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Back to the Healthcare Drawing Board
There have been many efforts throughout time to make major changes in the laws of this country and the culture of its people in a short amount of time. I have found none that succeeded. Laws relating to civil rights, labor and workplace safety, environmental, and income taxes all took decades to come to fruition. They were all step by step processes.
Even the stock market crash of 1929 and the Great Depression were not enough to cause immediate passage of securities laws. It took ten years for all of the laws that are the foundation of today’s markets to be put in place. Ten years is extraordinarily fast for our government to make such sweeping changes.
Little victories laid the foundation (see the NEPA in 1969). An obvious and easy fix came next (see the Clean Air and Clean Water Acts of the early 1970s). The idea that cleaning the environment was important and that the government must lead the way became the norm rather than the other way around. RCRA, FIFRA, NRC, CERCLA, LUST and many others were passed, re-authorized and strengthened under both Republican and Democratic presidencies over the next 20 years until the framework of today’s environmental laws and culture were firmly in place. The last major environmental law was passed in the late 1980s.
Today the government is dealing with carbon emissions. The question is no longer whether this is the realm of the government. The questions surround whether carbon is really an environmental problem and if so, what are the ramifications.
So looking at history and reality, this government needs to look at healthcare as a long term incremental process.
Step one has got to be the establishment of the federal government as the source of healthcare regulation. Pass a first law that simply states that national healthcare and health insurance will be regulated across state boundaries by the US Department of Health and Human Services and that the States are now preempted from regulating healthcare, unless the insurance company or provider has absolutely no inter-state or federal involvement (no patients from out of state, no Medicare or Medicaid reimbursements, etc.).
Republicans favor this as it opens competition across the entire country, allows smaller creative carriers to get into the game, and eliminates the costly state-by-state compliance. Democrats should favor this because it gets the federal government in the game. This is critical if a government run plan is ever going to fly.
Step two will be to mirror the idea of the government option, by allowing associations to buy group priced insurance across the country for their members, whether they are companies, union workers or covered by the United Way. In the process, allow people to buy into the US government workers group plan if they want. This also spurs competition, which Republicans should like, allows commercial creativity and gets the federal government into the healthcare providing game.
Combine Medicare, Medicaid, Veterans benefits, US employee and military benefits under one umbrella and provide these as one. Take this out of the hands of the States and make it uniform across the country. Gain experience, eliminate red-tape, increase efficiencies, lower costs, compete and show that the federal government can do this extremely well.
If it makes sense, it is then a fairly easy next set of steps over time to add regulation and coverages provided by the government for catastrophic cases that go over a certain limit, cases that require experimental treatments, cases where the patient is permanently disabled, and high risk cases where malpractice is a big concern for practitioners. Take the step that begs for attention.
Finally, twenty years from now, universal government provided healthcare, IF it is still required to provide adequate coverage for Americans who want it.
There is an old saying, those who fail to heed the experiences of history are bound to repeat them. In this case, we should repeat what history shows us is the right way to make major sweeping changes.
13 Responses to “Back to the Healthcare Drawing Board”
“Pass a first law that simply states that national healthcare and health insurance will be regulated across state boundaries by the US Department of Health and Human Services and that the States are now preempted from regulating healthcare, unless the insurance company or provider has absolutely no inter-state or federal involvement (no patients from out of state, no Medicare or Medicaid reimbursements, etc.). “
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I still think Congress can ramrod universal single-payer through [reconciliation now necessary] under the mandate of the Constitution Article I, Section 8, Line 1 which states:
“The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;”
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If access to affordable healthcare isn't in the interest of the “general Welfare”, then nothing is. Not having adequate and affordable healthcare has become a national burden and even a national security issue. Any half-baked attorney could make this argument. With a Congress jam-packed full of attorneys, one wonders why they couldn't make this simplist of arguments? Funds could be derived from taxation of snack foods, tobacco or alcohol..the three main killers of people in the US that are legal businesses.
Oh sure the frenzied Medmob sheep known as “teabaggers” would have a nuclear meltdown, whipped on by their MedMob masters, but in the end when the dust settled, we'd have universal care, they'd be celebrating not having to pay premiums while still being denied and charged huge deductables and celebrating not having to burden their small businesses with employee coverage and workman's comp issues…we'd all be producing more GDP and finding a foothold once again in fiscal solvency.
When you lance a boil the patient squirms and screams bloody murder. But in the end their relief is palpable and their appreciation will be a given.
“Congress shall have the power..” It's not just a saying; it is a directive.
In a related issue. The win for Brown in Mass. is only saying one thing: people are really just basic creatures at their heart. The GOP understands this and has understood this for decades. Meanwhile the dems in their lofty world of intellectualism have overlooked how people vote: with their guts and monkey instincts. And like our great ape cousins, we want a leadership with balls. In a visceral sense, Brown exposing his g'nads in the photo layout might've subconsciously sealed the deal for him with both men and women. Meanwhile the passive and laconic dem candidate was seen as just another waffling suit filling a democratic seat in Congress.
If just once, just for once the dems shelved their intellectual strategies and went silverback, like say with ramming healthcare down the throats of the obstructionists, you would see a LANDSLIDE victory in November this year, because the numbers are on the side of dems in their own party and would pick up the middle in DROVES if they exhibited teeth like this…if only they would pull their cajones off the ice pack and put some fire into them.
Oooga booga. Wins every time and doesn't the GOP know it. Even the intellectuals secretly long for a dominating leader..
Sil, you're still wrong, and always will be. The General Welfare clause is a qualification on the power of Congress to levy taxes. It's not an unlimited grant of power to do what makes you feel good, and claiming it's valid because it's a “welfare” program is sub-50-IQ equivocation. Nope. Try again.
A grant of power is obviously not a command to exercise it (much less without authority). DQ.
Wow. A post by Ned that I can agree with. Mostly because I don't see anything else passing, admittedly, but I can still agree with it as a series of first steps that can then be observed for effectiveness.
“Sil, you're still wrong, and always will be”
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According to the laws of probablity alone DLS, this statement is false. Even if must be by accident ,even I will sometimes be right..
When you're out to discredit a poster like me, you need to be careful in the company of intellectuals like here at TMV. They can discern broad generalizations like that one for their real meaning: ad hominem. The more gruntesque boards would fall into line. Know your target audience..lol.. ; )
Any part of the constitution means whatever the current power “interprets” it to mean.
“According to the laws of probablity alone DLS, this statement is false. Even if must be by accident , I will SOMETIMES be right.. “
You have been right before, Sil, about things, and no doubt you will again. But not about this and related issues. Nor is Father Time with his feeble non-defense of judicial activism and rationalization of what liberals want.
Part of the problem is that you may be laboring excessively hard under this delusion:
“And everyone knows that all of this expensive waffling, obstructionism and bullshit is all about protecting MedMob's right to subjegate the PEOPLE for profit.”
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“a series of first steps that can then be observed for effectiveness”
That is exactly is what is needed currently, as well as being the obvious approach to take to this.
Federal interventionism, as I've written before, is inevitable (I'm guessing competion within 20 years, and it might take as few as ten). It is not a panacea, is not obligatory, is not “the right thing to do” in and of itself. It should not be accompanied by typical liberal naivete and common misconceptions and myths, and subsitution of desire and emotion for reason (which is so typical of the Left). Reform of the existing system, with a more-regulated existing system that we have now, is the first step. The Dems and proponents of interventionism have yet to get even this correct, or even think of it correctly.
Meanwhile, the ridiculous lack of forethought as well as adeptness on this is scandalous. Not a single moment's thought has probably been paid by proponents and supporters to details such as this, for example. It affects the grandiose and silly dreams of some when it comes to preventive and more thoroughly comprehensive care under our “insurance” model.
This is just one example of details many of us have been aware of from the start, and have repeatedly tried to raise as relevent issues, only to have them discarded or disparaged by the dreamers.
http://www.californiahealthline.org/road-to-ref…
“a series of first steps that can then be observed for effectiveness”
Aside from beginning with reform of the existing system as the obvious first step, what Ned was describing here, incrementalism, is the strategy that obviously comes to mind for federal takeover of health care, and it was obviously the choice this past year by the Democrats (rejecting Medicare for All or “single-payer” because it would be too much for the public to accept all at once, so quickly).
They blundered with their incrementalism, and they really should have acted sooner last year, and limited their first efforts only to reform of the existing system, and they would have won likely approval from the public. (Many want regulation of health insurers, and for that matter, banks and so on; the public does not want an enormous amount of additional regulatory, bureaucratic, and political baggage to accompany desireable reforms.) What other measures they should have attempted should have been smartly chosen and easily defended against the critics. (A Medicare buy-in down to age 55, aside from its being a very-late gimmick, smacks of an obsolete entitlement-mentality early-retirement viewpoint, given that specific age. Instead, there should have been research results showing an abrupt cut-off in insurance affordability or availability beyond a certain age, and whatever age that was found to be should have been the buy-in age that was proposed. People don't think!)
Any incrementalism they try, or any related stunts, should be intelligently conceived next time.
The General Welfare Clause is nigh on meaningless, and has been since the eighteenth century. The intent of the Framers, as Chief Justice Marshall, Alexander Hamilton, James Madison, et al. expressed it, was that the General Welfare Clause meant only that one purpose of legislation could be general welfare, but that the general welfare alone was insufficient as a reason to levy a tax. As to national security, this applies not to anything but armed and violent strife, that is attacks on Americans, or levying a tax to fight a war, or outright rebellion. It does not mean that the Constitution protects people because it makes them feel secure, or even that it keeps people from dying. The National Security Clause only applies to armed and violent conflict. So, once again, you have misinterpreted the Constitution to argue your case. I would, however, have you be the one arguing that before the Supreme Court when the Robin Hood Provision was challenged in the Courts. That argument alone would get you laughed out of court.
What will Congress do now?
“To just throw up your hands and say you're going to walk away from health reform would be a significant mistake.” — Ron Wyden
“If this bill is pushed through despite the message sent from Massachusetts, I believe it will spur a tremendous backlash.” — Susan Collins
“The Senate bill clearly is better than nothing.” — Steny Hoyer
“I don't think I can vote for the Senate bill, and I don't think there are the votes in the House for the Senate bill” — Anthony Wiener
“The General Welfare Clause is nigh on meaningless,”~a spindoctor
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Then, using your conclusion, logically so is the rest of the Constitution. If we don't have a document outlining our governance, why was I forced to take american gov. in highschool and college? Like Father Time said, it's up to the ruling party to interpret the meaning of “general welfare” and enact legislation that reflects that interpretation. I'm saying there is a DAMN GOOD CASE to do just that with regards to the general populations health, which directly affects their productivity and ability to defend this nation.
Your words teeter on the edge of treason DLS. And no, I'm not being melodramatic. Anyone seeking too dismantle the Constitution by rendering it meaningless is a traitor. Millions have died or been maimed or tortured upholding the meaning of that document
“Your words teeter on the edge of treason[,] DLS”
You may actually believe this. It's not about the actual Constitution and our system of government that you're writing about and even thinking of, but something in some other place, somewhere else.
Sorry, Sil, I am not a spinmaster, but rather a law student. Thus, I am a bit more aware than most of what the powers of government are, and who has what power.
Your interpretation that it is the province of Congress to determine what the Constitution means is completely off base. The most fundamental case in American Constitutional Law explicitly points out “[i]t is emphatically the duty of the Judicial Department to say what the law is. Those who apply the rule to particular cases must, of necessity, expound and interpret the rule.” See Marbury v. Madison 5 U.S. at 137. Thus, it is the power of the Judiciary, not the Legislature, to interpret the law.
The Supreme Court, as well as other federal courts, have unquestionably, and unfailingly, limited the application of the General Welfare Clause to only those cases in which there is already another sufficient constitutional justification for the law. That is the law. If you wish to give new effect to the clause, seek amendment to the Constitution. However, any argument that the General Welfare Clause applies outside of increasing the justification for an already constitutionally justified law will fail in the courts, the final arbiters of what the Constitution means.
Your argument regarding interpretation of the Constitution as being the province of Congress belies your statement that you understand the American Government. Marbury unequivocally refutes your statement that Congress has any power to interpret the Constitution. That power lies solely with the Courts.
Because you misapprehend the fundamental tenet of Separation of Powers, your argument fails. All the law is against your argument. So sorry.