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Supreme Death Panel

© Jim Morin

Is it constitutional, or isn’t it? And if we don’t get reform, how many more people will die?



  1. I have not been following this closely enough, but I wonder if the right isn’t shooting itself in the foot.

    If forcing everyone to buy coverage is unconstitutional, then the only way to get health-care reform so as to make it available to everyone is single-payer, right? Right? (I’m really hoping here.)

    And out of curiosity, does anyone know the current numbers for support for single-payer? Last I saw it, it was easily a majority of the US citizenry…. 😉

    *goes to sip coffee*

    Wednesday, December 15, 2010 at 4:03 am | Permalink
  2. patriotsgt wrote:

    Thought Dancer – How’s the coffee? I’m not sure what the latest polls indicate, but here’s my take on it. I think the mandate will fall, but the remainder of the bill will stand. That becomes an issue, because the rest of the bill depends on the mandate. When the Dems lose the majority in the house come Jan. they won’t be able to fix it without repub support and that is not likely to happen.

    The problem IMHO with single payer is that is has not been explained to the public well. I keep abreast of many news/political issues and I am not sure how it would get implemented and what the consequences bad and good would be. I consider myself an avg joe, but if I don’t exactly know, then there’s got to be a whole bunch of folks that have no clue and will listen and believe whichever talking head is moving their lips. There needs to be a PR campaign on the benefits of single payer, the costs and avantages vs our current system.

    *finishes cup of coffee*

    Wednesday, December 15, 2010 at 7:06 am | Permalink
  3. PatriotSGT: First cup of coffee is gone here too, I’m about to either make a second or make some tea. 😉

    I honestly don’t know how the health care bill can survive if the mandate fails. House of cards, etc., metaphor applies here. The mandate’s the firm tabletop that the house needs.

    And I’m still wondering what the current support/oppose numbers would be for a single-payer scheme, but I’m not Nate from fivethirtyeight: I’ve no clue how to find that information.

    But, if those numbers are as positive as I think I’m remembering they are, then falling back on the old system is *not* going to play well come 2012. To many people don’t like the old system, and they are going to be angry about having to deal with it. I suspect that anger is going to be exasperated by other economic “crises” that will be generated to force the general public to accept even more cuts in social welfare and more benefits going to the wealth. At least one such “crises” is already hitting the mainstream medial: the debt ceiling “crisis.” Other somewhat artificial “crises” will be manufactured to keep this incoming Congress in deadlock. That’s going to anger the electorate even further.

    We’ve already seen signs that the electorate’s patience is wearing thin, and that compromise and triangulation are not appeasing the bulk of populace (motivating both “extremes” of both parties). I doubt that more compromise and triangulation is going to help.

    Frankly, we’re in for some seriously loud, angry, aggressive campaigning in 2012, and I suspect that the “moderates” will not be the people deciding the elections. Once the various extreme members of the parties get into Congress, and possibly the Presidency and Executive branch, the hope to get anything done will fade into a distant memory.

    Unless, of course, a different way of responding to politics takes hold. Kind of like the way the commentators here on Political Irony argue, disagree, and, often, come to consensus. The Beltway, and the 24 hour news cycle, et al, could not only learn from us and people like us. They *need* to do so, if we want to avoid repeating our history. (We do remember that we’re capable of warring on ourselves, yes?)

    Ok, I need to make myself another latte. I hope that made sense and that I didn’t make too many typos. 🙂

    Wednesday, December 15, 2010 at 8:32 am | Permalink
  4. Jason Ray wrote:

    The requirement for people to buy insurance was inserted to give insurance companies an offset for having to cover pre-existing conditions etc. It is not necessary for the rest of the law to be upheld, and there are multiple ways to address the issue even if the mandate is overturned.

    This ruling, from this judge, in this state, is merely one of many bullets that will be flying around on the court challenges and we’ll see what happens when it gets to the Supreme Court.

    Wednesday, December 15, 2010 at 9:35 am | Permalink
  5. ebdoug wrote:

    One way to address to ruling is for medical care (hospitals and MDs) to refuse care to people who don’t have insurance. Since the government will supplement the insurance or pay for it outright there is no excuse not to have insurance. That self righteous morbidly obese uninsured unemployed nurse from Beck’s first Washington tea party rally is going to cost me money. She needs to be putting something into the kitty.
    Now perhaps the answer is opt out of each state as it wants by the people’s mandate. No medical care for those people except at charity run clinics. (the rich can pay the charity care) Needless to say there will be no Federal government funding for medical care in those states. Massachusetts now has a 98% compliance for health insurance coverage. I don’t hear people screaming and yelling about having to have insurance in MA. Right Starluna?
    I am starting with a new MD in next month (six annual visits without being taken seriously about a serious condition until I asked if a culture could be done is enough with my present MD.)
    I was asked exactly what insurance I have when I was doctor hunting.
    You have an appendix rupture, you are in an accident, you don’t have insurance, you go to Charity Hospital in New Orleans if it is open yet.

    Wednesday, December 15, 2010 at 10:11 am | Permalink
  6. No u wrote:

    I stopped following this issue long ago, because its a mess, but if I’m right the republicans call it unconstititual because people are being forced by buy healthcare? In which case I agree. What if the government forced everyone to buy a pet, because stats show people with pets live longer? People would flip because of the expense. Healthcare is much more serious so people dont think about being forced to by something.

    I say you have a government run healthcare, but if you dont want it, or any healthcare at all, you can be on your merry way(last I checked you get a $5,000 fine for not having healthcare under obamacare)

    Really, if you want to take that risk, then go ahead. I’m all for having healthcare everyone can afford, but you shouldnt be forcing it and punishing those who dont want anything.

    Next thing we know I’ll be fined for my car not being blue…

    Wednesday, December 15, 2010 at 10:33 am | Permalink
  7. Sammy wrote:

    No U, you bring up comparisons that are apples to airplanes.

    As for healthcare, or the lack thereof, it’s only anecdotal, but my son’s girlfriend is in desperate need of a surgical procedure to “fix” an messed up (technical term) pancreas. Lack of medical insurance keeps this from happening, so they (the hospital) keeps sending her home with new medication to help keep pancreatitis flare-ups down. She’s already spent three weeks in the hospital this year, on top of previous stays. I’m guessing that at some point all these ER visits and hospital stays will outpace the cost of the damn surgery.

    To further exacerbate the situation, these constant flare-ups prevent her from finding and keeping steady full-time employment, which prevents her from having medical insurance. Oh, and there’s the little issue of pancreatitis being a serious, sometimes fatal medical issue. So yeah, it may kill someone I know and love like a daughter.

    Wednesday, December 15, 2010 at 12:08 pm | Permalink
  8. TENTHIRTYTWO wrote:

    If the public option and single payer are socialism, and a mandate is unconstitutional, what then is Republican’s solution for health care?

    If there isn’t a way to provide health care for everyone, how do you simultaneously stop the abuse of the system from both sides: people not having insurance until they are sick and insurance companies denying rightful claims as pre-existing conditions?

    Wednesday, December 15, 2010 at 12:24 pm | Permalink
  9. Iron Knee wrote:

    No U, your example is pretty silly. Forced to buy a pet? There are so many animals in shelters that nobody would be forced to pay money for a pet.

    There are plenty of ways to get around the problem if (for some stupid partisan reason) the Supreme Court decides that the individual mandate is unconstitutional.

    PatriotSgt, I don’t agree that the problem is that single payer has not been explained to the public enough. Single payer is “Medicare for everyone”. Easy to understand, and you wouldn’t need a thousand page bill. And there have been plenty of polls that show that Americans want “Medicare for all” (at least as a choice) by 3 to 1 margins. See

    Wednesday, December 15, 2010 at 12:51 pm | Permalink
  10. patriotsgt wrote:

    IK – I don’t mean to come across as combative, but I’m truly not clear on “single payer” and I’m sure many others are the same. My unknowing guess would be that everyone pays a premium to someone (the gov) and they get health insurance. Now here’s my questions:
    What doctors can you see?
    What are the co-pays/
    What is the cost for a single person or family?
    Are there different rates based on age, health, etc?
    Do rates increase and for what reason?
    Does this replace insurance companies?
    Does it fairly compete against insurance companies?

    If I have these questions there’s got to be others like me.

    Wednesday, December 15, 2010 at 1:22 pm | Permalink
  11. Iron Knee wrote:

    There are several forms of single payer. The version I like is very similar to Medicare. There is no premium (it is funded out of taxes). So there is no “cost” beyond taxes, no rate increases, and it replaces insurance companies for basic health insurance. You can see any doctor you want.

    I like the system in New Zealand. They have single payer, but it covers mainly preventative care and catastrophic care. You can buy an additional policy from a private health insurance company, which will cover elective care and other things (but in NZ, this coverage is very cheap, since everyone has preventative and catastrophic coverage automatically). Also, car insurance is much less expensive there (it cost me $200 a year when I lived there) because it doesn’t have to have medical coverage like here.

    There have also been proposals for making Medicare “opt in” for anyone under the current age limit. In that case, there *would* be a premium, but they would have to figure out how that is determined. Then anyone could choose from the government plan or a private plan. There are some countries that have systems like this, and they seem to work ok.

    To answer your questions, we’d need an actual proposal in Congress for a single payer system. But given the power of the health insurance industry, that isn’t bloody likely.

    Wednesday, December 15, 2010 at 2:06 pm | Permalink
  12. patriotsgt wrote:

    Thanks for the detailed explanation IK! The single payer seems like a workable alternative for those without insurance. If it was funded through a work deduction like medicare and SS that would seem to be the best model. Perhaps a system like NZ would work here and appease the insurance industry, those that can afford private health insurance, but provide coverage for those that can’t. If our politicians had come out an said our new HCR will require a 3-4% payroll tax on everyone, but provide basic coverage for all and still keep our current systems of insurance plans, coverage and choice. They would have had a much easier time selling HCR instead of the complicated trillion $ plan they proposed.
    Seems like they’re trying something similar with this 1.1 trill omnibus spending bill with 1600 + earmarks stuffed in it and when the house gets the tax deal they’ll stuff it full of pork and dare people to oppose middle class tax cuts. (sorry about getting off track )

    Wednesday, December 15, 2010 at 3:58 pm | Permalink
  13. No u wrote:

    Silly examples or not, I dont want the government forcing me to buy anything

    Wednesday, December 15, 2010 at 7:19 pm | Permalink
  14. ebdoug wrote:

    Answers to “no U” Obamacare was based on the Republican plan of 1993 which Romney used for Mass:
    In this article are described the penalties from the Federal Government starting in 2014. There is no $5000 fine, not even in Massachusetts. Your source was not reliable.
    If a person has a medical problem without insurance, I pay for that person to be treated in higher premiums. I resent that. Either that or that person goes untreated so I don’t have to pay. To go without insurance says that you will never, never have a medical problem that needs treatment or you are being very selfish.
    Sammy: no one should ever be without health insurance. When I was living in one room in a barn (I had electricity and heat, got water from a dug well and boiled it) I could not afford health insurance. My two children were covered. I got “catastrophic” insurance. Currently the deductible is about $5000 a year. OK, the girlfriend develops this horrible pancreatitis (pain second only to kidney stones that Geitner had last weekend. My total sympathies) She pays the first $5000 for the surgery she needs. Now her friends and fund raisers are going to kick in the raise that for her, right?
    If any of you meet anyone without insurance, tell them about high deductible catastrophic insurance please. Hard to find but keep on looking. No meds covered. Annual physical and mammogram are covered to try to keep you well.
    If you are so down and out that you can’t afford catastrophic or your relatives can’t afford it for you, Medicaid is the way to go.

    Wednesday, December 15, 2010 at 7:38 pm | Permalink
  15. starluna wrote:

    No U – would you be o.k. with a system that had an opt out provision that denied care to those who hadn’t paid into the system?

    Wednesday, December 15, 2010 at 8:06 pm | Permalink
  16. joover40 wrote:

    I heard a great explanation on NPR that might clarify why the mandate is not unconstitutional. (Excuse me as I paraphrase.) Health Care is not like any other product – say a big screen tv. If you don’t buy that big screen tv, and your team makes it to the Super Bowl, you cannot go running into the store demanding they give you a tv you didn’t pay for. However, if you don’t buy health insurance and you get into a car accident (or other unforseen emergency illness), the hospital is required to give you medical attention – and the tax payers foot the bill. Why would anyone think that is ok? — the only way that one should be able to opt out of paying into health insurance is if they refuse emergency care under all circumstances. (honestly, not the type of society I would want to live in)

    Wednesday, December 15, 2010 at 8:22 pm | Permalink
  17. patriotsgt wrote:

    ALCON – Ebdoug is absolutely right. Check with your state, because most low income families/persons qualify for some level of medical assistance via medicaid. Also, perform google checks for foundations that offer assistance. Lastly, check with your local representatives at local, state and federal levels as they may know of little known programs that exist for those in real need.
    Good luck!

    Wednesday, December 15, 2010 at 8:27 pm | Permalink
  18. patriotsgt wrote:

    No U – I agree with your stance. I don’t believe the gov has the right to tell people not actively engaged in commerce, that they must engage in commerce. I also know that the argument to that is everyone will eventually at some time in their life enter into the health commerce industry, ie go to a hospital, get a rx from a Dr. etc.

    But my analogy might make more sense to some: Suppose the Gov mandated that everyone grows wheat and must sell that wheat to the market. If they don’t they will be fined until they do grow wheat. The country needs wheat and if everyone produces it we can lower the cost for all benefiting every American and indeed effecting world markets by lowering the cost for all mankind. There will be a quota of 1 bushel per person per year. It would be constitutional since virtually everyone is/has entered into commerce with wheat by virtue of previously buying/consuming a produst containing wheat.

    Now, if they had just called it a tax to begin with there would be no discussion as the gov has the ability to levy taxes.

    Wednesday, December 15, 2010 at 8:41 pm | Permalink
  19. starluna wrote:

    PatriotSgt – the eligibility for Medicaid varies widely by state. Many states only use the federal floor for their eligibility standards, which is a very low standard. Only the absolute poorest and most indigent have access to care under these criteria. Under these rules, Medicaid is only available to children under the age of 6 and the elderly receiving nursing home care. Some states put in their own money to widen the eligibility standards. Years ago, CA’s eligibility covered children through age 10 (I don’t know what it is today). MA covers children through 17. But they do that with their own money.

    BTW – the vast majority of Medicaid dollars goes towards the nursing home care for the elderly not for children or for poor adults.

    Thursday, December 16, 2010 at 7:58 am | Permalink
  20. patriotsgt wrote:

    Thanks Starluna.

    Thursday, December 16, 2010 at 9:30 am | Permalink
  21. Jason Ray wrote:

    Thanks, joover40, that’s a nice explanaiton from NPR.

    None of these rulings will mean anything, this issue is going to be driven up to the Supreme Court and until then it’s all window dressing.

    The NZ version of single payer than IK describes is I think the “best” model for US healthcare, but “best” only means “in theory, this is the most effective”. I see little chance that it would ever be enacted, especially after what we’ve seen with this HC bill.

    And if it was, while it would be “best” for health care receivers and possibly providers, hundreds of thousands of Americans would still lose their jobs or be significantly disrupted. It might be a necessary evil, but it’s a hard evil to swallow especially when the pharma industry is one of the largest poltiical contributors to both parties.

    Thursday, December 16, 2010 at 10:59 am | Permalink
  22. ebdoug wrote:

    When I was working OB in California in the late 1960s, the obstetrician related the story of his visit with his wife to Australia. She needed a D&C. Even though she was only a visitor, the operation was performed free due to National Health Care. He was amazed and very impressed. Now almost 50 years later………………..

    Thursday, December 16, 2010 at 5:43 pm | Permalink
  23. TENTHIRTYTWO wrote:

    One of the comments on a link from another post I found interesting: virtually all environmental regulations use penalties based on the commerce clause.

    Thursday, December 16, 2010 at 7:38 pm | Permalink
  24. starluna wrote:

    Tenthirtytwo – actually, the legal logic is that environmental regulations are not unconstitutional because of the commerce clause. Therefore, penalties for violating regulations are consistent with the commerce clause.

    Friday, December 17, 2010 at 8:12 am | Permalink
  25. TENTHIRTYTWO wrote:

    So, would it not follow that penalties for violating regulations for the interstate insurance market would also be consistent with the commerce clause?

    I guess to me it seemed too similar to ignore.

    Friday, December 17, 2010 at 9:01 am | Permalink