Why the individual mandate philosophically is right/ or wrong

[cybrsage]

What I don't get about this whole 'it's tyranny' thing is that the government has already had for many years what is in fact much greater coercive power.

What they could have done instead is simply tax you for whatever costs there were, bought the insurance for you from private industry, and then given it back to you (if they felt like it). In fact had you not wished to have insurance you could just as easily been taxed for something you weren't getting either.

In such a case you would have had far less freedom over what you wanted to do with your life and your money, but nobody would argue that the government had the power to do that. The idea that this sort of legal structure is some sort of assault on freedom is pretty hard to arrive at when you look at the situation rationally.

They could have, but they did not. What they did instead was create an unconstitutional system.

 

[Hayabusa Rider]

What I don't get about this whole 'it's tyranny' thing is that the government has already had for many years what is in fact much greater coercive power.

What they could have done instead is simply tax you for whatever costs there were, bought the insurance for you from private industry, and then given it back to you (if they felt like it). In fact had you not wished to have insurance you could just as easily been taxed for something you weren't getting either.

In such a case you would have had far less freedom over what you wanted to do with your life and your money, but nobody would argue that the government had the power to do that. The idea that this sort of legal structure is some sort of assault on freedom is pretty hard to arrive at when you look at the situation rationally.

Yet it is a usurpation of traditional restrictions. The point you make is that there are no limits on what the government can make you do. Constitutional limits are effectively erased. Now some may see that as a good thing. I do not. To address your point there is no guarantee that the government can do as you suggest. Until the SCOTUS officially tosses the meaning of the Constitution under the bus and everything not excluded is permitted, I wouldn't bet the farm on anything. In fact the only reason i'd vote for Romney is the hope that his SCOTUS picks won't give in to agenda over Constitution.

 

[fskimospy]

Yet it is a usurpation of traditional restrictions. The point you make is that there are no limits on what the government can make you do. Constitutional limits are effectively erased. Now some may see that as a good thing. I do not. To address your point there is no guarantee that the government can do as you suggest. Until the SCOTUS officially tosses the meaning of the Constitution under the bus and everything not excluded is permitted, I wouldn't bet the farm on anything. In fact the only reason i'd vote for Romney is the hope that his SCOTUS picks won't give in to agenda over Constitution.

There really is, Medicare is almost exactly this except that the government provides the insurance instead of subcontracting it out to other insurers.

Unless you are going to argue that Medicare is unconstitutional as well, the government has already engaged in activity that is far more coercive in the realm of health care. What you are arguing is that if the government makes you buy health insurance or pay a tax, there is no limit to what it can do. In our current situation the government simply forcibly taxes you for health care under Medicare and then dispenses it as it sees fit. If anything, you have more options under the new arrangement, yet you believe it to be a greater infringement on liberty. It makes no sense.

 

[cybrsage]

There really is, Medicare is almost exactly this except that the government provides the insurance instead of subcontracting it out to other insurers.

This is a huge difference.

 

[sactoking]

There really is, Medicare is almost exactly this except that the government provides the insurance instead of subcontracting it out to other insurers.

Unless you are going to argue that Medicare is unconstitutional as well, the government has already engaged in activity that is far more coercive in the realm of health care. What you are arguing is that if the government makes you buy health insurance or pay a tax, there is no limit to what it can do. In our current situation the government simply forcibly taxes you for health care under Medicare and then dispenses it as it sees fit. If anything, you have more options under the new arrangement, yet you believe it to be a greater infringement on liberty. It makes no sense.

It makes sense, but it also doesn't make sense.

It doesn't make sense: you're right that there isn't really anything effectively different between the individual mandate and taxation to effectuate gov't provided coverage.

It makes sense: the Constitution was written with specific prohibitions in place, one of which is that any power not specifically enumerated to the Federal government is left to the states.

I won't presume to speak for others but my biggest problem with the individual mandate is not what it does but how it does it. If Congress had taxed us and used that tax money for "universal healthcare" I wouldn't necessarily be happy but I would understand. My problem with the ACA is it effectuates it results through yet another expansion of Commerce Clause authority. It's an expansion that I think is unconstitutional and will lead to ever-greater abuse and intrusion by the government into our lives.

 

[fskimospy]

It makes sense, but it also doesn't make sense.

It doesn't make sense: you're right that there isn't really anything effectively different between the individual mandate and taxation to effectuate gov't provided coverage.

It makes sense: the Constitution was written with specific prohibitions in place, one of which is that any power not specifically enumerated to the Federal government is left to the states.

I won't presume to speak for others but my biggest problem with the individual mandate is not what it does but how it does it. If Congress had taxed us and used that tax money for "universal healthcare" I wouldn't necessarily be happy but I would understand. My problem with the ACA is it effectuates it results through yet another expansion of Commerce Clause authority. It's an expansion that I think is unconstitutional and will lead to ever-greater abuse and intrusion by the government into our lives.

Can you describe to me something that this authorization will allow that could not be accomplished through other means? I've heard that the US gov could force you to buy broccoli. Of course the US gov could already tax you, buy broccoli, and then give it back to you if it wanted. Outrage on liberty not found.

The real expansion of the commerce clause that I would see would be determining that health care was interstate commerce, but that seems like a no brainer to me. (our health care system most certainly does not terminate at various state lines)

 

[sactoking]

Can you describe to me something that this authorization will allow that could not be accomplished through other means? I've heard that the US gov could force you to buy broccoli. Of course the US gov could already tax you, buy broccoli, and then give it back to you if it wanted. Outrage on liberty not found.

The real expansion of the commerce clause that I would see would be determining that health care was interstate commerce, but that seems like a no brainer to me. (our health care system most certainly does not terminate at various state lines)

Like I said, it (opposition to the mandate) makes no sense from the standpoint of the operational goals; a tax and distribution itself would be effectively the same. That's not my main concern.

My problems with the expansion of interstate commerce are twofold:
1) It effectively nullifies McCarran-Ferguson; and
2) It seeks to define purely intrastate commerce and lack of commerce as interstate commerce.

McCarran-Ferguson overturned South Eastern Underwriters and made the regulation of insurance a purely state matter, except in those matters where Federal regulation was required (National Crop Insurance Corporation, National Risk retention Act, etc.). The individual mandate seeks to invalidate McCarran-Ferguson by placing the Federal government as the foundational regulator of health insurance.

Beyond that, the individual mandate seeks to impose Federal government into transactions that it should not be regulating. As a Nevada resident, if I purchase health insurance from Health Plan of Nevada (a Nevada domestic company with headquarters in Las Vegas) and go to Carson Medical Group (a Nevada domestic company with headquarters in Carson City) how am I effectuating interstate commerce subject to Federal regulation?

As a Nevada resident, if I decide not to purchase health insurance at all but go to Renown South Meadows Medical Center (a Nevada domestic non-profit hospital with headquarters in Reno) how is that interstate commerce subject to Federal regulation?

As a US citizen, if I decide not to participate in an economic activity at all how can non-participation be rationalized as participation subject to regulation?

 

[fskimospy]

Like I said, it (opposition to the mandate) makes no sense from the standpoint of the operational goals; a tax and distribution itself would be effectively the same. That's not my main concern.

My problems with the expansion of interstate commerce are twofold:
1) It effectively nullifies McCarran-Ferguson; and
2) It seeks to define purely intrastate commerce and lack of commerce as interstate commerce.

McCarran-Ferguson overturned South Eastern Underwriters and made the regulation of insurance a purely state matter, except in those matters where Federal regulation was required (National Crop Insurance Corporation, National Risk retention Act, etc.). The individual mandate seeks to invalidate McCarran-Ferguson by placing the Federal government as the foundational regulator of health insurance.

Beyond that, the individual mandate seeks to impose Federal government into transactions that it should not be regulating. As a Nevada resident, if I purchase health insurance from Health Plan of Nevada (a Nevada domestic company with headquarters in Las Vegas) and go to Carson Medical Group (a Nevada domestic company with headquarters in Carson City) how am I effectuating interstate commerce subject to Federal regulation?

As a Nevada resident, if I decide not to purchase health insurance at all but go to Renown South Meadows Medical Center (a Nevada domestic non-profit hospital with headquarters in Reno) how is that interstate commerce subject to Federal regulation?

As a US citizen, if I decide not to participate in an economic activity at all how can non-participation be rationalized as participation subject to regulation?

Because as a Nevada resident you are extremely unlikely to only participate in health care transactions that only affect entities in Nevada. That hospital interacts with agencies out of state in dozens, if not hundreds of ways, and the services it provides to you are directly affected by them.

Regardless, for Congress to regulate commerce it does not need to establish that there is no conceivable way you could get around its interstate effects.

As a US citizen it is effectively impossible for you to decline to participate in the health care system. Basically every person in this country will at some point in their lives require care from any number of medical facilities. The prospect of non-participation is a fantasy.

EDIT: Not to mention that the commerce clause has been interpreted by the USSC to cover purely in-state activities that relate to a larger interstate goal of the federal govt.

 

[Ausm]

Simple answer: Let hospitals purchase insurance that covers them for treating poorer people with no insurance.

Fern

Guess who is going to foot the Bill either way?

 

[shadow9d9]

This is a huge difference.

They tax us and subcontract out all the time. This just skips a step. No big deal at all.

 

[Mr. Pedantic]

Those numbers sound correct. However, what can't be scored is the damage this does to the willingness of people to enter the medical field and for those already in it, the willingness to stay in it. When living in IL, frivolous malpractice lawsuits were driving doctors from that state. There have been many initiatives to limit the ability of patients to sue their physicians. Laws were being passed to help assure that only cases with warrant were able to proceed. This, although still a small factor, is still an inconspicuous driver of healthcare costs. But it adds up to more than what the CBO numbers show.

The problem with malpractice lawsuits is that it doesn't provide an incentive for doctors to practice better, and it doesn't provide any learning opportunities for other doctors to learn from what their colleagues do wrong. The litigatory culture fosters an environment where you are unwilling to admit your mistakes because you feel you will be more likely to be sued, less likely to be employed, and less likely to be liked by colleagues and patients. And it fails to provide an environment where people can learn from theirs and other people's mistakes because it propagates fundamental attribution error. Rather than focusing on the environment that created the mistakes, litigation forces the focus onto the individuals. They disappear, but the people that replace them are equally likely to commit the same mistakes because it is the environment that drives the errors - time constraints, lack of training, communication/teamwork issues, bureaucratic issues, etc.

 

[sactoking]

Because as a Nevada resident you are extremely unlikely to only participate in health care transactions that only affect entities in Nevada. That hospital interacts with agencies out of state in dozens, if not hundreds of ways, and the services it provides to you are directly affected by them.

Regardless, for Congress to regulate commerce it does not need to establish that there is no conceivable way you could get around its interstate effects.

As a US citizen it is effectively impossible for you to decline to participate in the health care system. Basically every person in this country will at some point in their lives require care from any number of medical facilities. The prospect of non-participation is a fantasy.

EDIT: Not to mention that the commerce clause has been interpreted by the USSC to cover purely in-state activities that relate to a larger interstate goal of the federal govt.

That's the typical counter-argument I hear, but I don't think it holds water.

Let's take the first part, that a purely in-state transaction has interstate reach. That logic could be applied to every single transaction ever undertaken in the modern history of the United States. If I use a NV insurer and go to a NV doctor that is not an interstate transaction. If the NV insurer chooses to reinsure with a New Hampshire company or the doctor buys tongue depressors from Georgia those are separate transactions and not party to my transaction. Extending your argument, could you conceive of any possible economic transaction that would not be subject to the commerce clause?

Let's take the second part, that lack of activity is itself activity. That logic could be applied to every single transaction ever undertaken in the modern history of the United States. If I choose not to buy a car and instead ride the bus, riding the bus is an activity subject to regulation by someone but inactivity is, by definition, not activity. Extending your argument, could you conceive of any possible transaction that would not be subject to regulation?

 

[Hayabusa Rider]

Let's take the second part, that lack of activity is itself activity. That logic could be applied to every single transaction ever undertaken in the modern history of the United States. If I choose not to buy a car and instead ride the bus, riding the bus is an activity subject to regulation by someone but inactivity is, by definition, not activity. Extending your argument, could you conceive of any possible transaction that would not be subject to regulation?

In the case of Medicare a service is directly paid by taxation. In the case of a mandate that is not the case. This is a punishment for not doing as told. The gyrations needed to attach this to the commerce clause brings into play a theoretical price paid not based on actual usage. Further this is not a nation that owes it's government an explanation or accountability for whatever one does. As you have pointed out anything which a potential cost now becomes fair game with no restrictions other than the good faith of the government. There are now no inherent protections from anything. This legislation aside surrendering complete control over to the state seems incredibly foolish. I'd rather not surrender my birthright for a bowl of lentils.

 

[woolfe9999]

In the case of Medicare a service is directly paid by taxation. In the case of a mandate that is not the case. This is a punishment for not doing as told. The gyrations needed to attach this to the commerce clause brings into play a theoretical price paid not based on actual usage. Further this is not a nation that owes it's government an explanation or accountability for whatever one does. As you have pointed out anything which a potential cost now becomes fair game with no restrictions other than the good faith of the government. There are now no inherent protections from anything. This legislation aside surrendering complete control over to the state seems incredibly foolish. I'd rather not surrender my birthright for a bowl of lentils.

You are punished, actually more severely, for not paying the taxes for these "indirect" services than you are for not directly buying the insurance under this new system. And it doesn't really matter from a moral standpoint whether it is direct or not. Whether it matters from a legal standpoint or not is another discussion, yet it just doesn't make sense to approve of one and call the other "tyranny." Taxation is compulsory. Indeed, it's backed by criminal sanction.

 

[werepossum]

Just FYI- starting 1/1/14 the eligibility threshold for Medicare can be no lower than 133% of the Federal Poverty Level and the exchange tax credits won't fully phase out until 400% of the FPL, so there is a decent amount of help available.

400% of FPL for a family of 4 is $89,400.

Yeah, it'll eventually be a huge wealth transfer program. I'll be very surprised if private health insurance even exists by 2030, and very surprised if the majority of Americans aren't on Medicare by 2020. Health insurance is doomed to be limited to policies covering the things Medicare doesn't cover. Probably within thirty years even those will be eliminated; you'll take what government decides to give you and you'll like it, unless you're wealthy enough to go elsewhere or get around the rules here. Hillarycare is our future.

 

[werepossum]

Like I said, it (opposition to the mandate) makes no sense from the standpoint of the operational goals; a tax and distribution itself would be effectively the same. That's not my main concern.

My problems with the expansion of interstate commerce are twofold:
1) It effectively nullifies McCarran-Ferguson; and
2) It seeks to define purely intrastate commerce and lack of commerce as interstate commerce.

McCarran-Ferguson overturned South Eastern Underwriters and made the regulation of insurance a purely state matter, except in those matters where Federal regulation was required (National Crop Insurance Corporation, National Risk retention Act, etc.). The individual mandate seeks to invalidate McCarran-Ferguson by placing the Federal government as the foundational regulator of health insurance.

Beyond that, the individual mandate seeks to impose Federal government into transactions that it should not be regulating. As a Nevada resident, if I purchase health insurance from Health Plan of Nevada (a Nevada domestic company with headquarters in Las Vegas) and go to Carson Medical Group (a Nevada domestic company with headquarters in Carson City) how am I effectuating interstate commerce subject to Federal regulation?

As a Nevada resident, if I decide not to purchase health insurance at all but go to Renown South Meadows Medical Center (a Nevada domestic non-profit hospital with headquarters in Reno) how is that interstate commerce subject to Federal regulation?

As a US citizen, if I decide not to participate in an economic activity at all how can non-participation be rationalized as participation subject to regulation?

SCOTUS ruled that one cannot grow wheat for domestic consumption without the permission of Congress because that enables you to not buy wheat from other, presumably out of state entities. Allowing the federal government to ban self-sufficiency for an individual is surely much more drastic than allowing the federal government to mandate responsibility, or if you like, banning self-sufficiency for a state. SCOTUS recognizes very, very few legitimate limitations on the power of the federal government. Not buying health insurance is not much difference from not buying wheat.

As Kelo v. New London made clear, a majority of SCOTUS considers individuals to be property of government (at all levels) and our highest function to be providing for those governments.

 

[Dr. Zaus]

That's one case in which the USSC screwed up bad.

 

[Hayabusa Rider]

You are punished, actually more severely, for not paying the taxes for these "indirect" services than you are for not directly buying the insurance under this new system. And it doesn't really matter from a moral standpoint whether it is direct or not. Whether it matters from a legal standpoint or not is another discussion, yet it just doesn't make sense to approve of one and call the other "tyranny." Taxation is compulsory. Indeed, it's backed by criminal sanction.

Your point seems to be that we must accept what we are told to do and if we tolerate or approve one thing than we must bow to all.

 

[cybrsage]

They tax us and subcontract out all the time. This just skips a step. No big deal at all.

Not a big deal if you think the Constitution is of no importantance.

 

[cybrsage]

As a US citizen, if I decide not to participate in an economic activity at all how can non-participation be rationalized as participation subject to regulation?

This is key, and notice no one even attempted to rebutt it.

How can non-participation in commerce be considered participation in commerce and therefor subject to regulation?

 

[shira]

This is key, and notice no one even attempted to rebutt it.

How can non-participation in commerce be considered participation in commerce and therefor subject to regulation?

Because the class of people refusing to be insured can't "not participate" in the health care system. It's a slam-dunk certainty that a percentage of these people will fall ill and will require care. And for those who can't afford to pay for their care, society will bear the burden.

The uninsured use the health care system and are a financial burden on the rest of society.

 

[Ausm]

I thinks is great that you believe in this. There's no disagreeing with what you believe is a right but please explain where you come up with having your beliefs imposed on others. Some people believe in certain things but they don't get to impose that belief on others. Some believe in God, others don't. So you agree that believers in God should be able to pass a law saying everyone should have God in their lives? I didn't think so.

I don't disagree with you believing in this anymore than someone believing in God, Satan, Santa, or the Easter Bunny but we are nation with guidelines that don't allow for beliefs to be imposed onto others. Believe what you want, but don't try and make others subscribe to those beliefs.

You mean like the Right jamming through Voter I.D laws, trying to criminalize Contraception, and constantly ramming their religious beliefs down everyone's throats?

 

[nonlnear]

Because the class of people refusing to be insured can't "not participate" in the health care system. It's a slam-dunk certainty that a percentage of these people will fall ill and will require care. And for those who can't afford to pay for their care, society will bear the burden.

The uninsured use the health care system and are a financial burden on the rest of society.

This is a better argument than the prevailing opinions in Gonzales v. Raich. However the point raised by sactoking was ruled on by SCOTUS using a far more ludicrous line of reasoning. At issue was non-commerce, non-interstate activity in an industry where it is very easy to never participate in the commercial market - interstate or otherwise. In that ruling the reasoning was that by not participating in the [interstate] commercial delivery system and providing one's own supply, one reduces demand in the interstate commercial market, thereby "participating" in it.

I agree there is a more compelling case for the Commerce clause to apply in the medical industry, where non-paticipation is a short term illusion. Unfortunately since SCOTUS jumped the shark with Raich, that more sound line of reasoning will never be used except in press releases.

 

[Hayabusa Rider]

This is a better argument than the prevailing opinions in Gonzales v. Raich. However the point raised by sactoking was ruled on by SCOTUS using a far more ludicrous line of reasoning. At issue was non-commerce, non-interstate activity in an industry where it is very easy to never participate in the commercial market - interstate or otherwise. In that ruling the reasoning was that by not participating in the [interstate] commercial delivery system and providing one's own supply, one reduces demand in the interstate commercial market, thereby "participating" in it.

I agree there is a more compelling case for the Commerce clause to apply in the medical industry, where non-paticipation is a short term illusion. Unfortunately since SCOTUS jumped the shark with Raich, that more sound line of reasoning will never be used except in press releases.

When non participation can be justified as action what limits exist in fact on what government on government compulsion? I don't mean good will.

 

[nonlnear]

When non participation can be justified as action what limits exist in fact on what government on government compulsion? I don't mean good will.

I didn't say that I liked the commerce clause argument about health care. I only meant that the argument in the case of health care is a better argument than what was held in Raich. To me it is a better legal argument under current law, but I don't much like current law.

I personally would like the commerce clause to be rewritten to pertain only to financial instruments, the maintenance of standard weights and measures, and safety standards. To me the fact that health care is often interstate commerce doesn't provide a compelling philosophical reson for federal micromanagement of corporate operations.