A Court of Two: Supreme Court Takes Up Health Care With Scalia and Kennedy In The Spotlight

This week, the Supreme Court will take up its historic three-day consideration of the health care law. My Supreme Court class will be spending two weeks on the four insular issues before the Court, including the question of federalism.

For a prior column on my view of the federalism question, click here.

As I have previously noted, it is not simply Justice Kennedy but Justice Scalia that will be the focus of attention in these oral arguments. In order to support the states, Scalia will have to distinguish past statements embracing broad interpretations of federal jurisdiction. For all intents and purposes, this could be an argument before a court of two with the parties striving to lock in both Scalia and Kennedy.

It is a closer case because of the refusal of Justice Kagan to recuse herself. I have previously said that I believe there are strong arguments to be made for such recusal by Kagan. If the Administration prevails, her participation will always be viewed in history as problematic by many.

I have stated before that I believe that the cases favor Congress in the lower courts, but that there is strong precedent on both sides. Obviously, both challenging the law are emphasizing United States v. Lopez, 514 U.S. 549, 115 S. Ct. 1624, 131 L. Ed. 2d 626 (1995) and United States v. Morrison, 529 U.S. 598, 120 S. Ct. 1740, 146 L. Ed. 2d 658 (2000). The Court stated in Morrison that it would not accept “the argument that Congress may regulate noneconomic, violent criminal conduct based solely on the conduct’s aggregate effect on interstate commerce.” Id. at 617. In Lopez, the Court required more than what Professor Fried appears to demand in the nexus to support federal authority. In striking down the Gun-Free School Zones Act, the Court found that the claim could not be sustained “under our cases upholding regulations of activities that arise out of or are connected with a commercial transaction, which viewed in the aggregate, substantially affects interstate commerce.” Lopez, 514 U.S. at 561. Again, the question as stated by Chief Justice Marshall is whether this claim conforms with “the letter and spirit of the constitution.”

As I have stated, people of good faith can disagree on these points and the matter cannot be fully resolved until put before the Supreme Court. Most people anticipate that Justice Kennedy will be the swing vote on a close decision. In both Lopez and Morrison, Kennedy voted to strike down the laws. However, in his concurrence, Kennedy did note that the history and language of the Constitution “counsels great restraint before the Court determines that the Clause is insufficient to support an exercise of the national power.” Moreover, Kennedy did vote to uphold the Controlled Substances Act in Gonzalez v. Raich, 545 U.S. 1 (2005). He agreed that, absent the authority, Congress could not regulate drugs. I am frankly not convinced that the same nexus can be established here.

There is also some question over Justice Scalia’s view since he also concurred in Raich. In that decision, Scalia noted that “[u]nlike the power to regulate activities that have a substantial effect on interstate commerce, the power to enact laws enabling effective regulation of interstate commerce can only be exercised in conjunction with congressional regulation of an interstate market, and it extends only to those measures necessary to make the interstate regulation effective. . . . Congress may regulate noneconomic intrastate activities only where the failure to do so “could … undercut” its regulation of interstate commerce.” However, he also found that “[t]his is not a power that threatens to obliterate the line between “what is truly national and what is truly local emphasis added.”

I view the health care legislation as presenting a new type of federal claim and one that could leave few things as protected by federalism by expanding Congress’ enumerated powers to an unprecedented scope.

94 thoughts on “A Court of Two: Supreme Court Takes Up Health Care With Scalia and Kennedy In The Spotlight

  1. As I have stated, people of good faith can disagree on these points and the matter cannot be fully resolved until put before the Supreme Court.

    They are looking at it closely, if the hours of oral argument allowed is any indication.

  2. This is an easy one to guess. ACA will make a ton of money for the insurance industry so the little 4, the corporate representatives on the court like Scalia & Kennedy will be in favor of it. One or two of the rational actors will side with them & is done.

  3. I was listening to the line up of attorneys….. One sticks out is Clement…..

    If I recall….. The issue is not ripe…… Seems to be another Marbury moment……

  4. As I see it, the problem is not that the government forces everyone to buy insurance but that it forces everyone to buy insurance from a PRIVATE, PROFIT-MAKING company.

    And, then, if one does not buy that (assuredly, over-priced) insurance product, the government will step in and FINE the person for not buying the product.

    Who needs good advertising-copy writers when an industry has the government acting like its ENFORCER, leveling crippling fines on anyone unwilling to buy some over-priced (and crappy) product?

  5. The idea the govt can force people to buy insurance is dangerous. If I read Mr. Turley in the past correctly he isn’t far from that view, because what will they force you to do next? America’s health care system is broken because of so much intervention by govt into it, short of universal health care which I have here in Canada which is slow, costs way to much and delivers less every year, America should consider removing all federal medical program’s and allowing it to be a state issue. My mother who has had severe pain in her abdomen for months went to the doctor 3 times to complain that something was wrong was told repeatedly it was just menopause. Finally after enough complaining she was granted an x-ray, the results were a mass in her left abdomen. She had to wait over 3 months for a CT scan, to find out if she had a potentially cancerous mass on her abdomen. Now while Americas health care system is broken due to govt intervention, and inflation, I would have much rather seen her go to the states and pay someone to have her diagnosed in a more timely fashion. Believe me when I say health care is not only rationed it continuously cut. Socialized medicine does not work, and the new law is merely a step toward it, and I believe a dangerous one.

  6. If Medicare Is OK, Obamacare Should Be Too

    Jonathan Cohn
    March 22, 2012 | 11:13 pm

    The lawyers challenging the Affordable Care Act will offer many arguments next week, when they make their case in front of the U.S. Supreme Court. But their most central claim is that the law is “unprecedented”—that it represents “a revolution in the relationship between the central government and the governed.”

    As they tell it, the requirement that nearly everybody obtain insurance, or pay a penalty to the government, forces people to pay for something they might not want or need. The constitution, they say, does not “empower Congress to seize control over decisions so basic as to how the people spend their money.”

    Put aside, for a moment, the fine distinctions of the interstate commerce clause and other constitutional matters the court must ponder. In principle, is the basic obligation that comes with health care reform—to pay for a mutual protection scheme that some individuals might not find advantageous or desirable—really so novel?

    Hardly. It’s an obligation most of us meet on a regular basis, every time we get a paycheck.

    I’m speaking, of course, about Social Security and Medicare. Each program is a form of “social insurance” and each serves the same basic function: To protect us from financial shocks that we cannot anticipate or avoid. With Social Security, the shock is reaching retirement without enough income. With Medicare, the shock is high medical bills during old age. During our working years, we pay into these programs by handing over portions of our incomes, in the form of payroll taxes. And we don’t have a choice about it, unless we want to start evading taxes.

    The Affordable Care Act is also a form of social insurance. It, too, seeks to protect us from problems that we cannot anticipate or avoid: Illness or accident before we turn 65. To get that protection, we must contribute towards its cost—by obtaining a qualified health plan on our own or, failing that, paying a fee to the government. The government then uses that fee to finance the provision of health care services for those who couldn’t pay for it on their own. The obligation is, if anything, less onerous than the one for Medicare and Social Security. By law, the government cannot impose criminal penalties on people who fail to meet the mandate. The worst the government can do is withhold future tax refunds.

    So why is the Affordable Care Act such an unconscionable infringement of liberty, while those two other, more revered programs are not? Some critics have suggested the Affordable Care Act is fundamentally unfair, because it effectively requires relatively healthy people to subsidize relatively unhealthy people. But that is true of Medicare and Social Security, too. The whole point of any social insurance is to ameliorate the impact of sheer chance on life—whether it’s being born with the wrong genes, growing up in the wrong neighborhood, or coming into contact with the wrong physical threats. Social insurance programs redistribute funds from the lucky to the unlucky, on the very sensible theory that any one of us could end up unlucky (and, at one point or another in our lives, probably will).

    A truer distinction is that Medicare and Social Security are real government programs: The bureaucracies that run Medicare and Social Security actually distribute the benefits, in the form of checks or payments to health care providers. The Affordable Care Act is a more privatized system, in which private insurance companies are the direct financiers of benefits for many people. But even that distinction is blurrier than it might seem. Medicare has long offered beneficiaries the option of enrolling in private insurance plans, rather than the government-run program. And today about a quarter of all beneficiaries do just that. Those companies operate under close government supervision and regulation, it’s true. But so will the companies offering insurance through the Affordable Care Act.

    Where the Affordable Care Act clearly differs from Medicare is in the alternative it lacks: Under the Affordable Care Act, many people won’t have the option of any public program at all. Their only choice will be private insurance, through a job or through the market place. This is a bug, not a feature, as far as liberals like me are concerned. But it’s difficult to see why conservatives would believe this makes the law more intrusive than Medicare or Social Security. The idea behind channeling coverage through private insurance, and the rationale behind excluding a public plan from the options, is to allow the free market more room to operate.

    Conservatives should know this better than anybody, because they have spent a generation making this argument and lobbying to privatize all social insurance. They’re the ones who keep trying to transform Medicare into a voucher system. They’re the ones who talk about replacing Social Security with a system of private investment accounts. But if it’s wrong to make obtain private health insurance for when they are under 65, why is it ok to make people obtain private health insurance for when they are over 65—or build retirement pensions by depositing money into private equities?

    Constitutionally, the differences among these programs may matter. The legal justification for Medicare and Social Security comes from the federal government’s power to levy taxes. And even some judges who have ruled in the favor of the Affordable Care Act have said (wrongly, in my view) the government cannot make that claim, because advocates didn’t use the term enough when debating the law.

    But insofar as the legal case against the Affordable Care Act rests upon a broader argument about liberty, it doesn’t make a whole lot of sense—unless the critics of health care reform are ready to junk Medicare and Social Security too. Something tells me they’re not.

  7. It’s ludicrous in the extreme to imagine that the Supreme Court would reject a law that codifies fealty to corporate hegemons and indemnfies their profligacy with mandatory tribute. That government will do the leg breaking on behalf of private enterprise and then charge the mark (citizen) for that “collection service” through taxation of the victims themselves positively makes them salivate with anticipation for future uses of the model, usually referred to as fascism.

    Lucky they have those black robes. It’s gonna be pretty sticky in there for the next few days.

  8. What Firefly said.

    D.S., We also have trouble getting appropriate diagnosis in a timely fashion. Sometimes it’s b/c we can’t pay for it, sometimes it’s due to md incompetence. Sometimes we just have to be persistent in finding the right dr.

    It took me years to get relief for something that was finally fixed after treatment for an incorrect diagnosis. A brother-in-law finally got a correct diagnosis when he relocated and refused to give his new dr. access to previous records. New dr. ran tests until he found that it was too much potassium. A previous dr. had diagnosed gout and subsequent drs just treated him for gout w/o effect. Both of us had excellent insurance.

    Don’t you also have the right to pay for treatment if you’re not satisfied with the free stuff?

  9. S.Mom, I like my SS check every month. I’d probably be on the street if I didn’t have it. Hope I never have to use the medicare.

  10. Obamacare and the Supreme Court
    A guide to the health-care case

    Mar 26th 2012, 11:48 by C.H. | NEW YORK

    BARACK OBAMA signed his health reform into law on March 23rd, 2010. Within minutes Florida’s attorney-general had filed suit against the law, along with 12 other states. Since then they have been joined by the National Federation of Independent Business, four private individuals and 13 additional states. Starting today the Supreme Court will hear their case. A decision is expected by the end of June.

    Most political brawls are drummed-up follies, but the fight over health-care reform is legitimately historic. The law is the biggest achievement of Barack Obama’s presidency. If it survives, Democrats say, it will expand and transform American health care. Republicans, though, see it as a government intrusion into private affairs. If the law is upheld, they say, no area of American life will be safe.

    America’s highest court usually devotes one hour to arguments. For this case it will devote six hours, spread over three days. The Economist has a seat for the proceedings; we’ll be posting our thoughts on Wednesday, and a detailed story will appear in next week’s issue. In the meantime, here is a guide to the arguments.

    Reams have been written about the case. This guide attempts to provide a simplified summary. Readers hungry for additional information should visit the American Bar Association, the SCOTUS blog and the ACA Litigation blog, which are stocked with briefs and other resources. C-SPAN has a video of a great debate between Paul Clement (the lawyer for the states), Mike Carvin (the lawyer for the National Federation of Independent Business), Neal Katyal (a former Solicitor General) and Akhil Amar (a constitutional law professor at Yale).

    QUESTIONS BEFORE THE COURT

    There are four issues before the Supreme Court. Attention has centred on the constitutionality of the “individual mandate”, which requires most Americans to buy health insurance or pay a penalty. However there are three other questions before the court, two that are procedural and one that is substantive: whether the case must wait until 2015, after the mandate takes effect; whether the rest of the law must fall if the individual mandate is struck down; and whether the law coerces states to expand Medicaid, the health programme for the poor.

    MONDAY: DECIDE NOW OR LATER?

    Question: Does the Anti-Injunction Act prevent the court from deciding this case until 2015? The court has granted 90 minutes for arguments on this topic.

    Background: The Anti-Injunction Act of 1867 bars court challenges to taxes before those taxes have been levied. The individual mandate will go into effect in 2014. Those who fail to buy insurance will pay their first penalty in 2015.

    Mr Obama’s argument: This is the rare instance in which Mr Obama and the states agree, albeit for different reasons. Mr Obama’s lawyers want the court to decide the case now, arguing that Congress did not intend the law’s “penalty” to be treated as a tax under the Anti-Injunction Act.

    Challengers’ argument: The case should be decided now. The health law assesses a “penalty”, not a tax. Furthermore, the suit challenges the mandate itself, not the penalty. The Anti-Injunction Act bars a person from suing, but it does not bar a state from doing so.

    Court-appointed lawyer’s argument: Because neither the challengers nor Mr Obama want a decision to be delayed, the court appointed a lawyer to argue that the case should wait until 2015. Robert Long, of Covington and Burling, contends that the court should not rule on a constitutional matter until it is compelled to do so, that is, after the tax has been levied.

    Analysis: The government’s argument here is among its most confusing. Mr Obama’s lawyers argue that the penalty falls within Congress’s power to tax, but the penalty should not be treated as a tax under the Anti-Injunction Act. Nevertheless, only one appellate court, in Virginia, ruled that the suit must wait until 2015.

    TUESDAY: THE INDIVIDUAL MANDATE

    Question: May Congress mandate the purchase of health insurance and penalise those who fail to obey? The court will spend two hours hearing arguments on this topic.

    Background: America’s health-care market has clear failings. In 2009 50m people without insurance bought health care they could not pay for. This shifted costs to those with insurance, in the form of higher fees. Meanwhile insurers may raise rates or deny coverage to the sick. The Democrats’ health law attempts to remedy these problems, among others. The poor receive subsidised insurance. Those who can afford insurance are required to buy it. Those who disobey are assessed a small penalty. According to Democrats, requiring insurance for the healthy will balance the cost of insuring the sick. Those who buy insurance will no longer subsidise those who do not.

    Mr Obama’s argument: The constitution’s commerce clause authorises Congress to regulate health care, an industry that accounts for nearly 18% of America’s GDP. The health law seeks to expand insurance coverage and lower the cost of care. The individual mandate is a necessary, proper way to meet the law’s goals. The law does not regulate inactivity, as the states contend. Not buying insurance is an economic decision to pay for your own health care. Given that millions of Americans buy more health care than they can pay for, the decision to self-insure has a substantive effect on interstate commerce. Furthermore, the mandate’s penalty falls within Congress’s power to tax.

    Challengers’ argument: The mandate is an unprecedented expansion of Congress’s power, “a revolution in the relationship between the central government and the governed.” The commerce clause authorises Congress to regulate economic activity. It does not authorise Congress to regulate economic inactivity. Allow this mandate and Congress may require Americans to eat broccoli or buy cars to support Detroit’s carmakers. The government’s insistence that the penalty is a tax is undermined by Democrats’ constant assertion, in 2009, that the penalty is nothing of the kind. Furthermore, the states are challenging the mandate, not the penalty.

    Analysis: Two federal courts of appeals, in Ohio and Washington, DC, upheld the mandate. One federal court of appeals, the Eleventh Circuit, overturned it. The Supreme Court agreed to hear the appeal from the Eleventh Circuit. Working in Mr Obama’s favour is a recent case, Gonzalez v Raich, in which the Supreme Court ruled that Congress could criminalise an individual’s growth of medical marijuana for personal use. Antonin Scalia, a conservative justice, wrote: “Congress may regulate even noneconomic local activity if that regulation is a necessary part of a more general regulation of interstate commerce.”

    WEDNESDAY: “SEVERABILITY”

    Question: If the individual mandate falls, must the rest of the law fall too? The court will devote 90 minutes to this argument.

    Background: The mandate is the most prominent piece of Mr Obama’s health reform. However the law is gargantuan. Its 2,700 pages cover everything from calorie counts on menus to drug rebates for the elderly.

    Mr Obama’s argument: Should the mandate be overturned, only two other provisions should fall with it. The reform requires insurers to cover those with pre-existing conditions and bars them from hiking fees for the ill. Mr Obama’s lawyers concede that the mandate is necessary for these requirements to work—without the mandate, individuals would simply wait until they got sick to buy insurance. This would prove disastrous for insurers. However the rest of the law should stand. The states may not fight provisions of the health law that do not apply to them.

    Challengers’ argument: Health reform sought to achieve near universal health coverage without increasing the deficit. The mandate was the main way to do this, but the entire law served this goal. If the mandate falls, the entire law should fall, too.

    Court-appointed lawyer’s argument: The Supreme Court appointed an impartial lawyer, Bartow Farr, to argue that the rest of the law should remain if the mandate falls. Mr Farr contends that the provisions outside of the mandate are “perfectly lawful”. Congress would rather have the law without the mandate than no health law at all.

    Analysis: The insurance industry supported the law because of the mandate. The requirement that individuals buy insurance balanced the myriad, onerous rules on insurers. The Eleventh Circuit’s ruling was insurers’ worst nightmare. The appellate court struck down the mandate but upheld every other part of the law.

    WEDNESDAY: MEDICAID

    Question: Is Congress’s expansion of Medicaid unduly coercive to the states? The court will hear one hour of arguments on this topic.

    Background: Medicaid provides health care to the poor. It is paid for by both the federal government and the states. However Washington foots most of the bill, providing 50% to 83% of funding for each state’s Medicaid programme. Beginning in 2014, the health law will expand Medicaid to childless adults with incomes of up to 138% of the federal poverty line.

    Mr Obama’s argument: This is not the first time that the federal government has expanded eligibility for Medicaid. The government may attach requirements to the aid that it provides. Strike down this expansion as coercive and other federal requirements would be similarly vulnerable. Besides, the federal government will pay for most of the expansion—100% in 2014, tapering to 90% by 2020.

    Challengers’ argument: The law’s expansion of Medicaid is unduly coercive. Technically, states could refuse the government’s new terms for Medicaid. But the federal government’s support for Medicaid is so large that refusing Washington’s help is impractical. States have no choice but to acquiesce to the government’s terms, even though they are strapped for cash.

    Analysis: No lower court sided with the states, making this challenge the least likely to succeed. However the Supreme Court surprised observers by agreeing to hear this issue in the first place, so another surprise may come in June.

    From The Economist

  11. Medicare and Obamacare are two quite different mandates.

    Yes, one has to pay for insurance in both; but with Medicare, premium costs, medical coverage and payments for medical services are ALL controlled by the government. That is NOT the case with Obamacare. With Obamacare, the “customer” is required to buy insurance from a PRIVATE, PROFIT-MAKING company with no protection that: (1) the costs for that insurance will be kept in bounds, or (2) the insurer will pay for medical procedures the “customer” needs to stay healthy and/or alive.

    As I said, medicare and Obama care two very different kinds of program.

  12. I don’t agree with the principle behind socialized health care programs such as Medicare or Medicaid. But what we have in those programs are federal programs funded by federal tax dollars.

    With Obamacare, we are establishing the precedent of legally requiring U.S. citizens to engage in business transactions with privately owned companies operating in a particular industry, in this initial case, the health insurance industry.

    This is simply not right.

  13. Without exaggeration, the final ruling has the potential to be the most important declaration on how the Constitution divides up power between national and state governments since the New Deal days some three quarters of a century ago. Without exaggeration, it could be the most important pronouncement on the federal “safety net” since the Social Security Act was upheld by the Court in 1937. Without exaggeration, a decision to strike down all or part of the new health law could be the most severe rebuff of Congress’s power over the national economy since the Sick Chicken Case in 1935. And, without exaggeration, a nullification of the Act in whole or in part could be the most devastating blow to presidential power and prestige since the Steel Seizure Case in 1952.

    The law at issue is not directly about civil rights, but for the nation’s working poor, the coming ruling on the law’s validity could be as important to them as a 1938 decision was for racial minorities, essentially starting the modern civil rights revolution. And for individuals who want to be left alone by their government, the final decision may be a reminder of a 1905 decision that first spelled out a theory of individual liberty that, in time, would contribute importantly decades afterward to that same civil rights revolution.

    Yes, it is that important — at least in potential. Whether or not it lives up to that potential may depend, to a significant degree, on how the Justices react to the 90-minute argument that opens the week on Monday. Many observers, and certainly most of the media, have been waiting most eagerly for Tuesday’s two-hour argument, when the biggest cog in the entire machinery of the Affordable Care Act, the individual mandate, is up for review. From Lyle Denniston at SCOTUS blog

  14. The primary goal of a PRIVATE, FOR-PROFIT insurance company is to make a PROFIT.

    IF, after making a PROFIT for the shareholders and paying the high salaries and bonuses today’s CEOs “require,” the insurance company can still “afford” to provide some healthcare to its customers, it will do so, if grudgingly.

    The government-run Medicare program, on the other hand, is NOT supposed to make a profit but IS supposed to try to keep the American people healthy, alive, and able to be as independent and productive as possible.

  15. Can Texas make me eat broccoli?

    Joey Fishkin

    One of the fascinating things about the constitutional battle of the coming week is how much argument and agitation is going on outside the Court—and how disconnected much of it is with anything going on inside the Court. And yet there are many subtle connections between the popular and judicial conversations. I wonder, for instance, whether part of the reason courts evaluating the ACA have talked so much about the commerce power, and so little about the power to tax (which to my mind is at least as strong an argument for the ACA’s constitutionality), has to do with the fact that the public, political battle about the ACA has been joined in terms of commerce, not taxation.

    Outside the courts, one huge argument is if the government can make you buy insurance, can it make you eat broccoli? This argument seems to have a lot of rhetorical bite. But the most straightforward response is the question in the title of this post. Can your state government make you eat broccoli? If the answer is no, as it surely is, then there must be some reason, other than limits on federal power, why that is so. The most likely reason is that states force-feeding us vegetables would violate fundamental liberty interests protected by the Fourteenth Amendment.

    In other words, the “broccoli argument” does its rhetorical work by turning a question of Congressional power into a question of individual liberty. And that, in microcosm, is what the entire public debate about the health care law is about, and why that public debate differs so much from the debate at the Court. Few people other than Mitt Romney really believe that it is perfectly fine for states to pass an individual mandate, yet unconstitutional for Congress to do so. That position—pure federalism, drained of all libertarian talk of personal freedom—simply does not have the political heft it needs in order to be a winning argument. And so opponents of the ACA marry federalism to individual liberty in a way that leaves them in the odd position of suggesting that if Congress has the power under the Commerce Clause to pass the individual mandate, then it could make you eat broccoli… in which case, Texas could pass a statute and force me to eat broccoli right now.

    One of the things I will be watching for this week is the degree to which any Justices who are skeptical of the ACA find ways to make their arguments resonate with the arguments against the law out in the public sphere—which means getting beyond commerce and enumerated powers and speaking in terms of individual liberty.

    Balkanization

  16. There was a very intersting segment on c span last night about the Supreme Court and its building, people, judges, library. They interviewed some of the Justices and a discussion about questioning during oral arguments was featured for a short while. Justice Thomas, who is somewhat ridiculed by the scotusblog folks for not asking questions in oral argument, was very articulate and his reasoning made a lot of sense. Rather than interrupt, interupt, interrupt, each judge in sequence, let the attorneys say their piece.
    Alito, Kagan and the others who were so proud of their ability to interrupt looked a but egotistic. A judge should not have to pin down one attorney on some point and say AHA! It is if they are a bit insecure and a bit dumb.

    Give the lawyers their day in court: Let em talk.

    TalkinDog

  17. FIREFLY, thankyou for reminding everyone that: “The primary goal of a PRIVATE, FOR-PROFIT insurance company is to make a PROFIT.”

    You are so right that FOR-PROFIT health insurance companies are mainly interested in short term goals, profits for shareholders, and high salaries and bonuses for CEOs. Healthcare to its customers is not the priority that it should be.

    In my experience, for-profit in medicine can come down to making profits by denial of needed care – that, to me, is UNETHICAL!

    I am a family physician and I am so grateful that President Obama has been able to put the brakes on the for-profit health insurance industry.

    I pray that Obamacare, or something like it, is declared constitutional for the common good of all patients in this wonderful country of ours.

    I had the opportunity to do several years of training in Ireland and England.
    It was great to be able to focus on the needs of the patients, rather than on what their insurance would NOT COVER.

    It is important for the physician to have time to hear the patient’s story. In for-profit medicine, productivity is demanded of the doctor to an inhuman degree. Even excellent emergency room doctors have lost their jobs because they were not seeing enough “heads-per-hour”. How can we give quality care when we, as physicians, are under such pressure to please the employer by number counts of patients seen?

    In my experience, for-profit does not belong in medicine. Any profit needs to go back into improving patient care and not to stockholders and CEOs.

    Sincerely, Dr Rosemary Eileen McHugh, M.D.,M.B.A., Chicago, Illinois

  18. The notion that forcing people to pay private sharks has anything to do with the New Deal or with helping those unable to defend themselves is a sad twisted comment on just how far people will bend their “lying eyes” to see what they want. It’s right up there with insisting that “creationism” is based on science.

    If one looks at how many top level bankers have gone to jail for patently illegal acts against homeowners, or at how private insurance companies have laughed at scant regulations and raised the cost of health insurance through the roof in Massachusetts (now that people are forced to buy insurance from them) , one will get an idea of just what sort of “historic” an event this judicial ruling will be.

    This court is made up of the most conservative, corporate friendly justices ever assembled in one room since the gilded age. That they are virtually guaranteed to support the individual mandate should provide a strong hint as to what sort of history is being made here.

  19. This ruling will have nothing to do with making people buy broccoli and everything to do with forcing them to empty their pockets for the profit of giant corporations. If more profit for private enterprise can be made by the government forcing its citizens to buy broccoli than health insurance, then and only then will the case in point be about broccoli.

  20. I still don’t believe it is the right of any govt to force you to buy something, it’s completely beyond what the constitution intends. Regulating commerce was supposed to simply allow free trade between states not run the economy, Obama has already shown he has no regard for the constitution & he seems to believe the govt is a cute all for everything. If, and I hope it doesn’t pass, what are all the poor people who simply cannot afford it going to do? Just another jack boot on the throat of everyone for the special interests, its interesting to watch what used to be the most free country in the world devolve into what can only be described as some facist, progressive melting pot. Big business wins but we’ll make sure everyone pays there fair share. The people who fought the revolution are rolling in their graves.

  21. This case has to do with legitimizing a totally new and economically destructive relationship between the public and private enterprise and making that relationship enforceable by the government so as to save corporations the expense. Healthcare is simply a cruel and ironic way of making this relationship appear to have a humanitarian bent when current events regarding bailing out corporate behemoths with zero penalties for their illegal behavior as well as current efforts by both political parties to destroy the social safety net clearly demonstrate that nothing could be farther from the truth.

  22. Lyle Denniston Reporter

    Posted Mon, March 26th, 2012 1:28 pm

    Argument recap: Moving on to the mandate

    Analysis (Updated 1:54 p.m.)

    When Chief Justice John G. Roberts, Jr., commented at the end of Monday’s first day of hearings on the health care law, “We’ll continue argument on this case tomorrow,” it seemed to have a secondary meaning even if he did not intend it. The comments and questions of the Justices during the 89-minute exchange left the distinct impression that they are prepared to rule on the constitutionality of the mandate that individuals must buy health insurance, and not push the issue off into the future. The exact route they would take was a bit uncertain, but their skepticism about taking a pass now was clear.

    Chief Justice John G. Roberts, Jr., soon began a line of inquiry that, he said, amounted to Long’s “biggest hurdle” to closing the courthouse to the challenges to the mandate and its penalty. Going back to the Supreme Court’s decision in Helvering v. Davis in 1936, upholding the original Social Security Act, the Chief Justice noted that that was a tax challenge and the government had waived its right to block that lawsuit. “So,” Roberts asked, “are you asking us to overrule the Davis case?”

    That did not mean, of course, that the Court would ultimately uphold the mandate. That is tomorow’s question, although the Justices asked many questions about the mandate, showing they are deeply curious about its scope and meaning. But an argument that at times seemed almost to bog down in the dense complexity of the tax code pointed toward a refusal to bar the lawsuits that had challenged the mandate and had put its survival before the Court this week. One of the telltale signs of that sentiment was that not one Justice, and no lawyer at the lectern, said that it would be premature and a contradiction of the Court’s tradition against deciding constitutional issues prematurely for the Court to rule promptly on the mandate’s validity.

  23. Pompous theater. The mandate is a foregone conclusion and has been since the moment Obama got rid of any sort of strong Public Option (government regulatory pressure) in his secret dealings with the insurance giants.

  24. D.S 1, March 26, 2012 at 1:07 pm

    I still don’t believe it is the right of any govt to force you to buy something, it’s completely beyond what the constitution intends.
    =========================================
    What about automobile insurance, aircraft insurance, or boat insurance?

  25. “Pompous theater. The mandate is a foregone conclusion and has been since the moment Obama got rid of any sort of strong Public Option (government regulatory pressure) in his secret dealings with the insurance giants.” -Brooklin Bridge

    “Pompous theater”, indeed. If I had to bet on the mandate, I’d swing your way. More money for the insurance companies — it would seem like a no-brainer.

  26. What about automobile insurance, aircraft insurance, or boat insurance? -Dredd

    It’s less expensive and one can choose not to own a car, fly a plane or buy a boat. I hate the idea of a health insurance mandate.

    Many people are already stretched to their limits, financially. And many aren’t going to want government assistance or vouchers (or whatever is being proposed). In the future, it’s my bet that not only will many go without health insurance, they’ll also go without any health care at all, if possible, to avoid paying a penalty.

    The mandate is a terrible idea, but “a foregone conclusion”, as Brooklin Bridge said.

  27. Rather have this than none especially if one has a pre-existing condition and no insurance. Obama did not get rid of the public option. That is pure propaganda.There were never the votes for it. Lieberman and Ben Nelson and every single republican were against it. There was no way 60 votes could be achieved.

  28. The Affordable Care Act has been a real gift to young people and seniors:Already more than two million young adults have gotten health insurance through their parents’ policies. More than five million seniors and people with disabilities have saved more than $3 billion on prescription drug costs, according to the Department of Health and Human Services. Millions of Americans have consumer protections that, for those unlucky to need them, have made a real difference in their lives.

    Of course, it won’t be until 2014 that we see the really big changes in health insurance coverage —the expansion of Medicaid to include everybody with income below 300 percent of the poverty line, the creation of a marketplace with subsidies where individuals and small businesses can get affordable insurance without discrimination. Undoubtedly this helps explain the public’s ambivalence. I agree with Jonathon Cohn’s assessment here.I know a lot of unemployed young people that would have gone without healthcare if this legislation had not been signed into law.

  29. TPMDC
    Sandra Fluke Is Relevant, Say Anti-Health Reform Tea Partiers

    Health Care Before The Court
    Evan McMorris-Santoro March 26, 2012, 12:45 PM 3728 65

    A lot of Republicans on the national stage would rather not rehash the battle over Sandra Fluke, the Georgetown Law student who galvanized the left last month when she was attacked by Rush Limbaugh after arguing in favor of contraception coverage.

    Not so here outside the Supreme Court, where the justices heard the first day of arguments over health care reform. Fluke was a central topic among the several dozen tea party protesters who gathered outside the court Monday. As a much larger crowd of organized pro-reform activists from labor and other Dem-friendly groups marched in support of the law, one tea partier yelled, “Real women pay for their own birth control!” — a clear reference to Fluke and the fight over contraception access she embodies.

    Others were more direct. One protester carried a sign that said, “Sandra Fluke I don’t want to pay for your birth control,” which drew criticism from the pro-reform crowd. “Do you agree with what Rush Limbaugh said?” A pro-reform demonstrator yelled into a small group of tea partiers gathered around the sign.

  30. Obama did not get rid of the public option. That is pure propaganda.

    Oh yea, I forgot how valiantly Obama used the bully pulpit to argue for a strong public option and how much pressure he applied to a congress where both houses were controlled by Democrats. What were his words again? Oh yes, “The public option is but a tiny sliver of my plan, we can get rid of it with no problem”. That sell out took a lot of courage and a lot of people really appreciated him “at least trying.”

    As for Obama making a secret deal with the insurance companies, read this. It doesn’t sound anywhere near as much like propaganda as the starry eyed version of this legislation being about making health care afordable or even available.

    For the rest of it, Insurance companies have proven themselves to be masters of loop holes when it comes to people with pre-existing conditions and the co-pays for the basic “poor folks” plan are astronomical. This is pure junk-health care offered as the thinnest of excuses to establish corporate ownership of people’s meager resources and governments willingness to legitimize and facilitate that ownership.

  31. Brooklin Bridge, There were never 60 votes. Period. If you have the names of sixty senators that would have supported a public option, please post.

  32. Healthcare Reform
    Tuesday, Oct 27, 2009 1:10 PM Central Daylight Time
    Lieberman will join filibuster of public option
    The independent senator from Connecticut’s decision all but kills the legislation’s chances
    By Alex Koppelman

    Progressives didn’t even get 24 hours to celebrate the victory they won in getting Senate Majority Leader Harry Reid to include a version of the public option in his healthcare reform bill. The celebration was cut off Tuesday afternoon with the news that Sen. Joe Lieberman, I-Conn., will vote with Senate Republicans to filibuster the legislation.

    “I’ve told Sen. Reid that if the bill stays as it is now I will vote against cloture,” Lieberman told Politico. “To put this government-created insurance company on top of everything else is just asking for trouble for the taxpayers, for the premium payers and for the national debt. I don’t think we need it now.”

  33. Just a side question here:

    Is it true that by claiming religious reasons, the Amish and Muslims would NOT have to pay into any mandated health insurance program?

    I heard something to that effect today and I am curious.

    If it is true that groups can be excluded from the mandate for religious reasons, then it is also true that (perhaps) millions of people might still turn up in emergency rooms when needing care, and the taxpayers will still have to pay for their medical care.

  34. S.Mom, read the link. Obma sold out the public option. Read the link, Miles Mogulesco has far more compelling and substantiated evidence for the claim than simply repeating that Obama didn’t have the 60 votes. No one ever has sixty votes unless they try for them or unless they are Republican and then they don’t even need the 60 votes. And as to LIeberman, it is widely agreed he was simply returning a favor to Obama for not having him thrown out of any leadership positions.

  35. Not true. Lieberman has long been an opponent of a public option even before Obama ever appeared on the scene. His wife worked for Pfizer and he was in their pocket. You sound very familiar.

  36. Swarthmore mom:

    Lieberman comes from Connecticut, home to most of the insurance executives in the nation — the Big Money Boys; that’s why he would naturally oppose anything that would cut into the PROFITS of insurance companies.

    Obama has NO such excuse for NOT fighting for the public option.

    We were exhaustingly told what a “spellbinding” orator Obama was, but he never used his oratorical skills to wage even a tiny fight for the public option.

    Obama is a political coward.

  37. Firefly, I hadn’t heard about religious group claiming exemption, but I would hardly be surprised. It will be taken up, no doubt, once the Supreme Court goes through the theatrical motions they are currently engaged in and come out, quelle surprise, with a ruling that legitimizes corporate control of private resources. Once that ruling makes the theft look as wholesome as apple pie, the other ducks will quickly line up. No doubt at the very least, however, Christian groups and government officials will be exempt from the mandate, though not from the benefit, just as they are from peeing in a cup.

  38. Swarthmore mom:

    You’re the one who claimed “There were never 60 votes” as if the president has NO ability to persuade anyone of anything.

    Do you imagine FDR passed all that New Deal legislation without having to persuade anyone of anything? Do you imagine FDR persuaded Congress to vote for Lend-Lease without having to persuade anyone?

    Obama was pretty useless; he COULD have fought for the public option but chose NOT to.

  39. S.Mom. You seem to be the one who doesn’t want to talk about the case as soon as there is any disagreement with your voluminous but uncritical support of Obama and his corporate health care.

    Call facts Obama-bashing if it makes you feel better…

  40. The Affordable Care Act Two Years Later: #HealthcareWorks

    It’s been two years since the Affordable Care Act (ACA) — the groundbreaking health care law that improves access to affordable, quality health care for millions — was passed. Already more than 20 million women are receiving preventive care without co-pays. It is the single biggest advancement in women’s health in a generation.
    As a health care provider whose doctors and nurses serve nearly three million people every year through its nearly 800 affiliate health centers across the country, Planned Parenthood is committed to expanding access to affordable care. Here are seven reasons why we are celebrating the Affordable Care Act.

    1. 20 Million More Women Have Received Preventive Care without Co-pays
    The numbers don’t lie. It’s been two years, and 20 million women are receiving care they previously had to pay for. That’s more than 27,000 women every single day receiving coverage for preventive services, such as mammograms and Pap tests.

    2. Increasing Access to Contraception
    In a time when many are trying to restrict access to comprehensive reproductive services, the Affordable Care Act increases access to contraception for women. Under the ACA, insurance companies and employers (with the exception of churches and other places of worship) must cover contraception without any additional co-pays. It’s no surprise that this is one of the most popular benefits of the health reform law — maybe it’s because birth control use is nearly universal. Ninety-nine percent of all sexually experienced women and 98 percent of sexually experienced Catholic women have used it at some point in their lives. Not to mention the fact that 58 percent of women who use the birth control pill use it for purposes other than pregnancy prevention, including managing endometriosis, ovarian cysts, and other medical conditions. It’s basic preventive care and can save women up to $600 per year.

    3. Expanded Access for Women (especially Young Women)
    More access means more healthy women. Under the law, access to affordable health insurance will become available for the nearly 13 million women of reproductive age who will be newly eligible for insurance coverage. Young women (and men) under the age of 26 don’t need to worry about immediately being dropped from their health care plan upon graduating college. In the majority of cases, they will be able to remain on their parents plans no matter if they are married, living with their parents, still in school or looking for a job. These women and men will be able to be covered up until the age of 26.

    4. Ending Discriminatory Practices Against Women
    The ACA protects women from insurance companies charging higher premiums, sometimes up to 150 percent more than men. Insurers will no longer be able to deny health care coverage because of a “pre-existing condition” such as breast cancer, high blood pressure, or diabetes. This is especially good news for women who have been denied coverage because some health insurers have claimed that even pregnancy or being a survivor of domestic violence is a pre-existing condition.

    5. Promoting the Health of Women by Covering Preventive Care
    By guaranteeing coverage of preventive care, such as lifesaving breast cancer screenings and immunizations without co-pays, the Affordable Care Act promotes the health of women. Additionally, all new health plans will be required to offer essential benefits for women including maternity care, reproductive care, and prescription care. The law also guarantees access to their ob/gyn provider without another doctor’s referral or approval from the insurance company.

    6. Your Insurance Company Can’t Come Between You and Your Doctor
    Every woman knows how important access to ob/gyn providers is to maintaining good health. But, too many women have faced barriers to accessing them. Under the law, your insurance company can’t come between you and your doctor. Because of the ACA, women will have guaranteed access to an ob/gyn provider without having to wait for a doctor’s referral or approval from the insurance company. Women will have a choice of doctors.

    7. Affordable Care for a Lifetime
    Because of the health care law, millions of women will no longer have to worry about what happens if they get sick or have a preexisting condition. Women will be able to receive the care they need without fear of discrimination or higher premiums simply because of their gender. The ACA represents the greatest single advance for women’s access to health care in a generation. More access means healthier women and healthier families.

    Planned Parenthood

  41. Not true. Lieberman has long been an opponent of a public option even before Obama ever appeared on the scene.

    Bull. Try reading thisOR THIS

    You asked me to provide the names of 60 representatives that would have voted for a public option that Obama did everything in his power to trivialize; well, perhaps you would be good enough to refute these hard links substantiating that LIberman was FOR the public option before he was AGAINST it.

  42. Planned Parenthood is at the SCOTUS in support of Obamacare and the tea party is down there protesting against it and attacking Sandra Fluke again. I am with Planned Parenthood.

  43. Brooklin, That’s not 60 names. Ben Nelson was not voting for it either. Then, Kennedy died and it was all over.

  44. S.Mom, you havn’t taken up one single link I provided.

    I have shown links that provide solid evidence that Obama secretly negotiated away the public option and the same showing that Lieberman was FOR the public option in 2004 and again in 2006. Of course you’re not going to reply. You have no reply.

    It’s impossible to give you sixty names and you know it because Obama never wanted 60 votes or 30 votes or 20 votes or 10 votes or even one single vote for the public option and he proved that by never giving one single solitary speech — he was so famous for — on it’s behalf. That is, once he was elected.

  45. Not saying Obama could not have tried harder but after Kennedy died it was numerically even more of an impossibility. Also, there was no stronger proponent of national healthcare in the Senate than Ted Kennedy. The loss was a double whammy for the cause.

  46. Perhaps Planned Parenthood, like AARP, simply wants a seat at the table. Simply wants to be part of the “grown ups” and so is willing — like the CEO of AARP — to let the masses be fooled by propaganda about “earning the right to be heard” while he secretly negotiates accepting cuts in social security and raising the age for Medicare.

    Good luck with that.

  47. Swarthmore mom:

    Obama didn’t try at all for the public option. He was AWOL on the public option and threw single-payer out the window before the negotiations even began.

  48. brooklin bridge, I don’t like the health insurance companies. I am hoping Obamacare is just a step toward medicare for all.

  49. firefly, If the SCOTUS strikes down Obamacare, do you really think the republicans in Congress will turn around and vote for single payer? I don’t.

  50. Swarthmom

    it’s true they didn’t have the 60 votes, but it would have been good to see some repubs read out of a phonebook for a few days.

  51. S.Mom, this isn’t about health insurance companies; it’s about fascism. It’s about an increasingly authoritarian government constantly wrapped up in dubious wars requiring and being ready to enforce that it’s citizens participate in a pathological relationship with giant private enterprise that has a proven track record of placing profit above all humanitarian concerns and of avoiding any and all responsibility for illegal and unethical actions against those same people by the act of buying and corrupting politicians.

  52. Swarthmore mom

    “do you really think the republicans in Congress will turn around and vote for single payer? I don’t.”

    Don’t be absurd.

    The time for Obama to fight for single-payer or at least the public option was at the beginning of the negotiations.

    But he didn’t even try. He gave up on both before even entering the room to negotiate.

    Why do you assume criticism of Obama comes only from Republicans? Obama has been a huge disappointment to many if not most Democrats who believed him when he said all the fine things during the campaign. I never did believe him but I also never imagined he would be the disaster for Democrats that he has been.

    Please don’t assign opinions to me that I have not expressed and do not hold.

    Thank you.

  53. Simply because one gets out in front of a lynch mob doesn’t mean it’s a parade, and simply because it’s called “affordable” health care doesn’t mean it’s about government representing the health interests of it’s citizens.

    Clearly we won’t get single payer if the Supreme Court declares it illegal to force people to buy junk from ruthless sharks. But then this was never about single payer or any other form of care for the health of citizens. It has always been solely about legitimizing government use of economic force against its citizens for the benefit of corporations.

  54. Vengeance, “Now look at the fine mess we’ve started.” Do you think healthcare should have been left alone and not changed at all”?

  55. Health care, in almost any form other than the current total fiasco, has been set back by at least a generation by the Democratic seal of approval on a purely corporate giveaway.

    The legislation as signed into law by Obama has almost no provision for Federal regulation (which would be pretty strict as you can tell by the number of bankers they have sent to prison for illegal foreclosures). It makes no provision to give states the money to enforce what few rules it specifies that might actually constrain providers from ripping people off. It still leaves a huge number of people totally uninsured and it looks almost intentionally designed to be vulnerable to corrosive attack by Republicans and corporate Democrats alike(meaning most all Democrats). It has language that explicitly damages woman’s rights over thier own bodies.

    No legislation at all would have been vastly better than this ritual celebration of the ownership society with a nasty twist of puritan venom thrown in to boot.

  56. I wanted to refute Brooklin’s assertion that what we’re calling healthcare reform “…has always been solely about legitimizing government use of economic force against its citizens for the benefit of corporations…” because I truly do not believe that characterizes the or a goal of the Obama administration in proposing ACA. I simply don’t believe a single payer program was doable. This was pretty hard to get done and I believe there will be some benefits of having more people insured thus cutting into the cost to the government and for those of us who pay higher premiums to cover those costs for providing medical care for the uninsured.

    However, since the original idea did come from the Heritage Foundation in the early ’90’s and was in large part (including the individual mandate) proposed by Bob Dole as the GOP counter to the Clintons’ single-payer plan in 1993, it would be a fair characterization to say it feeds the “free market” view of turning government functions over to for-profit companies.

    The primary issue I have with the conservative view is that where such actions may shift a cost out of the government budget, it doesn’t necessarily lower the cost of that now shifted product or service to the end user. In fact, by the mere necessity of being a for-profit firm, this cost shifting to for-profit companies virtually ALWAYS costs the consumer more out of pocket dollars in a short time period.

  57. Good analysis, r. c. The republicans had already gone crazy with exaggerations of Hillarycare calling it socialized medicine. Maybe they prefer Ron Paul healthcare. Just let the uninsured die rather than have the government either pay for or mandate anything.

  58. Howard Dean on the mandate:

    http://dailycaller.com/2012/03/26/howard-dean-predicts-supreme-court-will-declare-individual-mandate-unconstitutional/

    “I’m not a lawyer,” Dean said. “As you know, I’m a physician. So I don’t speak about the constitutionality of the individual mandate. But it’s definitely not necessary for the bill to succeed. It was mainly put in by academics who built the program for Gov. [Mitt] Romney in Massachusetts — they had done it there — and for insurance companies who will benefit from extra customers. But the truth is that the number of so-called free riders, people who will refuse to get insurance until they get sick, is going to be very, very small.

    Dean then argued, “It would have been easier for them not to include an individual mandate in the first place because mandates make people mad.””

  59. Brooklin bridge, Why is Planned parenthood demonstrating in favor of it?

    If you bothered to even read my comments, you might find I had already given a plausible answer to that question. Probably Planned parenthood is demonstrtin in favor of the mandate to prove that they are adults and deserve a place at the negotiating table just as AARP has done

  60. Brooklin Bridge,

    Excellent points. Just letting you know they’re not falling on deaf ears; despite the fact that you’ve directed them towards an Obama apologist.

  61. “Good analysis, r. c. The republicans had already gone crazy with exaggerations of Hillarycare calling it socialized medicine. Maybe they prefer Ron Paul healthcare. Just let the uninsured die rather than have the government either pay for or mandate anything.” Excellent comment, what is the Republican alternative, death? What is more absurd than the Tea Party elders who are obviously on MEDICARE protesting for the government to keep their hands off of their health insurance! Since the Republicans have created a criminal and corrupt corporate state masquerading as a democracy, you would think they would embrace the crony capitalism of a mandate of Americans having to purchase insurance from the “For Profit!” health insurance monopolies that are an ATM for Wall Street! Perhaps we should start over, how about universal health care for all Americans!

  62. Everyone here in Taiwan has to pay for National Health Insurance, which the government runs efficiently and which costs my wife and me a grand total of $40/month. In America, I had no health insurance and would have died had I not gotten out of that bigoted, hyper-militarized, crony corporate asylum and moved to a civilized country that knows how to run a national health system that charges everyone, but spreads the risks and costs accordingly over the entire population.

    If Americans really wanted a national health insurance system, they would not ask the Supreme Court or American insurance companies, but would invite some health insurance experts from Taiwan — or any other number of competently governed countries — to explain how effective governments do these sorts of things.

  63. This individual mandate in particular, and the health care legislation in general could only have been dreamt up by the Mafia as little as forty years ago.

    And that does not in anyway conflict or contradict what rcampbell said about Bob Dole who I think joined the Mafia at precisely the point where he decided that all the benefits of education etc., he obtained personally from the GI bill upon return from WWII, were far too rich a mixture for any subsequent generation of Americans to handle.

  64. And I coudn’t agree more with Michael Murray,

    you would think they [the Republicans] would embrace the crony capitalism of a mandate of Americans having to purchase insurance from the “For Profit!” health insurance monopolies that are an ATM for Wall Street!.

    You truly hit the nail on the head! The only point you might miss is that those Republicans endowed with the ability to count the number of fingers on at least one of their hands are indeed rubbing them together in total glee and disbelief that this colossal transfer of wealth into the coffers of the plutocracy might actually be about to happen and that as a supreme irony they can blame the Democrats for it.

  65. Jack

    I also see the 6-3, but I seriously see Kennedy and perhaps even Roberts joining the liberals on the side of Constitutionality. I wouldn’t even be shocked to see Scalia join in to make it 7-2.

  66. I do NOT see it as a liberal point of view that requiring every American to buy a product, insurance, from a PRIVATE, PROFIT-MAKING corporation is Constitutional.

    The right-wingers on the Sup.Ct. are probably salivating at the thought that they have the power to transfer great gobs of wealth FROM the middle class TO their corporate friends.

    I would have no problem with the government mandating everyone to pay for insurance THROUGH the government, even if eventually farmed out to private companies, because then the government would regulate the premium costs and the coverage provided.

    I consider myself a lifelong liberal and I hate the mandate in Obamacare because it is nothing more than a great gift to profit-making corporations. And I wouldn’t be surprised to see some of the “states-rights” conservatives on the Supreme Court “forgetting” their concerns about state government powers v. national government powers because of their zeal to help their corporate friends.

    By adopting many Republican views, Obama has confused a lot of Democrats who don’t know how to be Democrats anymore.

  67. I believe that Obama and Hillary have the right idea. Here in Maryland we have MHIP which is a permanent state option and now also the federal temporary option until ACA goes into effect. The state and federal MHIP is excellent insurance, better in some ways than my current business plan HMO. I believe that Michael Murray raises a very good point in that it is quite possible to have cheap excellent insurance through the government, Not all national healthcare plans end up like Canada’s.

    I further believe that it is inhumane to deny anyone insurance and thus healthcare for any of the following reasons, some of which overlap:

    1. You are poor. I know of people who are honest and hardworking and their business even offers a plan, but they are just too poor to afford the high premiums and deductibles. That’s horrible.

    2. You are old. Old people have very expensive insurance They also are more likely to have a preexisting condition.

    3. You are fat. You can be denied healthcare for being obese just as you can be denied life insurance for the same reason.

    4. You have a preexisting condition. Many millions of people have this problem. I personally have a medical condition with my back that requires medicine, CT scans, MRI’s etc. I have personally been denied health insurance by Blue Cross for this reason. I had to go on MHIP until I got back on a work plan.

    5. You have a family. Health insurance goes way up when you have a spouse and dependents. The likelihood of a preexisting condition also is much higher in a group.

    6. You are here illegally. I know this is a sensitive subject, but we have millions of Latinos here illegally. I work with Latinos every day and I could not ask for better coworkers and friends. I know Obama said that illegals will not be eligible for affordable reasonable (non-exclusionary) ACA healthcare. That is WRONG. It is immoral and inhumane to tell people that they can stay here but not have affordable readily available healthcare. Which leads to my next comment.

  68. People argue that hospitals pick up the slack for anyone without insurance, including many illegals. Again I do not want to slight anyone. I love Latinos. However it breaks my heart to see people bringing in their kids with an earache
    or something to the emergency room. It is wrong to make someone wait 5 hours to see a doctor for their kid. Hospitals are not exactly the best place for a little kid to be. Or the elderly for that matter. MRSA or methicillin-resistant staphylococcus is a big problem in hospitals. Also, the tendency of hospitals is to send you home if you are not dying or seriously ill.They cannot treat a patient completely. They cannot properly treat the mentally ill in my opinion. I include run of the mill depression/anxiety that so many people have in the mentally ill category. They cannot give you the expensive drugs you need for whatever ails you. It is also wrong to force people to wait until they are sick enough to be admitted to the hospital before receiving care.

    Also it can be argued and this in my opinion is the most pressing issue with this subject is that DENYING HEALTHCARE IS BAD FOR THE ECONOMY.

    http://www.slate.com/articles/news_and_politics/prescriptions/2009/11/the_nativism_tax.html

    I think that the economic savings will ultimately be enormous under ObamaCare or ACA. I also think that denying healthcare to illegals is dead wrong if only for economic reasons.

  69. Dr Rosemary Eileen McHugh, M.D.,M.B.A., Chicago, Illinois:

    In a free society you would have the right to start a company that does just that.

    You seem to be well qualified to start a medical insurance company that would operate under your premises, why havent you? Why havent others?

    Forcing people into a single payer government system is not in the best interest of a free society.

  70. Brooklyn Bridge:

    “S.Mom, this isn’t about health insurance companies; it’s about fascism.”

    you got that right but with one minor criticism.

    S.Mom, this isn’t about health insurance companies; it’s about statism.

    Now it is correct.

  71. Brooklyn Bridge:

    “It’s impossible to give you sixty names and you know it because Obama never wanted 60 votes or 30 votes or 20 votes or 10 votes or even one single vote for the public option and he proved that by never giving one single solitary speech — he was so famous for — on it’s behalf. That is, once he was elected.”

    If he had it wouldnt have passed. He is going about it through the back door. I wouldnt worry, if the Supreme Court says it is constitutional it will be a few years until government is providing universal care for all citizens.

  72. Obama care will never lead to single-payer healthcare or Medicare-for-all.

    Much more likely is that declaring the individual mandate of Obamacare Constitutional will lead to the PRIVATIZATION of Medicare and Medicaid — and the insurance companies are delirious with joy in anticipation of the riches that would bring them.

  73. If he had it wouldnt have passed. He is going about it through the back door. I wouldnt worry, if the Supreme Court says it is constitutional it will be a few years until government is providing universal care for all citizens.

    Yea just as soon as Santa Claus and the eight tiny reindeer deliver all the presents…

  74. Brooklin Bridge:

    Obama is a statist and he knows how to use the law. If it is declared constitutional, there will be government funded universal care, eventually.

    Some of the provisions are good, keeping children on policies until 26 is one. That isnt much of a risk for most insurers since 26 year olds are healthy. But it is something.

  75. Lyle Denniston Reporter

    Posted Tue, March 27th, 2012 12:20 p
    Argument recap: It is Kennedy’s call

    Analysis

    If Justice Anthony M. Kennedy can locate a limiting principle in the federal government’s defense of the new individual health insurance mandate, or can think of one on his own, the mandate may well survive. If he does, he may take Chief Justice John G. Roberts, Jr., along with him. But if he does not, the mandate is gone. That is where Tuesday’s argument wound up — with Kennedy, after first displaying a very deep skepticism, leaving the impression that he might yet be the mandate’s savior.

    If the vote had been taken after Solicitor General Donald B. Verrilli, Jr., stepped back from the lectern after the first 56 minutes, and the audience stood up for a mid-argument stretch, the chances were that the most significant feature of the Affordable Care Act would have perished in Kennedy’s concern that it just might alter the fundamental relationship between the American people and their government. But after two arguments by lawyers for the challengers — forceful and creative though they were — at least doubt had set in. and expecting the demise of the mandate seemed decidedly premature. SCOTUS blog

  76. Bron:

    “that is an interesting prediction, how did you come by that? What makes you think so?”

    All one has to do is study history, follow the money and follow Obama’s record so far.

    Everything for the past 30 years — and with increasing intensity, lately — has led away from providing a fair and secure safety net for Americans and TOWARD helping the corporate interests. Laws and regulations put in place during the FDR years to protect us from the greedy among us have been demolished and/or turned on their head and redesigned to help the wealthiest, the Medicare prescription drug plan was mostly a gift to the pharmaceutical companies, and Obamacare is a gift to the health insurers. With the Citizens United decision in place, money is now more corrupting than at any time since the days of the robber barons, and I don’t see that ruling being overturned any time soon, do you? Who in Congress is going to vote to stop the flow of money into his or her own pockets?

  77. Bron, Firefly:

    You do have a point. I don’t know that you are right though. In fact many doctors and insurance companies are quite worried about ACA. They believe that it will destroy them. They may just be dumb and paranoid and your more cynical analysis is correct. However let’s say you are right and Obama, the Senate and congress is in the pocket of health insurers. Isn’t the end result the same? Everyone finally gets insurance and the costs of uninsured medical care is drastically lowered.

    However the current policies of the insurance and thus the entire healthcare system is currently controlled by insurance companies. The policies are unfair and are helping to bankrupt our Nation in my opinion. Thus, the entire system is no longer a viable option.

    Here is a quote from the Slate article I mentioned above:

    “According to a May 2009 study by Families USA, a nonprofit consumer group, the annual cost of uncompensated care is about $73 billion, of which $30 billion is paid by government and charity. The remaining $43 billion is passed onto health insurers, thereby raising the average family insurance premium by $1,017 annually, about 8 percent of the average family premium. Families USA calls this a “hidden health tax.””

    That 73 BILLION dollar number most of which is carried by families, is simply unacceptable. With the aging of the Baby Boomers, that number will skyrocket without the reforms .

  78. commoner:

    “Everyone finally gets insurance and the costs of uninsured medical care is drastically lowered.”

    That is not necessarily going to bring the costs of insurance premiums down; while the costs to the insurer may go down, the insurer is under no obligation to pass that saving along to the customer.

    The insurance companies CAN just opt to charge more and more and more for their premiums so they can give bigger and better salaries and bonuses to their top executives.

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