The forgotten issue in Obamacare

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Obamacare is unconstitutional. The federal government lacks the authority to compel citizens to engage in commerce. Let’s hope at least 5 of the 9 justices on the Supreme Court get this one right. But while this issue is the focal point of libertarians and conservatives, there’s a deeper concern that is sometimes overlooked.

The purchase provision in Obamacare is unconstitutional because crafters of the legislation wanted to retain the illusion that Americans would retain control of their own healthcare by purchasing their own insurance. This is the key funding mechanism for the scheme, but it could have been circumvented by going straight to a single-payer plan funded through (higher) tax revenues. Democrats are not united behind a single-payer scheme yet, so the purchase provision was as far as they could get. If the Supreme Court strikes down all or part of the plan, there’s nothing to keep the left from expanding Medicare, Medicaid, and other programs to achieve the same goal.

This reality exposes a problem that must be addressed, sooner or later. The 40-60 million Americans “without health insurance” come from various walks of life, but many are and will use the system without paying for it. The “lack of access to healthcare” is a problem, but the fact that many without coverage will shift costs to the rest of us is a major issue. I don’t favor a purchase mandate, but the current approach encourages free riders. If we are going to provide “emergency” health care to anyone in the country regardless of “ability to pay,” we must come up with a way to require that those individuals pay what they can and use the system more efficiently. This will involve some difficult choices about who has a right to various levels of healthcare without paying for it. Until this issue is addressed, the single-payer crowd will try to exploit it.

16 Comments

16 Comments

  1. JERRY  •  Mar 30, 2012 @8:53 PM

    WHY CAN’T THE IRS WITHHOLD MONEY FROM YOUR PAYCHECK FOR PEOPLE WHO DON’T PAY THEIR MEDICAL BILLS? WHY CAN’T WE DEPORT ILLEGALS WHO SHOW UP IN THE EMERGENCY ROOM? THIS IS COSTING US A FORTUNE.

  2. Jeff  •  Mar 30, 2012 @9:12 PM

    Dr. Parnell you are the first to ask the question that has puzzled me throughout the whole debate and Jerry is thinking the same thing…why are there free riders? If you have no insurance you make a payment plan!

  3. Curt  •  Mar 31, 2012 @6:51 AM

    There are free riders because we have decided that its humane to give everyone free with EMTALA. Then we think it’s cruel to ask them to pay what they can. The same people who don’t pay their medical bills get welfare, EITC, and pay for cell phones and HBO.

  4. Aliza  •  Mar 31, 2012 @9:51 AM

    Health care is a BASIC human right. It is not in the constitution and it is sad.
    Illegal workers, who do the jobs Americans are no more willing to do, cannot afford paying the enormous prices hospitals charge. They are not covered through the employer and their salaries are too low to afford purchasing health insurance plans. Those who live on welfare and receive EITC cannot pay E.R costs either.
    Two years ago I had to go to E.R. I paid $250 co-payment up front + $1500 bill for a 4 hours visit. The rest of the costs were covered by my insurance. This is sheer madness!
    “Free riders”? How about some compassion?

  5. jeff  •  Apr 1, 2012 @2:19 PM

    We have Medicaid for people who are too poor to afford insurance. Of course, you have to be a citizen. Government intrusion in health care is a big reason why costs are already so high.

  6. Berri  •  Apr 2, 2012 @11:12 PM

    If healthcare is a basic human right, then who has the basic obligation to pay for it?

  7. Aliza  •  Apr 3, 2012 @6:25 PM

    The government. If it is a basic right, I expect my government to provide me with basic rights and needs. It’s basic, right?

  8. Berri  •  Apr 3, 2012 @6:59 PM

    Hey Aliza, the government has to get its money from taxpayers, which means your “right” must come at someone else’s expense. Don’t I have a right to keep my own money instead of paying for your healthcare?

  9. Aliza  •  Apr 3, 2012 @11:53 PM

    Hi Berri,
    On the personal level, I pay my own healthcare and my right does not come “on someone else’s expense”. I do not have a problem with that my taxes will benefit the society as a whole. You have the right to think differently and I respect that. This is an ideological dispute.

  10. marc  •  Apr 4, 2012 @8:45 AM

    Hey Aliza
    I’m glad you pay for your healthcare. If you want to pay for someone else’s then you can write your own check. Don’t force berri or me to do it!

  11. Arthur W.  •  Apr 4, 2012 @6:36 PM

    Three thoughts: (1) tort reform would dramatically reduce cost, (2) catostrophic insurance would keep people from being wiped out and (3) look to charities for those who can’t pay. Expanding on the last point. Hospitals came about in this country through religious institutions, hence the names, Methodist Hospital, Baptist, St. Mary’s, Mt. Sinai, etc. There are currently 87 faith-based clinics providing free primary care in this country. Other examples of special needs free care are Scottish Rites and St. Jude’s.
    But the larger point is that nothing is free. Doctors and techicians get paid. Hospital staff don’t work for free. The money has to come from somewhere. This government is broke. It simply does not have the money. Raising taxes isn’t going to happen. Obama wanted to do it by forcing young people who don’t want insurance to pay through a mandate. Those who want “free” health care need to tell us what other “free” services they are willing to give up. And please think big. It needs to be in the trillions.

  12. Jeff  •  Apr 4, 2012 @7:46 PM

    There are more people getting free health care than ever. Where do we draw the line,meaning who gets it free and who has to pay for those who get it for free? Is it $50,000 household income, $60,000, how much? The ideal solution is everyone pays for their own, backed up by a safety net for those who have truly fallen on hard times. We should be enacting policies that make that the goal. Arthur offers some excellent solutions to that end.

    Also we should think about incentives. Giving away free things reduces incentives to work. Again, I ask, who is going to pay if it is free or subsidized for everyone? The rich of course. They will be demonized for not paying their fair share, even though they are paying way more than their fair share already. It is easy to attack a small percentage of the population with these types of tactics.

    Bottom line – reward non-production and you will get more of it. Penalize production and you will get less of it. If you have kids or a business, this is self-evident. Ths is basic human nature and if we think it doesn’t apply to these big government solutions, we do so at our peril.

  13. Bradley S. Rees  •  Apr 5, 2012 @6:37 AM

    Arthur lays out some actual solutions for our flawed health care delivery system, and Jeff above makes some very valid points, as well. However, it is crucial to understand that HarryCare (aka ObamaCare) was neither designed nor passed into law for the purpose of improving access to health care or the affordability thereof. As with all centrally-planned and government-imposed “improvements” for the “greater good of society at large,” the ultimate goal is control over the individual in an attempt to shape human nature to bend toward the will of the wise guardians and philosopher kings.
    The incessant quest to reach the inaccessible intangible of “Utopia” is the result of not just a misunderstanding of human nature, but consciously ignoring the absolute of human nature. Have you ever said to yourself, “I just can’t seem to get through to these Progressives with logic and reason”? That is why. The “True Believers” *must* reject reason outright, in order to continue their mad quest.

  14. Aliza  •  Apr 5, 2012 @2:29 PM

    Then why a national health care plan works for Europe, Canada, and Israel? It even works for Massachusetts. Are they all wrong?

  15. Jeff  •  Apr 5, 2012 @8:17 PM

    Works? It is tolerated is the best you can say. Wait time and cost of insurance is up in Mass. England is trying to increase market incentives. You see what is happening in other Euro countries – debt, chronic high unemployment and social unrest. It is bigger than just health care. When you decrease the value of work the results are predictable. The fight then is who is going to pay and how much and why aren’t they paying more? It is a viscious cycle.
    Let’s try solutions that lower the cost of care and lower the cost of insurance so everyone can buy their own. Start with giving equal tax treatment to emplyer provided and individually purchased insurance. This would stimualte competition, guaratneed renewal and portability. Why go to a big government solution when we know it has a terrible track record?

  16. Arthur W.  •  Apr 5, 2012 @8:27 PM

    Don’t forget Cuba and China. It’s not like we don’t have national health care here too. There are currently six Federal programs (Medicare, Medicaid, Federal Employees, VA, Active Duty Military, Retired Military.) How are these programs working? Heard any complaints about Medicare or VA Hospitals lately? Both sides tell us Medicare is going broke. So a program that affects 25% of our citizens with the full faith and credit ob the Federal goverment behind it is going bankrupt. And we want to expand similar coverage to the other 75% of the people… Oh well, as they say, there’s only one degree of broke.