As the Supreme Court considers the new health care law it is worthwhile looking at some basic facts to better understand the issue:
1. Not all Americans have health insurance but all Americans have access to medical care.
2. The problem with health care is not availability but cost. Medical services tend to be very expensive. Our health care costs two to three times what comparable care costs in the European Union countries.
3. We also have a problem with who pays. The person who does not pay for services rendered, e.g. emergency room services, has his bill passed on to those who do pay.
4. The reason health care is less expensive in the European Union is probably because the government provides universal care under its direct control. But it is still expensive. It is instructive to note that the largest expense for most European Union country government budgets is health care.
5. The new health care law is a “windfall” for health insurance companies. They will be required to accept all comers but they are able to increase rates to cover the higher risks. They are also guaranteed payment since the Federal Government will pay for those who are unable to pay.
6. The new health care law is an open ended commitment of Federal funds. The intial estimate of additional costs over ten years has been increased from $800 billion to $1.5 trillion. And this is not a certain number.
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Leo, With no training in economics or health care financing, I turn to those better informed like Paul Krugman. In today’s NYTimes, Krugman cites Justice Scalia’s comparing buying broccoli to buying health insurance. Krugman points out that the two aren’t the same.
“When people choose not to buy broccoli, they don’t make broccoli unavailable to those who want it. But when people don’t buy health insurance until they get sick – which is what happens in the absence of a mandate – the resulting worsening of the risk pool makes insurance more expensive, and often unaffordable, for those who remain.”
Krugman then favorably cites Reagan’s Solicitor General Charles Fried who recently told the DC Post, “I’ve never understood why regulating by making people go buy something is somehow more intrusive than regulating by making them pay taxes and then giving it to them.”
Krugman further notes that the Obamacare ‘mandate’ originally came from “the ultra-conservative Heritage Foundation,” not from liberals. Nevertheless, as a classmate of Justice Scalia (Georgetown, ‘57), I sadly shake my head again, dreading that the decision on Obamacare will come down from him and the Court majority that gave us Citizens United.
There is only one question to ask in regard to letting the “free market” establish a health insurance system and that is: “How do you make a profit paying for the care of sick people?” The answer is you don’t. The only way to make a profit is to insure healthy people until they get to be 65 and then medicare will take over as the cost of paying for their health care goes up.
As the one time boss of a a public relations firm, Hill and Knowllton Turkey, I am always alert to the subtle game played by “spin doctors.” Now we have Democrats characterizing the “mandate” of the health care law as originating from the Republican side of the equation, e.g. the Herigage Foundation, Newt Gingrich, and Mitt Romney. It won’t fly.
Leo, Okay, let’s assume you’re not wrong: the Heritage Foundation and Republicans didn’t originate the health care mandate. But Mitt Romney? He never supported the mandate? You’re saying Romney didn’t sign into law Massachusetts’ health care? That there’s no mandate in that law?
As for the Heritage Foundation, in the late1980s or so, Stuart Butler of the Foundation picked up on Wharton School conservative economist Mark Pauly’s early notion of a minimum coverage mandate. The purpose was to guard against the adverse effects of free-riders, i.e., those who refuse to buy insurance but then get emergency care at a hospital or elsewhere without paying, leaving health care providers, governments, and the rest of us, who bought insurance, burdened with the free-riders’ costs.
Over on the Hill, in the ’90s, Senator John Chafee and 19 other Republicans proposed the mandate in their health care bill. Maybe Heritage and the others have changed their minds since then, but they pushed the idea at the start.
So, whoever else you might want to castigate as “spin doctors,” I’d say that Paul Krugman in yesterday’s NYTimes was right in pointing out that the Heritage Foundation and Republicans advocated the mandate idea early on.
@ Tina and Leo,
So what? The Affordable Health Act must be ruled constitutional or not on its own merits….not on political spin, etc. It was desperate tactics of the Solicitor General to cite the Heritage Foundation and, quite frankly, IMHO, insulting to the Court.
I want Obama to be re-elected. but his team is second rate, now.
Just second rate. Maybe it is not too late for them to realize that they are living in the “Beltway Bubble” and are only talking to each other…and missing critical and opposing viewpoints, so they are totally unprepared….just like they were for the MA election that cost them the 60 vote majority in the Senate and the 2010 election that cost them the House and many state government offices.
Joey, Agreed – Obamacare “must be ruled constitutional or not on its own merits.” But did the Court majority decide Citizens United on its constitutional merits? And the two Bush v. Gore cases?
Look, go back about 75 years. A Court of Justices, predominantly appointed by conservative presidents of the era, decided that the Social Security Act was constitutional. Go back less than 60 years. Chief Justice Warren, nominated by Eisenhower, persuaded all the Justices to support Brown v. Board.
However, since the Bush v. Gore cases and through Citizens United, maybe we former PCV do-gooders need to get realistic, even tougher. So, how ’bout you help the team, (“second-rate,” as you call it) in Ohio, and I’ll help in Pennsylvania? What d’ya say?
Impeach Earl Warren!
Bit Tino,
I live in Colorado.
But, Tino,
I live in Colorado and I am evidently having trouble seeing to boot.
Funny, everyone says the Supreme Court should rule based on the facts and law. However, all say four liberals will support the health care law and four will oppose it, according to their presumed poltiical bias.
Tino. President Obama proposed and the Congress adopted a law that makes it mandatory for all Americans to buy health insurance, the so-called “individual mandate.” Now his administration and its like minded voices are saying it was a Republican idea. This means that either Obama is led by, or influenced by, Republican policy thinking, which is patently absurd, or the Dems are trying to divorce themselves from the action that they put into place.
LEO, As followup to my comments last week on Obamacare, I’d add one final thing: yesterday’s DC Post contained this: “From Bush v. Gore in 2000 to the Citizens United decision in 2010 to the possible Obamacare ruling, the Supreme Court puts politics above the people in the name of the Constitution.” (No, I didn’t write the op-ed.)
JOEY, The headline to the inside carry-over says, “Obama Can Win, Even If Health Care Doesn’t.” (So you can just stay in Colorado.)
Granted that Mark Penn, adviser to both Clinton’s, wrote Sunday’s op-ed. But what Penn said still holds, especially if you consider the Court’s decision long ago over Social Security and then how Chief Justice Warren personally went about convincing the Justices to hand down a unanimous decision in Brown. Okay, you’re now spared anything more from me on health care financing.
Tino.
Well that is a relief. I like Colorado.. .Now about the spelling problem.
All kidding aside, one of my very real concerns, is that Democrats are perpetually optimistic, without reason. They were convinced that MA would never elect a Republican to fill Ted Kennedy’s old Senate seat. They were “surprised” by the biggest Republican sweep in 2010. I call it the “What? Me Worry?” syndrome.
So, I would be packing, except Colorado is also a swing state.
I am not optimistic about the President’s chances here. There is work to do done, everywhere.