It is fitting testament to the fundamental problem with our health care system that the key legal question the Supreme Court is considering today is whether the requirement that most people have health coverage is a violation of the commerce clause. The legal issue is whether the act of not buying a product constitutes commercial activity. Opponents question whether the government could require people to buy any product, with broccoli as the favorite example. (Do people really hate broccoli that much?) The underlying premise of the challenge is that health coverage is a commodity, not a public good.
In defending the individual mandate, the government argues that health care is not like other commodities. As NPR's Julie Rovner reported last May when a federal appeals court in Virginia was considering the issue, "[Acting U.S. solicitor general Neal] Katyal drove his point home repeatedly: Health care is not like any other product; everyone consumes it, whether they buy insurance or not. 'That is a virtually universal feature of human existence,' he told the judges. 'Everyone is going to seek health care. Nobody can know precisely when.'"
Candidate Obama made the same point during a memorable moment of a debate with John McCain in October of 2008. When NBC's Tom Brokaw asked the candidates, "Is health care in America a privilege, a right, or a responsibility?" Obama's answer was crystal clear: "I think it should be a right for every American."
In economic terms, the point that both Obama and Katyal are making is that health care is a public good, not a private commodity. As I write in Fighting for Our Health:
The theory that health care is a consumer good like any other commercial product and that health care markets work like other markets is pure fantasy, at odds with everything we know about how health care is actually consumed. Health care markets violate the fundamental tenets of market economics...
Health care is a public good, not a commodity. The reason that other developed countries spend so much less on health care, and cover all their people and deliver higher health quality care, is that these countries recognize this fact. As a public good, health care must be made available on an equitable basis to all, and prices and supply must be regulated. In the rest of the developed world, almost everyone has their health coverage supplied by the government or by a regulated nonprofit insurer, and the coverage comes with very low out-of-pocket costs. In other words, other developed countries follow the exact opposite course recommended by conservatives and achieve systems that are much more efficient economically.
The passage of the Affordable Care Act sets the United States on the course to making health care a public good, which is why conservatives are so deeply opposed to it. For the first time, the government has a legal obligation to make health care affordable. The ACA accomplishes this in a uniquely American way, a combination of a big expansion of public coverage through Medicaid, financial penalties for employers who do not provide coverage for their workers, and income-based government subsidies for people to buy regulated private insurance.
The individual mandate is a key component of that last measure. Without the mandate, the regulated market would fail, since allowing people to buy coverage only when they need it drives up costs for everyone else and leaving people without coverage shifts the costs of their care to others. In short, a private decision not to buy a public good has substantial public consequences.
The great irony of the conservative challenge to the individual mandate is that there is no credible legal challenge to the concept that the government could raise taxes to provide public health coverage to everybody. Because both conservatives and those who profit from the health care industry have opposed a national insurance system, the ACA was developed first in Massachusetts and then nationally as a grand compromise. If the Supreme Court were to rule against the individual mandate, the only remaining constitutional course to provide coverage to everyone is through national health coverage.
Regardless of what the Court rules about the constitutionality of the individual mandate, health care will still be a public good, even if our health care system continues to have a schizophrenic relationship with the economics of health care, treating it like a public good and a commodity at the same time. In the long run, the only way to achieve a health care system that provides quality care that is affordable to the nation will be for the system to recognize that health care is a public good. The ACA is a major step in that direction and would be so even without the mandate. The expansion of Medicaid, the incentives for employers to pay for coverage, and other features of the law that regulate insurance rates and change the way Medicare pays providers all treat health care this way.
If the Supreme Court rejects the mandate, millions of people will go without health coverage, thousands of them will continue to die prematurely each year because they lack coverage, and tens of thousands will continue to suffer from crippling medical debt. Still, the economic pressures and tragic personal pain caused by our current health care system will continue to drive the United States in the direction of making health care a right. That will be true even if the Supreme Court decides that health care is more like broccoli than clean water and air.
Cross-Posted from New Deal 2.0
Ethan Rome: Paul Clement Calls for Tax Hike in Supreme Court Arguments Against Obamacare
Adam Winkler: No Surprise: The Supreme Court Is Hostile to Health Care
Trevor Burrus: Baking Some Humble Pie for Congress
Larry Womack: Looks Like the Cynics Were Right About the Supreme Court
Since our health insurance models work on shared risk pools, insurance then becomes a collective, shared affair, and since in this model one's actions, even if it is to forgo insurance, DOES impact others, and therefore is activity. And since health care itself is so expensive in this country that economic devastation is all but guaranteed unless one has health insurance to mitigate it, and the cost goes up with every uninsured trip to the ER and every poorly insured chronically ill patient, both to the medical market, insurance market and governments both state and local.
So since insurance is a relational good, the individual mandate is sound. However, I was more excited at one of the more obscure provisions of the ACA - a switch from fee-for-service to fee-for-performance. The Health ministers of the G20 have all told the USA repeatedly that this is one of the single most important things for a nation to do to get its health costs under control. Now, it would be easier to do with a DHS or Nordic model single-payer system, but that's another can of worms.
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The mandate is the single reason I oppose Obamacare. I have no problem with the government opening and operating a VA-like system open to the public. But it should be funded from taxes. The idea that the government is requiring me to go and give my money to a private, corporate entity is wrong. It is just one more step along the way of the merger between business and government, with business dominating and calling the shots.
I hope the whole enchilada is sent back to the kitchen, not for reheating but to be thrown into the chef's face. We DO need a national health care system. We DON'T need the monstuousity that Obama put together for his corporate friends.
o Mexico
o Turkey
o the United States of America
http://www.pbs.org/newshour/rundown/2011/09/mexico-nears-universal-health-care-goal.html
Mexico Nears Universal Health Care Goal | The Rundown News Blog | PBS NewsHour | PBS
"As the United States continues to debate the legality of President Obama's healthcare law, south of the border Mexico is preparing to celebrate a healthcare milestone of its own: universal coverage.
Ten years ago, half of Mexico's population had no health insurance. Then the congress passed a law guaranteeing access to care, and a government insurance program called Seguro Popular was born..."
A single payer system would have been better, would have been constitutional, and we must really ask ourselves why the Democrats didn't institute it.
When they tried anyway, he had them arrested.
They are known as the Baucus 8.
No argument from me. We really don't have two parties: We have two tax exempt corporations that deliver political power to monied interests. At best, they compete with each other for our votes, but they no longer are about political philosophy or about the best way to serve the American people.
A majority of Americans certainly want health care, just not federally mandated care. It is past time to dump the whole mess on the states and say "Do whatever it is your voters will tolerate to get most people covered for most negative health events."
If California wants free contraceptives and abortion coverage, well and good. If Alabama doesn't--that's fine too. Obviously Massachusetts' citizens like their mandate, and I'll bet Vermont would go single payer. Once size most definitely does not fit all in America.
What isn't being said is louder than the multitude of defenses for this Republican free-market idea pressed upon us by a supposed Democrat.
Such as the fact that 20% of Massachusetts residents (where almost 99% of the population has health insurance) cannot afford basic health care. That's 1 out of every 5 people.
The fact that community health care centers and non-profit hospitals have both been struggling to keep up with providing "free" care to take up the slack caused by the effectiveness of the coverage mandate.
The fact that the private insurers regularly scream bloody-murder because they aren't making enough money on policies that still require thousands in deductibles be met (yearly) before they pay for even the simplest visit to a primary care physician.
If forcing 25 million people to buy overpriced insurance (ignoring the other 30 to 35 million that still won't be helped for a moment) that offers less than minimum coverage (especially for serious or catastrophic needs) is equivalent to health care, one could assume that forcing people to buy gold coins is tantamount to guaranteeing someone will have a financially sound retirement.
This statement is so true yet the GOP attack this with everything they have and want to insure that what is mentioned above becomes reality. How do these people look into the eyes of their constitutes that would benefit the most from this and say “Sorry, I’m not here for you, I’m here for the insurance company”.
"You stole my Momma's baseball bat!!!"
That rhyme that I learned 60 years ago in the First grade best describes Obamacare. First grade, I might add, best describes the mentality of the GOP.
Truth told: Obama did NOT invent the individual mandate. He copied the idea from the Heritage Foundation, a conservative, Republican think thank. He also copied Romney-care =- with Mitt Romney's blessing.
So-called Obama care is misnamed. We need to call it Heritage-care, giving credit where it's due.
By including the individual mandate, Obama was attempting a bi-partisan approach - and for attempting to reach across the aisle, the GOP has bitten his fingers off.
If the Supremes declare ACA unconsitutional, all sorts of horrible things will happen between the decision and election day. The American people must act. There is only one choice: Medicare for all.
(P.s. We need an overwhelming Democratic majority in Congress and we need to re-elect President Obama. Then let's impeach a couple corrupt judges on the Supreme Court - for conflict of interest violations. Yes, the Constitution does permit us to do so.)
The whole concept of insurance is different from any other commodity because it has to do with catastrophic issues - things such as major financial lose, crippling injuries, life and death. And to compare it with as mundane an act as being forced to buy broccoli is arrogantly disingenuous - one does not risk grave personal injury in buying vegetables at the local market.
There are things that society has agreed to make the sole responsibility of governments: the military, police, fire protection, road and sewerage maintenance, along with semi-public/private responsibilities such as utilities. Some method of insuring the general health of the public at large should be included.
Americans are obsessed with medicine (actually, they're obsessed with living forever, narcissists that they are). It's not something that insurance can handle.
Hi, 1%. Nice jacket. Listen, we haven't had a real raise in about 30 years. We notice your income's risen 11% just this past year, while ours went up only $30 ...
We've been working hard: Our productivity numbers are really high. Considering how desperate so many of us are, the crime rate is still pretty low. And in fact, your GOP+TP political puppets ... I mean, your political, uh, favorites ... are still polling high compared to the fact that, well, let's face it, they only work for you guys, for the 1%.
Nice shoes, by the way.
So ... We'd *really* like a raise. You know, maybe you could take a few hundred billion less in insurance profits? What about cutting back the war machine a tiny bit, just a trillion or so? What about the $2-3 trillion in cash your corporations have? Wanna share a little?
A number? Well, we'd sure appreciate it if 45,000 of us weren't dying annually for lack of health insurance. We'd like it if 22% of our children weren't living in poverty ... I mean, you've got $20 trillion in wealth: it wouldn't take TOO MUCH of a raise to help us.
Please?
Nice tie.
Actually, let me tell you something. While we have been working harder than ever, taking more risks than ever, and trying to juggle a thousand balls at once we managed to either maintain our income or increase it while the middle class has struggled to do the same.
However, in the same time period my tax bill has not materially changed, but those of the lower and middle classes has been drastically cut. By drastically I mean a 300% increase in the number of people not paying federal income tax. I also mean a 1700% increase in the number of people with a negative federal tax liability.
As the 1%, we are getting a bit tired of constantly being told how we don't pull our weight and are expected to endlessly contribute more to the federal/state governments in order to provide for the bottom 51%.
When does it end?
When does it end? Well, I guess it either ends in another Great Depression, just prior to which, by the way, was the last time top tax rates were as low as they are now;
perhaps it ends in a change of heart for people who could stop working and earning any more money now and still be wealthy 10 generations from now (that's the top 0.01%) ...
Perhaps it could end in a violent revolution, in which case, we ain't askin' buddy, we're tellin' ...
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Many of the homeless are veterans.
"Civilization and anarchy are only seven meals apart" — Spanish proverb