Health insurance is not broccoli
Nick Estes
The Supreme Court can recognize the legitimacy of Congress’ Commerce Clause power to make you buy health insurance without deciding it can make you buy broccoli.
At the recent Supreme Court arguments, Justice Antonin Scalia suggested that if Congress can regulate interstate commerce by making you buy health insurance, it can make you buy anything — like broccoli, for example.
That’s not true. There is a big difference between broccoli and health insurance!
Here it is: If you don’t buy broccoli, no one else is going to buy it for you. In contrast, if you don’t buy health insurance, the rest of society has to pay for the emergency health care you are almost certain to use eventually.
Why does society pay for people’s emergency health care but not for their broccoli? Because in our society, we generally don’t let people just die in the streets. If you don’t have health insurance, you will have a terrible time getting routine and preventive care, or following up on your doctor’s orders. But hospitals are required by law to provide emergency care and they do it. Somebody has to pay for it.
If you get emergency treatment but don’t have insurance, the hospital normally will send you a bill, frequently for thousands of dollars. Most people can’t afford these bills, at least in full, so the hospital usually has to eat much of the cost. The hospitals pass it along in the form of higher charges to those who do have health insurance (usually through their employers). This causes a huge impact on the national health insurance market – raising the price by over $1,000 per family per year.
The failure to buy vegetables, or virtually any other product, doesn’t give rise to such dramatic interstate market effects on everyone else. This is why Congress has the power to require people to buy health insurance but not necessarily the power to require the purchase of other products where failure to buy them has only a remote and uncertain impact on interstate commerce.
Benefits beyond economics
Of course, upholding this law will have beneficial impacts way beyond mere economics. People without health insurance may get emergency room care at society’s expense, but they don’t get much else. That’s not only completely inefficient, it’s completely dangerous for their health.
According to a study by Harvard Medical School, one American dies every 12 minutes from lack of health insurance.
The uninsured — adults and children — often go without screenings and preventive care. The uninsured are more likely to be diagnosed with a disease in an advanced stage, when treatment is least effective and most costly, and they may well die from it.
Research shows that these conditions greatly improve when individuals obtain health insurance.
Looking at children, for example, research shows that children with insurance are more likely to get well-child care, immunizations and prescription medications; serious childhood health problems are more likely to be identified early and children with special health care needs are more likely to have access to specialists; children with insurance experience fewer avoidable hospitalizations, have improved asthma outcomes and miss fewer days of school.
‘Individual mandate’ is critical
Everyone deserves adequate health care, and the way that is obtained in this country is through health insurance, both private and public. We can’t demand that insurance companies accept everyone for coverage if healthier people aren’t required to buy insurance like everyone else. Otherwise the price goes through the ceiling.
This is a national humanitarian as well as economic problem, and the “individual mandate” is critical to its solution. The Supreme Court can recognize the legitimacy of this exercise of Congress’ Commerce Clause power without deciding that Congress has the power to make you buy broccoli!
Estes is a health policy analyst for New Mexico Voices for Children.
So Veronica will be the Mr. Estes’ new boss, how delicious! This organization has once again shown it’s “talent” for picking leaders.
Dr.J: Heritage proposals were very limited, to ONLY catastrophic illness coverage, not a no deductible plan for everything from condoms to blood pressure readings as often as you want like ObamaCare with no limits. Thus theirs were very cheap, limited, and not everyone individually was on the hook for expensive insurance.
Dr.J:Thus those are also totally unlike ObamaCare and the socialistic “individual mandate”, it is unique and the SCOTUS knows it
So a Republican plan with a mandate limited to catastrophic coverage is fine and dandy, but one with low deductibles is an unconstitutional deprivation of our most cherished liberties? You have a very strange understanding of the constitution. The general rule is that if congress has the power to do it, it’s not up to the court to decide whether they chose the best way or to second-guess the details.
Personally, I’m supporting the Republican’s ideal plan. It’s called the “Let ‘Em Die In The Street Act.” It would remove from federal law the requirement that hospitals that take Medicare or Medicaid payment evaluate and stabilize everyone who comes into the ER. It would explicitly allow the hospitals to check finances first, and it a person was unable to prove their ability to pay (perhaps because they were unconscious) the hospital could put ‘em out on the street to die.
Right now hospitals are obliged to evaluate people and say things like “yep, you’ve got breast cancer. With chemotherapy you’d have a 95% chance of full recovery, but since you can’t pay for chemotherapy, expect to die in agony in 12 to 18 months”. That’s a silly waste of resources – just let ‘em die. Don’t bother with the evaluation.
That’d make health care like broccoli.
Dr. J:
I actually have read them, both… unlike you, who obviously hasn’t, since – setting aside the fact that not covering preventive care has actually been demonstrated to be far more expensive to the American people – you have, as usual, completely mischaracterized the contents of the Affordable Care Act; indeed, literally the only way one could possibly believe most of your viewpoints is to take the easy way out and parrot back sound-bites from the GOP and our increasingly-lazy 15-minutes-of-”news”-repeated-ad-infinitum-over-24-hours media rather than taking a surprisingly simple effort at self-education. As usual, very little you’ve said about your oppositions viewpoints and positions even remotely resembles what they actually believe, and by taking the easy way out of launching personal attacks against people who you’ve actively refused to listen to you’ve only made yourself look remarkably incapable of mature debate.
You left out another very important distinction IP, the Heritage proposals were very limited, to ONLY catastrophic illness coverage, not a no deductible plan for everything from condoms to blood pressure readings as often as you want like ObamaCare with no limits. Thus theirs were very cheap, limited, and not everyone individually was on the hook for expensive insurance. You need to read these thing, or maybe you did and just thought you could get by misrepresenting them with partisan talking points from the DNC directives.
Dr. J, once again you prove yourself incapable of reading what people actually write and insist on assuming that they believe what you decide they believe. No where did I say I do not support the individual mandate; I simply pointed out that you – as usual – have no idea what you’re actually talking about… mostly because you have an unfortunate habit of assuming that what you believe is true actually is. You are – at least partially – correct (yes, it is possible for opinions to exist in a non-absolute state); the Heritage proposal required households to purchase health insurance, and the Affordable Care Act requires individuals to purchase health care; additionally, the Heritage Foundation proposal didn’t include individual cost saving measure, provisions for waivers, or prevented insurance companies from denying insurance to people simply because there was a risk that those people might actually need to use it. For that matter, the Affordable Care Act’s version was intended to be coupled with a public option… which, of course, the Democrats in Congress gave away in a pointless attempt to gain Republican votes. Other than that, the two proposals are actually written almost identically.
IP, you do know that the version of the individual mandate in ObamaCare is nothing like the one the Heritage group proposed. And your list is not exactly the most conservative Republicans I ever heard of, many were defeated because of their less than conservative values. Please. And if ObamaCare and its’ individual mandate is such a product of “spineless” Democrats pandering to Republicans, why are Obama and all the left wing Democrats fighting so furiously to see it kept intact? Consider the author of this very article, why would he and the left wing “Voices” support something that bad? I bet even Griego would support ObamaCare and this individual mandate, and you don’t?
…socialistic “individual mandate”
…Which was originally proposed in 1989 by those well-known socialists, the Heritage Foundation, and which was widely supported by such prominent socialists as Bill Frist, Orrin Hatch, George Bush, Sr., Chuck Grassley, Mitt Romney, Newt Gingrich, John McCain, Robert Bennett, Tommy Thompson, and Chris Bond, some of them as recently as September of 2009. Seriously, Dr. J, do you ever bother to learn about things you insist on pretending to speak with authority on, or do you just assume that because you believe it, it must be true?
Incidentally, stever, this proposal is exactly what I was talking about when I mentioned spineless Democrats filling bills with Republican ideas in an attempt to get bipartisan support, which the Republicans then vote against only because they’re being proposed by Democrats this time. This is why I don’t simply ignore the complete non sequiturs you insist on spouting; it would be irresponsible for me to let such ridiculous statements go unchallenged.
QT, read my comment again and again, then read your’s again.
IP You really should stop responding to me. I’m wasting your valuablr time.
concerned, paying a fine is not the same as personal financial responsibility wrt car insurance. You don’t “pay” anything in the car insurance example, you just have to show you could if needed, big difference, no government revenue. And it seems some, for various political reasons and to ignore a certain demographic the liberals want to ignore, forget that Social Security and Medicare are only forced on you to be “bought” by government if you work and earn money. There are millions who don’t and don’t pay anything into it. Thus those are also totally unlike ObamaCare and the socialistic “individual mandate”, it is unique and the SCOTUS knows it.
stever:
Not buying it, or not getting it? There is a subtle but important difference. Also, do I need to comment on the wild hypocrisy of making a direct assault on another person’s education level for having the temerity to disagree with you only the day after a discussion about your apparent insecurities over the belief that others are doing the same to you? Just because you ignore reality doesn’t mean it isn’t true.
That’s kind of witty Stever but I don’t get it, caring for health isn’t optional? Oh, now I get it, Republicans don’t want caring for health to be an option. One can either afford it or one cannot.
Let’s see, what else does my Federal tax bill pay for besides Dick Cheney’s healthcare?
btw, erikhawkes, excellent blog!
IP Sorry, not buying it.
Could you be serious for a moment
If you can’t distinguish between a state requirement for motorists to have liability insurance for an optional activity and the federal mandate for everyone, then your not educated enough to be serious with.
Stever, you are so witty! Could you be serious for a moment and explain to me why gay people who don’t have children have to pay school taxes? My biggest bills are taxes and I pay them to the government.
whaussamen, I too see the conflict when it comes to auto insurance and health insurance – obviously both help the general public and provide other positive benefits to the citizenry.
The Republican agenda remains entrenched in corporate handouts, protectionism for the rich, selected priviledge, greed and the other deadly sins.
Author wrote : “due to the fact that the U S had little or no money to fund such a project, so passed it on to the owners.”
If one accepts this reason as needing to pass a cost on to the owners then the idea of individual mandated health insurance makes equal sense. We are bankrupting our economy with an archaic system of delivering health care to the very people who own it, the taxpayers. Why should we not require the citizens to carry insurance when they have the ability now to pass the cost on to the taxpayers via indigent funding, emergency rooms, etc. ?? We are already paying for the system.
…he/she then writes: “The ship owners of that time were taking undue advantage of the seamen, thus a protection was instilled. But at no time did the government take over the insurance companies duties, nor en-snarl the country in a costly project that it could ill afford.”
I’d argue that the insurance companies are the current embodiment of the old ship owners and the customers are the embodiment of the seamen. We who are stuck with a closed system of health care insurance are forced to pay the costs of the uninsured also through taxes. Yet, we have no recourse but to pay the exorbitant costs or go without coverage. Forcing all those in the healthcare system (virtually every citizen) to pay something results in a larger pool of payees and a lower rate individually. I see no language in the health care reform act that allows the government to take on the duties of the insurance companies. In fact, they love the idea of 40 million new rate payers in their rolls.
Actually, Dr. J, Obamacare does allow one to take “personal financial responsibility” and pay a fine instead of purchasing health insurance. And yes, no one is forced to drive a car—but with health care there is still the issue of liability. If you do not purchase health insurance, when you require (and indeed you will) expensive medical treatment, taxpayers and those of us who do have insurance will be liable for the cost of it. All of those blathering about ‘liberal’ policies seem to have forgotten that the individual mandate came out of the Heritage Foundation. Hardly a bastion of liberalism. Among the things that the government ‘forces’ us to buy: a retirement plan (social security) and medical coverage for our senior years (Medicare). Unfortunately, the for-profit insurance lobby will fight to the death over a similar single payer system (Medicare for all) because they know it will be the death of their high-margin cash machine.
Come now, stever, pay some attention; it’s hardly the first time that Republican members of Congress voted against things they supported simply because Democrats were the ones proposing them; the GOP has turned into an absolutist cabal more interested in being right than doing right, and most elected Democrats are, as usual, so obsessed with the actual definition of bipartisanship that they are perfectly willing to spinelessly tailor each and every bill to win votes from Republicans whose own party would never let them vote alongside Democrats no matter how beneficial doing so would be for their constituents.
“ with a strictly Republican plan”
that not one single Republican voted for. Come on, they could barely get enough Democrats to vote for it and you’re going to tell me Republicans prevented passage of a single payer system.
qofdisks says:
“With the Democratic sweep after the disaster of the Bush Administration, President Obama and the Democrats missed an opportunity to really institute change and we ended up with a strictly Republican plan that basically let the industry write the law such that many of the systemic problems will go uncorrected.”
My, how quickly you either forget or wish to alter history for your own partisan agenda. If you will remember, there was not one single Republican vote for ObamaCare. It was legislation passed by 100% Democrats, if you don’t like that, talk to them, don’t complain about Republicans.
I agree with Otis comments of compassion and common sense. I also want to add that it is not only the people that do not have coverage that are in trouble. Working people that have jobs offering insurance are paying hundreds every month in premiums for health insurance that does not function as protection from financial ruin or can not be relied upon to cover a major illness or injury. Insurance premiums are increasing at double digit rates every year while paychecks are stagnant. Co-pays and deductibles have gotten to the point where insured people cannot afford to go to the doctor and delay treatment almost as long as an uninsured person with the effect of higher health costs due to lack of timely maintenance and monitoring.
Our healthcare system is not only un-affordable, it is Byzantine and utterly undecipherable with respect to record keeping, obtaining treatment, billing and pricing. Doctors are over-worked and underpaid and hardened of heart while nurses are being laid off and the few that are left are over-worked. Hospitals are bleeding money. Medications are the most expensive in the world. Everyone involved is left with trying to game the system just to desperately survive with a modicum of compassion.
This nation’s healthcare system is just so incredibly inefficient and broken.
With the Democratic sweep after the disaster of the Bush Administration, President Obama and the Democrats missed an opportunity to really institute change and we ended up with a strictly Republican plan that basically let the industry write the law such that many of the systemic problems will go uncorrected.
So what is the difference in government mandating auto insurance versus health insurance?
State governments vs the federal government. Federalism look it up.
QT, try paying attention to the issues. There is a not so subtle difference between taxes and what is at issue here. I understand it may be confusing but give it a shot.
Because w, you don’t have to have a car or drive to live in this country. ObamaCare requires ALL people to have health insurance, and no amount of “personal financial responsibility” money or bond is allowed to substitute. No exceptions, no allowances, or you will be fined and the money goes to the government. Typical one size fits all left wing government bureaucracy.
A quick search for auto insurance requirements by States indicates a mandatory requirement in most states including New Mexico which requires liability coverage that covers at least $20,000 per person for injury to one person, $50,000 per accident for injury to more than one person, and $10,000 per accident for property damage. New Mexico, drivers who can prove financial responsibility,$60,000 cash available to cover costs incurred through an accident, can provide self-coverage rather than using an insurance company and must provide proof of financial responsibility to the state. It appears that states that don’t require auto insurance require proof of financial responsibility.
So what is the difference in government mandating auto insurance versus health insurance?
Otis, the 1790 Congress passed the laws as a temporary measure, due to the fact that the U S had little or no money to fund such a project, so passed it on to the owners. It was a failed and faulted measure which was later abandoned.
Taken in context you have to remember that we had just fought a War of Independence, but some measure had to be taken to protect the country, thus mandatory arming of the country. The ship owners of that time were taking undue advantage of the seamen, thus a protection was instilled. But at no time did the government take over the insurance companies duties, nor en-snarl the country in a costly project that it could ill afford.
As is usual in American debate the principle point is money, cost, finance, etc. A human being’s health is not only about cost, finance and affordability. They are slightly more complex and their health involves significantly more than just how much something costs. It’s the old adage about the fool who knows the cost of everything and the value of nothing. The burden of not having health care for her children to a single mother struggling to provide a decent home can’t be quantified in dollars. The emotional drain to a family who are decent, hard-working and perhaps self-employed in a marginal business yet can’t afford the huge costs of medical insurance don’t show up in any budget analysis. One of the striking differences in our quality of life and that of more civil societies is universal health care. Anyone who has spent time in a western country enough to be introduced to some of the day-to-day realities of the citizens knows the quizzical look when the subject of health care comes up. The quality of life (there is such a phenomenon) is different in societies where huge segments of the society don’t struggle with fear and dread of the health care issue. They tend not to understand how a country like the U.S. where many (falsely) claim t have the best system in the world can leave tens of millions out of the system. We won’t even go into the discordant claim of our being a “Christian” country wherein about 42 million citizens can’t access basic healthcare other than on an indigent or cash basis. The fiscal aspect of health care is, of course, very important. But, it is not the only aspect of why universal access to health care is an idea whose time has come.
The first congress in 1790 mandated that ship owners purchase medical insurance for crew members. The congress of 1792 mandated all able bodied men would purchase firearms. The myth that the government has never required citizens to purchase service or product comes from folks not familiar with the issue. One of the amicus briefs filed in the current case outlines these cases. It was filed by one of those left wing liberals from Haaaavad Law. His name is Einer Elhauge and his article can be found in the recent The New Republic wherein he ‘splains the argument.
Yo Eric, Congress made me buy Dick Cheney’s new heart, it also made me buy a certain cost for he and Bush’s trillion dollar illegal war in Iraq. I am not in the one percent so I have to pay taxes.
Besides, I am all for something that will ultimately bring insurance and medical costs down.
Congress cannot make you buy anything; not under the commerce clause or any other clause. Therein lies the problem. The U.S. government has been hijacked by criminals trying to install a fascist technocracy. Furthermore, to assert that health insurance be mandatory is to say that LIFE is a privilege not a right – which is pure evil.
I am not a consitutional scholar or even a lawyer but the ends don’t necessarily justify the means. Its a nice thought, makes for compelling debate points and political ads but its not that simple. That’s the question before the court, is this type of “mandate” constitutional without regard to its purpose?
Sorry, not very convincing and of course given the source I know why. I have to agree with Justice Scalia, and I suspect the majority will too. A very invasive and expansive government based on left wing ideals, like we had when Obama came to power in 2009, could justify most anything based on “the common good” and their view government is the answer to all things society needs. Take broccoli, they could argue it is so healthy, full of fiber, and low in calories that it would be the ideal food for every meal. It would reduce heart disease, obesity, colon cancer, why all manner of health problems that cost many billions of $$ to society each year. Therefore, it would be mandated that people buy and eat it three times a day, a minimum of some portion size and a new government agency would be formed to ensure compliance and police it with penalties, fines, maybe even jail time to offenders. Don’t think it is possible? Just wait and see what happens if the individual mandate is upheld and the camel gets his nose into your tent, big brother will not only be watching but in your lives almost daily for many things to make sure you comply with the “rules”, its’ for your own good you know, and the “common good” of course.
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