Wednesday, March 28, 2012

Didn't Clear My Head

I went skiing with Tabula Rasa yesterday. It was a perfectly wonderful day, but then this morning the headline in three papers is the individual mandate to buy health insurance looks to be in serious jeopardy. Even the most perfect days can only last 24 hours.

My thoughts have been a little heavy this morning. I sent the following message to Mike, an attorney, to try and make a little more sense of things. Maybe you have some opinions too:

I have wondered for some time now if the everyone-buy-insurance thing would undermine this health care law. I am not sure that it sits all that well with me, however much it seems the only way forward. What I am wondering is, if the affordable care act clause about universal purchasing is struck down, how will this affect the Massachusetts law? Isn't the provision there nearly identical? in a New Yorker article from last June, the author found this statement from somebody close to Romney at the time they were debating the Massachusettes legislation:

According to Murphy, Lischko, and Gruber, Romney believed that the logic in favor of a mandate was impeccable. Federal law requires emergency rooms to treat patients regardless of their ability to pay. “This is not Calcutta,” Murphy said. “We don’t let people go and die in the street. And then the question is, Who bears that cost? Those costs get paid by increased premiums for the people who do buy insurance, or they get paid for through socialized costs and claim our tax revenues and come at the expense of other things that people might want to do, like building roads and bridges. And in the Republican Party that I grew up in—go back to the welfare debate, it’s about personal responsibility—that seems pretty reasonable.”

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In other words, requiring health insurance demonstrates more personal responsibility (making it more Republican) than eventually and effectively becoming a ward of the state anyway.

The whole article is wonderful. It made me hope that the Constitutionality might not be such an issue, but now the whole thing appears to be hanging by a thread. 

Also, if the personal mandate provision is struck down, the next step is to rule on whether or not the rest of the law can stand without it. I think there is one possibility. Another provision in the law requires that insurance companies spent 80% on health care. I read a commentary that said the provision will basically drive the for-profit groups out of business, leading to overall cheaper health care, allowing more and more people to buy it. This editorialist (democrat) was hopeful that it was a first step toward universal health care. . . . and I say not unless Obama gets a chance to replace another justice or two.

And one last thing. Rick Perry's campaign had an idea to amend the Constitution to allow each sitting president to replace a Justice every 2 years. The oldest justice would retire. This would mean that each Justice could only serve 18 years and have less long term effect on the court. It would also mean that the make up of the Court would shift, but not too rapidly and lag behind the political process by a few years. It would make the appointment process less contentious, and probably allow presidents to appoint justices with a little more time on the bench. No doubt you've noticed that appointees keep getting younger and younger so they can have influence longer and longer. Anyway, I just wanted your take on the idea.


Slyck and Slim said...

I agree that increased personal responsibility is the key to patching up the Healthcare crisis in our nation...however...I think the real issue here is: is this Constitutional to make every American buy it? Is that what we want the Federal government to start doing, or do we leave it to the states? Personally, I feel like each state has different circumstances and this might better be "treated" on a state by state basis. Too many federal mandates begin to smell like socialism. We might get better long term results by writing to our state representatives and making our voice heard at the state level. Just my two cents.

Rick interesting idea, yes, if we could assure that honest men were always with integrity to uphold the Consitution and judge with fairness and wisdom -- not with bipartisan influence. There are always consequences attached to amending the Constitution...aften not seen for many years. I think we have to approach amendments to the Constitution with great care and not rush into anything so consequential.

Science Teacher Mommy said...

I don't think labels like "socialism" are all that helpful . . . I think that most people advocating for this are really of the belief that this will be helpful and not part of some slippery slope. I do see the legitimate concerns involved, however, in what the Court is having to consider. I think Justices of both liberal and conservative persuasions asked hard questions and really sought to find answers.

The irony, I think, is that the current Affordable Care Act includes many key provisions the Republicans were pushing for in the 1990's in an effort to stop a nationalized health care system. INCLUDING the individual mandate. Romney himself spent much time as governor debating this issue and in the end decided that requiring health insurance demonstrated more personal responsibility and the best possible public good at the same time.

The Republican reasoning was that each person had a personal responsibility to buy health insurance because if not, WHEN (not IF) they got sick, they essentially were paid for by everyone else--through medicare or higher insurance premiums or higher health care costs. (My brother once worked with a cardiologist who never collected a dime on nearly 50% of his patients. To keep his doors open he had to charge very high prices to insured patients. Any doctor in private practice will give the same story.) A person of sufficient means may feel that they have a RIGHT to NOT by health care, but by that reasoning, they also have an obligation to stay the heck home and not seek treatment when they do get sick unless they intend to pay entirely out of pocket.

I think the appointment thing every two years is to create a response to the inherent bias in the system. The truth is, that there are fundamentally different views of how the Constitution should be interpreted. This argument has been in place from the beginning of our government. Whether a justice's argument is right or wrong depends entirely on the lens through which you view the role of government. And any close reader can find a founding fathers to back their claim. Maybe the best we can hope for is that the Court will more or less reflect a variety of viewpoints so their decisions are reasoned and carefully considered.

Science Teacher Mommy said...

Oh, and Slim--I totally think that ANY state that comes up with their own health care plan that controls costs and provides greater universal coverage either through mandates to businesses (like Hawaii) or individuals (like Mass.) or by creating exchanges or whatever idea that works should be exempt from the Federal plan.

But the problem has been ongoing for a very long time, and only a handful of states have shown any inclination to fix the problem. If the states HAD shown the courage of the statesmen in Romney's Massachusetts it would be a non-issue.

Caitlin said...

I appreciate your well thought-out post and I wish more people did their own research on this subject instead of regurgitating the nonsense spewed by political commentators. I'm watching this ruling very closely (like refresh-my-browser-to-see-news-headlines-every-30-mins.) since my daughter uses Medicaid and I use the Preexisting Condition Insurance Plan (PCIP) created under the Affordable Care Act. I can't get individual coverage due to cancer almost 6 years ago. If the entire law is struck down (which as time goes on, it's looking more plausible) I lose my coverage. Period. Now I am scrambling to get prescriptions filled, a pap smear (i've had 1 in 6 years), a last minute visit to an oncologist for a preventative exam and labs. I pay almost $400 a month for PCIP and I've been in extremely good health since I had cancer but I can't get private coverage. But I still feel ashamed and humiliated when comments are made (by an especially passionate woman at church) about the "leeches and losers" who use government programs. Of course she is singling out stereotypical examples of who she thinks "those people" are. I don't look like "those people" she's describing and yet I am one of them. It's hard enough to take care of a handicapped child and to put aside my ego to admit that I can't cover the $2,000 monthly bill for my daughter's therapy, and let's not even get into the medical costs. Does she know what it's like to be uninsured? Does she know what it's like getting into her car EVERYDAY wondering if this could be the day she's in a terrible accident that could cost her family hundreds of thousands of dollars? Does she know what it is like to update her Living Will to specify that she wants someone to "pull the plug" no matter how good chances are that she could survive? Has she thought to herself "It's better to be dead than to sink your family into bankruptcy." Probably not. I get it. The court needs to only look at the Constitutionality of the law. That's what I want them to do in all cases. The Supreme Court can't be influenced by individual situations, like mine, and put faces on their rulings. But that's the funny thing about health insurance, it's not a "faceless" issue. My SIL just lost her mother in the Philippines to a stroke. She could have been treated with surgery and there was a good chance she would have lived many more years with minimal impairment. But her family could not pay. So she was sent home. My SIL made it to her mother's bedside and was with her for a few hours before she passed away. I can't. Even. Imagine. So what is the answer? I don't know. It's complicated to say the least. How can we have this conversation without mentioning the immigration status of the 10(ish) million of people living here illegally? Not only will they not be eligible to buy the mandated insurance but they can't even pay taxes that the majority would be happy to pay if granted citizenship. Maybe we should rethink our overcomplicated/exclusive immigration system and stop worrying about the changing demographics of a country made up entirely by immigrants. *Sigh* My heart is racing and I need to end this rant. After all, once this ruling comes back, I won't be able to afford to have a heart-attack. Thank you for taking a well-researched look at an ugly problem.

Science Teacher Mommy said...

Oh. My.


I think you are right about those terrible stereotypes. We don't know when that horrible "leech" isn't at all, but a wonderful person right next to us in the pews.

What did Uchtdorf say about judging? STOP IT.

The reality is that our modern political world is complex. There aren't easy solutions.

I hope this goes well for you and so many others. Your family is exactly those for whom the law is designed--those who work and don't have access.

Caitlin said...

I'm seriously embarrassed about my rant. So sorry. This is an issue I feel passionate(ly?) about. Plus, I'm coming out of this depression induced isolation fog and I'm still not quite ready to rejoin "polite society" yet. But I still stand by my expressions of gratitude for your willingness to form your own independant opinion.