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A group of fifty doctors along with the non-profits groups, Single Payer Action and Our Economy, filed an amicus brief with the Supreme Court arguing that the individual mandate in the Affordable Care Act should be struck down. From Single Payer Action’s blog:
The doctors are challenging the government’s claim that the individual mandate is necessary to reach Congress’ goal of universal coverage.
“The court should decide the constitutionality of the individual mandate based on the best available evidence,” said attorney Oliver Hall.
“That’s why it is so important that these medical doctors provide the court with the information in their brief, which demonstrates that Congress can address the United States’ healthcare crisis by adopting a single payer system.”
“It is not necessary to force Americans to buy private health insurance to achieve universal coverage,” said Russell Mokhiber of Single Payer Action. “There is a proven alternative that Congress didn’t seriously consider, and that alternative is a single payer national health insurance system.”
The brief argues that Congress doesn’t need the new power to compel individuals to buy a product from a private company to effectively regulate the healthcare marketplace. It can easily do so with its current approaches, such as a single payer system, which is used for Medicare. The individual mandate is therefore neither a “necessary” nor “reasonable” expansion of authority to achieve the government’s stated objectives.
The policy argument for the individual mandate has always been extremely dubious. If the government wants everyone to be covered by health insurance, an individual mandate is an ineffective tool that will never fully achieve that goal. Other methods that have the government just directly provide insurance for those without insurance with very basic coverage would do a significantly better job. Congress only needs the mandate, because it actively chose not to use one of several more effective alternatives that are indisputably constitutional.
From March 26-28 the Supreme Court will be hearing 5 1/2 hours of oral arguments on the constitutionality of the ACA. This is one of a flood of amicus briefs filed for what is sure to be one of the most closely watched Supreme Court cases of the 21st Century.
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Interestingly, NPR covered RomneyCare this morning. On the one hand, they said that most folks don’t mind the mandate; on the other, they mentioned that RomneyCare as originally created did nothing to rein in health care costs. It took action from Massachusetts’ current Democratic governor, Deval Patrick, to do something about costs — which he did by denying the insurance companies what until that point had been effectively automatic rate increases. They raised a big stink, but since Patrick had the rest of the business community on his side, they eventually gave in.
Too bad Obama hasn’t tried doing that with ObamaCare.
Sounds like a date for Occupy the SC.
Jon, I’m not sure how this legal stuff works. Will these groups and doctors work along with rightwing groups to end ACA or at least the individula mandate? I don’t have a problem with that by the way. Sometimes they are right for the wrong reasons.
I listen to Mark Levin sometimes mainly when he’s discussion ACA which his legal team is working against. He makes some solid constitutional arguments, at least the way he presents it.
Mandates are bad again!
If I remember correctly, and I’m sure I don’t, Obama was bedded by Phama and HMO’s allowing higher prescription drug costs and little other cost controls in the bill. While slightly OT, Obama and Congress never seriously considered single payer. The health care fiasco was my catalyst in realizing just what a two face Obama is.
Wonder how many lobbyists the insurance companies deployed to DeeCee to counter this. Only way to kill these fuckers is to deprive them of their life’s blood – money. Medicare For All!!!
March 26-28….I’ll set my DVD.
Why is all this so damned difficult??? Every other industrialized country has national healthcare.
Of course, I KNOW why it is so difficult, really. Too many filthy rich people benefitting from the “status quo”. Too many politicians “bought off” by previously referenced people.
The individual mandate increasingly is looking like it will not see the light of day when 2014 rolls around – likewise, with many of the exchanges.
The GOP’s failure to embrace their own Heritage-Foundation-designed health care reform plan just might grease the skids for single payer. Everyone I know understands Medicare-for-all and how it would work. Even the Republicans, and their only objection is that it’s “socialized medicine”. But don’t take their momma off Medicare.
The only problem with the doctors’ approach is that it is too damn logical!
What? But it’s Valentine’s Day! I have a man-date all set up for tonight with my sweetheart. :-(
Granted, it’s not required by the federal government. :-P
Medicare for All would be simple, popular, and deprive the insurance companies of much needed profits. Consequently it cannot be considered by either major party.
It was done to get the Health Insurance Lobby’s financial aid in the 2010 elections. However, the massive unpopularity of the screwjob that was the final deal more than countered the relatively small amount of cash eventually delivered to Democratic candidates — and the doomed Democratic candidates forced by their leaders to embrace the deal had to spend a full year anticipating and contemplating their unavoidable electoral doom as a result.
It currently costs 3% of everyones paycheck to provide Medicare for 40 Million seniors. How much would payroll taxes have to be raised to provide Medicare for All (270 million more people)?
Why not just remove the cap?
In general that covers Medicare Part A only (hospital care, nursing home care — so called catastrophic coverage). Medicare Part B covers doctor’s visits and such, is optional (and inexpensive), and for most the premium is deducted from the Social Security benefit each month. Part D premiums (prescription drugs) may also be deducted from the SS.
What if this leads to the complete repudiation of the credibility of both major political parties?
That would be awesome. I hope they overturn the whole stupid mess that is the ACA.
For FDR to get SS implemented (and much of the New Deal), he had to accommodate the evil bastards in the lynching South. Farm workers (poor sharecroppers — white, brown, and black) were excluded, along with many other excluded citizens. Medicare and Medicaid were resisted by the medical institutions (and the lynching Southerners). Let’s pretend that the private insurance companies, PhRMA, and the Chamber of Commerce are the latter-day lynching bastards whose time is running out.
This entire bill is a political disaster. It is a bitter irony that Obama purposely loaded it with GOP ideas and goodies (in his never ending, stupid quest for “bipartisanship”), and not one Republican voted for it. Dems have to defend this monstrosity of a mandate, and none of them really want to. Can’t blame them. The mandate should be tossed, period.
Obama has some of the worst political instincts ever. ACA and the debt debacle were painful to watch.
There is no cap.
much less than what is currently cost for employers to provide private insurance.
“Obama has some of the worst political instincts ever. ACA and the debt debacle were painful to watch.”
——
You can that again. But don’t. It’s too depressing.
Well let’s do the math: 270/40 = 7, multiply that factor by the 3% currently paid so that’s what-21% or so?
Right now, I’m giving up 19.2% of my gross wages to insurance. So, let’s see (and I’ll even round down for you), 19 + 3 = 22%…huh…now I was a history major so maybe somebody else here can confirm that 22 is still more than 21? For far superior coverage at that.
Jog on.
Oh, and by the way-that 19.2% will jump up later this year when my wife gives birth to our first.
Really? According to your previous post:
http://fdlaction.firedoglake.com/2012/02/14/level-of-americans-without-health-insurance-continues-to-rise/
Therefore, the current cost for those employers to provide private insurance is zero. Since Medicare for 40M is 3%, I’m guessing Medicare for the next 270M would be more than zero.
I’m not opposed, I just wonder, how much?
I agree with your math, but would even allow that the other 270M wouldn’t need the same level of Medicare as the olds, so maybe it’s really only a factor of 5, therefore 15%.
As you point out, that works good for you because you spend almost 20% already on health insurance.
But that’s why I asked. Add your federal tax rate, plus 12% for SS, plus 15% for Medicare and the paycheck gets pretty small. Some people (young, healthy, poor) choose for whatever reason to risk it and not pay for health insurance.
Medicare for All wouldn’t be optional. Talk about the ultimate mandate.
I wouldn’t use ‘rapidly’ as a substitute for ‘gradually’ like he does. Would you?
I don’t understand? It’s a direct quote from the link.
Yes, and it looked absurd then also.
Since you’ve already pointed out that you were a history rather than math major I’ll politely point out that your 21% was to cover the rest of the 270M Americans. You still need to cover the 40M olds at a current 3%.
So 21 + 3 is 24% which is more than 22%.
Jon on indeed. :-)
Why the selective focus on increased nominal taxes, without looking at the countervailing savings? Under “Expanded and Improved Medicare For All” (HR676), these would include:
* Lower medical prices, via monopsonistic bargaining (e.g., 40%-50% savings on patented prescription drugs)
* Dramatically less administrative overhead (a savings estimated at $400 billion a year)
* Elimination of provider-side conflicts of interest (e.g., unnecessary referrals by physicians to diagnostic and treatment centers in which they have a financial interest, estimated to be responsible for 50% of Medicare billings in some locales)
* Elimination of the hidden healthcare-tax burden of Medicaid, the Veterans Health Administration, Tricare, the Federal Employee Health Benefits Program, state and local health insurance programs, the Indian Health Service, employer-paid premiums, and itemized medical deductions
* Avoidance of costly urgent and remedial care through the provision of timely preventive and maintenance care
… and last but not least …
* Elimination of all health insurance premiums, deductibles, and copays
Back in 2008, the Commonwealth Fund published an economic analysis of various healthcare bills that were in Congress in 2007. The single-payer bills were the *only* ones projected to achieve 100% coverage while causing total healthcare expenditures to *go down*. The decrease wasn’t dramatic, but it was a step in the right direction, in contrast to all of the other approaches. (The CBO projects that under the ACA our aggregate healthcare expenditures will increase by at least 2% of GDP by 2019.)
Turning to real-world evidence, France has a functional single-payer system* that provides excellent, comprehensive coverage to literally 100% of the population. They spend 11.2% of GDP on healthcare and get better overall outcomes than we do by most key measures. We have a dysfunctional kludge system that provides mediocre-to-adequate coverage to around 80% of the population. We spend 18% of GDP on healthcare and rank close to the bottom on most OECD outcome measures. If we were able to adopt France’s system wholesale, we could theoretically save around $1 trillion a year on healthcare — (18%-11.2%) x $14.7 trillion US GDP — while covering absolutely everyone. I’m not suggesting that Americans could ever be as efficient, cooperative, egalitarian, and community-minded as the French, but they do offer a real-world example of the potential savings (and excellent care) that single-payer can offer.
Anyway, both theoretical projections and real-world evidence suggest that under single-payer, your total healthcare-tax burden is going to be lower than the total healthcare-expenditure burden you’re bearing now.
*For historical reasons, France still uses multiple sector-based insurance funds. Functionally, they operate as a national single-payer system.
“It is a bitter irony that Obama purposely loaded it with GOP ideas and goodies (in his never ending, stupid quest for ‘bipartisanship’), and not one Republican voted for it.”
No, Obama was just hoping Republicans would give him cover for the secret backroom deal that he made with his corporate pals.
All this current medical plan is, is a plan to attach to every American an extortion clause and leg shackles for the One Percent who own us. We know that there are millions of Americans that don’t have the price of a Happy Meal so these people will be brought into a Welfare program in which every cent they have or earn and everything of value they ever bump up against is available for extraction by the OnePercent. Our Government is not the people controlled tool of a democratic nation, no, it is an animated corpse, in which the OnePercent extort and imprison and declare war, pretending to be the once real Government.
The One Percent banks run Welfare, make no mistake, and with their Government hat on, they demand that people come in and have their fiancees reviewed two or three times a year. These people are subject to work programs, drug tests, and hearings that are courts of law with private judges and administrative personnel that have the power of government. In these hearing, which come in the form of short notice summons, you are read your rights and cross examined.
I don’t know why people can’t just have health care like other industrial nations without so much slave like domination. People worry about the computer chip, believe me this is just as bad. The problem is the bankers believe the taxpayer money is theirs and the government is also their private control the people biz. There is noting remotely democratic about America any more. And the take over of the American Government by Wall street was done to control exactly this type of people extraction and control.
I am with you. Medicare for All (MfA) fans seem to think MfA will be free. If we get it and don’t do anything to change our cost of health care, we are doomed. We have to cut our health care cost as a % of GDP in half. It is doable, but Americans are going to have to suck it up to get there.
It will take some of the following and a lot more.
1. Enforce medical home.
2. Enforce ACOs for large clinics and hospitals.
3. Enforce REAL non profits (limit CEO salaries; eliminate severance packages; limit reserves (example: 200% of statutory reserves.
4. Lower earnings for health care providers.
5. Providers charge everyone the same am’t for the same care; allow gov’t to negotiate lower prices.
6. Single insured pools per health care economic region that prevent cost/price shifting among insured groups.
7. Disengage health insurance from our jobs, but require employers to contribute to the cost of our health insurance.
8. Move to a consumer driven value/price choice system.
I am not a lawyer and I know nothing about Commerce Clause jurisprudence. But since constitutional law is the intersection of law and politics, I’m going to go ahead and give my two cents’ worth on the individual mandate anyway:
I think an individual mandate to purchase a private product or service could arguably be a defensible exercise of federal commerce power if the product or service were so tightly regulated and price-controlled, and its benefits so egalitarian, and its cost so fairly apportioned as to make it functionally indistinguishable from a tax-funded, government-provided product or service. Switzerland’s highly regulated, highly subsidized, highly egalitarian, nonprofit multipayer system — which has an individual mandate and only costs 12% of GDP* — would probably qualify. I suspect Japan’s multipayer system might qualify as well (individual mandate, ~8.5% of GDP, great outcomes). The Patient Protection and Affordable Care Act of 2010 (PPACA), with its widely divergent benefits packages, its non-universality, its total lack of price controls, and its staggering cost (>20% of GDP) doesn’t even come close. In the context of PPACA, the individual mandate amounts to the federal government pimping out the citizenry to a predatory, parastic industry to have even more blood sucked out of them. (It will bleed fewer individual patients to death, true, given that PPACA’s other provisions curb some of the most egregious insurance company abuses, but it will definitely suck more blood out of them in the aggregate.)
I don’t mind being required to pay my fair share for an efficient, equitable healthcare system, but I object to being pimped out to Big Health. I’m firmly with the single-payer doctors on this one.
*If you exclude the small, ultra-wealthy tax haven of Luxembourg, Switzerland has the second most expensive healthcare system in the world. It covers 99.5% of the population, costs 1/3 less than ours, and gets among the best medical outcomes in the world. If Swiss insurance companies could negotiate fees and prices on a national instead of cantonal level, it would be even less expensive, but then Swiss pharmaceutical companies and doctors would get mad…
FDR did all he could to avoid SS being implemented, and when he could avoid it no longer he made sure that it was supported by a cruelly regressive tax.
FDR was just fine with the evil Bourbons: he thwarted the passage of anti-lynching laws.
Private insurance companies, Pharma, etc. are Obama’s fake opposition, his excuse not to give people what they want, so of course he will accomodate them. A single payer system would increase people’s expectations for a more responsive government, something both parties will do anything to avoid, including going to war.
“Total health-care costs fall when poor are provided insurance.” There’s some good math in this article. I like math as a tooL for practical decision-making.
http://www.huffingtonpost.com/2012/02/10/health-care-costs_n_1266442.html
Another issue that I wasn’t aware of until I had a rare medical problem is that single payer systems are great for preventative care and common problems. People in Europe, UK, Australia can, on rare occasion, wait years to get into a super-specialist for a rare problem and accessibility is determined by where you live. I support a single payer system and universal health care. I was very idealistic about it because I had no real knowledge of it’s practical application. I’m not making an alternate proposal… just saying I was unpleasantly surprised to hear about the difficulties people have getting into see specialists with all the bureaucracy involved with the various national programs. If you’re interested, google femoroacetabular impingement and/or hip dysplasia and read about what’s happening in the UK, Canada and Australia when people try to get in line to be treated. I’m currently being served by the ACA. I have purchased a Pre-Exististing Condition Plan and it has saved my leg from a birth defect. Now that fate has placed me into the middle of this issue I’ll have to learn more but just wanted to raise the point that once I became involved first hand with a population of people from all over the world all dealing with the same rare illness, I got a unique look at how various health care systems work for that particular problem. None are perfect. My assessment based on that experience is that in most cases the system functions better in places with universal health care but when there’s a problem for someone, it’s a BIG HUGE problem. We could learn from those problems but pretending that single payer is a panacea is impractical.
Fair enough; no one is saying single-payer is a panacea — just much better for the vast majority of patients than what we have now or what we will have if and when the Affordable Care Act is fully implemented.
I’m curious whether you ran into any fellow patients from Switzerland or France who couldn’t get reasonably prompt, appropriate treatment for your shared condition. I’ve never come across anecdotes about excessive waits in these systems.
When you evaluate delays in other countries, remember to take into account how well their systems are funded, as well as how many subspecialists they have in your area of need. (Countries with smaller populations often have a disproportionately smaller number of subspecialists than we do.) Consider also how long your wait would have been in the US if you had not been able to afford your subsidized pre-existing condition plan. From what I’ve read, that seems to be the case for many patients with pre-existing conditions. Would you have qualified for your state’s Medicaid program? Would you have been able to find a surgeon and facility willing to treat you at Medicaid rates?
I’d also be interested to learn how the cost of your insurance and out-of-pockets compared to those of patients in other countries who did manage to get treated in time. (And of course, I’m interested in hearing about how happy their are with their medical outcomes.)
I’m glad you and other patients in your situation have reaped significant benefits from PPACA. However, I believe that all of us, including you, would have done better under Expanded and Improved Medicare For All (HR676). Barring a huge initial backlog of untreated patients, you would likely have gotten your treatment just as promptly; with a universal provider pool being paid uniform rates, you would have had your pick of any hospital and doctor that had an open slot; and it would have cost you nothing out of pocket. And I would have been happy to help pay for your treatment through my health insurance taxes, because I know I would still be coming out ahead.