Obamacare

Without A Mandate, ObamaCare Won't Work. Oh No!

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In The New York Times, David Leonhardt defends ObamaCare's individual mandate to purchase health insurance—and warns of what might go wrong if it is repealed:

Two federal judges upheld the individual mandate this year, saying that it fell under Congress's power to regulate commerce. But Judge Henry Hudson, of a Federal District Court in Virginia, ruled on Monday that Congress had overstepped by prohibiting a form of inactivity — that is, not buying insurance. And as Reagan did with Medicare, Judge Hudson argued that the mandate had a larger meaning: he said it "would invite unbridled exercise of federal police powers."

In truth, the law is quite moderate. It is more conservative than President Bill Clinton's 1993 plan or President Richard Nixon's 1974 plan (in which the federal government would have covered anyone who wasn't insured through an employer). It's much more conservative than expanding Medicare to cover everyone. It is clearly one of the least radical ways for the United States to end its status as the only rich country with millions and millions of uninsured.

But the law depends to a significant degree on the mandate. Without it, some healthy people will wait to buy coverage until they get sick — which, of course, is not an insurance system at all. It's free-riding.

Without the mandate, the cost of insurance in the individual market would rise, perhaps sharply, because some healthy people would not be paying their share. Just look at Massachusetts. In 1996, it barred insurers from setting rates based on a person's health but did not mandate that individuals sign up for insurance. Premiums then spiked. Since the state added a mandate in 2006, more people have signed up, and premiums have dropped an average of 40 percent.

By necessity, there is some subjectivity to the term "moderate," but Leonhardt's case for why the law should be described that way is made entirely on the basis of what the law is not: Nixon's failed plan, HillaryCare, or Medicare for all (ie: single payer). But even if one agrees that these proposals were extreme, that doesn't reduce ObamaCare's fiscal impact or its constitutional overreach. It is hard to label the mandate, in particular, as "moderate." The Congressional Budget Office has described it as an "unprecedented form of federal action." The federal judge in the Florida case has described it as both "novel" and "unprecedented." And, as Leonhardt notes, a federal judge in Virginia ruled the mandate unconstitutional. So here we have a law that calls for unprecedented federal action and, in doing so, tests and perhaps goes beyond the constitutional limits of Congressional power. But somehow it's "moderate?"

Leonhardt also notes that without the mandate, premiums would rise "because some healthy people would not be paying their share." But as Jacob Sullum argued earlier today, the only reason for this is that, starting in 2014, the law restricts insurers from engaging in most risk-based insurance pricing. The free-riding Leonhardt warns about is enabled by regulation prohibiting insurers from selling policies that match cost with risk, forcing everyone else to pick up the slack.  

So sure, it's probably true that premiums would rise if only the mandate were stripped from the law and the rest left to stand. If that happened, as Leonhardt says, healthy people would exit the market, waiting to buy insurance until sick, leaving a smaller pool of sick (and expensive) individuals. As I've said before, repealing just the mandate isn't a fix for ObamaCare's flaws.  

But even that is hardly reason to worry. Because the law lacks a severability clause, which would have let the rest of the law stand should one part be ruled unconstitutional, it's not likely that the mandate will be killed while the rest of the law is left untouched. Instead,the Supreme Court would likely follow Judge Hudson's lead and "sever with circumspection," jettisoning provisions that cannot function without the unconstitutional section but leaving the remainder intact. That means that the rules requiring insurers to sell to everyone and limiting risk-based pricing would likely be out the door. (As Judge Hudson's ruling notes, the Obama administration has made the fact that the insurance rules and the mandate are inextricably bound together central to its case: "The Secretary characterizes the [mandate] as the vital kinetic link that animates Congress's overall regulatory reform of interstate health care.")

This also provides some context for what happened in Massachusetts. Premiums on the individual market did drop after the introduction of the mandate—but that's to be expected when you bring a lot of younger, healthier people into an insurance pool after a decade of rules requiring insurers to sell to anyone and limiting pricing based on preexisting conditions. The only reason a mandate would reduce prices similarly nationwide is if those regulations were already in effect at the federal level and had driven up costs accordingly. They're not. ObamaCare doesn't require insurers to abide by these rules until 2014. And, as I already explained, if the mandate is invalidated, those rules are likely to be cut as well.

So the reason for a mandate is that it offsets the cost of other expensive regulations—regulations which can be expected to be dropped if the mandate is ruled unconstitutional.

And in the broader picture, it's the constitituonality of the mandate—not the policy or the politics behind it—that matters for the purposes of these challenges. Whether the law is moderate, timid, or extreme is not what's up for review. The task of the courts in examining the mandate is solely to determine whether it passes constitutional muster. The law may well "depend to a significant degree" on the mandate. But if that's the case, and if the mandate is unconstitutional, then the mandate—as well as the rest of the law—should go. 

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  1. FEED ME! FEED ME!

  2. In truth, the law is quite moderate.

    This hip check is moderate compared to the full force face punch you could have gotten. What’s the problem?

    The individual mandate fails, premiums spike and/or private insurance companies go tits-up and, following the Constitution’s Too Big to Fail Clause, they will be bought out by the Feds. Sounds like ObamaCare is working as planned.

  3. “Without the mandate, the cost of insurance in the individual market would rise, perhaps sharply, because some healthy people would not be paying their share.”

    THOSE EVIL HEALTHY PEOPLE!!!

    1. dammit, you beat me to it.

      Not paying their share of what? Health care that they are not using?

      1. We gotta, you know, spread the liabilities around.

      2. Not paying their share of what? Health care that they are not using?

        This is an excellent followup question.

      3. Not paying their share of what? Health care that they are not using right now?

        There, fixed it 4u.

        1. Re: Danny,

          Not paying their share of what? Health care that they are not using right now?

          There, fixed it 4u.

          Would you think appropriate to pay now for electricity you’re not using? Or are you also using the “free rider” canard to justify theft?

          1. The electricity analogy is so bad it’s pretty much unsalvageable. But let’s try:

            Electricity is used in operating rooms. I might need an operating room tomorrow. Or 50 years from now. You’re in the same boat. So we pay into a pool, and once we pay, we are covered for the operating room, including the electricity, for the near term and the long term. So, yes, I guess I would pre-pay for the electricity in that sense.

            1. Re: Danny,

              The electricity analogy is so bad it’s pretty much unsalvageable.

              Really? Because that is what you’re proposing – paying NOW for something you’re NOT using, even if you plan to use it later – the question is, why not pay for it LATER, when you USE it?

              I am not going to even entertain the rest of your post, it’s unreadable.

        2. No you didn’t, you made it worse. I have to pay for something now that I may use in the future and when the future comes, I’ll have to pay for it then too.

          How does that fix it. As with all government mandates, it only makes it worse.

          1. You’re only paying for insurance, now and in the future. You are not paying twice for anything in any relevant sense.

            You would only be paying twice if you had to pay for insurance today, then pay out-of-pocket in the future. Which is not the situation.

            1. Re: Danny,

              You’re only paying for insurance, now and in the future. You are not paying twice for anything in any relevant sense.

              You’re paying twice if you did not plan to buy it before. For instance, when you’re young you ride a bike; and then when you have a family and you buy a car, you pay only once for the car, when you want it.

              If the government makes you buy a car, when you are still riding your bike and not plan to have a car, then you’re paying TWICE: once because you have to (now), and another when you need to (after).

              Doesn’t matter if healthy people will use services later, you’re still making them buy NOW, when they did not plan to do it.

            2. Danny|12.15.10 @ 6:13PM|#
              “You’re only paying for insurance, now and in the future. You are not paying twice for anything in any relevant sense.”
              You should have stayed on the bus until it got to school.

        3. Danny, the law not only mandates that healthy (aka low-risk) people buy insurance. It mandates that insurance companies not be allowed to charge them relative to risk. In other words, it forces low-risk people to pay disproportionately, relative to their expected future health care expenses.

          the reason healthy people would drop out of such a system is that their expected future costs are so much lower than their resulting insurance premiums as to make it not worth the price of their premiums.

          If the government allowed risk-based pricing, low risk individuals would not be disincentivized from participating, and would not drop out of the system. Moreover, it would not *matter* if they did, since the higher-risk people would be bearing their fair (as in “proportionate to risk”) share of health care expenses.

      4. It really takes a frikkin’ sociopath to think that way. Unbelievable. At least he’s out in the open, so we know who he is.

    2. Can you believe the nerve of those assholes, not paying their share for services they don’t use!

      1. Can you believe the nerve of those assholes, not paying their share for services they don’t use at the moment!

        There, fixed it 4u.

        1. We need to make 1 year olds get auto insurance also. They will pay into the pool, not use it, but someday they might.

          Great idea.

          1. 1 year olds cannot drive until they are 18. But anybody can get sick or injured at any age. You’re analogy is weaksauce poured over a weakchop, with a side of weakfries.

            1. Re: Danny,

              1 year olds cannot drive until they are 18.

              WOW! Way to cop-out from that one, Danny! Top notch!

              The analogy is actually proper: Making someone purchase something they don’t need or want right now, supposedly because they may use it in the future.

              But anybody can get sick or injured at any age.

              Sure. And at ANY AGE, one can purchase health insurance, right? Even 1 year olds.

              Idiot.

              1. You are conflating health care services with insurance coverage for health care services.

                From that error, all your other errors arise, Old Mexican.

                Health insurance is something you maintain over time because it covers an expense that will arise at a time you cannot predict. So it cannot be compared to something you want “now” or “later” or “in the future,” like a car, or electricity, or a bike, or even auto insurance.

                Saying you will want health care at some future point when you are sick or injured is one thing. Saying you would want INSURANCE FOR health care necessarily entails having that coverage in place now so it is available for the contingency.

                Read, study, and learn the difference. Your confusion will then be cured.

                1. A rationale for the mandate with which you obviously agree is that eventually I will consume healthcare resources, so I must prepay for them now, through insurance. That’s your argument, right?

                  The most significant flaw with this reasoning is that health insurance is not a product that you pay for once and have forever. Typically you pay for health insurance coverage for a year, six months, or some other discrete term. You are correct in stating that I probably will spend money to see a doctor or be treated at a hospital at some point in the next fifty to sixty years. However, there is a very good probability that I will not consume any healthcare expenses in 2011. I’m young and in excellent health. My decision to forgo health insurance in 2011 is not an irrevocable decision to pay my healthcare costs out of pocket for the rest of my existence; it’s a decision to do so for 2011. And for that period, the probability that I will need to see a doctor is low enough that it cannot be said that I will ever in my life incur a healthcare expense that is not covered by insurance.

                  You cannot state that it is It is simply false to

                2. Health insurance is something you maintain over time because it covers an expense that will arise at a time you cannot predict.

                  But you can predict with some level of certainty that you are quite unlikely to need it when you are young and healthy, and ought to be able to make your own decision about whether to spend your money for health insurance or not. When you get older, and more likely to need it, and have more disposable income, it will likely become a better deal for you. Being forced into an “insurance” pool with other less healthy and older people is a good deal for them, not you.

                  1. Being forced into an “insurance” pool with other less healthy and older people is a good deal for them, not you.

                    Indeed. That is why one is forced to pay into Medicare all one’s life – even after one begins receiving Social Security – and yet is not covered by it until after age 65. Even then one will need a supplemental policy that will cost nearly as much as a “full coverage” policy did when one was young.

                3. “Your confusion will then be cured.”
                  How do you cure your stupidity?

                4. You ain’t buying a whole life policy with a fixed premium for life. Health insurance premiums are readjusted at every renewal. Your argument makes no sense. Last year’s premiums have no affect on this years premiums. Read, learn and study before talking trash.

            2. Frankly, I thought my analogy was right on.

              1. It was right on, Greer. I’d hate to see what kind of rates a 1 year old would have to pay, though.

        2. Can you believe the nerve of those assholes, not paying their share for services they don’t use at the moment!

          There, fixed it 4u.

          If they are young and healthy, they may never use it – and for the same reason they may never use Social Security – they may die first or it may not be solvent by the time they need it. There may not be much of a deductible with that insurance now, but you can bet your ass that in 10 or 20 years time there will be – that or the premiums will be high as hell, providing there still are insurance companies by then. It’s just another scam to suck revenue out of the population to pay for existing, failing government programs.

    3. BASTARDS! How dare they exercise and eat right! Force them to eat MickeyDees three times a day – that’ll learn ’em!

    4. It’s the dispositive assumption here that really pisses me off.

      “Well, of course the aggregate health care burden of all of society should be borne equally by all people. It’s in the social contract, after all. We have an obligation to take care of each other. How can we have fair and equal healthcare if not everyone is paying for it?”

      Barf.

      1. It gets worse, or stays the same, depending on how pessimistic you are. Remember “being a woman is not a pre-existing condition”?

        Barf indeed.

        1. Barbara Mikulski ran that on a commercial this cycle, and I was all like “so when did you change?”

    5. THOSE EVIL HEALTHY (FOR THE MOMENT) PEOPLE!!!

      There, fixed it 4u.

      1. Re: Danny,

        It’s not as funny: lacks the italics.

      2. You are becoming tiresome, Danny.

        1. Then maybe you need to take a nap.

          1. “Then maybe you need to take a nap.”
            Then maybe you need to think.

        2. (for the moment)

        3. He is being obtuse. I would say “for the moment,” but I doubt that’s the case.

          1. A touch! A distinct touch!

    6. Agreed. Healthy people are just to damn selfish. Why should they refuse to pay for something they neither need nor want?

      this is America, where ‘paying your share’ means propping up the ill ways of others.

  4. Somebody call a wahhhmbulance! Stat!

  5. But the law depends to a significant degree on the mandate. Without it, some healthy people will wait to buy coverage until they get sick ? which, of course, is not an insurance system at all. It’s free-riding.

    Looks like a Scooby-Doo finish:

    “And my plan would have worked if it weren’t for those stingy healthy people!”

    1. “And my plan would have worked if it weren’t for those stingy healthy (for the time being) people!”

      There, fixed it 4u.

      1. Re: Danny,

        No, you didn’t.

        1. We must agree to disagree.

          1. We all agree that you’re a retard, Danny.

      2. Danny (dumba**)

        There, fixed it 4u.

  6. “Without it, some healthy people will wait to buy coverage until they get sick ? which, of course, is not an insurance system at all. It’s free-riding.”

    The whole thing is not an insurance system at all – it’s an entitlement/welfare program.

    When citizen A is forced to buy “insurance” that is required to cover citizen B’s pre-existing condition, that isn’t insurance – it’s welfare.

    1. Unless it’s mutual ex ante. Which it is.

      1. Re: Danny,

        Where is it mutual, ex ante?

        1. A pays to cover B, and B pays to cover A, before either gets sick. Get it?

          The only welfare component is coverage for people that are too poor to pay the premiums, but that is already in place. ObamaCare didn’t create it.

          1. Re: Danny,

            A pays to cover B, and B pays to cover A, before either gets sick. Get it?

            You’re an idiot, Danny. That’s not what was being argued:

            “When citizen A is forced to buy “insurance” that is required to cover citizen B’s pre-existing condition, that isn’t insurance – it’s welfare.”

            1. Pre-existing conditions include latent conditions, like a genetic pre-disposition to cancer or heart disease.

              And what you are calling “welfare” counts as welfare whether it is part of the insurance program or just out-of-taxpayer-pocket direct payments.

              And we already have welfare, as very well we should. So it’s not an argument against the insurance program, now is it?

              1. So why add even more welfare to it?

              2. Pre-existing conditions also include already having cancer.

                But if you allowed insurance companies to charge B more because he has a genetic condition that increases his risk of cancer, then A would not need to be charged disproportionately more than B, and A would not be incentivized to drop his coverage.

              3. Your making a great argument for abolishing welfare, it perpetuates the stupid.

                What the court has ruled in this district is not simply whether the law is good policy or bad policy that is besides the point. The point simply is that there are limits to the power of government in the constitution and limiting the power of the federal government is the reason why there is a constitution to begin with. If the founders wanted to grant the federal government unlimited power or did not care if the federal government acquired unlimited powers they would not have written the constitution to begin with. That is what courts are supposed to do with matters of law, rule whether or not the law in question is inside the scope of the constitution or or not.

          2. Danny|12.15.10 @ 6:17PM|#
            “A pays to cover B, and B pays to cover A, before either gets sick. Get it?”
            Gee, I didn’t think most kids learned to type until the 3rd grade.
            Obviously, typing is now a kindergarten subject.

          3. “A pays to cover B, and B pays to cover A, before either gets sick. Get it?”

            Nonsense. Individuals don’t have equal amounts of medical problems over their lifetime. Some have extensive and expensive problems and others have virtually none.

            “The only welfare component is coverage for people that are too poor to pay the premiums, but that is already in place. ObamaCare didn’t create it.”

            Wrong again.

            The fact is that government inteference in freedom of contract related to any commodity (which is what health insurance and medical treatment are) in such a manner as to cause some to get a benefit that they could not get or pay for on their own and causes others to get less and/or pay more than they would otherwise have to is welfare.

  7. In The New York Times[…]

    … there was once this op-ed,
    which said “people suck.”
    People read, and people though,
    “what else can you say, you fuck?”

  8. It is clearly one of the least radical ways for the United States to end its status as the only rich country with millions and millions of uninsured.

    Mine was one of the least radical ways to implement the socialist utopia.

    1. You guys were pussies.

      1. It always starts innocently enough.

        It always starts out, “We could all learn to be less greedy”, but somehow it always ends, “If we want to make an omelet, we need to break some eggs.”

        That is the problem with the left…

        I said something once about how they always run out of other people’s money to spend, and here is a prime example…

        We need to help the uninsured–so let’s sic the IRS on them? They ran out of other people’s money to spend before they even started!

        1. Still waiting on that omelet. The service at Chez Marx sucks.

      2. Say what?

    2. All of you probably owe me royalties. Let me check with my lawyer.

      1. You killed all the good ones already.

  9. It’s pretty incredible to realize that it’s already a foregone conclusion that the legally whimsical and unpredictable Anthony Kennedy gets to decide for all time whether this abomination passes muster or not.

    Frankly, no one person ought to have as much power as Kennedy does, especially when he’s completely unaccountable to anyone.

    1. My money says he splits the baby and declares the current law unconstitutional and then mandates Congress to go back and come up with a real universal health care plan that addresses a new right to healthcare that he’ll define in his opinion.

      Then he will pat himself on the back for being so smart.

  10. “It is clearly one of the least radical ways for the United States to end its status as the only rich country with millions and millions of uninsured.”

    “If not for anything else, let’s do it at least for the prestige!”

    This guy sure knows how to make solid, logical arguments: pragmatic fallacies, appeals to reputation…

  11. I was wondering if Suderman could slither through the whole post without using the words “pre-existing condition.” He did it. Nice work, snake.

    1. Re: Danny,

      Not so fast:

      Premiums on the individual market did drop after the introduction of the mandate?but that’s to be expected when you bring a lot of younger, healthier people into an insurance pool after a decade of rules requiring insurers to sell to anyone and limiting pricing based on preexisting conditions.

      I actually read the post instead of using Ctrl F.

      1. Don’t expect too much from him, OM.

      2. Good catch.

        Actually, I didn’t know about “Control F.” I just missed that particular line.

        He’s still a snake, though.

        1. Danny shoots! He FAILS!

          And you were sooooooo confident that you were right, the condescension was just DRIPPING from your comment.

          What a lib-tool….

  12. Oh nooo, free riders! Ending free rides has been a libertarian meme forever. Now the statists suddenly discover its uses for one issue only.
    Now they need to discover our solution: pay for your ride or get the heck off the bus.

    1. I overlooked their other complaint about free riders: unions want compulsory dues because of collective bargaining. Simple solution: you don’t pay the dues, you ain’t covered.
      Bargain with your employer yourself.

  13. Speaking from an entirely anecdotal experience, my employers costs for healthcare this year have DOUBLED. We just went through our enrollment period and the majority of our employees went from PPO to HSA accounts because the increase in costs is marginally offset through pre-taxed contributions to our HSA account, provided we don’t need any major non-life-threatening hospital visits.

    1. And that happened under the glorious pre-ObamaCare status quo.

      1. Considering the increase in costs in comparison to previous years increases (again it DOUBLED this year), it appears pretty obvious that insurance carriers are loading up now to deal with the implementation of Obamacare.

        1. So you’re saying Obama is right, and the insurance companies are Monocled Greedmongers?

          1. Actually, what I’m saying is that Obamacare has created the double-edged sword of making healthcare less affordable for people who already have it, and making insurance companies feel justified in sticking the upcoming increase in operational costs to the current paying customers.

            Well done.

            1. Actually, what I’m saying is that Obamacare has created the double-edged sword of making healthcare less affordable for people who already have it, and making insurance companies feel justified in sticking the upcoming increase in operational costs to the current paying customers.

              That’s actually how ‘universal health care’ works no matter how you slice it. You can replace the insurance company with a bureaucracy, but its all the same financially: Give money to me (Uncle Scam) and I take a cut to give it to this more-politically-preferred douche over here.

      2. “And that happened under the glorious pre-ObamaCare status quo.”
        So ‘unconstitutional’ is OK if some ignoramus didn’t like things before?

  14. Frankly, no one person ought to have as much power as Kennedy does, especially when he’s completely unaccountable to anyone.

    On the bright side, whoever replaces him when he retires will be worse.

    So, these are the days. Woot.

  15. It is clearly one of the least radical ways for the United States to end its status as the only rich country with millions and millions of uninsured.

    And hey, if giving everyone insurance doesn’t end our status as the only rich country with blah blah blah, then there’s always tanking our economy.

    “Hey, we don’t have universal healthcare in America, but give us a break, just finding clean drinking water has become a more pressing concern.”

  16. Anyone making constitutional arguments on non-constitutional grounds should be mocked then ignored.

    Whether this is a good plan or a bad plan matters not at all, the mandate is unconstitutional.

    1. But but but, if it IS a good plan, then CLEARLY we need to ditch that dated fishwrapper that us nutjobs hold in such undeserving adoration. Yeah, I wrap my fried fish in National Constitutions, wanna fight about it?

    2. They used leaches for healthcare back then and didn’t know anything about anti-biotics. Of course Obamacare is constitutional.

      See, that was easy.

      1. I don’t know why I spelled antibiotics like that. Maybe I was doing it in olde American Eng-lish.

        1. John’s way. 😉

        2. Maybe there were a lot of asari commandos back then?

  17. Behold, I am Mayor McCheese, destroyer of families.

    A mother of two from Sacramento, Calif., says that McDonald’s uses toys as bait to induce her kids to clamor to go to McDonald’s and to develop a preference for nutritionally poor Happy Meals. With the help of the Center for Science in the Public Interest, today the mom, Monet Parham, is filing a class action lawsuit aimed at stopping McDonald’s use of toys to market directly to young children.

    “I am concerned about the health of my children and feel that McDonald’s should be a very limited part of their diet and their childhood experience,” Parham said. “But as other busy, working moms and dads know, we have to say ‘no’ to our young children so many times, and McDonald’s makes that so much harder to do. I object to the fact that McDonald’s is getting into my kids’ heads without my permission and actually changing what my kids want to eat.”

    “What kids see as a fun toy, I now realize is a sophisticated, high-tech marketing scheme that’s designed to put McDonald’s between me and my daughters,” Parham said. “For the sake of other parents and their children, I want McDonald’s to stop interfering with my family.”

    1. “I object to the fact that McDonald’s is getting into my kids’ heads without my permission and actually changing what my kids want to eat[.]”

      I should sue Cosmo for putting ideas on my wife’s head about the frequency of sexual intercourse – I think I have a case!

    2. I know a simple two letter word in English – and Spanish! – that would keep McDonald’s out from in between her and her children and no one would have to get sued, either.

      1. I find that speaking to your kids in German is more effective.

      2. She doesn’t even have to do that. She could go to the McD’s drive thru, buy a Happy Meal with the toy, give the toy to her kid and give the hamburger to the dog.

        See, everyone’s happy!

    3. Filing a class action suit is easier than telling the kids to fuck off and eat your mac and cheese?

    4. Gosh, parenting is so hard. If only the government could step in and help out!

    5. Apparently the woman filing the lawsuit is state employee of a the CA dept of Health.

      She even has a .ca.gov email addy.

      http://www.futureofcapitalism.com/2010/12/monet-parham

    6. I object to the fact that McDonald’s is getting into my kids’ heads without my permission and actually changing what my kids want to eat.

      Maybe I should sue because politicians are getting into my fellow citizens’ heads without my permission.

    7. Send her to Pyongyang, where the Dear Leader makes all the hard choices for everyone.

    8. Parenting is hard! I’m going to sue McDonald’s because I can’t say no to my kids.

  18. In truth, the law is quite moderate. It is more conservative than President Bill Clinton’s 1993 plan or President Richard Nixon’s 1974 plan (in which the federal government would have covered anyone who wasn’t insured through an employer).

    He’s really arguing this is a moderate plan because more extreme proposals failed to pass? Really?

    But the law depends to a significant degree on the mandate. Without it, some healthy people will wait to buy coverage until they get sick ? which, of course, is not an insurance system at all. It’s free-riding.

    With the mandate, there will still be free-riding, as the penalties are less than the cost of buying the insurance. Thus:

    Without Even with the mandate, the cost of insurance in the individual market would rise, perhaps sharply, because some healthy people would not be paying their share.

    1. If insurance rates cant be set by age or gender or body weight or preexisting conditions, then a free rider problem exists.

      They really dont seem to be too concerned about free riders in health care most of the time.

  19. The New York Times, the mouthpiece of the The Democratic Party, who counts on the non-net-tax paying to act as their unquestioning base, complaining about free-riders is beyond simple irony. It’s some sort of Mega-Irony, the kind only found in the ultra-dense heart of a Ironic Neutron Star.

    It’s like The Fraternal Order of Police issuing a condemnation of “those fucking fascist pigs, man.”

  20. In truth, the law is quite moderate.

    Moderate be damned- is it Constitutional?

    1. Extremism in the defense of liberty is no vice! Moderation in the pursuit of justice is no virtue!

      Cicero? (Yeah, I know who said it in 1964, I mean originally)

      1. Okay, verified, it was Cicero.

      2. Didn’t Thomas Paine say that too?

  21. So sure, it’s probably true that premiums would rise if only the mandate were stripped from the law and the rest left to stand.

    But wasn’t the amount of the penalty under the PPACA mandate significantly less than the expected price of premiums? Plus, weren’t we been told at one point that the penalty will be “voluntary” or something like that?

    The penalty never had any teeth to it, so it wasn’t clear that it would actually get people who were struggling to pay their bills to buy health insurance.

    1. Voluntary? Hahahahaha!

      1. OK, looked it up again. They actually wrote into the language of the law that the IRS cannot use a lot of its usual tax collection enforcement methods: civil or criminal lawsuits, or penalties for not paying the penalty.

        The IRS could, at least in theory, put a lien against someone’s property, collecting the penalty whenever that property is sold.

        1. Or deducting it from any tax refund, Social Securty or other government check you may have coming now or in the future. You don’t do your own taxes, do you? 😉

    2. For a household with median income of about $50,000, the penalty will eventually ramp up to 2.5% of income, which would be, what, $1250? So, if $1250 is significantly less than health insurance premium cost (not sure where to look up typical numbers), it might make more sense to just pay the penalty.

      Also, have to keep in mind that purchasing high-deductible, catastrophic insurance doesn’t qualify as satisfying the mandate.

      1. That’s my problem with the entire system. Isn’t health insurance just suppose to be for catastrophic stuff? I don’t need health insurance for yearly checkups or doctor visits because I have the flu.

    3. This is a part that rarely get discussed. The entire mechanism is doomed to failure, and clearly intended to smash the private insurance marketplace by creating an inevitable mismatch between covered risk and revenues.

      All leading to the ‘too big to fail’ takeover by the Feds. Here’s an oldie but a goodie that wraps it up nicely.

      http://tinyurl.com/konhpw

  22. I want McDonald’s to stop interfering with my family.

    Maybe you could get a truck, fill it with wholesome food, and park at the curb in front of McDonald’s; they’ll be tits up in a week, after you leech all their customers away.

    1. NO! TOO MANY CHOICES!

      They really don’t like choices, you see.

      1. toys in a meal for kids =/= lawsuit
        parents w/o backbone = children raising children

        1. Welcome to Nerf World.

    2. Cross-thread winner.

    3. Well at least you guys aren’t harping about the snowball fight anymore.

  23. “…because some healthy people would not be paying their share.”

    He said this. HE ACTUALLY FUCKING SAID THIS. People who aren’t using the system would not be paying for their part of the system. Mkay.

    1. To be fair, he obviously means people who are healthy now but will need care later.

      1. but how much? My old man has hardly used a drop of medical services so far. He has to pony up to cover everyone else because he *might* have to use expensive services in the future?

        That’s like the skinny guy having to starve like the rest of the kids in fat camp.

  24. It is clearly one of the least radical ways for the United States to end its status as the only rich country with millions and millions of uninsured.

    We aren’t a rich country – we are fucking broke. Our unborn grandchildren are already in hock!

  25. Healthy people are the new Kulaks.

  26. Reading this, I’m less optimistic that Obamacare will be struck down. If striking down part of the bill means striking down all of it, then I think some conservative-leaners on the court may too afraid of the political consequences of killing the bill. Democrats will declare war on the supreme court just like they did in the 30’s.

    1. But they lack the votes to actually do anything about it. I don’t see how you get a 10th or 11th or 15th judge confirmed with the current need to get 60 senators to buy off on your nominee.

    2. FDR declared war on the Court. Other Democrats were actually horrified at the proposal, which is why it didn’t come to fruition (the Dems had huge majorities in Congress at the time).

  27. Without the mandate, the cost of insurance in the individual market would rise, perhaps sharply, because some healthy people would not be paying their share.

    I believe I mentioned this yesterday as the primary concern of the ObamaCare backers, rather than the uninsured, unhealthy people who add to system costs by showing up at emergency rooms. It’s good to see an ObamaCare backer admit it openly.

  28. So what if people don’t get insurance and can’t afford to pay the penalty? Aren’t we back where we started?

    1. Not exactly, not exactly. Firstly, we’ll have lots of new government employees. Secondly we’ll have even more money as a result of those who do get insurance and those who can afford the penalty. Thirdly, we’ll have even more leave to interfere in how people live their lives and the choices they make – got to protect our “investment” you know. Last, but not least and due to the first three, we’ll have even more power to reward some and punish others.

    2. No, if you ‘cant afford to pay’ you qualify for a ‘subsidy.’ A subsidy funded out of the general revenue – ie. other people’s taxes.

      In other words, another Ponzi scheme doomed to failure.

  29. I for one am very concerned at the stupidity caused by embracing ObamaCare, e.g. incessantly equating health and auto coverage.

  30. Us single payers all tucked away down in Canada all get equal access to mediocre care, unless you know the right people….. We both suffer from distorted incentives; how many patients/procedures you process increases your pay. Not much in the way of pay for quality.

    BTW we have a doctor shortage in Ontario. A fucking shortage!

    1. How are those Nigerian immigrant doctors doing for you, by the way?

  31. Well the law that passed doesn’t have a mandate. The law requires insurance companies to provide insurance coverage to everyone, whether they buy it or not. The penalty for not paying for the insurance is less than the market value of the coverage that the law grants everyone as a right, so no one will be foolish enough to pay the price when the government will steal it for them and give it to them for 1/10th the price. But if NO ONE pays for insurance, then there will be no premium money to fund claims. (The penalty money goes to the government, not the insurance pool.) So that thing which the government steals and then gives to you? It won’t exist to steal.

  32. Young people, who voted overwhelmingly for Obama, are really going to get it in the tailpipe over the next few years.

    They are going to have to pay high community rates for health insurance, which they don’t even want or need, to pay for the expenses of older folks.

    They are going to probably have to pay higher FICA taxes soon, for Social Security they won’t ever get.

    And business ain’t hiring, because they are scared of what these jokers in Washington are going to impose on them in the way of taxes, fees, mandates, regulation, rules, etc.

    I wonder if young folks have any idea what’s coming for them. I doubt it.

    But they got to vote for a cool black guy in 2008! So that makes it all worth it.

    1. A point I made to my nephew and his wife, the latter of which is a granola-crunching pinko. I told them their secular savior was sticking it to them nice and hard.

    2. I’m hoping this will drive young people away from the Democratic party. This bill is pretty much why I’d never vote for a Democrat as long as I live.

  33. Judge Hudson’s decision is good news, and we all hope that it will prevail when Obamacare finally reaches the Supreme Court two years from now. However, that is not certain, and there remain substantial political powers who regard this vast extension of federal power as acceptable based upon the Supreme Court’s vast expansion of the interstate commerce clause since 1937. The only sure way to stop not only Obamacare, but the innumerable other ways in which the federal government has increased its power beyond the original scope of the Constitution, is to reverse those Supreme Court cases and restore the interstate commerce clause to its original meaning. Given how entrenched these Supreme Court precedents are, this will require a constitutional amendment restating the original, very limited scope of the interstate commerce clause. See http://www.timelyrenewed.com

  34. One solution; Buy health insurance if you think you will need it in the future. If you don’t have any insurance you will have to pay cash or go without care. — Just rescind all of the free health care legislation now on the books.

  35. The whole concept of insurance is to safeguard for unexpected events in the future.

    If insurance companies are not allowed to pick those they insure or charge rates according to risk, why the hell is there any reason for insurance companies? They just become an unnecessary middleman.

    This whole issue seems to be wrapped in stupidity.

  36. So. Could someone explain to me why not buying insurance you don’t need is “free riding”, but using insurance for a condition that existed before you were on the insurance program, isn’t?

    Isn’t that along the lines of being allowed to buy homeowners, at the regular rate, while your house is in flames? The cost being subsidized by all your neighbors.

  37. The nanny state worries about your health on the one hand but then oops finds that the old fogies want the best care with only a 20% co-pay of already discounted prices. So now Berwick is hired to ration care for the old fogies. And Palin is attacked for pointing out the obvious.

    I absolutely adore SP but she should realize that Medcare without rationing is fiscally impossible.

    1. Yuo are assuming she is arguing for the antithesis, but that is not a given. the formulation is thesis, antithesis, then synthesis.

      Obama and his allies want to pretend that government run healthcare means no rationing. She is calling them out on that lie. Given limited resources rationing already is a reality.

      All of which says nothing about how we are going to solver the long term problems (other than first getting past the plainly dishonest rhetoric from the stealth socialists.)

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