Human Resources News & Insights

Will court decide constitutionality of health coverage mandate?


Constitutional challenges have been levied by more than a dozen states against the new healthcare reform law that mandates individuals purchase health coverage.

One of the challenges is being made by Virginia, which has already enacted a law exempting its citizens from the federal mandate to purchase insurance.

Another is being spearheaded by Florida with the support of 12 other states (South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Colorado, Michigan, Pennsylvania, Washington, Idaho, and South Dakota).

Both lawsuits claim the newly signed reform bill’s requirement that individuals purchase health insurance is unconstitutional.

The mandate, which won’t take effect until 2014, is central to the bill’s main goal of providing health insurance to nearly 32 million more Americans — and Democratic leaders and those in the White House don’t appear to be worried that it’ll get shot down.

“We’ll win these lawsuits,” press secretary Robert Gibbs said he was advised by administration attorneys.

Both lawsuits are in federal district courts, and many analysts believe they’ll end up before the Supreme Court.

Do you think these lawsuits threaten the current coverage mandate? Let us know in the Comments Box below.

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  1. OK, I don’t want to start a big political debate on this. I’m just thinking don’t we already have a mandate that everyone has to buy car insurance or it’s a felony conviction? Should we add that mandate to this lawsuit as well?

  2. HR in IL says:

    Comparing auto insurance to health insurance is comparing apples to oranges. Usually auto insurance is there as a benefit for those you inflict harm to by your actions; health insurance is for the benefit to the person carrying it and their family. So the mandate to auto insurance is necessary, but my opinion is there is a better way for health insurance other than by mandate. The government is setup to get billions by forcing this down people’s throats.

  3. Only liability insurance is requred for car insurance so that your lack of auto insurance will not negatively affect others should an accident occur.

  4. In response to Mitch…two major differences. You don’t have to own a car and auto insurance is governed by state not federal law. Not the same constitutional issue.

  5. You do have a choice if you want to purchase auto insurance – it’s called freedom of choice to own and operating a motor vehicle.

    Auto insurance is required at a State level not a Federal level. Also, you are only required to carry liability insurance not full coverage – to cover the cost of damaging someone else’s property. The auto insurance industry can and does increase your rates for a number of reasons, including if you live in an area that has – per statistics a high cost of living area. They can also cancel your coverage for excessive tickets or accidents.

    Some how I do not believe that this health care plan is going to work same way. Comparing this health insurance plan and auto insurance is like comparing apples to rocks – not even close.

  6. In addition to the above, auto insurance is optional….you can choose whether or not to own a vehicle. If you choose to not do so, you do not need auto insurance. Forcing me to buy health insurance is not optional, so it is not the same. I’m not a constitutional lawyer, but I don’t see how forcing someone to purchase something can be constitutional.

  7. The other fundamental issue here is around rights vs. privelage. Driving an automobile is a PRIVILEGE that entails certain legal requirements; including the need to purchase liability insurance (at the minimum) to cover losses imposed on someone else. As such, there is a CHOICE (freedom) to decide whether or not to purchase a vehicle altogether and assume the liabilities this requires. This bill has made healthcare a RIGHT with the caveat that you MUST purchase a plan or be penalized. Here’s where it gets tricky. What we’re really saying is everyone has a right to access affordable healthcare, but you don’t have a CHOICE as to whether or not you wish to purchase it. Therefore, this is truly a constitututional issue with some meat around the bone because, at the core, you’re taking away the ability of a free society to do with it’s private, disposoable income what it wills.

  8. 20 states are now involved in this lawsuit with more to come.
    It is unconstitutional and is going to be determined by the supreme court.
    This was a totally non-representative process and for good reason – few people would approve of the bill. But while we fret about this matter the Alinsky crowd is off destroying the country.

    Paul Volker said the value added tax is inevitable (taxes all purchases = national sales tax) in order to pay for the socialistic programs we simply cannot afford. 47% of Americans do not pay income taxes…this will drop to about zero in another year. You voted for this not me.

  9. To get back on track……….If the Supreme Court DOES NOT deem this Mandate unconstitutional, there is no freedom left in America. If the Government can MANDATE you to buy something from a private company, it can MANDATE you to buy ANYTHING it deems you should have. A General Motors (pardon me, Government Motors) automobile, for example. However, watch this closely, because Obama doesn’t want us buying health insurance from a private company, anyway. So, if this gets deemed unconstitutional, he will just say, “Well, I tried…..we will just have to go to the public option……sorry……I tried.” And BINGO! now we have socialized medicine just like the lucky people in England and Canada. Plus, we have a BIG DEBT!

  10. If we are comparing auto and health insurance – here’s a question -why should health insurers not be able to institute plan limits and/or charge higher rates for high risk insureds? If you are a poor driver with speeding tickets, accidents, DWIs, etc., you expect to pay more for your insurance because you have a higher risk of causing high dollar claims. But, the govt is saying that health insurers cannot charge more for high risk people. If you are overweight, smoke, drink and don’t exercise or don’t see your doctor regularly, shouldn’t you pay more than your coworker who takes care of themselves?

    Also, car insurance has limits to what they will pay for repairs, medical costs, etc. But, this bill makes it illegal to to put lifetime limits on health insurance. Our company has had many large claims where we have paid literally 100s of 1000s of $ for a handful of people. Some have no treatment end in sight. Our plan has a $1,000,000 lifetime limit which has been met by a few. With this bill, we would continue to be on the hook for millions of dollars year after year with no lifetime max. This, of course, will cause premiums to be raised for everyone. Doesn’t seem right.

  11. What should have been done is this: allow an option for individuals to not buy health insurance, but they sign a waiver that states they cannot receive healthcare. Just like you can purchase the ability to be an uninsured motorist but if you total your car you get nothing. Common sense, right?

  12. Jennifer says:

    Sorry, I have to agree with Mitch….when someone without health insurance goes to the emergency room and cannot pay the bill it ends up becoming a burden to us the tax payers….it also causes the hospital to charge more, increasing our insurance rates…so to me someone without health insurance in fact does and can harm me…..therefore, I do not see that big of a difference between auto and health insurance.

  13. There are so many people out of work, how does penalizing them for not carrying insurance going to help. I know it’s not until 2014 but it will be here before you know it. We the people in the USA have freedom of choice provided to us by the constitution. We all need to stay on top of this and write to our representatives let them know how we feel.

    Bottom line the government is spending so much money that now they want to tax and penalize us to pay for their overspending.

    I’m still in shock about this Health Reform among other things the goverment is doing. Those folks in Washington don’t have our worries. They have great insurance and an outstanding Pension Plan.

  14. I understand the premises of paying taxes to support the services our government provides. I don’t understand the premises of being forced to pay for a healthcare coverage package that may not fit mine or my family’s needs. And if I chose not to pay for it, then be outrageously penalized for it. I’d much rather barter services with my medical provider. Hey doc, fix my broken arm and I’ll clean your offices for six-months, year, etc.

  15. In Virginia auto insurance is not required, not even liabilty coverage, however if you CHOOSE not have auto insurance on your vehicle you are required to pay an uninsured motorist fee. This, to my knowledge is the same way the health care coverage mandate is set up. If you don’t want it there is a penalty on an anual basis. It’s not a totally free choice. All in all I do not agree with a mandate that says I would have to have medical covereage through the government and if I don’t I would have to pay $600+ a year for that choice.

    I believe the current lawsuits should threaten the current coverage mandate. Whether I have health insurance or not does not adversley affect the next persons freedom, so tell me why should anyone be required to have it or pay a penalty if they don’t.

    My opinion, its a back door way of raising taxes.

  16. Jeanette says:

    As framed the law does not really require you to have insurance. It simply denies you a tax credit if you don’t have it. This adds to you tax bill and effectively fines you if you don’t have insurance. Given the above. I don’t think the suits have merit.

  17. I think we may be missing the point of universal coverage and the historical impact of what lacking coverage has had on this country. Individuals without health care are a big burden on public funds, now. It would be cheaper if health care was available and utilized rather than individuals showing up at emergency rooms with conditions that could have been handled on a much lower level than catastropic. Most children and adults will need medical care on some level at some point. Consider the fact that if someone gets sick. unable to function, and/or is in pain, he/she will eventually show-up or be taken “somewhere” to minimize the discomfort or save his/her life. Taxpayers generally will pay for these medical services. Why not take the burden off the public funds with the knowledge that anyone who needs medical attention, no matter how large or small has insurance that will share the cost.

    So to me, it isn’t a matter of our right “not” to be made to have medical coverage but our responsibility to take care of anyone that may need medical service.

  18. Well I agree that comparing the two may be apples to oranges, however, let me just state for the record Sandra that by not having health insurance, you are in fact, affecting other people through higher premiums.

  19. Johnny Trlica says:

    If people are required to have insurance to protect their cars (or others’ cars) shouldn’t they be required to protect their own bodies?

  20. This is simple…..Do you want the right to go to a hospital should you get injured in an accident, get cancer, suffer from an illness, get help for a disability, etc.? Currently the system is set up to guarantee some care to all, as the ER can’t turn anyone away. Nor is it right to turn away those that need care and say ‘sorry, you don’t have insurance, you can’t be treated here.’ If you’re going to guarantee care, then there has to be a guaranteeing payment for such services as neither the provider nor patient should be stuck with the bill. Currently, you are not required to have insurance, but if you don’t have insurance, but could, you shouldn’t go to the doctor/hospital/etc. when you are sick/injured and can’t afford the big hospital bill (thousands of dollars, which most of us don’t have in the bank). But where’s the first place anyone for that matter, insured or un-insured, are going to go when they get sick or injured? Likely the hospital, and they shouldn’t be stuck with the bill, nor should someone, insured or not insured, be stuck with these massive medical bills that this legislation is trying to fix. Point is, everyone needs to pay into the system that may use the system, as we’ve guaranteed access to all, and universal health care, single-payer system or mandating health insurance are just some of the few ways to do it.

  21. Auto insurance and health insurance are totally different, so I’m not going to weigh in on that argument. But, I hope the court does look at the constitutionality of forcing citizens to purchase health coverage. I’m more disappointed that the healthcare reform bill does nothing to address rising costs of health care. I think the focus on mandated coverage does not attack the bigger issues of health care. Mandating coverage takes all the competition out of the insurance market and all plans start to look the same and have the same version of scaled back benefits which I think is the direction we are headed. Eventually we will have a more socialist system of healthcare which I believe citizens will be more disgruntled with in the end.

  22. Article 1, Section 8 of the Constitution (generally referred to as the “Commerce Clause”)gives Congress the power to “Regulate commerce with foreign nations and among the several States and with the Indian tribes”.

    It will be very interesting to hear the legal arguments that will be presented by both sides as to whether this clause gives Congress the authority to require a citizen to buy anything, including health insurance. I’m sure this will end up before the Supreme Court, so this issue will be decided by nine learned jurists.

  23. Does anyone have anything to contribute about HEALTH insurance?

    Does anyone live in Mass where it is required already? How is it working there for them? Is it positive or negative?

  24. The bottom line is the rich get richer and the poor get poorer. You have the working class who are always expected to pay for it all. I am a family of 5 and being forced to purchase health insurance I can’t afford. So what do I do not pay my electric or gas bill in order to afford health insurance. This whole thing is totally unfair. Freedom what is that. We might as well be a communist country.

  25. Akber A says:

    There has to be other clauses in the Constitution , besides power of the Congress to regulate commerce, which allows the Congress to impose federal taxes on incomes, deduct social security and medicare taxes from paychecks and contractors’ receipts etc. These payments by individuals to the Federal Government are for the direct and indirect services being provided currently or with a commitment to provide in the future.

    Health Insurance can also be categorized in the similar way. This is a payment by individuals with income, for the commitment and guarantee by the Federal Government to provide extremely necessary service that all of us would most certainly need before medicare kicks in at the age of 65.

  26. I call this reform “PayCare” instead of Healthcare Reform.

  27. Judy Buckley says:

    I agree with Brenda and RWA. We are already paying for the uninsured. Health care costs would have to go down if everyone had insurance and could be seen before a condition got critical, instead of using the ER as their primary care physician. We already pay through higher premiums and hospital rates, and the insurance companies already put pressure on the employers who pay for most health care insurance by raising the premiums annually (“we make every effort not to raise premiums, but unfortunately, this year . . . etc.”) and offering possible options with somewhat lower rates and trimmed benefits, higher co-pays, deductibles on prescriptions, etc. I’ve said before, our employer insurance plans have gone up each and every year, usually in the double digits. So, maybe we ought to try something new – it may be better. If it’s not, we can find a way to vote it out.

  28. Hi All-I am an HR manager for a home health agency in Massachusetts. I have to laugh when everyone is up in arms about the democrats who pushed this reform when it was the illustrious Mitt Romney who forced this in Massachusetts before he conveniently left the state. It is an administrative nightmare to collect the data to prove to the state that you are offering medical insurance to everyone you are supposed to. Mass requires that you offer it to employees who work a minimum of 35 hours-so guess what-many employers only hire workers for 34 hours and don’t offer medical insurance. Employees are forced to go to the state sponsored plans which are not that affordable (approx. $550/month for a basic individual plan). In some instances, depending on a person’s income, it is cheaper to pay the penalty that buy insurance. You can’t be denied care so eventually someone pays the cost. I firmly believe that this country is in desperate of health care reform but mandating it is just going to create scenarios where employers will find the loophole to not offer insurance and not get penalized. What is very interesting about Massachusetts is that it traditionally had a very low percentage of uninsured individuals as the Medicaid system really did pick up people who couldn’t afford, or weren’t offered, insurance. My personal feeling is that a huge part of the health care problems in the US are directly related to the pharmaceutical industry and the ridiculous amount of money they charge for prescription drugs.

  29. I am going broader than the requirement to purchase health insurance…it’s another personal freedom taken away. When one no longer has a choice there is no freedom. By the same token, the requirement and new burdens on employers will result in people not being able to afford it and employers not even offering it and just paying the tax penalty as it could be cheaper than offering a plan to employees. Then all of those people will look to a government sponsored plan which is what the powers want anyway, a socialized medical plan (oops “National Health Care”). In addition, what about those who have a religious reason not to use certain medical treatments and procedures? Are we now violating their religious freedoms by forcing them to purchase insurance for something in which they do not believe? “Redistribution of Wealth” is what’s happening here not only through Healthcare Reform but everything going on in DC and that’s not right. Why do I always have to pay for everyone else?

  30. BJB, you do have a choice! You have a vote! You also have the right to speak out. Socialized medicine is a lot better than the crooked system we have set up anyways, don’t speak of it as if it were the devil. Single-payer would be better. But if those that have a reason not to believe in healthcare reform, such as those seeking religious freedom, they also have to vouch out of receiving care since they don’t believe in paying for it.

  31. The issue here is not health CARE but health INSURANCE and mandating that private citizens be forced to purchase products or services from a private industry or pay a fine – not a tax the law specifically states that it is NOT a tax. Fines are penalties for violating law. This law is criminalization of not having insurance. It has nothing to do with health CARE!

    That said, if Congress can mandate this and it be foud constitutional by the Supreme Court, this does not bode well for the few rights we have left. For those arguing about social responsibility and giving up a little to help the majoriy I have this to say: if you throw one rock into the Grand Canyon it doesn’t do much, if every one throws a rock in it will be the Grand Rock Pile, and that is what has happened to our rights we give up a little here and a little there until there are very few left.
    The issue here is rights not health care, and just another little bit we are being asked to give up of what are our basic human liberties. The question now is not dealing with this bill, it passed with huge public dissent and against the will of the majority, if you trust the polls; the question that should frighten you is, “what’s next?”

  32. I share you thoughts, BJB. I just don’t see why employers should be burdened with supplying health care insurance in the first place. It all started during WWII when companies needed workers, so they offered “bennies” to entice people to come to work for them. So…..see what that caused many years hence. I hate it when someone comes to apply for a job and the first question is “What are the benefits”. Doesn’t matter what they would be asked to do, or what the job entailes……….no, just what are the bennies. That is just wrong.

    Has anyone read the part of the bill that calls for a civilian “army”, trained by the Military? Heard a quip on Fox news with Judge Napolitano…….then it was “off” the site. Haven’t heard it anywhere else. Makes me think they are saving it for a more opportune time.

  33. This legislation is a road map to the President’s goal of a single payer system. Watch what happens in MA as a predictor for what will happen throughout the country. The state government has enacted price controls on the health insurance companies. The insurers are not selling policies to individuals or small businesses because they will lose money on virtually every one of those policies under the price controls now in place. The Gov has ordered the insurers to sell policies to those markets again and the insurers are refusing, so he is taking them to court. Imagine, the government forcing a business to sell their product! Eventually the insurers will pull out of the state and EVERYONE will go on a government single payer system in the state. If that happens in MA the rest of the country will follow within 24 to 48 months.

  34. Cynthia says:

    To RWA: yes, we have a vote. And I for one did not vote for ANY of the people currently in office, so your point is what???? I would rather keep what rights I still have under the “crooked” system then give them up for socialized medicine. And just because I don’t agree with the new laws does not mean I do not pay. I pay weekly for medical, dental, life, and vision insurance. Do not assume that because I do not agree with the law that I refuse to pay my bills. Instead of being insulting you might want to stick with the original topic of this article, which is if you feel the lawsuits will threaten the new laws. I for one hope they do!

  35. JAGGER I believe what you are reffering to is on page 1336 Second 203 Commissioned and Ready Reserve Corps.

  36. I think we would be a little happier if we were to receive the same health insurance as our Senators, Representatives, and government officials receive. If we as the people should mandate that they have the same insurance as we will in the very near future.

  37. Jagger, I think what you are looking for is section 5210 pg 1336 in the text

  38. Point is, this is constitutional, and it’s set out to fix a system that’s already crooked. I for one am at an employer where the rates are through the roof for insurance and the employees on the plan are stuck and getting robbed by the high premiums. Not fun. Hell, socialized medicine has worked, just ask Canada who’s citizens greatly support their universal health care system.

    Also, Cynthia, just because you didn’t vote for who’s in office doesn’t mean you didn’t have a chance to share your input. Speak out! Join political groups that support the same things you do! Vote in every which way you can! And if that doesn’t work, to hell with it, run for office! But don’t say that you didn’t have a choice and that this bill isn’t yours; you had representation.

  39. Jeanette says:

    Actually as of 2014, when mandatory coverage begins, the Congress will have to be covered by a policy from one of the alternative exchanges set up. They will no longer have a seperate system.

  40. RWA: – Clearly, many of us DID NOT have the representation we thought we did. When the majority of Americans have said they didn’t want this bill passed, it was passed by our “representatives” anyway. That is not representation of the people.

  41. We will have to wait and see whether this law or portion of the law is, in fact, constitutional. That is what judicial review is all about. Marbury vs Madison 1803. What any of us thinks is not relevent. What the SCOTUS decides is relevent.

  42. RWA-Socialized medicine does not work in Canada or anywhere else. Canadians come to the U.S. for major procedures because they can’t get those things done there. There is a huge shortage of physicians and it can take months for simple medical procedures. In addition, government health insurance is covering less all the time and the use of private insurance to fill the gaps is increasing. I’ve spent a great deal of time and effort on this and I’ve found that Canada is moving away from strictly socialized programs and going to the privitization of part or all of many programs. The current administration is patterning many of their proposed legislative changes on so many failed or failing Canadian programs. The most telling comments have come from many of the Canadians I’ve talked to in tha last several months. When I ask them what they think of U.S. health insurance reform, almost all of them said that once the laws change they don’t know where they are going to go for their health care!

  43. RWA you are right we had representation – about the same representation that the colonies had when King George and Parliament decided to start housing soldiers in our homes and taxed us on everything they could rthink of. We pprotested first through regular channels but were not heard, and then we protested in a way that changed the world. Our representation needs to put down the law books and read a history book.
    I have yet to see a poll that shows that this law has ANY universal or even majority support. How is that representation?

  44. Lots of conflicting opinions here and some are obviously hot, which is understandable.

    My biggest gripes, if I have to chose, would be the way this healthcare reform package has been shoved through without enough thought and careful analysis of the impact. I am concerned that the debt will further erode the dollar to the point of collapse. I don’t feel our government has our best interest at heart, nor do I feel they are operating in a way that is constitutional. They seem to have their own, largely hidden, agenda and there is a huge lack of concern for what the people want. I am fearful of the direction the current administration is leading us and can only hope America survives. Just my opinion and I hope I’m wrong about a lot of what I see coming. Maybe the American people will take a stand and do something about it. I’m looking for opportunities to stand up an make a difference myself.

  45. Here’s an idea that should make everybody happy on the health insurance mandate issue. You shoud be exempt from the mandate if you sign an irrevokable agreement to forgo any health care that you can’t pay for yourself. No showing up at the hospital’s door demanding your “right” to treatment. If you’re willing to do that, you should be allowed to decline health insurance coverage with no penalty.

    By the way, this “mandate” just means you pay more tax if you don’t buy health insurance. Big deal. You also pay more tax if you don’t have mortgage interest to deduct. The next thing you know, somebody will be suing because the government is forcing people to buy houses in order to get a tax break.

  46. Peter, I second your first paragraph! The second paragraph is also true.

  47. You keep calling it a tax. It is not a tax it is a fine. Actually read the bill. A tax is an obligation, a fine is punitive for a criminal act. They don’t give you a “fine break” for owning a home.

  48. I have a novel idea. Why, when someone goes to the emergency room, do they not get “charged” just like everyone else, insurance or not. THEY owe that bill. That bill goes to collection, just like any other bill they might ring up. If they can’t pay, they file bankrupcy, and lose whatever the bankrupcy court finds available to help pay off the debt. What is left over, can be billed to the Government (the government can use the 1 trillion $ they alloted for this HC fiasco). If people had to be responsible for their own health care debts, or suffer the consequences, they may be more prone to “choose” to become insured.

    The part of this Bill that really has me concerned today, is that it is mandated that NO doctor can invest in a hospital. What sense is that? It seems to me they are the ones that SHOULD be able to build hospitals, or at least have a financial interest in them. That is THEIR business. Am I off base on this, is there something I haven’t thought of? What do you think?

  49. Hey, Jagger, what’s the specific cite on your claim that under the health insurance reform no doctor can invest in a hospital? On what page, paragraph, etc. can I find this? I’m willing to believe you’re right but I’m sick of all the hearsay and urban legend type stuff that I hear about this law. There are a lot of wild claims out there that are more based on what “feels right” to the believer than on what’s actually true. Just because somebody says it’s so I’m not going to believe it, even if it fits my predjudices. Faith based thinking is OK when it comes to religion, but too many people apply the same logic to areas where it’s easy to figure out the truth, if you’re willing to do the work of tracking it down instead of baying with the group of hounds you happen to be with.

  50. Peter, I read this in Monday 12, 10 edition. I tried to copy and paste it here, but either it is blocked from that application or I don’t have the expertise to do it. I think the is archived, so if you go there, you may be able to see that report. The bad thing about the way the Health Reform Bill is written, the language is such that without the lawyer speak mind or the ability to read between the lines, many of these things are not uncovered until those with those abilities delve into it. But piece by piece it is being disected.

    Sebelius Says President Obama Has Instructed All Cabinet-Level Departments to Promote Public Health
    ( – Health and Human Services Secretary Kathleen Sebelius says President Obama “expects” all cabinet departments to leverage their resources in support of public health, a move she suggested is unprecedented. Sebelius explained that the Department of Transportation can operate as a “health agency” by funding bike trails for communities, for example.

    Health Law Bans New Doctor-Owned Hospitals, Blocks Expansion of Existing Ones
    ( – The new health care overhaul law, which promised increased access and efficiency in health care, will prevent doctor-owned hospitals from adding more rooms and more beds. The new health care rules single out physician-owned hospitals, making new projects ineligible to receive payments for Medicare and Medicaid patients. More than 60 doctor-owned hospitals across the country that were in the development stage will be canceled, said Molly Sandvig, executive director of Physician Hospitals of America.

  51. After reading most of the responses here, I find it amazing that not one person has even touched on a crucial point in health care reform – the moral imperative of providing health services to everyone in a population. Many respondents to this post obviously think that market-driven health care is fine and that only those who can afford health insurance should have it. And, because it is market driven, that it is perfectly fine for health insurance companies to make a profit on this coverage. Unfortunately, sickness is an equal-opportunity condition. Sickness can happen to people that carry insurance or not, whether by choice or by inability to pay for it.

    I believe that it is immoral to deny health services to people who are sick. Why should someone be denied services because they are unemployed, or because they work for a company that is too small to be able to afford to purchase coverage for their employees, or if they do (or did) the employee contribution would be unaffordable? My guess is that most respondents to this posting have health insurance through an employer-sponsored plan, just like I do. I believe that it is reprehensible to allow people to go into bankruptcy or die, simply because they cannot afford health coverage.

    The health insurance system we have now in this country incorporates several different models, including the out-of-pocket model (for people who do not have health insurance), the employer-sponsored health plan, the government pay (i.e., single payer) model that we affectionately call Medicare and Medicaid, and the government provider model which we can find in the Veterans Administration, the Indian Health Service (Public Health Service), as well as in many municipalities who provide charity care in large institutions such as Cook County Hospital and Clinics (Chicago), New York Health and Hospital Corporation, etc. It should be noted that nothing in the health reform bill changed the ownership of providers (hospitals, clinics and doctors/providers) and they will remain largely private. So, for everyone calling this a government takeover of health care or socialized medicine, please stop calling it that. It isn’t and never will be. What the reform act largely addresses is insurance reform. (In fact, it is because we have so many different systems in this country that our health bill is so expensive.)

    The reasons that we needed health insurance reform have been ably discussed outside of this blog and I don’t need to go through the arguments here. Some respondents have written about the need to lower health care spending and that this bill will not achieve that. There is a lot of merit in those views, but not for the reasons many of you state. The potential for health care spending to go down is because with everyone covered, disease should be better managed before it gets to an acute (read: expensive) stage as some of you have pointed out. Also, spending should be reduced once various providers and health systems talk to each other via electronic records, should these systems take advantage of the incentives to make such a switch to the digital world. A lot of waste is present in the system in performing duplicate tests and examinations. Also, another reason we need insurance reform is that I believe that it is unethical and immoral for an insurance company to cancel coverage after the insured has become sick and thus will negatively affect the underwriting profits of the insurance carrier. One provision of the reform act mandates that health insurance companies must spend at least 80% of the premiums for health care. Today, insurance companies spend more to deny coverage than it would cost them to pay the claims. Why? Denied claims payment means more profit.

    So, let’s look at fundamental health economics and why the individual mandate (otherwise known as government-mandated insurance) is a necessary part of reform. If a country demands that insurance companies take all applicants regardless of pre-existing conditions, age, physical condition, etc., then to make this viable from an economic point of view, you must increase the pool of the insureds to include the healthy, as well as the sick. When we open the gates, the sick will definitely sign up for health insurance. This will increase the riskiness of the pool of insureds. To mitigate this risk, the pool must carry more healthy people at the same time. Otherwise, the economics of scheme will not work.

    What really surprises me is that so many people want to deny coverage to so many others. The last time that there was this much opposition to federal law, exclusionary tactics and waving of the states’ rights flag, it spawned a little jaunt in the woods known as the Civil War. As I recall, it didn’t come out too well for the side that was in favor states rights and opting out of federal law.

    Finally, let me relate some “Universal Laws of Health Care Systems” as stated by Tsung-Mei Chung, the leading health economist in this country:

    1. No matter how good the health care in a particular country, people will complain about it.

    2. No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.

    3. The last reform always failed.

    However, given all this, I do not think that any citizen of one of the other industrialized countries of the world who has better health care than in the US (e.g., France, Germany, UK) would want to give up their system in favor of ours.

  52. Jagger, please keep in mind the biases of your source. Here’s some information you might not be aware of about, from Wikipedia:

    “The site was founded on June 16, 1998 under the name “Conservative News Service”, using the domain name[2] Back then, it had a three-year budget of $5.46 million, funded entirely by private donations, and a staff of four reporters and two editors.[2]

    As of 2007, described its role as serving an audience which puts a “higher premium on balance than spin” by covering stories that mainstream news organizations ignore.

    “In response to these shortcomings, MRC Chairman L. Brent Bozell III founded in an effort to provide an alternative news source that would cover stories that are subject to the bias of omission and report on other news subject to bias by commission. endeavors to fairly present all legitimate sides of a story and debunk popular, albeit incorrect, myths about cultural and policy issues.” [3]’s motto is “The Right News. Right now.”[4]’s editor from 1998-2005 was Scott Hogenson, who also worked as the chief of radio operations for the Republican National Committee in 2004. has staff in Washington, D.C., London, Jerusalem and the Pacific Rim. Editor-in-chief David Thibault (deceased) became top editor in April 2005. He died on July 20, 2007.[5]

    Terence P. Jeffrey became editor-in-chief in September 2007. Jeffrey was and remains an editor-at-large for the conservative weekly newspaper Human Events. He wrote editorials for The Washington Times from 1987-1991 and was research director for the presidential campaign of Patrick J. Buchanan in 1992. Jeffrey was Buchanan’s national campaign manager in his 1996 campaign.”

    In short, this “news source” is a mouthpiece of the Republican Party. The Republicans have spouted so much BS about this bill that I treat everthing they say as “false until proven true.” Instead of relying on this type of obviously biased source, why not look at the law itself? It’s readily available and not that hard to navigate. Or at least get your news from a more neutral organization.

  53. Bravo Peter , bravo.

    I am impressed.

  54. Thanks, Peter, for the lesson. Can you give me a source of a “neutral organization?”

  55. JZ………..perhaps you could go to work for Obama. You did a much better job of explaining his view of this plan than he does. Could it be that he knows something you don’t, which accounts for his inability to put it into words? And, this did not start out as Health Care Insurance reform. It’s just that his first attempt at Health Care Reform didn’t fly very well, so he started attacking from a different angle. When that didn’t fly so well, he did what any good Saul Alinsky trained person in power would do. Get it passed, no matter what. Who cares what the majority of Americans think. They are just too dumb to know what is good for them.

    And just in case you didn’t know it, Medicare rejects MANY more claims than private insurance companies do. Or did I just read that in some “biased” Republican publication?

  56. Peter, the citation you arw asking for is section VI page 1529 of the act as passed. It prohibits the expansion of rueal pysician owned hospitals.

  57. *are. *rural *physician. – sorry about the typo’s the blackberry keys are too small for my fingers.

  58. JZ – I am not against health care reform, I’m a firm believer in helping and providing health care in the communities. I have been involved in the set up of a FQHC in my community.
    I am however against further erosions of our constitutional rights – no our basic human rights. I realize that there is a view point that the constitution is just a piece of paper, that it is outdated, that it shoud be ignored in favor of what people see as “right.”
    That’s how every facist and socialistic state started out, with good intentions. I agree something needs to be done but this law was the wrong thing to do. Show me something constitutionally sound that controlls cost and access to health care not violating our human rights and criminalizing not having insurance and I’d back it.
    This law is not constitutional, was not passed with true representation of the constituents wishes, and is in direct violation of our human rights to purchase or not purchase private goods or services.

  59. Jagger, I’m delighted that you appreciated the lesson and I’d be glad to elaborate further. A “more neutral organization” is one that has the goal of helping you understand issues from more than one perspective so you can make up your own mind. Here’s a source that gives insight into both sides of the physician hospital issue:

    In contrast, your right wing source has an opinion that it’s pushing. As far as I can tell, that opinion is that people must be convinced that Democrats are evil by any means possible. So, the issue of restrictions on public support for physician owned hospitals is presented as just another example of Democrat evil: “The new health care overhaul law, which promised increased access and efficiency in health care, will prevent doctor-owned hospitals from adding more rooms and more beds. [“Democrats are lying promise breakers!”] The new health care rules single out physician-owned hospitals, making new projects ineligible to receive payments for Medicare and Medicaid patients [“Democrats unfairly single out some hospitals!”].” If there is any information in your source that tries to explain why some people think the approach in the law is a good idea, you didn’t see fit to include it. If you look at the source I provided, you’ll see a more genuinely “fair and balanced” view than you’ll ever see on the likes of Fox news.

    So: I’m trying to figure out whether you fully understand and support the Republican game plan, including the strategic use of half truths and smears like “socialism” and “death panels” to bamboozle the masses and retake power, or whether you’ve just been bamboozled yourself. I hope it’s the latter.

  60. LZ, please rest assured that you will not be forced to “purchase or not purchase private goods or services.” You will simply have a choice: If you choose to not to buy health insurance, you will pay more taxes. Similarly, you have a choice whether or not to support charities. If you choose not to make charitible donations, you will pay more taxes.

    Now, I suppose you could be so financially secure that, if you choose not to purchase health coverage, there is no risk that people like me will be forced to subsidize your medical care with our tax dollars. If that’s true—if you will permanently waive your right to lean on everyone else if you run out of money and can’t afford to pay for your care—I’m fine with that, and I will support a system that lets you make that choice.

    The reality for most people is that they aren’t rich enough to be in that category. And we don’t have a system heartless enough to let foolish people die on the street with no care. So why shouldn’t people be expected to cover part of their own risk either through buying a policy or supporting the system with more taxes if they can afford to do so?

    In any event, if it is unconstitutional to establish different tax consequences for different economic decisions that people make, a whole lot more than health care reform is unconstitutional. Let’s get real and acknowledge that this is a bunch of grandstanding by Republicans that is wasting a lot of taxpayer money.

  61. LFR, thanks for the citation. On the issue of a tax vs. a fine, I haven’t parsed the legislation to learn what exact name the “tax/fine/penalty” is called. I defer to Shakespeare, who wrote (in Romeo and Juliet), “a rose by any other name would smell as sweet.”

    Actually, I just paid my taxes and had to pay a $12 “penalty” for underwithholding. Doesn’t make me a criminal, I won’t be going to jail, it won’t be coming up on a background check. Why should I care whether it’s called a penalty, or a fine, or a fee, or whatever?

    The bottom line is, you will not be criminalized for not buying health insurance. You will just have to pay a fee, tax, fine, penalty, donation or whatever for the privilege of not doing so. Now, if you refuse to pay that “whatever,” THAT will be criminal. Just like not paying your taxes is criminal.

  62. RWA—thanks for your kind comment on my post. I looked back and read yours, and I totally agree with you. Some of the folks on this thread seem to think that laws should be passed strictly based on polls (in particular, no doubt, those paid for by Fox news). Whatever happened to old fashioned republican government (small r) where we elected representatives to exercise their best judgment for the common good? It doesn’t always work the way I want either—the Bush years were a nightmare for me—but I figured losing gracefully is part of the deal in a democracy. When I hear Republican leaders intone, “The American People oppose this bill!!!” I’d like to say, gosh, how about those of us who elected Obama and an overwhelming Democrat majority in order to have things our way for a change???? What are we, Canadians?

    There are some parts of the world where the losers go into hiding with their guns and bombs and wage guerilla war on the winners. It’s too bad that we have some people on the fringe who think living in a world like that is better than paying 5 or 10% more in taxes, so those who weren’t born smart, lucky and/or rich can get a little helping hand from their more fortunate neighbors.

  63. Peter:
    Your statement that Fox News and republicans in general are trying to paint all Democrats as evil is quite a generalization! Both sides of the aisle do enough mudslinging and promoting half-truths to confuse even the most intelligent among us. Fox News is not the evil empire that most Democrats espouse it to be. The other major news networks are so liberal, that if it were not for Fox News, we would never hear the other side of political debates or the possible consequences of proposed laws. Since the majority of Americans get their news from the major tv networks, I for one am grateful that Fox News seems to always be in opposition to the others. Yes, some of their commentators are extremely conservative, but some on the other networks are extremely liberal. We have to listen to both sides and make our own judgements.

    I also think that most Democrats (and apparently a lot of people on this blog) think that all Republicans are evil, don’t care about their fellow man and want people dying in the streets if they can’t afford health insurance. That is just not true. Most Republicans are just as caring as Democrats, they simply think that more government is usually bad as the government has a history of bungling the administration of almost everything they take over. Programs run by the government almost always cost more to administer and have more fraud and abuse than if a private company ran things. Examples – think military spending – $300 for a hammer, VA Hospitals – worse care in the country for those who deserve the best, Medicare – more fraud & abuse than any insurance program, even the IRS – if you call with a tax question multiple times, you get multiple “right” answers. ACORN, HUD, FANNIE MAE – all govt run programs, all disaterously mismanaged.

    FYI – i am a registered Democrat, but I am completely disgusted with Pelosi, Reid, Rangel, Obama and the whole lot. They have usurped the power of the people to push their own agenda. Americans be damned.

  64. This one has been beaten to death before the law was enacted and will continue onward.

    Some people think it is a “moral imperative” to provide health care for people. It was a moral imperative to go to war, I recall as well. Funny, we can go to war and kill others as an imperative. Some people’s imperatives are not that of others.

    This country is unlike any other in the world. Comparing ourselves to others is interesting but proves nothing. We were founded upon the principle of individual rights – they are above that of a collective – they are above any government mandate. To say you have a right to health care is to say you have the right to someone’s services, be it a doctor, nurse, etc… If you have a right to their services then they are not free. Your “right” is their enslavement. That is not what this country is about. You have a right to be free to pusue your dreams but not at the expense of another. People think this country is a democracy where majority rules. It is not. It is a representative republic.

    If we say health care and health insurance is a right then let us put it in the constitution – that requires a super majority.

    Historians will recall that this country was founded to avoid a repressive, taxing, controlling government. We have strayed far from that now and approach the conditions once existing that forced a revolution. Most of use feel badly for those with less and many give freely to help those in need. The evil is when a government forces charity upon it’s citizens through taxation – the redistribution of wealth. This is not promoting the general welfare – to promote the general welfare would not be to take from others and give to a few. But that is exactly what we have been doing for the past 70 years since progressives have surfaced. There is a difference between Congress’ duty to promote the General Welfare vs promoting Specific Welfare for a subset of its citizens. Promoting the General Welfare would be to tax all for the common good (ie, Defense) for example.

  65. Peter, we could have a real debate over who is or is not bamboozled, but I have found it is a waste of time to try to influence a progressive liberal. They just come from a different mind set. I may be “old school” but I was always taught that in America, anyone who REALLY wanted to, could become anything they wanted to be. That is not so true anymore, because those in POWER are pulling the strings, and manipulating the market………so many times, right is wrong and wrong is right. I don’t call them EVIL, but I do think they are wrong, and they are making America something other than the America I grew up in.

    That is their intention, and if the get their way, they will do it. And America will be lost forever.

  66. A rose by any other means…is not quite the case, and I am not absing my opinion on any media source, but on the text of the law itself.
    I find it interesting that on one hand you say this is not a criminalization, however you do state that to refuse to either have insuraance OR
    Pay the penallty (sorry for the start of a new line, phone issue) you WILL be criminalized. That’s like saying if you choose to speed you’re not crimialized until you ger caught OR don’t pay the ticket. It’s stilll criminalization of not having insurance, a privately owned service, or you pay a public – government – penalty. That is the issue, not if people have access to care.
    I’d rather see a single payor system with a TAX in place than see people criminized because the flat can’t afford the insurance OR the penalty.

  67. Jim Dowdell says:

    I pray the supreme court rules this provision unconstitutional. If it does not, there will be no end to future federal mandates requiring individuals and corporations to purchase whatever goods and services the all knowing in Washingto D.C. deem to be in our best interest.
    Doesn’t anyone cherish freedom anymore?

  68. After the Kelo decision (eminent domain), I’m not sure if the SCOTUS even bothers to read the Constitution, but I will wait for their decision on this issue.
    Even if this provison is found to be “contitutional”, I think that many healthy people will simply pay the penalty/tax/fine if it is less than their healthcare premium and then when they get sick, buy insurance. If they get “hit by a truck”, then they go to the ER and must be treated.

  69. It has become painfully apparent that judicial experience and adherence to the constitution of the United States is irrelevant to the current administration. POTUS said the constitution is an impediment to his plans……there is a tip we all missed huh?

    As for the value of this health care bill…it is more apparent that it was not devised with much if any input from citizens – who are now finding out just like Greece there is only so much “free ride” before the piper has to be paid…..nothing is free.

    No wonder congressman Waxman cancelled his big charade of marching big businesses into the capital to demean them for raising the notion it would cost them millions or billions …..he got a tip they were actually correct…..oops! Never mind.

    Now that this POS is in charge we deserve all we get…which will be a third world nation.

  70. Martin, you may have missed the “tip”, as did many more Americans……..However, I did not miss it. Glenn Beck pointed this out numerous times during the campaign.

    Right now, he is pointing out things about the Cap and Trade fiasco that people should become aware of, but probably won’t if the just listen to the regular news shows. I know the Left “hates” Glenn Beck (like the “hate” Sarah Palin) but his crew gets hold of things long before the mainstream does……and he has hold of something BIG right now.

    He has a dedicated line for the White House, so they can refute anything he says but so far, there has been “silence”.

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