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Wednesday, September 30, 2009
Thursday, September 3, 2009
A view on healthcare
So, again with the politicalness. I know, it's probably annoying, but I like to try and stay up on things. I've been researching the healthcare thing and actually reading the bill (so thrilling, let me tell you) and getting in some heated debates over it (Nate, man, keep trying) and figured I'd just stomp out my position and why I feel as I do. But first, common objections and why they don't quite work...
It's unconstitutional!
The biggest, greatest argument of the last week or so seems to focus on the 10th Amendment and the fact that (and I quote)..."The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."
There you have it, right? Since no where in the constitution is health care even dreamed of, we have to assume that the federal government has no right to mess with health care. End of story, right?
Except it's not.
There are two clauses in Section I Article 8 of the Constitution that might provide loopholes for getting things through. In fact, historically, these have been used to usher in a wide variety of legislation and administration not specifically outlined, but deemed "necessary and proper" to accomplish those goals.
The first is the "general wellfare" clause. Basically, the government has a responsibility to ensure the "general wellfare." So we have to figure out, then, exactly what constitutes the "general welfare." This was an issue that arose right off the bat. It's actually arguable that the 10th Amendment was a reaction to the early trend towards a larger, more powerful Federal government based on a literal (James Madison's words, not mine) reading of that clause. Alexander Hamilton used this cause often in his defense of the National Bank (and, yes, they were both catastrophes. We will speak no more of them other than in principle). More recently, this clause has helped push through legislation establishing such institutions as the FDA, OSHA, USDA, FEMA and other great letter-named groups that, in their charters if not their actions, serve to help the people by ensuring safe food and drugs, establishing guidelines for a safe work environment and assisting in emergencies. None of these are directly commissioned by the Constitution, but all exist, at least in theory, to help the American people and to achieve what is necessary and proper to insure the general welfare. It is a small step, then, to see that the regulation of insurance for the welfare of the general populace could fit under this heading.
The second Constitutional clause is the same one that brought early advances in the civil rights movement, the FDIC, and, interestingly enough, federal kidnapping charges, among other things. This is the clause that the Federal government may regulate interstate commerce. The Civil Rights Act of 1964 was passed on the basis that any establishment serving the public could, in theory, be serving persons from out of state. Therefore every public establishment must obey laws enacted by the federal government regulating interstate commerce. Dictating that no establishment may discriminate on skin color was not in the Constitution, but Congress used the commerce clause to force the issue. As my health insurance covers me even if I wander into Indiana, it has the potential to engage in inter state commerce, therefore the federal government has precedent to regulate it. Oh, and, yes, this does give the federal government amazingly broad powers, but for the most part the constitutionality of these actions has been upheld.
The kidnapping thing also applies here since transporting an individual across state lines is an inter state act, the federal government can act on it. The commerce part, ultimately, becomes almost vestigial.
Aside: There is a discussion going on in regards to what defines "commerce" and whether or not that includes goods or services or both. Since health insurance would be interested in services as well as goods (medications, band aids, etc.) the question is pretty easily avoided. It is also worth noting that the Civil Rights Act of 1964 deals exclusively with services, but not with goods at all, and that this act has been upheld under Supreme Court review, so the application to health care is, infact
So, yeah, the 10th Amendment might have something to say about it, but it has been rendered almost moot. To say the Federal government only has rights to do what it has rights to do is, simply put, true. However, the elasticity of the language in Article 1 Section 8 provides avenues the 10th Amendment cannot block. While it is a noble attempt, the truth is it does precious little in the entirety of the law. "The amendment states but a truism that all is retained that is not surrendered." (US v Darby). To use it successfully one must prove that there is no rational that supports federally regulated health insurance, and that simply cannot be done as long as either of these remain.
As an aside, check out McCollogh v Maryland. Interesting decision from 1819 that limits and expands the federal government's powers. That's your homework.
But it's our right!
Bluntly put, it's not. Looking back at the 10th Amendment (which does sum up parts of the Constitution if not adding much to them) the only rights the people actually have are those not granted to the Federal Government or to the state governments or those specifically granted to individuals. That's why the 1st Amendment is such a big deal. It gives rights specifically to the people, rights that no level of government can take away. It's also why the second amendment is so contentious. (who is getting those right? Individuals? the public at large? The answers to those questions determine where you start in the debate and where you end up)
Besides, what right are we talking about? The rights of the individual? Even if you have some inexplicable right to choose your health insurance, you still have choices under this plan that are similar to the choices you have today, just without some of the bad parts. The rights of the insurance companies? As previously discussed, they can fall under the commerce clause and therefore their rights are subject to the federal government. It's not unlike banks who are limited in what they can sell to the public and, by extension, the public is limited on what they can buy from banks (since the selection was limited earlier). But, for the most part, these restrictions are put in place to protect either the public, the banks or the shareholders of the banks. As we have recently learned, when those restrictions are bypassed bad things happen. Bad things are happening in the health care arena already, we need some regulation to get us out of it.
But the government will screw this up!
Most likely, yes, they will. In fact, you can probably be sure of it. There will be problems, loopholes, omissions, beauracracies and shortfalls. That's the nature of the beast. However, if my experience with non federally mandated healthcare indicates anything, it's that we already have those in spades. This isn't an attempt to replace a perfectly working system with a flawed and broken one, but rather an attempt to replace a broken system with one that can be fixed by a central authority. But, yes, there will be growing pains if this starts. There always will be that issue, but the potential here is to make it better, something lacking in the current system.
This also brushes up against the point that the government is not always the best at regulating industry. Yes, the bank meltdown was an indication of this. But so was the bank meltdown of 1929. I know we're not out of the woods yet, but there is no sane economist who can say that we're as bad off now as we were in, say 1930. The difference was regulation. The problem, though, is that regulation is reactionary. Something has to go wrong before we know to not let that happen again. Every time we make a system, a method arises to take advantage of that system and then the system has to adapt. That, or you dismantle every system and hope for the best. That's anarchy, not libertarianism. Let me know how that works out for you.
This will raise taxes!
Actually, that's a mixed bag. For some people, yes, for other people, no, for most people...maybe.
$1,000,000,000,000 over 10 years translates to about $275 a year per person and that's before you count savings from lessening the burden on Medicare/Medicaid and from emergency care. And before you count the added taxes from those who choose not to have insurance. And before you figure the extra taxes generated on the income private insurance companies will receive from their new subscribers and pass on to their new employees or to medical professionals. Remember, money moving in the economy generates taxes, this will get a lot of money moving, and a lot of that will come back as taxes. At any rate, it's still cheaper per year than the Iraq war.
This limits my choice!
Not really. Not more than it's limited already. If anything, it actually opens some valid options that weren't there before. Previously, the only way of getting a group insurance plan where you could not be dropped due to paperwork errors or pre-existing conditions was to go through your employer. This means your options here were, shall we say, limited. You could buy on the open market, but if you did that you run the risk of being dropped. Your employer's plan can't do that. Plus, you would be evaluated individually and probably end up paying more (more on that later).
Under this system the only thing that is removed is the plans that can drop you. Instead there arises this "marketplace" where various insurance companies sell group rate plans to the public. These group rate plans function like your employer's group rate plans, only without that employer part, which also means you have to pay for everything yourself. This also means they can't drop you.
This is going to drive up premiums!
There's the fear that all these bottom tier folks suddenly getting insurance will somehow hike the rates on the rest of us.
That's not how insurance works. The massive "marketplace" group will be evaluated on their own terms and a rate will be set for that group. It makes no sense for an insurance company to set that rate too low (and attempt to pass that on to the rest of us) since a disproportionate number of people would then try to purchase that policy and then end up costing more, on average, then the policy brought in while employers shopping for insurance for their employees see cheaper rates across the street. For example, if the actuaries in the insurance company decide that the average person in that pool will cost around $5,000 a year to insure, there is no incentive for them to lower the rates below $5,000 or else they would run the risk of loosing money with each additional subscriber. It will cause them to run as close to that number as possible, but that's what's happening now with individual and group insurance policies. That's how your employer's group got the rate they did.
As an aside, the reason this has potential to save people currently insuring themselves money is because each individual policy is evaluated on its own terms. A group of 1000 people actuarially will ring up fewer health care costs in a give year than 1000 individuals. Strange, but true. The key word was "actuarially" (as opposed to "actually"), which has a lot to do with the human tendency to avoid harm, statistics and boring math. In a given year anything could happen to one person. A car accident, a heart attack, a stroke, a pregnancy (well, in 50% of people anyway), anything. But in a group of 1000, the chances of all (or any of) those things happening to everyone are slim, so the overall rate can be lower. If you're young and healthy and don't have a significant family history, you probably wouldn't notice the difference. However, if you not, the group system can save you a lot of money.
But this is stealing from the rich to help the poor!
Actually, no part of this is. At least, no more than the current system. Seriously, it's just not there. Everyone is responsible for their own health insurance. The rich, who probably already have it, will not have to pay for the poor than the poor will have to pay for the rich. That's actually how insurance works now. Your CEO pays so the kid in the mailroom can get his appendix out if he needs it. And, no he doesn't pay it all directly, but he would possibly be getting a little more pay if the company didn't have to pay insurance. It's just that now the big group in the marketplace all pay for themselves just like your company pays for itself.
It didn't work in Canada/France/Djibouti!
First off, I have no idea if Djibouti has nationalized health care. In fact, I doubt it, but it's just a fun word to say/type.
And second, this is not the Canadian system. That is a single payer program. Although Obama has expressed interest in going that way, I think that's a huge mistake for now. A nation needs to go through steps to get there, suddenly pulling the rug out from under people like Canada did was horrible idea that the Canadian people are still paying for. But this is not that. This will still allow you to have the same private insurance company you already have. This isn't the government taking over clinics and hospitals and redistributing doctors like Canada did.
And the French system, having talked to actual French people, isn't that bad.
Comparing this to the Eastern Bloc communist systems is also apples to oranges. The biggest problem over there was lack of resources, lack of funding, lack of infistructure, lack of caring for the people. Any healthcare system in that environment would fail. So did their transportation infistructure, their power grids, their basic water and sanitation needs. Yet all those are run or overseen by our government with little to no complaints most of the time.
So, that's why I'm not against it. That's that. Sorry it's so long, and I know it's not going to convince people one way or the other, but I tend to hide in the background and not say much, but lately the far right has just been letting me down. It's just that I expect more than half formed arguments and random ad hominem attacks in my political discourse.
It's unconstitutional!
The biggest, greatest argument of the last week or so seems to focus on the 10th Amendment and the fact that (and I quote)..."The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."
There you have it, right? Since no where in the constitution is health care even dreamed of, we have to assume that the federal government has no right to mess with health care. End of story, right?
Except it's not.
There are two clauses in Section I Article 8 of the Constitution that might provide loopholes for getting things through. In fact, historically, these have been used to usher in a wide variety of legislation and administration not specifically outlined, but deemed "necessary and proper" to accomplish those goals.
The first is the "general wellfare" clause. Basically, the government has a responsibility to ensure the "general wellfare." So we have to figure out, then, exactly what constitutes the "general welfare." This was an issue that arose right off the bat. It's actually arguable that the 10th Amendment was a reaction to the early trend towards a larger, more powerful Federal government based on a literal (James Madison's words, not mine) reading of that clause. Alexander Hamilton used this cause often in his defense of the National Bank (and, yes, they were both catastrophes. We will speak no more of them other than in principle). More recently, this clause has helped push through legislation establishing such institutions as the FDA, OSHA, USDA, FEMA and other great letter-named groups that, in their charters if not their actions, serve to help the people by ensuring safe food and drugs, establishing guidelines for a safe work environment and assisting in emergencies. None of these are directly commissioned by the Constitution, but all exist, at least in theory, to help the American people and to achieve what is necessary and proper to insure the general welfare. It is a small step, then, to see that the regulation of insurance for the welfare of the general populace could fit under this heading.
The second Constitutional clause is the same one that brought early advances in the civil rights movement, the FDIC, and, interestingly enough, federal kidnapping charges, among other things. This is the clause that the Federal government may regulate interstate commerce. The Civil Rights Act of 1964 was passed on the basis that any establishment serving the public could, in theory, be serving persons from out of state. Therefore every public establishment must obey laws enacted by the federal government regulating interstate commerce. Dictating that no establishment may discriminate on skin color was not in the Constitution, but Congress used the commerce clause to force the issue. As my health insurance covers me even if I wander into Indiana, it has the potential to engage in inter state commerce, therefore the federal government has precedent to regulate it. Oh, and, yes, this does give the federal government amazingly broad powers, but for the most part the constitutionality of these actions has been upheld.
The kidnapping thing also applies here since transporting an individual across state lines is an inter state act, the federal government can act on it. The commerce part, ultimately, becomes almost vestigial.
Aside: There is a discussion going on in regards to what defines "commerce" and whether or not that includes goods or services or both. Since health insurance would be interested in services as well as goods (medications, band aids, etc.) the question is pretty easily avoided. It is also worth noting that the Civil Rights Act of 1964 deals exclusively with services, but not with goods at all, and that this act has been upheld under Supreme Court review, so the application to health care is, infact
So, yeah, the 10th Amendment might have something to say about it, but it has been rendered almost moot. To say the Federal government only has rights to do what it has rights to do is, simply put, true. However, the elasticity of the language in Article 1 Section 8 provides avenues the 10th Amendment cannot block. While it is a noble attempt, the truth is it does precious little in the entirety of the law. "The amendment states but a truism that all is retained that is not surrendered." (US v Darby). To use it successfully one must prove that there is no rational that supports federally regulated health insurance, and that simply cannot be done as long as either of these remain.
As an aside, check out McCollogh v Maryland. Interesting decision from 1819 that limits and expands the federal government's powers. That's your homework.
But it's our right!
Bluntly put, it's not. Looking back at the 10th Amendment (which does sum up parts of the Constitution if not adding much to them) the only rights the people actually have are those not granted to the Federal Government or to the state governments or those specifically granted to individuals. That's why the 1st Amendment is such a big deal. It gives rights specifically to the people, rights that no level of government can take away. It's also why the second amendment is so contentious. (who is getting those right? Individuals? the public at large? The answers to those questions determine where you start in the debate and where you end up)
Besides, what right are we talking about? The rights of the individual? Even if you have some inexplicable right to choose your health insurance, you still have choices under this plan that are similar to the choices you have today, just without some of the bad parts. The rights of the insurance companies? As previously discussed, they can fall under the commerce clause and therefore their rights are subject to the federal government. It's not unlike banks who are limited in what they can sell to the public and, by extension, the public is limited on what they can buy from banks (since the selection was limited earlier). But, for the most part, these restrictions are put in place to protect either the public, the banks or the shareholders of the banks. As we have recently learned, when those restrictions are bypassed bad things happen. Bad things are happening in the health care arena already, we need some regulation to get us out of it.
But the government will screw this up!
Most likely, yes, they will. In fact, you can probably be sure of it. There will be problems, loopholes, omissions, beauracracies and shortfalls. That's the nature of the beast. However, if my experience with non federally mandated healthcare indicates anything, it's that we already have those in spades. This isn't an attempt to replace a perfectly working system with a flawed and broken one, but rather an attempt to replace a broken system with one that can be fixed by a central authority. But, yes, there will be growing pains if this starts. There always will be that issue, but the potential here is to make it better, something lacking in the current system.
This also brushes up against the point that the government is not always the best at regulating industry. Yes, the bank meltdown was an indication of this. But so was the bank meltdown of 1929. I know we're not out of the woods yet, but there is no sane economist who can say that we're as bad off now as we were in, say 1930. The difference was regulation. The problem, though, is that regulation is reactionary. Something has to go wrong before we know to not let that happen again. Every time we make a system, a method arises to take advantage of that system and then the system has to adapt. That, or you dismantle every system and hope for the best. That's anarchy, not libertarianism. Let me know how that works out for you.
This will raise taxes!
Actually, that's a mixed bag. For some people, yes, for other people, no, for most people...maybe.
$1,000,000,000,000 over 10 years translates to about $275 a year per person and that's before you count savings from lessening the burden on Medicare/Medicaid and from emergency care. And before you count the added taxes from those who choose not to have insurance. And before you figure the extra taxes generated on the income private insurance companies will receive from their new subscribers and pass on to their new employees or to medical professionals. Remember, money moving in the economy generates taxes, this will get a lot of money moving, and a lot of that will come back as taxes. At any rate, it's still cheaper per year than the Iraq war.
This limits my choice!
Not really. Not more than it's limited already. If anything, it actually opens some valid options that weren't there before. Previously, the only way of getting a group insurance plan where you could not be dropped due to paperwork errors or pre-existing conditions was to go through your employer. This means your options here were, shall we say, limited. You could buy on the open market, but if you did that you run the risk of being dropped. Your employer's plan can't do that. Plus, you would be evaluated individually and probably end up paying more (more on that later).
Under this system the only thing that is removed is the plans that can drop you. Instead there arises this "marketplace" where various insurance companies sell group rate plans to the public. These group rate plans function like your employer's group rate plans, only without that employer part, which also means you have to pay for everything yourself. This also means they can't drop you.
This is going to drive up premiums!
There's the fear that all these bottom tier folks suddenly getting insurance will somehow hike the rates on the rest of us.
That's not how insurance works. The massive "marketplace" group will be evaluated on their own terms and a rate will be set for that group. It makes no sense for an insurance company to set that rate too low (and attempt to pass that on to the rest of us) since a disproportionate number of people would then try to purchase that policy and then end up costing more, on average, then the policy brought in while employers shopping for insurance for their employees see cheaper rates across the street. For example, if the actuaries in the insurance company decide that the average person in that pool will cost around $5,000 a year to insure, there is no incentive for them to lower the rates below $5,000 or else they would run the risk of loosing money with each additional subscriber. It will cause them to run as close to that number as possible, but that's what's happening now with individual and group insurance policies. That's how your employer's group got the rate they did.
As an aside, the reason this has potential to save people currently insuring themselves money is because each individual policy is evaluated on its own terms. A group of 1000 people actuarially will ring up fewer health care costs in a give year than 1000 individuals. Strange, but true. The key word was "actuarially" (as opposed to "actually"), which has a lot to do with the human tendency to avoid harm, statistics and boring math. In a given year anything could happen to one person. A car accident, a heart attack, a stroke, a pregnancy (well, in 50% of people anyway), anything. But in a group of 1000, the chances of all (or any of) those things happening to everyone are slim, so the overall rate can be lower. If you're young and healthy and don't have a significant family history, you probably wouldn't notice the difference. However, if you not, the group system can save you a lot of money.
But this is stealing from the rich to help the poor!
Actually, no part of this is. At least, no more than the current system. Seriously, it's just not there. Everyone is responsible for their own health insurance. The rich, who probably already have it, will not have to pay for the poor than the poor will have to pay for the rich. That's actually how insurance works now. Your CEO pays so the kid in the mailroom can get his appendix out if he needs it. And, no he doesn't pay it all directly, but he would possibly be getting a little more pay if the company didn't have to pay insurance. It's just that now the big group in the marketplace all pay for themselves just like your company pays for itself.
It didn't work in Canada/France/Djibouti!
First off, I have no idea if Djibouti has nationalized health care. In fact, I doubt it, but it's just a fun word to say/type.
And second, this is not the Canadian system. That is a single payer program. Although Obama has expressed interest in going that way, I think that's a huge mistake for now. A nation needs to go through steps to get there, suddenly pulling the rug out from under people like Canada did was horrible idea that the Canadian people are still paying for. But this is not that. This will still allow you to have the same private insurance company you already have. This isn't the government taking over clinics and hospitals and redistributing doctors like Canada did.
And the French system, having talked to actual French people, isn't that bad.
Comparing this to the Eastern Bloc communist systems is also apples to oranges. The biggest problem over there was lack of resources, lack of funding, lack of infistructure, lack of caring for the people. Any healthcare system in that environment would fail. So did their transportation infistructure, their power grids, their basic water and sanitation needs. Yet all those are run or overseen by our government with little to no complaints most of the time.
So, that's why I'm not against it. That's that. Sorry it's so long, and I know it's not going to convince people one way or the other, but I tend to hide in the background and not say much, but lately the far right has just been letting me down. It's just that I expect more than half formed arguments and random ad hominem attacks in my political discourse.
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