Your Humble Narrator is not a fan of the Patient Protection and Affordable Care Act (PPACA), a.k.a. ObamaCare, or of the decision in NFIB v. Sebelius, which upheld almost all of the PPACA. Here are some of my thoughts on the decision, taken from scribblings in the margins of notebooks at last week’s conference, on the backs of receipts stuffed in my wallet, and on napkins stuffed in my pockets:
1. Back in an aught-nine interview of President Obama, George Stephanopoulos argued that the individual mandate was a tax, going so far as to back up his claim with the dictionary definition of “tax”. Obama argued that it wasn’t a tax, and that “look[ing] up Merriam’s Dictionary, the definition of tax increase, indicates to me that you’re stretching a little bit right now.”
In the decision that upheld ObamaCare last week, a five-justice majority ruled that the individual mandate is a tax (so that it could be upheld under the Taxation Clause) and is not a tax (so that the case wasn’t put off until 2014 and so that Obama didn’t look like he was raising taxes). I await the President’s opinion on whether the Court’s logic constitutes a “stretch.”
2. Under the PPACA, the feds could punish states that don’t participate in the new Medicaid expansion by taking away all their Medicaid funds. The Court ruled this part of the PPACA to be unconstitutionally coercive. But if the Court just upheld the taxation of being non-insured, then surely Congress can conjure up some creative tax legislation to punish those states anyway. You don’t want to expand Medicaid the way we want? Fine. We’ll just tax the end users of your Medicaid funds at 100%.
3. The strongest, most cogent argument the Administration could have offered in defense of ObamaCare was: “Look at everything else we already do! Look at Social Security, Medicare, Medicaid, NCLB, corporate subsidies, welfare programs– and you’re gonna tell me that this bill crosses the line? There is no line.”
(It works better if you imagine it coming from Alec Baldwin in Glengarry Glen Ross mode. Great scene.)
I’ll grant that I expected the individual mandate to be struck down 5-4, if nothing else was. But seriously, considering everything the government already does, how can we say anything’s off limits, or reserved to the states? The Tenth Amendment has been nothing more than a sprig of parsley for decades; the same’s been true of strict construction for even longer. So if you want these federal programs reformed, eliminated, or devolved to the states, you’ll have to do it the hard way: through the elected branches, because the Court won’t do it for you.
4. This ruling might not be such a big deal. We’ve already established that the President can ignore policies he deems unconstitutional, can unilaterally create policies that he thinks “America can’t wait for,” and can even grant waivers from his own pet policies. At this point, what would stop a President Johnson or a President Romney from granting everyone a waiver?
5. I think the Broccoli Complaint (i.e., “Now that we have ObamaCare, the government can force you to buy anything!”) rings hollow with the supporters of ObamaCare. Whatever complaints Obama has about his opponents, he probably isn’t afraid that they’re going to make him buy anything. Seriously, what are the conservatives or the libertarians going to make you buy, and tax you if you don’t?
6. An awful lot of folks are mad at Chief Justice John Roberts because of his vote on the individual mandate, because he appears to have switched his vote, and because he appears to have bowed to political pressure. I get that. But I find it interesting that virtually none of the anti-ObamaCare ire is directed at Justices Ginsburg, Breyer, Sotomayor, or Kagan. Didn’t they vote wrong, too? I know that the Roberts vote is far more disappointing because he was expected to strike down the mandate, and that it’s human nature to be angrier at those who disappoint us than at those we expected to screw up in the first place, but he was only one of five justices to go along with the “tax and not a tax” convolution. And those other four considered non-commerce (not buying insurance) to be just as subject to regulation as commerce (buying insurance). Why not call them out on it publicly?
7. I took this quiz, offered by the Henry J. Kaiser Family Foundation, which is pro-ObamaCare, to see whether I knew “the real facts” about ObamaCare. I got all ten right, “better than 99.6% of Americans.” Am I supposed to love the bill now? Or can I reasonably expect the proponents of the bill to listen when I say that the costs will far and away exceed the benefits?
VDV'S JOURNAL 
I blame you for my understanding of economics and hence my usual state of frustration with the world around us. Don’t get me wrong. I am glad I know the difference between what is said to benefit a given population, and what actually benefits a given population. The chocolate outer layer always seems delicious. It’s not till you take a bite that you realize you’ve been given a dirt filling. But I remember a day when I didn’t worry about the direction our contry was heading in. We were America, and that’s all i thought I needed to know. But you know. Rome was Rome. Britain was Britain. Bad government decisions can bring any country to its knees. However, I have confident expectation that some good change can take place over the next 20 years or so. It’s never hopeless.
For the record, I got 8/10, “better than 90% of Americans.”
LikeLike
Well put, but chocolate-covered dirt?
LikeLike
It seemed like the best notion at the time to convey the impending disappointment of ObamaCare. 🙂 Too many people like many of the foods I find appalling. I thought dirt was a safe way to be all-inclusive.
LikeLike
I think it’s wonderful. Then again, I’m also a citizen of the strongest democratic socialist economy that’s currently doing it’s best to pull the weight of the Euro.
And I’m a twenty something without health care, and a precancerous pre-existing condition that without Obama care, couldn’t afford to pay my hefty medical bills alone.
Isn’t it even slightly comparable to the states ability to force you to buy car insurance if you drive? You can still purchase minimal health insurance at cheaper cost than paying the fine (alright, tax) without. It provides health care to the part of the population that otherwise could not afford it. Surely someone who already needs it can nit pick the political aspects of a federal law, but it’s extrodinarily beneficial to someone like me, of which there are many.
I agree that things could have been done tidier, but it’s the US Congress. They were lucky to have gotten ANY bill through both house and senate, and they certainly weren’t going to start the entire process over and risk it for revising.
I’m happy. I completely see the downfalls, and by no means do I argue perfection. But I think it’s better than what we had before. And I’m certainly in a better position financially and health wise than ever before.
LikeLike
1. “And I’m a twenty something without health care, and a precancerous pre-existing condition that without Obama care, couldn’t afford to pay my hefty medical bills alone.”
You’re not a 20-something without health care, you’re a 20-something without health insurance. I know it seems like a minor semantic confusion, but using the terms “insurance” and “care” interchangeably leads us to think that we’re supposed to (or have to) use insurance to pay for routine medical treatments, checkups, physicals, etc. This distorts health care prices, distorts signals between producers and consumers of health care, and in turn drives the cost of health insurance higher.
2. “Surely someone who already needs it can nit pick the political aspects of a federal law, but it’s extrodinarily beneficial to someone like me, of which there are many.”
(I assume you meant “has it” instead of “needs it”.)
Is it mere nitpicking to worry about the constitutionality of a law just because the law is beneficial to you? If it weren’t beneficial to you, would it still be nitpicking?
It is true that there are many people who will benefit from ObamaCare. But I have no reason to believe that they are not outnumbered by those who will be hurt by ObamaCare; i.e., those who are picking up the tab.
3. “Isn’t it even slightly comparable to the state’s ability to force you to buy car insurance if you drive?”
I suppose it is, but instead of thinking about whether it’s comparable at all, think about what makes it only slightly comparable: there are plenty of legal and reasonable ways to avoid buying auto insurance (walking, getting rides, taking a bus or train, delivery services, not being physically able or legally permitted to drive).
Under ObamaCare, how can I avoid buying health insurance?
Well, I could avoid buying insurance by not being alive. This doesn’t work for me. I haven’t not been alive since 1976, so I’m out of practice. Furthermore, I have no intention of not being alive again for another hundred years, unless Kurzweil’s singularity occurs in the meantime and then who knows? I may be around for millennia.
I could also avoid buying insurance by lobbying HHS to grant me or my employer a waiver. However, I won’t give one more red cent to the Obama campaign, so that waiver probably isn’t coming.
I might be able get away with not buying insurance and not paying the penalty/tax, because the law includes restrictions on the government’s ability to collect the tax. But I wouldn’t want to count on not getting audited by the IRS, and I don’t expect this loophole to be around forever.
So the state can force me to buy something unless. ObamaCare’s “unlesses” aren’t pleasant.
4. “I completely see the downfalls, and by no means do I argue perfection.”
You’re half-right.
5. A serious question: if you’re a German citizen, why aren’t you making use of their health insurance system (or what prevents you from using it)? Is it simply not being over there, or would anything stop you even if you were over there?
LikeLike
I’ll give the rest a proper response later, but to quickly answer (5), I’d need residency in the EU in order to receive benefits, like healthcare or education. Essentially, they want to ensure I’m paying in my taxes before claiming my piece of the cake.
The system Germans have is similar to what we now have in the US, in that the citizens are required to choose from over 140 private companies (that the government has absolutely no role in running) or a “national” option.
One big difference is based on the principle of income, in that if you make more money, you pay more money into the system, as determined by a set percentage (with no ceilings), insuring everyone hurts equally to benefit equally. I’d also like to mention that the German healthcare system had a $5.28 billion surplus in 2011, which is a result of the German economy booming and the collective wealth increase of the population.
LikeLike
“One big difference is based on the principle of income, in that if you make more money, you pay more money into the system, as determined by a set percentage (with no ceilings), insuring everyone hurts equally to benefit equally.” [emphasis added]
Do you mean that everyone receives benefits in equal proportion to the taxes they pay (if I pay more in taxes, I get more benefits)? Or do you mean that everyone gets equal benefits regardless of the taxes they pay?
And what if you’re broke, or indigent, or disabled to the extent that you can’t pay taxes? How do they handle volk who don’t pay taxes?
LikeLike
And in one of life’s little ironies, the increase in number of insured may actually decrease access to care:
LikeLike