Showing posts with label individual mandate. Show all posts
Showing posts with label individual mandate. Show all posts

Tuesday, March 27, 2012

letter to annals - constitutionality of ACA

Annals of Internal Medicine published an article by 2 Harvard economists claiming that the ACA is constitutional. The following was my response.


Drs Gruber and Cutler contend that the ACA individual mandate is essential for the integrity of the medical payment system which they favor but this is hardly the constitutional point. These Harvard economists should instead attend to whether the ACA comports with basic economic principles (as outlined in the textbook of economics written by their own Harvard colleague (1)) and leave the legal reasoning to others.
 Medical insurance is not insurance at all, but is a high priced pre- payment system. It is by far the worst way to pay for anything. It relieves the patient and physician from the trouble of making appropriate price motivated trade-offs and substitutions. The system requires large administrative cost for coding, billing and documentation, none of this with medical value. Inherent in all this is a large amount of wasted resources which could be directed toward useful alternatives. Price fixing produces waste, decrease in quality and loss of competitive forces that improve services and bring prices down.
It seems incongruous to contend that a citizenry who already pay for this system indirectly cannot pay for it more directly. Small items like lab tests and doctor visits and even small procedures are affordable out of pocket for the average individual and there would be less waste and lower cost if paid this way. Bona fide lower cost insurance that belongs to the individual could pay for high priced unexpected medical events.
Granted that persons with low income or serious chronic illness need society's help but total government command and control is surely not the best solution.
The ACA mandates an expansion of our present wasteful pre-payment price-fixed system to every individual. It forces free citizens to waste the fruits of their labor for the sake of a collectivist experiment. It will almost certainly raise the cost and reduce the availability of medical services for everyone.

1. Principles of Economics 2011 Edition. Chapter 1. N. Gregory Mankiw.


Wednesday, March 24, 2010

Is Romney reneging on the individual mandate?

I haven't seen where Romney was criticizing the mandate. The article gave no reference. I heard him defending the Mass plan, although he says he was obligated to agree to aspects he didn't like. I do hear much negative about it, including major criticism from the Lt governor at the time, who is now running for governor. He was a Dem and has switched to Ind. All agree that coverage met expectations, but cost has increased, not decreased and the Mass budget is accordingly in big trouble. Furthermore payments have decreased and several hospitals are sueing the state because of it and may go out of business. I talked to one internist I know who is retired. He was not a supporter but says he hasn't heard much complaint from his doctor friends.
I do not think it inconsistant at all to have an overall positive attitude about this plan applied in Massachusetts but to be against a national plan with a mandate, although I'm sure all the libs will spin it that way. Mass did not have a true mandate ala Obamacare. The Mass plan says that you must have insurance or proof of available funds to cover yourself in case of emergency. I'm not sure the mechanism or the amount required to assure this. That's much more American. Obamacare says you must buy insurance and you must buy insurance with a particular type of coverage. This is not in keeping with American political ideas of personal freedom and that is one big reason why it's so unpopular.
Whether it is working in Mass or not, the medical environment there is drastically different there than in other parts of the country and this universal plan is foolishness. The program in Indiana for the state employees that is based on HSA's is supposed to be popular and working well, and saving money. If one has a business or residence in a state with regulations you consider oppressive, you can always move your business or residence. Obamacare is inescapable and is the stuff of Socialism. Another major, major difference is that Romney had real transparency and worked with input from all political segments to craft the plan. He obviously had to include the liberal Dem politicians but the Heritage Foundation was a major advisor. Obamacare is polarizing and unpopular. It is ignoring the will of at least 1/2 of the citizens. It is also experimental. Neither Obama, or Pelosi or anyone else knows how it is going to come out and it may contribute to major economic problems for the US. Obama and his friends theorize that it will not but they are taking a major risk with the welfare of this country and shame on them for doing it.
Romney has major executive experience, both inside government and in the private sector. He is smart and thoughtful and has his personal act together. Read his book. It is excellent and not just a political screed like all the other spate of political books from left and right. It is real political philosophy and not a navel-gazing autobiography like Obama's books. Objection to him because of his religion is ignorant and no different than opposing Kennedy because of his Catholicism.





Mar
rch 24, 2010

Flashback of the Day

"Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian."

-- Mitt Romney, defending the individual mandate to buy health care in the Wall Street Journal back in 2006. Romney now criticizes the same mandate in the recently passed national legislation.

Thursday, December 24, 2009

60 leaders stood up to insurance companies and stood up for working families all across America.

Isn't it strange that the 60 leaders were all from one party. Anyway they sure socked it to those horrible greedy insurance companies who now are going to have to sell their product to everyone in the whole country even if they're sick as hell. And if they charge somebody more than they can pay well then the government will just take care of everything. And those bad young healthy people are not going to get away with not buying their product anymore no matter what it costs. Can you imagine the stupid people on wall street were idiotic enough to pay higher prices for the insurance company stocks when they knew that President Obama was very mad at them and told everybody they were very greedy and were causing all our problems. Well when everybody sees what happens to those bad insurance companies they're going to know just which one of those parties did it and they will get everything that they deserve. You wait and see.


From: Terrence Carden <tscii@comcast.net>
Sent: Thu, December 24, 2009 7:41:14 AM
Subject: 60 leaders stood up to insurance companies and stood up for working families all across America.

The New York Times
T

December 24, 2009
News Analysis

In Senate Health Care Vote, New Partisan Vitriol

WASHINGTON — The vote on Monday, in the dead of night, was 60 to 40. The vote on Tuesday, just after daybreak, was 60 to 39. And the vote on Wednesday afternoon, at a civil hour but after less-than-civil debate, was 60 to 39 again — an immutable tally that showed Democrats unwavering in the march to adopt a far-reaching overhaul of the health care system over united Republican opposition.

The votes also marked something else: the culmination of more than a generation of partisan polarization of the American political system, and a precipitous decline in collegiality and collaboration in governing that seemed to move in inverse proportion to a rising influence of lobbying, money, the 24-hour news cycle and hostilities on talk shows and in the blogosphere.

The health care legislation is likely to be approved Thursday morning, with the Senate divided on party lines — something that has not happened in modern times on so important a shift in domestic policy, or on major legislation of any kind, lawmakers and Congressional historians said.

The Democrats flaunted their unity on Wednesday at a news conference with nearly their entire caucus in attendance.

Many senators said the current vitriol, which continued on the floor on Wednesday with a fight over when to cast the final health care vote, was unlike anything they had seen. "It has gotten so much more partisan," said Senator John D. Rockefeller IV, Democrat of West Virginia. "This was so wicked. This was so venal."

Even in a bitter fight over President Bill Clinton's budget in 1993, decided 51 to 50 with a rare tie-breaker vote by Vice President Al Gore, the partisanship was not as stark as it is today. Although no Republicans voted for Mr. Clinton's budget, six Democrats joined them in what amounted to bipartisan opposition.

Mr. Rockefeller said the health bill had created an almost perfect storm of political and policy disagreements, so that some of the bitterness reflected basic philosophical disputes crystallized by President Obama's agenda. "If there was ever a time for that kind of partisanship to come out, this was the bill to do it," he said.

Ross K. Baker, a political scientist at Rutgers University and an expert on the history of the Senate, said that in earlier eras, senators would routinely cross party lines to vote in favor of major legislation on issues like civil rights and social welfare policy.

In 1965, the Senate created the Medicare program by a vote of 68 to 21, with 13 Republicans joining 55 Democrats in favor, and 7 Democrats joining 14 Republicans in opposition. In 2003, some Democrats in both the House and the Senate voted with most Republicans to add a prescription drug benefit to Medicare.

"It certainly is a culmination of a long period of intensifying political polarization," Mr. Baker said of this year's showdown over health care. "It has gotten so bad now that Republicans don't want to be seen publicly in the presence of Democrats or have a Democrat profess friendship for them or vice versa."

With Democrats nominally controlling 60 seats, the precise number needed to overcome Republican filibusters, there is no room for wavering Democrats to break ranks. If they held one less seat, there would be no choice but to win over a Republican; one or two more, and one or two senators with apprehensions could be released to vote no.

Some lawmakers predicted that the Senate would eventually rediscover its genteel equilibrium.

"There's a tolerance level here for what we have just been through, and I think we have hit the tipping point," said Senator Christopher J. Dodd, Democrat of Connecticut. "It got rougher than it should. We are getting precariously close to fracturing an institution where no one wins, so I think we are going to be back on track."

But some experts said that the divide in the Senate reflected a broader political shift that lawmakers cannot easily reverse. "In the 1970s, for instance, there was a much wider political spectrum in both parties," said Donald A. Ritchie, the Senate historian. "You had conservative and liberal wings in both parties."

Mr. Ritchie and many senators said they had witnessed the change in the last 30 years.

"You have got this divide, this polarization in America," said Senator Olympia J. Snowe of Maine, the only Republican in recent weeks to seriously consider supporting the health bill. "People become risk-averse, politically risk-averse. There is no incentive to reach across the divide and appeal to a broader inclination. It looks like pragmatism is a political cop-out; compromise is certainly viewed that way."

But even as senators complained about the rancor and expressed nostalgia for a kinder era, they conceded that the hyper-partisanship was likely to continue, potentially coloring coming debates on other major issues including financial regulation, climate change and, perhaps, immigration.

Senator Max Baucus, Democrat of Montana, and chairman of the Finance Committee, said the political — and often personal — divisions that now characterize the Senate were epitomized by the empty tables in the senators' private dining room, a place where members of both parties used to break bread.

"Nobody goes there anymore," Mr. Baucus said. "When I was here 10, 15, 30 years ago, that was the place you would go to talk to senators, let your hair down, just kind of compare notes, no spouses allowed, no staff, nobody. It is now empty."

For more than 30 years, the major parties — Democrats and Republicans — worked every angle to transform politics into a zero-sum numbers game. State legislatures redrew Congressional districts to take advantage of party affiliation in the local population. The two-year campaign cycle became a never-ending one.

Senator Orrin G. Hatch, Republican of Utah, who worked on many bipartisan health care bills over the years, often with a close friend, the late Senator Edward M. Kennedy, Democrat of Massachusetts, said that the both parties were to blame but that external factors including ethics rules also discouraged senators from fraternizing.

"Both parties have become very polarized," Mr. Hatch said. "A lot of that is because of the stupid ethics rules. We can't get together at various events. A lot of people complain about taking foreign trips, which are really critical for us to understand foreign policy. The Internet is constantly badgering everybody. In the process, it's gotten pretty doggone partisan, both ways. It's bad."

Mr. Hatch and Republican leaders said the lack of any support on their side showed that the health bill was mortally flawed.

The majority leader, Harry Reid of Nevada, at a news conference on Wednesday with most of his caucus standing behind him, offered a different take.

"I don't see this as 60 Democrats versus 40 Republicans," he said. "I see it as 60 leaders who stood up to insurance companies and stood up for working families all across America."