With the impending, and unprecedented, 3 days of arguments over the Affordable Care Act occurring early next week, it's interesting to see that the test case being used to challenge the law has now become a test case demonstrating the necessity of the law.
Mary Brown, the woman who asserts no one has the authority to make her buy health care is now bankrupt, at least in part due to medical bills. From theLA Times article:
Mary Brown, a 56-year-old Florida woman who owned a small auto repair shop but had no health insurance, became the lead plaintiff challenging President Obama's healthcare law because she was passionate about the issue.
Brown "doesn't have insurance. She doesn't want to pay for it. And she doesn't want the government to tell her she has to have it," said Karen Harned, a lawyer for the National Federation of Independent Business. Brown is a plaintiff in the federation's case, which the Supreme Court plans to hear later this month.
But court records reveal that Brown and her husband filed for bankruptcy last fall with $4,500 in unpaid medical bills. Those bills could change Brown from a symbol of proud independence into an example of exactly the problem the healthcare law was intended to address.
I think at this point the solicitor general just has to point at the plaintiff and say "See! See!".
People without health insurance are still covered by the ethical obligations of EMTALA. They can still see doctors and get treatment and not pay their bills. Then who pays for it? All of the rest of us.
The "individual mandate" should be called a "personal responsibility" provision, because the fact is all these rugged individualists are parasites. They are refusing to pay into the system then benefiting when they, inevitably, need to use it.
And how about the argument that the commerce clause can't for such an individual responsibility provision?
The couple owed $2,140 to Bay Medical Center in Panama City, $610 to Bay Medical Physicians, $835 to an eye doctor in Alabama and $900 to a specialist in Mississippi.
"This is a very common problem. We cover $30 million in charity and uncompensated care every year," said Christa Hild, a spokeswoman for the hospital center. "If it's a bad debt, we have to absorb it."
So, this couple has generated bills in three different states that they now will not be able to pay and the rest of us have to eat the bill for them. It's amazing how the plaintiff's own actions have justified nearly every argument for the bill. When healthcare now represents something like 1 in 7 dollars spent in this country, how can we argue that the commerce clause does not allow congress to regulate it?
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The biggest problem of the uninsured is that by the time they need it, what could have been a preventable (or easily treatable) problem is something serious enough to demand attention - and the more they dislike hospitals, the worse the problem is going to get before they do something about it.
While it is true that people accrue debts with hospitals and such and that everyone else has to absorb those bad debts when they are not payed, it cannot be denied that forcing people to get health insurance is terribly immoral and against the constitution. The real thing our country needs to do in order to fix this problem is to not require hospitals to help people unless they are payed upfront. Essentially what requiring people to have health insurance is doing is taking the burden of self-preservation off the people and handing it to the government. As a country, we cannot lose another one of our rights!
@2 Lee: "it cannot be denied that forcing people to get health insurance is terribly immoral and against the constitution." Lee, I don't know where you live but in every state I have lived liability insurance is required to register a car, the alternative is to pay into an uninsured motorist fund, i.e. be taxed. Requiring people to get health care insurance is the same as requiring ever car owner to get liability insurance - where is the constitutional challenge to those laws. God requiring someone to kill his child is immoral - don't think morality applies at all here
An ad hominem is a fallacy and therefore doesn't make an argument. You never wondered why Lady Justice has a blindfold? You have to support government forcing you to buy something with no reference to any individuals, stereotypes, etc.
@ Lee: "The real thing our country needs to do in order to fix this problem is to not require hospitals to help people unless they are payed upfront."
I am ashamed to share my nationality with you.
The fundamental difference is that you can choose whether or not to own, use or drive a car (which is considered to be a privilege), and the insurance mandate is attached to that. The health insurance mandate is attached to simply being a resident of the country, and is therefore a different ball of wax. While I may favor the mandate on purely pragmatic grounds, I don't think it's an open and shut case as to whether this is constitutional.
LC@2:
So be sure to hand your credit card to the cashier as you are wheeled into the trauma center!
What was it that Gandhi said about people like you, Lee? Oh, yeah:
@Lee "it cannot be denied that forcing people to get health insurance is terribly immoral"
I deny that it is _terribly_ immoral.
Gunning down an innocent kid in the street is.
But you have an odd scale of what is and is not terribly immoral. Genocide? Poisoning an ecosystem? No, it's requiring folks to pay for health insurance, while also subsidizing it for poor folks.
Due to EMTALA and ethical constraints hospitals have to take all comers.
All people will require some form of health care at some point in their lives. Forcing others to pay for it is irresponsible.
This measure should not be called a mandate. It should be called "personal responsibility". After all, you still have a choice, you can still refuse to buy insurance, but then you have to pay a tax that represents the burden those who make that choice impose on the rest of us.
We are paying for the medical care of the uninsured. It raises all of our premiums. Costs get shifted to governments, hospitals and the insured and we're sick of it. Be responsible, pay for your damn selves.
This may or may not damage the case against affordable care act, but either way it's still damning for the status quo. Even if she (56 years old) and her husband had insurance, it's quite possible that the only policies they could afford would have had deductibles higher than $4500.
@bobh-There is a very large difference between car insurance and health insurance. The only car insurance that is mandatory (at least in my state) is insurance that is protecting the other person. The only mandatory car insurance is car insurance that protects the person that you hit. (Last time I got rear-ended, my bumper got replaced, they guy's bumper who rear-ended me did not get replaced). Health Insurance, on the other hand, should be a personal choice because it only protects the person who is buying it. If I don't care about being protected in the even of personal illness, then I shouldn't be required to buy health insurance.
recap:
car insurance-protects the other people; mandatory
health insurance-protects you; not mandatory
See, this is one of the big lies of the GOP. They ***always*** talk about, "Taking personal responsibility". Yet, the reality is, the moment someone tries to enforce it, or demand it, it becomes, "invasive", "persecution", or a, "unreasonable government mandate".
Case in point, as of just this last week or so a state representative in Arizona, and a Republican, was ticketed for running a red light. While he paid the ticket (personal responsibility), he is now proposing to change the law, so that he won't be ticketed again, for the same offense (i.e., denying that it should have been his responsibility, or that what he did was wrong, but that the law was, instead).
The words, "personal responsibility", for these people means *everyone else*, not them. The moment it becomes them they they look to remove laws that inconvenience them, find loopholes, hide what they did, get other people to lie for them, or "rally the base" against, "unreasonable government regulation". Absolutely *everything* other than taking responsibility. The only difference in this case is purely that there is someone they don't like in the Whitehouse, and fighting against the requirement that people take real responsibility for their choices is useful politics right now. If it had been one of them elected, they would be, right now, insisting that this was the *correct* way to fix the problem, would force everyone to be responsible, and anyone claiming otherwise is a communist.
Oh, and just to be clear, how many people, tonylurker, what percentage of people, in actual reality, can get by with, in all but major cities, where if everyone was using it, it probably wouldn't be close to adequate anyway, public transportation, instead of "choosing to drive"? 5%, 10%, 50% (at the most)? Why the hell, if half or more of the people in the entire country pretty much *must* drive, would it somehow be less of a "mandate", instead of choice?
And, that said, we also do silly things like mandating that people feed their kids. While we have a lot of states that allow certain things I consider abuse, at least 6 of them ***do not allow*** parents to get by with not taking their kid to a doctor, and having them die instead. We require schooling. Why? Because ignorance people that don't know anything, make bloody poor citizens. There are mandates all over the place, some are for safety, some are for our well being, and some are *both*. And, every one of them is enforced, either by having us pay to buy the stuff needed to abide by them (safety equipment for workers, for example, which a company, or the worker, in some cases, can't just choose not to have), or via taxes.
So, its total BS that requiring "accident/health problems" liability insurance is a) different, or even b) not an issue of public safety. At the very least, I don't want the guy that can keel over at any moment, that is dizzy for no reason they can figure out, who has a life threatening problem, they don't know about, or could have a full blown coronary/aneurism, from an unidentified, etc., stumbling into the road, fainting while driving, dying while giving *me* medical treatment, like surgery, or becoming confused by a head problem, or mental problem, or what ever else, and accidentally poisoning my food, building my car wrong, forgetting to reconnect my break lines... Do I have to go on?
Its not about someone with the damn sniffles. That is when they should have gotten checked in the damn first place, so it didn't turn out to be some odd fungal infection, or something, which a few months later puts them at the head of a 50 car freeway pileup, because their brain exploded that day, while I was in the 5th car in the pileup, or something. People that can't stay healthy endanger me, could make me sick, either can't, or shouldn't be, working, and *can* have things wrong with them, which could have been detected and dealt with, which ***could*** not just inconvenience you, but kill you.
And, you think both that a) its not the governments job to make sure those people stay healthy, and get treated, or b) that if the government won't bloody do that, we shouldn't "force" them to do it themselves, and take responsibility for the consequence, if they won't? Do you really even understand what is going on here, or do you think we are talking about people deciding whether or not they want to buy a band-aid, when they get a paper cut?
@Lee: "recap: car insurance-protects the other people; mandatory health insurance-protects you; not mandatory"
Do you know how to read? Look at what Mark says in post 10 (or look at the facts of how our health care system currently "works"):
"...you still have a choice, you can still refuse to buy insurance, but then you have to pay a tax that represents the burden those who make that choice impose on the rest of us.
We are paying for the medical care of the uninsured. It raises all of our premiums. Costs get shifted to governments, hospitals and the insured and we're sick of it. Be responsible, pay for your damn selves."
Mandating health insurance DOES protect the other people from having to front the money for care when the uninsured inevitably require medical attention.
Recap: whether or not YOU care about being protected, your country and the medical community cares about it; they WILL and MUST treat you if you are injured/sick, by law and by a code of professional ethics. So be it through purchasing insurance for yourself or paying a tax to cover the cost of your healthcare, you should be paying your own medical bills, not your fellow Americans; wouldn't you say?
Unless of course, you're a dirty Commie...
(couldn't resist)
@NJ: I loved your bringing in the Ghandi quote. Then I just checked Lee's link to his page:
"The Christian Perspective on Political and Science Topics"
HA!
So, Lee; the "Christian perspective" here is "Eh, let 'em die"? Really?!
You disgrace your nation AND your religious-namesake
(A sad day when the areligious have to take the high ground with the Christians on basic moral/ethical questions...)
@lee ... The real thing our country needs to do in order to fix this problem is to not require hospitals to help people unless they are payed upfront.
OK: let's take that idea and see where it leads.
Are you prepared to pay the EMTs when they arrive at the scene of an automobile accident, as you are lying there pinned under your vehicle? You want them to leave you there, squished, until you can manage to get out your wallet and prove you can pay for the care and the ambulance ride?
Do you want the ER to leave your injured child in the aisle until you can get there with the several thousands it will take to treat the head injury he sustained during football practice?
If you collapse while hiking a local park, who will go to your car to retrieve your insurance card?
Your attitude is "let them die in the gutters like rats".
I hear a lot of things I agree about, a lot I don't. I am a public employee in WIsconsinwalkerstan who has had my insurance go from one in which I and my family would get ourselves checked if we had health issues that constituted a true concern to one in which we now cannot afford to go in unless we are concerned for our survival--because our new insurance has such a high deductible that it may cause us to lose our homes. What now? Hope I don't steal the thread, but what do we do without some national standard?
The time has come to destroy the US government.
Yes, yes. We all know you're oppressed now that you have to stop being a fucking leech on society. Bet you hate welfare and food stamps though. You wouldn't be a martyr unless you hated welfare and food stamps.
"it cannot be denied that forcing people to get health insurance is terribly immoral"
Uhm, how can it be immoral to require that people pay for what they'll need? Is it immoral for your insurer to require you pay insurance premiums BEFORE you need to claim???
"and against the constitution"
Yeah, where does it say that?
"The fundamental difference is that you can choose whether or not to own, use or drive a car"
And if you could choose whether to get ill or not, and if you couldn't infect others, then this analogy would hold.
But it doesn't.
You can't choose whether to pay your taxes or whether to obey the law. You can't choose whether to pay for the purchase or just walk out the shop without paying. And you can't choose to ignore a contract agreement.
But tell you what, if you don't like a country that will give healthcare to people without paying, you can leave the USA and go to a country that doesn't do that.
I hear Somalia is lovely this time of year.
"Health Insurance, on the other hand, should be a personal choice because it only protects the person who is buying it"
Nope, since I can't choose whether you can infect me if you go untreated.
YOUR healthcare protects ME.
I feel like I've said it so many times I'm going blue in the face. We are paying for the uninsured already. Their actions are forcing our premiums, taxes, and bills to be higher. Your car analogy doesn't work, if anything it makes our case because your health insurance protects us from having to pay for you when you get sick. What imaginary place do you live that the uninsured get sick and then just stay home and die?
In 1798 the congress passed a law requiring mandatory health insurance for any private employees working on Maritime vessels. At the time sailors were a very poorly paid, and often an unhealthy itinerant population which would regularly impose great healthcare burdens on port cities. If good part of the merchant fleet arrived at once the locality could be bankrupted.
This was signed into law by Adams, one of the 'founding fathers', so given they wrote the constitution one might assume they thought it constitutional.
http://www.addictinginfo.org/2011/11/11/the-u-s-passed-mandatory-health…
@jpgk-insults in this disscussion are uncalled for. Anyway, if I have said anything that is communism then Ihave either mistyped my words or the computer has glitched. To rule that out, I went back and reread all my previous quote and did not not find any communism in them, what I found was capitalism. All I have been advocating is that people should take responsibility for themselves-this is the basis for capitalism. Socialism is, actually, what government health care is.
@Tsu Dho Nimh-When did I ever say I wanted people to die in the gutters like rats? Are you not aware that I also would be included in this free market healthcare plan? Are yoi not aware that doctors should have the right to only treat people if they pay their bills? Are you not aware of how many times patients will simply walk away after having been treated never to pay their bills (that is no differnt than robbery)? Why should doctors have to pay for these paitent's bills? It is no differnt than if someone walks into walmart to buy food and yet they have no money. Will walmart let them buy food? No. If walmart decides to be charitable then they can give the person some free food, but no onee in their right mind is going to give every bum off the street free food. Why? Because that would raise the price of everyone else's food. This ties into the no government health care because, if there was universal government health care, everyone would be paying for everyone elses insurance. That would create a monopoly on the insurance companies. Last I heard, the government was all for breaking up monopolies. Alzo, if we can make government health care, why not make a government grocery store. If we made a government grocery store, then people would all be able to be fed for free! Then we could make government housing, we could all live in vovernment accomidated houses a nd taxes could pay for it all. But, wait, there's more, we could all have government issued clothing and we could pay for it through taxes. I'm starting to sound like a socialist aren't I? And it all started with government health care.
Lee, you're becoming unhinged.
EMTALA requires physicians to treat all comers. It's actually protective since doctors are obligated by our code of professional ethics to treat the sick, even if they can't pay. If you think doctors will turn away the sick because they can't pay you are wrong (we may turn away the healthy however). This will never happen. Give up on it. It is a pipe dream. It is against everything we stand for as a profession. How many more ways can we drill this into your head. IT WILL NOT HAPPEN.
This law is addressing the fact that people are not taking responsibility for themselves. It is forcing people to stop making others pay for their medical care. It is personal responsibility incarnate. This is the equivalent of liability insurance for your car because when your body crashes and you're not insured, we pay. The insured, the working, the taxpayers pick up the bill. We're sick of it.
Your paranoia about this being a slippery-slope to socialism is not borne out by the world experience. We are the last industrialized country not to have universal health care. However, we are not the last capitalist country. While there is an element of socialism in all countries, even ours, universal healthcare has not ended capitalism in Japan, Germany (universal healthcare since the 1800s), Singapore, Australia, Italy, France, New Zealand etc. They are all still capitalist countries, and guess what. They pay 50% as much per capita for healthcare, while providing better, more comprehensive care to all.
This also does not generate monopolies as there are multiple insurance companies. This argument makes no sense.
Calm down, count to 10, and take a look at the data. Look at the rest of the world. Health care is not Armageddon. Not even close. If anything it will make the US more competitive, increase our standard of living, and decrease the cost of care. All while making sure everyone takes responsibility for the cost of their care.
"@Tsu Dho Nimh-When did I ever say I wanted people to die in the gutters like rats?"
When you said this:
"not require hospitals to help people unless they are payed upfront."
you two-faced buffoon.
"Alzo, if we can make government health care, why not make a government grocery store"
1) You don't have to.
2) Food stamps.
"then people would all be able to be fed for free!"
Are there no poorhouses? Maybe they should just get on with dying and reduce the surplus population, hmmm?
"Then we could make government housing"
You already do.
"But, wait, there's more, we could all have government issued clothing and we could pay for it through taxes"
You already do, except it's not paid through taxes to government, but by raised premiums to a corporation who will want a percentage of the cut, thereby increasing the premium by MORE than the cost.
As an American living in Japan, I can tell you that EVERY foreigner from Britain and the US that lives here LOVES the Japanese national health insurance system. It's a flat 9% of your income, whatever your income is. It is NOT market-driven (thank god), but instead most prices are regulated by the government. Even if you are uninsured, or refuse to carry the national health, it's still so, so much cheaper than the US. And there is no bullshit "pre-existing condition" clause either. It ALL gets paid for and dealt with.
Yeah, yeah, everyone in America has the stupid knee-jerk reaction of "OMGSOCIALISM WHYSHOULDIPAYFORYOU" but here's the thing. Living in the USA, barely making ends meet, I was told that my health insurance would be 300 dollars a month, regardless of my salary. I barely made 900 working full-time, so there was no way I could carry insurance, and my employer didn't offer it. But if it were a flat 10%, I could have definitely afforded that. And living in Japan, I don't feel one bit guilty that the guy down the road who makes half a million a year is having to pay 50K for insurance, part of which is helping me and other people who don't make as much, because oh poor guy, he still has 450 thousand dollars left to play with. I don't mind having mine skimmed either, because I can afford it, and it gives me peace of mind.
So Markh, your post of "We are paying for the medical care of the uninsured. It raises all of our premiums. Costs get shifted to governments, hospitals and the insured and we're sick of it. Be responsible, pay for your damn selves" really pissed me off. Maybe if healthcare premiums were actually AFFORDABLE for the working stiff, the US wouldn't be having this problem. Maybe if hospitals didn't OVERcharge the uninsured to make a profit off of what they couldn't bilk the notoriously stingy insurers for, say, $200 for a Bandaid, we wouldn't have such a crisis now. Or even better, maybe, since insurance is essentially a gambling business, if insurers were required, as casinos are, to return 97% of their income on payouts, we wouldn't have this crisis. And casinos make a hell of a lot of money even on a 97% payout, fyi.
Oh, and the Japanese are the healthiest, longest-lived people on the planet. I think their evil, godless socialist medicine, where the rich help the not so rich and the poor, and everybody pays at least something (except for the truly poor) has a lot to do with that. Oh, and doctors make extremely good money, too, no lack of a generous income on their end despite 'government interference'.
Is their health care system perfect? Of course not, I do have issues with it sometimes. But coming from a country where I could never have afforded health insurance on my own, and where said insurance is rapidly getting to the point that only the wealthy or very, very well-off can afford the premiums, I am so glad to have the Japanese system to depend on. The 9% is far, far more fair to everybody than what is available in America. It's just a shame that Americans have this irrational fear of government-mandated health care, which, if it forced insurers to pay back 80%, would actually be more affordable. And yes, the $200 bandaid story is real.
So, Lee, would it be immoral if your state did it? (Like Romney did in Mass.)
A covered colonoscopy I just had found something that needs to be removed before it turns into invasive cancer. I had no symptoms. Luckily I have insurance.
If I did not have insurance, think how expensive that would be to *you* if I would walk into an emergency room a few years hence with full-blown colon cancer and no way to pay? Would it be moral to allow me to suffer like that and bankrupt myself before passing the rest of the costs on to you?
Ex Pat. You are right. I've been too general in my criticism. Those that can afford health care and don't get it are being parasitic. I feel like with the libertarians here making that argument the comparison is justified, and they are not using as an argument that they can't afford it. Also, the ACA is going to subsidize those with lower incomes so that they can either buy into employer plans, health exchanges, medicaid/medicare etc so hopefully affordability isn't going to be the issue. This won't be an unfunded mandate at least.
So, I apologize, as stated it sounds like I'm blaming the poor for being uninsured, that is not it at all. I'm rejecting the notion that those that refuse to pay it on principle are anything but parasites because they will get sick, and we will still have to pay for their care. They are like the driver without liability insurance.
Thanks for the description of the Japanese system. I'd read about it and it sounds great, hopefully stories like yours will help the Lee's of the world realize that universal healthcare doesn't cause the death of capitalism/puppies/love/jesus etc.
@Lee: Not much of an argument, and it ignores the evidence about herd immunity (it's not just vaccines!!) and patterns of the spread of disease.
We live in a world where people can travel thousands of miles in a day.
Some of 'em can be carrying bugs of some virulence which are comparatively easy to disperse through a population quickly - therapy-resistant TB, for example, or some of the nasty influenza virii. Such bugs can get into the population and spread.
Sure, upper-middle-class and upper-class folks might be able to get treatment, but in a society without a minimum threshold for care, it'll be like India, where the prevalence of disease among the working class and poor means everyone is exposed to diseases which tend to get more resistant to treatment because they're never really treated en masse.
Granted that your fantasy of a world with no safety net makes you wet, but y'know, it kind of ignores the overall social costs of living without a net. Think of early Industrial Revolution Victorian England, or the current state of things in much of the third world where our manufacturing occurs.....illness breaks people, families, and lack of treatment spreads disease and exacerbates the problem.
I don't care for the mandate myself, because I think it's a huge giveaway to the insurance industry. But if it gets us significantly closer to universal care, it's an OK step. Personally, I think single-payer ("Medicare for all") is the way to go, but convincing selfish people like yourself to share is akin to shoveling back the tide.....people like you never see reason until you've been in a position where you suffer from the lack of regulation or mandate, and then often say "well, *my* case was different, I deserved care" rather than understanding that EVERYONE in that position deserves care....
If the Browns can't afford $4500 in medical bills, then they can hardly afford insurance premiums, and this law is not much help to them. Nor is it much help to others who need health care, not just health insurance. There is little in the way of cost controls in this law that requires Americans to contribute to the profits of insurance companies.
A single-payer system would be a humane way of addressing our health care access problems. It's disappointing that Obama went with the Romney model instead.
This thread reminds me of the hypocrisy of Ayn Rand, who complained bitterly about the eevils of socialism, but after she got lung cancer from smoking like a stovepipe all her life, she eagerly claimed Social Security benefits to pay her medical bills. That "principled stand" always breaks down when the lone wolf suddenly realizes he has to rely on society after all.
Re MarkH @ #25
Yeah, that German national health plan was proposed by that dangerous socialist, Otto von Bismarck. End snark.
@12 Lee, your health insurance protects me. You will ge the medical care you need but I will end up paying for it in higher insurance premiums and higher taxes. Just like liability insurance for uninsured motorists protects me, so does health insurance for you.
To whoever wrote that car liability insurance is different because driving is a privilege. Health care isn't and someone has to pay for it. Now I suppose I might accept removing the "personal responsibility" part of the Affordable Care Act for everyone like Lee whom I assume would be willing to sign a living will that states that under no circumstances should anyone provide any medical care of any kind. Anyone against the affordable care act because of the "personal responsibility" requirement who won't sign such a living will is just a free loader who wants what society can provide but is not willing to pay his share for the benefits.
JN #31,
While you may favor a simple single payer system, it's wrong to state that Obamacare has little in the way of cost controls.
"Democrats, on the other hand, are promoting a slew of delivery-system reforms in the Affordable Care Act. Theyâre hoping competitive bidding works, but theyâre also trying comparative-effectiveness review, pay-for-quality, accountable-care organizations, electronic health records, penalties for excessive readmissions and medical errors, and a host of other experiments to determine which treatments and processes actually work and how to reward the doctors and hospitals that adopt them."
http://www.washingtonpost.com/blogs/ezra-klein/post/why-ryancare-and-ob…