SCOTUS seems poised to destroy Obamacare

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One of the most important features of the new Health Care Insurance reform is that everyone has to be on board. Normally, as in a normal country with a normal government and stuff, taxes would be raised in some fair manner and this would pay for health care. In our screwed up country, that can’t happen because it violates the Don’t Tax Me Bro religious belief of 50.01 percent of the country. Apparently. Therefore, the mandated insurance rule that requires everyone has insurance was introduced to make it possible to have a national health care plan that kinda works. However, since the US Government, capable of putting people into concentration camps large and small, capable of massive spying on its own citizens, capable of running down our own economy to fund wars of occupation in foreign lands, can’t, according to the US Supreme Court, tell people that they have to buy health insurance instead of just getting sick enough that society is forced to take care of them for free (but at a higher cost to us).

Fine. Let it be that way, but maybe we have to make some other rules as well. Like, federal funds can be withheld from any state that funds hospitals that treat people without insurance. That would force states to fix this problem on their own. Or not. If not, we get a nice addition to the Third World effect, and the difference between the haves and have nots would grow and become more regional. Then, at least, we get to have a civil war instead of one of those pesky foreign wars!

Actually, I’m fine with getting rid of the mandate. It’s easy to fix. We simply impose a large additional “person tax” on every person, collectible via both income and capital gains taxes, which is double the cost of a public option insurance policy. Then, if someone buys into a public option insurance policy (probably expanded medi-whatever, with state and federal offerings, because heaver forbid we do it the easy way) then they become exempt from the tax. Having any other certified medical insurance would also exempt one from the tax.

Anyone who is stupid enough to pay the tax gets a) to pay the rest of us a lot of money and b) has no health insurance.

We don’t know the final outcome yet, of course. This concern … that SCOTUS will strike down the mandate … is based on current reporting from NPR at the scene, where arguments among people who will not be affected by their own decision in any way at all are being made.

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24 thoughts on “SCOTUS seems poised to destroy Obamacare

  1. Oddly enough this “no insurance tax” was pretty much what was in effect in Michigan (under Romney’s father as governor)for auto liability insurance. If you didn’t have proof of insurance when you went in to get plates, you were charged a tax (sorry, I can’t remember the amount — around $100 maybe– it’s been 40+ years). The tax funded a pool to reimburse people hit by uninsured motorists. It was not insurance, though, if the fund paid out on your behalf as an uninsured, the amount was added to your state income tax bill.

  2. But just yesterday, the opposite conclusion was reached by spectators based on things that Roberts had asked. Why is today’s round of questioning any more of a sign of what’s to come than yesterday’s?

  3. Aratina, I would assume that the amount of information and ability to analyze it goes up daily. Besides, what is being said today is pretty much what has been expected all along. I didn’t see the report you refer to for yesterday, though, so I can’t really say.

  4. Don’t assume that the questions asked by the justices presage their opinion.

    They’re supposed to ask tough questions — even ones contrary to their position.

    I think the main Constitutional question is a pretty simple one. Can Congress regulate interstate commerce or not? It’s pretty clear that Congress can and that the healthcare industry is interstate commerce.

    The other question is whether Congress can impose an unwanted financial burden on individuals. Sure — it’s called a “tax” in other situations. A rose by any other name.

  5. This recap of the case today, in SCOTUSblog, seems to give nuanced reporting and professional analysis.


  6. CA has the same proof of (auto) insurance law on the books. If they turn over Obamacare, they will have to throw out all of the proof of auto insurance law all over the country.

  7. Kevin — I think the difference with auto insurance is that it’s a penalty assessed by a state — and not the federal government.

    Since the (federal) government can levy an income tax, I would think that they can impose some sort of tax like Greg (Laden) suggested in his original post. The only problem with his idea is that it would require congressional approval, something that seems unlikely at this juncture, and, worse, it isn’t part of the current plan (though if the justices read it as such…)

  8. Does the requirement to carry health insurance also prevent insurers from dropping or refusing coverage? Is there any kind of ‘minimalist’ coverage that must be provided by insurers for those who cannot afford comprehensive coverage? Exactly how much is the penalty fee for not having coverage?

    This could so easily lead to a ‘damned if you do, damned if you don’t’ situation for those who are already hugging the poverty line and aren’t provided medical insurance as a part of their employment compensation (assuming they are even employed).

  9. @sithrazer: The short answer to your question is yes, the affordable care act does work both ways in adding protections to consumers to prevent the ‘damned-if-you-do’ situation described. Insurance companies are going to be more restricted in who they can deny coverage to and why.

  10. machintelligence, gwen: A federal mandate is not equivalent to a state mandate, and an auto insurance mandate (as a precondition for driving — which you don’t have to do) is not equivalent to a health insurance mandate (limited only to… people who are alive).

    sithrazer: As I understand it, insurers are prohibited from dropping or refusing coverage by the Affordable Health Care Act, but that’s not directly related to the individual mandate. The Act also includes provision for subsidies for those who can’t afford insurance by themselves. I don’t know the numbers, but the goal of the whole thing is to keep people out of poverty, not put them in it.

    I’ve never supported the individual mandate. It’s the Republican plan, for fuck’s sake. Obama campaigned against it, and that’s one of the reasons I supported him. So I’m pretty conflicted about this case. Mostly, I just hope they won’t throw the baby out with the bathwater.

  11. How bout this, stop frivolous lawsuits against doctors. This will lower malpractice insurance costs, which will inturn cut down medical costs
    Then old uncle same can regulate the insurance companies, which will inturn lower rates, then with a nominal tax you would be able to subsidize the people who still couldn’t afford the insurance.

  12. Stopping frivolous lawsuits against doctors really requires much larger civil suit reform than just this one issue. It’s something I support, but it’s a much bigger deal than you probably think. Some people say that you just “punish” frivolous or unsuccessful lawsuits, but that really removes a lot of people’s realistic ability to find justice. What you actually need to do is get rid of the mercenary civil system, and bring the civil suit system into the criminal system.

    That is, you take your case to the local DA who decides if there’s a case or not, and if there is they prosecute the case for fines and other punishments. The big problem with this is the potential for corruption. It’s 6 of one, half a dozen of the other to be honest. The big plus side is that at this point we can get over the stupid concern about oversized judgements and focus on making effective penalties for corporations.

    There are three options for health care, basically. You have single payer, you have a mandate-driven regulated market system, and you have a non-regulated insurance system that are able to rip citizens off left right and center. There are no other options.

  13. I have always thought the “mandate” was a bad idea. Simpler to have a tax to provide for a public health, single payer system, run by the government. Then have an equal tax deduction for those who buy their own health insurance. This avoids all the court nonsense and preserves choice. Only problem; git it past a bunch of lawmakers who are in the pockets of the healthcare industry, who are terrified of a public option. On the one had they claim: any time the government gets involved in healthcare you suffer, on the other: we cannot possibly compete with a public mandate because they don’t need to rake in billions of profits for fat cats like us.

  14. “How bout this, stop frivolous lawsuits against doctors. This will lower malpractice insurance costs”
    By next to nothing, this is a complete red herring:
    “Medical malpractice payouts are less than one percent of total U.S. health care costs. All “losses” (verdicts, settlements, legal fees, etc.) have stayed under one percent for the last 18 years. Moreover, medical malpractice premiums are less than one percent of total U.S. health care costs as well. Dropping for nearly two decades, malpractice premiums have stayed below one percent of health care costs. Americans for Insurance Reform, “Think Malpractice is Driving Up Health Care Costs? Think Again,”

  15. The reason why malpractice settlements have dropped is the introduction in certain states of caps. Prior to tort reform, not only were malpractice awards rising far faster than the rate of inflation, by the mid-1970’s malpractice insurance was frequently unobtainable, especially for certain specialties. Reference from Harvard University study here.

    Since the introduction of award caps in all but six states, the payouts have dropped – but in those states. The remaining states continue to see above-inflation-rate increases in payouts and subsequently, of insurance rates, again where insurance continues to be offered. Reference here.

  16. Greg, your fixes seem a perfectly sane thing to do. Should have been that way from the start. Unfortunately, if SCOTUS kills this law, that is it. It’s over for universal health-care coverage. In 2009 the Dems had control of the House and 59 votes in the Senate (plus Lieberman). It was a once-in-a-generation chance to do good things.

  17. lordshipmayhem
    I followed some of your links.
    “Empirical research has found that there is little correlation between malpractice payouts and malpractice premiums. A study by researchers at the University of Texas, Columbia University and the University of Illinois based on closed claims compiled by the Texas Department of Insurance concluded that “the rapid changes in insurance premiums that sparked the crisis appear to reflect insurance market dynamics, largely disconnected from claim outcomes.”
    Basically it is called profiteering. In New Hampshire the premiums got so high for some specialties the state had to step in and set up a fund for the insurance. The result was a whopping surplus that then started a fight between the state who wanted to grab it and the doctors who had paid in. I cannot remember who won.

  18. “We don’t know the final outcome yet, of course. This concern … that SCOTUS will strike down the mandate … is based on current reporting from NPR at the scene, where arguments among people who will not be affected by their own decision in any way at all are being made”

    It will be like other decisions from this court, made on political-ideological grounds and the constitution be damned! That disgrace to the legal profession, Scalia, has already indicated that if the mandate is deemed unconstitutional then the whole law should be simply invalidated – despite no findings concerning the validity of the other 2600 pages of it. That’s pure ideology! His sock puppet Thomas doesn’t appear to have had anything at all to say, or did I miss something?

  19. The followiing statement may sound kind of silly: as a consumer I do not commit to buying things until I know HOW MUCH THEY COST.

    As a health insurance agent, prices started to go up in the 1980s when government started putting mandates in plans. I used to be able to sell a hospital only plan for $50/month. No more. Everybody in Californa is required to have everything on their plan mandated by the state. No more cheap insurance. nobody can afford it.

    Keep the government OUT OF THE FREE MARKET. They screwed it up.
    I don’t even want to sell it anymore.

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