No sooner had health care reform been signed into law than several states’ attorneys filed suit to have the law declared unconstitutional on the grounds that the federal government cannot force a citizen to purchase a private commercial insurance product.
My first reaction was “Oh here we go another tactic to stall or thwart reform!” I do believe that is the intent. However, my second thought, born of the Libertarian side of me, was “Well, I suppose they have a point.”
Why should someone who does not want health insurance be forced by the government to purchase a private commercial product? There is certainly no provision for this in the Constitution. I should not have to buy something I don’t want . This is a good argument but limited in scope.
But those backing this tactic have not thought this idea through. Their logic says that I can refuse to buy insurance as my right. OK. But what happens when the time comes that I need health care? (Note I said “when”, not “if.” Barring unfortunate accidents, all of us at some point in our lives will require care.) Will the providers (doctors, hospitals, ambulance services) have the right to deny me care because I was too obstinate or cheap to pay for insurance? No. The current Emergency Medical Treatment and Active Labor Act (EMTALA) law requires all hospital and ambulance services to provide emergency care to anyone regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions.
Individuals can refuse to buy insurance but providers are not afforded the right to refuse to offer care even though they will not be reimbursed. What’s to stop all of us from refusing to carry insurance and then just showing up at the hospital when we need care? Let someone else pay for it! Who? All of us pay through taxes and/or higher insurance premiums for those who won’t buy.
So our friends the states’ attorneys are telling us that we don’t have to buy insurance, and that if we don’t, the public will pay for our care if we need it. This is illogical and inconsistent. And it is what we have had until last week.
If our states’ attorneys think it is unconstitutional to force individuals to provide for their own care, then logically it should be unconstitutional for the hospitals and ambulances to be required to render those services unless the affected person can prove that they have insurance or other resources to pay for their care. How can the government force the private sector to pay for an individual? The states’ attorneys should also be suing to free providers of health services (and ultimately the public) from this unfair burden.
Our society decided through the EMTALA law of 1986 that no one should be refused emergent care. Doesn’t it seem logical then that we should attach a duty to that privilege and require that everyone who may benefit contribute for their own and the greater good?
The logical alternative would be not to require you to have private insurance, and abolish EMTALA in fairness to providers and the public. Then when the ambulance arrives and finds you have no insurance, they can drive away, secure in the knowledge that they are following the law. And you will lie in the street and die with all of your Constitutional rights intact.
I think you have found the boogey man I have been looking for (the forcing of someone to buy insurance). Then you also pointed out the ethical question that we face once again when people don't have insurance - currently we have to cover them anyway. Difficult decision to make.
ReplyDeleteJohn P.
While I appreciate the logic of your blog entry, I don’t believe the states’ attorney have a point at all. The federal government was formed, in part, “to promote the general welfare”.
ReplyDeleteUnfortunately, in our country, private insurers have been allowed to take a profit from the health insurance premiums paid by our citizens for the last several decades. Since this is the existing system, the easy road to expanding coverage to more of our citizens was to allow this atrocious system to become even more entrenched.
For the opponents of a viable Public Option to throw up this challenge (citizen cannot be forced to purchase a private commercial product) is the epitome of hypocrisy. Citizens in many of our states are “forced” to purchase auto insurance, all parents are “forced” to purchase food for their children and clothing for themselves. As our society becomes more complex, rugged individualism will need to be redefined.
Lawyers who put forth the unconstitutional argument following the passage of the health-care legislation remind me of Ambrose Bierce’s definition of a lawyer – one skilled in the circumvention of the law.
Gerry
But some would argue that no one is "forced" to buy a car or have children. I agree that their whole point is idiotic even if I understand their logic. After writing this I found that the basis of the argument is in the commerce clause with which I am not conversant. Isn't it funny that some people like to run to the constitution and original intent, but then ignore what it actually says and what the "intent" was. In this case I am referring to the 2nd amendment which is very clear that the right to bear arms is so that the militia can be prepared to provide for the "common defence." There was no intent to have a standing army at the time. (Ooops! A new topic to be discussed at another time.)
ReplyDeleteI don't want to be forced to buy health insurance either. A lot of people who feel that way also believe in personal responsibility (see JoAnne's guest blog)and are providing insurance for their families right after shelter and groceries. So again, those of us who take care of ourselves are forced to bail out others who don't. If you have little there is medical coverage available. For folks who are above that line, perhaps they should consider health care purchase before the 52" plasma television or the man cave or pick up truck or other "ride". I am sure legal scholars could rip my argument to shreds, but I am telling you how I FEEL about it regardless of actualities. And I am not alone. We do not want to share the wealth. Sharing is being stranded on a desert island and finding a chocolate bar in your back pack and giving half to the other survivor. There is no "sharing" of wealth. I earn and I have to give part of it to someone who doesn't earn. I will freely donate money to causes I believe make a difference but I don't want to be forced to share my money with someone who would rather just sit and wait for it than get a job of their own. It doesn't really do them any good either. If you taught him to fish he could feed himself. That I would consider donating to. So that is who I am a right wing nut job racist bible clutcher.
ReplyDeleteSandy, with all due respect you obviously know nothing about health care or insurance. Having worked in health care for 30 years as a clinician and in administrative areas, and having worked for an insurer (Aetna) I know a bit more about this than you. I will try to educate you.
ReplyDeleteFirst – this law us designed to help the working class for the most part. Poor people are already covered by Medicaid. This law is about those who work for small businesses that cannot afford to offer their employees health care, or for those like me who have to shell out over 70% of my pension for health insurance. These people are waitresses, construction guys, accountants for small firms etc. An example: a number of years ago I had a patient whose father had his own construction firm. Business was down, so he dropped his expensive health insurance thinking his family could get by for a few months until business picked up. Sadly, his 16 year old son (my patient) broke his neck playing football and became a quadriplegic. Do you have any idea what 24/7 care costs? This family will pay for the rest of their lives unless they declare bankruptcy. What if that were your son?
Second – there is no sharing of wealth involved. It is a sharing of RISK. You pay home insurance in case you house burns down, as do I. Your premiums will never pay the cost of re-building your home. My premiums help do that. It is the basic underlying tenet of insurance. Shared RISK, not shared wealth.
Third – all of us already pay for those without insurance, though it is extremely inefficient. The doctors, nurses, therapists, techs etc all get a paycheck for doing their jobs, even when that person shows up uninsured. How? The costs of giving that care are reflected in the charges etc. that the hospital sends to the insurers of other patients. What do the insurers do to cover this extra cost? They increase your premiums! This year some insurers increased their rates 40%! Is this how you want to cover the uninsured?
Fourth – you have insurance. How nice for you. But I dare say you may change your tune one day if you are unlucky enough to have a severe accident or contract a serious illness that is costly to treat. Many Americans have been surprised to find that their comfy insurance plan just decided to drop them or to raise their premiums exorbitantly. And then where would you be? No insurer would pick you up because you would cost them too much money.
My suggestion to you is to get educated and find out the truth. Quit listening to dittoheads who want to tell you how to think. Besides, your attitude is extremely selfish. Maybe you should read that bible you clutch.
Sandy. My apologies. The last 2 sentences are not appropriate to a civilized discussion. But I do hope you will seek out real information instead of what the media machines spew out. They are not doing us average Americans any favors.
ReplyDeleteNobody is "forced" to buy a car, but if they buy one, they are "forced" to buy insurance. To me, the similarity begins and ends there and is all that is necessary. If it's "unconstitutional" for make people buy health insurance, then the same same logic should apply to car insurance.
ReplyDeleteKurious points out what is often missed in this debate - the fact that uninsured sick and injured are not denied treatment and that the cost of that treatment is passed on to those of us who are lucky enough to be insured and, sometimes, to the state or the federal government. Hospitals have to operate, clinicians are obligated by their established code of ethics to provide care to the sick and injured, and our society mercifully does not condone leaving people to die or become disabled because we allow heatlh care to be denied
ReplyDeleteThe answer of course is to provide a single health care system to our citizens such as the rest of the industrialized and second world countries do. We already have it - it is called Medicare and our elderly have had their lives enriched and extended as a result of it.
In economic terms, this makes sense. It saves on overhead, gives us power to deal with providers, cuts back on all the insurance cmpany advertising costs, spreads the risk, does not allow insurers to refuse to insure persons because of pre-existing conditions or family medical histories (insurers can do that) and protects those who might otherwise be dropped from coverage.
It's clear that the United States is not yet ready to provide for all its citizens what it has sucessfully provided to its elderly. What we have now is a hybrid that will help, but not fix, our broken system.
There are some basic rights that should not be subject to the vissitudes of a market that, as recent events demonstrated, can do such significant harm to the average citizen that it can result in foreclosures and significant finacial disruption of our economic system. Health care is one of those rights. This is a first step in the right direction.
I believe I mentioned I was posting how I feel. Facts are a cold comfort when you have no heat. And as has been proven time and again, facts can be manipulated or omitted or massaged to fit ones end game. What I KNOW is that over 40% of the people in this country do NOT pay taxes. Which in my mind means they should be making less than me. I have a pension of $1500 a month and I pay taxes on that. I also pay a bunch for health care as I am not 65 yet. When Dubyah's cuts expire I will be paying $48 a month MORE. Nowhere in the bible I am cluching (I have my gun in my other hand!) does it say people have a right to health care. If it said that in the constitution it would have been put on a bill board by now. People who seem to find broader interpretations also say we have a right to education. Look how well that program is turning out!!! Of course that is my own stupid opinion. But it is mine along with my vote and regardless of how others attempt to marginalize those opinions I know I am not alone in my thinking. But thank you all for the belittling pats on the head. Maybe windows can create a writing in crayon program so I could understand at least some of the smaller words better.
ReplyDeleteThere are none so blind as those who will not see. - John Heywood, 1546
ReplyDeleteYou might think I am blind but I hope you have your "good" health care when you need treatment for a white cane whoopin! I am doing okay thanks, Fox news comes in braille! You have a good site. I am trying to talk my big gun into coming on and defending my honor!
ReplyDeleteSandy,
ReplyDeleteIt was never my intent to allow this site to become a name-calling free-for-all. I reacted to the emotional content of your original post instead of addressing the issues you mentioned in a more thoughtful manner. My idea here is that all of us regardless of label or opinion can discuss calmly and with an effort to hear the other side. When we stop listening we stop learning.
I am blessed that the first comment on this issue is from a good friend of many years who has worked for a long time in health care and who is also a self-described Christian Conservative. I admire him greatly.
Recently John and I discussed the abominable divide in this country. JoAnne alerted me to an article by David Frum a conservative columnist. (http://www.frumforum.com/waterloo-page) John, JoAnne and I all agree that this guy is on to something. Certain people in the media are messing with the minds of Americans for their own profit. We need to find our own answers based on our own fact checking.
So I am glad you responded. I will do a better job of keeping emotion out of the discussion.
Kurious
PS. I have crappy Blue Cross which I pay for entirely myself on a pension that is half yours. If I wanted to continue the coverage I had through my employer Blue Cross wanted $1529/month! Yikes! Also, I don't like the current law. I would rather have a single payer system but am willing to live with the compromises that were included to satisfy more conservative elements. This is the way we do things in this country and what makes us great.
I didn't want to be naughty but my hackles rise when I feel someone thinks I am stupid because my opinion differs with theirs. Very few Americans are against health care for all we just have different opinions on how to get there. And a lot of people have very little confidence in anything that comes out of this congress. Time will tell. I will be interested in the continuing story of Hannity and his charity. I thought the rebuttal letter by Oliver North answered MY concerns.
ReplyDelete