Health Insurance and the Commerce Clause
Writing in today's Wall Street Journal, Judge Andrew Napolitano argues that Congress should use its authority under the Commerce Clause for a legitimate purpose and allow the interstate sale of health insurance:
The same Congress that wants to tell family farmers what to grow in their backyards has declined "to keep regular" the commercial sale of insurance policies. It has permitted all 50 states to erect the type of barriers that the Commerce Clause was written precisely to tear down. Insurers are barred from selling policies to people in another state.
That's right: Congress refuses to keep commerce regular when the commercial activity is the sale of insurance, but claims it can regulate the removal of a person's appendix because that constitutes interstate commerce.
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Firrrrst!
Oh yeah. That worked so effing awesomely for credit cards. Who will be the Delaware of bait-and-switch health insurance contracts? Alabama maybe? Or Connecticut?
It's so wonderful to crap on federalism and state sovereignty when it serves the interests of the GOP donor base.
Judge Andrew Napolitano for the US Supreme Court!
Nicely done, Judge. At first blush, the kind of barriers to interstate commerce erected by the states around health insurance are exactly the kind of thing that the Commerce Clause was intended for.
What exactly is the states' rationale for barring insurers from competing across state lines?
Anyone?
The same Congress that wants to tell family farmers what to grow in their backyards has declined "to keep regular" the commercial sale of insurance policies. It has permitted all 50 states to erect the type of barriers that the Commerce Clause was written precisely to tear down. Insurers are barred from selling policies to people in another state.
Leave it to a bunch of Ivy league fucks to get the commerce clause 100% wrong. Why should I respect anything these cocksuckers have to say other than they control the leashes of the dogs that would do me harm?
This issue has still confused me, so bear with me. I'm in California... is there a state law that says that I am not allowed to buy insurance from an out of state provider? What is the specific rule about this?
I ask because I see a lot of references to this, but I still don't actually know the mechanics. So let's say I tried to buy a policy from a company in Utah. If they sold me a policy, what state law would they be violating? Utah's? California's? Or is the violation at the time of reimbursement? If I send them a bill from my doctor, would they be allowed to pay a portion of it?
If anyone can point me to some specifics on this, I would appreciate it.
"What exactly is the states' rationale for barring insurers from competing across state lines?
Anyone?"
Power.
The insurers don't want the simple prerogative of selling across state lines.
The insurers want to set up shop in a low-regulation state, then sell to the other states without having to comply with the laws of those other states.
So if, say, Vermont requires insurers to pay for an overnight after giving birth but Alabama does not, then insurers want to incorporate in Alabama and sell policies in Vermont that do not cover the maternity overnight.
Imagine if you could disobey the speed limits in one state by wearing the license plates of a different state, and you have an idea of what the insurers are trying to get for themselves.
The Changing Face of Democrats describes the switch from Jefferson-Jackson views to those of Rousseau-Marx for the Democratic Party. Find it on http://www.claysamerica.com or http://www.amazon.com under Clay Barham books.
Imagine if you could disobey the speed limits in one state by wearing the license plates of a different state, and you have an idea of what the insurers are trying to get for themselves.
Only if you are capable of convincing yourself that a public good such as speeding laws has any relation to a private good such as health insurance.
Nothing is without externalities, MikeP. If an overnight maternity stay incrementally helps the newborn be healthy and safe -- a reasonable judgment even for lay voters to make -- then the child, and society as a whole, benefits and voters can make a democratic political choice accordingly. There is no excuse for undermining that choice with a commerce-clause reach-around.
(...or else just shut your maggot-hole about federalism, permanantly and forever, but that won't happen).
Don't feed the trolls.
Can't answer that, but the Federal law that imposes it is the McCarran-Ferguson Act.
Up until 1944, insurance was not considered "commerce" and not subject to federal regulation. But in United States v. South-Eastern Underwriters Association, the Supreme Court held that Congress could regulate insurance transactions that were truly interstate. Congress then enacted the McCarran-Ferguson Act (15 U.S.C. ? 1011) which provided that the laws of the several states should control the insurance business, but that the Sherman Act, the Clayton Act, and the Federal Trade Commission Act were applicable to the insurance business to the extent that it wasunregulated by state law.
Keep in mind that insurance companies that sell policies in your state may be headquartered elsewhere but must jump through certain state hoops to sell in your state.
Dan,
The benefit to the parents and the child themselves so far outweigh the benefit to society as to make the latter's concerns patently irrelevant.
There is every excuse to prevent states' abrogating the inalienable right of the actually affected individuals to buy whatever insurance they damn well please.
Dan:
Please explain your reasoning behind denying choice in more affordable coverage to those who wish to pay only for what they want. If a woman wants her insurance company to cover an extra night's stay, why shouldn't she be willing to pay a marginal increase in premium for it?
MikeP, db:
Don't dodge the process-based argument at issue. The federal government could destroy the state laws by making it a race to the bottom, with the lowest state regulators controlling for everybody, which is what you want, and what the credit card industry already has ( -- great how that turned out in real life).
Or, by the very same mechanism of the commerce clause, the federal government could do the opposite, and impose high regulations on all insurance coverage.
Why not let the people of each state make their own choice at the ballot box, and the best state programs will succeed, while the worst state programs will fail?
If low-regulation is so damned awesome, why not let the good voters of State X figure out that they should emulate the low-regulation policies of State Y?
Don't trust democracy anymore?
Want Washington DC overriding every state government on the best way to regulate insurance?
Well, of course you don't ...
... except when you do!!!
Uh, Dan - you're missing the point. If you value these benefits and are willing to pay for them, you can buy a policy that provides them. If I don't place the same value on them, or are unwilling or unable to pay for them, I should be able to buy a different policy. Why do you find it necessary for the majority to impose its values on everyone through the political process?
Why not let the people of each state make their own choice at the ballot box, and the best state programs will succeed, while the worst state programs will fail?
Boy, that took some editing to fix.
Without that editing, it sounded like you were consigning tens of millions of your fellow countrymen to the ash heap of forced poor choices on something as critically important as health care. I know you didn't mean to.
Don't trust democracy anymore?
Anymore? I never trust democracy when it comes to private decisions.
Where do you think you are posting?
Dan,
I want to introduce a concept you seem unfamiliar with:
A rider to an insurance policy.
Sandman,
Most states require a company to be licensed with the state insurance regulator before selling insurance in that state. So, you can't buy insurance from a Utah-licensed insurance company (that is not also a California-licensed company) because they won't sell it to you, because they don't want to get fined by California for selling insurance illegally in California. Most national insurance companies have a subsidiary for each state in which they do business.
Will, MikeP, db --
If your arguments are so flawless, make them to your representatives and your fellow citizens, and persuade them to enact such laws in your state. Let the citizens of other states do likewise.
If you think (-- and I guess your really are stupid enough to think this --) that insurance companies are going to offer cheaper insurance if allowed to skimp on benefits and that such dearly-obtained cheapness is to the indisputable benefit of the consumer (but are you really that stupid?) then have congress enact a real law authorizing doing business that way.
But please, enough of this charade that the commerce clause was designed to force a race to the bottom in every sector of the economy. You're not fooling me, and you won't fool anybody else with a lick of sense.
But please, enough of this charade that the commerce clause was designed to force a race to the bottom in every sector of the economy.
Yes, because every other sector of the economy aside from the state regulated sectors of alcohol and guns is a total and utter disastrous race to the bottom where consumers never get anything they want.
You're not fooling me, and you won't fool anybody else with a lick of sense.
Nobody every buys anything from another state. Check.
Sandman,
Most states require a company to be licensed with the state insurance regulator before selling insurance in that state.
I'm no insurance regulation expert, so caveat this, but typically:
Its not just that they are licensed, its that they have to show that their operations in that state are financially sound. Among other things, this means that you're not allowed, as I understand it, to assemble risk-sharing groups across state lines/jurisdictions.
MikeP --
You must have a PhD in irrelevant digressions.
You want to get the regulatory regime you deem best, by any means necessary, process be damned, but you lack the guts or the facility with language, or both, to say so.
You would scream and holler if the same federal legislative mechanisms were used to impose high regs on a low reg state, but you have no sense of reciprocity or fair play to inhibit committing the same sin in the opposite direction.
Enjoy the little world you made for yourself inside your head. It is much easier than the real one.
In Pennsylvania, the Blue Cross in central Pa. is prohibited by state law from selling its policy in Eastern Pa. I don't know which party passed this anti-competitive law but I do know it survived the Republican Tom Ridge administration which was concurrent with Republican control of both houses of the state legislature. Gee, I wonder what one would find it one were to "follow the money?"
RC Dean-
Yes, licensing comes with a number of conditions. Some involve safety and soundness (financially strong enough to pay claims, not taking on too risky investments, capital ratios, etc.) and some involve what has to be in the insurance policies themselves, how they're marketed and a whole host of other rules.
You would scream and holler if the same federal legislative mechanisms were used to impose high regs on a low reg state, but you have no sense of reciprocity or fair play to inhibit committing the same sin in the opposite direction.
Of course I would. Government abrogation of the right of contract overreaches the legitimate authority of government whether it is done at the federal or state level. Why should I not fight it at both levels?
But, in particular, the interstate commerce clause was included in the Constitution to prevent exactly this sort of protectionism between states. That it is not only appreciated, but enforced, by the federal government is a massive win for insurance and government special interests and a huge, huge loss for the populace as a whole.
I certainly do wish that some parents would control their children's internet use better.
Dan,
My business has insurance companies as clients, and I am intimately aware of what they are worried about and how they operate.
Mike P is right, and it is you who is detached from reality.
Within each state, and within the limited areas they are allowed to compete within each state, there is a cutthroat competition to maintain better apparent service.
The arrangment of state markets reduces competitive pressure and the barriers for entry ensure that crappy companies can stay in business for a long time.
However, whenever the degree of regulation is reduced, and insurance companies are given greater latitude in what they offer, immediately they start seeking out niches where they can be the top provider.
The only race to the bottom is razor thin profit margins and a desperate attempt to keep people from badmouthing the company. Some companies seek to cut spending by not paying out claims, hoping to offer generous settlements that include a gag order on the few lawsuits it generates. Other companies, like Aflac, go crazy trying to make sure that all claims are paid within three days.
Interestingly, when offered genuine choice, consumers tend to purchase insurance from the good guys, and the bad actors eventually go bankrupt in a welter of scandal.
In the good old days, anyone could start an insurance company. In theory, 100 people could set up a mutual company that has very low risk of being bankrupt by a statistically unlikely streak of significant claims. They don't do so because of the onerous restrictions that the current state-regulated regime creates.
Insurance is a good like any other. Satisfy consumers in a free market, and you will be rewarded by profits and increased bsuienss. D a crappy job, and you will eventually lose all your customers and be relegated to the dung-heap of history. It is the cartelization of the insurance industry by the current legal regime that allows the bad actors to keep screwing over their customers and stay in business.
"...is a massive win for insurance..."
So why is the insurance industry trying to undo it?
***********
N.B.: There is no such thing as a substantive "right of contract." You're talking nonsense, and falling into the trap of empty-headed "rights discourse."
State action is required to enforce contracts, and the state can, as a matter of prioritizing the use of scarce public resources, say which types and categories of bargains will and will not be enforced; and it can do so with an eye on consumer protection, however paternalistic, counter-productive, and ill-considered the wall-eyed Objectivist snot-sniffers may feel that such protections are. You don't have a right -- moral, constitutional, or natural -- to the most "efficient" contract regime as you may see it. Other considerations are legitimate when the public sets the rules of government action. The public may suspect that insurance companies will, even with an undesired mandate, offer coverage at the same price as without the mandate. Even if the public is actually wrong, no fundamental rights are being violated when it votes accordingly and makes some baseline rules about the substantive terms of an insurance policy.
tarran --
You are a pencil-necked, bird-chested community college loser who lives in your mom's basement, picking your nose while you sit at the keyboard wasting bandwidth and oxygen. You make up a bunch of bullsh!t about your keen and first-hand insights to the health insurance industry. You don't know jack, and you are beneath belief, or even notice. You probably deliver chinese food on a bicycle.
But even if I am mistaken on that count, see 4:42 pm.
So why is the insurance industry trying to undo it?
Got any evidence to offer on this?
You would scream and holler if the same federal legislative mechanisms were used to impose high regs on a low reg state, but you have no sense of reciprocity or fair play to inhibit committing the same sin in the opposite direction.
By the way, could you explain how this logic of yours works with Jim Crow laws?
Wait, the insurance industry is trying to undo McCarran-Ferguson?
This is news to me.
This is just getting silly now. Each state has the right to regulate all insurance sold to its residents. If the individual states are stripped of that power, then the federal government will be responsible for all insurance regulations. Is that really what we want?
This is just some asshole move to get around state regulation. If an individual state sees fit to relax regulation in a specific area, great.
In NJ State Farm really fucked up an already fucked up auto insurance market, and Christine Todd Whitman threatened to throw them the fuck out of NJ. It was easing of regulation that allowed companies like Geico and Progressive to come in and provide competition and stabilize the market. As far as I'm concerned, the federal government has no business coming into NJ, or any other state, and telling them how to regulate their insurance markets.
But that's just my humble opinion.
Now we get to the nub of it. MikeP thinks todays insurance regs are as evil as Jim Crow, and the right to buy low-reg insurance is as fundamental as the rights given to African-Americans under the Civil War amendments.
Way to go.
Wow, every one of those assertions is wrong!
Actually, my clients are commercial property insurers. Nice try though. And by the way, if what I said was a bunch of made up bullshit, then they wouldn't be paying me for my services: they hire me to standardize the reports that go to underwriters so they can make underwriting decisions more quickly and accurately - i.e. not accidentally insuring properties they don't want to cover and missing out on properties that are good risks.
As to your little tirade at 4:42, I don't see how the failure of a socialist monopoly (government supplied courts) in any way falsifies the notion that the provision of insurance is subject to the same competitive pressures that affects any other service provided on the free market.
I do like your crack about objectivists though. The way they worship the state sickens me.
Dan,
Analogy of kind is not necessarily analogy of degree.
Care to answer the question?
MikeP --
You get a constitutional amendment passed saying that "the right to contract health insurance shall not be infringed," and I'll be fine with a federal teardown of state insurance regs.
Until then...
So slavery was okay because there wasn't yet an amendment against it?
Oh christ, we're some of your best and most logically-consistent and ardent advocates, you fucker. If you're going to shoot something in the foot, don't make it your own allies.
The funny thing is that Jim Crow laws were a product of the government by democracy that Dan seems to be such a big fan of.
And note that Jim Crow laws were designed to prevent the improvement in economic and social status blacks inevitably enjoyed under a free market; the very free market that Dan decries as causing a "race to the bottom".
Yes, exactly MikeP. The clear and unmistakable implication of my statement is that slavery was okay. There is, of course, no other reasonable way to interpret it.
You are a bag of hammers.
Dan exists in a tautological world, where rights only exist if the government enforces them, and because the government sets priorities on what rights get enforced, it can therefore define them out of existence.
Not quite, Dan - you do realize that people exercise their rights without government backing every day, don't you? Or do you think the Jesus-screamer on the street corner has a city permit?
No, Dan.
The clear and unmistakable implication of your statement is that rights are decided by political process with no normative consideration.
Anyway, to get back to the point...
So why is the insurance industry trying to undo it?
Got any evidence to offer on this?
TAO,
I'm not shooting anyone in the foot.
And given the Objectivist tradition of officially renouncing old-friends or acquaintances for the "anti-life" crime wandering off the true path of Randian purity, I find your comment pretty funny.
Mike and Optimist have followed the libertarian dogma right into its logical cul-de-sac: unlimited affirmative rights to enforcement of contract.
Two people can form a contract on anything, ANYTHING, and the government's only choice is to enforce same by its terms, however inequitable or inefficient or unworthy the public may deem it. When the government says "'contract X' is not a legitimate contract, and won't be upheld by law" it denies freedom.
The government and its resources, the taxpayer dollars, have to be used to enforce that contract, and the voters cannot deem it inimical to public policy, however heinous and arbitrary the use of a bargaining-power differential may be.
Let us hope and pray they and their creed forever remain as desparate and lonely as they are today.
oh good, tarran, so what you're doing, basically, is taking the worst exaggerations and proclivities of some and broad-brush painting the rest of us with it.
wow, cool, can I be collectivist too?
Dan - I see a lot of weasel-words in your last little screed, with very little substance.
For example, how different must bargaining power be before it becomes a "heinous" use thereof? When I bargain with Microsoft for a copy of Windows, for example, I would say you'd be hard-pressed to find a more out-of-whack "bargaining power" differential, wouldn't you? And yet, Microsoft doesn't charge me 1000 dollars a copy. Why is that, do you think?
Oh shoot! Angry Optimist cops to being a Randian! That takes a pair of eggs for sure.
The New Republic has a great recent book review on Rand and her cronies. I wonder if Angry Optimist would have serviced Rand like Nathaniel Branden had to?
I just don't see what's so horrific about letting insurers offer whatever plans they like and letting people decide which plan they want. This strikes me as hard to argue against.
No "weasel-words." I'm content to leave it up to the voters which insurance contracts they will and will not spend their hard-earned tax dollars enforcing.
Not everything boils down to fundamental rights. The voters might cut off a reasonable insurance contract, or they might allow an unreasonable basis for denial of coverage. Either way, It's not the same thing as slavery or censorship or a warrantless house search. On some things, the voting public has the prerogative of screwing things up for the rest of us. That's the imperfect system we have, and it is often better to give it 50 separate runs at the state level than one big run at the national level.
Two people can form a contract on anything, ANYTHING, and the government's only choice is to enforce same by its terms, however inequitable or inefficient or unworthy the public may deem it.
When, pray tell, did I imply that the right to contract meant the right to have that contract enforced by the state?
When the government says "'contract X' is not a legitimate contract, and won't be upheld by law" it denies freedom.
No it doesn't. No one has the right to make someone else enforce their contract for them.
You really don't understand rights, do you.
What is MikeP suggesting? Self-help enforcement of contracts? Bring your own gun?
I am suggesting that the insurance contract can arrange for the insurer's home state to be where contract disputes are heard. Your own state doesn't need to enforce the contract.
And if no state will enforce the contract, you are free not to buy from that insurer.
Duh.
oh I see, Dan is a complete and total mishmash of illogic and screaming.
poor widdle feller.
Oh, so now MikeP is going to repeal the Full Faith and Credit Clause?
My state won't have to enforce the originating state's decision against my state's policyholder?
No it doesn't. No one has the right to make someone else enforce their contract for them.
What exactly is The Seventh Amendment?
In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise re-examined in any court of the United States, than according to the rules of the common law.
My state won't have to enforce the originating state's decision against my state's policyholder?
Why not? That enforcement now becomes an interstate matter and, as you note, the full faith and credit clause applies.
Are there raging civil wars over Microsoft's Windows XP Pro EULA?
This is done all the time!
The Seventh Amendment guarantees that your case won't be thrown out of court as unenforceable?
So, basically, MikeP never had a point. He just likes pissing up a rope.
Your state does not have to enforce the contract... until it has to enforce the contract!!! Hahahahahahahahahahahahahahaha!
Go drown in your own puke.
Now, let's think about this - if the majority of society decided "Any contract for food Dan makes is invalid as a matter of public policy, and will therefore not be enforced", are you really going to stand idly by while you starve to death?
Just curious. Again, Dan, you are positing a tautology: anything society enforces is a right, anything it doesn't, isn't, and that is completely monstrous. To Godwin the thread, it's shit like that that leads to the Holocaust.
Your state does not have to enforce the contract... until it has to enforce the contract!!!
No, it does not have to enforce the contract. It has to enforce the judgment.
Could you please buy a better sig generator? The one you are using is really scraping the bottom of the barrel.
By the way, I assume from your evasion that the one falsifiable thing you said...
So why is the insurance industry trying to undo it?
...is false.
MikeP, that's seems to be pretty much par for the course with this guy.
Sigh.
Of course, I should point out that there are numerous insurance companies. Many if not most of them are led by officers who are experts in corporatism and the use of big government/big business alliances to ensure nice revenue streams.
It's not inconceivable that some of these companies are lobbying for having the Feds regulate (and cartelize) the industry, hoping to cash in on the changed regulatory regime.
In the end, though, there are many insurance companies that like things the way they are now with states preserving their revenue streams and allowing them the freedom to screw over their customers with little risk of sanction.
One of the drivers of state regulation was the fact that the courts had ruled that insurance companies were subject to anti-trust scrutiny. By having the states regulate the industry, the insurance companies could escape scrutiny by anti-trust lawyers.
The idea that the regulations that make it difficult to compete and innovate somehow benefit the consumer is the most funny of Dan's assertions. He probably things public choice theory is the study of the dynamics by which the winner of an award targetted at NPR produced programs is picked.
I finally thought up a solution that will work.
It will make libertarians happy and it will make conservatives happy.
1. Deregulate health insurance...take away all of the regulations.
2. Create a Socialized PUBLIC PLAN which is completely voluntary and libertarians/conservatives can stay out of them...if they wish. This plan will be taxed at a high rate...however, it will cover all that pay toward the tax. The usual/customary cared covered by private insurance would be the standard for this public policy. The government can hire Doctors/Hospitals from the tax revenues and employee people directly and offer clinics.
3. The People that don't want healthcare or public healthcare will NOT BE TAXED. Tax ONLY those people that selected the PUBLIC PLAN. The Libertarians/conservatives and all those other people on TV that don't want health insurance and prefer wars can keep their current insurance or choose not to have insurance at all.
4. Remove ALL restrictions from hospitals/doctors from having to treat anyone that doesn't have insurance. That is, if you don't have medicare, medicaid, the public plan, or private insurance...you cannot get any treatment....including emergency treatment.
5. Allow a three month window to join the Public Plan. Anyone who opted not to take the Socialized PUBLIC PLAN will NOT be allowed into the plan for five years. If you've opted to pass on the public plan, pre-existing condition clause will apply and will NOT be covered in the public plan.
The insurers want to set up shop in a low-regulation state, then sell to the other states without having to comply with the laws of those other states.
So if, say, Vermont requires insurers to pay for an overnight after giving birth but Alabama does not, then insurers want to incorporate in Alabama and sell policies in Vermont that do not cover the maternity overnight.
Imagine if you could disobey the speed limits in one state by wearing the license plates of a different state, and you have an idea of what the insurers are trying to get for themselves.
How about letting the individual buying the policy decide if an extra night's stay in the hospital is worth the marginal increase in premiums.
There is absolutely no reason to think that providing consumers with more choices would cause consumers to prefer the cheapest and least extensive coverage. It's not like they can't read the policy before buying it.
Moreover, there is no reason why Blue Cross of Utah couldn't simply sell a policy designed to meet California's particular requirements anyway.
I just don't see what's so horrific about letting insurers offer whatever plans they like and letting people decide which plan they want. This strikes me as hard to argue against.
According to Dan, if you allow people to make choices, the vast majority of the population will choose the shittiest plan available. Because everyone in America is so amazingly stupid, compared to Dan, who knows what's best for them.
Anybody still interested in whether MikeP is anything more than a smoke-blowing, time-wasting, bad-faith liar, here's one link that puts the lie to his completely bulls--t, made-up claim that the industry does not want to ape the credit-card system of race-to-the-bottom regulation:
http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1025&context=ois_papers
Note that AHIP's main DC flak is the author.
"Leave it to a bunch of Ivy league fucks to get the commerce clause 100% wrong."
They got it very wrong a long time ago when they dreamed up the notion that it allowed to regulate anything that they claim has an "effect" on interstate commerce rather than just actual interstate commerce transactions.
That's not what the Constitution says and it most certainly was not what was intended by the founders.
But even if I am mistaken on that count, see 4:42 pm.
OK, so who is playing Dan? I'm impressed - this is almost Neal level trolling.
"I finally thought up a solution that will work.
It will make libertarians happy and it will make conservatives happy.
1. Deregulate health insurance...take away all of the regulations.
2. Create a Socialized PUBLIC PLAN which is completely voluntary and libertarians/conservatives can stay out of them...if they wish. This plan will be taxed at a high rate...however, it will cover all that pay toward the tax. The usual/customary cared covered by private insurance would be the standard for this public policy. The government can hire Doctors/Hospitals from the tax revenues and employee people directly and offer clinics.
3. The People that don't want healthcare or public healthcare will NOT BE TAXED. Tax ONLY those people that selected the PUBLIC PLAN. The Libertarians/conservatives and all those other people on TV that don't want health insurance and prefer wars can keep their current insurance or choose not to have insurance at all.
4. Remove ALL restrictions from hospitals/doctors from having to treat anyone that doesn't have insurance. That is, if you don't have medicare, medicaid, the public plan, or private insurance...you cannot get any treatment....including emergency treatment.
5. Allow a three month window to join the Public Plan. Anyone who opted not to take the Socialized PUBLIC PLAN will NOT be allowed into the plan for five years. If you've opted to pass on the public plan, pre-existing condition clause will apply and will NOT be covered in the public plan."
I have a better plan, which has even fewer steps:
1. Have everyone voluntarily give money to the government for funding everything, but make it so that everyone gives even more than they do right now just because they're so ennobled and challenged by the call to service and stuff.
2. Elect politicians that are good and wise and will place what is best for the nation as a whole (determined objectively using science) above partisanship and cronyism and beliefs that I disagree with and consider laughable.
3. The politicians in step 2 will use the money from step 1 wisely to solve all our problems, not just healthcare!
Seriously, your #1 is a political nonstarter, 4 would end in outrage as soon as the first person died due to being denied care, and there's no way to force politicians to stick to 3 and 4 short of a constitutional amendment and several assassinations to make the point stick. Are you just goofing around or something?
"According to Dan, if you allow people to make choices, the vast majority of the population will choose the shittiest plan available. Because everyone in America is so amazingly stupid, compared to Dan, who knows what's best for them."
Under the status quo, most people don't 'make choices' to begin with. Unless several consumer-empowering reforms (notably, breaking the link between employment and insurance) went in to balance this out, the lefties are right that more people might get screwed than would benefit. Their example of the credit card companies shouldn't be carelessly dismissed.
A cynic familiar with American politics should assume that the worst outcome will happen -- most consumer-friendly reforms from the right will be tossed out, and this "reform" will be taken alone as a "compromise" with the opposition, though in reality it will be a concession to the insurance industry to get them on board with giving the government more control over health care. Then, when the insurers inevitably abuse the shit out of it, it will be used as evidence that economic freedom and deregulation is a disaster and that we should all give the government still more control over health care.
Taken alone, many of the other proposals from the right will still provide some benefit; they don't require interstate insurance to work properly, but the reverse is not true. From a practical perspective, this is one reform that libertarians should put on the back burner or drop entirely.
Indeed, from a practical perspective, they should support ending the tax loophole for insurance plans, as it would be a true compromise with the tax-loving side of the political spectrum. Meanwhile, it would start creating pressure toward breaking the link between employment and insurance. That pressure could be increased dramatically by mandating for several years that employers allow their workers to take their insurance subsidy in cash. Without being encouraged by their boss and the IRS, workers will mainly see downsides to employer plans (e.g. losing it when you lose your job) versus individual policies. As fewer workers use employer plans, employers will see little reason to offer them at all. It's actually a little like the argument that the public option will eventually push everyone into government care, but in reverse.
here's one link that puts the lie to his completely bulls--t, made-up claim that the industry does not want to ape the credit-card system of race-to-the-bottom regulation:
Do you even read the evidence you offer as your proof?
The concluding paragraph of this academic legal study of the possibility of purchase of insurance across state lines (PASL)...
That is supposed to be the ringing proof that the insurance industry is trying to undo the prohibition of buying insurance across state lines? This paper is trying to conjure reasons not to make that reform!
Dan, I wasn't trying to blow smoke or be a bad-faith liar. I asked because I honestly don't know why such a stupid restriction exists and can see only three interests that want it that way: state legislatures, state insurance bureaucracies, and insurance companies.
You made the claim that insurance companies wanted to get rid of that restriction. Although it seems that the opportunities offered to small insurance players by lifting that restriction would be very threatening to the big players, I can imagine that large companies that think they could be more competitive in regulatory capture at the federal level might want interstate markets, and so would like to see who might actually be in favor of that reform.
If you are indeed a Neal-quality troll, I say well done. I enjoyed it.
If you are not, could you at least read your links before you make me read them?
Have we experienced this race to the bottom in other industries like retail or restaurant or lodging?
Indeed.
"Have we experienced this race to the bottom in other industries like retail or restaurant or lodging?"
Does the federal government require that your state allow those who run restaurants and hotels to be able to choose which state's laws they have to obey? The actual products sold at retail might be unrestricted in many cases, but the retailers themselves still usually have a variety of state and local laws to deal with.
This argument is flawed: Judge Napolitano cites a Supreme Court decision that says that the commerce clause only allows Congress to regulate activities across states that are purely commercial in nature. The sale of insurance across state lines is clealy commercial, so he seems to undermine his own conclusion. He also makes a deceptive statement that the practice of medicine occurs in a providers office within a single state. That is true most of the time, although it's not uncommon for a primary care provider to send a patient across state lines for care in a tertiary care hospital in another state. But the real issue is that he tries to say that the practice of medicine is comparable to the sale of health insurance, which it clearly is not. Even the argument that the practice of medicine is only regulated by the state in which it's practices is not accurate. The DEA regulates the subscribing of controlled substances.
Finally, he seems to want it both ways. He wants the sale of insurance to occur across state lines, but he doesn't want Congress to have the ability to regulate it. Once it's sold across state lines, it seems to me that it comes under Congress' ability to regulate interstate commerce.