notes) a case of first impression.
Kman (d30fc3) — 1/31/2011 @ 1:15 pmIt is difficult to imagine that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place.
narciso (e888ae) — 1/31/2011 @ 1:19 pmI don’t find much in the opinion to be convincing
Naturally, because you didn’t bother to read it, just as you never bother to read anything here before opening that blowhole.
Let’s hope that the SCOTUS will do everyone a favor and blow this thing out of the water, before the Dem’s insane demagougery goes into warp drive.
Dmac (498ece) — 1/31/2011 @ 1:22 pmI’d wait for it to go to the Florida Supreme Court. They always get the big decisions right.
carlitos (a3d259) — 1/31/2011 @ 1:25 pmBTW, cannot wait for the microphones being shoved in Pelosi and Reid’s mugs after it’s finally shot down, questions about why they crammed the thing through in the middle of the night without even knowing just what the hell was in it, shutting out the GOP entirely during their backroom deals, paying off the insurance and BigPharma lobbies, etc. Then we can ask Obama if he still feels like “I won.”
Dmac (498ece) — 1/31/2011 @ 1:25 pm(1) Health insurance isn’t tea.
Everybody’s health care costs go up as a result of health care insurance deadbeats.
(2) The founding fathers had no problem mandating the purchase of health insurance for private citizens.
Kman (d30fc3) — 1/31/2011 @ 1:26 pmnarciso #6 –
+1
jim2 (a9ab88) — 1/31/2011 @ 1:26 pmActually, I did. Make stuff up why don’t you.
Kman (d30fc3) — 1/31/2011 @ 1:27 pmFunny, carlitos, but this being a federal not a state issue, we don’t have to worry, this goes to
narciso (e888ae) — 1/31/2011 @ 1:28 pmthe 11th Ct in Atlanta
Kman #10 –
I do not claim to be a lawyer, but the example you cited read to me to be a condition of employment for a specific and narrowly-defined job, not a requirement directed at all citizens throughout the land.
jim2 (a9ab88) — 1/31/2011 @ 1:30 pmThanks narciso. You’d think that the words “United States District Court” at the top might have given me a clue.
carlitos (a3d259) — 1/31/2011 @ 1:32 pmKman
you didn’t even read your own link. They talked about congress taxing people and then using that money to create a hospital to serve the same population. which is similar in the sense that it is… not at all.
Aaron Worthing (e7d72e) — 1/31/2011 @ 1:32 pm“(2) The founding fathers had no problem mandating the purchase of health insurance for private citizens.”
False comparison. They required it of mariners, not for just living and breathing in the U.S.
daleyrocks (479a30) — 1/31/2011 @ 1:33 pmbtw, okay, so we are going on the theory that john adams never did an unconstitutional thing? does the alien and sedition acts ring a bell in your empty head?
Aaron Worthing (e7d72e) — 1/31/2011 @ 1:34 pmMinorities and chirren hardest hit.
daleyrocks (479a30) — 1/31/2011 @ 1:34 pmjim2, kfap is well known for its incremental stupidity. It eases into its nonsense one comment at a time until a crescendo of fail is achieved.
vote for pedro (e7577d) — 1/31/2011 @ 1:35 pmIt was a law which required seaman in private employment to purchase health care insurance. If the ACA individual mandate is beyond Congress’ power, why wasn’t that law?
In this regard, a law would be unconstitutional whether it affects sailors only, or whether it effects “all citizens”.
Kman (d30fc3) — 1/31/2011 @ 1:36 pmWhen will our long national nightmare be over?
daleyrocks (479a30) — 1/31/2011 @ 1:36 pmThen you would say that Congress DOES have the power to force SOME people to purchase health insurance? They just can’t force everyone??
Kman (d30fc3) — 1/31/2011 @ 1:37 pm“It was a law which required seaman in private employment to purchase health care insurance.”
D’oh! It did not tax non-mariners to pay for the health care of mariners or vice versa. Comparability to ObamaCare – Zip.
daleyrocks (479a30) — 1/31/2011 @ 1:38 pmkfap=∅
vote for pedro (e7577d) — 1/31/2011 @ 1:39 pmKman
From your own stupid link:
Do you notice we are NOT ACTUALLY TALKING ABOUT INSURANCE?
Further, this TAX (not insurance), was assessed on the ship, not on the sailors.
Aaron Worthing (e7d72e) — 1/31/2011 @ 1:41 pmKman
you didn’t even read your own link. why should we believe you read a word of the actual decision?
Aaron Worthing (e7d72e) — 1/31/2011 @ 1:42 pm“Then you would say that Congress DOES have the power to force SOME people to purchase health insurance?”
To this day separate rules govern the insurance requirements for maritime workers.
daleyrocks (479a30) — 1/31/2011 @ 1:43 pmNo, I mention it to rebut the rightwing presumption (employed by Judge Vinson, among others) that the “founding fathers could never imagined the Commerce Clause to mean… blah blah blah”.
Here we have a law showing that the nation’s founders serving in the 5th Congress, and there were many of them, apparently believed that mandated health insurance coverage was permitted within the limits established by our Constitution. Based on that 1793 law, they COULD have imagined something like the Affordable Care Act.
Kman (d30fc3) — 1/31/2011 @ 1:46 pmWell, even if that is true, why is constitutional in one instance and not the other?
Kman (d30fc3) — 1/31/2011 @ 1:47 pmKmart, here’s some advice before the next time you’re thinking of posting something here:
Dmac (498ece) — 1/31/2011 @ 1:52 pmBut I haven’t read a word of the decision. I will post analysis when I do.
Kman
> why is constitutional in one instance and not the other?
Well, there is a surprise. you haven’t read the constitution, either.
Aaron Worthing (e7d72e) — 1/31/2011 @ 1:57 pmKman
btw, notice you don’t even dispute my point which is that your own article doesn’t support the claim that this was mandated purchase of private insurance. instead it was a tax to build hospitals.
Aaron Worthing (e7d72e) — 1/31/2011 @ 1:58 pm“why is constitutional in one instance and not the other?”
Kman – Do the analysis and get back to us.
daleyrocks (479a30) — 1/31/2011 @ 2:00 pmThe accusations by partisans about the politicization of every single friggen court case is a bad bad trend. A few judges are corrupt or overtly agenda driven. But I have to believe that most judges, especially at the federal level, take their oaths and responsibilities seriously. I hated when Obama criticized and embarrassed the SCOTUS at last year’s State of the Union. I hate what is already being done on lefty blogs to assassinate Judge Vinson’s character. And yes I hated some of the venom leveled against the Illinois Supreme Court last week.
We can point to the Holder justice department as being a highly political operation, (which it is and should not be) but that too shall pass. However, if citizens at this time in our history automatically lack trust and belief in an independent judiciary across the board, and assume every ruling is beneficial to team D, or to Team R, rather than beneficial to team America, then our nation is well and truly screwed.
elissa (d7ac61) — 1/31/2011 @ 2:06 pmelissa – I blame Sarah Palin and her eliminationist rhetoric for this decision. There, I said it.
daleyrocks (479a30) — 1/31/2011 @ 2:08 pmI read Kman’s link, and a fair bit of the comments back and forth on it afterwards, and decided that my ADD would never allow me to be a lawyer, unless there is a subset that does not involve unending picayune argument back and forth. A certain amount of back and forth to clarify points I enjoy, as I do like to be precise, but in the face of unending quibbling I would eventually respond as I would in chess, ping-pong, or tennis, and instead of being patient I would force the issue and either “hit a winner” or make an error.
MD in Philly (3d3f72) — 1/31/2011 @ 2:08 pmIt’s a payment to the government — mandated by the government — to cover a sailor’s health care.
Kman (d30fc3) — 1/31/2011 @ 2:12 pmI’m asking YOU, because my position is that it is constitutional in BOTH instances.
Kman (d30fc3) — 1/31/2011 @ 2:13 pmkman
yes, the payment of taxes for a public facility.
which is 100% different from requiring you to buy something, you complete moron.
indeed the difference between a tax and the mandate was discussed in detail in the last opinion from vinson. The last time they said, “oh, well, the mandate is justified as a tax” and he replied, “um, except it isn’t a tax.” moron.
Aaron Worthing (e7d72e) — 1/31/2011 @ 2:14 pmelissa-
The main thing that gives me hope for our country [other than belief in the sovereignty of God], is the knowledge that things were already so bad before 1800 that Jefferson was paying people to distribute lies about Adams (or so I was told by a PBS program on Adams). So, if partisan lies are nothing new, perhaps we will survive after all.
MD in Philly (3d3f72) — 1/31/2011 @ 2:17 pmYou’re probably right, Daleyrocks. However, I will need to tune into PBS Newshour tonight in order to obtain verification and support for your theory about SP’s role in this ruling.
elissa (d7ac61) — 1/31/2011 @ 2:17 pmmd
here’s the simple answer. how do you know a comment by Kman is dishonest? if it is written in the English Alphabet.
Aaron Worthing (e7d72e) — 1/31/2011 @ 2:18 pm“I’m asking YOU, because my position is that it is constitutional in BOTH instances.”
Kman – Fine, tell me why the first one is constitutional and I’ll tell you why the second isn’t.
daleyrocks (479a30) — 1/31/2011 @ 2:18 pmAW:
Yes, rather than forcing a sailor to buy something, it merely requires employers to withhold a part of the sailor’s wages and contribute it to a sailor’s future health care, whether or not the sailor wants it or not.
That’s “100% different”? You can’t see the relationship?
Kman (d30fc3) — 1/31/2011 @ 2:19 pmKman advertises on us.
Bus Stops (4b0f2e) — 1/31/2011 @ 2:23 pmDaley:
It’s within Congress’s powers under the Commerce Clause and the Necessary and Proper Clause. One person’s active decision to “opt out” of health care coverage imposes a burden on the majority who choose to get health care coverage.
Kman (d30fc3) — 1/31/2011 @ 2:23 pmWhy do people assume that opting out places a burden on others? If I opt out, and pay for my family’s health care out of pocket, how have I burdened the system?
JD (4b0f2e) — 1/31/2011 @ 2:26 pmKman
> it merely requires employers to withhold a part of the sailor’s wages
No, actually the statute didn’t require that either.
so apparently you didn’t read the statute underneath, nor did you even read my comments about it.
> You can’t see the relationship?
No. And we have discussed this before:
https://patterico.com/2010/12/01/boycotting-abortion-has-obamacare-been-sunk-by-citizens-united-and-the-naacp-v-claiborne-hardware/#comment-727003
Aaron Worthing (e7d72e) — 1/31/2011 @ 2:27 pm“It’s within Congress’s powers under the Commerce Clause and the Necessary and Proper Clause.”
Kman – Not as interpreted in the late 18th century. Sorry libtard troll. Judicial activism had not yet distorted the commerce clause out of all recognition at that point. Its original meaning was to prevent states from engaging in retaliatory or punitive commerce against one another.
Enough attention for a know nothing such as you today.
daleyrocks (479a30) — 1/31/2011 @ 2:27 pmKman’s definition of the commerce clause means that there is no actual limit to Congress’ reach under the Constitution. A plainly ridiculous interpretation.
SPQR (26be8b) — 1/31/2011 @ 2:29 pmDaley – dont go confuzzling that kmart clown with facts. That Constitution is old and hard to understand so we should just make stuff up that fits with the leftist Narrative.
JD (4b0f2e) — 1/31/2011 @ 2:29 pmPeople who do not buy a Lexus 400h place a greater burden on the system, so the govt under penalty of a fine, should mandate the purchase of a Lexus 400h for every home.
JD (4b0f2e) — 1/31/2011 @ 2:31 pmJD
or in the opinion, which i am still reading, the government can force you to buy a GM car right?
Vinson says no.
Aaron Worthing (e7d72e) — 1/31/2011 @ 2:34 pmPeople who don’t buy clothing put a burden on those of us who do buy clothing, so Congress should mandate clothing purchases …
SPQR (26be8b) — 1/31/2011 @ 2:35 pmAW – Beelzebub Obumblef@ck would likely love to make that happen, to pay off his union masters, yet again.
JD (4b0f2e) — 1/31/2011 @ 2:37 pmI have faith in the law being struck down by the SCOTUS. What I wish I had more faith in is for the states to begin legislating on tort reform, specifically as that pertains to medical malpractice cases. This legal racketeering must stop. What incentives would a state offer medical practitioners and hospital management corporations if it controlled the ambulance chasers by putting them out of business, short of Shakespeare’s suggested course?
In addition, the monopoly of the American Medical Association must be broken in order to eradicate the choke hold it exerts on medical school admissions and increase the supply of doctors in the United States. How many potentially great, competent doctors don’t materialize as a result of archane admission controls?
Finally, states should organize themselves to offer the best range of care options for their residents at every level of the age spectrum. Bureaucrats wont know how to do this, but entrepreneurs can. A Tea Party offshoot on Entrepreneurial Priorities? Would this attract more people into the movement?
I have a leather ass so criticize my naivete or lack of liberal fascist enthusiasm for centralized government…whatever. Bottom line is that once Obamacare is chit-canned, we might see an economic boom as a result of getting a second chance to reinvent health-care without the residue of the Pelosi Galore-Bending Reid fiasco dragging us under.
bear1909 (a275fd) — 1/31/2011 @ 2:37 pmPeople who do not buy food, place a burden on those that do, so the govt should mandated minimum food purchases of specified approved foods.
JD (4b0f2e) — 1/31/2011 @ 2:38 pmAaron- I was just interested in seeing what the precedent supposedly was.
There is an issue here that as a physician bothers me, though I am not sure how to solve it.
It is easy to require a person owning a car to have insurance on it if they are going to drive it. One doesn’t have to own a car, and there are potential consequences for society when one drives a car. In addition, we typically don’t care if an individual owns a car or not; and if a person drives a car without insurance, I’m told that in some jurisdictions that is not only against the law, but nthe law is actually enforced and we largely don’t care if a person has a huge fine, or their car impounded, or whatever.
One problem is, we do care if someone shows up in the ER or in the doctor’s office with appendicitis, for example, whether they have insurance or not. So, if we don’t require people to buy into the system up front, how do we handle the urgent life-threatening situation, the catastrophic illness resulting in long-term disability, or the person without insurance who was pay out-of-pocket who know has a probable cancer? We (as a medical professional) do feel a moral responsibility to provide care. We don’t care if they can no longer afford top of the line Mercedes as their family cars, but we do care if medical bills end up costing them a job because they can’t pay for a car, or their house.
So, what do we do that demands a person be “financially responsible as possible” that captures some cost of their care and provides incentive to have insurance that is not crushing? If people can’t afford a reasonable payment plan do they get forced into bankruptcy? I don’t know much about that process accept I understand there are some protections available.
MD in Philly (3d3f72) — 1/31/2011 @ 2:55 pmWrong. There were very few founding fathers in the 5th congress. Try again.
Nate_MI (68c8a4) — 1/31/2011 @ 2:57 pmJust saw that ALL GOP Senators have signed on as co-sponsors of the Obamacare repeal bill.
elissa (d7ac61) — 1/31/2011 @ 2:58 pmMD – one of the big differences in the strained and flawed auto analogy is that the auto insurance required is not for you or your car, but for damages caused by you and your car.
I still have not heard someone like kmart explain how paying for your own healthcare places a burden on the system.
JD (4b0f2e) — 1/31/2011 @ 3:04 pmPardon the multiple typo errors.
The fact is that it is a health-care issue, not a doctor issue. A doctor may have no problem giving free care some of the time- before Medicare and Medicaid it was assumed normative to do “one’s fair share”, but modern medicine includes costs of blood tests, xrays, etc., equipment fees for procedures, hospital fees to cover the architects, liability for the person who mops the hallway, etc., etc.,
This is how the person or family who doesn’t buy insurance but pays out of pocket can put the burden on people who do, unless you require the person without insurance pays their complete bill, even if it means 30 years of indentured servitude/ taken directly out of your paycheck.
Now, I think most people who want to pay out of pocket would be willing to pay for high-deductible catastrophic care.
MD in Philly (3d3f72) — 1/31/2011 @ 3:06 pmActually, it is 100% different. What you are describing is akin to withholding tax money from an employee to pay for road maintenance, whether the employee wants to use those roads or not.
It is not the same thing as forcing a person to buy a commercially-provided product.
Some chump (4c6c0c) — 1/31/2011 @ 3:06 pm““I note that in 2008, then-Senator Obama supported a health care reform proposal that did not include an individual mandate because he was at that time strongly opposed to the idea, stating that ‘if a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house,’” Judge Vinson wrote in a footnote toward the end of the 78-page ruling Monday.
Now that is some funny stuff.
JD (4b0f2e) — 1/31/2011 @ 3:07 pmJD-
Let me clarify. I am not using car insurance as an analogy for health insurance to argue why we should have mandated health insurance. I am comparing how the situations are different and how it makes sense to require car insurance in ways that are not valid for health insurance (which you point out makes it not a valid analogy if one wants to use it as such).
Having said that, I also put forth the real consequences of not having each. I can easily live with the fact that someone has no car insurance, hence they can not drive a car. I can not live so easily with the idea that a person with no health insurance does not get health care (again, not a true analogy, but I think you see my point).
MD in Philly (3d3f72) — 1/31/2011 @ 3:12 pmMD in Philly, the error in your logic is that there is no constitutional “right” to health care.
Democrats like to claim that “everyone” has a “right” to health care. But that’s a false claim. As there is no “right” to health care, it is not true in a constitutional sense that those who fail to buy insurance to cover the costs of their health care are a “burden” on others.
As a society, in a variety of ways including the ER mandate and various forms of welfare spending and charitable works, we made provision for health care of varying levels for the indigent.
But they have no “right” to it in the Constitution.
SPQR (26be8b) — 1/31/2011 @ 3:14 pmJust to make things plain, the merchant navy has from the beginning of the USA been regulated by Congress, whether under its power “to regulate Commerce with foreign Nations, and among the several States”, or “to make Rules for the Government and Regulation of the land and naval Forces”. (I’m not sure whether the latter power was understood at the time to extend to the merchant navy, but it wouldn’t surprise me.)
The law in question imposed a 20 cents a month tax on sailors on “ships of the United States” that were engaged in foreign trade, or that were licensed to engage in the coastal trade. And there should be a clue big enough for any honest person to get it: how is it that one needed a license to engage in the coastal trade? Because it’s an industry that is directly under Congress’s authority. Any sailor who didn’t want to pay this tax could find employment either in some other industry, or else on a foreign ship.
It’s noteworthy that the money collected had to be spent on the health care of sailors in the region where it was collected. So everyone who paid this tax could see directly where it was going. But Congress’s authority to set up this scheme clearly came from its authority to regulate that specific industry in the first place, which in turn rested ultimately on its relationship to the national defense.
Milhouse (ea66e3) — 1/31/2011 @ 3:15 pmbumblef will still have trillions of wasteful spending for his legacy plus it looks like he’ll be leaving the middle east in turmoil and leaving behind an America shorn of credibility and respectability and with a piss-poor credit rating to boot.
That’s probably worth every penny daddy Soros spended.
happyfeet (a55ba0) — 1/31/2011 @ 3:18 pmI was not arguing with you, MD. I assumed you understood the difference.
JD (4b0f2e) — 1/31/2011 @ 3:21 pmTo sell health insurance to individuals, as a company in competition with others seems impossible without risk stratification. In that situation what is being sold is true “insurance” against the possibility of costly events.
Health insurance as obtained through employment or a group plan is different in that it is in part insurance, but also in part a cost-sharing arrangement for the care of existing medical conditions. It is the fact that medical care is readily available for many once lethal conditions, but the cost of one specific intervention is so high to the individual that a large portion of people would not be able to pay or find the payment financially disasterous.
So there is a two-sided issue. If a person does not want to partake in essentially a cost-sharing cooperative, could they really be excluded from care if they couldn’t pay when they needed it? And if costs aren’t shared by a large enough segment of the population, then the individual cost is prohibitive.
MD in Philly (3d3f72) — 1/31/2011 @ 3:24 pmI appreciate that, JD.
SPQR- I agree there is no “right” to health care, not only legally, but also morally. However, I think moral issues are ultimately better resolved not by determining “rights” but by fulfilling “responsibilities”.
In this way I am reminded of what Reagan said about communism, that it works in hell, but they already have it, and in heaven, but they don’t need it. Everybody is equal in hell in that nobody gets their rights, and everybody gets them in heaven without asking, because everyone is busy fulfilling their responsibilities.
MD in Philly (3d3f72) — 1/31/2011 @ 3:31 pmMD in Philly, I don’t address the moral issue because my point is solely about the legal argument that people who don’t purchase health insurance are a “burden” and that their inactivity has an impact upon us. They are a “burden” only in that we’ve already decided to accept something we were not required to accept.
So this faux “burden” cannot give rise to extend a power of Congress to regulate. It becomes a circular argument that extends Congressional authority beyond its constitutional bound.
SPQR (26be8b) — 1/31/2011 @ 3:34 pmYou know who this ruling helps? Governor Good Hair.
daleyrocks (479a30) — 1/31/2011 @ 3:36 pmI see your point, SPQR. I guess I assume your point is true. My question comes from the point of knowing bills need to be paid to keep a medical office or hospital open and people will walk in the door sick without an ability to pay, sometimes both (sick and poor) due to their own unwise actions, sometimes in spite of “doing everything one can” to be healthy and prosperous. Knowing there is no legal reason to require cost-sharing/insurance participation, how do we promote and reward responsibility, discourage irresponsibility, but treat everyone as human.
MD in Philly (3d3f72) — 1/31/2011 @ 3:44 pmI guess I’m thinking of how we improve the health care system once ObamaCare is out of the way, looking foward to what the alternative is.
MD in Philly (3d3f72) — 1/31/2011 @ 3:46 pmMD in Philly, that is a good question with tough answers. And I meant at no time to question your good intentions and good faith in the subject.
SPQR (26be8b) — 1/31/2011 @ 3:52 pmMD, if you have a chance to peruse the economic plan put forward by Paul Ryan less than a year ago, that may give you a blueprint on what the GOP alternative will consist of – but only if they have the gonads to stick together and actually present it within it’s original form. Ryan made sure that every consituency will feel some sort of pain, there were no sacred cows in his plan. Social Security, Medicaire, Medicaid – they all get wacked in one form or the other. Ryan makes the case that we can only discuss true healthcare reform if we confront the entitlement programs first, and control the runaway costs we see annually with Medicare.
Dmac (498ece) — 1/31/2011 @ 3:56 pmMD
Well, the simple answer is this. Obamacare is more likely to be considered constitutional if enacted by a state, rather than the F.G.
The FG probably can’t force you to buy auto insurance, either.
Aaron Worthing (73a7ea) — 1/31/2011 @ 4:27 pmSPQR-
I know you weren’t giving me a hard time. Your comments were perfectly reasonable and helped me clarify what I meant. “I know who my enemies are, and you’re not one of ’em.” 😉
Dmac-
From what I’ve seen and heard from Ryan, I’d expect him to have as good of a plan as anyone- I’ll try to get to it.
Aaron-
Yes, individual states trying to problem solve and show what works and what doesn’t on a smaller scale first. makes sense.
I just heard on the radio that the judge, in his decision, footnoted a 2008 quote from Obama, when he was against the individual mandate (before he was for it). The comment said in part, “If individual mandates work, we could require everyone to buy a house and we could get rid of the homeless”. [Or something to that effect] Obama knows how to make a point, especially on the campaign trail!!
MD in Philly (3d3f72) — 1/31/2011 @ 4:37 pmIn contrast, the Chinese version:
Now that’s an individual mandate …
SPQR (26be8b) — 1/31/2011 @ 4:48 pmWe never seem to hear about the healthcare reform disasters that have unfolded in MA and TN – those were good indicators about what wasn’t going to work.
Dmac (498ece) — 1/31/2011 @ 4:50 pmMD in Philly, if you’d like an idea of how free-market health insurance could work, here’s how:
* Unlink it from employment. Health insurance should be something everybody buys for himself, and keeps regardless of job changes, just like auto insurance, fire insurance, life insurance, etc. The reason it’s linked to employment now is partly because of government regulation during WW2, and partly because premiums are tax deductible if paid by an employer but not if paid by an individual. I’d reverse that; make employers pay tax on premiums they pay for their workers, while not taxing people who insure themselves and their families, and you’ll quickly see a change in the market.
* No mandates, minimums, or pretty much any other regulation on what packages can be offered. Let companies offer whatever coverage they think will sell. And no restrictions on selling into different states.
* How to motivate the young and healthy to insure themselves when they don’t rationally need it? The same way the life insurance industry does it: if you get a policy when you’re young and healthy, the company can’t drop you when you get old and sick. So long as you keep paying the premiums, they have to keep offering you a substantially similar package unless you agree to change it. But if you try to buy in when you’re already middle aged and beginning to run down, expect higher premiums and more restrictions.
Milhouse (ea66e3) — 1/31/2011 @ 4:53 pmMD…the answer lies in making people who walk into an emergency room pay for their care. the problem lies in the hospitals and doctors not choosing the path of making them pay, but in charging rates higher than necessary to those who do pay to cover losses of those who don’t. And while this sounds harsh, it is necessary to keeping the cost down for all, which would lower insurance costs, encourage higher deductible plans, and other measures that would have helped to solve this problem long ago.
reff (7206a4) — 1/31/2011 @ 4:58 pmpart of the problem with ER’s and their costs are laws that require treatment regardless of ability to pay.
not saying i approve of turning away people on moral grounds, but the fiscal realities are the fiscal realities.
also, as well shown here in SoCal, its one thing to guarantee ER coverage for citizens, but why are we paying for all the illegals?
redc1c4 (fb8750) — 1/31/2011 @ 5:46 pmMilhouse and MD,
I’d take it a little further. Get rid of the insurance plan as currently implemented and use the auto insurance paradigm. Only supply catastrophic, high deductible insurance with the a maximum insured payout the same as the deductible. This way the insured pays for preventative care and if something big happens, the insurance company pays for it. Also, non-medical care like breast enhancement and non-medical necessary nose jobs, … would not be covered. All other medical care would also be tax deductible. While we’re changing what’s deductible from taxation, lets make ALL food non-taxable.
I believe that this will reduce the overall cost of medical care since the doctor won’t have to bill the insurance companies for preventative care or when the patient has a cold. Basically everything under the deductible is between the doctor and patient.
The is like veterinarian care in Canada. It’s inexpensive, available and doesn’t have long wait times for non-preventative care.
Tanny O'Haley (12193c) — 1/31/2011 @ 5:57 pmThis along, with price controls, should solve the problem.
Michael Ejercito (64388b) — 1/31/2011 @ 6:13 pmI agree that cost shifting in health care should be gotten rid of. Currently, the charge for the same ER visit will depend on which insurance company, because they all have their own contracts, including Medicare and Medicaid, depending on the plan how much copay, etc., and then the supposed “standard charge” to someone without insurance, which is a lot higher than insurance companies pay and a lot lower than most people can pay. To contract for the same price as things currently are might be claimed to violate anti-trust. It seems to me you can’t look at costs of health care unless you know what the cost is, not a smorgasboard of charges depending on who it is.
It is “not right” that people who pay subsidize those who don’t, and doctors can take steps to remove patients from their practice for not paying, or send collection agencies. But no doc I would go to would refuse to care for a patient because they cannot pay, and sending a collection agency after someone is begging for some kind of malpractice claim as revenge. Not that it isn’t done, but as you say, fiscal reality may mean you eat a loss rather than incure legal fees and an increase in your malpractice rates.
Sometimes what is offered for coverage is more for marketing than for fiscal sense.
Milhouse, I agree decoupling from employment would be a good move. IIRC we’ve had some discussion before on the history of how the two were intertwined. Regardless of that, they are and I think they shouldn’t be.
High deductible availabilty should be available. I’ve read/been told that such “catastrophic” plans are illegal in some states- doesn’t make sense to me, don’t know if it’s true. I guess medical/health savings accounts could figure into this as well.
MD in Philly (3d3f72) — 1/31/2011 @ 6:36 pmMD in Philly, high deductable catastrophic plans were killed off by the barrage of mandates of what had to be covered. Obamacare also renders true catastrophic health insurance illegal.
SPQR (26be8b) — 1/31/2011 @ 6:38 pmThanks SPQR.
Long ago and far away last century when we were first married we had such a plan. For 25 years plus we have had employer based plans as is usual. So I guess I missed it.
“Makes sense”, something that could keep costs down was outlawed….
MD in Philly (3d3f72) — 1/31/2011 @ 6:42 pmCatastrophic coverage just makes sense for healthy young men. Banning it is practically just robbing them to fund other demos.
Dustin (b54cdc) — 1/31/2011 @ 6:58 pmMD in Philly, about a dozen years ago I had a high deductable plan from Blue Shield. It was very reasonable in cost and covered nothing before the deductable was met.
I had a skin infection on an ankle and my doctor decided to hospitalize me for IV antibiotics. It was in fact the most miserable week long hospital stay I’d ever had because I felt fine and was cooped up in the hospital for a week.
The bill came to quite a few thousand dollars, I can’t recall how much, but after applying the insurance contract rate, I recall that the bill was knocked down to almost exactly $20 below the deductable. I was not unhappy.
I can’t get that insurance policy any longer, I tried very hard a couple of years ago to find it or an equivalent.
SPQR (26be8b) — 1/31/2011 @ 7:03 pm____________________________________________
The very thought that the friggin’ IRS, with its maze of pencil-pushing bureaucrats, would be the enforcer of ObamaCare was enough to make it an oncoming debacle. And a disgusting power play to boot.
It’s interesting that some big-money insurance companies signed on to ObamaCare because of the provision that a variety of Americans would be forced into becoming new customers of such companies.
Mark (411533) — 1/31/2011 @ 7:18 pm_____________________________________-
One person’s active decision to “opt out” of health care coverage imposes a burden on the majority
And so many liberals, when dealing with the huge burden imposed upon the healthcare system by the “undocumented” — particularly in cities like Los Angeles — wave their hand, shrug their shoulders and proclaim “c’est la vie!”
Mark (411533) — 1/31/2011 @ 7:24 pmOnly purpose of the commece clause is to prevent states from restricting trade with other states and levying tariffs on goods moved between states. The use of the commece clause to justify congressional overreach into every part of life is unconstitutional.
Have Blue (854a6e) — 1/31/2011 @ 9:20 pmThe momentum is slowly building; it may take a while longer, but our country will see the return of constitutional rule of law!
Chris Taus (3d6445) — 2/1/2011 @ 6:18 pm