Will the Courts Wreck Health Care?
^WASHINGTON — As if our political system was not having enough trouble already, we now confront the possibility that a highly partisan judiciary will undo a modest health care reform that is a first step toward resolving a slew of other difficulties.
As you watch the suits against the Patient Protection and Affordable Care Act work their way through the courts, consider that what you are really seeing is a great republic tying itself into as many knots as possible to avoid facing up to a challenge that every other wealthy capitalist democracy in the world has met.
Yes, all the others have decided that it’s both more just and more efficient for all its citizens to have health insurance. Countries do this in different ways. Some rely primarily on government, others on a mix of private and public resources. But given the costs of health care, even the most conservative governments have concluded that the public sector has to play a large role in its provision.
Not us. No, thanks to our own peculiar brand of conservatism that sees government-subsidized health care as a lurch down the road to serfdom and dictatorship, we kept finding ways to evade the problem — until last year’s breakthrough. But having failed to block health care reform in our elected branches of government, conservatives now hope that they can achieve their end through judicial fiat. They were against judicial activism until they were for it.
And we Americans are thoroughly inconsistent. We supposedly oppose government health care, yet Medicare — essentially a system of socialized insurance — is an exceedingly popular program. That’s why House Republicans are paying such a high political price for their efforts to dismantle it.
Conservatives talk an excellent game about individual responsibility and the idea that there is no such thing as a free lunch. They have a point, which makes it all the more astonishing that their legal attack has focused on the health law’s requirement that all Americans purchase health insurance. (Mitt Romney actually understands this. That’s why he’s in the midst of trying to square his own support for an individual mandate in Massachusetts with anti-mandate orthodoxy among GOP primary voters.)
There’s a simple truth here. People who get sick and show up at emergency rooms will get care whether they have insurance or not — and they should. Under a law signed by President Reagan — the Emergency Medical Treatment and Active Labor Act of 1986 — nearly every hospital is required to offer treatment to those in urgent need of help. The law stops private hospitals from “dumping” (the word of art in the medical profession) patients onto public hospitals.
The way things work now, the cost of treating those patients falls onto those who already pay for insurance, or onto the taxpayers. The mandate is designed to get everyone inside the system and have them pay something. The new law also provides subsidies for those who can’t afford the full cost of insurance.
In defending the Affordable Care Act before the 4th U.S. Circuit Court of Appeals in Richmond on Tuesday, Neal Katyal, the acting solicitor general, offered a defense whose breathtaking simplicity cut through all the nonsense being peddled by the mandate’s opponents. “Everyone is going to seek health care,” he said. “Nobody can know precisely when.” That’s why it’s important to establish a fairer and more rational way of covering the costs in advance.
Virginia Attorney General Ken Cuccinelli made a revealing argument against the mandate. He kept referring to health insurance as a “private product.”
There’s the rub. Health care is anything but a “private product.” The system is replete with cross-subsidies from hospitals, taxpayers and the already insured. There is no law requiring a car dealer to give you a new Lexus if you just walk onto the lot that compares to the statute requiring hospitals to treat you if you show up. We consider health care a largely public good, but we don’t pay for it that way. That’s foolish.
If a conservative majority on the Supreme Court eventually strikes down the individual mandate, it won’t change this reality. It will simply delay our day of reckoning as we keep trying to rationalize the mishmash that is our private/public health care system. Like it or not, collective provision will always be central to any humane health care system. Our competitors understand that. The sooner we do, the better.
E.J. Dionne’s email address is ejdionne(at)washpost.com (c) 2011, Washington Post Writers Group
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Of course an individual mandate makes sense. If we’re going to provide universal coverage, we need to require universal contributions.
The problem is simply that current law doesn’t permit it. Mr. Dionne manages to miss the point yet again, getting through his whole column without using the word “constitution.” Rather than ignore what’s written in it, we should either change it to permit a law we consider sensible or find a funding approach that passes constitutional muster.
George Will summed up the central question here well: do we have a constitution or not?
The real issue is that we are getting gouged for medical services in this country. Private enterprise has failed. We need to get the costs down, on everything. But that would mean the whores in Congress would have to stop taking money from the medical industry long enough to tackle that problem. Until costs are controlled nothing we come up with is going to fix things.
Again, a private market would have competition. The government could fix a lot of the cost problems simply by bidding out products and services with doctors, hospitals, and pharmaceuticals instead of working out campaign kickback arrangements with them.
You know, looking a Dionne’s title, I would say that it’s way too late for that. The courts are working on the ACA, which is another matter altogether.
While I don’t support the entire bill, I do support the individual mandate, for some of the reasons the article mentions. However, when it hit the courts, I was amazed at how weak the arguments for its legality were, being based mostly on the idea that the Federal government can base laws based on interstate commerce you _don’t_ engage in. While the author is quick to try and pint a partisan finger, the fact is that if you think that the interstate commerce clause can be used to cover things you aren’t doing, then it is hard to see what it doesn’t cover.
I think the bill could probably be redrafted to be constitutional. The Democrats would probably have to reach a consensus on health care to get that, but they should have done that in first place.
Up to now, I lacked the first hand experience with the cost structure of the delivery system to form an intelligent opinion on the reasonableness of costs, but now I can declare these to be not unreasonable.
I hadn’t been a hospital patient since 1987. However, the cleaning lady left a bucket at the foot of one of the stairways and I went down them one evening a few weeks ago without turning on the lights. I tripped over the rim and hit my temple on the marble floor. I had a pretty good sized goose egg, so I thought I had better rule out something more serious than a contusion.
I went to the local community hospital and asked for a CT scan. They gave me the standard ER triage routine and then took me into Radiology. The radiology read took only a few minutes and they told me it was only subcutaneous. The nurse told me to stay around for meds and doctor discharge, but I said to hell with that. I got up and left.
Here’s the interesting part. I have an HD policy, but it still gets me network access in the deductible layer. The hospital and docs submitted gross charges of $3K, but the network discounts knocked everything down to $800. CT scan $400, radiologist $60, ER attending $120 and ER facility $220.
What I suggest we do is make everyone pay out of pocket below $5k, but give everyone the network discounts. I thought $800 was reasonable given the equipment and the immediate, late night access.
$800 to run a machine over you for a few minutes, find nothing, and cure nothing? I’d say you’re quite generous; that seems reasonable only compared to $200 bills for 15 minutes with a doctor in his office. Your brain probably took less damage from the marble floor than it has from long-term exposure to crazy medical bills.
Even setting aside my own opinion of what a “reasonable” bill might be, the 4x difference between the sticker price and the negotiated price is enough to conclude the providers are trying to pull a fast one. Competitive, transparent markets don’t have that sort of highballing–sellers attempting it are quickly kicked to the curb.
Amazing! Simply amazing!
Mr. Dionne writes a 700+ word essay arguing why the courts should not rule against the Patient Protection and Affordable Care Act, and not once does he even mention the words “Constitution” or “constitutional.”
One of the fundamental arguments that ahas been raised against the Patient Protection and Affordable Care Act is that it is unconstitutional by virtue of the fact that there is nothing in Article I, Section 8 of the U.S. Constitution that grants the federal government such broad powers.
Why doesn’t Dionne even address the question of whether the law is Constitutional? Is it because he is unable to rebute the argument, or is it that he simply could care less about what the Constitution says?
Dr. J,
Whoops. I didn’t read your reply before posting my own. Apparently I am not the only person at TMV who would be shocked that a well-known columnist would demand that the courts would automatically rule in favor of a law without even bothering to consider the underlying constitutionality of that law.
Why do Americans even bother praise the U.S. Constitutional anymore? It’s quite clear that the majority of Americans only support those portions of the document that are convenient for them.
Sometimes I think that the hostility towards Tea Partiers is in large part due to the fact that they are anachronisms who still really care about whether acts of government are constitutional or not. While their critics may reference the Constitution when it is convenient for them, most are hypocrites who ignore that document whenever its contents might undercut their own positions. Being a hypocrite can bring about strong internal discomfort, easily redirected as anger towards those whose stance and words are more consistent and more honest. Thus, real respect for the Constitution can inspire vitriol from hypocrites who love the Constitution only when it is convenient to do so. In this way, people who are at all close to consistent about applying the Constitution are labeled “nuts” and “extremists”.
I’ll have a lot more respect for the “Constitution is sacred people” and take them far more seriously when they start protesting in front of the White House against the right of the President to have a US citizen assassinated without any due process of Law, or Judicial Review…
Extrajudicial Executions
US Tries To Assassinate Own Citizen In Yemen
I don’t remember to many Tea Partiers getting all that upset when George Bush decided to spy on all Americans and tap their phones…
Those Tea Baggers love of the Constitution is very dependent on who is in the White House, and which amendment of the Constitution is being shredded…
BTW When are they going to start protesting the US going to war without declaring wars?
DQ:”I don’t remember to many Tea Partiers getting all that upset when George Bush decided to spy on all Americans and tap their phones…”
——–
Like you, many Republicans don’t understand the tea party either. When some representative candidates came touting the Patriot act (one guy in particular was trying to tell us how it was so great under Bush, but not under Obama, as if he didn’t realize the law would last longer than one term), they got a bit of schooling that they obviously weren’t ready for — one of the best times that I ever had at a meeting.
I don’t get this site… I heard about it through another blog I read’s blogroll, and was told by someone it used to be THE place for centrists and moderates.
But while there are a few moderate-ish posts here, the vast majority is just a bunch of stuff attacking the right, some general not all that political commentary, straight up liberal op-eds from liberal types like E.J. Dionne here, a bunch of stupid non political pop culture crap and even some stuff from a certifiable left wing firebrand named Kathy something.
What the hell?
The center is overwhelmingly against the individual mandate… just read the polls.
You don’t get to make the center out to be something YOU want it to be. You’re part of the problem here… You should stop pretending to be moderates and just come out at a liberal blog site. Otherwise you’re just as bad as any other spin doctored political hack site, trying to make itself out to be something it isn’t to lure people in.
I can’t stand the Tea Party either… but a LOT of folks on the right did in fact get upset with Dubya and company when the public began understanding some of the devilish details of the Patriot Act. Libertarianesque folks like take up a big chunk of the Tea Party were some of the most vocal opponents of portions of the Patriot Act that infringe on privacy. And their defense of the Constitution is no different than anyone else’s. They defend an interpretation of it, just like the left does when it ignores the parts about freedom to bear arms, and myopically focus only on parts that fit in with their ideological preconceptions.
Centsurgent is right. If you ask the direct question, “Are you for an individual mandate?” Americans in general are opposed. But, as in all politics most centrists realize there are few easy answers to really hard problems. When you drill deeper most admit covering preexisting conditions is impossible without some sort of mandate.
http://www.businessweek.com/lifestyle/content/healthday/650359.html
Independents and moderates who find a single-payer hard to swallow and want to preserve the existing employer-based insurance especially understand the nuances of healthcare issues.
I take exception to the charge that TMV is a left-wing institution. I feel this way not only because I contribute from time to time but, because the views expressed here quite frequently make me mad. A true centrist website should always make you a little mad. If you find yourself agreeing with most everything a website has to offer, you are most probably a right or left winger reading an equally extremist website.
No one has spelled it out for me but, I would say TMV is balanced within the whole website and not necessarily within individual articles. My opinion, not the site’s
@DR Welch
No one has spelled it out for me but, I would say TMV is balanced within the whole website and not necessarily within individual articles.
I hate to continue the threadjacking, but I think the question is whether a moderate website is one that presents two extreme (for lack of a better word) divergent views or one that presents moderate views. I don’t think that first presenting something by Michael Reagan, then presenting something by EJ Dionne means you are a moderate website. There is such a thing as a moderate viewpoint which is not represented in that scenario and is relatively rare at TMV.
>> When you drill deeper most admit covering preexisting conditions is impossible without some sort of mandate.
Not true at all. There are several options on the table, by think tanks on both sides, as well as politicians on both sides, that could replace the individual mandate, should it get struck down in court or get blocked some other way.
>> I take exception to the charge that TMV is a left-wing institution.
If I had actually said that, you might have a reason to “take exception”. I didn’t call it a left wing, I said it’s liberal.
This is obvious just by running through the posts from the last few months. I emailed some of the bloggers who’s sites I frequent and are openly moderates and centrists, and the ones familiar with the site said the same thing about TMV… that it has taken a hard core left turn over the last couple years. I can’t speak to the turn, since I just discovered it, but it certainly isn’t anything resembling a voice representing moderates, much less centrists.
>> If you find yourself agreeing with most everything a website has to offer, you are most probably a right or left winger reading an equally extremist website.
So you can’t agree with a site unless you’re a left or right winger? Please do tell me how that makes even a little bit of sense.
The bigger name op-ed writers I’m most in agreement with are centrist. Same with think tanks, politicians and bloggers… which I’m happy to say I’ve been able to dig up some great centrist bloggers in the last few months. I’m kind of new to blogs, but I’ve been a polling junkie for years… I know what a centrist is, based on where the American people stand on the issues, not what I personally think the center SHOULD be, which is the only explanation as to how this site tries to get away with calling itself a voice for moderates.
You’re not a voice for moderates when most of your posts range from left wing to moderate left. That makes you a liberal blog. Not a left wing blog, a liberal blog.
Dionne fails again. No surprise.
* * *
Is anyone really trying to pose as contesting the obvious of this site as being well left to farther left? [snicker]
Steady as she goes! Some would call it “moderate” (i.e., level):
http://www.theautochannel.com/news/2006/09/11/021569.1-lg.jpg
With so many on the Left, and so many influenced by them, having ignorance of or contempt for the Constitution and for constitutional federalism, why is it a surprise that those like Dionne never think for a moment about something’s constitutionality?
They just want more, more, more from a bigger, bigger, bigger “national” [sic; federal] government.
They’re facing not only citizen and taxpayer opposition, but crashing into the economic (and later, demographic) reality of a true Era of Limits regarding what they want, which is unsustainable, much less infinitely expandable, as well as improper.
Why doesn’t Dionne, and why don’t the farther-left gossip writers on this site, react to real news today, the latest Trustees’ reports about Social Security and Medicare that reveal the (unsurprising to the learned) news that the programs are in worse shape than before?
http://www.ssa.gov/oact/TRSUM/index.html
Naw, stick with the lefty play-pen stuff.
By the way, for non-dunces: Notice that another thing removed from ObamaCo SS and Medicare Trustees’ Reports now is the explanation of how these programs could be made solvent (by immediate changes to taxes and benefits, quantified, “or by some combination of the two”). Yet more unpleasant facts removed by ObamaCo…
Readers here did notice that, didn’t you? You were aware of the news and read the latest Trustees’ Report Summary, didn’t you?
[stare]
“I don’t remember to many Tea Partiers getting all that upset when George Bush decided to spy on all Americans and tap their phones…”
Read what you posted.
That action by the ACLU took place in 2006. The Tea Party didn’t form until 2008-2009. It is foolish to criticize the Tea Party for not protesting something which took place at a time when they did not yet exist. As for what the Tea Party is for or against, have you been to any of their protests or other gatherings and had civil discussions with them about this? How do you know what know about their beliefs? Do you just listen to those who are hostile to the Tea Party?