Monday, March 26, 2012

Health Care and the Constitution

By my standards as an attorney, I'm not fully prepared to comment on the argument taking place in the Supreme Court. Although I've studied constitutional law, and I've read a couple of the Court of Appeals cases on each side, and I've read some articles by constitutional law experts, I haven't read the briefs, and I haven't looked up all the relevant cases. Of course, lots of other people seem to be offering opinions on this topic, and I'm sure most of them haven't read all the briefs or looked up all the cases either. 

Still, I can't give a fully-polished lawyer's argument, so I'll just offer a couple of impressions. One is that the Supreme Court is overdoing this. Three days of argument on a question that doesn't that much more difficult from lots of other questions they have to decide? Especially considering that the argument for upholding the statute seems much stronger than the argument for finding it unconstitutional. Part of me would like to see the Supreme Court issue a quick decision saying this is an easy case, of course this statute is constitutional, let's move on. On the other hand, this is a landmark piece of legislation that affects everyone in this country, so maybe it makes sense to give it special attention, just so everyone understands that the Court is giving this case extra special attention.

There are a couple of questions I'd like to ask the justices if I had the chance. One is to ask why are they not troubled by the fact that I'm already being taxed to pay for their health insurance. I'm being taxed to pay for every federal employees' health insurance. I'm being taxed to pay for every veterans' health insurance. I'm being taxed to pay for health care for poor people, and I'm being taxed to pay for the health care of everyone over the age of 65. So why exactly is it such a problem that the government is asking me to chip in to pay for my own health insurance?  If it's good enough for federal employees and veterans, and the old and the poor, it ought to be good enough for the rest of us.

There is a practical reason why something like a mandate, or a tax, is required to make sure that everyone has access to health insurance. That is because the system is becoming unaffordable unless we have a way of making practically everyone pay into it. But there is also an evolution in our moral, and maybe also in our constitutional thinking that justifies the idea of universal health insurance, an idea that  is taken for granted in every single other advanced country, but encounters enormous resistance only in America. That evolution would recognize health care as a right of every citizen. and has to concede that the every man for himself philosophy just plain won't work anymore to protect us from catastrophic health problems that can strike any of us. But the fact that we need to make that leap also explains why those opposed to the idea of universal health insurance are fighting so hard against it. Because this argument might be seen as the last stand of the every man for himself philosophy that some take to be fundamental to American values.

Lots of people hate the idea that the government is now in the business of making sure we all take care of each other. They hated Social Security; they hated Medicare and Medicaid; lots of them hate the whole idea public education; and they sure seem to hate the Affordable Care Act, even though it is based more on a private model than any of those prior pieces of socialistic legislation.  But these self-reliant people who think they have no use for government are just going to have to recognize that if they get very sick, they are going to end up in the emergency room, or needing an expensive operation, and the rest of us are probably going to end up paying for it. So it's fair for them to pay too. And maybe it's good for lots of people to gather outside the Supreme Court and give vent to these feelings. If this very conservative Supreme Court votes to uphold the constitutionality of this Act, as they should, that will help establish that it is not inconsistent with fundamental American values to protect the right of every citizen to affordable health care when they need it.

UPDATE: Even though I don't have full confidence in the Supreme Court deciding this issue, unfortunately we can't leave it up to the people either. A new CBS poll says that only 25% want to keep the Affordable Care Act intact, while another 29% would keep the law but get rid of the mandate. Yet something like 85% support the ban on insurance companies' ability to reject people for pre-existing conditions. That means that a solid majority would like to be able to wait until they get sick before they have to buy health insurance. They would probably also like to wait until their house burns down before they have to buy fire insurance, but people seem to get that that would not work. Why is it so hard to understand that the same principle applies with health insurance?

9 comments:

  1. << So why exactly is it such a problem that the government is asking me to chip in to pay for my own health insurance? >>

    The vast majority of us already do chip in to pay for our health insurance. If you are not, you should be. I pay about $7500 a year. Most of the people I know that don’t chip in and should be are state and federal union members. The poor should be covered by bthose of us who can help; as should enlisted men and women. I think that takes care of almost everyone.

    << They hated Social Security; they hated Medicare and Medicaid; lots of them hate the whole idea public education; and they sure seem to hate the Affordable Care Act >>

    72% of us (according to the latest NY Times CBS poll) think Obamacare is a misconceived law. That doesn’t me we are haters or that parts of the bill are not essential. I would say almost all of the 72% already pay for a large portion of their health insurance, like I do. We already chip in at a tune of 10-20% of our incomes for health care -- plus taxes toward Medicare and Social Security.

    Who are the other 28%? The 72% like Medicare and Social Security, although everyone (absent a minority of progressives) admits the programs need some tinkering to continue to exist for our grandkids.

    << But these self-reliant people who think they have no use for government are just going to have to recognize that if they get very sick, they are going to end up in the emergency room, or needing an expensive operation, and the rest of us are probably going to end up paying for it. So it's fair for them to pay too.>>

    Who are these people you talk about with such disdain? How many of them are there? It sounds like an imagined army. Some of us simply don't agree with this law. It doesn't mean we are wrong or ignorant.

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    1. You are much better informed than most people, but even you are under the impression that union members who bargain for health insurance benefits somehow do not pay for them. But the union negotiators know there is always a trade-off between salary and benefits. Employers don't care whether they pay employees more or provide health insurance. The cost is the same to them. Which means that every employee receiving health insurance is paying for it. The only people who don't pay are the uninsured. That's about 50 million people right now, so I don't think we are reaching almost everyone. Maybe the most important thing about health care reform is getting those people to pay also, whether by requiring employers to provide insurance, or by a tax or by a mandate.

      People who are against any form of requiring everyone to buy in to the system in some fashion I believe don't understand the problem, or they don't understand how much it is costing us that not everyone is buying in.

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  2. << A new CBS poll says that only 25% want to keep the Affordable Care Act intact, while another 29% would keep the law but get rid of the mandate. Yet something like 85% support the ban on insurance companies' ability to reject people for pre-existing conditions. That means that a solid majority would like to be able to wait until they get sick before they have to buy health insurance. >>

    What it means is that the bill is very poorly written and not well understood by some supporters and detractors.

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  3. No. It means that Americans believe there is such a thing as a free lunch.

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  4. Specifically, who are these people who want a free lunch? Who are the people your article is directed at? I don't know them. If you are talking about the poor, they favor Obamacare. Who is left?

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  5. I'm talking about 85% of Americans, according to the poll, who think that we should prohibit insurance companies from denying policies to people with pre-existing conditions, most of whom are also apparently against any kind of mandate. That's a solid majority of Americans who believe that everybody is entitled to health insurance when they need it but healthy people shouldn't be required to pay for it.

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  6. It sure looks to like this is about more than healthcare. Parts of what the bill hopes to accomplish are badly needed. That is what must make it so frustrating to people like you who strongly support it.

    On the other hand the majority of the people who are not in favor of some parts of the misconceived bill _are_ already paying for their health insurance, to the tune of 10-20% of their incomes …

    … and, according to you, even the union members who do not pay into their health care (like I do) are paying into it; military too. That leaves only the poor not paying for health care right now. We pay for them.

    So what’s really the issue? The push back against Obamacare is less about health care (which needs a ton of work) and more about government overreach, constitutionality and the feeling of getting bullied. The bill was passed in a way that the majority of the country will not forgive. My view of the bill, along with that of a wide majority of my fellow Americans, is jaundiced. Made worse by carve outs and waivers that I find sickening; and gifts to large insurance companies who have been the nemeses of physicians and patients (all of us) as long as I have been in the business (30 years).

    I want what you want; everybody with basic health insurance and medical care available to those with pre-existing conditions. I am reaching my limit financially to contribute more in taxes and to my health insurance, but I would pay more of both to make that happen.

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  7. It's not true that only the poor are not paying. The poor are generally eligible for Medicaid. The people who are not paying are something like 50 million people who are uninsured right now for a whole host of reasons. These include young people who might not have steady employment, self-employed people who don't want to spend the money for insurance, part-time workers, full-time workers who work for companies that do not provide benefits, and unemployed people who also can't afford or choose not to pay for health insurance. Your gardener. Your cleaning lady. Your handyman. Etc., etc. (Don't tell me if you don't have a gardener or handyman. That's not my point. The point is that there are a lot of working people without insurance.)

    All these people are just hoping they stay healthy, and if they get sick, the rest of us have to pay for their care, and that's a big part of the reason why premiums are so high for the rest of us. Not to mention that the uninsured are billed astronomical rates for hospital stays, etc., and hospitals spend a fortune trying to collect those bills, and lots of people end up filing bankruptcy to avoid them. All of that is extremely inefficient! And that is why we have to figure out a way to make everybody pay, as well as the make the system more efficient, so that you and I can afford health insurance for our families and our employees.

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  8. << They would probably also like to wait until their house burns down before they have to buy fire insurance, but people seem to get that that would not work. Why is it so hard to understand that the same principle applies with health insurance? >>

    I agree with you. I find this irresponsible.

    I think the only way we are going to get everyone covered is to have a Medicare for all type system. I don't favor that but I do see it may be the only way to get everyone covered.

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