Hsieh On Obamacare: Three Important Take-Home Points
Paul Hsieh, MD, blogs at Pajamas about America in the wake of the Supremes' Obamacare ruling:
1) American health care will be in deep trouble in just a few years.Not only does the individual mandate stand, but also all the other provisions including various new taxes, new regulations on the insurance industry, and new payment and practice standards for physicians.
CNN recently reported that 17% of doctors in private practice might close shop within the next year due to a combination of factors, including "business expenses and administrative hassles, shrinking insurance reimbursements and costly malpractice insurance." Under ObamaCare many will likely join large "Accountable Care Organizations" or become hospital employees, accelerating the government-driven collectivization of American medicine. Under new medical practice incentives, doctors will become increasingly beholden to their paymasters, rather than their patients.
Medicare patients will also face de facto rationing under the Independent Payment Advisory Board (IPAB) which will set physician reimbursements. Given that private insurance companies generally mirror Medicare coverage and payment decisions, this means these government restrictions will likely affect millions of Americans with nominally private insurance as well.
However, Chief Justice Roberts also noted that the Court "does not express any opinion on the wisdom of the Affordable Healthcare Act." Rather, "That judgment is up to the people."
In other words, if Americans want to repeal ObamaCare, we will have to do it ourselves.
2) There are plenty of good ideas for free market health care reform.
Details at the link.
3) ObamaCare must be defeated politically.
The American people will have one final chance to kill ObamaCare at the ballot box this November, by electing politicians committed to repealing it. If Americans value their lives, they must repudiate ObamaCare soundly at the ballot box. The elected officials who supported it two years ago should sent packing.
Sorry, but I'm not optimistic. Nor am I optimistic that the reforms that were needed -- like untying health care from the workplace and allowing interstate purchasing -- will be enacted.
Here's Hans Bader on the harms of Obamacare at OpenMarket:
Regardless of whether it is unconstitutional, Obamacare will harm the health care system and reduce employment. The Dean of Harvard Medical School, Jeffrey Flier, noted that Obamacare will harm life-saving medical innovation. Obamacare is causing layoffs in the medical device industry. The healthcare law taxes medical devices and cosmetic surgery, arbitrarily discriminates against certain hospitals, and raises taxes starting in 2013 on investors. The Associated Press and others have noted that it breaks a number of Obama campaign promises.







I am not happy, but it could certainly have been worse. By applying an argument that borh sides and most pundits had considered - and discarded - that a financial penalty is a tax, Roberts was able to avoid whar would have been seen as a political-over-principle ruling by just about everyone.
I can still hope that as with Kelo. the opinion of "Constitutional, but bad" this "victory" will lead to actual defeat. PotUS and other Ds may say it is over and Rs should stop fighting, but that could have been said of Dred Scott. It is NOT "over." Far from it.
John A at June 29, 2012 3:58 AM
I am cautiously optimisitc. The SCOTUS just handed the Republicans the 2012 election, if they are smart enough to pick up the ball and run with it. (Which, admittedly, remains to be seen.) Roberts played a gambit, which I don't understand all the implications of, although I've been reading a lot of lawyer blogs trying to understand it (Althouse, Volokh, Powerline, etc.) I'm not sure the gambit is going to work, and at least in the short term it opens up a huge new power for Congress to compel individual behavior using the taxing authority. However, it also took a step in the direction of constraining the Commerce Clause power, and the continued validity of Wickard V. Filburn (the SCOTUS decisison that opened the Commerce Clause barn door) now appears to be in question.
Here's what's really changed, though. First of all, the individual mandate has been labeled a tax. One thing that's constant across nearly all of the political spectrum is that nobody likes paying more taxes. Second, Congress has a brand-new way of grabbing power, and it's a method that allows individual, private behavior to be regulated. Throughout the 20th Century, Congress leveraged the Commerce Clause to expand its regulatory power, but this power was mostly applicable to commercial behavior. Most people never engage in commerce except at the retail level, so they didn't notice a lot of this; it happened out of their sight. They noticed that prices went up and products got worse and some products disappeared and people lost their jobs, but they wrote off the bad effects to improved product safety, greedy outsourcing, and inevitable inflation. However, this new power is, in its initial use, targeted towards individual, private behavior. It will directly effect a lot of people. And no one doubts that a lot of Congressmen (Democrats and Republicans) will find this new power an irresistable temptation. Having the government tell a businessmen that you've never met that his business must obey racial hiring quotas and follow impossible environmental standards is one thing. Having the government tell you that you must lose 35 pounds and stop drinking Cokes, or else pay a surtax, is quite another.
So what's about to happen is that a lot of people who have been disengaged from politics are now going to start paying attention. And they aren't oging to like what they see. Constitutional scholars may be rejoicing that the Roberts gambit has started the process of drawing a boundary around the Commerce Clause, but to the guy in the street, the individual mandate is still legal and whether the Commerce Clause or the taxing authority gives Congress the power makes no difference to him; it's a power grab either way. These people will support anyone who takes steps to start reducing government power. I see the possibility of a grand coalition of old-school liberals, moderates, and Tea Partiers forming with the assistance of a new intellectual cadre. The new libertarian-inclined intellectuals will attack the problem at law, and the others will attack it at the ballot box. The part of Roberts' message that is most relevant here is: "Voters, we aren't going to clean up your mess for you." People are realizing that, no, politicans aren't all the same, and elections do indeed have big consequences.
A big change in American electoral politics is coming. I'm not sure what the outcome will be, but I see encouraging signs.
Cousin Dave at June 29, 2012 8:27 AM
Now what I'm wondering is what happens when a state's constitution comes up against a federal law?
==============================================
The proposed amendment would provide that:
The proposed amendment would not:
- Affect laws or rules in effect as of March 19, 2010. [Date Obamatax passed.]
- Affect which services a health care provider or hospital is required to perform or provide.
- Affect terms and conditions of government employment.
- Affect any laws calculated to deter fraud or punish wrongdoing in the health care industry.
==============================================It was approved in Ohio with 65.63% voting for it.
So even as a tax this is going to be the 10th vs the 16th.
I believe some other states did it as well.
Another point, is Obama promised not to raise taxes on those making less than $250K -- how dows this work in that promise?
Jim P. at June 29, 2012 7:13 PM
Even without Obamacare being fully implemented the effects can be seen now.
Many temp agencies are offering cheap healthcare "insurance" to their workers. I, for one, decided against this "insurance" because it is insurance in name only - the coverage is little more than the premiums.
I don't call that "insurance," I call it "giving my money away with nothing in return." However, Obamacare now requires me to buy this crap or give my money to the government with nothing in return.
Charles at June 29, 2012 8:33 PM
I worked as a security guard in the mid 90's with the same type of health insurance policies. I pitied the idiots that took it.
Jim P. at June 29, 2012 9:18 PM
Jim, I had not heard about that Ohio thing. I think that it will turn on this: when individuals in Ohio don't comply with the law, the federal government will not prosecute the state; it will prosecute the individuals. Will the state of Ohio defend those individuals? If not, the Ohio law will be toothless.
Cousin Dave at June 30, 2012 6:58 AM
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