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A Lesson In Constitutional Law For Rep. Perry
A Lesson In Constitutional Law For Rep. Perry
We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare and secure the blessings of liberty to ourselves and to our posterity, do ordain and establish this Constitution for the United States of America. - Constitution of the United States, Preamble
Republican state Rep Jeffrey Perry's purported "constitutional" argument against the pending national health care reform legislation is riddled with so many inaccuracies and false assumptions it's difficult to choose where to begin a response. But let's start with the fundamental constitutional purpose of promoting the general welfare of the United States.
Perry writes that the "general welfare" provision is "widely considered simply as a preamble to the Article I enumerated powers" of Congress which, as implicit in his argument, can therefore simply be ignored. That is widely considered only by know-nothing self-described "conservatives" like Perry who populate today's GOP and who loathe the idea that government can provide services and benefits to ensure the well being of all citizens supported by tax revenues.
The Preamble to the Constitution of the United States was not considered to be mere surplusage by the Founding Fathers, as it is by know-nothing Republicans like Perry today. It is intended, rather, to state the broad, fundamental purposes of our democratic constitutional government in light of which all of the more specific provisions which follow must be understood.
The Preamble to the Constitution lists several broad objectives, i.e. the basic purposes and ideals of our democratic American republic, as recited in the header above. Of those stated ideals, only two appear later in the enumerated powers of Congress, both of them in the tax clause, Article I, Section 8. There, it is expressly provided that Congress shall have the power to lay and collect taxes "to pay the debts and provide for the common defense and general welfare of the United States," emphasis added.
Here, providing for the general welfare with tax revenues is stated on co-equal footing with providing for the common defense, which tells me that the Founders believed it was a very important purpose. To follow Perry's logic, however, we would have to assume that Congress' use of our tax money to fight resource wars for corporate opportunity in places like Iraq is unconstitutional, even if it might somehow be included within the penumbra of "common defense," as it's simply found by way of "preamble" to the enumerated powers.
Perry then compounds his confused, error-laden argument by suggesting that federal health care reform legislation is somehow unconstitutional because the Constitution did not provide for taxing income until the 16th Amendment was adopted in 1913. The State Representative from Sandwich apparently cannot comprehend that the several amendments, including the Bill of Rights, are an integral part of the Constitution of the United States as provided by Article V, and as such they are "the supreme law of the land" as expressly stated in Article VI. It is appalling that an elected representative of the people can be so ignorant of such basic principles of constitutional law.
Perry's ignorance is further demonstrated by the Tenth Amendment argument he parrots from the national right-wing media hacks. The 10th Amendment is the basis for "states rights" opposition to federal legislation across the board. Historically, it was the rallying call for about a hundred years in defense of Southern Jim Crow laws after the Civil War, and it reached fever pitch in the 1950s as the Supreme Court began to strike those laws down under the 14th Amendment.
Back then, when the Republican Party had some intelligence and integrity, President Eisenhower rejected that reactionary mantra summarily in 1957 by ordering federal troops to enforce integration of Little Rock Central High School, to carry out the mandate of the Supreme Court's ruling Brown v. Board of Education, against the 10th Amendment "states rights" claims of Arkansas Governor Orval Faubus. That all changed with Reagan's blatant racist appeal to Southern bigotry when he opened his 1979 presidential campaign with a visit to Philadelphia, Mississippi, where the local Klan got away with murdering three civil rights workers, declaring his firm belief in "states rights." Todays GOP rants about states rights in a wide variety of contexts, from school prayer, teaching creationism, criminalizing homosexuality and other state initiatives that trample our civil rights and now, by tortured logic, opposing any significant health care reform.
What makes that Tenth Amendment argument legal nonsense, in context of either desegregation, separation of church and state, or providing health care in the interest of the general welfare, is the fact that powers are reserved to the states only if they are not delegated to the federal government nor prohibited to the States. In context of racial segregation, establishment of religion, et cetera, the Fourteenth Amendment specifically prohibits the states from abridging the privileges or immunities of American citizens, depriving any person of equal treatment under the law, or life, liberty or property, without due process of law. That principle of due process is embodied in the 5th and 14th Amendments, including substantive due process under which the federal courts overturn violations of civil rights and procedural due process in criminal cases.
The power to legislate in furtherance of the general welfare is expressly given to the federal government through acts of Congress, at Article I, Sect. 8, in addition to the general power of the federal judiciary to determine issues arising under the Constitution as between the states and their citizens. Thus, after the Court began to strike down the Jim Crow laws, Congress was able to enact the Civil Rights Act of 1964 under the political leadership of LBJ, bringing equality to Afro-Americans and other minorities in a wide range of economic, educational and social spheres that had previously been denied to them under the malignancy of 10th Amendment states rights reasoning.
Similarly, today, Congress is empowered under Article I, Sect. 8, through taxation and regulation of commerce, to promote the general welfare by enacting socially beneficial programs into law, such as Social Security, Medicare and ERISA, public health laws governing drug safety and communicable disease control and, by extension, health care reform legislation.
Self-proclaimed "conservatives" like Perry, in reality nothing more than social reactionaries, like to argue that the general welfare of the United States doesn't apply to individuals, as if the Preamble to the Constitution didn't begin with "We the People." To talk about the general welfare of the United States as being something different from the welfare of its people is inane. In any event, looking at the question of health care reform collectively, and not just as a matter of individual rights, clearly affects the general welfare of the United States.
Our general welfare is manifestly imperiled when hundreds of thousands of Americans have no real access to health care. When large numbers of people carrying untreated communicable diseases are allowed to mingle with the general population, it harms the general welfare. When large numbers of people suffering untreated chronic diseases miss work frequently or are discharged for absenteeism, that harms the general welfare. When large numbers of people become disabled and have to go on SSDI or general relief because treatable diseases are not treated, that harms the general welfare. When large numbers of people cannot afford to provide needed medical care for their young children, i.e. our posterity, that harms the general welfare. Federal laws which address such problems by providing for universal health care will therefore promote the general welfare of the United States beyond any doubt.
Perry recognizes that Article I, Sect. 8, gives Congress the power to regulate interstate commerce including today's interstate insurance industry, but then inexplicably claims that the individual mandate, requiring everyone to purchase insurance, doesn't rise to the level of interstate commerce. Here, he conflates the commerce clause issue with constitutional protection of individual rights by saying that the government cannot compel its citizens to purchase a product like health insurance. Perry clearly confuses the issue of delegated powers in Article I with that of our individual rights which arise under the first ten amendments.
Perry actually raises an interesting constitutional issue on this point, whether Congress can, in the name of its clearly delegated authority to promote the general welfare, compel individuals to purchase health insurance for their own good, thus depriving them of "freedom of choice." As with everything else under the Constitution, it's a question of balancing the public interest vs. individual liberties. As Justice Holmes remarked, freedom of speech doesn't mean we can yell "Fire!" in a crowded theater when there is no fire.
Under Perry's argument however, premised on an extremely restrictive reading of the Constitution, if Congress cannot compel us to purchase health insurance to promote the general welfare, then it surely cannot compel us to fight in wars to further the co-equal constitutional purpose of providing for the common defense, especially when such wars as in Vietnam and Iraq have nothing to do with actually defending America.
Moreover, when we are speaking of individual rights, it's not just the federal government that must be restrained but the states as well -that's what the principle of substantive due process is all about, enforceable in the federal courts against state government under the 14th Amendment. In the specific context of requiring individuals to buy health insurance, if it's unconstitutional for Congress it's also unconstitutional for the Solons on Beacon Hill, as with the Mass. Health Care Reform Act of 2006, initiated by GOP Governor Mitt Romney, voted for by most Republican state legislators, and then signed into law by Romney.
Of course, that particular issue of individual rights can be completely avoided by the simple, humane and logical step of enacting a single-payer, publicly financed health care insurance plan, to cover everyone supported by our federal tax dollars. This is clearly an important and permissible use of tax revenues to support the general welfare as provided in Article I, Sect. 8, of the Constitution, and it forces no-one to purchase an insurance product, as we all must do today in Massachusetts.
Mention single payer or even a public option, however, and Republican obstructionists like Perry all start bleating about "socialism." But since we're discussing constitutional law, here's another basic fact to consider. Nowhere does the Constitution mention capitalism as the required or even preferred basis of the national economy, nor does it prohibit the socialization of services or industries by either the federal or state government. It does mention private property in the 5th Amendment which allows the government deprive individuals of their property only through due process of law, but permits the government to take private property for public use, i.e. socialize it, upon payment of just compensation.
Today, we Americans take for granted a wide variety of socialized governmental services, many of which had at one time been provided by private enterprise, from public schools, to public waste management, to public water supply to public fire protection. Interestingly, fire protection had at one time been provided by insurance companies like Fireman's Fund, until the public began to understand it was too important a function to be left to profit-driven private businesses. Providing health care in the name of promoting the general welfare is equally important.
Perry's presumed right not to be compelled to purchase insurance is not specifically listed in the Bill of Rights or anywhere else in the Constitution. Such a right is, perhaps, within the broad scope of the 9th Amendment subject to the principles of due process, as is the fundamental right of the people to have access to health care.
Significantly, there is no insurance industry welfare clause to be found anywhere in the Constitution, either expressly or implicitly, as a limit on the government's power to provide universal health care to promote the general welfare. That socialized function of the federal government is not just constitutional, it's intelligent, humane and long overdue.
84 comments
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How did you get from the individual health care mandate to illegal immigration? That's a pretty big leap.
Re: the supposed budget busting of health care:
The best source we have for guaging the budget impact of programs is the CBO. If you have a better source, let's hear it. And the CBO says that the health care bills are paid for. Sure we should watch this closely as time unfolds, but for now - per the CBO - it's paid for.
And re: taxing the rich into the stone age: After nearly a decade of tax cuts that put them into orbit (some exaggeration here, of course) the wealthy can afford some hikes. We saw impressive growth in wealth concentration at the top income levels under Bush. Health Care reform will hardly send the wealthy back to hunting and gathering!
I hear what Lorne is saying, and he raises a legitimate question about paying for health care reform -which is far different from the issues of constitutional law addressed in this post.
Unlike Perry's ill informed 10th Amendment diatribe, Lorne is right to ask how we will pay for inclusive health care for all Americans can be paid for. I've suggested before that a single payer, tax supported program that gets the gaggle of private insurers out of the picture will be a lot more efficient and less costly because more of your health care tax dollar will get to pay for medical services as opposed to paying for advertising, lobbying, executive bonuses, company planes, risky speculative investments a la AIG, urban office towers, administrative process geared toward profit rather than paying valid claims and high powered law firms defending denials of valid claims in court -all of which your premium dollar, or your employer's, is paying for before your doctor sees even one penny.
So, when you disagree with some one, not only do you point out what you think is wrong with the person's opinion (which is fine), but you start with the insults refering to them as "know-nothing" and others. Of course you are simply brillant and are not wrong. We know that of all liberals. You keep telling us so.
Well here's one for you to lighten up the conversation:
What's the difference between a dead rat and a dead lawyer in the middle of the road? The rat has skids marks in front of it!
That's at the heart of the matter, isn't it? What do you think Counselor, will the Supreme Court end up hearing arguments about this? I personally feel that this issue, and any decisions therefrom, constitute a crossroad in the way in which our representative democracy will proceed.
The rancher nods politely, apologizes, and goes about his chores.
A short time later, the old rancher hears loud screams and sees the DEA Lawyer running for his life chased by the rancher's big Santa Gertrudis bull.
With every step the bull is gaining ground on the officer, and it seems likely that he'll get gored before he reaches safety. Lawyer is clearly terrified. The rancher runs to the fence and yells at the top of his lungs. Your badge. show him your badge.
Sorry too late.
Richards argument is that something as vague as "general welfare" can be translated into an individual right to government provided healthcare.
For now we will forget the provisions of this plan that has the government mandating that people buy a private product or face fines and or inprisonment.
Are these leftist intellectuals the very same people that have been arguing for years that the 2nd amendment, that clearly refers to individual rights numerous times, does not really refer to individual rights?
For many years the Richards,Rosies, and Micheal Moores were merely static noise in the background while productive citizens went about their daily lives building,creating,and producing actual goods and services.
These people are in charge now. For the first time many people are actually listening to these peoples thoughts and getting a good idea what they are really about.
This is going to be a fun few years.
Our country will be better for it in the end.
BTW, before you go raving about liberals, etc., please remember that arch conservative Bill Buckley was with us on this one.
As a matter of fact, I have handled many cases against SSA on disability claims, but my current practice in disability law is geared to ERISA and personal coverage. Atty. Julianne Soprano of Falmouth, however, has a large practice handling SSI and SSDI cases on contingency, along with Workers Comp. I refer SS cases to her and she refers ERISA cases to me -no referral fee, just quid pro quo, and we've been doing so for years. Many other lawyers nationally handle SS cases as well, most of them members of a focus group called NOSSCR.
Other lawyers specialize in Medicare claims, and I frequently negotiate Medicare liens as part of BI settlements for older individuals. Medicare will routinely compromise a lien to facilitate a settlement, but many profit driven private insurers will tell you to take a hike if you ask them to reduce a lien, though some of them will do so to some degree.
I use the term "know nothing" about today's GOP advisedly -it being the party that supports anti-intellectual, anti-science "states rights" policies such as teaching creationism, or "intelligent design" in public schools as if it were science, it being the party that claims holding prayer sessions in public schools is not establishing religion, it being the party that claims America is a "Christian nation" politically when the Constitution is unquestionably based on the secular ideas and principles of the Enlightenment, and so on. It was not always so, in the days before Reagan, as exemplified by honest conservatives like Eisenhower, and even Nixon whose dishonesty in Watergate was driven by political paranoia and not policy based as with today's GOP's obstructionism on every substantive initiative by President Obama, including health care reform.
I used that epithet about Perry specifically because his purported constitutional gloss on the health care issue is just another clear example of Republcan know-nothing politics.
The government workers at "Medicare will routinely compromise a lien". In other words give away taxpayer money.
The private insurance company that actually tries to collect their money, to keep the costs down for the rest of their ratepayers,are the bad guys.
Thanks for that inside wisdom.
This should be a real windfall for you if it passes. Keep fighting.
By the way, curious on your thoghts on the second amendment
It's a classic example of spreading risk or the law of large numbers.
More people paying in to the system at at a younger age should make compulsory health insurance self funding and less expensive for everyone.
How can you say that private insurers keep costs down? Their rates have been rising at 3 to 4 times the rate of inflation for many years! The U.S. devotes in the neighborhood of twice as much of its GDP to health care as do the European countries who have universal health care. And, of course, the large majority of Americans have private insurance.
Actually, I can't blame the private insurers: The primary directive of a private company is to maximize profit. It's their duty to their shareholders to increase premiums as fast as the market will bear.
Just one problem: That means that caring for its insureds is not the top priority of a private insurance company. Making money is #1.
The current system benefits insurance companies first, doctors second and if we're lucky, patients third...
Increasing the risk pool does not always work.
Barney tried this with the mortgage underwriting industry.
He ran into a few minor problems.
Insurance is regulated at the State not Federal level, therefore an open market across State lines would harm the consumer.
There is no comparison between mortgage underwriting and health insurance underwriting.
Tort reform removes the incentive to produce good products and services. Tort reform will create more people that need public assistance as they will no longer have the right to sue the party who caused them harm.
Are insurance companies just increasing profits 10% anually?
Yeah, the "let insurance companies sell across state lines" is a red herring isn't it? Insurance companies CAN do this as long as the plan their selling in multiple states fulfills all the insurance regulations of each of the states. Of course since the states all of a bunch of regulations this becomes, in effect, very difficult if not impossible.
It would take some very serious legal work (a constitutional amendment?) to get rid of the 50 state insurance departments. And of course, not one state would accept this: This would require a truly epic battle.
This is impossible. But it sounds good and thus is a useful tool for critics of health care reform.
I feel so foolish.
All this time I thought competition provided that incentive.
Who knew.
I can't speak to their profits, but premiums have gone up at 3 to 4 times inflation. Recently, that wouldn't be as high as 10%.
Another thing: Have you heard that the overhead rate of Medicare is around 4% and that the overhead rate of private insurance is somewhere around 25% to 30%? This is the percentage of premiums not paid out in claims.
The largest component of that, over half of it I believe, is profit. Obviously, Medicare has no profit.
Is that just a general statement or can provide some justification?
http://www.chinesedrywall.com
http://www.savive.com/casestudy/fordpinto.html
Tort Reform won't stop with medical malpractice and the cost attributed to test ordered to avoid malpractice claims is overstated.
AIG now called AIU Holding and Chartis, is an international company regulated by 50 States - that's how the Credit Default Swaps slipped through the regulatory cracks.
Health Insurance sold across State lines will result in the same regulatory cracks.
Try taking that up with the state insurance departments some time. I've witnessed this in Life Insurance which is much simpler than health insurance. This is much more difficult than you describe.
Who is going to overturn State regulation and write all new Federal Laws to regulate these insurance products?
I don't think I have much chance of getting my point across to you so I'll just say have a nice night, don't let the Tort Reformers Bite...
-let insurance companies sell across state lines to broaden risk pool
-health insurance is regulated at the State not Federal level
-caring for its insureds is not the top priority of a private insurance company. Making money is #1.
-Let's try tort reform first so the companies don't have to defend themselves against lawsuits
-health insurance is complicated.
And, it's done by contracts, written by insurance companies, and one has to be a specialist to interpret and evaluate what one's buying...
And, it's adversarial. Any well-defined level-playing-field fairness for the common people requires strong, extensive, federal regulations, and some standardized national levels of coverage.
And why involve employers at all? Let them keep their health-insurance-coverage money. Put all the bill on the federal taxes. Spread the risk, spread the cost. Let the insurance companies figure their costs (dump those bonuses and jet planes and sales staff) and bid for participation. Cheaper for everybody in the end.
Yup, that's what Germany, France, Switzerland, Japan, Taiwan and many others do and guess what: They cover everyone, have better outcomes than we do, and often spend about half what we spend.
In his original blog Rich argued for this: Universal Health Care. Unfortunately, that's not even close to being in the cards politically. Look at the incredible political struggle needed to pass Obama's modest bill!
I hear you. It's sad, but the anti-government faction is too strong to get the kind of reform we really need.
A realist,with some real world business experience,does not just parrot that phrase for justification of their ideological beliefs.
They follow the money and see the cause of these increases.
I explain this because self proclaimed intellectuals have a hard time with this concept.
What I will explain to you is fact, not "I heard" or "I believe".
Health care delivery is a service conductes by people. It is not a product that is influeced by cost fluctuation of material or ingredients.
The bricks and mortar end of delivery is static. This remains constant. This is the building itself that is usually helped by chatitable donations or foundations.
The only thing fluid in healthcare delivery is the cost of employees to perform delivery.
Let's look at the largest healthcare provider on Cape, CCH, to see how this works.
Their are 4000 unionized employees that deliver healthcare at CCH.
3000 SEIU members,800 in the nurses union, the rest in other assorted unions. (cont.
The nurses union won straight out 10% annual pay increases and a few work rules.
The SEIU won similar 10% pay increases through a combination of pay,work rules, and if you can believe it, a freeze on their contribution to healthcare premiums.
This hospital already loses money on every SSI, Medicare patient that walks through the door.
Where does the money for this 10% increase in delivery cost come from.
Private insurance rate increases.
The problem the union has is this system is maxed out. They don't want to hear private insurers tell them they can't keep raising premiums 10% a year on people that are already paying $1500 a month.
Just like Richard,these unions with prefer to deal with a government bureaucrat.
Hopefully one that they have selected, and or elected,that owes their political career to them.
So in ten years when the entire healthcare industry is a giant unionized government agency it will be run as swell as the DMV.
Look to the Hawaii teachers union to see how the rationing part plays into the game.
I had to use that line.
- Barack Obama
In fact we have just the opposite.
the Democrat leadership in the House and Senate plan on using a “Ping Pong” strategy to pass Obamacare. This strategy avoids a conference committee and allows the liberal leaders to put themselves behind closed doors, in secret, to write an update to Obamacare. Yet again, the elites in Washington exclude the American public and all members of the minority party from this secret sausage making process. http://www.redstate.com/brian_d/2010/01/05/obamacare-ping-pong/
And our Governor trampled on our constitution in declaring an emergency to appoint Kirk.
Nebraska and Louisiana senators vote bought and paid for by us. Unconstitutional.
http://www.cnbc.com/id/15840232?video=1376991308&play=1
Selling insurance across state lines in conceivable. Don't take my word for it: http://online.wsj.com/article/SB10001424052970203550604574360923109310680.html
Yes..now under the new tyrannical fascist state.
Damn the constitution..full speed ahead!
Richard will be .of course, legal advisor for the new "state' he so loves.
possee
Where have you been since 2001?
Damn the Constitution?
Where have you been since 2001?
You really think all this started with Obama and the Dems don't you?
ahahahahahahaha...geezus. That was a good laugh.
GOD these Bush apologists kill me!!!!
Especially since it was a Democrat Kucinich who was the only one who tried to do something about the destruction of the Constitution, not to mention ALL the other high crimes, and you righties call him a kook.
Let me guess...when a Dem does it, it's tyranny-- when a Repub does it, it's "for our own good"...that about right?
Ayup.
Buzz, I sympathize with you - a little bit of knowledge is a dangerous thing.
The reason insurance is permitted to be sold across state lines is that the companies that do so MUST BE LICENSED in every state they sell in. As long as states like Massachusetts and New Jersey can control who sells insurance in their state by telling them what they MUST cover (e.g., gender reassignment surgery, for instance), then nationwide insurance sales will not produce savings.
My problem is as Jane states - those who will be re-writing these federal regulations to define what an insurer MUST cover are not folks I can trust right now, they're NOT likely to draw the mandatory plan very narrowly, and the outcome is going to be, instead of expensive states like New Jersey and Massachusetts getting cheaper, the inexpensive states are going to get more expensive.
Richard: What limits if any do you feel the constitution puts on the federal government?
You betcha!
What facility (facilities) will next drop medicare patients?
Death panel? Ridiculous?
Holy cow! The same thing just happened to me,( higher premium, reduced benefits), (BCBS, effective 1/1/2010). I thought it was just me. I guess that's not the case.
The article that you provided did not address the point that I'm making which is practical not philosophical.
Today, each state has an Insurance Department which zealously protects its right to regulate the sale of insurance in its state. I'm no lawyer but I believe that the Constitution gives them this right. It would be incredibly difficult to overcome this. The states would fight nationwide plans tooth and nail.
Now, it may surprise you to learn that I agree with you: I would love to see private insurers selling nationwide. This would enhance competition and create much larger pools of insured which always leads to lower premiums. Jane has argued against this but I'll need her to explain further.
All I'm saying is that this would be MUCH harder to do than opponents of Obama's reform say. Reform opponents ignore the fact that selling private insurance nationwide would involve a herculean struggle with the states. When they present this as an easy fix they are being disingenuous.
Yeah, you're describing "cost shifting": When a hospital can't cover its costs because Medicare payments are low and because of the cost of caring for the uninsured, it socks it to private insurers. You're right, this certainly does affect private rates. A couple of things, however:
1. That does not eliminate the fact that the #1 goal of a private insurer is to maximize profit. Private companies will still increase premiums as much as the market will bare.
2. Did you know that Medicare includes a load in its payments to hospitals based upon the number of uninsured people they serve? Over the holidays, I got a chance to pick the brain of an executive at the hospital that accepts the most uninsured patients in Chicago. Medicare pays them 60% extra on each reimbursement for that. 60%!! That's done nationwide (% varies by hospital) and it reduces the cost shifting you mention.
One last small aside: Nearly all people will be covered under Obama's reform so this payment will go waaay down. This is the #1 thing that the GOP is calling a Mediare "cut". Nice wordsmithing huh?
No!! You don't say.
Funny-the same thing has been happening to people like me for many many years.
We are called "whiners", what label would you like?
Tea-Baggers?
Righteous truth-seers?
How about only matters when it happens to me?
It's only inevitable you know. Every action produces and equal and opposite re-action.
What's the re-actional opposite to Extreme Greed?
Extreme Poverty!
You didn't really think the perps would take the punishment did you?
No, that falls on us, the willing accomplishes.
When you fly high, you gotta fall low.
Insurance reform is the anti capitalist red herring you bought from the likes of Richard the fish monger.
He has plenty.
It's starting to rot and get stinky.
Don't look behind the curtain.
Everything is rosy. You're right.
You mention "pending medicare cuts" but can you describe the cuts that Obama proposes?
I tried like heck to find this on the web awhile ago and came up empty. Then a hospital executive explained to me that the "cuts" will be made up primarily of 2 things:
1. Reductions in the amount paid to hospitals to cover uninsured patients. This will happen because there will be many fewer uninsureds.
2. Elimination in the 18% premium paid by Medicare to private insurers offering Medicare Advantage. I'll elaborate more at the end.
In a nutshell: Obama is not proposing much or any of what we normal people call "cuts": Reductions in benefits. As always, the GOP is misleading us.
Re: Medicare Advantage: This was created a number of years ago to introduce "competition" into Medicare. Private companies would be allowed to insure elders to compete with Medicare and, presumably, reduce cost. One problem: The private companies needed and received an 18% premium for providing this coverage. Nice competition, huh?
Nope, the term "Medicare cuts" is misleading.
You're really working hard to find anything in my writing that says that anything is rosy in health care. In fact, everything is sooooo messed up with health care in this country that we need a complete, root and branch reform. But, unfortunately, that's politically impossible in this country.
No Coyrat, I just point out when I think you're wrong on particular issues inside of the larger health care debate. I'm definitely not saying anything is rosy. It could hardly be worse!
"Congressional Budget Office estimates the legislation would reduce the budget deficit by $132 billion over the next decade, through a combination of tax increases on the health-care sector and spending cuts, which largely fall on Medicare payments to health-care providers." - (some $500 billion worth)
With regard to the elimination of the 18% premium to Medicare Advantage providers - this will adversely affect just about every medicare recipient. Medicare Advantage plans are a critical supplement to obtain coverage for medi-gap and/or prescription needs. Medicare Advantage providers will certainly pass their premium loss onto their subscribers.
Is that not the problem we face with healthcare costs increasing 10% a year?
Straight up question.
Universal health care would put a cap on how fast what the system pays for health care grows. That would filter down through the system and force many changes. Doctors would make less and they'd probably move to being paid a salary. The unions you mention wouldn't be able to demand as much. Less leading edge technology would be used. Congress would be forced to cave and allow Medicare and the Universal Health system negotiate prices with drug manufactures. And there would be a raft of other changes too forced by management of the "top line" (what the system pays). Many of these changes would hurt. But the alternative - today's explosive growth left unchecked - will destroy the system.
There's a straight answer. You might disagree, but it's straight.
Your first quote about Medicare jives with what the first “Medicare cut” that I mentioned. Since hospitals will have many fewer uninsured patients, they’ll receive less of a bump in their payments from Medicare to compensate for uninsured care. To use words from your 1st paragraph: That’s a cut that "...falls on Medicare payments to health-care PROVIDERS”. Not beneficiaries. (caps intended).
Wikipedia says that about 19% of all Medicare beneficiaries use Medicare Advantage. To tell you the truth, I thought the number was lower. You say: “Medicare Advantage providers will certainly pass their premium loss onto their subscribers”. Do you know for a fact that Medicare Advantage providers can jack up premiums like that? I’d seriously doubt it. Those providers will have probably to do one of 3 things: Lower their costs to retain their profits, accept lower profits, or get out of the Medicare business.
Don’t you have any qualms about a system supposedly created to introduce competition into the system that paid, from the very beginning, 18% extra?
Is the system you described what you support?
Did I read that correctly? "Less leading edge technology would be used."
Is the system you described what you support?
Did I read that correctly? "Less leading edge technology would be used."
There are none so blind as those who will not see, and none so ignorant as those who will not understand.
When Medicare compromises a lien, it is not giving away "taxpayer money." It is, rather, assuming a share of the injured party's cost and risk in collecting the money from the tort feasor who caused the injury and the consequntial medical costs. That money would otherwise not be returned to Medicare or the taxpayer.
If you knew anything about what you presume to criticize you would know that the typical plaintiff in a personal injury case, upon collection of damages, pays an attorneys fee of one-third the recovery plus case expenses. Medicare routinely discounts its lien on the case proportionately, which many private insurers refuse to do. That's a windfall profit to them, where the injured person bears all the risk and expense and the private insurer gets the hog's share of the recovery.
I work hard for my clients and I resent having to do free collection work for greedy, profit driven insurance companies who make close cases harder to settle.
With cuts in payment reimbursements, do you think providers will continue to treat medicare patients if they have a choice? Providers already lose millions treating them. And now they will, or would, lose even more.
The 18% premium paid to medicare Advantage providers is a waste in that billions of these dollars are said to go toward lavish perks, salaries and excessive marketing - and do not benefit the beneficiaries. If nothing else, this demonstrates yet another example of the government's inability to oversee spending of tax dollars. Advantage plans will likely close or become too expensive and the subscriber will lose out.
Two people walk into a store and slip and fall on the wet floor.
One has private insurance, one is covered by medicare.
They both have the same injuries, and they both require $12,000 in medical care from this accident.
Medicare pays the medical bills for one, the private insurance pays the $12,000 bill of the other
They both hire you to recover this $12,000 from the store.
You are succesfull and the store pays each plaintiff $12,000.
Are you saying the private insurance company that paid out the $12,000 wants to recover $12,000, while Medicaid will settle for $8,000 so you can be paid $4,000 out of the settlement?
The answer, of course, is to replace them with insurers who don't care whether they lose money or not, because it's not THEIR MONEY.
Everybody makes out great.
Lawyer speak makes me nauseas.
His interpretation is either right or wrong.
If it is correct, then, in terms of the principles of the Declaration, and the manifest intent of the Founding Fathers, the "Constitution-As-Living-Document" has indeed become "a covenant with hell and a compact with the devil" (William Lloyd Garrison) and ought to be accordingly consigned to the flames.
Anyone for the "Suffolk Resolves"?
http://en.wikipedia.org/wiki/Suffolk_Resolves
R5
It's been awhile since your question so I doubt you're still following this but I'll respond anyway.
Yes, I did say less cutting edge technology would be used.
Now, I suspect from your question that you think that that would be a terrible thing. Well, I agree: It wouldn't be great.
But here's the situation we're in now: Everybody wants unlimited care but they don't want to pay for it. That formula doesn't work anywhere in life, including in health care. If you want the absolute best of everything, you've gotta pay for it. The question is: Can you afford that?
I love fancy cars but I can't afford a Ferrari. It never enters my mind. What would you think of me if I absolutely demanded a Ferrari, bought one, then wrecked myself financially?
That's what a health system that doesn't have realistic limits on the use of cutting edge technology is like.
We have to have a health system that we can afford. And living without the Ferraris of health care is necessary for that.
Private capital invested in companies that make breakthroughs in science.
The return on investment is realized when these methods,and or products pass every government test and is given FDA approval.
Billions of capital is invested in this industry annually.
It can cost billions to develop a product to the point of approval.
Return on investment is realized because people worldwide will buy these products to extend, reduce suffering, or improve quality of life for themselves or family members at any cost.
Right now America is the world leader in development of medicine.
Look at the advances in medicine realized in the last fifty years under this system.
This science will never end.
One thing will change.
If the privare return on capital is discouraged in this country with government mandated limits on return, this will be one more industry moved overseas.
We really don't need that right now.
If the privare return on capital is discouraged in this country with government mandated limits on return, this will be one more industry moved overseas.
We really don't need that right now.
Well stated and factual.
Many wonder why so many jobs(millions) have gone overseas.
One reason..overregulation/taxation/unions.
Of course, cheap labor is another big culprit..just imagine the new govt doctors, new govt innovations..by the likes of Pelosu and reid..ohhggggg.
possee
Who's greedy?
Follow the contribution money.
Passage of the health care legislation, 'to promote the general welfare' will require that everyone must be covered by health insurance, either through an employer or purchase it themselves. If that coverage does not conform to some abstraction as envisioned by a bureaucrat they may be subjected to tax penalties and/or incarceration.
If the incremental or imposed cost of that 'required' coverage prevents that same person or family from having adequate housing, minimal utilities, food, and clothing what will be the affects 'on the general welfare'?
The current mortgage crisis, created by federal meddling and mandates, facilitated too many people obtaining mortgages they could not afford, and under more logical regulations would not have been able to qualify. How many 1,000's of those people are on the brink of foreclosure just praying their monthly expense do not increase? How will health care cost increases affect them and 'the general welfare'?
Agency against agency 'over general wlfare'.
No I cannot cite any case or constitutional provision where the government is empowered to compel individuals to purchase insurance. That's why I said Perry raised an interesting question on that narrow point. I then went on, however, to point out that we have exactly that here in Massachusetts, a compulsory health insurance law that Romney takes credit for, in addition to our compulsory auto insurance law. I did point out that uninsured sick people create a public health risk, much as uninsured drivers create a public safety risk. I also made it very clear this is a matter of individual rights under the 9th Amendment, not states rights under the 10th as Perry would have it. And I concluded that the issue could be entirely avoided by simply enacting a single payer system where nobody is compelled to purchase private health insurance, as that would clearly be promoting the general welfare without violating anyone's individual rights -as well as intelligent, humane and, in the long run, a lot less expensive to society as a whole.
The general welfare provision is clearly not used to justify "violations" of state sovereignty. The general welfare language in the Preamble, and in the tax clause are there as express delegations of authority to the federal government, defining, respectively, an important part of its fundamental purpose and specifically its power to spend tax revenues. Because that power is expressly delegated to Congress in Article I, Sect. 8, specific substantive policies and programs which implement it are not "reserved to the states" under the 10th Amendment. And that's "strict construction," sir.
Again, though, rather than trying to fine tune regulation of interstate insurance business under the Commerce Clause, what we really need Congress to do is to enact a single payer health care system which would then completely avoid the problem of uniformity you allude to as well as lotabaloney's concern for individual rights, as well as best serving the general welfare of the people of the United States, intelligently, humanely and in the long run most efficiently.
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About This Blog
Richard Latimer is a 1972 graduate of U. Mass, Amherst and a 1975 graduate of the Columbia University School of Law and was admitted to the Massachusetts Bar in 1975, the U.S. District Court, D. Mass. in 1976, and the First Circuit Court of Appeals in 1977.
He and his wife of 39 years, Adrienne, have a 22-year-old son Brian, a 2006 graduate of Falmouth High School, who is presently enrolled at Fitchburg State College majoring in media, communications and film studies. Richard has been active in local Falmouth politics, presently as a Town Meeting member and present Chairman of the Planning Board.
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