Friday, July 13, 2012

The Supreme Court, ObamaCare and Moral Claims of Freedom

The Supreme Court has spoken. The constitutional battle over ObamaCare is over. The President and his much derided solicitor general won on most of the legal merits and the policy implementation. Even as the Supreme Court (rightly in my view) rejected the Administration's argument that the Commerce Clause allowed a mandate to purchase health care coverage, it (wrongly in my view) allowed the individual mandate to stand by wrongly characterizing it as a tax. Very few people besides Lauryn Hill, Wesley Snipes or Irwin Schiff question the government's ability to tax and spend so the Supreme Court called the mandate a tax and allowed it to stand.

So that is that. Short of a (currently unlikely) Romney victory and (quite unlikely) total Republican November sweep of the House and Senate, the Patient Protection and Affordable Care Act is a settled issue. There are some Republican governors who are threatening, as is their right, to refuse to set up exchanges or expand Medicaid while for the 33rd time the House voted to repeal the law but those are die-hard responses that won't "pull up ObamaCare by its roots" as some desired.

One thing that I've noticed is that partisans on either side make the mistake of personalizing the Patient Protection and Affordable Care Act (hence the name ObamaCare). This explains the insane "I will break him" attitude of many Republicans and the joy of some PPACA supporters who didn't really look at the fine print.

Too many PPACA supporters make the mistake of assuming that all opposition must, by definition, be based in dislike for the President. This is not the case. There are two major objections to the PPACA, which are shared in different ways by principled dissidents on both the left and right as well as some libertarians across the board.
First, there has been a reduction in freedom. This is the critical issue to people who tend libertarian and/or are opposed to the mandate. 

Unfortunately many people on the left and/or supporters of PPACA miss this entirely. They assume that anyone who invokes this concern is either a useful idiot (if they're leftist) or a liar (if they're on the right). Well maybe. But remember we talked recently about how many people on the left place equality and compassion as the highest and in some cases only moral values. This is an excellent example of that. In order to supposedly move towards equality and compassion the people who support the mandate are perfectly willing to reduce your freedom to make choices about what sort of health care you want. Now think about some of the other power-mad people that are in executive office around the nation. Can you imagine what a President Bloomberg might do with such powers? What sort of nation do you want? Do you want an activist relatively unrestrained centralized government?
I live in Michigan which has a higher than normal amount of truly obese people of all races. It's especially bad for Hispanics and Blacks. All else equal, obese people cost the public and private sector more in medical coverage. They clog the health care system with their (preventable) diseases and conditions. The slender, underweight, normal sized or moderately overweight workers pay money into a system that transfers much of that money to obese care. Why should I pay money to subsidize some free-loading fattie? So OBVIOUSLY we need a mandate that obese people (BMI of 31 or greater, or body fat pct of 32% or higher) join a health club and maintain that membership until their BMI falls to 28 or lower. To make it nice and constitutional we'll just levy a tax on porcine people who refuse the new mandate or can't lose the weight. Sound good?? Well if I happened to own a health club I would love this idea. 
People that drive trucks use more gasoline, contribute more to global warming and damage roads more quickly. And those doggone people won't stop buying trucks even as gasoline stays above $3/gallon. So OBVIOUSLY we need a mandate that everyone purchase either a Volt, a Focus, a Leaf, or a Nano. So those of you who like your Rams or F-150s sorry pal. You're hurting the economy. But why stop there?
There's a doctor shortage, This affects health care. And that's commerce. Too many smart people are going into law or finance. This is an OBVIOUS resource misallocation. Don't these people know that they owe it to us all to make the right choice? We'll just mandate that certain people become doctors. After all chances are that they're receiving some form of government tuition assistance. And should they disagree well that's no problem, we'll just refuse them student loans and make them pay added penalties on any income earned outside of the medical field. We'll soon have more doctors to treat the expanded patient base.
Now that we've accepted that anything (including inactivity) that impacts commerce can be taxed and mandated why not just go for broke. Business hiring decisions have a much larger immediate economic impact than health care provision health care. Corporations are sitting on trillions in cash and refusing to hire people. This hurts the economy. In fact it's economic treason. So let's just mandate that corporations hire people until the unemployment rate is at 5% or lower. Those companies that refuse will have to pay a penalty tax. The Secretary of Commerce and the Secretary of Treasury will oversee this program.
And so on. You may think I am being ridiculous. Maybe I am. You may think there are political, legal or constitutional barriers. You may even think some of those are good ideas. But I don't think any of them are good ideas. And I think they are slightly more likely than they were a month ago. The government has unparalleled coercive powers. I don't think it's a coincidence that after the PPACA was upheld we see NYT editorials endorsing the idea of using eminent domain to seize homes that are underwater and give them to other investors for resale or using the power to draft to create a national service cadre of lower paid/unpaid young workers that would undercut unionized labor.

Secondly, the law doesn't solve the problem it was meant to solve. It does not bend the cost curve. How could it? Big pharma maintains protection from cheaper generic drugs. Hospitals have greater incentives to merge. There is no legal mechanism to limit or prevent premium increases. All else equal there will be greater demand for roughly the same supply of services. That means, premiums will increase, as mine already have. It makes it more difficult, if not impossible to push for a single payer program in the US and may increase medical costs abroad.
Who are the people who lack health insurance. Well some are the long-term unemployed. Others are illegal immigrants, who will still be uncovered under this plan and will still be seeking assistance in the ER. Others are people with conditions that are simply so expensive to treat that their insurer has kicked them off their plan and/or other insurers have refused to cover them. Others are employed people who either can't afford coverage or who work somewhere where coverage isn't offered. And finally there are people who, affordability aside, have made a rational choice they they don't currently need health care insurance. 
This last group (the smallest) has received much scorn and opprobrium for supposedly driving up insurance premiums. People speak of them with contempt. They tend to be younger and/or in better health so they are much desired as customers by insurers because they will tend to pay premiums but cost very little in coverage. I don't understand why it is okay to speak with disdain of people standing on their own two feet but if someone has an unkind word to say about a welfare recipient, who is taking from the system, then that's a bad thing. At the very least it's safe to say that this law will have some unintended consequences.

Obviously some people are not fans of the 9th amendment, the 10th amendment or of a Federal Government with limited enumerated powers. That's fine. Evidently portions of the Constitution don't mean what I thought they meant. Cool. Hey I'm no constitutional scholar. I'm just an IT guy.

But, if we did decide that we really really really wanted a Federal Government with limited and enumerated powers and that the 9th and 10th amendments were actually meaningful amendments rather than the redheaded ugly stepchildren of the Bill of Rights, what changes would we need to make to the Constitution since evidently some parts just aren't clear??? This is not a rhetorical question. My concept is that government should stick to its limited roles but otherwise leave me alone.

Now that the issue has been settled, at least in the courts:

What are your thoughts?

Do you at least understand the opposing side (whatever side that is)?

Do you think this will be an issue in the November election?

Do you want a limited federal government or a large unlimited federal government?

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