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Archive for the ‘health care’ Category

The health care story of the day is that the Left — yes, the Left — has turned against the health insurance mandate.  National Review Online has a great roundup of the liberal opinionmakers who are storming the barricades, including Markos Moulitsas of Daily Kos, Keith Olbermann, Howard Dean, and Jon Walker of Firedoglake.

It’s a bit rich, of course, since the individual mandate has been in the bill since the beginning.  The same arguments being employed now by the Left have been championed by anti-mandate conservatives — including this blog — for months now.  I suspect that what’s really going on here is that liberals are angry about the lack of a single-payer or its Trojan Horse, the public option, in the Senate bill.  They have to give their folks in Washington some ammunition to bring it down.

Rather than taking on their president, however, they are choosing to go after the real outrage in the bill — the fact that it’s “sell[ing] the middle class into corporate servitude” when it “makes them criminals if they don’t buy insurance.”   In fact, since the Obama campaign opposed the mandate during the campaign (his central point contention with Hillary on health care), their attack gives him cover to retrench to his original anti-mandate position.

I’ve argued for a while that conservatives made a mistake when they attacked the public option as the central front in the war against the Left’s health care agenda.  It’s the mandate’s coercive, unconstitutional power that has the most potential to destroy the relationship between Americans and their government.  If it takes lefty bloggers to get this issue front-page status, that’s fine with me.  To my liberal friends, feel free to raid this blog’s posts on the mandate if they help you make your case.  And to my conservative friends — now’s the time to join the fight!

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Because it’s been too long since the last one.

  • As regular readers will know, I’m incredibly passionate about the Orwellian freakishness that is the health insurance mandate in Obamacare.  Unfortunately, it’s so wrong on so many levels, it’s sometimes hard to explain why without being, well, verbose (ahem).  Luckily, there are writers whose clean language, pure logic, and persuasive arguments demand fewer words and more attention.  Read Shikha Dalmia.  (And while you’re at it, read The Black Commenter).
  • Michael Gerson is not a raving right-wing ideologue.  He is, however, very scared of where Attorney General Eric Holder is taking us as a country.  You should be, too.
  • I mean, the dude said “it depends” when asked if Osama bin Laden would be read his Miranda rights.  Seriously?  You don’t know this?  There isn’t already a 20-page memo on “what you will do if you capture Bin Laden?  We’ll decide when it happens?  Incredible.
  • Michael Franc gives us the scorecard on exactly how “moderate” these Democrats are, particularly on fiscal matters.  GOP candidates, start your engines.
  • And finally, our good friend Head Muscle shares his worthy insights on the two Koreas.  It’s a moving read, and it subtly explains why we conservatives fight the statist, totalitarian impulse with such vigor.  The world gives us — history gives us —  these irrefutable case studies, yet the theories (and the oppression) persist.

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One of the only fair defenses of the stimulus bill is its immediate psychological effect.  At the time it was passed, the nation was very, very scared. The general sense was that the government needed to “do something.”  Everyone knew that the new Democratic administration wasn’t about to cut taxes as a means of stimulating the economy. Thus, it was assumed that a huge fiscal stimulus – in the form of new spending – was needed, both to inject funds into stalled markets and to alleviate the sense of near-panic in the country.

While the stimulus has largely failed at kickstarting the business cycle, it did satisfy the “do something” impulse. The economic wound did not open further, although it did continue to bleed jobs. The next step, then, is to repair the wound.

In fact, let’s continue this medical analogy.   In the crucial first moments after a serious injury, furious activity is the norm.   Doctors work quickly to set bones, apply pressure, bandage cuts, or even conduct invasive surgery.  Once the trauma patient’s immediate crises are curtailed, however, she needs something very different: long periods of stability.  Rather than constant stimulation, she needs calm and rest.  While it may look like nothing is happening, the body’s forces are working to naturally heal itself.  No doctor can force a wound to close — it can only create the conditions whereby the body will do it on its own.  No doctor would ask a patient to learn a new job, or train for a marathon, while recovering from a serious accident.  And it’s mad scientists, not physicians, who experiment on patients on the mend.

Not my physician of choice.

The same lessons apply to our economy.  While the early days of last fall’s crash may have warranted emergency measures, the time for frantic maneuvers is long past.  Rather, this economy needs the government to step back and give it some time to heal.  Further poking, prodding, and experimentation only waste energy and resources when those are sorely needed by the economic “body” to replenish reserves, invest in capital improvements, and slowly rebuild inventories and workforces.  Businesses will not begin to recover until they know the assault is over.  And right now, they fear that Dr. Government is waiting right outside the door with another experimental procedure.

 

The twin spectres of costly health care mandates or greenhouse gas regulations have led companies that might have some cash on hand to hold onto it.  They might need those dollars to pay for higher health care costs, or to cover rising fuel prices.  International firms that might have seen a weak-dollar economy as a good place to invest are standing on the sidelines, wondering if the cost of doing business in America is about to skyrocket.  And small businesses deciding between hiring that next employee or saving for the next rainy day are being given every reason to put up the umbrella.

Bon Jovi agrees.

Stability, not activity, is what we need today.  That’s why the best thing our president could do for this economy — and even for his health care program — would be to call a 12-month regulatory truce.  No new rules for a year — including new regulatory programs like cap-and-trade or health care.  Now able to make economic decisions with some relative sense of certainty, Americans would regain confidence.  The dollar would rebound, businesses would react, and investors would reap the rewards.  It would send a strong signal to the markets that the mad scientist has been captured, and Dr. Obama is in.  It would also boost public confidence in the President, restoring their sense that he listens to their concerns and is willing to change course when the moment calls for it.  He wouldn’t even have to abandon his big-government aspirations — he’d just have to delay them.  And it wouldn’t cost him a dime.

Sounds like pretty good medicine to me.

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The House Ways and Means Committee confirmed today that the mandate provisions in Pelosicare will follow the form we’ve all expected: obey or go to jail.  While it’s an unconstitutional, brutal, and outrageous provision, it does crystallize the legal issues in a way the Senate bill does not.  These people have abandoned any pretense of addressing public concerns.  They want their power and they want it now.

For those who are following the mandate saga, there were some outstanding contributions to the debate in recent days:

See my previous commentary on the health insurance mandate here, here, and here.

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As you know, this blog has explored several ways whereby the proposed mandate that everyone obtain health insurance is unconstitutional.  Ignoring entirely the advice of this blog, the Senate Finance Committee reported out a bill that included a mandate, albeit a watered-down one.  In fact, it appears that any bill that will be voted on by Congress this fall will contain a mandate for individuals to obtain health insurance.  This begs the question – if a health insurance mandate is passed and signed by the President, what does it really matter?  Sure, Congress has pushed the envelope of constitutionality in the past, and rarely has it been struck down.  But isn’t this just an academic debate among legal eggheads?

Sadly, the answer is no.  Passing an unconstitutional health care mandate can only poison American politics, whether it survives a court challenge or not.  Let me explain why.

Nightmare Scenario I:  A Health Care Mandate Withstands Court Scrutiny

American jurisprudence is essentially a process of accretion. Accretion is a word used more frequently in geology, describing the layering of rock over the ages.  Imagine yourself standing on the edge of the Grand Canyon, staring at the wondrously colorful scene.  You see before you the dozens of layers of soil, rock, and sand that have been laid down, one upon the other, over centuries.  At the time each layer was established, those who were there to see it knew only of the layer being created, or of the layer beneath.  With a little work, they could dig slightly deeper to see one or two layers below that.  But they stood on all the layers that went before them, even if they never saw them.  They may have heard stories of them, or seen pictures, but they could not truly know the deepest rock upon which they stood.  And the same goes for you — though you stand on the top of all the layers laid bare by the Canyon, walk away and you will know only the rocks of yesterday, and the soils of today.

So it is with the law.  We like to think of philosophies like originalism and natural law as a harkening back to the way things used to be, but in many ways that’s not correct.  No serious legal thinker today advocates a return of U.S. law to the way it was at the time of our founding.  Sure, the concepts of checks and balances, separation of powers, federalism, and limited government spring from the constitutional well, and we would be wise to drink from it more often.  But while James Madison did not preconceive the Federal Communications Commission, he also couldn’t conceive of the telephone.  Jefferson’s dream of an agrarian society did not include ConAgra or ADM.  And while Lincoln’s vision for America included a transcontinental railroad stretching across the frontier, his imagination could not stretch as far as the moonshot at the center of JFK’s New Frontier.  This isn’t a pitch for a “living constitution,” but it is a recognition that the very things we consider America’s greatest achievements have always forced America’s political leaders to adjust the structure of our government to fit the circumstances.

(more…)

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Perhaps the most amazing thing to me about President Obama’s popularity tailspin is how easy it would be for him to get out of it.  People still like the guy (although that may be changing, as well) — they just don’t like his policies, and they don’t think he’s listening to them.  Any one of the following five things would improve his political standing, at virtually no political cost to him:

  • Say he won’t be closing Guantanamo – yet. This is obvious to all involved, but his team’s continued insistence that he’s working toward his one-year deadline runs against the grain of most Americans (55% oppose the move, 33% support it) and makes him look silly.  Conservatives would hail this as a win, and liberals would frown that their man has gone soft.  But this isn’t a change of mind, it’s just a change of timeline — and a recognition of reality.  Behind the scenes, his team could still try to find a way out of the mess, without giving opponents the talking point.  Far better to take this “loss” now than in January when his promise comes due – and he can still close the prison at any time.  Isn’t this just the pragmatic, non-ideological perspective for which Americans elected him last November?
  • End the intelligence inquisition. Most observers believe that the Administration’s continued assault on the CIA was much more about Eric Holder than Barack Obama.  It was a wildcat move by an Attorney General whose allegiances lie with the left wing.  The President has laid the groundwork for this — he’s already said we need to look forward, not backward, and he has never explicitly endorsed Holder’s escapade.  This would come a little late, but it would show the public that he’s not beholden to his base and can openly disagree with his team — something Bush never could seem to do.  Would the Left be furious?  Maybe, but this fight is so 2008, and it’s not the kind of thing you want hanging over Democrats’ heads going into a tough 2010 midterm election.  Make that double for any actual prosecutions of CIA employees, so there’s really no upside to pursuing this.  There’s plenty of upside for ending it.
  • Go to Berlin on November 12th. Make a speech (he’s good at that).  Say only good things about America.  Say nice things about Ronald Reagan and Jack Kennedy.  Walk through the Brandenburg Gate.  Speak out against tyranny and oppression.  Speak harshly about Communism.  Take credit (on behalf of his country) for helping to end it.  Recommit to the defense of Europe, and call on them to help us defend the free peoples of the rest of the world.  Americans love this stuff.  No one will criticize it (except the Russians, and they don’t vote).  Everyone will say it’s a change of tone.  It will distract people from the drudgery of health care, et. al. Not doing this will get noticed, to his detriment, I believe.
  • Set a deadline and keep it against Iran. Ahmadenijad is America’s boogeyman of the moment – and he’s earned it.  There is absolutely nothing redeeming about the guy, and there is no constituency in this country for coddling him and his regime.  Obama has spoken much about the need to use diplomacy to solve the situation in Iran.  To date, his understanding of diplomacy has meant ignoring a rigged election and brutal oppression; setting deadlines and watching them float by without consequence; and revealing knowledge of duplicity but showing no interest in punishing it.  He’s earned his nice guy bona fides.  No one doubts he wants to solve this thing without firing a shot.  But that sets him up perfectly to deliver a stemwinder against the most hated man on the globe.  Obama’s stern speech can set one last deadline, leaving the door open for progress on our timetable — but if Iran blows it, he’s got Congress to back him up.  Obama looks strong; his buddies in Europe can’t help but fall in line.  In short, the trap is set — the only question is, is Obama building a trap or a dollhouse?
  • Publicly retrench on some element of health care reform. It’s no secret that the American public is both fatalistic and incredibly concerned about the President’s health care agenda.  He’s overpromised, overspent, and underdelivered.  But the Democrats are convinced that if they do not pass their behemoth of a public health care regime now, they will never get another chance.  I disagree – a well-designed, publicly-supported program that will pass is likely to entrench the Democrats as the “health care party” for a long time to come, giving them other opportunities to improve upon their program (assuming it works, of course).  Within the health care polling, there is an emerging path for success that scares me to death, but would save the day for the Administration.  Let’s build it from the ground up, using the great polling data from Rasmussen Reports.  The public wants more private sector competition, and they are OK with a public option that improves such competition.  They aren’t OK with a Trojan Horse public option aimed at overtaking the private sector.  People also hate the idea of forcing people to buy health care, but everyone agrees that without getting the “young invincibles” into the health insurance market, costs will go up.  Americans are more concerned with cost control than they are universal coverage.  Taking these issues together, Obama presents a new way forward.  He publicly takes a government-run public option off the table.  He then says he will only support a bill with a non-profit or member-run plan that subsidizes care on a sliding scale basis — essentially an expansion of Medicaid up to an income limit where someone could easily participate in the insurance market.  He then says that participation in the non-profit plan or some other employer-provided plan will be mandatory for all individuals who receive federal aid (in the form of student loans, grants, housing assistance, etc.).  Obama also states that anyone who is uninsured who receives care at a public hospital will automatically be enrolled in the plan, and the government will pay for her first instance of care.  That takes the sting out of the mandate — suddenly, the only people who are forced to participate are the ones who take taxpayer funds.  Now, you’ve got a public option that appears to be out of the government’s hands.  And Obama’s mandate shift will have placed the onus of the mandate on those who are already government’s “takers,” not “givers.”  And perhaps most importantly, the President would show that he’s willing to take charge and make changes in response to public concerns.  The rest of the plan — the guaranteed issue, the taxes, the Medicare cuts, the rationing – would remain.  Nothing could be more positive for the Obama Administration.  And nothing would be more harmful for the future of the country.

To quote our President’s favorite phrase, let me be clear: I have no desire for this President to recover his popularity.  While some of these changes are things I would favor in isolation, together they would give great momentum to an agenda that would threaten our future.  But I also have no expectation that this White House could bring itself to make these minor course corrections in service of their larger goals.  And thus, this nation’s fragile promise lives on.

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In an earlier post, I explored whether the Obama health insurance mandate was constitutional in a positive sense — is the federal government empowered to take this action?  But through the very interesting debate that resulted from that post, it occurred to me that there is a second question that needs to be asked.  Does the Constitution affirmatively prohibit such a mandate?

The Thirteenth Amendment to the Constitution is one of the simplest and most morally-defensible principles in our charter:

Section 1.  Neither slavery nor involuntary servitude, except as punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.

Section 2.  Congress shall have the power to enforce this article by appropriate legislation.

Pretty easy thing to avoid, no?  No American shall be forced against her will to serve another.

As an initial matter, let me be clear – I am in no way suggesting that the severity, cruelty, and horror of human slavery is comparable to the relatively-minimal cost of the health insurance mandate on most Americans.  What I am comparing is a principle, and it’s the principle that is prohibited in the Thirteenth Amendment.  At an elemental level, the two practices are the same.

In the form of slavery practiced in the United States in the 19th Century, a man was born or brought into this country with an obligation to serve another.  His service demanded that he expend at least some, if not all, of his energies, time, and labor on the tasks he was given by his master.  In exchange, he was usually given the basic needs for human survival – food, clothing, shelter – but not much more.  If he failed in his duty, the law allowed him to be punished.  If he fled that obligation, the government would hunt him down and force him to return to servitude.  The man could do nothing to pay his debt or satisfy his obligation – he was bound for life.

Consider, now, what Obama’s health care mandate requires you to do.

You must, from the day you become a citizen of the United States, labor to earn money to pay a health insurance company.  In return, you are given a promise to pay for most health care services you require.  You are coerced to remain in this relationship under penalty of law.

If you become unable to work, you must still seek health insurance from the government (if you are poor, from Medicaid) or spend your savings on health insurance (for those who are not poor).  If you fail to do so, you will be punished by the government.  If you lose your job, you have no liberty to choose to forego health insurance to pay your mortgage, or buy food for your family, or keep your daughter in college.  If you fail to keep your health insurance, you are a criminal.

This obligation begins, for most of us, on the day we are born.  Most children will be covered on their parents’ policy, but their parents will immediately be forced to work harder to pay their children’s legally-enforceable debt.  If the parents stop paying, not only will the parents be liable, but so will the children.  An infant without health insurance will be a fugitive from justice.

When we grow up and become independent (if not sooner), we will be expected to lift the yoke of health insurance off the shoulders of our parents and begin paying for it ourselves.  Nevermind that this might happen in our teens, or that we’ll be lucky to pay for pizza delivery to our freshman dorms — the government will demand that you pay for your health insurance first.

If you have a conscience-based objection to the insurance required by the government, you cannot follow your conscience and forego coverage.  If you can’t stand the idea of purchasing insurance that covers abortion, you will be punished by the law.  If you think a man should stand on his own two feet and refuse to accept “welfare” like Medicaid, you must spend your last dollar on health care or face indictment.

If a health insurer sees that you have stopped paying your premiums, he has a vested interest in snitching to the government, hoping that the threat of law enforcement will get you to start paying again. If the threat isn’t enough, the government can act to force you to get insured or lose your remaining liberty.

If you ever let your health insurance lapse and the government fines you, you’ll be forced to tell future employers that you have been convicted of a crime.  Even if you never used any health care during the lapse, your non-payment of premium is a criminal matter.

In short, under the Obama plan, you can never escape your health insurance masters – you can only choose which master you wish to serve.  If you ever lay down your shovel and try to walk away, your government overseer will find you, punish you, and put you back in line.

***

We are a society that is blessed in countless ways.  One of those blessings is a total ignorance of human bondage.  In other countries, marriages are enforced like servitudes.  In Africa and Southeast Asia, classic 19th Century slavery is still practiced and, to some degree, countenanced by the government.  Even in some Western democracies, citizens are forced into petty private obligations at the government’s whim, small sacrifices of liberty for the common good.

As much as we often decry the loss of freedom in the U.S., we are an astoundingly free people, particularly in the commercial arena.  We are allowed to organize our lives in innumerable ways, and the government largely stays out of the way.  One of those ways is health care.  Most of us go the easy way, taking the insurance offered at the office, muttering curses at the co-pays but largely happy with the care.  Some smaller percentage of us do other things, others take advantage of government programs, and a small but not insignificant group opt out of the insurance market altogether.  Does this liberty cost the nation?  Yes – all liberty does, because liberties imply the right to make mistakes.  But We the People decided some 232 years ago that the costs didn’t matter – we wanted freedom.  We fought the bloodiest war in American history to extend this freedom to everyone.  We endured decades more of strife and struggle to break the cords of bondage forever.

Surely – surely – our first black President isn’t about to be the first to sign into law an act of Congress that abridges the Thirteenth Amendment?

chains

*this post used to be entitled “The Health Insurance Mandate: Is It Slavery?,” but some friends pointed out that involuntary servitude is the more precise term.

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