Social Question

john65pennington's avatar

Where in the Constitution does it give Congress authority to administer a healthplan?

Asked by john65pennington (29187points) March 23rd, 2010

I have searched the Contstitution and i have yet to locate a sentence, a phrase or a paragraph that states the Federal Government has the authority to administer any type or form of healthcare to the people or the states. if you find this authority, would you please advise me?

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68 Answers

snowberry's avatar

Seeing as how “health plans” were non-existent back then, I don’t think there is any.

jfos's avatar

Where does it say about NASA and bicentennial coins and calling french fries “freedom fries”?

Snarp's avatar

It’s right next to the part where they have the authority to regulate the airwaves. Right before the part where they’re authorized to help fund and regulate the initial development of a network linking computers all over the world.

MrItty's avatar

Where in the Constitution does it state that if something’s not in the Constitution, the Federal government isn’t allowed to do it?

malevolentbutticklish's avatar

@john65pennington: This is part of why many states are challenging the constitutionality of this bill.

stratman37's avatar

Let the flaming begin, but if the White House is gonna provide federal funds for abortion, we don’t have long until judgement comes to this nation…

Cruiser's avatar

@john65pennington While you are looking there see if you can find the part that grants authority to the government to control over 50% of your life.

john65pennington's avatar

Cruiser, i heard you. i expect many lawsuits from this situation. 12 states are already in the process of suing the Feds.

ragingloli's avatar

General welfare and interstate commerce clauses.

BhacSsylan's avatar

there is nothing in the constitution to say that they can. Until various amendments, it also never said we have a right to freedom of speech, to bear arms, etc. It also never said the government could let women vote.

I understand why people think this is unconstitutional, they’ve got a good argument. However, I also think Obama is rather smart, and would not have run this bill through if he thought it was going to be shot down a few weeks later. He was a lawyer for quite a while, he (probably) already has a defense lined up.

Snarp's avatar

In the end, only one person’s opinion on this matters.

talljasperman's avatar

where does it say that It cannot?

john65pennington's avatar

BhacSSylan, i think Congress put the cart before the horse in this situation. Congress should have made an amendment to the Constitution to make their bill legal. i expect many lawsuits challenging its legality. the Supreme Court will most likely have the final decision.

JeffVader's avatar

Hmmmm, not sure if Washington & his cronies were aware of healthcare plans back then….

BhacSsylan's avatar

Um, sorry, what amendment were you referring to? I was just pointing to the fact that the constitution was made to be changed with time, and has done so, and that “Where is it in the constitution” is not always a valid reason, since many things used to not be in the constitution.

And as a few other posters have said, many simple laws are made that have nothing to do with the rather restricted view of the constitution, which deals only with human rights and how the government should operate. Easy point: we have quite a few laws governing what substances you can put in food, and how to label it. Where is that in the constitution? I think that’s a rather nice law to have, too.

john65pennington's avatar

jfos, NASA is internal with the Fed Gov.and does not directly effect all the people. coins and freedom fries do not directly effect all the people. a new healthcare program will effect all the people, especially and directly in their pocket.

jealoustome's avatar

Obama was a Constitutional Law professor. I’m pretty sure he has thought of the attacks that will be levied against this reform. Also, the Congress has power to “regulate commerce among the several states.” This is where they get the authority to do everything they do. Even the Civil Rights laws were tied to commerce to make them constitutional. For Congress to be allowed to regulate an industry, the industry has to have an affect on the overall economy of the country. I believe the healthcare industry meets that test. Edit: And as far as administering a plan, this would fall under the same scope as social security and medicare which have already passed the test as well.

BhacSsylan's avatar

@john65pennington just because it’s going to affect all people doesn’t mean that the rules change significantly. Really, they shouldn’t, or you’d be able to get away with singling out racial groups, etc. All people or some people, if it’s denied by the constitution, it cannot work.

That being said, if it’s not denied by the constitution, such as when thinking about food regulations, then it’s allowed to pass. Either it is denied or not, that’s all the Supreme Court has the authority to say. Granted, they’ve said more stuff over the years, but that’s all the power that the constitution grants that particular body.

john65pennington's avatar

jealoustome, civil rights, commerce and healthcare are really a stretch of ones imagination to tie together. if i were on a jury i would never be convinced the three had anything in common.

jealoustome's avatar

@john65pennington Constitutional law cases are never seen by a jury, they are only judged by judges.

I took Constitutional law not long ago, and I can tell you that a lot of it is counterintuitive. It just isn’t simple and straightforward.

Snarp's avatar

Really there’s only one thing in here that could be seen as unconstitutional, and that’s the mandate to buy insurance. An interesting thing about the Supreme Court, they can rule that part unconstitutional and leave the rest of the plan in place. Which would essentially put the insurance companies out of business, which would allow us to start from ground zero, which would eliminate the biggest obstacle to a single payer health plan. Interesting. . .

fireside's avatar

This link details several things that are not in the Constitution but are accepted by the people.

The Air Force
Paper Money
Political Parties
The Right to Vote

Are you suggesting that Congress should not have passed laws on these topics either?
It is the duty of Congress to pass Federal laws.

jealoustome's avatar

@Snarp I was wondering about this as well, but a friend brought up the fact that we must buy car insurance. Still seems like it might be different as, I believe, car insurance is mandated state by state not at the federal level.

Snarp's avatar

@jealoustome I think it’s a weak case at best, but I expect it would hinge on this notion of State versus Federal action, and perhaps on the notion that cars are optional, a device which you must be licensed and registered to operate, and therefore mandating insurance for car owners to reduce liability claims is a different matter. Of course, I never thought the Supreme Court would allow unlimited corporate spending in political campaigns.

Captain_Fantasy's avatar

That part that gives power to make laws? That’s the one.
I’m pretty sure the constitution doesn’t make mention that prostitution is illegal but we still just go right ahead and make it illegal.
The constitution doesn’t contain all our laws

john65pennington's avatar

If the Congress is mandating health insurance requirements to the states and individuals as a “necessity”, isn’t this a freedom violation of a persons Constitutional rights? have the citizens once again lost another battle to maintain their individual rights in America? the Commerce Laws of the Constitution are very vague. its intent, in my opinion, was to permit, allow and encourage commerce, or goods trading, between the states, not the healthcare business.

john65pennington's avatar

C. Fantasy. you are confusing Fed. law with state and local laws.

El_Perseguidor's avatar

I am not American. I wonder if your constitution talk about invade other countries or have military bases all over the world… and of course CIA interfering in other governments and “suggest” genocide?

john65pennington's avatar

El, your answer has nothing to do with the question at hand.

El_Perseguidor's avatar

jajaja Well, it is in some way, you do not protest for all the bad things that you country have done without been in your constitution. It won’t be in Fox news, but what I’m saying it’s true. So, this time they are doing something good, but here we have people mad, against to something that don’t know. It doesn’t matter if is or not in your constitution. Sounds like someone saying that if it’s not in the bible cannot be true.

P.s. Sorry for my poor English, I hope I explained myself.

bellusfemina's avatar

If you choose not to participate in the healthcare plan you will be taxed. This becomes an issue, because it is illegal to tax someone for something they do not have.

Snarp's avatar

@El_Perseguidor I’m with you. The constitution fundamentally requires that everyone be treated the same under the law. No where does it allow individuals plucked off the streets in foreign countries to be removed from the right of habeas corpus or access to due process. That’s a lot more serious violation of the constitution than health care reform.

jealoustome's avatar

@bellusfemina I’m not sure that is true. If you don’t have kids, you still have to pay taxes for public education. Of course, that is at the state level, but it sets a precedent. I’m guessing my income tax doesn’t go to things that are all directly related to me. I’m sure that there are plenty of government programs supported by my taxes that I could not personally take advantage of. If anything, the tax you speak of might be more fair because of the ability to choose to take advantage of the benefits.

dalepetrie's avatar

Point #1:

Article 1, Section 8 of the U.S. Constitution, which delegated authority to Congress “to lay and collect taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.”

62.1% of all personal bankruptcies are due to people not being able to pay their medical bills. Though I can and have cite many, many reasons why maintenance of the health of our populace is part of the general welfare of our country, that one stat alone is proof positive that not only our individuals, but our entire economy and system of governance has its general welfare served by reforming health care.

Point #2:

I and others have explained this in far greater detail on other forums you’ve participated on, you’re not going to get a different answer if you just ask your question in a different way.

Point #3:

The government has LONG provided health care under Medicare, why has this been fine and dandy for close to 80 years and now people suddenly think it’s an affront to the Constitution?

Point #4: The government is only REGULATING the EXISTING for profit health care system, and not, as you misinterpreted it, “administering” a health plan.

Cruiser's avatar

@dalepetrie I don’t buy into your justification of using that 62% figure of bankruptcies are due to overwhelming medical bills. Sure that may be a main reason for some bankruptcies but an overwhelming majority of bankruptcies are due to poor money management chiefly over extension of credit…buying things they cannot afford. Oops a medical crisis comes along and of course they have to file bankruptcy not because of the medical bills but because they are already underwater financially. People need to accept responsibility of their financial means and abilities and stop looking to the government to give them a pass on responsibility for their own poor decisions.

malevolentbutticklish's avatar

@Cruiser: Thank you! The Japanese save ⅓rd of their income ON AVERAGE (some more some less). If someone wants to say that they declared bankruptcy because of medical bills they will need to show that they saved ⅓rd too. The truth is almost no one who is a life long saver ever declares bankruptcy due to medical bills.

iam2smart99037's avatar

The necessary and proper clause. It’s their catchall for doing whatever they want.

stratman37's avatar

“other duties as needed” I hate that one!

dalepetrie's avatar


You can doubt it all you want, but a very conservative methodology was used to come up with this figure and I think you’ll find it’s well supported. Whether you live frugally or rack up charges on your credit card that you can’t afford, if you are suddenly hit with a financial burden that outstrips your net worth due to an illness or injury, it would have bankrupted you no matter how frugal you’d been. Per the above link from the American Journal of Medicine,

“Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance.”

Doesn’t sound like a bunch of fiscally irreponsible fools to me.

semblance's avatar

I am an attorney.

Nothing in the US Constitution specifically gives Congress the power to regulate health care. However, nothing in the Constitution gives it the power to set educational standards, impose environmental regulations, motor vehicle standards, and many other things which people do not question.

The strongest constitutional basis for health care is found in the “Commerce Clause”, which gives the US government the power to regulate interstate commerce. Decades ago, back during the Great Depression, the US Supreme Court interpreted the Commerce Clause to mean that the federal government could even regulate commercial activities that were wholly within a single state as long as those activities might have some theoretical affect on interstate commerce. For example, when wheat production was regulated by the federal government a farmer could not even grow his own wheat for his own family’s consumption without complying with the federal government’s regulations. Thus, the long standing interpretation of the Commerce Clause is so broad that the federal government can regulate just about anything, anywhere in the US, that involves some form of commercial activity. Undeniably, health care does.

So, as the law stands today, the carping about health care reform has no constitutional basis. Of course, since at least four members of the US Supreme Court have questionable intellectual honesty, that could change.

dalepetrie's avatar

@malevolentbutticklish – I’m sure that theory would be great comfort to a “lifelong saver” who had his life savings wiped out when he got cancer and reached the $1 million lifetime benefit within the first 3 months of treatment. With insurance 8½ years ago, I paid $2,200 out of pocket to have a baby…without the insurance it would have been $45,000. All told, ⅓ of my salary from the time I started my career until I had a child would not have covered it. And that’s just a baby. Even if it didn’t bankrupt you, would you REALLY want your life savings wiped out just because you got sick. How is that fair or just or humane? Tell you what, if you don’t like it, don’t carry insurance and just pay the penalty for not having insurance, I’m sure it will be a drop in the bucket if you’ve saved ⅓ of everything you’ve ever made. And it will protect the rest of us should you get permanently crippled by a drunk driver and require a lifetime of hospice care which you will be able to pay for until your life savings runs out, but will after that need to turn to the government to subsidize you.

Cruiser's avatar

@dalepetrie That was the tipping point plus you are pointing to 2007 when the real estate market bubble burst. What is also missing is how they lived their lives up to that point. Dale I could pull all sort of facts and figures out of documented sources and it would not change your desire to believe what you feel the need to believe. I am OK with that. But the fact remains you know that life is full of curve balls and that is why you buy insurance before you buy the new car…before you get the big screen TV, before you go to disney world, before you buy a home you may not be able to afford, before you go out to restaurants once a week….you work 2 jobs if you want luxuries…you save for that rainy day like I do, like millions of other do….you don’t suck on the teat of the government unless you have exhausted all other means.

malevolentbutticklish's avatar

@dalepetrie: $45,000 should be enough for 6–9 babies: “It costs between $5,000—$8,000 for a normal vaginal delivery and up to $12,000 for a cesarean deliver.”

dalepetrie's avatar

@Cruiser – well, I’d love to see your data, because what I’ve seen says that health care related personal bankruptcies are STILL growing at over 42% a year, regardless of the housing bubble. I’m not saying some people don’t live irresponsibly and then regret it. But again, look at what the data says about the people filing these bankruptcies. Middle class, working, with health insurance, educated…not the kind of people who “suck off the government teat”. You want a more recent statistic, OK…17,000 people a WEEK in 2009 were declaring bankruptcy because of medical bills. Yes, you buy insurance so that you WON’T lose everything you’ve worked for when “life throws you a curve ball.” My point is that let’s say over the course of 10 years, you fritter away $100,000 on things you really don’t need…well, OK, that’s a matter of your values system, but maybe you got that big screen TV because you work hard for a living, you make good money, and you feel like maybe you want to, oh, I don’t know, actually have something you enjoy in life before you’re too old to enjoy it. Maybe you do that instead of going out to movies, recouping your costs in a couple years. Maybe you took that trip to Disney because it’s really a good place to bring your kids, and your kids would be too old to enjoy it in a couple more years. Not everyone is going to choose to live frugally, some will save NOTHING for a rainy day, some will pinch every penny and never get a moment’s fun out of life and just hope they don’t die too young from the stress to enjoy their riches, and MOST people will be somewhere in the middle…affording themselves the occasional luxury.

So, let’s go back to my example, let’s say you save instead of fritter away $100,000 in things you could have done without over a 10 year span, maybe you’d even have $150k saved if you invested smartly. But then you get cancer, and even though you’ve saved, even though you and your employer have put several hundred dollars a month into the pockets of your insurance company, they either drop you or impose a lifetime limit. And if you have to leave your job for health reasons, once COBRA (which is way too expensive btw for most working people, and particularly for the unemployed who most need to use it) is gone, you’ll be denied because of a “pre-existing condition”. So, that 150k lasts you maybe a couple months, then what do you do? Hell, maybe you die. Wouldn’t it have been nice to have a big screen TV and have taken your kids to Disneyworld…if you’d known you were going to live to say 45 years old, maybe you would have made different choices.

And that is why a social safety net is necessary. I agree it’s there when you’ve exhausted all other means. I draw unemployment, have been for 13½ months since my employer shut down. I was fortunate to get a conversion policy when my company went bankrupt, or I would have been denied coverage because of my diabetes. But you know what, I PAID into that unemployment system out of every check, and I’m damn glad it’s there, because my family still has a roof over their heads and food in their stomachs. As for what I’ve worked for…l saved in the form of 401(k) defductions wherever possible, but for the past 10 years, I’ve suffered one layoff after another, every single time it hasn’t been a termination for cause of any kind, it’s been “just business”, other people were affected and where possible I’ve been given some severance. But it’s been a tough decade for me, I’ve maxed out almost all of my available credit now, and I was a person who paid all my credit cards in full and on time, always without exception. I had a tremendously good credit score, but when the credit crunch came, every line of available credit I had was taken away from me, my accounts were closed, and as soon as I started carrying balances, because after a few months with no income, it’s a necessity, all my interest rates went through the roof.

Yeah, life throws you curve balls, and that’s why FDR instituted the New Deal programs, which Conservatives have been trying to weaken ever since. How many people have avoided poverty and economic tragedy because of the social safety net? How many of them would have agreed with you (and me), that you work hard for what you get, you take personal responsibility, but you want to make sure that if something completely outside your control comes along, you don’t end up losing EVERYTHING you’ve ever worked for. You might not look to the government first, it’s not as if I haven’t applied for 1,000 jobs, gone on countless interviews and been this close a painful number of instances, but I’m glad unemployment insurance is there for me.

A close personal friend of my wife fell in love with an illegal immigrant who had been trying to gain legal status for years, and the only reason he was here illegally was because there was no future for him where he came from, and there was no legal way for him to immigrate, indeed the only legal way for him to do so was to first come here illegally, then get caught, then ask for an adjustment in legal status. That is how most “legal” immigration is done in our country these days. Only 55,000 people from the entire rest of the world are allowed to even apply for legal immigration to the US each year, many of those applications are denied, and people from the 19 countries whose citizens most want to be here are prohibited for filling out those applications.

So yeah, you could say she made a mistake marrying and breeding with a foreigner, but you love who you love, hard to fault someone for that. Well, even though they had two young American born daughters, our government deported him, event though he worked hard, several jobs, paid in taxes but never filed a return to get any of it back, and wanted nothing more than to see his daughters grow up, he was deported. THe same day he was deported, his wife was sent to the hospital. Due to a) 10 years of stress trying to get her husband’s status adjusted with the threat of deportation hanging constantly over their heads, b) years of scrimping and saving, both of them working multiple jobs just to get by just so every extra dime they got could be put into his legal case, and c) because neither of them had health insurance, him being undocumented, and her only working multiple part time jobs that didn’t offer benefits to part time employees, she had let a virus go untreated for 4 months and it attacked her already stressed out heart. Bottom line, she went into congestive heart failure, ended up with 15% function in her heart, was prohibited from ever working again or even picking up her daughters. She had no husband to provide for her or to take care of the kids, no source of income…last resort was Social Security. Took her a year to get a settlement because they didn’t believe someone at age 35 could be that bad off, but eventually she won her case, only to have her entire settlement evaporate, because it was about 11 grand, 3 grand went to her attorney and the other 8 was wittheld because her father had loaned her 8 grand from his 401(k) which he, an accountant, had saved his whole live for, and being 59 at the time, he was just about to need that money for retirement…SS said it wasn’t a loan, it was a gift, simply because he was her father. She lost her home that they’d been paying down for years, and were it not for a) Social Security, b) state funded medical assistance and c) the kindess of a friend who got married and rather than sell her house for a profit, she rented it out to this person for less than she pays a month for the mortgage. Meanwhile, the house has lost a ton of value and would not be worth selling now, the friend with the “extra” house is now having a hard time meeting her obligations because even though their only TV is about 30 years old, they drive modest cars and only go on vacation to visit his parents once a year, even though she makes good money at a stable state job with great benefits, she’s struggling now too.

This is NOT the American Dream. This is not how it’s supposed to be. If you work hard, live modestly, save what you can, you’ll get by. Bullshit. This is why we need a social safety net for things that impact our very lives and well being….we SHOULD be able to look to a Government that in its very charter stated it accepts the responsibility of providing for the welfare of its citizens to feel that if we work hard, do what we should, and life does throw us a curve ball…we get sick, or injured or old and we can’t work, we can’t pay our bills despite our best laid plans, then it benefits us ALL to pay a little into a system so that this “insurance” is there for us, if we are the unlucky bastards who end up needing it.

But I am a man of facts….if you have something that can disprove anything I’ve said enough so that it will change my perspective on what I’ve seen happening to myself and my friends, by all means, please do share. But don’t insult me by saying that what I said isn’t true, and that you could prove it, but I wouldn’t listen to you so why should you bother…that is a weak ass, cowardly response, and you know it. You ask anyone who knows me on Fluther and they’ll tell you straight out, I’m nothing if not fair. I listen to what people have to say, I don’t shut down debate or run from an arugment…I use facts to support what I say. I would never pull a bitch move like you just did.

@malevolentbutticklish – not that it’s any of your business, but those figures you quoted are as you said for completely normal birthing scenarios, but you know what, the vast majority of women I know who have kids did not have a simple in and out birth experience. My wife had to be induced 3 weeks before her due date, because the baby was getting too big, after 36 hours in the hospital while they were trying to induce, the doctor said the baby was having decels, so they did an emergency C-Section. The baby had low blood sugar and very slight jaundice…neither was all that suprising, particularly since my wife hadn’t been allowed to eat anything for 36 hours. But they decided “to be safe”, they’d put my health son in the NICU, and they used every delaying tactic in the world to keep him there, even though he was fine and would have been OK had he gone home with us. My wife had to stay in the hospital for the maximum 4 days after the delivery because her incision infected and they had trouble bringing her out of the drug induced coma they’d put her in to do the C-section. 5 days total in the hospital for my wive, 7 days in the NICU for my son, C-section which was probably not really necessary, but which has become standard medical practice for hospitals to do if induction isn’t successful in the first 36 hours (they need the beds to generate more revenue you know). Total bills were 45k. Insurance disallowed 22k of it. I paid 2,200, insurance paid the rest. Quote me whatever facts you want, but please refrain from questioning my honesty when I tell you about something that hapopened in my own fucking life.

Snarp's avatar

So 13 states have filed suits against this bill. I wonder how much tax money is going to be spent by those states on a legal battle they likely won’t win, and that won’t matter much if they do? Constitutional or not, are you all proud that in this time of economic distress and state budget cuts that those states think this is what’s worth spending your taxes on, instead of say, maintaining funding for education, parks, roads…..

malevolentbutticklish's avatar

@Snarp: Yes! I am very proud of the 13 states. We need freedom and liberty more than park-maintenance and olympic-sized swimming pools in the school system.

malevolentbutticklish's avatar

@dalepetrie: So on closer analysis the actual cost was 23K NOT 45K as you originally stated. Then you say “Quote me whatever facts you want, but please refrain from questioning my honesty when I tell you about something that hapopened in my own fucking life.”

fireside's avatar

@malevolentbutticklish – Just because the insurance company disallowed payment of 22K doesn’t mean that it wasn’t on the bill. If he didn’t have an insurance company to review and disallow those charges, he would be liable for the full 45K.

When you go to the doctor and they write up an invoice for $100, they have to take whatever the insurance company negotiates it down to, whether it be $85 or $55. That doesn’t mean that the invoice presented to the uninsured person would be less than $100.

malevolentbutticklish's avatar

@fireside: “If he didn’t have an insurance company to review and disallow those charges, he would be liable for the full 45K.” <== WRONG. If you get a bill from anyone ever in the amount of 45K and you think that bill may be incorrect in the high direction you need to review it. You think the insurance company didn’t pay someone to review the bill? How can they pay someone to review it and you can’t? I MYSELF WAS SUSPECT… just based on the small amount of information I knew. Turns out I was correct.

fireside's avatar

@malevolentbutticklish – Yes, you can have someone review it and fight the charges, but that doesn’t mean that you are not liable until the charges are reduced through negotiation or legal settlement.

Dr_Dredd's avatar

@Snarp I think all of the legal bills generated by these lawsuits should be paid by the individuals filing the suits, not the states themselves. A “loser pays” strategy might make people think twice.

Interesting point earlier about Kennedy’s being the only opinion that matters…

Snarp's avatar

@Dr_Dredd Unfortunately it is the state Attorneys General acting as agents of the state filing the suits. I’m assuming they have their Governors’ authorization, which makes the state liable. I’d be perfectly content if some individual who felt he or she was harmed by being forced to buy insurance filed the suit, then they would have to pay for it.

jealoustome's avatar

@Snarp Our attorney general, in Colorado, filed. I can’t imagine our Democrat governor supported his decision. I can’t stand our attorney general. I’ve met him and he’s a total prick. I immediately wondered who gave the go ahead for him to file a suit. It doesn’t seem to have anything to do with what the people of Colorado want. Our state gets more left-leaning democratic every year.

Snarp's avatar

@jealoustome That seems strange, but Colorado is strange. You have Boulder, but you also have Colorado Springs. A more politically divided state I cannot think of.

Dr_Dredd's avatar

@Snarp Oh, I know. But I think in this case, we should make an exception and have the individuals doing the blatant political posturing (e.g. filing the lawsuits) liable.

malevolentbutticklish's avatar

@fireside: In fact if the charges are in dispute you are NOT required to pay them until the dispute is resolved (unless the judge says differently).

Cruiser's avatar

@dalepetrie All very well thought out and articulated and even interesting to read. The only problem I have aside from the new bill being mandated and forced upon me/us is that it will now be managed and run by our government. I cringe when anyone uses any form of our government as a business model for running anything that could otherwise be handled in a free market business model. You used Social Security as your example and that one pains me the most. The Social Security program is nothing more than a big piggy bank that the Government has “borrowed” into the ground and this is not just an Obama issue though as the Government already owed 2 Trillion to the Social Security Trust Fund when he took office and Obama used the Trust Fund as a piggy bank to fund his Bailout package. I can’t find the latest IOU total but I’m sure it’s huge by now. So I expect Mr. Obama to hold out as long as he can before announcing the inevitable 2% increase on social security tax that still won’t guarantee enough money to pay the benefits it will owe. Yes why not let good old Uncle Sam screw this pooch too! So sure why not give the government one more reason to screw things up even worse. I guarantee you when this is all said and done this Health care reform will be double the 900 some odd billion dollar cost that the CBO has estimated it to cost. Got anymore good examples to share with me?

dalepetrie's avatar

@malevolentbutticklish – you apparently don’t understand insurance. You see, if I go to the doctor, they bill me the rack rate, just like if I call a hotel’s 1–800 line and book a room without a discount. If I had no insurance, my liability WOULD HAVE BEEN 45k. Insurance companies negotiate rates with health care providers to set maximum allowable billings. So, let’s say a doctor’s billing rate for something is $200, the insurance company will say, OK, we would only be willing to pay $90 for that service. So the medical provider says, “why should we take $90 when we want to bill $200”? And the insurance company says, “because we have 3 million members who if you don’t accept our terms will not go to your clinic because you don’t accept their insurance.” The provider says, OK, we’ll bill $200, if you pay the bill, you only have to pay $90 and you disallow the rest. That’s how it works. So there was no “mistake” on my bill, I was BILLED $45k, the insurance company was billed $45k. The insurance company agreed to pay $22k of that, I had to pay $2,200 of that, and the rest was written off per the contract the health care providers had with my insurance company.

@Cruiser – problem is, you’re under the impression that our health care will now be “managed and run” by the government. A few things are wrong with that.

1) Our health care system will now be more “regulated” by the government than it was before, just like air traffic control, Wall Street, etc. We did NOT move our health care system into private enterprise…that’s what many of us wanted, but it didn’t happen. We instead mandated that insurance companies can not pull the bullshit they’ve been pulling by raising rates, canceling the policies of sick people, imposing lifetime limits, denying coverage for necessary medical expenditures, and denying enrollment based on pre-existing conditions. THIS IS NOT A FEDERAL TAKEOVER OF OUR HEALTH CARE SYSTEM.

2) As for Social Security, you may be worried about where the money is coming from, but hey, you have money sitting somewhere you need cash, perhaps at times it’s better to borrow it from yourself than say China, like we borrow all our other money from. I’m 38 years old, and ever since I first heard the words “Social Security”, people have been saying it was going to collapse, it was going to become insolvent…it won’t be there for this generation or that generation or the following generation. How many times has the death of Social Security been predicted and not come true? Essentially, it’s all scare tactics, it will continue to be there, I’m not in the slightest bit worried, because the fixes are very easy.

3) I don’t believe a 2% increase in Social Security payroll taxes would be a good thing, what I think WOULD be a good thing would be to eliminate the cap at 106,800, or at least to create a donut hole and reinstate it after 250k like we’ll be doing with Medicare.

4) Social Security has been there for tens of millions of people when they’ve needed it, for a system that has done so much good for so many people, I fail to see why so many hate it.

5) I don’t think it’s necessary for a special fund to be set aside for Social Security in the first place…it is backed by the full faith and credit of the US, just like our currency, the biggest threat to Social Security as I said is the mindset that would remove the “security” part of the equation by letting funds be invested (and lost) in the free market.

6) Currently we DO have not ONE, but TWO government run health care plans that cover millions of Americans. One is Medicare…and you find me a retired person on a fixed income that isn’t thankful for Medicare. Two is the VA…again, serves a HUGE need for our veterans, makes their already messed up lives a little easier. If it weren’t there, I can’t even imagine what our society would devolve into.

7) Both Medicare and the VA have problems at times, as does any enterprise. Show me a private company the size of these government agencies you decry that hasn’t had its share of problems. But they work, and they work efficiently, at a FAR smaller cost than private industries. Removing the profit motive from health care (which we HAVEN’T done btw) removes hundreds of billions in overhead right away…I don’t get why conservatives don’t understand that.

8) I have no basis to conclude that this reform will cost more than the CBO says, and let me think about this for a minute, on one had we have a non partisan organization whose mission is to study exactly this type of thing, staffed with experts qualified to give a professional opinion. On the other hand, we have a guy on the internet, who rants against this health care reform without even understanding that it’s not a government takeover of our health care industry (will there still be for profit insurers? You bet your ass), who “guarantees” it will cost double what these experts say, but who provides no basis, no analysis, no grounding for this assertion. I know which I tend to believe.

malevolentbutticklish's avatar

@dalepetrie: If the disallowed charges were due to prior agreement (and not some other reason) and you were not allowed a “most favored nation” agreement then why choose this doctor? I do not have insurance and I see doctors which exclude those who do. In this fashion I know that I am not subsidizing them. According to the CDC, in 2005–06, 11% of physicians had no managed care contracts.

dalepetrie's avatar

@malevolentbutticklish – if you’re asking why I would choose the health insurance I have, it’s because it’s what my employer offered. It has nothing to do with any sort of “special” or “most favored nation” status. My insurance was accepted by the provider I chose. That provider had agreed with my insurance company (I had NOTHING to do with this) on what rates they would pay. This is how ALL insurance works. Any health or dental policy offered in this country, you can call their 800# tomorrow and have them explain it to you if you want, but they negotiate rates for EVERYTHING. They go to every single health care provider and say, OK, if you accept our insurance, you will have access to our insured policyholders. In return, you need to give us a discount. As for why I chose this doctor (and it wasn’t just the doctor, it was the doctor, the hospital, the anesthesiologist, the NICU, the surgeon, several providers billed for services which is why it was so high), we went to the doctor whom we trusted, who had provided my wife with prenatal care throughout her pregnancy.

Yes, there are some doctors who don’t negotiate with health care providers who only deal directly with patients, usually on an a la carte menu basis. Problem is, despite your 11% figure, from my perspective, they are few and far between. They are uncommon enough that in fact just last month I saw a story on the local news about one local doctor who was taking a “novel” approach to providing care services, by not taking insurance.

If you actually have the ability to go to a doctor who charges a reasonable amount because they don’t take insurance and they can bill less because of the lowered overhead, well good for you, but that is a solution that will not work for most people. For me, at the time it wouldn’t have worked because hey, I didn’t know of a single provider like that. Plus, I’m paying for (and my company is paying for) insurance, why wouldn’t I use it? So, let’s say for a moment that I could have found a doctor who would have only charged me $22k, that still would have been financially crippling for me at the time, and chances are my liability would have been more than 22 but less than 45.

Today, I couldn’t just eschew insurance because I’m a type II diabetic. Even WITH all 3 of us insured, my out of pocket medical expenses, not including premiums was $4,000 in 2009. I’d say it costs $11,000 – $12,000 total in health care expenses for myself, my wife and my son, that’s with insurance. If I had NO insurance, my drug costs alone would be over half of that, and if I had to pay the non-negotiated rate, even with a provider that discounts because he doesn’t take insurance, I’d still end up, in a year where I had no major medical problems of any kind, probably spending 1½ to 2 times as much overall for my family’s medical care.

My point is, even with insurance, the cost to keep one’s self healthy and alive, is exorbitant, if you have a chronic illness it’s outrageous, and that’s even if you can get insurance. I would wager that even if 11% of medical physicians have no managed care contracts, they serve less than 2% of the overall population…because for 98% of the people, that would not be a practical solution.

So it’s clear to me that you are judging something you know nothing about, you’ve dropped out of the system, and that works for you. So if you want to keep doing what you’re doing, you still can. You just have to pay a penalty to do so, but if you are not in a high enough income bracket to afford that penalty, it will be offset by a credit designed to help you buy insurance. I would guess that even you would find in a couple years’ time that the way the new system is set up, it will save you money to buy health insurance, whereas right now, that may not be the case.

But the problem as I see it is you’re acting as if I had some sort of choice in any of this….today’s health care system does not leave the average consumer with choices. If you’re wealthy or if you’re in tremendous health, you are able to go without insurance. But there’s always the what if, and if you do get terribly injured or sick, you would come to regard not having insurance as the biggest mistake you’ve ever made. Because you don’t buy insurance to game the system and make it the most profitable for you, you buy insurance to insure yourself against the unexpected. If you could count on the expected, you wouldn’t even have something called insurance…it never would have been invented. But basically because you are in the rare position in this country of being able to get by without insurance and not being concerned about the what ifs, you’re saying it’s a bad idea to regulate an industry which makes a killing off of the suffering of others. It’s a very selfish way of looking at the world, and I just hope you never have to face the cold reality of why your way of doing things makes no sense in the long run for the vast majority of people.

Dr_Dredd's avatar

Agree with @dalepetrie. Insurance companies generally reimburse very low rates for office visits (especially for primary care). They take what is known as the “usual and customary rate,” which they won’t divulge, then give doctors a certain percentage of that. Doctors can charge whatever they want, but insurance companies will always reimburse the same way.

(Oftentimes, reimbursements won’t even cover overhead, so doctors try to make it up by seeing more patients. If you’re kept waiting in the waiting room for a long time, blame the insurance companies.)

dalepetrie's avatar

@Dr_Dredd – I also think your comment on another thread is germane here, the idea of a “die in the street” card.

I fully support ammending the legislation so that anyone who chooses to opt completely out of the insurance legislation without paying the penalty for not carrying insurance would be issued a card which states that they do not choose to be insured. Providers could legally refuse service to anyone with one of these cards who couldn’t pay for their services up front. Awesome solution!

Dr_Dredd's avatar

@dalepetrie Unfortunately, it goes counter to professional ethics. If someone like that showed up in the emergency room, doctors would feel ethically bound to treat them. I don’t think that’s necessarily a bad thing, since I would hope my doctor had my best interests at heart, but it does make health care costs more problematic.

dalepetrie's avatar

@Dr_Dredd – that’s the system I want to push for as well, I don’t think anyone should go without health care because they can’t pay. But if someone is so vehemently opposed to receiving anything they see as a handout, and so steadfast in their beliefs that every single thing that happens to you, good, bad or otherwise, regardless of whether your decisions impacted it in any way, is your individual and personal responsibility, then really it’s unethical for THEM to opt into a system only as a last ditch resort when things don’t go as planned. I’d say if anyone were to be fully educated on the potential negative impacts of opting out of the entire system, and were willing to basically accept what would amount to concientious objector status for health insurance, if they could demonstrate that they knew and understood full well that this meant that if something happened to them that they could not afford to pay for, they would suffer or die, then I think the ethical responsibility of the health care provider is satisfied. It’s kind of like when your religious beliefs conflict with modern medicine, it is very rare that we force anyone to seek treatment they do not believe in, generally the only time the government intervenes in cases like this is when the welfare of a minor is concerned. I would say that any adult who wants to accept complete responsibility for every aspect of his life should be allowed to permanently opt out, and their objector status could be ethically handled the same was as a person who objected for religious or moral reasons. And since it would be completely voluntary and self-imposed exile from the system, well anyone foolish enough to actual make that decision would have to accept the personal responsibility for having done so. I think you present this option to people and I’d be surprised if you could find more than 200 people in this country who would sign up for it. Now I pulled that number straight out of my ass admittedly, but it seems inconceivable that most people wouldn’t reveal their hypocrisy when push came to shove.

Dr_Dredd's avatar

@dalepetrie Interesting. I hadn’t thought about it in terms of people refusing certain types of medical care, and not being forced to do so. When you put it like that, it does make sense. However, like some of the Jehovah’s Witnesses cases where it was determined that parents couldn’t refuse blood on behalf of their kids, I think that parents should not be allowed to refuse health insurance on behalf of their kids.

With respect to people opting in at the last minute, I guess it’s like there being no atheists in foxholes.

dalepetrie's avatar

Totally agree.

Snarp's avatar

Some interesting thoughts here on the constitutionality of a mandate to buy insurance.

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