SUBSCRIBE NOW WELCOME BACK. Do you want to continue reading where you left off? New Republic subscribers can pick up where they left off no matter which device they were previously using. SUBSCRIBE NOW

Go Home Let's All Take a Moment to Breathe, OK?

JONATHAN COHN MARCH 27, 2012

Let's All Take a Moment to Breathe, OK?

BY JONATHAN COHN

Everybody calm down. And when I say everybody, I include myself.

Tuesday’s oral argument at the Supreme Court was not the finest hour for health care reform, for the philosophy of activist government, or for Solicitor General Don Verrilli. But oral arguments don’t typically change the outcome of cases. They are important primarily for the signals they send about the justices’ thinking. And those signals can be difficult to interpret.

Administration officials on Tuesday were quick to remind reporters that Judge Laurence Silberman gave the government a very hard time when it argued the same case before the D.C. Circuit Court of Appeals. But Silberman went on to uphold the law, in what was by any standard a stinging rebuke to the critics. In the Sixth Circuit, Justice Jeffrey Sutton also put administration lawyers through tough questioning before issuing his own, equally unambiguous decision upholding the law. As Sam Stein points out at Huffington Post, the questions from Silberman and Sutton were awfully close to the ones conservatives were asking on Tuesday.

Nobody I know predicts the justices will vindicate the Affordable Care Act as strongly as either one of those judges did. And that tells you just how dramatically Tuesday’s hearing changed expectations. Before those arguments, credible legal experts were still thinking the court would uphold the law by a majority of six-to-three or even seven-to-two. Now the betting seems much more mixed, with the smartest court watchers I know suggesting the outcome could really go either way. The odds, in other words, are 50-50 at best. 

Still, you can find credible reasons to think the justices will uphold, whether it was Chief Justice John Roberts’ comments about the tax power on Monday or Justice Anthony Kennedy’s parting comments on Tuesday, acknowledging that health care might be a special case in which the government ought to have some special powers, assuming there’s a limit to them. Here’s how Elizabeth Wydra, chief counsel from the Constitutional Accountability Center, sees things shaping up:

I think Roberts and Kennedy are still in play. Having watched many oral arguments, I've seen Kennedy and Roberts ask tough questions with much more of a bite behind them than their admittedly tough questions asked of the Administration today; they didn't seem to me to be partisans of one side or the other. Finally, despite what many of us hoped based on his Raich concurrence, which is squarely on point, Scalia is pretty clearly voting to strike down the mandate.

Wydra is a fan of the law, obviously, since she wrote an amicus brief defending it. But Lyle Denniston, at SCOTUS blog, had a similar take:

If Justice Anthony M. Kennedy can locate a limiting principle in the federal government’s defense of the new individual health insurance mandate, or can think of one on his own, the mandate may well survive. If he does, he may take Chief Justice John G. Roberts, Jr., and a majority along with him. But if he does not, the mandate is gone. That is where Tuesday’s argument wound up — with Kennedy, after first displaying a very deep skepticism, leaving the impression that he might yet be the mandate’s savior.

And here's Richard Primus, a constitutional law professor at the University of Michigan and former Supreme Court clerk, via e-mail:

As was true before today, I wouldn't be surprised to see the thing go down 5-4. But it's still the case that I wouldn't be surprised to see it upheld, either. Roberts and Kennedy were asking exactly the questions that I'd expect them to ask irrespective of which way they are going. I would now be somewhat surprised to see Scalia come on board -- I have a pretty good idea of what his opinion distinguishing this case from Raich will look like. But I can also imagine quite easily what Kennedy's opinion sustaining the law would look like. ... Don't misunderstand me. Today was not encouraging for the government. But the game isn't over, either. All in all, I think it's mostly where it was before, and we'll still have to wait and see.

Later I’ll have more to say about these portents, favorable and unfavorable. Or, more accurately, a colleague will have more to say about them. (Watch this space.) In the meantime, though, assume that the court does strike down the mandate. That leads to another question: What else might it strike down? That’s one subject the Court will take up on Wednesday, in its final day of hearings on this case.

The issue is “severability.” That’s the question of whether, by invalidating one part of the law, the Court must invalidate the whole thing. Normally, laws include a severability clause, stipulating that the statute can survive even if the courts throw out one part. The Affordable Care Act lacks such a provision, apparently as a byproduct of poor drafting. Citing that, the states argue that the Court should throw out the whole law if it decides to strike down the mandate.

The government disagrees, except for one key caveat: It sees the insurance reforms as the equivalent of a package deal. Without the individual mandate, the government says, regulations requiring insurers to provide coverage to everybody (“guaranteed issue”) at a uniform price (“community rating) can’t work. (Whether the court should actually throw out those regulations now actually seems to be a separate question, having to do with legal issues I only partly understand and won't bother to explain right now.)

Given that the states also find the mandate essential to community rating and guaranteed issue, could the courts nevertheless strike down the mandate but leave those other two insurance reforms in place? Actually, the answer is yes. The court has even solicited a brief to this effect, from a lawyer making the case that ditching the mandate needn’t require ditching the rest of the insurance reforms. I happen to think he has a point, or half of one anyway.

As a practical matter, insurance reform without a mandate causes serious problems. If you don’t believe me, read my story from last week about New Jersey, which tried to do just that—and failed miserably. It’s the nature of the beast. Once you create an insurance system where everybody is entitled to coverage, rates will go up unless most people participate. And as the rates go up, more people flee the system. You end up with what the wonks call an “adverse selection death spiral.”

But study the New Jersey history carefully, because what happened there may not be precisely what happens in the nation as a whole if the mandate falls victim to the conservative justices. The Affordable Care Act has several features that New Jersey did not. Chief among them are subsidies, which will make insurance more feasible for—and more appealing to—people who otherwise might forsake it because of cost. The law also has a system of risk adjustment, which is basically a way of forcing plans that attract healthier enrollees to subsidize those that attract sicker ones. In theory, should help mitigate the effects of the adverse selection death spiral.

Are subsidies and risk adjustment sufficient to create a well-functioning insurance market? Most experts, including the Congressional Budget Office, say no: They believe that insurance without a mandate will mean premiums go up and insurance coverage goes down, relative to what they would have been if the mandate were in place. That’s why the mandate is necessary, at least in the legal sense of the word. But these elements alone might—that’s “might,” not “would”—be enough to stabilize the market, so that a lot of people are still better off. The predictions from CBO and other authorities show that, for example, insurance reform without a mandate still results in more people getting insurance than would otherwise have it.

And if that happens, both states and the federal government would have a chance to respond by revisiting the terms of the law. (That’s one of the few virtues of the long lag time before the new insurance system comes into place.) In an ideal world, Congress would enact reforms that established the mandate anew, but under terms that the Supreme Court would approve— by, for example, reconfiguring the penalty as an explicit tax, with an offsetting credit for those who have insurance. That’s almost certain not to happen, given political circumstances, but the federal government might—particularly under pressure from the insurance industry, which worries about reform without a mandate—come up with other methods of improving participation, such as stiff penalties for late enrollment. A few states might even enact mandates on their own. (The Court has indicated that would be constitutional; it’s the federal power to impose a mandate the critics are attacking.)

The results would like likely fall short of the nearly universal coverage that the Affordable Care Act is supposed to achieve, with some states doing much better than others. But that might still be an improvement over the status quo, with at least a chance of further improvement later on. A decision to strike down the mandate would be a breathtaking act of judicial arrogance, damaging to the country’s well-being and to its delicate balance of governing powers, but there’s a chance other parts of health reform could survive in some form.

follow me on twitter @CitizenCohn

SHARE YOUR THOUGHTS

Show all 61 comments

You must be a subscriber to post comments. Subscribe today.

61 comments

In the dark days of the Bush Administration, and after 9/11, I feared he might declare martial law. He behaved himself. Perhaps the surprise will be that Obama will declare martial law, mobilize the National Guard, and force Single Payer Health Care down the nation's throats.

- skahn

March 28, 2012 at 12:18am

You must be a subscriber to post comments. Subscribe today.

If the Justices can't come up with some limiting principles, they are either very poor Justices and/or they need some better law clerks because I can come up with some right now. Everyone is involved in the health care market, which is not necessarily true of all markets. Other markets do not suffer from an adverse selection problem which can result in market failure. And even if the federal government's economic reach is far, it would leave untouched cases like Lopez (gun-free school zones) which limit federal power. That didn't seem so difficult.

- dsimon

March 28, 2012 at 12:21am

You must be a subscriber to post comments. Subscribe today.

Well, if the mandate goes, there goes Obamacare--fo sho. But I'm not so sure that's such a terrible thing provided it doesn't hamstring Obama's re-election bid, and I somehow doubt it would. 1. Such a ruling would give the lie to the idea that this "conservative" SCOTUS is not an activist SCOTUS and, more importantly, it would highlight that these activist judges are fundamentally antidemocratic. Obama would have free reign to make Supreme Court appointments a central issue of his campaign, and he would be right to do so. I would hope to hear language like, "Make no mistake, with the aid of my Republican predecessors in the White House--one of which who wouldn't have been in the White House without the direct assistance of the Supreme Court--a right wing cabal has taken over our highest court and has chosen to stand against two hundred thirty-odd years of American tradition and use its position consistently to overturn the duly expressed will of the American people and to remake this great land into a place where only the rich can thrive and the rest of us go begging." 2. It would free us up to push for Medicare for All, the only truly rational solution to our health care problem.

- AaronW

March 28, 2012 at 12:40am

You must be a subscriber to post comments. Subscribe today.

As you implied, maybe they're just creating cover for themselves? If they're tough as nails in the questioning, there may be fewer recriminations later when they support the mandate. Or so they hope.

- Claris

March 28, 2012 at 4:29am

You must be a subscriber to post comments. Subscribe today.

if the mandate is struck down, then Democrats should push Republicans to fund free riders, make free riding the central issue of the campaign, find examples of rich white young adults who show up at the hospital without insurance and get free care, then drive off in their sports cars. And end coverage for Congress, let those assholes pay themselves on the open market, but Democratic congressman will be too selfish to do that. And will the provision that young adults up to the age of 26 be allowed to stay on their parents coverage survive? When college graduates of rich Republicans looking for their first job get sick it will have to be mommy an daddy who bail them out or let their kid be forced to start out their life bankrupt.

- blackton

March 28, 2012 at 8:24am

You must be a subscriber to post comments. Subscribe today.

Aaron. Point #2 is well made. Problem has been the constant pusillanimous BHO approach to most everything domestic -- health care, stimulus package, financial reform, debt limit extension, etc (Hard to think of anything that doesn't fit the description). And those who appear to believe that BHO will suddenly grow a backbone as a lame duck in a second term are engaging in as much magical thinking as do TEA party adherents.

- drofnats1

March 28, 2012 at 8:32am

You must be a subscriber to post comments. Subscribe today.

I think it's going to be difficult to make the case that the SC is antidemocratic when polls show so many people disapprove of the law.

- s.trabka@frontier.com-old

March 28, 2012 at 8:38am

You must be a subscriber to post comments. Subscribe today.

Well, I'm not convinced to breathe. Tell the Supreme Court I will turn blue unless they uphold the mandate. We've only got three choices, a private market solution, a government provided solution, and nothing. You can't cut taxes and do a government provided solution and insurance companies can't socialize the risk of no preconditions without the mandate. So guess what? We got nothing if they don't uphold it.

- Nusholtz

March 28, 2012 at 8:57am

You must be a subscriber to post comments. Subscribe today.

"A decision to strike down the mandate would be a breathtaking act of judicial arrogance, damaging to the country’s well-being and to its delicate balance of governing powers" 1. What unmitigated BS. Earth to liberal moonbat parasites --- THE ONLY PEOPLE SUPPORTING OBAMACARE AND THE INDIVIDUAL MANDATE ARE Dems. 78% of Repub. and 56% of independents oppose it. We are a Democracy. 2. And the individual mandate is clearly unconstitutional. Get your head out of your confirmation bias and smell the commerce clause.

- mr_rationale

March 28, 2012 at 9:10am

You must be a subscriber to post comments. Subscribe today.

drofnats1: He'll definitely grow a "backbone" if the SCOTUS kills his central legislative achievement.

- maxhencke

March 28, 2012 at 9:11am

You must be a subscriber to post comments. Subscribe today.

mr_rat: " THE ONLY PEOPLE SUPPORTING OBAMACARE AND THE INDIVIDUAL MANDATE ARE Dems. 78% of Repub. and 56% of independents oppose it. We are a Democracy." Yes, and over 80% support a ban on discrimination based on preexisting conditions. Unfortunately, it's very hard to have the ban without the mandate; the former without the latter would collapse the entire private health insurance industry (as people wait until they get sick to buy insurance). You can find majorities for lower taxes and more services too; does that mean responsible legislators should enact those polices because We Are A Democracy? Tall about moonbat.... "the individual mandate is clearly unconstitutional." If it were clear, we wouldn't have divided lower court decisions and a clearly divided court. Plus most legal scholars believe it is constitutional (or at least should be based on precedent). But I suppose some people have no tolerance for ambiguity, even if that's what the situation is in the real world.

- dsimon

March 28, 2012 at 10:16am

You must be a subscriber to post comments. Subscribe today.

Good article, and an especially interesting point about the oral arguments before the Silberman and Sutton courts. My (not very strong) gut feeling is that the mandate will be upheld, perhaps 6-3, but not due to the advocacy skills or legal strategy of the Obama Administration, which was the poorest in modern memory. I think the mandate gets upheld because if it goes, it will be virtually impossible to keep the community rating and pre-existing conditions provisions. And a decision to eliminate them, as well, would cause a firestorm, I think, that would imperil the Court's legitimacy. If, on the other hand, the Court did try to just excise the mandate, without the others, the insurance companies would set their hair on fire, thus setting the stage for a face-saving amendment to the law that would give individuals a menu of "financial responsibility" options, like state auto and workers' compensation insurance laws do. For almost everyone, the only viable option would be getting insurance, but they could, at least in theory, put up a bond or set up an escrow account of some type. Thus, the legal obligation would be financial responsibility, not the purchase of private insurance.

- CABChi

March 28, 2012 at 10:28am

You must be a subscriber to post comments. Subscribe today.

"I think it's going to be difficult to make the case that the SC is antidemocratic when polls show so many people disapprove of the law." Yes, sasanqua, but I bet that the overwhelming majority of those who oppose the ACA are already secretly taking advantage of the law. And they will take more advantage of it in the future. They just won't have the guts to tell anybody. Hypocrites, they. They're opposing a Republican sponsored law from the Nineties strictly for political reasons--to get Obama out of office.

- magboy47.

March 28, 2012 at 10:41am

You must be a subscriber to post comments. Subscribe today.

You know, I don't care that much what happens to the mandate. I care about the rest of the law. If the mandate is struck down, I trust the insurance lobby to find a way to address the death spiral; say what you will about them, they're a resourceful bunch, and they won't sit by quietly while their clients are driven into bankruptcy. They'll come up with a way to split off some Republican legislators and get things fixed. If they don't, well, then, private health insurance is dead in this country. It'll be ugly, but it might lead to something better in the end. But if all of Obamacare is struck down, say goodbye to health care reform for at least ten years and probably twenty or thirty. Liberals who think this would "open the way" to single-payer are kidding themselves. It doesn't work like that. Since the 1960s, every attempt to tackle health care reform has been less ambitious and more conservative-friendly than the one before it. Obamacare was the brainchild of Mitt Romney and the Heritage Foundation! When one attempt at reform fails, the next is smaller, not bigger.

- Dausuul

March 28, 2012 at 11:10am

You must be a subscriber to post comments. Subscribe today.

"Earth to liberal moonbat parasites" Just a quick question about that word, "parasites"... doesn't "parasite" describe something that simply feeds off another organism and gives nothing back? I seem to recall some data showing where federal money goes when disbursed to the individual states, vs the money each state send to Washington. If I recall correctly, what it basically showed was that of the states taking in substantially more money than they were paying in federal taxes, the vast majority were deep-red states with republican governors and republican-led legislatures. So.... doesn't that men, all things being equal, that it's the gop that are really the "parasites" here? Help me out, maybe I'm confused. Of course, another way to look at it would be how individual people compare rather than the states. In that case, wouldn't you call a "parasite" someone who screams about socialism, yet has no problem living under the umbrella the US military provides, drives on highways, conducts business on the internet, etc... somebody who seems to have a serious emotional problem with having to pay an extra $1,000 out of that $50,000 in monthly income, even though they enjoy a far greater proportion of largess provided by the government than, say, someone making $20 - $30 thousand per year? That seems a lot more likea a parasite to me.

- Tristan

March 28, 2012 at 11:43am

You must be a subscriber to post comments. Subscribe today.

"Since the 1960s, every attempt to tackle health care reform has been less ambitious and more conservative-friendly than the one before it. Obamacare was the brainchild of Mitt Romney and the Heritage Foundation! When one attempt at reform fails, the next is smaller, not bigger." I agree with you, Dausuul, except for one thing. There will come a day in the future when a distinct majority of Americans can't even afford to buy health insurance, let alone pay their health costs out of their own pockets. And the Republicans will have the government so small by then that there will be no help for people from that end. When children are dying in parents' arms, because they can't afford health care, there will be action in the streets. And if there isn't, all that will mean is that all the interactive brain chips are in place, and there won't be much concern about human matters anyway. Sweet scenario, eh? Making massive profits off the sick, the injured, and the dying is one of the most disgusting things that's ever happened in human history. That's the only thing that makes me ashamed to be an American.

- magboy47.

March 28, 2012 at 11:46am

You must be a subscriber to post comments. Subscribe today.

I realize this is an overreaction on my part, but I've been fighting the long defeat against the Right ever since Reagan was elected over thirty years ago. I also recognize that a bad oral argument does not necessarily translate into a bad decision. Still, there's no time like the present, and no sense in being unprepared. So I ask, and this is a serious question: Does anyone know if, because my paternal grandparents were both Canadian citizens who became US citizens, whether I'm eligible for dual US-Canadian citizenship? I know it appears I'm overreacting, but I'm simply exhausted and worn down with the destruction and stone age logic of the Right. I need someplace to rest.

- ghiaurov

March 28, 2012 at 11:52am

You must be a subscriber to post comments. Subscribe today.

To Mr. "Rational", you epitomize what I mean. First, last time I checked, there was no question that a majority of the Senate and a majority of the House voted to pass the Affordable Care Act. That is how a the particular democracy works. We elect members of Congress, and they pass the laws under which we live. We do not pass the laws, and then periodically have national polls taken using dubious methods and amend the work of Congress accordingly. Second, the polls I see do not reflect the reality you create. Moreover, if the Affordable Care Act is givien a chance to implement fully, twenty years from now you'd see twenty-somethings screaming in the streets every time someone dared to suggest a change to the "Obamacare" they would have, even while they work third-world jobs for the 1%. And I could just as easily point out that the overwhelming majority of Americans want the Bush tax cuts for the rich repealed. Whre's your outrage over that. Hell, complying with that would pay for Medicare for all, which is what Congress should have passed. Third, the laws under which we live, and their constitutionality, are not controlled by national popularity contests. Were that the case, you should also be screaming about the illegality of our troops in Afghanistan, which Americans overwhelmingly oppose. Fourth, no, the mandate is not "clearly" unconstitutional. In fact, the majority of constituional scholars consider the constitutionality of the mandate a no-brainer. You know nothing about the Constituion, or its commerce or nececessary and proper clauses.

- ghiaurov

March 28, 2012 at 12:10pm

You must be a subscriber to post comments. Subscribe today.

To CABChi, if it is upheld, I pray that it's 6-3, that would cause me to have some respect for CJ Roberts, which I assume would make up the sixth vote. I don't believe he personally would support the Act, but would recognize that if five justices did, having the Chief Justice on the opinion, or even writing, might allay some of the rancor over this. I thought Thomas and Alito were a lost cause even before the argument. People spoke of Kennedy as a swing vote, but others also recognized that Scalia might be as well, if he stayed true to his principles. His wacky regurgitationof the Bachmann broccoli meme was a shock to many (how could a person of his intellect buy into such an absurdity). Still, Scalia is known for his combative tone from the bench. Perhaps he channeled Bachmann to see if he could get a rise out of the Solicitor General.

- ghiaurov

March 28, 2012 at 12:40pm

You must be a subscriber to post comments. Subscribe today.

I, too, have been wondering how the pre-existing conditions and community ratings provisions could survive without the mandate. It's interesting to note that candidate Obama originally thought that subsidies could create a functioning market without the mandate, so maybe it could work? I can envision some states setting up mandates on their own, which would be interesting to see -- you'd have states with near universal coverage combined with states like Texas, which are moving towards coverage for no one. I wonder how that would impact the long term ability of states to attract employers, residents, etc. (Of course there is no philisophical difference between states mandating coverage and the federal government doing so. If it offends one's libertarian sensibilities, it should offend equally. The constitional argument just gives the opponents cover with a seemingly principled argument.) Does anyone (hint: J. Cohn) recall how the systems work in the countries that have universal coverage provided by private companies, which I think describes Germany, Switzerland, and the Netherlands, in terms of the existence of some kind of mandate? I know that the governments heavily regulate the insurance market but am wondering if there is a mandate to buy insurance. If so, we can say that there is no example anywhere of a market that manages to provide universal coverage through private insurance without a mandate. On the other hand, if they don't have a mandate, I'd be curious to know how they make it work. And as an aside, did anyone see David Brooks's latest idiocy yesterday, in which he approves of the mandate but is critical of the centralized mechanisms for cost control? His wise suggestion (sarcasm here) is that instead of the government -- which has massive amounts of data to assess best practices and purchasing power to leverage price cuts -- the private market forces (such as patients) will drive down costs by shopping around. It's as if he had never heard all the policy discussions surrounding health care reform and had no understanding of the fact that patients can't actually bargain for better prices.

- shellski

March 28, 2012 at 1:54pm

You must be a subscriber to post comments. Subscribe today.

DSimon writes; " Unfortunately, it's very hard to have the ban without the mandate; " No it's not. You simply tell everyone "you can buy insurance at any time, but it takes 6 months to kick in. And the bills you incur during that 6 months are YOUR responsibility" So, if you get in a car wreck and the medical bills are $15,000, then congrats, those are YOUR responsibility. If you want to get a tattoo and other expensive body art, or smoke like a chimney instead of getting health care, then great. Just understand one accident and you are looking at bankruptcy. The mandate in some ways is simply a way to have the ultra-healthy (18-35) subsidize the very sick. I'm not sure that should be forced on anyone.

- seattleeng

March 28, 2012 at 2:38pm

You must be a subscriber to post comments. Subscribe today.

Tax? Mandate? User Fee? WTF? This is simple arithmetic. If everybody's in, it's cheaper. But without careful design and monitoring (with authority to make serious modifications), that just means we go bankrupt faster. Health care costs are driven by rent seeking in the already nearly unaccountable morass of Medicare/Medicaid/Social Security and associated monopolistic interests in the "private" sector. We need real reform. I doubt this is it, but I'll take it for now.

- Robert Powell

March 28, 2012 at 3:14pm

You must be a subscriber to post comments. Subscribe today.

So, if you get in a car wreck and the medical bills are $15,000, then congrats, those are YOUR responsibility. umm...no...there is a thing called bankruptcy. And what if the bills are $150,000, shall we let the person die on the side of the road? Are you willing to step in and pay that money? And bankruptcy just fops the money off on us, I propose you pay for it. And the idea that the ultra-healthy will stay ultra-healthy forever is idiotic. What you are proposing is that the young pay nothing, and the middle aged and old pay everything, which would make the system prohibitively expensive for many middle aged Americans, who will forgo health care, who will then get really sick many of them dying, eating away at our own productivity not to mention the incredible costs associated with a family having no father or mother. But your response is..???

- blackton

March 28, 2012 at 3:15pm

You must be a subscriber to post comments. Subscribe today.

" What you are proposing is that the young pay nothing, and the middle aged and old pay everything" No, I'm proposing people can opt-in if they wish. If they don't opt-in, then they will be treated but they are on the hook for the bill. Same as today. Forcing 20 somethings to pay will not reduce the final bill for everyone else by much at all. This is because there aren't that many uninsured 20-somethings relative to the general population. RP: "If everybody's in, it's cheaper." Yes, true. But at what cost? The savings is a few % at best. One year of cost growth! But the risk to the law's survivability was HUGE. Look, if forcing everyone to get insurance meant 50% reduced insurance costs for me and was critical to the financial workability of the solution, then i get it. Fight like hell for the mandate. But it wasn't. It was a very minor cost reduction and contentious as hell. And rather than say "Eh, OK, we're mostly concerned that we can get insurance to anyone that wants it, regardless of pre-exsiting health," the GREEDY dems went for broke AND put a poison pill in the solution that would result in all or nothing. So, it's looking like WE THE PEOPLE get nothing because the dems wanted EVERYTHING. Strategically and tactically, the dems failed at the most basic task. FAIL FAIL FAIL. Drunk on their own power. Ramming it through. Serves them right. Next time it's hopefully a simple law with just 5 requirements. 1) Everyone accepted. Coverage kicks in after 6 months. If you lapse in payments more than 2 months, then it takes 6 months to start again. 2) Coverage available from gold plated to catastrophic, with associated price tiers 3) No more state lines 4) If health care expenses (including insurance) are more than 10% of your income, then congrats, you get a rebate to ensure nobody pays more than 10% So simple. So much opportunity for the market to innovate. What a missed opportunity that every single righty would have gotten behind.

- seattleeng

March 28, 2012 at 4:11pm

You must be a subscriber to post comments. Subscribe today.

> So simple. So much opportunity for the market to innovate. > What a missed opportunity that every single righty would have gotten behind. Are you kidding? What you're suggesting is very close to the "public option" that Republicans fought to the death against -- a standardized insurance that anyone could get if they couldn't find what they needed in the private market. The mandate wasn't ideal, but it was the best the Democrats could get. Ironically, if the Supreme Court strikes this down, they'll essentially be saying that if the US wants universal health care, the only system that's definitely constitutional is a single-payer system like Canada's. The Republicans should be careful what they wish for.

- miket-nyc

March 28, 2012 at 4:39pm

You must be a subscriber to post comments. Subscribe today.

Miket, Similar to what I heard at the local GOP Caucus. As local Republicans talked about health care, they seemed to be re-inventing something like the "Obama-care" they so abhor, but were struggling to find a new name and package for it. Perhaps they could call it "Romney-care"? No, I doubt that will fly. Perhaps they could call it "Christian-care"? But, of course, they want people to have "choice" -- uh-oh! Well, let's say that people should be able to select from "Catholic-care" and "Protestant-care" -- and just to show we are not prejudiced -- "Mormon-care." And instead of being /t/a/x/e/d, they will pay for their care with a tithe! TITHE-CARE! Now we are cooking!

- skahn

March 28, 2012 at 5:08pm

You must be a subscriber to post comments. Subscribe today.

seattleeng, you simply doesn't understand people. That's why you told me once that, if there were a lot criminals involved in the housing market collapse (and there were), they'd all be in prison. Uh-huh. People who refuse to buy health insurance are never going to pay, under any circumstances, for any part of their ensuing medical bills. And then the taxpayers and insurance holders will have to pay the sometimes-huge bills that these bums will be racking up. I think it's entertaining that you'll be helping to pay their medical bills. And you're still talking about the market innovating. The main reason health care costs are so obscenely high is because of monopoly and price fixing. There is no market working when there are captive consumers dealing with the most important part of their existence--their health and their very lives. You need to get away from statistics for a while and study human nature. It's a critical reason why the market doesn't work when it doesn't, especially in the area of health care. It's a law of human nature that when you deregulate the economy, monopoly and price fixing ensue. That's what's happened in health care. And no hocus-pocus statistical proposal of yours will make people want to compete when they don't have to.

- magboy47.

March 28, 2012 at 5:49pm

You must be a subscriber to post comments. Subscribe today.

mike-nyc writes: "Are you kidding? What you're suggesting is very close to the "public option" that Republicans fought to the death against" Nonsense. It is essentially John McCain's plan, except McCain provided exchanges for those that couldn't get insured. I think Obama's solution for dealing with those that can't afford insurance was the better approach. "Ironically, if the Supreme Court strikes this down, they'll essentially be saying that if the US wants universal health care" No, if they strike this down, they'll be saying the government can't force you to buy something from another private entity. Same thing states have been saying while Obama was crafting his solution. Hubris. Greed. Here's a list of congressfolks commenting on their alleged authority to do this back when it was being written. It shows you just how clueless some of our leaders are. Rep. Conyers cited the “Good and Welfare Clause” as the source of Congress’s authority [there is no such clause]. Rep. Stark responded, “the federal government can do most anything in this country.” Rep. Hare said “I don’t worry about the Constitution on this, to be honest [...] It doesn’t matter to me.” When asked, “Where in the Constitution does it give you the authority …?” He replied, “I don’t know.” Sen. Akaka said he “not aware” of which Constitutional provision authorizes the healthcare bill. Sen. Leahy added, “We have plenty of authority. Are you saying there’s no authority?” What a waste of time these folks have caused if this is overturned.

- seattleeng

March 28, 2012 at 5:50pm

You must be a subscriber to post comments. Subscribe today.

"seattleeng, you simply doesn't understand people." And I doesn't understand grammar.

- magboy47.

March 28, 2012 at 6:12pm

You must be a subscriber to post comments. Subscribe today.

Magboy writes: "People who refuse to buy health insurance are never going to pay, under any circumstances, for any part of their ensuing medical bills" So what? Most on food stamps today use the money freed up by food stamps to spend money on wasteful things in their lives. They smoke. They drink. They have tattoos and piercings. Food stamps just enable those habits. Why do you suddenly care what someone does? Food stamps costs me a hell of a lot more than unpaid emergency room bills. And if you are really concerned about unpaid ER bills, then vote to kick out illegal aliens. In Texas and California, they consume an overwhelmingly disproportionate share of ER resources. In 2006, Texas had $1.6B in illegal alien ER costs that were written off according to USAToday. Texas is 8% of the population. That means that nationally in 2012, costs due to illegals are likely >$20B. That is more than half of our unpaid medical bills. How much are uninsured 20-somethings costing me without insurance? They are about 10% of the uninsured. My gut says that illegals are much, much more expensive than the 20-somethings. Magboy writes: "The main reason health care costs are so obscenely high is because of monopoly and price fixing." They are high for a lot of reasons. Read the McKinsey paper and let me know what you think. This paper was a real eye opener for me. I previously bought into the drug company and trial lawyer nonsense, but the data shows those just aren't a big component. www.mckinsey.com/Insights/MGI/Research/Americas/Accounting_for_the_cost_of_US_health_care Don't eat the linkDon't eat the linkDon't eat the linkDon't eat the linkDon't eat the linkDon't eat the link

- seattleeng

March 28, 2012 at 9:32pm

You must be a subscriber to post comments. Subscribe today.

I don't know where this ultra-healthy 18-35 concept comes from. I've been pretty healthy all in all (touch wood) but I've suffered from asthma since I was about eleven years old. I have to have an inhaler with me every day. They aren't expensive really, but in quite a few different stages of my life I've been glad that I lived in Europe where being unemployed or self-employed didn't mean you were cast out of the system. Also, there is such a thing as a generational contract -- younger people who don't consume much health care pay now because when they are older they are going to need the system in which they will consume more.

- ironyroad

March 28, 2012 at 10:37pm

You must be a subscriber to post comments. Subscribe today.

Excuse me but, it is obvious that the Supreme Court will make a political decision. The Supreme Court is Republican, and thus will find the law unconstitutional. This is obvious and we should all stop debating the obvious and move on to more important things. Those who care about the issue should be working on how they will respond to the obvious. Everyone "PLEASE GET OVER THE OBVIOUS."

- BFichthorn

March 29, 2012 at 12:53am

You must be a subscriber to post comments. Subscribe today.

seattleeng: "DSimon writes; 'Unfortunately, it's very hard to have the ban without the mandate;' "No it's not. You simply tell everyone 'you can buy insurance at any time, but it takes 6 months to kick in. And the bills you incur during that 6 months are YOUR responsibility'" I wrote it was hard, not that it was impossible. And I doubt that a 6-month waiting period would be effective in preventing the insurance "death spiral." There are many chronic conditions that last a lot longer than 6 months, so the waiting period would not prevent most of the costs of those illnesses from burdening other policyholders. There is the possibility of having an enrollment period where failure to enroll (effectively an opt-out) means exclusion for at least several years, though none of our peer nations have adopted that approach. "Here's a list of congressfolks commenting on their alleged authority to do this back when it was being written. It shows you just how clueless some of our leaders are." Most legal scholars agree that the mandate is constitutional. Of course, that doesn't mean the Court will find that it is. But it shows that Leahy is far from "clueless." And cherry-picking the comments of others doesn't prove your point; I suspect it's very easy to find examples of extreme cluelessness on the other side of the aisle as well. And examples of cluefullness on both sides.

- dsimon

March 29, 2012 at 1:02am

You must be a subscriber to post comments. Subscribe today.

seattleeng writes: "So what? Most on food stamps today use the money freed up by food stamps to spend money on wasteful things in their lives. They smoke. They drink. They have tattoos and piercings. Food stamps just enable those habits." Seattleeng, I think this is what I resent most about your posts - your mindless slandering of people with no facts or logic. Not only do I find these characterizations offensive and inappropriate, they completely negate anything worthwhile you might have to say. Don't you understand how you undermine your own credibility? I'm surprised anyone bothers to respond to anything you write anymore.

- Claris

March 29, 2012 at 7:31am

You must be a subscriber to post comments. Subscribe today.

The same for you, mr_rationale. If you want to play, play nice, please.

- Claris

March 29, 2012 at 7:39am

You must be a subscriber to post comments. Subscribe today.

dsimon writes: 'Most legal scholars agree that the mandate is constitutional. " Completely unsupported. What you mean is "the legal blogs I frequent all thinks this law is awesome". Get out a bit more, and you'll find there are plenty of legal blogs that have been taking this apart from day one. The Atlantic just wrote a piece today "Did bloggers kill the health care mandate" where they look into several legal blogs that have been building a case against this before the toner had cooled on the legislation. People that live in echo chambers are often surprised by events. Get out more, and you won't be as surprised. Of course, if you never get out, then it appears everything that doesn't go your way is a vast right wing conspiracy. Here's to hoping the justices telegraphed correctly this week. "Claris writes:" Seattleeng, I think this is what I resent most about your posts - your mindless slandering of people with no facts or logic. Claris, I'm sorry you are unable to connect basic stats into a fact. Smoking is overwhelmingly an act done by the poor anymore. Look it up. Welfare is overwhelmingly used by the poor (and creeping upwards). Look it up. Ergo, the government gives a poor person that is a smoker $200 for food, the $200 really just enables them to buy cigs, because they no longer need to spend that money on food, the government has done that for them. Now, look at the upward march of food stamps as they creep up into the lower rungs of the middle class. Your typical food stamp recipient (in my town) is adorned with expensive tattoos and piercings. Their cart is loaded with red bull and lots of other crap that is very bad for them. And BING! out comes the food stamp card! "Oh, and can I get $5 of lotto tickets too?" How is it they have money for tattoos and lotto tickets but not for food? Do you not remember the recent $1M lottery winner that was on food stamps? How does a food stamp recipient have money for lotto? Answer: Government enabled it. I'm sick of paying for this. Honestly. We cannot afford it.

- seattleeng

March 29, 2012 at 12:19pm

You must be a subscriber to post comments. Subscribe today.

Claris, let me ask this simple question: Do you agree that if a person on food stamps has enough money to buy a $8 pack of cigarettes, doesn't that mean that BY DEFINITION the government gave them too much in benefits?

- seattleeng

March 29, 2012 at 12:22pm

You must be a subscriber to post comments. Subscribe today.

I'd just like to reiterate the point I made above, that calling 18-35 year-olds "ultra-healthy" is misleading because you can be pretty healthy all in all in that age-group but still need some treatment for a congenital condition or similar, not to mention what happens if you are female and pregnant. It isn't exactly an "illness" -- quite the opposite really -- but it does require health care in some shape or form, and indeed continuing beyond birth unless you want to raise the infant mortality rates. Basically you don't have to be a member of Mensa to grasp that the most intelligent, humane, and efficient way of managing a national health care system is to have everyone in that system.

- ironyroad

March 29, 2012 at 2:28pm

You must be a subscriber to post comments. Subscribe today.

I mean as a group they are ultra healthy. Not every single one of them. There are indeed very sickly 22 year olds. But on average, they need medical services far, far less than those 40 and above.

- seattleeng

March 29, 2012 at 10:04pm

You must be a subscriber to post comments. Subscribe today.

Claris, care to answer the question? Crickets??? Here it is again: Do you agree that if a person on food stamps has enough money to buy a $8 pack of cigarettes, then the government gave them at least $8 too much in benefits. Simple question, really.

- seattleeng

March 29, 2012 at 10:06pm

You must be a subscriber to post comments. Subscribe today.

seattle, you are making a false distinction between "healthy" and "sickly," as I pointed out in my earlier post. Large numbers of young people are healthy in general but have one thing -- a congenital condition of some kind, for example -- that needs some treatment. It doesn't have to be expensive, but it's necessary and either it's covered or they are responsible for it and it hangs over them as a financial threat even though they aren't consuming very much. That is why, if we are in a private insurance system as opposed to a single-payer system, the individual mandate is required to keep everyone in. Your argument about "healthy young people" dismisses the individual on the grounds that he belongs to a demographic whose general characteristics in a statistical evaluation diverge from that individual's, and he will be judged by those general characteristics, not his own.

- ironyroad

March 30, 2012 at 1:17am

You must be a subscriber to post comments. Subscribe today.

Irony, no matter how you want to slice it, there is a % of 20-somethings that do not need any medical care each year. None at all. There is a smaller % of 30-somethings that don't need any medical care all ina given year. And a smaller group of 40-somethings....and 50-somethings.... But the fact is, even when you consider congenital issues, even when you consider accidents, and even when you consider chronic health issues... 20 somethings need less medical care than 40 somethings. I wish the 20-somethings would get health care. But I'm not ready to tear up the constitution to make it so.

- seattleeng

March 30, 2012 at 12:21pm

You must be a subscriber to post comments. Subscribe today.

seattle, I don't deny that there is such a percentage, but I think you start misunderstanding the meaning of that percentage if you exclude all the things that happen in INDIVIDUALS' lives. Pregnancy and childbirth is one quite common event, and a much much larger proportion of women have children in their 20s than in their 50s. Whichever way you slice it and dice it, there's no basis for allowing people to free-ride the system up until the moment they need it when they can then exploit the ER loophole (btw I asked on another thread why you made that remark about me only now being against free riders -- I was puzzled because I haven't said anything new about health care that I haven't been saying for a while -- you never answered) Your last point is very weak. If the same policy in the ACA had used the word tax instead of the word mandate, we wouldn't be having this discussion.

- ironyroad

March 30, 2012 at 1:04pm

You must be a subscriber to post comments. Subscribe today.

irony writes: "Whichever way you slice it and dice it, there's no basis for allowing people to free-ride the system" Free riding happens all throughout the system. Each light rail trip in Seattle costs the taxpayer $32 per rider per trip. The rider only pays $4. Each bus ride costs the taxpayer $6. The rider only pays $3. Free riding is a fact of life. It happens. Now, if you are really concerned about free riding, then focus where it happens the most. Welfare. I'll ask you since Claris wouldn't answer: If a poor person on welfare has enough money to buy an $8 pack of smokes, then doesn't that mean we've paid them at least $8 too much welfare? And welfare if brimming with these problems. The national cost of 20-somethings in ER is a rounding error. If you really are concerned about unpaid ER costs, then focus on illegal aliens. We fix the BIG problems first, and then we work our way down to the little ones. Welfare is a big one. Illegals in the ER is a medium one. 20-somethings in the ER is a teeny one.

- seattleeng

March 30, 2012 at 3:02pm

You must be a subscriber to post comments. Subscribe today.

Honestly seattle, I don't know where to begin as your arguments and analogies are so wild. Let me take two of them: 1. Presumably the value of the light rail trip is calculated in terms of benefit to the city and its population: less traffic on the road, less pollution, more mobility, better connections for tourists and people who have business at the airport, less parking demand etc. The passenger paying $4 is no more a free rider than the person driving on the federal highway system who is also the beneficiary of subsidy. I think it's extremely unlikely that your figure of $32 is correct, but in any case there are positive effects of a good urban transport network -- some that take a while to kick in -- that make it a worthwhile investment for taxpayer dollars especially in a fairly densely-populated metro area like Seattle's. 2. Not only is health care way the most serious financial problem facing the country longer-term, it is precisely the current 20-somethings who are going to bear the brunt when if goes out of control. The ACA is also an attempt to get a real handle on healthcare spending. 3. I don't know about claris -- I didn't mention welfare.

- ironyroad

March 30, 2012 at 3:16pm

You must be a subscriber to post comments. Subscribe today.

Irony, you are stretching to to claim all those societal benefits. Most bus riders do not have a car at home. If the bus didn't exist, they wouldn't be able to go anywhere. So, no, bus riders are not doing everyone else a favor. It is their only means of transportation. Remember when NOLA flooded? The only people left were those that relied on public transportation. It was a very large number. You could argue the bus enables them to work, I guess, and that that is a benefit to others. But that really only becomes true when we are a full employment and we NEED more workers. A key exchange was thus in front of the supreme court (from NYT): “The young person who is uninsured,” Justice Kennedy told Michael A. Carvin, a lawyer for private parties challenging the law, “is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries. That’s my concern in the case.” Mr. Carvin responded that the law actually frustrated individual responsibility. “They’re compelling us to enter into the marketplace,” he said, but “they’re prohibiting us from buying the only economically sensible product that we would want, catastrophic insurance.” Think about this very, very hard. This point is very important. If a 20-something DID want insurance, they would likely buy a very inexpensive policy. But here the government is not only compelling you to buy something you probably don't want. But they have gone a step further and compelled you to buy a "gold plated" version of something that you don't need. That is very, very onerous and very, very unfair. There is a massive re-distribution today from the very young to the very old. And the chances are very good that the very young today will not enjoy their golden years the way the boomers are enjoying theirs. I cannot fathom continuing to heap even more burden on our young.

- seattleeng

March 30, 2012 at 3:59pm

You must be a subscriber to post comments. Subscribe today.

And BTW, Irony, note how many superfluous services some states REQUIRE to be a part of health insurance. In WA state, they require ANY policy to support naturopathy. I have never used that in my life, and never will. And yet I must pay for it because some tree-hugger in Seattle gets a placebo effect from the treatments. See how devious this becomes? Naturopathic doctors get a lobbyist, convince the state to make it mandatory, and suddenly it's a huge windfall for them and a burden for me. Can't you see aromatherapy being mandated? And pot? And birth control...pretty much anything a lobbyist can dream suddenly becomes fair game. . What a joke this entire thing becomes.

- seattleeng

March 30, 2012 at 5:31pm

You must be a subscriber to post comments. Subscribe today.

I don't understand your first paragraph, seattle. Assuming that the issues of public transit are similar (not identical, however) between the light rail system and the bus network, it sounds as if you think nobody should be allowed to move about the city unless they have a car. That is loopy, or would be. I presume you're not actually saying that, so I would reiterate that a rational case can be made for promoting mobility and discouraging individual automobile journeys so that the city as a whole benefits. Then it becomes a matter of numbers and efficiencies, with quality-of-life factors included, how the public transport option is executed (e.g. light rail requires land purchase but is in the longer term more cost-effective than buses with internal combustion engines). I'm baffled by Carvin's claim. Does he think 20-somethings never become pregnant, for example? Seriously? Does he (do you) you believe that every 20-something will rush out to buy catastrophic coverage the moment the ACA disappears? The problem is that you can't do universal coverage on an insurance model that prevents exclusion or recission without universal participation. It just a fact, and grumbling won't change that.

- ironyroad

March 30, 2012 at 5:34pm

You must be a subscriber to post comments. Subscribe today.

Irony writes: " it sounds as if you think nobody should be allowed to move about the city unless they have a car." No. I'm saying a bus ticket should reflect the actual cost to ride the bus. irony writes: "'m baffled by Carvin's claim. Does he think 20-somethings never become pregnant, for example" No, but a 22 year old gets pregnant and has a $5000 deductable policy, then they are on the hook for the first $5000. Novel concept, isn't it? Do you think aromatherapy should be a mandatory part of all insurance? Or should I be able to buy insurance that doesn't include certain things, including aromatherapy and birth control? Think very hard about my assertion here: You tend to favor anything that permits cost shifting. All liberals do.

- seattleeng

March 30, 2012 at 8:02pm

You must be a subscriber to post comments. Subscribe today.

Why does a bus ticket have to reflect the actual cost? Why can't a municipality decide that the benefits of a reasonably-priced public transport system are worth paying for? Name me a single great city in the world that doesn't have a public transport network in which ticket prices are at "actual cost." Neither, in fact, does a car ride reflect the cost it takes to maintain the highway, deal with parking and traffic congestion, handle pollution issues, and all that. The only difference is we call the former "subsidy" and the latter "investing in transport infrastructure." The reason why we have public policy decisions that are not market-based is that we want certain things in our society that could not operate if everyone had to pay the market price or if the operator worked on a profit logic. Best example: if the Post Office were to operate entirely on a market principle, then there would be thousands of small towns and remote rural without mail collection or deliveries. Part of the function of a U.S. post office is psychological -- so people see a visible sign that they are part of the larger nation. And is there, historically, something particularly "liberal" or "conservative" about the USPS? Not a thing. How about you doing some hard thinking, seattle? -- I haven't noticed it much in evidence as you keep shifting arguments from central to peripheral issues. I have the impression I keep having to re-invent the wheel here. Aromatherapy -- gimme a break!

- ironyroad

March 30, 2012 at 8:49pm

You must be a subscriber to post comments. Subscribe today.

Sorry -- that sentence should read "Name me a single great city in the world that HAS a public transport network etc etc"

- ironyroad

March 30, 2012 at 8:51pm

You must be a subscriber to post comments. Subscribe today.

irony writes: "Name me a single great city in the world that doesn't have a public transport network in which ticket prices are at "actual cost. The cities are great in spite of the subsidies. They are not made great because of them. irony writes: " Neither, in fact, does a car ride reflect the cost it takes to maintain the highway, deal with parking and traffic congestion, handle pollution issues, and all that." Yes, in fact our gas taxes DO pay for all this and more. Most cities take gas taxes to fund public transportation. So does the federal government. There is no hard thinking for me to do. * You believe everyone should buy a standard insurance plan, regardless of how gold plated it is. And if they can't afford it, it should be paid for by others. * You believe the gov should force you to buy this plan * You see no problem with adding special services, such as birth control and acupuncture to the required standard plan, and making everyone pay for it EVEN if they never want or use these optional services. * If a large enough group of the people want something like aromatherapy, and if it makes them feel very good about themselves, then that shoudl also be added to the required basic coverage. * You believe there is no limit to what the required plan might require. If the government decides it is required, then everyone must pay for it. * This massive cost shifting does not bother you, but you are happy when it happens in all other aspects of our government. Which is these bullets is wrong?

- seattleeng

March 31, 2012 at 3:02am

You must be a subscriber to post comments. Subscribe today.

No, if you starting charging access to public transport at market prices the way you suggest, then the city (whether it's Paris or Seattle) would grind to a halt within 24 hours and the urban economy would begin to crumble. The city needs mobility. Public transport users pay taxes too, and the bus company pays gas tax. Oil companies get subsidies, however, that others don't. Which of the bullets is wrong? 1, 2, 4, and 5 definitely; I'm not sure I understand what you mean in 6 but the probability is that it's wrong too. 3 is correct although we would probably disagree on what constitutes a legitimate special service -- I would tend to say yes to birth control and no to acupuncture (unless you could show that it was a cheaper or more effective treatment than other options in a particular class of cases). seattle: "There is no hard thinking for me to do." You know, when someone makes a really dumb remark in public, it's awkward and discomfiting. Please don't do that.

- ironyroad

March 31, 2012 at 1:26pm

You must be a subscriber to post comments. Subscribe today.

The cities would not grind to a halt. There is a core bus service that can pay for itself. These routes have buses that are continually >50% full. Where the economics falls apart is when the bus services run too many routes with few on board. Dump these routes, or charge market value for them. But having a tax payer pay for a bus with 3 people on it, day in and day out, is ridiculous. It makes an SUV look flat out frugal in terms of pollution. There was a day (back before deregulation) where airlines operated routinely almost empty flights. I have been one of less than 10 people on an airplane before way back when! But in the 30 years since deregulation, airlines have gotten more and more efficient at planning and optimizing, and in fact I cannot remember the last time in 10 years that I flew on an airplane that was less than 50% full. Today, an airline like Alaska has someone in a seat 80 to 90% of the time. And I'm all for financing driving 100% through gas taxes. We just have to get states to stop robbing their gas tax funds to pay for other things. Just to make sure I don't misunderstand....You are stating that you don't believe the government should be able to force you to buy an insurance plan with a bunch of stuff you don't want or need? Do I understand you correctly?

- seattleeng

March 31, 2012 at 4:41pm

You must be a subscriber to post comments. Subscribe today.

But the concept of a bus SERVICE implies that it's not organized around a market principle in which those with more money can avail of more of it, or are the only people to avail of it. If you have a working-class neighborhood where many people don't have cars, then the demand for public transit is going to be high, but if you charged some kind of market price for the ticket, then that would reduce the number of people who could travel on it. You have to have a different set of criteria for a public service that is, in its broad operation, beneficial to the city. Your proposition was "You believe everyone should buy a standard insurance plan, regardless of how gold plated it is. And if they can't afford it, it should be paid for by others." I don't believe this. Firstly, there is a contradiction between "standard" and "gold plated." If someone is required by law to get a standard plan the clear understanding is that it is not regardlessly gold plated. Secondly, I don't believe that using financial tools including transfer payments to enable e.g. people in low-wage jobs to purchase health insurance is "being paid for by others" any more than the Iraq war was being paid for by people who passionately disagreed with it (or, if you like, tough cheese -- you can't mark your tax dollars 'only for X and Y'). Thirdly, it's not the government that is doing the compelling but the law. If you had phrased it "everyone should be in, or should purchase, a standard insurance plan, with assistance for those who can't afford it, and those who can, but refuse to, participate should be subject to an appropriate legal sanction (for example, a fine, or a mandatory ID saying 'I'm a moron and if I'm unconscious in an ER please don't treat me')", then I'd be ok with that.

- ironyroad

March 31, 2012 at 6:42pm

You must be a subscriber to post comments. Subscribe today.

I think if I hear the term "parasite" one more time I am going to scream. Ditto, ridiculous hair-splitting arguments that favor corporate riches, the profit-taking off the backs of the sick, that magboy mentions, and other rent-seeking behaviors - read this - about how people (especially women, especially older women) are struggling to afford basic necessities like food. The situation for huge numbers of Americans is flat out desperate. Alas, those of you who refer to us as "parasites" are obviously clueless; you know nothing about what it means to be cold, hungry, to be without electricity, to be without enough for rent. Too many benefits my sweet bippy. http://www.huffingtonpost.com/2012/03/29/older-women-basic-expenses_n_1389179.html?icid=maing-grid7|maing6|dl1|sec3_lnk1%26pLid%3D148061

- Sophia

March 31, 2012 at 6:49pm

You must be a subscriber to post comments. Subscribe today.

PS shame on you. A person who would call another human being a "parasite" should wash his mouth, and his brain, with soap. You have no idea what people contribute. Because people are poor it doesn't mean we are worthless. You don't see the tender care a daughter lavishes on an elderly, lonely parent; or the care given to injured animals, or the nurturing of gifted students, or the beauty created in darkness.

- Sophia

March 31, 2012 at 6:51pm

You must be a subscriber to post comments. Subscribe today.

I will die. Probably not tomorrow. I may die quickly (in full possession of my mental faculties, as did my father at 43). I may die slowly, lost in the mists of dementia, as my mother did with Alzheimers, in her 80s (mercifully in a senile fog as my evangelical sister prated about Jesus to her). Today is Sunday, April 1. Not a propitious calendar day. At least one person here (at least by widespread agreement) continues posting comments after passing the point where good sense indicates he should continue. I don't think I am at that point yet. Once a month, I narcissisticly invite to advise me whether to continue or retire. I may ignore your counsel. I probably will ignore your counsel..

- skahn

April 1, 2012 at 9:58am

You must be a subscriber to post comments. Subscribe today.

Bad start. Should say "invite YOU to advise me."

- skahn

April 1, 2012 at 10:00am

You must be a subscriber to post comments. Subscribe today.

I find it rather interesting when Seattle makes the claim that because the Government sets a 'standard of coverage' and that its inclusion of contraceptives as part of that coverage is forcing a majority of people to pay for something they won't ever use comes off as facetious. 51% of the US population is made of females (who in this grand society we have, are still expected to bear the full responsibility of not getting pregnant, yet are simultaneously denigrated for taking necessary precautions). If we take this sliver of the health care market, women "consume" health care (like it's a fungible commodity like pork bellies) at a significantly higher rate than men do. Even those extremely healthy twenty-somethings that aren't covered by their parents anymore and are working various part-time jobs with little to no benefits. These healthy, vibrant twenty-something women go to the gynecologist once a year, use birth control (pills, ring, patch, etc) for birth control monthly as well as for other health issues, 25% of women have HPV or need screening for it. They go to the dermatologist once or twice a year, they see the eye doctor once a year, etc, etc. And they use these services regularly and often. If they decide to raise a family, the first year of OB-GYN visits increases exponentially. So we're talking about a significant chunk of the population that does use those services that you personally may not. Seattle, when's the last time you hung out and talked with someone under 40 or a young women in her late 20s? You're earlier statement "If a 20-something DID want insurance, they would likely buy a very inexpensive policy" exhibits a clear disconnect with the realities of the under 40 population. Yes those under-40 folks tend to think they're healthy BUT they DO want insurance to cover the very basic needs and at the least cost. EVERYONE wants that. I want the best coverage I can get for the least amount of money and I'm 40. So how is the argument that requiring a working person without insurance to get a basic policy tearing up the Constitution? Most of these younger people don't or wouldn't go to the doctor because they didn't have or couldn't afford insurance. Most high deductible plans are for all intents and purposes a 'last line of defense' against something catastrophic and often exclude covering some of the services that 51% of the population uses. Most private insurance companies offer these services because it's good business and yet, I hear so much noise from the right about how 'requiring' future policies for the newly covered to have a basic set of services is somehow anathema to 'life, liberty and the pursuit of happiness'. I would have preferred that Gov't. just simply did Medicare 'E' for everyone and then let people opt out of the increased payroll tax with proof of continued enrollment in their own policy (that had the basic standard of care as Medicare). It isn't that difficult to recognize that folks need to have skin in the game ( I agree wholeheartedly) but I also recognize that many of those under 40 wouldn't actively choose to get insurance on their own but if you enrolled them automatically then they would opt to accept it (while those who cringe at a having a government administered insurance policy would find their own). This premise applies to IRAs and 401Ks. Making the enrollment mandatory increases the likely hood of savings versus relying on voluntary enrollment. How would that be different than incentivizing a healthy 20-something without insurance to get it? Is the ACA perfect? Hell no. It is, however, a perfect embodiment of the absolutely inefficient system that we have been blessed with for over 200 years. The sausage making was laid bare for all to see and people realized how utterly screwed up our system has become. Yet at the same time, the effort at reform had to happen sooner or later. If the GOP were serious about reform they would work to improve the law vs. repealing it and replacing it with the white noise they offer up in it's place.

- singlspeed

April 3, 2012 at 1:44pm

You must be a subscriber to post comments. Subscribe today.

apologies for the all bold. that pesky formating bug of TNR strikes again.

- singlspeed

April 3, 2012 at 1:47pm

You must be a subscriber to post comments. Subscribe today.

SHARE HIGHLIGHT

0 CHARACTERS SELECTED

TWEET THIS

POST TO TUMBLR

SHARE ON FACEBOOK

Close