“Clouded By Misperceptions”: Five Myths About The Health-Care Law
The Supreme Court will hear three days of arguments starting Monday on whether President Obama’s Affordable Care Act is constitutional. Twenty-six states have filed challenges to the health-care reform law. The main issue, on which the lower courts have split, is whether Congress had the power to pass this law under the Constitution’s commerce clause. The answers to that and other questions are clouded by misperceptions about the law itself. Let’s debunk them.
1. The “individual mandate” forces everyone to buy health insurance.
The law states that, beginning in 2014, individuals must ensure that they and their dependents are covered by health insurance. Taxpayers who do not meet this requirement will have to pay a penalty that the law calls a “shared responsibility payment.” It begins at $95 for the first year and never exceeds 21/2 percent of anyone’s annual taxable income.
A large majority of Americans, of course, have health insurance through their employers, Medicare or Medicaid and are already in compliance with this requirement. Given the relatively modest payment required of those who choose not to maintain insurance, no one is being forced to buy a product they don’t want.
The challengers argue that the mandate is a binding requirement that makes anyone who goes without insurance a lawbreaker. The government has determined, however, that those who pay the penalty, like those who are exempt from the penalty, are not lawbreakers. As a practical matter, the so-called mandate is just a relatively modest financial incentive to have health insurance.
2. Only the individual mandate is at stake in the Supreme Court case.
The mandate is not a stand-alone provision that can be invalidated without affecting the rest of the law. In fact, it is merely an ancillary measure that makes two more-fundamental provisions of the law workable: “guaranteed issue” and “community rating.”
A significant problem with our nation’s health-care system has been that insurance companies can reject applicants who have had health problems, including minor ones. The guaranteed issue provision prevents companies from turning down applicants because of their medical conditions or history. The community rating measure bars insurers from charging higher premiums to those who have had illnesses or accidents.
Experience in the states has shown that if people can’t be turned down for health insurance, there must be an incentive for them to sign up for it before they have an accident or illness. The individual mandate was enacted to ensure that the central, nondiscrimination provisions can work as they were intended — to provide everyone access to affordable health care, regardless of their medical history or current conditions.
If the court were to strike down the mandate, the law’s popular provisions on preexisting conditions would fall as well.
3. If the court upholds the health-care law, it means Congress has the power to require Americans to purchase any product.
The health-care case is a test of Congress’s power under the Constitution to regulate commerce among the states. One way to defend the law is simply to say that a requirement to purchase insurance or any other product sold in interstate commerce is obviously a regulation of that commerce. President Ronald Reagan’s solicitor general, Charles Fried, and conservative judge Laurence Silberman have adopted this view.
The Obama administration is not relying upon such a sweeping argument, however, and its more limited claim would not justify any law that required Americans to buy products such as cars or broccoli.
The mandate does not force people into commerce who would otherwise remain outside it. Instead, it regulates the consumption of health care, an activity in which virtually everyone will engage. Right now, people who go without insurance often shift the costs of their health care to other patients and taxpayers. That situation is different from what happens with any other type of purchase.
Would the government’s defense of the mandate also support a law requiring Americans to buy broccoli or a car? The answer is a simple and emphatic no.
4. The law is socialist.
Actually, the opposite is true. The principal reason the Affordable Care Act has been called unprecedented is that it declines to follow the New Deal approach of having a monolithic government agency be the single provider of a good or service. Instead, the law adopts a new approach, one conservatives have long supported, of using providers in the private market to deal with social and economic problems.
In defending his “Massachusetts mandate” as a conservative model for national health-care legislation, former governor Mitt Romney editorialized in 2009 that by imposing tax penalties on people who choose to remain uninsured, an individual mandate “encourages ‘free riders’ to take responsibilities for themselves rather than pass their medical costs on to others.” And, as Romney noted, conservatives have never been inclined to favor freeloaders.
5. The law is an extraordinary intrusion into liberty.
Liberty is always said to be fatally eroded, it seems, when great advances in social legislation take place. The lawyers who urged the Supreme Court to strike down the Social Security Act of 1935 argued that if Congress could provide a retirement system for everyone 65 and older, it would have the power to set the retirement age at 30 and force the very young to support everyone else.
It was said that if Congress had the authority to create a minimum wage of $5 an hour, it would also be a regulation of commerce to set the minimum at $5,000 an hour. In 1964, critics argued that if Congress could tell restaurant owners not to discriminate on the basis of race, it could tell them what color tablecloths to use. None of these things happened.
Nothing in the health-care law tells doctors what they must say to patients or how those patients are to be treated. It only requires people to either have insurance coverage or pay a modest tax penalty.
Nearly 75 years ago, a Supreme Court dominated by appointees of conservative presidents rejected the challenge to the constitutionality of the Social Security Act. The words of Justice Benjamin Cardozo’s 1937 opinion are relevant today:
“Whether wisdom or unwisdom resides in [the statute in question] it is not for us to say. The answer to such inquiries must come from Congress, not the courts.”
By: Walter Dellinger, The Washington Post, March 23, 2012
“An Irreducibly Tangible Question”: What Happens To The Uninsured If Health-Care Reform Is Dismantled?
When the Republican presidential candidates talk about health care, the discussion usually moves quickly toward the philosophical and the abstract.
Take Rick Santorum’s appearance at the Christian Liberty Academy last weekend in this Chicago suburb. Before a raucous crowd, the former senator from Pennsylvania portrayed President Obama’s health-care-reform law as an “affront to freedom.” In Santorum’s telling, the plan is not so much an attempt to reshape the health care system as the worm on a line meant to hook Americans on Big Government. “What tribute won’t you pay to the government if they can promise that if you give them more they will … take care of you?” he asked dramatically.
There’s no question that an ideological chasm over Washington’s proper role in health care separates Democrats and Republicans. And there’s no doubt that some Democratic strategists believe that average Americans will grow more tolerant of activist government if they see it providing them more direct benefits, such as health insurance.
But the debate over health care reform — which will intensify again next week as the Supreme Court hears oral arguments on challenges to the law’s mandate on individuals to buy insurance — involves more than competing philosophies or political strategies. At its core, it raises an irreducibly tangible question: what, if anything, to do about the nearly 50 million Americans who today lack health insurance.
Those millions of uninsured rarely intrude into the promises from GOP congressional leaders and the party’s presidential field to defend liberty by repealing Obama’s plan. But ignoring them doesn’t make them go away. If the 2012 election rewards Republicans with enough leverage in Washington to erase Obama’s initiative, they will face the choice of finding an alternative means to expand coverage or allowing the number of those without insurance to grow, with far-reaching consequences not only for the uninsured but for those with insurance as well.
Without some policy intervention, there’s little question that access to health insurance will continue to decline. Since 2000, the number of the uninsured has jumped from 36.6 million to 49.9 million, about one-sixth of all Americans.
That number would have been even higher if an additional 20 million people over that period had not obtained coverage through Medicaid and the Children’s Health Insurance Program. This growth partially offset the unrelenting erosion in employer-based care: The share of Americans obtaining coverage from their employer has declined every year since 2000, in good times and bad.
Earlier this month, the Congressional Budget Office forecast that, absent the new health-care law, the number of uninsured would rise to 60 million by 2020. That large a pool of uncovered Americans would create enormous strain for the health-care system.
The uninsured themselves would feel the most immediate effect, of course — studies show they are much more likely than those with coverage to defer or entirely forego needed care. But such an increase would also produce upward pressure on premiums for the insured as providers, especially hospitals, raise prices for those with coverage to offset the cost of uncompensated care to those without it. “The idea that repeal [of health-care reform] is somehow going to lower your premium is folly,” says Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics. More likely, he argues, repeal would increase premiums.
Obama’s health-care law, whatever its other virtues or flaws, represents a serious effort to break this cycle. CBO, echoing earlier projections, estimated last week that it would cover 33 million of the uninsured. No Republican has offered a plan to cover anywhere near so many. In 2009, the Congressional Budget Office estimated that the principal House Republican alternative to Obama’s proposal would cover only 3 million of the uninsured.
Both Santorum and Mitt Romney have proposed unspecified tax credits to cover some of those without coverage. Douglas Holtz-Eakin, president of the center-right American Action Forum, notes that Republicans believe that allowing interstate sale of insurance plans that offer more bare-bones coverage will reduce premium costs and expand access. Even so, he acknowledges, because so many of the uninsured have meager incomes, any tax credit big enough to meaningfully expand coverage still requires “a lot of money.”
But Republicans are proposing to shrink, not increase, federal health-care spending. Both Romney and House Republicans want to convert Medicaid into a block grant and cut federal spending on the program about in half by 2030. Even if those cuts provoked greater efficiency, the Urban Institute has estimated they could swell the number of uninsured by 14 million to 27 million beyond the effect of repealing Obama’s coverage expansion.
Leading Republicans almost all portray the health-care debate as a philosophical turning point between a limited central government and one they see as overweening and even tyrannical. But the debate also represents a much more practical turning point, between a society that attempts to approach universal health coverage and one that accepts millions of people living without insurance — with unavoidable costs for the uninsured and the insured alike.
By: Ronald Brownstein, The Atlantic, March 23, 2012
“Affordable Care Act For The Wealthy”: The Rest Of You Can Have Vouchers
It’s not uncommon for the über-wealthy to equip their mega-mansions with pricey private home theaters, spa-worthy washrooms, and palatial pools. Now an increasing number of the super-rich are setting aside space in their homes for another purpose: top-notch medical care.
According to Bloomberg, more well-off families are paying up to install at-home emergency rooms, which can cost upwards of $1 million, and forking over as much as $30,000 a year for “concierge care,” which puts the best-of-the-best physicians at their disposal anytime, anywhere.
“Wealthy people want to have a little exclusivity and want better service than they can get at their normal healthcare facility, and they’re willing to pay for it,” Rick Flynn, principal and head of the Family Office Group with Rothstein Kass, told Bloomberg.
Guardian 24/7, a Virginia-based medical care company founded by former White House physician Sean O’Mara, charges as much as $12,000 a month for its ReadyRooms, Bloomberg reported, which feature discreetly installed medical equipment available at the touch of a button.
If a medical emergency arises, homeowners can immediately contact an on-call emergency physician—a much faster response than waiting for an ambulance to arrive and transport the ailing homeowner to the hospital, the company’s website notes.
“Before Guardian, this kind of medical protection was only available to one person,” the company’s website says. “Now, presidential-level care can be yours—on your schedule and your terms.”
And if you thought for a minute the super-rich might have to be without immediate access to medical care outside the confines of their estates, think again. Guardian 24/7 installs any number of medical apparatuses from X-ray machines to CT scanners on yachts, motor coaches, and aircraft.
By: Meg Handley, Washington Whispers, U. S. News and World Report, March 16, 2012
“A Lying Candidate Will Be A Lying President”: More On Mitt Romney’s Lies
Is Mitt Romney a guy who tells a bunch of lies, or is he a liar? That the question Jonathan Chait asks, and he winds up sort-of defending Romney, saying that his lies, many of which revolve around his effort to deny his own history, have been practical in nature. “It’s Romney’s bad luck that fate has dictated his only path to the presidency lies in being a huge liar,” Chait says, so those lies don’t tell us much about what’s deep in Romney’s character.
There are two problems here. The first is that Romney lies about President Obama as often as he lies about himself. It’s just that when he does the former, he does it with actual squirming (if he’s sitting down), the phoniest smile you’ve ever seen, and panic in his eyes, so it’s really obvious. The second problem is that Chait’s distinction applies to pretty much every political liar in history. There’s always a reason why a politician lies. The biggest lies come when they get caught doing something they shouldn’t have (Nixon with Watergate, Reagan with Iran-Contra, Clinton with Monica Lewinsky). They might be telling themselves, “Taking responsibility is all well and good, but it’s better for the country if I get out of this scandal and continue with my duties.”
In fact, saving one’s own skin, whether from scandal or the displeasure of the party base, is a near-universal motivation for politicians’ lies. In Romney’s case, what he got caught doing wasn’t trading arms for hostages or getting serviced by a young intern, but supporting abortion rights and health care reform, which to the people whose votes he’s now seeking are sins even more deplorable. I’d argue that Romney’s lies about Obama (see here for some ) are the worse ones, because it wasn’t like some reporter backed him into a corner and he was grasping at straws to keep primary voters from hating him. He could make a critique of Obama that’s just as persuasive without making things up, but he chooses not to, fairly regularly.
So is there a real meaningful difference between a politician who’s a liar, and a politician who tells many lies? No—or, at least, none that will matter to us as citizens. Experience tells us that a guy who lies as a candidate will not only tend to lie just as much as a president, but will probably lie about the same kinds of things. If he’s lying on the campaign trail about whether he has cheated on his wife, it’s a good bet he’ll end up telling us more lies about future cheating. If he’s lying on the campaign trail about what his tax plan contains, it’s a good be he’ll end up lying to us about his tax plan when he tries to pass it, as George W. Bush did.
So the really important thing to watch out for is the guy who tells lies about policy. Which would seem to apply fairly well to Mitt Romney, whatever happens to lie deep within his heart.
By: Paul Waldman, The American Prospect, March 15, 2012
“In An Awkward Spot”: How Mitt Romney Advocated Obamacare And Lied About It
In 2009, Mitt Romney had a problem. He was running for the Republican presidential nomination, and the towering achievement of his governorship in Massachusetts — health-care reform — had been embraced by President Obama. Romneycare played almost no role in Romney’s 2008 presidential run, but the emergence of the issue onto the national agenda threatened to link Romney with a president Republicans had already come to loathe.
His solution was simple. He seized upon the one major difference between his plan and Obama’s, which was that Obama favored a public health insurance option. The public plan had commanded enormous public attention, and Romney used to it frame Masscare as a conservative reform relying on private health insurance, and against Obama’s proposal to create a government plan that, Romney claimed, would balloon into a massive entitlement. Andrew Kaczynski collects several televised appearances and one op-ed in which Romney holds up Masscare as a national model.
This tactic backfired when Obama had to jettison the public plan, and Republicans came to focus on the individual mandate as the locus of evil in Obamacare. What was once a Republican idea in good standing was now, suddenly, unconstitutional and the greatest threat to freedom in American history.
This left Romney in an awkward spot.
It’s hard to run for president as the advocate of an idea that your party considers the greatest threat to freedom in history. His response was to simply revise the past, much as he did with abortion. Romney now claimed he had never advocated a federal version of his Masscare program. Here’s Romney at the December 11 GOP presidential debate:
Speaker Gingrich said that he was for a federal individual mandate. That’s something I’ve always opposed. What we did in our state was designed by the people in our state for the needs of our state. You believe in the 10th Amendment. I believe in the 10th Amendment. The people of Massachusetts favor our plan three to one. They don’t like it, they can get rid of it. (COUGH) That’s the great thing about (COUGH) a democracy, where individuals under the 10th Amendment have the power to craft their own solutions.
The coughs are in the original transcript, for what it’s worth. I’ll leave it to the psychiatrists to say whether we ought to read anything into them.
And here’s Romney at a January 23 debate:
My health care plan, by the way, is one that under our Constitution we’re allowed to have. The people in our state chose a plan which I think is working for our state.
At the time we crafted it, I was asked time and again, “Is this something that you would have the federal government do?” I said absolutely not.
I do not support a federal mandate. I do not support a federal one-size-fits-all plan. I believe in the Constitution.
This is clearly untrue. Romney, as Kaczynski has shown, repeatedly held up the Massachusetts model in 2009. For instance, from the USA Today op-ed:
There’s a better way. And the lessons we learned in Massachusetts could help Washington find it. ..
For health care reform to succeed in Washington, the president must finally do what he promised during the campaign: Work with Republicans as well as Democrats.
Massachusetts also proved that you don’t need government insurance. Our citizens purchase private, free-market medical insurance. There is no “public option.” …
Our experience also demonstrates that getting every citizen insured doesn’t have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar.
The remarkable thing is that none of Romney’s opponents challenged these demonstrably false claims. If you check the transcripts of the debates, Romney simply lies about what he advocated, and then everybody lets it go.
Among other things, this underscores the sheer incompetence of his opposition. Kaczynski is an excellent researcher, but it’s not as if he had to comb the ends of the Earth to find these nuggets. He culled them from such sources as USA Today and Meet the Press. Every opposing campaign either failed to look up this basic stuff or failed to train the candidate to understand it. Romney is now on the verge of escaping with the party nomination having embraced a program his party considers inimical to freedom itself and blatantly lied about having done so without any major opponents pointing this out. It’s pretty incredible.
By: Jonathan Chait, Daily Intel, March 5, 2012
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 