Is Universal Health Care Constitutional?

[Pangloss]

(Edit: I cross posted this with iNow, but it was written to npts2020.)

 

Well they'll be subsidized, which will be paid for by a half-trillion-dollar tax increase.

 

Which I guess means we're all going to have to pay an additional $1,667 to our health insurance companies to cover that tax increase, which will be levied on those companies. Pretty funny, actually -- that may be the heart of the insurance industry's current grumblings, just the fact that they're going to take the blame for that price increase. But the hope is that that additional expense will result in a vast reduction in indigent care, which is much less efficient because it takes place only on an emergency basis, instead of before you get sick, and at high ER costs, e.g. a box of Kleenex costing $25 instead of $1.25.

 

But in my opinion none of this does enough to address the underlying problem of an insufficiently regulated insurance industry. Sure they've added some regulation to stop them from denying coverage based on pre-existing conditions, but how about regulation opening their books and forcing them to use the federal standard for all companies known as GAAP -- Generally-Accepted Accounting Principles, instead of the insurance industry's unique SAP -- Statutory Accounting Principles -- which vary by state and are largely at the whim of the reporting company, and are used primarily for industry health determination, not regulation of practices? How about regulation forcing them to adhere to every single monitoring and regulatory practice that ANY OTHER corporation has to adhere to? These possibilities for reform have gone largely ignored because the insurance lobby is so powerful.

 

And so the result will be that this "reform" will mean "solving a problem" by printing more money and giving it to the insurance industry, just like we did in 2003 with the Medicare Prescription Drug Benefit, instead of actually fixing the problem by overhauling the insurance industry itself and regulating its practices appropriately.

[iNow]

How does your concern about the government printing more money to cover costs reconcile with the CBO numbers I shared earlier in the thread about deficits being significantly decreased under the bill? Are you suggesting that the tax revenues and clawback provisions in the bill aren't going to be enough to cover the costs, and that the CBO was mistaken?

 

Also, I'm curious about your suggestions that insurance companies will still be largely unregulated, especially considering there are more than 400 pages in the bill of regulatory provisions.

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In this article, there is discussion of winners and losers due to this bill. Insurers are placed firmly in the losers section:

 

 

http://www.reuters.com/article/idUKTRE5BK3XA20091222

LOSERS

 

HEALTH INSURERS

 

* Insurers such as WellPoint Inc, UnitedHealth Group Inc and Aetna Inc overall will face a host of tighter regulations, higher taxes and caps on profits.

 

* Insurance plans for large groups would have to spend at least 85 cents out of every dollar on medical costs -- leaving 15 cents toward overhead and salaries, among other things. Small groups or individual plans would have to spend at least 80 cents per dollar on care. That proportion of spending, known as a "medical loss ratio," has varied widely and is closely watched by Wall Street due to its impact on profits.

 

* Private Medicare plans called Medicare Advantage would see roughly $118 billion in cuts over 10 years, according to various analysts. Reimbursement rates for the plans, which can offer more benefits than traditional fee-for-service Medicare coverage at a higher cost, would be tied to a competitive bidding process.

 

* New consumer protection provisions will change the way companies do business. They include banning preexisting medical conditions and ending limits on how much coverage patients can get from their insurers over their lifetime.

 

* The new Medicare advisory panel could recommend lower payments to private prescription "Part D" plans operated by a number of insurers.

[Pangloss]

That kind of claim really bugs me, that CBO prediction that the impact on the deficit will decrease over time. They make it sound like health care is going to pay for Iraq or something. Never mind the extra TRILLIONS we spent this year because we couldn't keep our hands out of the cookie jar. Congress just donned its Santa hat with the last spending bill and bought a bunch of Christmas presents for its constituents, but in touting that CBO report they're basically promising (Scout's honor!) not to buy as many presents next year. It's also reminiscent of the post-Clinton discussions about spending the surplus, or the recent debate over re-routing the TARP money. But be that as it may, I do understand that the CBO is saying that the program recovers its initial expenses over time and pushes the red/black line back the other way. It's nice to see SOMEONE FINALLY pushing the line in the correct direction!

 

But that's not actual cost-cutting, it's just getting everyone on the same bureaucratic page. More preventative care and streamlining a few IT processes doesn't mean paying less for drugs and surgery. We are, in the end, simply paying the insurance companies whatever they ask for their services. Without competition or enforced payment schedules (by either regulation or socialization), they can charge whatever they like, and we'll continue to pay it.

 

Insurance companies aren't in the business of helping America with its deficit. They won't lower costs over time, they'll raise them. They have no reason not to, because there is no competition or regulatory pressure forcing them to. Add to that the cost of new technologies and drugs as they appear over time, and you have even more upward pressure.

 

That having been said I'm keeping an open mind and watching how things go. I would love nothing more than to be wrong about all of this and have it work out beautifully.

[bascule]

But be that as it may, I do understand that the CBO is saying that the program recovers its initial expenses over time and pushes the red/black line back the other way. It's nice to see SOMEONE FINALLY pushing the line in the correct direction!

 

Yes, "tax and spend" is indeed a better strategy than "don't tax and spend"

[npts2020]

Supposing some substantial number of individuals who supposedly can afford to buy health insurance refuse to do so? What is going to happen, throw them all in jail so we can give them health care? The problem I have with it, is why should everyone have to buy into the crappiest healthcare (by nearly any statistic you wish to measure that with) in the industrialized world. Are buying into the Canadian or British or Cuban health care systems for insurance allowed?

[iNow]

Supposing some substantial number of individuals who supposedly can afford to buy health insurance refuse to do so? What is going to happen, throw them all in jail so we can give them health care?

 

http://www.nytimes.com/interactive/2009/11/19/us/politics/1119-plan-comparison.html

House Bill:

Penalty

: Tax equal to 2.5 percent of adjusted gross income over certain thresholds ($9,350 for individuals, $18,700 for couples).

Exemptions

: American Indians, people with religious objections and people who can show financial hardship.

 

Senate Bill:

Penalty

: $95 a year or 0.5 percent of a household’s income, whichever is greater, in 2014; $495 or 1 percent of income in 2015; $750 or 2 percent of income in 2016 (with a maximum of $2,250 for a family). The penalty would be adjusted for inflation after 2016. No penalty if the cost of cheapest available plan exceeds 8 percent of household income.

Exemptions

: American Indians, people with religious objections, people who can show financial hardship and people with income below 100 percent of the poverty level ($22,050 for a family of four).

 

We'll see what happens after reconciliation.

 

 

 

The problem I have with it, is why should everyone have to buy into the crappiest healthcare (by nearly any statistic you wish to measure that with) in the industrialized world.

Those statistics will change as part of this bill. The argument you are making would require us to ignore the protections and improvements being implemented.

 

Just a reminder: I support a single payer universal system, and a public option at the very least... Just trying to offer objective responses to your questions.

 

 

 

 

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We are, in the end, simply paying the insurance companies whatever they ask for their services. Without competition or enforced payment schedules (by either regulation or socialization), they can charge whatever they like, and we'll continue to pay it.

 

For your reference:

 

http://www.nytimes.com/interactive/2009/11/19/us/politics/1119-plan-comparison.html#tab=8

Insurers competing in the new exchanges would be required to justify rate increases and those who raise prices excessively could be barred from the exchanges.

 

 

 

Click here to learn how they are proposing the plans will be paid for: http://www.nytimes.com/interactive/2009/11/19/us/politics/1119-plan-comparison.html#tab=15

Edited December 24, 2009 by iNow
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[npts2020]

iNow; I appreciate your arguments and extensive references and am not meaning to attack you personally my friend. I just feel like you are defending the indefensible, we will have to disagree and see how it plays out over the next few years. If it comes out anything like you are describing, I will come down to Austin and buy you a beer. IMO this is going to be a boon to the insurance companies and do little to nothing for the rest of us.

[bascule]

Wasn't Obama originally opposed to mandatory buy-ins? I'll be very interested to see what happens when and if a bill reaches Obama's desk.

 

And to all of you who are questioning the constitutionality of a mandatory buy-in, I echo your sentiments, although that question could probably use its own thread.

[Pangloss]

Thanks for the Times link.

 

On another note, today's procedural vote, the last Senate vote on health care, was on the constitutionality question. Essentially they voted on whether or not it was constitutional. The vote was 60-39 (one Republican absent, I assume). It's significant that the question was asked of the lawyers in the legislative branch, given that it may end up being asked of the lawyers in the judicial branch, who will obviously not use a partisan vote to determine the answer.

 

National Public Radio calls the question "iffy" and suggests possible overturning by the Supreme Court, but they also mention possible avenues of justification in Article 1 and in the Commerce Clause. They have an interesting write-up of the different perspectives and answers to some common questions in this area:

 

http://www.npr.org/blogs/thetwo-way/2009/12/is_forcing_people_to_have_heal.html

[iNow]

If it comes out anything like you are describing, I will come down to Austin and buy you a beer.

Right or wrong, I'll buy the second round... At which point you'll see where my objectivity breaks down and I reveal my own disgust with private insurance and the persistent sub-optimal solutions coming out of our congress.

 

Admittedly, part of the reason I see this as actually "doing something for the rest of us" is my diabetes. I'm in pretty excellent health, just have juvenile diabetes, yet I've had to make some pretty distress-inducing decisions due to the structure of medical insurance in our country. I've had the unfortunate experience of being out of work for several months, and had to pay my cobra with my unemployment check. I could barely pay my bills, and yet I was diverting money towards cobra since I couldn't take a chance of letting my coverage lapse due to my pre-existing. More than once I had to decide whether to eat dinner or to buy my insulin (strange juxtaposition if you ask me), and had to decide whether to pay my rent or to buy glucose test strips. Those are decisions no American should ever have to make, and I consider myself a rather industrious and intelligent person. If I've had to struggle through such hardships, I can only imagine how bad it is for the countless others who have it worse.

 

I am tough, though. I made it through, and I'm fortunate to have work now, and a quality health plan.

 

However, that experience will forever change my feelings about healthcare in our country, especially when I hear about how it works so well in other countries. As I said, I know this bill is flawed, but I also know it's better than what we have now.

 

If anything, I hope it galvanizes people to demand better... to go the whole way and do this right... with a single payer universal system. In the meantime, however, I'll try to find the positive aspects of what is happening.

 

Anyway, I know just the place. They have about 110 different beers on tap.

[bascule]

They have about 110 different beers on tap.

 

Hope it's not Old Chicago

[iNow]

Hope it's not Old Chicago

 

Wow... No. That strikes me as the type of place where I'd need healthcare after visiting.

 

Btw - Yes, Obama campaigned against a mandate. Turns out, it's required to make this even come close to working.

[jackson33]

Well yes, the purpose of welfare programs is to promote wellfare. The concept of decreasing marginal utility means that transferring from those with excess to those lacking increases utility (welfare). As always, this will interfere to some extent with another right (right to private property), but we have decided to do this anyways. It seems to have been a good choice.[/Quote]

 

Mr. Skeptic;

The War on Poverty, by some estimates has cost the US taxpayers over 12 Trillion Dollars since 1966, yet currently now over 1T$ each year. I'm not sure what the 'Good Choice' was, but somethings not right. This article after this passage, list a series of questions, which you should conclude the War has accomplished very little, if anything.

 

When Lyndon Johnson inaugurated the War on Poverty in 1964, he assured the public that “. . . this investment [of tax dollars] will return its cost many fold to our entire economy.” Now that this “investment” has reached a trillion dollars a year we should evaluate whether the returns have, in fact, been large. Some questions to consider. [/Quote]

 

http://www.brookesnews.com/081509welfarepoverty.html

 

Do you think MAYBE a different approach than 'FREE' would have worked or would work better, like it has for many others that educated and worked their way out of poverty? I look at it this way; If a person has property worth more than me, however legally attained, he/she has the right to distribute by any mean wished, short of what we all are forced to contribute to....Most of us, wealthy or not, volunteer our money or time and that has worked just fine.

 

It seems to me that the Constitution allows us to maintain unspecified rights not mentioned in the Constitution. Even if this were not the case, it could be considered an extension of the right to life which is specifically mentioned.[/Quote]

 

The Constitution allows for a changing society, where by the agreement of 3/4ths the States, these changes can be made. Frankly, I'm not sure there is a right to 'Health Care' any more than there is a right to a car, food, a home, utilities or anything else requiring some effort to attain.

 

You will need to refresh my aging mind, on where the right to life is mentioned as a guaranteed right in the Constitution. You may be thinking of the 'Declaration of Independence' where the 'pursuit of life, liberty...' is an inalienable right, creator given.

 

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, that among these are life, liberty and the pursuit of happiness.[/Quote]

 

http://www.wfu.edu/~zulick/340/Declaration.html

 

As someone mentioned, another inalienable right (that cannot be transferred to another or others), would be dieing, can government deny me that right, forcing me to live forever....

 

npts2020;

Supposing some substantial number of individuals who supposedly can afford to buy health insurance refuse to do so? What is going to happen, throw them all in jail so we can give them health care? [/Quote]

 

inow;

Also, I'm curious about your suggestions that insurance companies will still be largely unregulated, especially considering there are more than 400 pages in the bill of regulatory provisions. [/Quote]

 

These are my primary concerns for feeling the Administration is counting on some items to fail; Very few not currently insured are going to jump in buying policies, that Insurance Companies (under those 400 pages) will have to charge more. They will wait and likely many others will actually drop out of their self paid current policies, until the need actually come up. When you start talking 6-8-10k/year for insurance, a fine (think starts in 2014, around $500, they dropped the jail thing) people are going to take chances. Tim Guitner and Axlerod were knee deed in Chicago politics, where back door entry into a desired policy has worked for decades. They know what I'm suggesting is probable, but I don't know why they have promoted or have gone along with it...

[iNow]

You will need to refresh my aging mind, on where the right to life is mentioned as a guaranteed right in the Constitution. You may be thinking of the 'Declaration of Independence' where the 'pursuit of life, liberty...' is an inalienable right, creator given.

Hi Jackson,

 

The sections of the constitution which your memory is failing to recall are the Fifth and Fourteenth Amendments. The right to life appears in more than just the declaration, which is not itself a governing document.

 

Merry Christmas.

 

 

http://docs.law.gwu.edu/facweb/jsiegel/home/ConstFrames.htm#Am5

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself,

nor be deprived of life, liberty, or property, without due process of law;

nor shall private property be taken for public use, without just compensation.

 

 

http://docs.law.gwu.edu/facweb/jsiegel/home/ConstFrames.htm#Am14

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States;

nor shall any State deprive any person of life, liberty, or property, without due process of law

; nor deny to any person within its jurisdiction the equal protection of the laws.

Edited December 25, 2009 by iNow

[npts2020]

I am thinking of starting a health insurance company. The payments will be $5/month for administration with 100% copayment fees. What is to stop me from doing so and then saying I am insured?

[bascule]

The War on Poverty, by some estimates has cost the US taxpayers over 12 Trillion Dollars since 1966, yet currently now over 1T$ each year.

 

Psst, we spent $360 billion on unemployment/welfare in 2009

 

Statements like "by some estimates" are best supported by sources. Otherwise, they're called "hearsay".

[iNow]

I am thinking of starting a health insurance company. The payments will be $5/month for administration with 100% copayment fees. What is to stop me from doing so and then saying I am insured?

 

Maybe these will help you in your endeavor:

 

http://www.ehow.com/how_4478642_start-insurance-company.html

http://www.startaninsuranceagency.com/

http://ezinearticles.com/?How-to-Start-Your-Own-Insurance-Company&id=1475707

 

From what I can tell, the most difficult parts would be state licensing and funding. I have been unsuccessful in finding information regarding oversight and compliance once the company is open, but that will likely be an obstacle to overcome, as well.

[jackson33]

OK bascule, this is your thread...but keep in mind that comment was directed at another poster indicating the success of the poverty program and a passing thought by myself....I'm off topic at your request...

 

Medicaid/Welfare payments, have not been consistent from there conception, but today for the most part States and the Federal Split the cost. For an example, using your Fiscal Year 2009 Budget (ending October 2009) the 584B$ Federal Expense (224B$ Medicaid/SCHIP and 306B$ Welfare/Unemployment) was matched or near match in and by each State. In addition each State may have additional welfare, for specific items, other States may not, to illegal immigrants, clinics and Hospitals, the most common. I believe the Food Stamp program*, is funded through the Farm Bill Appropriation, which runs through the Agriculture Department and several other departments have expenses, directly for the purpose of assisting the poor or impoverished. Anyway you look at this spending by all Government, funding from tax payers, exceeded ONE TRILLION dollars in that year and will surpass 2T$ this fiscal year (2010), which started in October 2009.

 

To the threads topic, Constitutionality; Nebraska, will receive (if passed) full exemption for there share of Medicaid payment (paid by the Federal) for the remainder of the program or into eternity, if you prefer that word, Louisiana will receive 300M$ to assist in the payments and a couple others other forms of assistance in Medical Expenses, to compensate for the proposed additions to the Medicaid System, all of which IMO are unconstitutional. Medicare is general paid entirely from Federal Funds.

 

Now, the point I was trying to make to the other poster was the 'War on Poverty' (Government Program) was designed to eliminate poverty by assistance, with the idea any expense during those first years would lead to a net profit to society over the years, it has not, growing to the current trillion per year. Most of us arguing against the Lyndon Johnson programs in the sixties, were similar to todays arguments on the HCB, that under the wording, they and this HCB can only grow, leading to increased cost, as public sentiment (those involved) would not allow any rationing or future cuts in total assistance. In fairness, some attempt has been made, limited times this assistance is available, the qualifications and amounts, but has been sidetracked by the departments (especially in the States),

 

*The Food Stamp Program, in 2008 cost 28.6 B$, while 1970 the cost was 577M$. States are only involved with about 1/2 administrative cost, the Federal the rest, not part of Johnson's programs, but another good example of explosive cost to intent by the Federal...

 

In 2008, SNAP served 28.4 million people a month at an annual cost of $34.6 billion. In February 2009, SNAP served 32.6 million people, an all-time record. SNAP participation fluctuates with the economy and with the pattern of poverty in America. As the number of persons in poverty rose, SNAP participation grows. When poverty falls, so does reliance on SNAP. Participation for the latest available month can be found on Program Data.[/Quote]

 

http://www.fns.usda.gov/fsp/faqs.htm

 

 

Many of the programs under the WoP have been discontinued, but if you read through this article, keep in mind his stated objective was to end Poverty, which apparently has yet to end and that Society would in the end receive a net GAIN ob any expense. The simultaneously keep in mind the current HCP, which is promised will not increase taxes (already wrong), reduce cost, increase quality and be net benefit for the Society....Note; This article was written in 2002, suggesting a total cost of 7T$, at the time, which is now well over 12T$, I've seen much higher.

 

 

 

As Murray Rothbard pointed out in an essay in Making Economic Sense, the amounts spent by federal, state, and local governments since the Great Society of the 1960s totals the staggering sum of $7 trillion. "And what is the result?" Rothbard asked. [/Quote]

 

http://mises.org/daily/1126

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inow; I really don't think you serious;

 

The sections of the constitution which your memory is failing to recall are the Fifth and Fourteenth Amendments. The right to life appears in more than just the declaration, which is not itself a governing document. [/Quote]

 

There is no guarantee to life, in the Constitutions, or any implied implication ever from the founders or any law ever made. NO ONE could do this, it's just that simple. Procedure for taking a life, has nothing to do with providing a service or if you wish determining when that service is cut off, I might add with out due process....

 

Hope you had a nice Xmas as well and best wishes for the New Year. I'll do my best to complicate it a little, but the sentiment is sincere. Maybe marriage is in your 2010 future, which IMO would do wonders for you....

[iNow]

Maybe marriage is in your 2010 future, which IMO would do wonders for you....

 

So, you're an advocate of polygamy now?

[jackson33]

No iNow, I don't really have an opinion on who does what with who or how many are involved. Could be mistaken, but thought you had mentioned a 'girlfriend' a time or two in the few of your 20k post, I've read. Even if you had, it could have been a friend (that happens to be female) or your a woman (don't think so). Just a little effort to lighten up your day, which is really difficult to do.

[npts2020]

Maybe these will help you in your endeavor:

 

http://www.ehow.com/how_4478642_start-insurance-company.html

http://www.startaninsuranceagency.com/

http://ezinearticles.com/?How-to-Start-Your-Own-Insurance-Company&id=1475707

 

From what I can tell, the most difficult parts would be state licensing and funding. I have been unsuccessful in finding information regarding oversight and compliance once the company is open, but that will likely be an obstacle to overcome, as well.

 

There is nothing in any of those links that tell me I couldn't start the insurance company I refer to and then call myself insured for federal tax purposes. I will be very interested when the final version of the bill is published to see exactly what sort of "oversight" there is.

[JohnB]

npts, you still aren't thinking straight.

 

Start your company and then get a thousand or so people to join it.

 

Then declare "problems" and ask for a bail out.

 

That's how to do business with .gov

[npts2020]

npts, you still aren't thinking straight.

 

Start your company and then get a thousand or so people to join it.

 

Then declare "problems" and ask for a bail out.

 

That's how to do business with .gov

 

Doggonit, always someone a step ahead of me. The point of that outburst was exactly what constitutes having coverage? Can I get a plan that costs a small fraction of whatever penalty is going to be imposed, even if it is crappy and won't really cover anything or is there some minimum standard?

[iNow]

The point of that outburst was exactly what constitutes having coverage? Can I get a plan that costs a small fraction of whatever penalty is going to be imposed, even if it is crappy and won't really cover anything or is there some minimum standard?

 

This is only a half answer to your question, but from the link I shared earlier in the thread:

 

 

http://www.nytimes.com/interactive/2009/11/19/us/politics/1119-plan-comparison.html#tab=7

Require insurance plans to offer a minimum package of health insurance benefits, to be defined by the federal government.

 

House version

• The basic plan would cover 70 percent of the cost of the benefits and would limit out-of-pocket spending at $5,000 a year for individuals and $10,000 for families. Consumers would pay the remainder, in deductibles, co-payments and other charges. The out-of-pocket limits would be reduced for people with incomes below 400 percent of the federal poverty level ($88,200 for a family of four).
  
  
   
  
  
• The exchange would offer three other benefit plans, covering up to 95 percent of costs. The Congressional Budget Office says policies bought in the individual insurance market now average 55 percent to 60 percent.
  
  

 

Senate version

• The basic plan would cover 60 percent of the cost of the benefits and would limit out-of-pocket spending at $5,950 a year for individuals and $11,900 for families. The out-of-pocket limits would be reduced for people with incomes below 400 percent of the poverty level.
  
  
   
  
  
• The exchanges would offer three other benefit plans, covering 70 percent to 90 percent of costs. A plan for catastrophic coverage would be available to people up to the age of 30 and those who are exempt from the requirement to obtain insurance.
  
  

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Doing some further digging, I found that all plans will need to comply with the minimum standards and requirements that exist now as part of the Federal Employees Health Benefits Program (FEHBP). More information regarding those regulations can be found here:

 

http://www.opm.gov/insure/health/reference/regs.asp

Edited December 29, 2009 by iNow
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[npts2020]

Thanks for the links iNow, definitely some fat to chew on. Seems like there are so many CFR's is because somebody already tried something like what I suggested above.