ObamaCare and the Commerce Clause

The Wall Street Journal's Jess Bravin reports on some of the potential constitutional problems with ObamaCare:

Since the New Deal era, the Supreme Court has broadly interpreted congressional authority under the Commerce Clause. Congress has successfully invoked that power to limit the amount of wheat farmers can grow, ban racial discrimination at restaurants and prosecute medical patients for raising marijuana to alleviate their symptoms.

But the court has never considered a federal program structured like the health overhaul, which would require people without insurance to buy it or face a tax or penalty. The nonpartisan Congressional Research Service said in July that it was a "challenging question" whether the commerce power extends that far….

Democrats say that failing to buy insurance is a form of economic activity, because it shifts costs to others in the marketplace through higher insurance premiums, and onto the public when the uninsured use emergency rooms to obtain primary care.

Read the whole thing here.

Comments

[Harry Reid]

I am not sure the commerce clause is part of the negro dialect.

[Democrats]

I don't have a problem with this concept.

[plantation owner]

Democrats say that failing to buy insurance is a form of economic activity,

I read that line this morning. I laughed out loud. By default doing nothing is now a form of activity. Fucking priceless.

[EJ]

so if I chose to not have a job, my inactivity effects commerce because i could have been producing something therefore via the interstate commerce clause the Congress has the power to force me to work... therefore slavery is legal.

[Voros McCracken]

Don't give them any ideas...

[Seamus]

In the Soviet Union, it was a crime ("social parasitism") not to have a job. If we passed a similar law here, I bet we could bring unemployment down to practically zero--just like in the USSR.

[EJ]

part of me just wants to leave the civilized world and go live in a cabin out in the woods somewhere and forget about all the shit going on

[Pro Libertate]

It would so rule if the SCOTUS were to strike this down with all of their hatred. What a radical change that could engender! It's even vaguely possible, given the court's current political composition.

[* NAME:]

A two-edged sword: If the constitutionality question makes it to the SC, and OCare is found UN-constitutional, there would finally be a decision on the limit of the ComClause. However, if the constitutionality question makes it to the SC, and OCare is found to be constitutional, then there is precedent for doing even more damage under the guise of the ComClause.

[R C Dean]

Believe it or not, that Democrat line is a pretty straight extension of the ruling in Wickard, to wit:

But even if appellee's activity be local and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress if it exerts a substantial economic effect on interstate commerce and this irrespective of whether such effect is what might at some earlier time have been defined as 'direct' or 'indirect.'

The question is, what activity, or inactivity, would not be interstate commerce subject to federal control, under this view? SCOTUS has already said that the activity need not be interstate, and need not even be commerce, to be regulated as interstate commerce.

[Michael Ejercito]

The question is, what activity, or inactivity, would not be interstate commerce subject to federal control, under this view? SCOTUS has already said that the activity need not be interstate, and need not even be commerce, to be regulated as interstate commerce.

Under this reasoning, Congress can regulate sodomy because sperm that is ejaculated during sodomy could have been instead ejaculated during vaginal intercourse, which has the potential of making a baby.

I am surprised nobody had thought of this before.

[Isaac Bartram]

Wasn't that pretty much the gist of Sacalia's opinion in Lawrence v. Texas.

[Hazel Meade]

Democrats say that failing to buy insurance is a form of economic activity, because it shifts costs to others in the marketplace through higher insurance premiums, and onto the public when the uninsured use emergency rooms to obtain primary care.

This is such a lie. Insuance premiums would not be elevated by your not buying insurance unless the government had imposed cost controls on them. They just want healthy people to buy insurance that has been deliberately overpriced so they can *subsidize* others.

Refusing to be USED as a milch cow to subsidize other people's health care premiums is not a form of "imposing costs" on them. It's just refusing to be used.

[Harry Reid]

It's just refusing to be used.

Oh, get out of here with your greedy self!

(I believe that's how the Negroes phrase it.)

[Tony]

They just want healthy people to buy insurance that has been deliberately overpriced so they can *subsidize* others.

Isn't that exactly the nature of insurance?

[heller]

Wait, the Democrats are moonlighting as insurance salesmen?

[heller]

I smell a conflict of interest...

[MikeP]

No. Not at all.

The nature of insurance is to have the insurer pay for unlikely but high-cost events.

Therefore, the inputs to the insurance premium are the likelihood of the events and the cost of the events. Subsidy and overpricing do not enter the picture.

You seem to be confusing insurance with welfare.

[Tony]

Which is another way of saying those with fewer expenses subsidize those with more. It's how insurance companies make money.

The only difference with a government plan is that it applies universally, making it 'social insurance,' rather than excluding high-risk customers as much as possible.

[R C Dean]

Which is another way of saying those with fewer expenses subsidize those with more.

Do you really not see the difference between insurance as a contract and insurance as a socialized redistribution scheme? The difference between a private company doing business as and with who it wants, and a government-mandated program to redistribute money?

In you mind, is there no difference between the local church delivering boxes of food to the needy, and food stamps?

[TrickyVic]

True. But your point is voluntary vs non-voluntary, which is a different issue, albeit an important one.

Insurance is about spreading the cost over a pool of people.

[Hazel Meade]

From the insurers point of view, insurance is about spreading *risk* over a pool of people. Not cost. The insurer charges each individual a premium that is appropriate to the individual's risk. The loss or addition of a single customer only changes the number of people the risk is spread out over. It's not really cost-shifting. It's risk-shifting.

[MikeP]

No. Those with fewer expenses do not subsidize those with more.

Each insured individual has some chance to face some covered event at some cost. To the extent those different chances, events, and costs can be determined a priori, the insurance company adjusts the premiums accordingly. It is pretty obvious that this maximizes economic efficiency. Those who are undercharged will cost the insurer too much, and those who are overcharged won't sign up and will cost the insurer the lost profit.

The difference in a government plan -- at least as promulgated in the legislation in conference -- is that there is no attempt to figure out actual chances, events, and expenses. Instead the bills are intentionally designed welfare where the young, healthy, and poor subsidize the old, unhealthy, and rich.

[Tony]

It is pretty obvious that this maximizes economic efficiency.

I think we can safely assume that happens, within the individual companies. Taking the system as a whole, surely efficiency is severely lessened by virtue of multiplied administrative costs.

But the whole gamble of insurance is that you may or may not get back in benefits what you pay in. Most won't, especially if high-risk potential customers are weeded out. A government plan is in principle no different from private insurance, minus the exclusion of high-risk buyers and profit concern. The former increases costs, the latter reduces it. The benefit is costs are spread among a much larger pool, and hey we'll all be old someday.

[Tony]

Also, the addition of low-risk buyers who wouldn't otherwise include themselves in the pool lowers costs across the board.

[MikeP]

No. It doesn't.

Person X costs insurers $Y. Person X is charged by insurers, including their gains on the premiums from investment, etc., $Z. $Z-$Y is profit, the insurer's return for having big pockets and smart actuaries. Person X's actual risk does not enter this equation except in the computation of $Y.

So long as low-risk buyers are charged properly -- that is, they are charged lower premiums to account for their lower risk -- they do not lower costs across the board.

Only in your bizarre notion of insurance where the low-risk are charged average prices does such theft lower costs across the board for others.

[Tony]

What about low-risk people who aren't in the system at all? Hence the concept of the mandate.

You're trying to tell me that every buyer of private insurance gets back roughly what they put in, minus a little, and that insurance companies' profits come primarily from investments?

[MikeP]

Low risk people who aren't in the system at all are foregone profit for insurance companies. But the companies -- if allowed to compete -- don't charge those people a greater premium than their risk warrants. Why would they? That would only drive them away because they would not be receiving benefits which were, on average, worth their costs.

Every buyer of insurance gets back roughly on average what they put in.

The difference is insurer profit and the insurer's cushion against future bad luck. The insurer invests the cushion and adds those proceeds to its income. It depends on how the investments do against the desired profit whether the return of the investments are greater than or less than the profit.

[Tony]

But what's to stop insurance companies from doing exactly what they do--maximize low-risk buyers and minimize high-risk ones to an increasingly exclusionary degree? At some point this equation breaks down, and you have many more dollars going in than going out.

This is of course entirely ignoring the social justice aspect. Those who can least afford health insurance are also those likely to have more health problems. This country came to an understanding of this with regard to the elderly already. But I suppose the good libertarian would simply let them die since there's no way private companies would insure them affordably.

[MikeP]

As I noted, the insurance companies charge what their customers cost. Low risk customers are charged less. High risk customers are charged more.

But actually, the good libertarian would recognize the difference between insurance and welfare, and make sure the latter doesn't wreck the market of the former.

[Tony]

So it's more important to preserve the profits of insurance companies than the lives of the poor and elderly?

[MikeP]

No. It is more important to preserve a functioning health care market than it is to maintain the illusion that the poor and elderly aren't getting welfare.

[Tony]

I'd hardly call our healthcare market functional, if by functioning you mean providing adequate access to healthcare for reasonable costs. If by functional you mean profitable, well they're doing pretty well.

I'm just asking you to be consistent. You surely can't be OK with a system in which the poor and elderly as well as the wealthy are all covered, but those in the middle are SOL. So extend your defense of the market to include a mention of the elderly, I dare you.

[MikeP]

First of all, the US health care system has had a century of government intrusion that pretty much guarantees it is not a free market.

As for the elderly, if they are poor, give them welfare. If they are not, don't.

Medicare should be phased out. Those covered who cannot afford health insurance or health care should get Medicaid like everyone else who cannot afford health insurance or health care.

The goal of government health policy should be to keep people from dying in the streets, not to guarantee that inheritances survive health issues.

[Tony]

First of all, the US health care system has had a century of government intrusion that pretty much guarantees it is not a free market.

I'll steal Chad's line here, pretty hard to have a falsifiable argument when you can blame the nearest government program for any and all problems in a given system.

As for the elderly, if they are poor, give them welfare. If they are not, don't.

This makes sense if you're interested in preserving the system we have. But there are more efficient things to do, such as covering everyone in a universal system.

[MikeP]

Let me amend what I said before...

It is more important to preserve what remains of a functioning health care market than it is to maintain the illusion that the poor and elderly aren't getting welfare.

Of course I believe we should roll back the countless interventions that make the US health care system so dysfunctional. Unfortunately, Congress is going exactly the wrong way on every dimension of the problem.

[TrickyVic]

"""As I noted, the insurance companies charge what their customers cost. ""

Not necessarily applies to the individual. Say you're young and work a job for 10 years, and that job provides you with Oxford insurance. Then you quit or get fired and start a new job, which offers you Atena insurance. Six months later you're diagnosed with cancer and Atena pays. What happened to the 10 years of premiums that were paid to Oxford? Oxford isn't going to partner with Atena to pay the bill. Your Oxford money went to other Oxford customers and will not be applied to your cancer treatment.

[MikeP]

And if you get hit by a car and killed the day before you are diagnosed with cancer, you cost no insurance companies anything.

Insurance companies charge each individual what the individual costs, averaged over all possible futures.

[MJ]

"This is of course entirely ignoring the social justice aspect."

It is always appropriate to ignore imaginary beasts.

[Hazel Meade]

You're trying to tell me that every buyer of private insurance gets back roughly what they put in, minus a little,

On average, within risk groups, assuming the insurance company is allow to charge different rates for different risks.

It's all about how finely you subdivide the insurance pool into varying risk groups.

[Zeb]

Not to low-risk buyers if their premiums go up, or if they didn't buy insurance before.

[Hazel Meade]

Yes, but your *expected* benefits (benefits avgeraged over others with your risk factors) don't exceeed the cost. And the expected benefit is different for different individuals.

What you are advocating is that we deliberately ignore the fact that we KNOW some people will, on average, consumer more than they are paying in, and force the insurers to charge them a reduced rate, and thereby take a guarenteed loss on that risk group.

That's the point, when you've got ONE guy with a history of cancer trying to get insurance at rate X, you can guess that maybe that individual won't get it again. But if you have a MILLION guys with histories of cancer, you can state with pretty good certainty about what percentage of them will have remissions, and about how much that is going to cost. You're saying "Accept all one million cancer guys, and charge them less than what you can mathematically calculate they will cost, and in exchange, we'll force a million peo[ple to buy insurance at rates much higher than their expected benefits."

[Tony]

But what's magical about the formula they currently use, except that it probably optimizes their balance sheet in their favor. All you're saying is that insurance companies deserve the same kinds of profits they're used to recently. Why should that be so? Any number of government policy changes can affect any number of industries. Government helps create the environment industry must exist in. If the people through their government think health security is more important than one industry's profits, let them go out of business; they aren't entitled to profits or even existence in the marketplace. They have to adapt to their environment.

[Hazel Meade]

There's nothing magical about the formula. But the benefit of varying insurance rates based on finer risk factors is that (a) nobody is forced to buy insurance, and (b) costs are appropriately assigned to their source. Which provides the kind of market-based price signals that disincentivize risky behaviors.

As well as excessive resource consumption. From a cost standpoint it doesn't matter if individual X is prone to sickness, or just goes to the doctor for every headache.

Which is another point, if the marginal cost to the individual of an extra doctors visit or test is basically zero (because their insurance rates are unrelated to the number of claims they file), then you're going to see people doing a lot more unnecessary testing.

[Tony]

The health market does not receive price signals based on rational consumer behavior. This kind of crap doesn't even happen in the widget industries, but even if it did, purchasing medical care is not anything like buying microwaves.

For this reason, what you call risky behavior isn't as much of an issue either. Show me some evidence that countries with heavily regulated health systems (even to the point of total regulation)--that is, countries whose healthcare markets are way more skewed from their natural course by governments--lead to more inefficient consumer behavior. The opposite is true, on average. They pay half per person. This efficiency argument you're fabricating out of libertarian pixie dust is completely off base.

Funny how risky behavior in the health market is the same thing as cautious behavior in regard to your health.

[Hazel Meade]

Show me some evidence that countries with heavily regulated health systems (even to the point of total regulation)-- --lead to more inefficient consumer behavior.

How about the fact that smoking is far more common in Europe,

http://ideas.repec.org/p/nbr/nberwo/12124.html

While Americans are less healthy than Europeans along some dimensions (like obesity), Americans are significantly less likely to smoke than their European counterparts. This difference emerged in the 1970s and it is biggest among the most educated. The puzzle becomes larger once we account for cigarette prices and anti-smoking regulations, which are both higher in Europe. There is a nonmonotonic relationship between smoking and income; among richer countries and people, higher incomes are associated with less smoking. This can account for about one-fifth of the U.S./Europe difference. Almost one-half of the smoking difference appears to be the result of differences in beliefs about the health effects of smoking; Europeans are generally less likely to think that cigarette smoking is harmful.

Now, I'd suggest that there might be some irrationality involved in Euorpeans behavior on that point. Specifically, they may be less liekly to believe it is unhealthy because they are to an extent shielded from the negative effects of smoking.

It's probably not the ONLY factor. But people are pretty damn good at confabulating reasons to do something that feels good, and reducing the negative consequences of it will make them a little more likely to do it.

[Tony]

It was kind of you to undermine your own argument with a perfectly reasonable explanation of this single health-related phenomenon.

But beyond that, it's perfectly plausible that the US has made more of an effort to discourage smoking than European countries while also having a worse healthcare system, which it does.

[TrickyVic]

"""Each insured individual has some chance to face some covered event at some cost."""

Some chance yes, but if you don't use your insurance, you don't get the money back. It was spent on someone elses services.

[robc]

Wrong. For insurance, each person is paying a rate that will cover their actuarially expected expenses (plus some profit). Some have larges expenses, some dont, but it isnt those with fewer covering those with more. Each person is covering their expected expenses (cost of event)*(probability of event).

[Hazel Meade]

I'm wondering if Tony has ever taken enough statistics to understand the meaning of "expected cost".

Tony, http://en.wikipedia.org/wiki/Expected_value

E[X] = sum_over_i(xi *P(xi))

so if xi is the cost of individual i getting cancer, and P(xi) is the probability of i getting cancer, then E[X] is the average expected cost of treating cancer for all individuals in X.

But, what if you can divide X into two subgroups Y, and Z, where E[Y] > E[Z].

You're saying that Z's should be forced to buy insurance so that Y's premiums will remain unchanged, despite the certain knowledge that Y's will cost more than what they pay.

[Tony]

I personally don't think people should be forced to buy insurance. I think insurance company calculations shouldn't apply to a need as basic as healthcare.

[Hazel Meade]

You're basically going bask to the "right to healthcare" standpoint.

Okay, well, what if there are not enough resources to provide healthcare for everyone? How do you decide who gets them?

[Tony]

Irrelevant question. We're already spending twice the resources on healthcare per person than other countries. The whole point is to lower costs overall, while expanding coverage. May not sound compatible but by all evidence it is not only compatible but a necessary combination.

[Hazel Meade]

Nobody is arguing that the current system is desirable.

Other countries restrict spending by rationing care or reducing wages of medical professionals. Which has resulted in a severe shortage of them in Canada. Hence the waiting lists.

We spend twice as much largely because of our third-party payment system, which the current legislation further entrenches. Under that system patients and doctors are encouraged to blow as much cash as they like on anything that might provide a tangential benefit, because they have no reason not to.

I'd also not that in many ways other countries are MORE free market than the US, because they allow drugs to be sold without prescriptions, don't restrict the supply of medical professionals, and most of the customer base pays out of pocket.

[Tony]

There are many variations of universal healthcare but they all involve some kind of redistributive scheme that allows for the universality, which nobody would argue the market acting alone would deliver.

We can agree that the current system is messed up. But how to change it should depend on the evidence available, and there aren't a lot of free market examples to go by.

[Hazel Meade]

Thst depends on how you define "universality".

Health care varies in quality and there is no reason to think that the free market couldn't provide low-cost health care, if more individuals and businesses were allowed to offer healthcare services. For example midwives, nurse practitioners, even "alternative" medicine. What counts as the "minimum" - a midwife, or are you entitled to a doctor in a hospital? Is that even necessary?

Did you know that alternative medical clinics are essentially forbidden from offering any "western" medical services on the side?

Why don't pharmacies have little clinics for treating colds, flus, and sprains in them? Wouldn't that be more efficient than going to the hospital?

Why do you need a licensed doctor with years of post-graduate education to perform an annual exam - why not train nurses to do them?

If you got rid of all that crap, there is no question that the market would be able to offer basic treatments, including preventive care. Ultimately, when care is rationed that's what you end up doing anyway ... the government eventually realizes it's too expensive to allow everyone to give birth in a hospital and instead starts pushing people to midwives.

The net outcome is that a single payer makes things more "equal" but it reduces the overall supply. Not just through the various restrictions on who is allowed to practice medicine, but also by destroying the profit incentives to increase supply in critical areas.

[Nick]

Insurance companies charge a premium to cover claims and overhead expenses. The profit they make comes from having the money you pay in premium for a period of time before they need to repay you that premium in the form of a claim payment. If they have your money for a year before you file a claim, that money earns interest and that's their profit. They charge you a premium based on what they expect to pay back to you, plus a small amount to cover expenses.

On the flip side, the government always tries to estimate a cost without properly assessing the risk. They are not qualified to set prices in the market so they will say it's less than it is so it sounds better to their constituents. They will underestimate 100% of the time if history is any indicator.

[R C Dean]

No, its not.

Insurance is a contract for a third party to cover your costs in certain circumstances.

It is only legislative fiat that converts into a social redistribution scheme.

[Marc]

You don't get it. People without insurance are driving your premium up. So your insurance premium will be lower if you pay for these people's insurance premiums. Step 3: profit!

[Harry Reid]

Exactly.

[anonymous]

The nature of insurance (as a voluntary, non-altruistic institution) is that everyone is theoretically mostly equal when they buy in, since no one one knows who will get unlucky and need to make a claim. If there is some skew in the risk, it's addressed by handicapping those prone to misfortune, not through subsidy.

[Hazel Meade]

No. An individual buys insurance to hedge against risk.

That is, you accept a small loss at known intervals instead of a small risk of a big loss at an uncertain future date.

The insurer makes the opposite trade, taking on the risk of a big loss in exchange for a small monthly fee. The insurer hedges HIS risks by attempting to build a large insurance pool, so that the risks of losses will average out.

But the insurer need not charge each individual the exact same price for insurance. If each individual's insurance rate is calculated independently, and is solely based on that individuals risks, there is no reason why adding or losing any individual would make anyone else's premiums go up. A larger pool reduces the risk to the insurer, simply by having more people to average over, but not the expected profit.

[Jerry]

What a fucktarded ruling that is Wickard vs. Filburn. Will the government start regulating breastfeeding now?

[R C Dean]

It certainly could. By engaging in breast-feeding, the mother is not buying infant formula, which is sold in an interstate market. Ergo, breast-feeding has an effect on interstate commerce, and is subject to control by the Total State.

[robc]

However, breast feeding lowers probability of breast cancer, thus they could force breast feeding until age 7 to lower health care costs.

[Banjos Kick Ass!]

Are my boobs the property of the state now?

[Bingo]

Only when they lactate or fail to lactate.

[Johnny Longtorso]

"If you don't do what we want, we will spend money. That spending will impact interstate commerce. That brings it under the Interstate Commerce Clause, and thus we can mandate anything we want."

[OMG]

Ding DIng DIng ?. Give that man a prize.

[Michael Ejercito]

Even if this law were struck down on Tenth Amendment grounds, it will not prevent states from enacting similar laws.

[EJ]

at least if the states do it i get to move to a different state if i dont like it. Thats the beauty of federalism. You get some choice over what system you are going to live in and the various juristictions have to compete with one another. A

t the local level i am far more supportive of the possibility of greater government. If x town in the middle Nebraska wants to create a universal health system for its town, fine. I'll move to another town where people don't want that.

[SugarFree]

Another day, another opportunity for a leftist to show he doesn't understand the concepts of "voluntary" and "consent."

[Old Mexican]

Democrats say that failing to buy insurance is a form of economic activity, because it shifts costs to others in the marketplace through higher insurance premiums, and onto the public when the uninsured use emergency rooms to obtain primary care.

The Dems cannot argue this, because whatever premiums an insurer decides to charge its customers, that remains a contractual agreement between the insurer and the insured. Bringing in a third party (making a person BUY insurance) just to keep the costs down for the currently insured is nothing less than extorsion and welfare for the better off. Mandating people to BUY insurance is also POST FACTO law, since the reason for the law is to compensate for raising costs IN THE PAST supposedly because people were not buying insurance. This is tantamount to punishing people for past but legal "sins", ergo Post Facto.

[Rich]

it was a "challenging question" whether the commerce power extends that far

So can the "simple answer" be far behind? 8-(

[Old Mexican]

Re: Tony,

The only difference with a government plan is that it applies universally, making it 'social insurance,' rather than excluding high-risk customers as much as possible.

The problem with spreading the risk among more people by force is that it creates and incentive for more individuals to take higher risks, or "moral hazard." Insurance should be 100% strictly a voluntary transaction, not a mandated one. People that want to insure themselves against a certain risk, can enter any offered pool of fellow insured to spread the risk among themselves.

Unfortunately, the tax code and regulations has made health insurance virtually mandatory, which increases the level of risk most people take, and increasing the demand for services, and this can only become worse if the risk is spread over a higher population - people NOTICE these things; they WILL notice that they can lead riskier lives since their costs are being spread over a wider populationm, this time by force. Obviously, the government will proceed to impose limits on people's freedom to reduce said risk, but this will inevitably lead to other unforseeable problems that the government will seek to solve with further restrictions which will lead to even further unforseeable problems, ad infinitum.

[Tony]

Is there any evidence of this moral hazard playing out in all the other countries that have a universal health insurance scheme? You really think people are gonna eat an extra steak and smoke an extra cigarette purely because they are covered by public health insurance?

[Tony]

I mean we're one of the least healthy developed nations already (until you start counting people over 65 of course). Don't think this argument flies.

[Old Mexican]

Re: Tony,

I mean we're one of the least healthy developed nations already (until you start counting people over 65 of course). Don't think this argument flies.

You don't think the moral hazard has increased in the US? People here see their doctors for the sniffles.

[Tony]

I agree with you that we need to impose reasonable rationing once we enact a universal health insurance scheme.

[Old Mexican]

Re: Tony,

I agree with you that we need to impose reasonable rationing once we enact a universal health insurance scheme.

Both things are unnecessary, Tony. First, insurance is not supposed to pay for routine or normal procedures. That should be left to the user and his pocket. Second, you wouldn't need rationing if the US Gov simply stoppoed taking its cues from the AMA on how many students of medicine to allow or who can practice medicine.

The problem itself has nothing to do with the non-universality of insurance, but with artificially-imposed restrictions on the market, which create unnecessary shortages.

[OMG]

Hey, how about this; I can afford health insurance because I work hard and made good decisions. I don't want my care rationed. You go off and reduce the cost of the system if you want by abstaining.

Fuck you

[Tony]

This presupposes that your ability to afford health insurance is the product of hard work and good decisions, rather than luck. It also makes the moral case that just because you don't work hard or make good decisions, you don't deserve health care. I suppose one can have a debate about that, but the first is theoretically quantifiable. If you find out that luck is some part of the average of causal factors for people's financial worth, will you favor redistribution by that amount? Or is it just fuck you to everyone but yourself?

[OMG]

No, its fuck you to anyone who wants to limit my freedom and liberty, when such limits restrict actions that do not harm other people and confiscate property for ends that discourage others from being responsible.

[OMG]

BTW Tony, I think that your response was pretty admirable given the tone I took toward you (although I still think that your the results of your logic are reprehensible).

[Marshall Gill]

I mean we're one of the least healthy developed nations already (until you start counting people over 65 of course)

Do you read your own stupid words? Why are people over 65 in the US healthier than other countries?!!! Use both brain cells here! What is different between our Socialized system for seniors and everyone else's?

Seniors are still able to access medical care outside the medical mirror of the DMV or Post Office. You stupid fucking cunt.

The goddamn MARKET produces better quality health care that our seniors can access.

Science H. Logic!

[Tony]

Um, and in large part they pay for that fabulous care with socialized medicine.

[Old Mexican]

Re: Tony,

Is there any evidence of this moral hazard playing out in all the other countries that have a universal health insurance scheme?

Sure: The shortage of doctors and the rationing indicate an unmet demand. Unless people on those countries are extremely unlucky, the unmet demand can only be explained by either an artificially-imposed supply (likely), or an inordinate demand, which would exist if people visited their doctors for EVERYTHING they can think of.

You really think people are gonna eat an extra steak and smoke an extra cigarette purely because they are covered by public health insurance?

You mean they are NOT doing it NOW? Funny, I have been in several cities around America and have YET to see the population looking as lean as the Vietnamese or the Thailandese.

[Tony]

America doesn't have a mandatory/universal coverage scheme yet, especially not when compared to other, almost universally healthier, countries. Why are you making my point for me?

[Tman]

We currently have and also have had several in the states. Tennessee almost bankrupted the state with theirs and Massachusetts is well on their way to bankrupting their state with Universal coverage.

Of course, if it's a NATIONAL program it will be all better and stuff, right?

[Tony]

I dunno, it seems to work in every other advanced country, at half the per-person cost. We're bankrupting ourselves by doing nothing already.

[Tman]

So your reasoning is despite the fact that we've shown it doesn't work in several different states, not to mention how miserably it fails when it does, we should still try it anyways?

[Tony]

Depends on what you mean by working. Ask citizens what their satisfaction level is with their state's health care scheme and see which come out on top. States are having budget issues across the board, and I'm not sure you can place blame on health plans alone. But why not compare apples to apples? Say, a large developed country like the U.S. with other large developed countries. Surely spending twice as much per person than any of them isn't optimal.

[Tman]

What I mean by "working" is lowering health care costs thus reducing the burden that said costs impose on state budgets. The current argument for imposing mandates for coverage is that this will lower health care costs and provided greater coverage.

In both stated I mentioned it is or did exponentially raised both health care costs and the states budgets. Less people are uninsured, that's for sure, but now everyone has higher costs.

Surely this isn't "optimal".

[Old Mexican]

Re: Tony,

I dunno, it seems to work in every other advanced country, at half the per-person cost.

If you know ANYTHING about costing, you would immediately find as suspicious a system that purportedly reports on the cost and at the same time provides the rules for reporting costs - like being catcher, pitcher and umpire at the same time.

We're bankrupting ourselves by doing nothing already.

I haven't filed for bankruptcy yet, nor do I foresee doing so, not for healthcare costs. Have you?

[Tony]

Your unfounded speculation about the motives of statisticians is truly convincing OM.

[Old Mexican]

Your unfounded speculation about the motives of statisticians is truly convincing OM.

Like I said above, Tony, statisticians are not the problem. They only report on what they are given, and since the socialist governments run their own health systems, per Public Choice theory their bureaucracies will have every incentive to lie about their numbers.

Again, I posit this question to you: Should we take at face value the numbers the WHO reports on the health of Cubans, considering the numbers come straight from the Cuban government? And what makes you think similar instances of exaggeration of results do not exist in the other government-run systems?

[Tony]

Since it's totally unfounded speculation, I don't think much weight should be given to the idea, but even so, surely countries have roughly equal incentives to lie about their stats, so it should come out as a wash.

[Old Mexican]

Re: Tony,

Since it's totally unfounded speculation, I don't think much weight should be given to the idea, but even so, surely countries have roughly equal incentives to lie about their stats, so it should come out as a wash.

Did you notice you concede my point, Tony?

By the way, the reporting done for the US comes from various sources as I explained above. The stats for those countries whose health syst4ems are controlled entirely by the government only have a SINGLE source: The very same governments.

[Tony]

Sorry, just did a little research, and the WHO compiles its own data, gathered from technical programs and regional offices. They check for the reliability of data and the reliability of comparability estimates. They don't just take countries' own reporting at face value.

[Old Mexican]

Re: Tony,

America doesn't have a mandatory/universal coverage scheme yet

No, what it doesn't have is governemnt-run universal healthcare, but the US is already VERY close to having universal insurance coverage through the IRS code, which leads to the same problems than total coverage by government mandate, except by degree.

especially not when compared to other, almost universally healthier, countries.

Where do you get the idea that other countries are healthier? Countries do not have health. If you mean the individuals that live in a certain country, then I would suggest you look at how the governments gather their numbers, since the bureaucrats that work the health services have a very good reason to LIE.

[Tony]

So your argument is that the US is actually healthier than other advanced countries because--you claim without evidence--their statisticians lie? Well, what about the WHO? What motive do they have to skew America's statistics?

[Old Mexican]

Re: Tony,

So your argument is that the US is actually healthier than other advanced countries because--you claim without evidence--their statisticians lie?

No, my argument is that you cannot say the US population is less healthy than other populations precisely because the bureaucracies that handle the health systems of those countries have an incentive to LIE. What i argue is that YOU cannot know for a fact and I cannot know for a fact which populations are "healthier."

Well, what about the WHO? What motive do they have to skew America's statistics?

The WHO only obtains the information the UN member governments provide, that's all. However, one has to believe that, for instance, the Cuban government is being truthful when reporting THEIR numbers to the WHO.

[Tony]

Okay so you've got pure, unfounded speculation going for your argument. I guess that's something...

[Old Mexican]

Re; Tony,

Okay so you've got pure, unfounded speculation going for your argument. I guess that's something...

What do you mean "speculation"? It is mere deductive reasoning: If those countries that you say have a better health system have government run systems, then only the governments report on the systems they run. Per Public Choice theory, the bureaucracies have EVERY incentive to lie about the numbers they report on, ergo, their numbers cannot be trusted.

Just so you know, the US government obtains its numbers on health issues from Medicare, Medicaid, private insurance and other private organizations. Unless you have a conspiracy in your hands, it would be more difficult to get everybody to invent the numbers, so the numbers come up as looking worse than those that come from more socialist governments.

[Tony]

Guilty until proved innocent, huh?

[Old Mexican]

Re: Tony,

Guilty until proved innocent, huh?

Nobody has said those governments have not committed any crime, Tony, so I don't know why you come with that hollier-than-thou attitude. The argument I am positing is that the very same governments that handle the health systems are the ones reporting their results and not a third-party evaluator. Why should one trust those numbers at face value? Why should it be different with governments what neither of us allow from private individuals or companies, which is to say, accept THEIR claims at face value?

[Tony]

As I said above, the WHO gathers its own data from offices around the world, and checks for the reliability of data and comparability. The U.S. has mortality rates roughly comparable to former Soviet bloc members of the EU.

This is a silly debate, actually. Its pretty commonsensical that the U.S. would have worse statistics given that a portion of its population has no access to healthcare.

[Old Mexican]

Re: Tony,

As I said above, the WHO gathers its own data from offices around the world, and checks for the reliability of data and comparability. The U.S. has mortality rates roughly comparable to former Soviet bloc members of the EU.

Tony, please stop being disingenuous - the WHO does not check for the reliability of the data. Just knowing that they report the Cuban data as is indicates that they are not in the fact-checking business.

As for the mortality rates, the US has always reported mortality rates very differently than in many countries.

This is a silly debate, actually. Its pretty commonsensical that the U.S. would have worse statistics given that a portion of its population has no access to healthcare.

Tony, choose your arguments - either the US needs a reform because people abuse the system (i.e. getting care and not paying for it, increasing premiums), or it needs reform because people are NOT getting care - you cannot have it both ways.

[Tony]

I dunno, I just read large portions of the 2009 WHO world health report, and unless they were lying, it said they gather independent data and check vigorously for factual reliability.

Tony, choose your arguments - either the US needs a reform because people abuse the system (i.e. getting care and not paying for it, increasing premiums), or it needs reform because people are NOT getting care - you cannot have it both ways.

Why the heck not? You can't reform abuse and lack of care at the same time?

[Paul]

Is there any evidence of this moral hazard playing out in all the other countries that have a universal health insurance scheme? You really think people are gonna eat an extra steak and smoke an extra cigarette purely because they are covered by public health insurance?

According to Obama and the Democrats... yes. At least that's a tangental in the idea with taxing the so-called "Cadillac plans". People being shielded from the true costs tend to overuse their plans thus driving up costs.

[Tman]

it was a "challenging question" whether the commerce power extends that far..

-only to a complete farking moron, or a member of Congress, but I repeat myself. The idea that people even need to DEBATE this question is simply depressing. The Interstate Commerce clause has become the one-size-fits-all hammer for every Congressional nail that they think needs a'fixin.

Can't we send Congress on vacation or something until the economy gets its legs back?

[Hazel Meade]

Nevermind that unless they repeal McCarran-Fergeson, that insurance markets are explicitly NOT interstate.

How the fuck do you regulate something under the interstate commerce clause when you've previously regulated it so that it is explicitly NOT salable across state lines?

[Enjoy Every Sandwich]

If I ask a woman out on a date and she turns me down, that affects interstate commerce because I won't be buying her dinner. So rejecting me should be a federal felony.

[Thom]

Oh, the Constitution. How quaint.

[Juice]

Forget the commerce clause. I get "progs" left and left telling me that all this is authorized by the general welfare clause.

The Congress shall have power To lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defence and general welfare of the United States

Face it. The constitution sucks balls.

[MikeP]

But Federalist 41 rocks!

For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power? Nothing is more natural nor common than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity, which, as we are reduced to the dilemma of charging either on the authors of the objection or on the authors of the Constitution, we must take the liberty of supposing, had not its origin with the latter.

[TrickyVic]

My personal health has nothing to do with the welfare of the country.

Leave to government to put the country in the shitter and think the general welfare clause applies to individuals instead of the state.

If they truly believed in that clause they wouldn't demean the general welfare of the US by passing bankrupting legislation.

[rst]

While it's fun to fantasize about a government that will actually willingly limit itself, the Wickard -> Raich line of thought makes it clear that the court is sympathetic to a facially meaningless assertion: that to not engage in commerce that is substantially interstate in nature is to alter the sum of that commerce, and thus one's choice to not engage in that commerce (say, by growing your own) is as valid a subject of legislative action as the choice to do so.

[Paul]

ObamaCare and the Commerce Clause

Yes

[LakerG]

"Democrats say that failing to buy insurance is a form of economic activity, because it shifts costs to others in the marketplace"

If this is true, then so is failing to buy anything else a form of economic activity - all buy/not buy decisions have an effect, however small, on prices.

And if you think Dems wouldn't, if successful this time, use this form of "reasoning" to force you to buy other things as they later see fit (in the name of the environment, most likely), I've got a bridge to force you to buy.

The implications of this notion are catastrophic to lovers of freedom.

[LakerG]

EJ (not Dionne, I presume!) - spot on re: slavery.

[prolefeed]

You're trying to tell me that every buyer of private insurance gets back roughly what they put in, minus a little,

Well, no. The point of insurance is that a dollar is not worth the same amount to everyone in every circumstance. The underlying idea is to take money that you don't have a high marginal use for, and use it to pay for catastrophic expenses that would leave you broke.

If you have $10K in the bank, each additional dollar isn't worth nearly as much as each additional dollar if you have $10 total in the bank.

[prolefeed]

So the point of insurance is to take this low-value dollars and pay them back to you when you have catastrophic accidents where you really, really need those dollars and value them much higher.

[MikeP]

This is true and explains why people buy insurance when it is, on average, a net loss in dollar terms. It is indeed a net gain in utility.

But in answering the question of how insurance companies set premiums and why premiums commensurate to risk maximize profit, it isn't as relevant. The dollars coming in and the dollars going out are all the same to the (solvent) insurance company.

[engagement rings]

Among Donald Berwick's greatest rhetorical hits is this one: "any health-care funding plan that is just, equitable, civilized and humane must?must?redistribute wealth from the richer among us to the poorer and less fortunate." Count that as one more reason that President Obama made Dr. Berwick a recess appointee to run Medicare and Medicaid rather than have this philosophy debated in the Senate.