There have been numerous comments about the Supreme Court's decision upholding the Affordable Care Act (ACA) otherwise known as Obamacare.
Advocates of the ACA stress its goals of providing health care insurance coverage to more Americans and prohibiting insurance companies from denying coverage to those with preexisting conditions. Those in opposition to the Act (as approved by the Court) point to its deficiencies primarily in the Act's mandates which limit individual freedom of choice, increased taxes (and the government's authority to impose them) and a rise in spending when we can least afford it.
Our current system for financing health care is broken. Since it is based on reimbursement of fees charged and not a competitive price structure, it has grown in costs and inefficiencies. Efforts to fix it by top down bureaucratic micromanagement have only aggravated its problems. No amount of tinkering, including Obamacare, can fix it. It should be replaced in its entirety.
The goals for a new financing system should be simplicity, efficient and sound health care administration, lower costs to the consumer and meet the constitutional criteria for individual rights of free choice.
Since our Republic's beginning, the system that has best met these criteria and been the engine of unprecedented prosperity has been that of free enterprise. History has shown in this country and others that government run economies lead to a loss of individual freedom and economic stagnation.
The answer to the health care problem should be clear. As a start, Obamacare should be repealed and replaced with a system of competitive private insurance able to compete in all states. Over time persons who become eligible for Medicare should have the option of choosing private coverage over the Medicare system. In order to provide coverage to most persons, government could subsidize insurance premiums for a stipulated program for those in need. As to preexisting conditions, an assigned risk pool, preferably administered by the individual states, should meet the need.
Now is not the time for half-measures. On this Independence Day, we should strive for a health care financing system that respects the individual right to freedom and meets his/her health care needs.
Advocates of the ACA stress its goals of providing health care insurance coverage to more Americans and prohibiting insurance companies from denying coverage to those with preexisting conditions. Those in opposition to the Act (as approved by the Court) point to its deficiencies primarily in the Act's mandates which limit individual freedom of choice, increased taxes (and the government's authority to impose them) and a rise in spending when we can least afford it.
Our current system for financing health care is broken. Since it is based on reimbursement of fees charged and not a competitive price structure, it has grown in costs and inefficiencies. Efforts to fix it by top down bureaucratic micromanagement have only aggravated its problems. No amount of tinkering, including Obamacare, can fix it. It should be replaced in its entirety.
The goals for a new financing system should be simplicity, efficient and sound health care administration, lower costs to the consumer and meet the constitutional criteria for individual rights of free choice.
Since our Republic's beginning, the system that has best met these criteria and been the engine of unprecedented prosperity has been that of free enterprise. History has shown in this country and others that government run economies lead to a loss of individual freedom and economic stagnation.
The answer to the health care problem should be clear. As a start, Obamacare should be repealed and replaced with a system of competitive private insurance able to compete in all states. Over time persons who become eligible for Medicare should have the option of choosing private coverage over the Medicare system. In order to provide coverage to most persons, government could subsidize insurance premiums for a stipulated program for those in need. As to preexisting conditions, an assigned risk pool, preferably administered by the individual states, should meet the need.
Now is not the time for half-measures. On this Independence Day, we should strive for a health care financing system that respects the individual right to freedom and meets his/her health care needs.
While much of the discussion has been on the costs of Obamacare I'd like to focus on the legal basis by which the bill was legislated (as a penalty) then as to how it was upheld by SCOTUS (as a tax). This is the sort of double-speak that has many Americans so soured on what goes on in Washington.
ReplyDeleteThe Individual Mandate is un-Constitutional as a violation of the Commerce Clause. The SCOTUS rightfully ruled that the Federal government does not have the authority to regulate inactivity. However, according to Justice Roberts the Congress does have the right to tax it. The Constitution enumerates several distinct conceptions of the Government's ability to tax. Amongst them are a capitation tax, excise tax and income tax. Justice Roberts can't articulate which type of tax this new healthcare tax would fit under saying that the court is not going to get into a semantic fight "over labels". Really? We have to wonder how the Framers would react to such cynicism.
So, it's a penalty when the bill was on the floor in Congress, it's a tax when the Solicitor General argues it in front of SCOTUS and now according to Jim Carney it's now a penalty again.
But it gets better. In his briefing, Roberts, in order to around the individual mandate, called the "fee" a tax. However, to get around the anti-injunction clause (which states that a citizen can't argue against a tax until Congress calls a payment to the government a tax) the "fee" morphed yet again into a penalty!
Ladies and Gentleman, this is one magic fee!
As a general matter, Americans are rightfully suspicious of the government's authority to tax. After all, we had a war of independence over these things. The odd thing is that, under the 10th Amendment, mandatory healthcare would be perfectly constitutional at the state level. That's why seatbelt laws, auto insurance and even the drinking age are STATE LAWS. It just so happens that every state adopts them.
What we have here folks is a massive power grab by the statists in the Federal Government. Justice Roberts has thrown the doors wide open on the Federal government's ability to tax virtually anything - both activity and now inactivity. So, what's next? The couch-potato tax? The grilling in the backyard tax? The typing on blogs tax? The drinking beer tax? The avoidance of Michelle Obama's vegetables tax? These all could be construed as inactivity. And that's just the point. The FEDERAL GOVERNMENT NOT YOU GETS TO DECIDE WHAT AN ACTIVITY IS!!!!!!
The Federal government just got away with an illegal nationalization of our healthcare industry. It's a $2 trillion power grab equal to 15% of our GDP.
The solution is rooted in the free market. Allow insurance companies to compete in all states. The major reason health care costs are rising is because it is an over-used good. People don't shop on price believing that their out-of-pocket cost (the co-pay) of $15 - $20 is "their cost". If doctors were mandated to publish menus (like in a restaurant) about the cost, the actual cost of procedures, then people would shop around for the best cost/benefit result. That result may involve forgoing the trip to the doctor in the first place which, as a sovereign individual, is (or was) my right.
Those who can't afford insurance should receive Medicare with an option for private insurance. This could be funded with a block grant to the states to fund.
In the final analysis, this has nothing to do with helping "the poor" inasmuch as it has to do with redistributing wealth and grabbing power. The Obama Administration has a remarkable record folks - of taking over key industries of this country - energy, banking, automotive and now healthcare. As a matter of direct spending the government is about 22% of GDP. However, if you add in these nationalizations the government is nearly 55% of the economy.
It occurs to me that liberals and we enlightened think we are speaking very different languages- and therein lies the rub and the rift.
ReplyDeleteEach believes it is speaking for a side of the health care conundrum. As always there are two sides to every debate, albeit one side usually is the strongest -there are still two sides, In this case, there is the DELIVERY of heath care and the FINANCING of health care. Woe to those who do not take each side into consideration..they are doomed to lose.
Delivery. There are persons within our country that are vulnerable: children, homeless veterans, the mentally ill who were cast out from protection and shelter...etc. The trick is to pull these out from the "simply unwilling" who need health care. The simply unwilling must be coaxed to earn their bread/health care and take responsibility for their actions and how they affect their health i.e., health dollar.
Still in all, a system must be found to care for the vulnerable in our society. The reinstatement of prenatal clinics (premature infants garner a huge bulk of our medical dollars), well baby clinics (where preventable conditions are easily found and easily, inexpensively treated), the institution of required newborn testing to include such things as gluten intolerance (saving millions later on). The reinstitution of neighborhood clinics to decrease expensive ER visits, to catch early hypertension, diabetes and its expensive complications. Prevention is the most dollar conscious step we can take and the least expensive.
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Delivery includes the aspects of simplified and shared record keeping,
economies of scale in purchasing, etc., tort reform, This entire side of the debate must be addressed, difficult and frought with philosophical and ethical issues as it is. Care at the end of life must be addressed.
And addressed with courage and fairness. If we do not address all of this along with the contentious issue of financing our health care system will flounder like a dragon without wings.
Competition. Recently I was admitted to a hospital in West Chicago: Delnor Hospital. As a nurse and a hospital administrator I am the most critical of the critical when it comes to hospitals and medical care. I could find no fault in this hospital, its excellence in every aspect blew me away. When commenting to a nurse about this, she informed me that it was all about competition. Indeed it seems Medicare has instituted a system of consumer evaluation of hospitals. COMPETITION WORKS.
Pride in care was evident everywhere in this Magnet award hospital.
"we enlightened". Ouch. While I am a social liberal, I consider myself a fiscal conservative. Am i half-enlightened? I think there is ridiculous amount of confirmation bias going on these days. Those opposed to Obama decided the day he was elected that he was evil and would lead to the downfall of this nation. After that, every action he took was wrong. Now that Romney is the presumptive nominee, people find a way to convince themselves he is the answer and fits their criteria of a great candidate.
ReplyDeleteI tend to look at issues like health care more conceptually. I dont think either side was happy with what ended up being the Affordable Care Act. The amount of horse trading that went on left a bill that hit some high notes (insuring more people and hoping to slow the rise or premiums), but not much else.
There must be something to the individual mandate if Romney pushed for it when Massachusetts overhauled their health care plan in 2006. I understand the legal issues of governments vs. states dictating such things, but if it was a necessary evil to reduce premiums for everyone (assuming the uninsured add costs for the insured), then what is the problem now?
I think we can all agree that competition among health care providers is good. I would see no problems if policies could be sold across state lines as long as they met the standards of state where the customer resided and clearly stated their benefits.
Ideally, we want everyone covered for the least amount of money possible. We should focus on prevention as much as treatment. Hitting the reset button is always going to be hard as all the politicians got something when they gave up something up during the initial passing of this bill.
We will see what comes of the next four months. I would just like to see the rhetoric of votes for Romney (against Obama really) being votes to restore our freedoms and save this great nation. Obama isnt going to ruin this country, nor is Romney going to save it. If anything is really going to change the people have to demand it.
I agree with Anonymous re. his analysis of the SCOTUS decision. As stated in his comments, the Federal Government "--now has the ability to tax virtually anything-both activity and now inactivity". This is a far cry from the concept of limited and enumerated powers envisioned by our forefathers in the Constitution and has serious implications for individual freedom.
ReplyDeleteThe goals cited by Hieromous for the delivery of health care are important to improving the nation's health. By emphasizing early intervention/ prevention, streamlining medical records and tort reform, we could improve health care delivery as well as reduce costs.
No one of these goals is inconsistent with a free enterprise system utilizing price competition and allowing individuals the freedom to choose their health care. As pointed out in the original post, concerns for the affordability of insurance for the poor could subsidized and preexisting conditions could be provided for by using assigned risks pools preferably administered by the states.
As to Ryan's comments, I would point out several factors:
1. The goals of achieving quality health care for as many as possible, with the lowest possible costs can best be reached under a competitive price structure with the caveats listed above.
2. We are $16 trillion in debt. We need to get our fiscal house in order (soon) by getting government spending under control and putting policies in place to encourage growth. If we don't, we will be facing a serious economic downturn affecting all segments of our economy including health care. That outcome won't help anyone especially the poor. (By the way, a recent Gallup poll indicates that 46% of respondents said that Obamacare will hurt the economy, 37% said it will help, 18% were undecided).
3. As to the Mass. mandate, a brief background:
The US constitution enumerates limited powers to the Congress to tax, regulate commerce etc. It also lists prohibitions (see sections 8& 9, Article I).
The constitution also puts some limits on the states powers prohibiting actions that may interfere with federal responsibilities such as making treaties, affecting interstate commerce etc. (see section 10, Article I).
We should also note that Amendment X of the Bill of Rights says: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people".
In conclusion, there is nothing in the US Constitution that prohibits Mass. (or any other state) from imposing a health care mandate as it so chooses. Whether it is sound policy is up to the state to decide. At the federal level, it is a moot point given the SCOTUS decision.
A short time ago, I researched the cost of healthcare insurance for federal and state employees. The examples I found were the U.S. Postal Service and Minnesota state employees. Approximate costs were $8,000 per year for employee and family. Adding 30M people to the H.I. "roles" equates to massive additional costs to either employers, employees, or both. You may note; for year 2016, the penalty for not having insurance coverage (aka a tax), starts at $695 for an individual and increases to $2,085 per family ($347.50 per child) OR 2.5% of income, whichever is GREATER. From what I have found for the employer "tax", such would be $2,000.
ReplyDeleteThe question becomes, how may our economy recover and employers compete in a "free trade" environment with additional cost burdens? Why expand operations in the USA when China beckons? As states and city governments face budgets which are over and above revenue, does it make sense to eliminate health insurance benefits and simply pay the $2,000 fine? Maybe I have missed an exemption of taxes on state and local government.....after all, we know of the 1,400 other exemptions.
A point I have not seen "debated": we all know the higher deductible the insurance policy, the lower the rates. When dealing with say, a near minimum wage employee base, will the required H.C. insurance be of low enough deductibles of which the employee may afford to pay out of pocket? Many people earning less than $50K per year simply live paycheck to paycheck. Something to think about as if an employee cannot afford the deductible, they might as well not have insurance.......
I end with two more points: if all people are required to have insurance, shouldn't non-for-profit designation end? Talking to any health care provider about preventative medicine as a means to avoid or "cover one's butt" from malpractice lawsuits and tort reform, simply was not covered via the Obamacare legislation. These additional costs could be reduced and taxes collected help pay for coverage and/or reduce the deficit. As Norm stated, a debt of $16 Trillion....From what I have researched, we will reach $16.4T by the end of Obama's term. This equates to $5.7 T in added debt in Obama's four years.
Or in other words, equal to the debt incurred from 2000-2008. We simply cannot afford four more years of Obama's leadership.
Kenny raises some very good points that I haven't heard before. The penalty for not buying insurance in future years will become really burdensome for families of modest means. However, if they elect to buy insurance, they will be either faced with high premiums or high deductibles (to keep the premiums within reach).
ReplyDeleteThere are better ways to solve this problem (and others such as covering more of those who are not now covered and/or those with preexisting conditions) by utilizing the free enterprise system and addressing the problems with specific solutions.