Can the Government Force You to Eat Your Broccoli?
The Supreme Court weighs in on food freedom.
Does the government have the power to compel a person to buy broccoli? That question, perhaps surprisingly, came up last week during the Supreme Court's unprecedented three-day hearing on the national healthcare mandate (commonly referred to by supporters and opponents alike as ObamaCare).
Conservative Justice Antonin Scalia used the broccoli question to illustrate he takes a dim view of the healthcare law, comparing it unfavorably to a law that would force individual Americans to purchase broccoli.
Everybody has to buy food sooner or later, so you [the federal government] define the market as food, therefore, everybody is in the market; therefore, you can make people buy broccoli.
Notably, the government lawyer defending the healthcare mandate chose neither to claim nor defend a governmental power to compel broccoli purchases, responding to the justice that buying food was "quite different" than buying healthcare.
What exactly did humble broccoli do—inasmuch as a vegetable may do something—to take its place in a debate inside such vaunted chambers? Republicans in Congress laid the groundwork for the broccoli question during confirmation hearings for current liberal Supreme Court Justice Elena Kagan in summer 2010. GOP senators wondered whether then-Solicitor General Kagan would uphold a law passed by Congress that would force Americans to buy fruits and vegetables. Kagan called the law dumb, but refused to say she would overturn it.
A subsequent 2010 federal appeals court decision calling into question parts of the national healthcare mandate helped sharpen the discourse around the law from the more general "fruits and vegetables" to broccoli.
The Court's analogous discussion last week of broccoli as it pertains to the healthcare mandate is both fascinating and an important moment for those who, like me and the nonprofit I lead, Keep Food Legal, champion the cause of food freedom. To Keep Food Legal, food freedom means the right of every person to grow, raise, produce, buy, sell, cook, eat, and drink the foods of their own choosing. A corollary of your right to eat what you want—and why the broccoli question becomes important—is that you also have the right not to eat a particular food. The right of a vegan not to eat steak, for example, is just as important as a non-vegan's right to eat the same steak.
Where does the current Court stand on the broccoli question? Regardless of the Court's decision in the healthcare mandate case, it's unclear whether Justice Kagan would uphold a "dumb" law forcing Americans to buy fruits and vegetables. (Notably, Kagan recently authored a unanimous Court decision that found states do not have the power to decide what animals may be turned into food.) And it would be too far afield to read into Scalia's remarks a belief that the federal government has no power (under the Commerce Clause, the federal constitutional authority at issue in Scalia's comment above) to prohibit the purchase of broccoli. Still, one could make a good argument Scalia would support just such an argument in favor of food freedom. (One need simply insert the word "not" after the word "people" in the Scalia broccoli quote above). Why? It turns out that Scalia has in fact previously opined (in dicta from a 1992 case that on its face also did not pertain to food) about "protect[ing] the right to eat."
So Justice Scalia appears to support an individual right to be free from government-mandated food purchases. And he also supports protecting a right to eat. Searching for a rule of thumb in Scalia's remarks in the instant (or current) case and in his opinion 20 years ago, one might conclude that he finds in the Constitution a fundamental, unenumerated right of the individual to make his or her own food choices—to select (by action) or reject (by inaction) the purchase of a particular food. Such an unenumerated right would dovetail rather nicely with the Court's First Amendment speech jurisprudence, which holds generally that individuals have a fundamental, enumerated right to speak (or not) absent a compelling government interest (such as the generally recognized prohibition on shouting "fire!" in a crowded movie theater that is in fact not ablaze).
While the current Supreme Court debate is informative, focusing just on the broccoli question and its analogous application to the national healthcare debate might cause one to miss the important history of cases that have had food at their very heart. Many of these cases also gave rise to some of the Court's most celebrated and vilified decisions. From cases like Lochner v. New York (a case pitting a bakery owner and its workers against state regulators) and United States v. Carolene Products (a case concerning federal-government authority to ban a company's milk substitute) to Wickard v. Filburn (which concerned the rights of a wheat farmer to grow food for his family above and beyond a federal quota) and The Slaughter-House Cases (a set of cases decided by the Court more than 100 years ago that centered on the animal-slaughter industry in and around New Orleans)—precedential cases centered on food continue to be at the fore of many of our most important cases and legal debates. (In fact, precedents established in Wickard, Lochner, and Carolene Products helped frame the Court's debate over the national healthcare mandate.).
While Supreme Court cases rarely focus on food and freedom, it is both interesting and important to note that Scalia is not the only Supreme Court justice to opine in support of food freedom. Others—from "leading liberal" Justice William O. Douglas to conservative Justice Stephen Field—came out even more forcefully than Justice Scalia in support of food freedom. As I noted in a 2010 law-review article (footnotes omitted):
The Supreme Court has never recognized an explicit right to eat certain foods. However, several Court justices have recognized a negative right to food. Justice William O. Douglas wrote, in dictum, that the Ninth Amendment guarantee of unenumerated fundamental rights includes "one's taste for food . . . [which] is certainly fundamental in our constitutional scheme—a scheme designed to keep government off the backs of people." Other Justices have come out against food bans. Justice Stephen Field argued that a right to make and procure food is an integral fundamental right of all Americans. Field called this right an essential element of liberty. Importantly, Field distinguished between food regulation and food bans, contrasting the former, which he called a reasonable exercise of state police power, with the latter, which he would proscribe as unconstitutional. More recently, Justice Antonin Scalia, also in dictum, said the Court need not recognize a right to starve oneself to death in order "to protect the right to eat."
So what does all of this Court chatter about food freedom really mean? Though the Court's decision in the healthcare case is likely months away— and Keep Food Legal takes absolutely no position on the constitutionality of the healthcare law (consistent with our narrow focus on issues of food freedom)—we are excited that issues of food freedom have resurfaced at the nation's highest court. The broccoli question has given millions of Americans pause to consider the scope of their rights as pertains to food—and even pushed the federal government's leading litigator to admit that it does not have the power to force us to eat certain foods.
In this way the broccoli question has also given a shot in the arm to the cause of food freedom. And so let's all take a moment and give thanks to broccoli, that floreted cousin of cabbage. Eat your broccoli, America, but only if you want to.
Baylen J. Linnekin, a lawyer, is executive director of Keep Food Legal, a Washington, D.C. nonprofit that advocates in favor of culinary freedom.
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Is this a signal to buy broccoli futures or not?
"Everybody has to buy food sooner or later, so you [the federal government] define the market as food, therefore, everybody is in the market; therefore, you can make people buy broccoli."
_
no, one has the right to starve oneself. however one does NOT have the right to starve one's kids. >swing n a miss, next batter up
That's right. That's why all kids shall be checked for signs of malnutrition by the Ministry of Health. Any kids that don't have a perfectly balanced diet will have their parents sent to the Ministry of Discipline for...processing.
Don't respond to it, sage. Just don't. Just Say No.
Meh, I'm just taking advantage of using a full size keyboard.
So you finally graduated from your midget's/child's keyboard? I'm so proud of you, sage. So proud. One day, you'll get to sit at the big boy table. One day.
Not until I'm out of my helmet, apparently.
We've talked about this, sage. The helmet stays on until you stop banging your head against the wall and shouting "Judge Wapner!", OK? End. Of. Discussion.
Getting sage off of the tiny toilet will be the real trick.
Geez, only 1.6 gallons per flush? I drop loads with the girth of a soda can. I don't like using plungers that much, thanks.
I drop loads with the girth of a soda can. I don't like using plungers that much, thanks.
Understood. Might I suggest a gentle stool softener instead?
Getting sage off of the tiny toilet will be the real trick.
I'm not repeating my above comment.
Yeah, but how many Kourics do they weigh? Put up or shut up.
Dude, they can't be measured in Kourics. They have to use a larger unit, the Moore. Last week I backed out a fire plug. At least 2.5 Moores.
Curse you, squirrelz!
The Bono is an even larger unit, sage. Trey and Matt prophesied it on the South Park.
Odd. I thought Government Day Care Schools were supposed to rectify this problem, thereby eliminating the need for parents.
Missing the context. Swing 'n a miss. Starving one's kids would not imply an obligation to purchase any particular food from any particular vendor. The context was a comparison of the health care market to the food market in terms of its uniqueness. The government argued that the health insurance market was unique in that non-participation counted as participation because the consumption of health care is inescapable. The consumption of food is equally inescapable, so the same argument could just as easily apply.
Would anorexics get concientous objector status and be exempt?
BTW, I am very thankful to have an alarm clock. As opposed to this:
http://www.youtube.com/watch?v=1tiGNrg58es
This was on the sidebar to your clip, sage:
http://www.youtube.com/watch?v.....re=related
This should be the LP theme song.
If we don't force the uninbroccolied to buy broccoli now, then there's no way we'll be able to keep broccoli affordable and available to everyone.
The only way the Liberals will make me eat broccoli is by shoving it down my COLD DEAD MOUTH!
So far the most common response I see from left-wingers about the idea of a broccoli mandate (other than how dare you insult my intelligence by making me think through the logical implications of policies I propose) is that not buying broccoli does not decrease another person's acceess to broccoli.
So bascially mandate supporters are completely blind to how supply and demand work since the aggregate effect of not buying broccoli (the standard SCOTUS set for what counts as interstate commerce in Filburn) would decraase production and limit access to it.
It also conflates health insurance (the mandated object) with health care (that which we must preserve access to). The left doesn't care about access to health insurance per se.
The government can force you to totally surrender your liberty, conscript you to die in a foreign war, or execute you outright. Now it can even search your body cavities for suspicion of a minor offense, thanks to the "small government " justices.
It is government. It has nukes. Its power is limited only by checks and balances and legitimate elections. Which is more than you can say for the nearest Koch industry polluting your air or water with impunity.
So fine the broccoli thing is stupid. Healthcare is a uniquely different market that necessitates buying in on an insurance model if things are going to be fair and efficient. To express a right not to pay for potential healthcare costs is to express a right to potentially mooch off others when you are hit by a bus or have a heart attack.
Life just sucks like that sometimes. As for what government has power to do--it has power to annihilate the major cities of the earth several times over. Oh well. At least you get to vote for the finger with access to the button.
Don't respond to the sockpuppet, folks. Just walk away, and there can be an end to the horror. Just walk away. Note that the "Tony" handle was either banned or taken, so it had to resort to "T o n y".
Just walk away.
I guarantee I've provoked more thought on these boards than your endless mindless bitching about Teams and your even more substanceless blog police bullshit.
I don't know what kind of malfunction is required to need to be surrounded only by confirmations of your own opinion, but I do know it's sad.
"I guarantee I've provoked more thought on these boards..."
Don't see how the fact that people have to think to unwind your tortured logic is net positive.
Sort of like smallpox provoked thought about vaccination.
You're even deluded in your self-congratulatory posts, Tony.
He's deluded enough to *make* self-congratulatory posts.
Delusional Much?
I bet "joe" is taken as well. Which is fine.
No, no. When joe came back that one time and got shellacked, it was hilarious. joe is welcome back any time to be a pi?ata.
He came back after leaving over the cartoon? I thought he stayed true to his word. Linky?
Here you go, big guy. You must have been in solitary that day, or wherever they put the serial masturbators.
This quote is quite choice:
If you say true - if you say that it is better that the judges understood those effects, and applied that understanding to the case - they you are endorsing the concept of judicial empathy, as articulated by Barack Obama.
Weird to see non threaded comments.
Tony seems spaced out these days...
/drumroll
Also, he seems cuntier than he used to be. I hope he snaps and kills someone in a fit of rage, or whatever it takes to remove him from society.
I'm pissed that someone stole my handle and that laissez-faire experimentalists couldn't handle freedom on so much as a comments board. Couple that regulatory epiphany with the fact that this place depends on the kindness of corporate charity rather than supply and demand, and it becomes all too much.
....or....
I'm really Mary Stack and I'm pissed I can't post walls of text under the handle "White Indian" anymore.
"Couple that regulatory epiphany..."
Uhh...there's nothing wrong with regulations, dingbat. Free markets are full of regulations. There's only something wrong with regulations laid down by institutionalized monopolies like the federal government.
Your salty ham tears are worth it, Tony.
$
"couldn't handle freedom"
What the fuck are you on about? Registration?
Straws, grasping at.
You want freedom? YOU CAN'T HANDLE FREEDOM!
Regulating your own website is unlibertarian? Giving and receiving gifts is unlibertarian? You do know this is nonsense.
That probably wasn't the real joe.
I miss joe.
Y'all could learn a lot from joe.
Perfect argument, since libertarians are in favor of conscription and pre-emptive nuclear war.
Or you could not purchase health insurance and then cover your costs out of pocket. Or you could beg charity. Or you could not pay, file bankruptcy, and ruin your credit. Or, in the absence of regulation forcing hospitals to treat you, you could refuse to carry insurance and then risk dying for lack of medical care when you need it. When the option of non-treatment is off the table there is no incentive. Creating an incentive by jailing people is just a different way of accomplishing the same objective: get people scared enough to take responsibility for their personal risks. The difference is that the latter is an unprecedented use of government force - you have never before in the history of American been required to make a purchase from a private company as a condition of being a free citizen. The legal justification is absurd, as the food market example clearly demonstrates. There is no difference in the logic of the argument. On the other hand, you'd have a better legal case (although still a morally bankrupt one) if we were discussing universal health care, administered by the government, paid for by direct taxation.
Shortest T O N Y - might makes right
$
What happened to the old Liberals/Civil libertarians like William O. Douglas? I've always considered myself liberal in that sense. There are not even a handful of liberals like that in the Democratic party anymore, and certainly none in the Republican party. "The Constitution is not neutral. It was designed to take the government off the backs of the people...." --William O. Douglas.
Douglas would be on no-fly lists and have an FBI file as thick as a stack of the IRS tax code, were he alive today.
There aren't any liberals in the Democratic party anymore. Not real ones.
The government can force you to totally surrender your liberty, conscript you to die in a foreign war, or execute you outright.
Do you imagine many of think those things are okay, too? Why cite them otherwise? I don't believe in summary execution or conscription. So now why, by your logic, should I believe in the insurance mandate?
Healthcare is a uniquely different market that necessitates buying in on an insurance model if things are going to be fair and efficient.
Do you have any basis for this belief other than the force of your own imagination?
Its power is limited only by checks and balances and legitimate elections.
People's rights are not a popularity contest, Tony.
I thought we settled that during the Civil War.
To express a right not to pay for potential healthcare costs is to express a right to potentially mooch off others.
We have this thing called bankruptcy. Before that, there used to be debtors' prisons. What you're proposing may not be as harsh as that, but it's a step back in that direction. And it's counterproductive to your own stated goal...
You want to put a burden on the poor--and sic the IRS on them--in order to do what? Alleviate a burden on the poor?!
Poor people don't owe you cheap healthcare, Tony. You should be ashamed of yourself for scapegoating them.
A universal healthcare scheme is the only thing that's proven to work and the fact that your silly little ideology can't handle that is only a problem with your silly little ideology.
There's nothing ideological about watching you advocate siccing the IRS on working people who are too poor to buy health insurance.
You're so obsessed with debunking someone's ideology, you can't even see that you're being used as a tool to hurt the working poor.
Shame is your only hope.
People who are too poor to buy insurance are handled by this law with increased subsidies. Of course I don't favor the Heritage Foundation plan we got, and ironically just universalizing Medicare would have less of a constitutional issue.
What are you proposing? Letting people who can't pay die? Building a vast network of debtors prisons for poor people with bad luck? Or continuing to shift their costs in a more inefficient way?
Because no matter what your proposal is it costs more than mine.
People who are too poor to buy insurance are handled by this law with increased subsidies.
Then why is the individual mandate necessary?
If ObamaCare makes healthcare so affordable for everyone, then why sic the IRS on the lower middle class?
Why did the Obama Administration argue for so long that the whole thing would fall apart without the mandate--without siccing the IRS on the lower middle class?
You're a tool, Tony. If ObamaCare makes health insurance so affordable, then what's the reason for the mandate?
What did working poor people ever do to you that makes you hate them so much? That makes you want to sic the IRS on them! Did they steal your lunch money when you were in school?!
Because Ken, by their very nature they are beneath him. Tony (or the liberal douches he represents) always claim to be looking out for the poor, but the only people they are really looking out for our themselves and their rich friends.
I didn't think Tony could be cuntier than he was upthread, but he never ceases to amaze.
I don't like the mandate. It was the free market alternative to a real plan, as originally proposed by Republicans like Mitt Romney. I don't think this law will control costs significantly.
But the mandate exists to balance new insurance nondiscrimination requirements. In addition to it there was an expansion of Medicaid; the law is not designed to burden people into poverty.
But you never answered my question: what's your plan? That a certain amount of freeloading and inefficiencies are tolerable compared to government having too much control? That free market, more appealing by the minute.
"what's your plan?"
Deregulate and delicense the industry. End tax incentives to employer provided health care. Opens up a low-end market for low-income people and drives the general price down to market equilibrium. Let charities provide for the 22,000 or so people denied for pre-existing conditions.
Which charities? Churches? I'm sure they'll appreciate the imposition. Would they perhaps have a stake in your public policy considering the burden it would be placing on them?
Would you be OK with arbitrary disparities in the access to such charity? What if they fell along stark racial or gender lines? How are charities--the sole safety net available in your system--which mostly would be churches, supposed to decide themselves which patients to cut off because their costs are too high?
See how it gets increasingly nightmarish when you think these things through?
By now, 2012, you have to defend not choosing to emulate a more successful proven model, such as exist in the entire rest of the modern world. Because even in theory your system sucks by comparison to any of those alternatives.
"Which charities? Churches? I'm sure they'll appreciate the imposition."
lol! Tell you what...government can pay for the pre-existing conditions (since it's miniscule amount) given they can show they ended up in that position through uforeseeable events, and anybody who STILL slips through the cracks can get picked up by the charities.
"Would you be OK with arbitrary disparities in the access to such charity?"
Of course.
"See how it gets increasingly nightmarish when you think these things through?"
No.
"a more successful proven model"
They're not more successful. They trade quality for price.
The 30-35% of the US health care market that's semi-free is the most successful. It's innovative, dynamic, and affordable to everybody that hasn't been priced out of the market by strict government regulations and licensing.
$
Nice list! I would add...
Make Medicare/Medicaid pay for the full cost of care--rather than let the government programs shortchange the system and leave the uninsured and insurance companies to make up for all the money hospitals lose taking care of Medicare and Medicaid patients.
That's probably the biggest misconception out there; people think that because they're on the government program, the government pays for ALL of their medical care. But just because you don't have to pay for it, doesn't mean the government pays for the rest.
They don't. The government expects hospitals to stay in business by effectively gouging the uninsured and insurance companies to make up for losses.
Want another suggestion? If you're gonna have a program for the elderly? Means test it! Get rid of the fiction that Medicare is a system where you get your money back--it isn't. It's a rip off scam, where they take your money all your life, and lots of people never get their money back in services.
Making poor working people pay for the healthcare benefits of wealthy people--because they're old and wealthy--is ridiculous.
Obama would never do that, though. He'll never consider anything that doesn't jibe with his rigid ideology. Socializing medicine isn't a means to an end for Obama--it's the end itself. He doesn't care what the results are. He just wants socialized medicine.
Tony should just come out and call for the abolition of all private charity.
Tony should just come out and call for the abolition of all private charity.
Only if it does not provide medical care that is mandated by ObamneyCare, as Catholic Charities and other faith based hospital networks can attest.
Remember, those private hospital networks and insurance companies, as well as the private donor's money, all belong to the Mighty Benevolent Federal Government AFAIIC.
I'm the one trying to protect charities from your placing the burden of an entire social safety net on them.
Justifying yourself by making charities the last resort is so psychologically revealing it's comical: you are openly admitting you think human welfare should be an optional concern, and you should be free to have no such concern.
Will you like Ms. Rand take your Medicare when you need it, though? It would be self-serving, and the beauty of a principle of maximum selfishness is that it doesn't require practicing any principles.
$
I'd like to get at least some of my money back, Tony... I paid into it, yet have not gotten even the proverbial thin dime in return.
I'd like it in cash, though.
And if everyone is so weak-willed and unwilling to sacrifice for principle as you are?
Or continuing to shift their costs in a more inefficient way?
Excessive cost shifting to insured patients is a myth.
"Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurance." For the typical insurance plan, this amounts to approximately $80 per year."
Linky
I don't think so.
http://www.bloomberg.com/apps/.....oYSI84VdL0
Bogus argument Greg.
Nowhere did it say that cost shifting was taking place. I stopped accepting CMS patients almost two years ago and I practice in a private surgicenter. You can also thank ObamneyCare for gutting $500 billion from Medicare proper to fund ObamneyCare.
Not to mention that ObamneyCare places extreme limits on Medicare Advantage plans, and large number of insurance companies no longer offer plans with ObmaneyCare preventing grandfathering Medicare Advantage policy holders into the new scheme.
Couple this with CMS (both Medicare and Medicaid) claim rejections as high as 40% of total claims submitted as per a given practice.
Try again.
I have no idea what you are talking about. You made a clear statement.
I provided a link that shows that cost shifting has been going on for a very long time. Would you care to clarify?
I provided a link that shows that cost shifting has been going on for a very long time. Would you care to clarify?
Refusing to treat patients who use CMS (Medicare) =/= cost shifting. Nowhere does it show that private insurance policies are bearing the cost proportion burden. It simply shows if patients wish to use CMS as an "insurance" provider, they must pay OOP themselves, not redirect costs to other patients.
It also fails as CMS is not insurance in the defined sense. It is an entitlement, payment assistance program with no risk adjustment or tolerance.
Try again.
Refusing to treat avoids cost shifting.
From the link:
Who do you think was making up the difference if it wasn't the private insured?
Refusing to treat avoids cost shifting.
So you concede cost shifting to private policy holders did not take place? Also, do you have the right to put a gun to my head and make me treat someone?
Who do you think was making up the difference if it wasn't the private insured?
Easy. Taxpayers, initially State then Federal as per reimbursement guidelines for uncompensated care (politicians have to buy votes somehow with fungible funding from The Feds who fund CMS), as well as those who pay cash (which is also not a defined insurance policy contract issued by an insurance underwriter).
My premise, which you have yet to refute, is that private insurance companies did not, as per my link, absorb and distribute this expense across the board for private insurance policy holders. It was not "shifted", that is redirected, to private insurance policy holders in the link you provided.
Try again. And do try not to move the goalposts, please.
Oh and Greg the reason Glendale lost money was that 500 billion that kicked in immediately with the last budget passed, and ObamneyCare funding is hardwired into the bill, therefore baselined and untouchable. CMS lost money under ObamneyCare and it showed up PDQ.
Which was my point @ post 6:55.
No I don't. Let me make this simple for you. If you take patients (Medicare) who do not cover your costs you have to make up the difference somewhere. That is called cost shifting. If you refuse to take those patients then there would be no need to cost shift. The Mayo clinic said enough is enough.
WTF? Show where I made any such suggestion. You can't. Then you accuse me of shifting the goal posts. "Try again".
If you take patients (Medicare) who do not cover your costs you have to make up the difference somewhere. That is called cost shifting.
Once again you moveth goal posts, and assuming the conclusion to boot. I suspect you are one of those who believe medical care is a "right." Therefore, you do wish to hold a gun to my head to make me treat patients. There are two things that can happen:
1) States and the Fed dole out money to cover shortfalls
2) I eat the costs.
Both of these account for shortfalls. Therefore no cost shifting to privately insured patients, which you stubbornly disregard.
Neither were worth the time and headache, so I no longer treat CMS patients. Privately insured people should not have to bear the brunt of shortfalls, and I demonstrated they appreciably don't.
If you refuse to take those patients then there would be no need to cost shift. The Mayo clinic said enough is enough.
Which is what I did. So I treat patients who have private third party insurance and pay OOP. Like Mayo. I'm still not seeing the problem here WRT privately insured and private pay patients, who Mayo will now agree to treat.
No cost shifting and no money sinks.
"...both of these account for covering shorfalls..."
Correction.
The article you linked to is about the uninsured and is based on "surprisingly, few peer-reviewed studies". It also states ""Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurance." The link you provided doesn't support what you're claiming. OTOH.
http://www.policyprescriptions.....st-shifts/
""Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurance."
And my initial statement: "Excessive cost shifting to insured patients is a myth." (Emphasis Mine)
Nowhere did I say there was no cost shifting, but certainly not the stratospheric levels requiring appreciable cost shifting to privately insured patients.
The article you linked to is about the uninsured and is based on "surprisingly, few peer-reviewed studies"
Define "Few". 3? 10? 100?
(continued)
(continued from 10:30)
WRT your block quote:
Of course private insurer payments are going to be higher, since those negotiated rates, which vary year to year as per rates set by CMS (Federal Insurance Regs state that insurance providers cannot charge above 5% of baselines determined by CMS). The hospitals have to make money somehow, as I said earlier (and have experienced in my own practice) medicare claim rejections are as high as 40%. At most with a private insurer? Maybe 10% Private pay is a crapshoot, since a patient can declare bankruptcy on those outstanding bills. Which is why we screen and run credit checks on OOP candidates for surgery, unless the pay beforehand in toto (and get the best rate. Cash is king.)
That 5% difference in pricing schedules account for the difference in per procedure pricing, and I also notice there is no apples to apples comparison of procedures, like a Laparoscopic cholecytectomy with CMS v. a Lap Chole with OOP or PPI.
I'm still not seeing cost shifting from uninsured to PPI/OOP patients in your link @ 9:54. Just because charges are higher (allowed by law) with PPI than with CMS does not mean cost shifting is present. The uninsured get Medicaid and therefore do have an avenue for treament, unless a charitable hospital arranges for treatment.
And, try again.
I'm crashing for the night. I will answer any rebuttals in the morning.
Only in your mind.
Let me make this simple for you. If you take patients (Medicare) who do not cover your costs you have to make up the difference somewhere. That is called cost shifting.
This is the second time you have made this baseless accusation. In your mind this is somehow germane to the argument. OTOH, It does tell me a great deal about you. So let me make this as clear as can be. What you suspect couldn't be more wrong. Putting a gun to anybodies head to force them to provide service has a name. It's called slavery. Slavery does not produce a quality product, it is morally repugnant. From an economics point of view there is nothing special about health care that would exempt it from the basic laws of economics. You get what you pay for.
Let me make this simple for you. If you take patients (Medicare) who do not cover your costs you have to make up the difference somewhere. That is called cost shifting.
That is the correct argument, provided you are not conflating uninsured patients with CMS patients. Which you are doing, and a common tactic of UHC, single payer, "medical care is a right" advocates.
My initial statement that started this thread refutes the notion that excessive cost shifting (an average of 1.7% I do not consider excessive) from uninsured (not CMS patients) to private insurance policy holders.
What you are doing is equating uninsured with CMS (Medicare) and that is where your argument fails. If Mayo was cost shifting, as asserted, they would not have declined to treat CMS patients; instead, they would have raised prices across the board for both PPI above negotiated 5% above CMS baseline rates (and would be in violation of Federal law) and OOP patients, effectively pricing OOP out of the market. They chose instead to drop CMS patients, so no cost shifting took place, since ObamneyCare gutted $500 billion from CMS (Medicare specifically, and essentially shut down most Medicare Advantage plans).
(Continued)
(Continued from 10:48)
This is the second time you have made this baseless accusation. In your mind this is somehow germane to the argument. OTOH, It does tell me a great deal about you. So let me make this as clear as can be. What you suspect couldn't be more wrong. Putting a gun to anybodies head to force them to provide service has a name. It's called slavery. Slavery does not produce a quality product, it is morally repugnant. From an economics point of view there is nothing special about health care that would exempt it from the basic laws of economics. You get what you pay for.
Since you have clarified your position (and had I draw it out of you to do so, as I have had many heated arguments with people telling, to my face, that indeed they can make me treat them at will, barring emergency cases) I know you are arguing in good faith. Trust me, it is germane to the argument, as I firmly believe to introduce any free-market or quasi-free market reforms it is imperative the question resolved when trying to solve our rising medical costs and providing as much quality care to as many people as possible.
Your last paragraph is pure artwork, and I thank you for clarifying you position.
Cost shifting is not a myth.
Of all the hospitals that have closed over the past ten years, how many of them were in areas with a high percentage of privately insured patients?
I bet the answer is zero.
It isn't the hospitals in South Orange County that are in trouble. It King Drew in Central LA. It's County USC! It's all the hospitals that serve a community with relatively few patients with private insurance and relatively more patients on Medicare and Medicaid.
I used to run a report every morning for our CFO that answered only one question: how many Medi/Medi patients are on the census vs. how many are privately insured?
We needed just one privately insured patient to make up for all the money we lost on eight Medi/Medi patients.
Does that number vary from hospital to hospital depending on specialties and codes? Hell yes, the ratio varies, but the gist is always the same... If you're losing money on every Medi/Medi patient, you can't make it up in volume.
Even if your 1.7% number was correct, by the way, that wouldn't be an equal distribution--it's about the local demographics. If you think Central Los Angeles, where almost no one has private insurance, makes up the same proportion of cost shifting as there is in a hospital in the lily white suburbs, yer outta yer mind.
It's all about demographics. And if 90% of that 1.7% is happening in a few underserved inner cities? That is devastating to those communities.
Does that 1.7% include reimbursement for long term care, nursing homes, etc.?
Does it include payments to doctors?
It doesn't surprise me if payments to doctors and SNFs help the average cost shifting look better...
Do the sources and uses analysis; that's the only analysis I need to see:
How much money is spent on hospital care in the U.S. every year?
How much of it comes from private pay patients, and how much of it comes from Medicare and Medicaid?
Compare that to the services given to people on Medicare and Medicaid vs. the services given to private pay patients...
If the resulting figure puts Medi/Medi patients within 1.7% of private pay patients, I'll eat my hat.
Jesus Christ, I had a medication that costs me $1,600 a month at your local pharmacy, and I know other people on the government program who get the same medication for a copy of next to nothing.
How dare I believe my own lying eyes!
Obvious troll is...obvious. I think by now it's well established that Tony is sockpuppet that plays a severely mentally handicapped Devil's advocate whenever we discuss something pertinent to the government's proper role.
And of course Ken is entirely stupid enough to respond. Sigh.
I mean I have encountered many actual, bona fide liberals who think and reason like Tony, but none of them would ever stay on a libertarian blog where their ideas are routinely challenged.
"Tony" is so obviously a sockpuppet that it makes me wonder who is dumb enough not to see it. Well, Ken, obviously.
Actually, I find this sort of thing enjoyable.
Some people like baseball. I like skewering horribly misled, idealistic tools.
None of them would ever stay on a libertarian blog where their ideas are routinely challenged.
Incidentally, for a lot of people, it isn't about ideas. The ideas part comes last for them. It's an identity thing. Their ideas to them are like country music and cowboy hats to people in Texas. They support whatever Obama's doing for the same reason rednecks like tractor pulls. It's just an identity thing.
Tony's like that. If he ever figured that out, it might be like a Paul on the road to Damascus moment. He's good practice, too, because if libertarianism ever takes off, it's gonna have to contend with that sort of mentality. The one that doesn't really care about the ideas themselves, just wears 'em like a cowboy hat.
He's good practice, too, because if libertarianism ever takes off, it's gonna have to contend with that sort of mentality.
I have to agree with that. Some people seriously do believe that 2+2=5 and just telling them they are idiots is not a sufficient counterargument.
Someone one said we could simply expand Medicare/Medicaid but that the individual mandate is a cheaper way to go. I would say that may be true only if you don't count vigorously sodomizing the Constitution as a cost.
This same someone mentioned the need for universal healthcare (because it is the only thing proven to work) as support for the individual mandate. Setting aside the fact that I have a '78 B210 that still works just fine, assuming he meant that universal healthcare is the only thing proven to work to provide universal healthcare, well that is just a tautology.
If he wants to argue that the individual mandate is the best method of achieving universal healthcare, I would argue that the most common argument I see in favor of that is that it is easier for insurance companies to pay big medical bills than for individuals to pay them - insurance companies have lots of money and individuals do not. They do in fact use arguments to support their contention that "free healthcare" is literally free. As far as I can tell, you have to be a stoned 26 year old college student at 2:00 a.m. in your mom's basement to follow the logic, so I can't effectively argue the point.
I do get it. Rather, I got it in 8th grade. I wasn't quite so stupid as to believe this amazing new philosophy of justified psychopathy was endorsed by the Constitution and thus required as if by holy writ--a mere assertion many here seem to resort to when they can't win on common sense.
But I grew up, read some real political scientists and philosophers, and grew out of it. There are good ideas here. They're just accidental byproducts of an untenable premise: that government is the ultimate evil. That's just quasi-religious nonsense.
If you don't have a utilitarian and pragmatic framework to your political worldview, then you just need to join the 20th century and get over it.
"If you don't have a utilitarian and pragmatic framework to your political worldview, then you just need to join the 20th century and get over it."
Uhh...free-market capitalism is utilitarian and pragmatic...as far as it goes. But nobody is completely utilitarian. Otherwise you'd see people advocating the extermination of the diseased, disabled, retarded, etc., since those would all be very utility maximizing proposals.
But nobody is completely utilitarian. Otherwise you'd see people advocating the extermination of the diseased, disabled, retarded, etc., since those would all be very utility maximizing proposals.
You have met Shriek, no? He is a Platonic par excellance.
As is Tony; Tony is a slightly different breed of Platonic. More of a Thomas Moore Utopian, actually. But a Platonic, nonetheless. I'm quite sure Peter Singer and Tony would get along very well.
Otherwise you'd see people advocating the extermination of the diseased, disabled, retarded, etc., since those would all be very utility maximizing proposals.
Depends on the utility function. Rule utilitarians (hey there!) in particular are extremely unlikely to advocate exterminating people because we have to apply the same rule to similar cases.
This is Tony in a nutshell. I've said it many times before. He cannot wrap his head around anything but a strict utilitarian-progressive moral framework, and consequently cannot understand or entertain any logical constructs but his own. Ironically, he then accuses everyone else of being too rigid in their thinking. It is self-evident in Tony-land that:
If you don't have a utilitarian and pragmatic framework to your political worldview, then you just need to join the 20th century and get over it.
With all due respect and discretion: Fuck you up the nose. No, we don't have to swallow the same moral premise that you did. It's not that we're ignorant of your deity of utilitarianism progressivism, Tony. We just rejected it. Probably around the same point in our intellectual development when you embraced it. We read some science and philosophy too. And we reached a different conclusion when we recognized that it's impossible to pick up a turd by the clean end.
And we reached a different conclusion when we recognized that it's impossible to pick up a turd by the clean end.
Very poetic in its simplicity. Well done.
I grew up, too, Tony... when I was twelve or so, I seriously believed in communism - enough to want to learn Russian and move to Russia.
But, like I said... I grew up.
Ken, I'd agree if you were right.
Just kidding. I would agree if Tony had ever once debated in good faith. It's NEVER happened. He's either a sock puppet for a regular or a 22 year old ass clown who has been indoctrinated by his professors into believing logic is irrelevant. Either way, he's not worth your breath.
This is what your policies lead to.
Damn, SF'd the link.
This is what your policies lead to.
Just the beginning, Nate. Barry could outdo the Brits if he really cared about The Downtrodden.
"A universal healthcare scheme is the only thing that's proven to work "
Unlimited single-payer (aka Medicare) is the reason America spends more in the aggregate for their health care than other countries. Up until the age of 60 or so, US costs are similar (once adjusted for the higher standard of living). It's only to the elderly that we devote massive resources to.
That leaves two choices if you want to bring the aggregate expenditure down:
1. Ration services (like they do in other countries) to the elderly, as Paul Ryan proposed (and was met with left-wing propaganda spouting about how we'll be cleaning their dead bodies off the street).
2. Free the market so that people can choose what they want to pay for their health care.
Paul Ryan proposed rationing care to the elderly?
IIRC he proposed rationing Medicare funding for the elderly.
The difference being that he would allow unlimited care for the elderly so long as they found a way to pay for it.
Yeah, like the market, if free, would offer levels of health insurance to fit most, if not all, budgets - high deductable cheap coveraqe, or low deductable good coverage, it's never happened and never will. /sarc
$
My newly adopted environmentalist religion proscribes the eating of food shaped like trees.
When broccoli is proscribed only professional scribes will have broccoli.
So my fave greasy Indo-Chinese take out place is verboten? Will I have to use Tide to get my A7 Broccoli Chicken?
Don't worry, there's always the Cockroached Mung Beans.
When the inevitable declaration of a broccoli shortage is announced, "hoarders" will be named the villain.
Michelle Obama is such a slimy tool. I inadvertently caught part of one of the Sweat, Fatties, Sweat reality shows (sometimes referred to as The Biggest Loser) and she was on being all smarmily congratulatory that the peasants had converted to a less icky lifestyle. Then the cut scenes showed she's going pry herself into workout garb of some sort and exercise with them next week. To borrow from the inveterate barfman: *barf*
I don't know what I clicked on that made whatever algorithm think I would make a great target for an ad by Michelle asking me to make a contribution and show that I was "on board with Barack", but whatever link that was? I wish I hadn't clicked it, okay?
If Reason's actually getting paid to serve those ads here, that's great. Seeing money move from the Obama campaign to Reason's bottom line can only be a good thing. ...but other than that? Getting a pitch from Michelle Obama to support her husband financially is like tryin' to sell me on...
I'd rather lick an ashtray.
I just finished watching the Penn & Teller: Bullshit! episode on fast food. It was awesome, by the way. Anyhow, the two "anti-fast food" advocates were so fucking smarmy. They had such disdain for the peasants who are too stupid to make correct choices. And since we refuse to voluntarily see how brilliant the "anti-fast food" advocates are, they want to use government coercion to force us to see how brilliant they are. Fuck them right in the ear!
That is the big problem I see coming down the pike - the debate is all about affordable "healthcare" when what most people want is cheaper access to doctors and nurses and hospitals, i.e. medical care. Getting rid of a brain tumor for less than $250,000 is medical care, eating your broccoli while jogging to your job of converting the defunct Pizza Huts into Tofu Huts after getting a good nights sleep is healthcare.
I am afraid most people think Obamacare is all about medical care when once Obamacare Phase 2 kicks in, we are going to find out just what they really mean by "healthcare".
Exactly the same as affordable housing actually being nothing more than afordable mortgages which were nothing more than gifts to fractional reserve financial businesses. Insurance mandates are even more blantant gifts to fractonal reserve businesses.
At least with housing the right to NOT assemble was intact - pay cash instead of borrow was still possible. An insurance mandate shits all over that right because self-insuring is not allowed.
To perhaps clarify - it seems to me that Baylen Linnekin seems to find it serendipitous that the argument as to the limits of the commerce clause involved broccoli as the silly little example of reductio ad absurdum, that the Judiciary Committee and the SC might well have asked: "If the commerce clause can compel the purchase of health insurance, can it compel the purchase of fuzzy dice as well"?
I am not so sure that the choice of "broccoli" was happenstance, I think the questioners knew full well that once you allow compelled health insurance coverage, federal mandates on diet and exercise wouldn't be far behind.
Of course. If they can ban smoking in private businesses, it would be absurd to think that ten years later, they'd be banning certain types of fryer fats and other food products.
Slippery slopes for ALL!
http://www.youtube.com/watch?v=0G7083ezHOQ
I am not so sure that the choice of "broccoli" was happenstance... federal mandates on diet and exercise wouldn't be far behind.
Keep in mind Jerryskids, the question was originally posed by Sen. Tom Coburn (R-OK) a medical doctor. Your consistent points delineating the difference between "Heath Care" and "Medical Care" is an important distinction, as medical care is what is actually dispensed by docs, nurses and pharmacists, et al. That is the actual product. The health care is what is practiced daily, even hourly, by the patient in their activities of daily living.
Of course the notion is "if we can compel you to purchase the vehicle that makes possible (absent cash) the purchase of medical care, it would follow that we can compel you to live your life in a certain way to enrich and improve the return on that investment."
By using the term "healthcare", it's a nebulous, all encompassing term to make easier regulation of medical care by redefining what healthcare actually is.
To drive the point home:
Is a boob job health care?
Is a hair transplant healthcare?
Is gender reassignment surgery healthcare?
Yoga? Accupuncture/pressure?
How about dental, orthodontic, and other allied health professions? Are braces health care?
Nutritional therapy, including health food stores? Is Whole Foods a health care provider now?
Hydrotherapy? Is a hot tub health care? How about an in-ground pool? A kiddie pool?
You want more? I can do this all day.
COMMERCE CLAUSE!
Will private pool owners eventually be forced to install permanent wheelchair-people lifts?
Fuzzy dice wouldn't work as an analogy since not everyone enters the auto accessories market.
The example has to be something privately produced that everyone has to ultimately buy, which pretty much narrows it down to food or housing.
housing.
Not everyone buys a house, apartment or condo. There are lifetime renters out there. Then there is the life of the free range urban/suburban gamboler more colloquially known as a hobo, bum or transient. A shelter sweller, if you will.
No. There just has to be a RISK that they MIGHT require it.
Since we're talking about forcing people to buy insurance.
Insurance is sold one month at a time. If I buy insurance this month and don't use it, it's not good for next month.
So the fact that I (might) "eventually" need health care has nothing to do with my purchase of health insurance for May. Only the risk that I might require health care in May is relevant.
So as soon as we start forcing people to buy insurance if there's any risk they might "transfer costs", I can think of lots of other cases where that's true.
Right off the top of my head, everyone should have to buy general personal liability insurance. You could cause someone injuries tomorrow, Tulpa, and if you're judgment proof those costs will be "transferred" to someone else.
Hmm.....would that be the "unique case" argument, that even if it seems like the individual mandate exceeds the powers granted in the commerce clause, health care is a unique product so the mandate would not, could not be used as a precedent to mandate say, fuzzy dice purchase?
To me that sounds an awful lot like "Trust me, baby, I'll only put the tip in".
"The example has to be something privately produced that everyone has to ultimately buy, which pretty much narrows it down to food or housing."
Oops!
Ignoring the whackos (Amish, xian-scientists, etc) who will not pay for medical service as commonly defined, there's a further problem.
We (none of us) need "insurance". We might well need and have to pay for medical service, but "insurance" has to do with that only peripherally.
So, tulpa, try again; do we need food "insurance"?
...which pretty much narrows it down to food or housing.
And clothing. Everyone's gotta be no naked.
And Education. Gotta get educated to some degree.
And Transportation. Everone's gotta move about.
And Defecation. Unless you never, ever crap and impact the the environment.
There are good ideas here. They're just accidental byproducts of an untenable premise: that government is the ultimate evil. That's just quasi-religious nonsense.
Since I don't hold that premise, I guess I can ignore your criticism.
Tony has a remarkable penchant for decrying and logically unraveling the justification for anarchy in places where no such argument has been advanced and where anarchists do not exist.
Shithead, assuming this is *the* shithead, has a penchant for any sort of dishonesty which, in his ignorance, he presumes 'wins' the argument.
Shithead's 'arguments' are an insult to anyone familiar with logic.
I win few arguments. Who is the judge? At least I attempt to make one on occasion.
You might as well go all-out, and call for the socialization of every aspect of our lives.
You DO have a president in office willing to entertain that, so why not step up to His level?
Why? No we don't. You're dumb.
There is an important distinction (which I didn't see in the article) between being forced to buy broccoli and being forced to actually eat it. In the former case one could discard or give away the broccoli, and the purchase requirement would not be much more onerous than a tax. Of course excessively high taxes also "eat away" at liberty, but as far as I know they have not yet been ruled unconstitutional.
You might also sell it an recoup some of the expense....
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If there is no limit to the commerce clause, then what is the limit to Congress' power?