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Friday, March 30, 2012

Liberals to Conservatives: Careful what you wish for...

If the Supreme Court strikes down Obamacare liberals will start rallying for a single payer health care system which would be a true move towards socialized medicine unlike the current plan that, GOP claims notwithstanding, more or less preserves the current for profit system of rationing health care.  Many liberals are praying that the GOP wins this battle for exactly that reason.
In arguments before the Supreme Court this week, the Obama administration might have done just enough to keep the Affordable Care Act from being ruled unconstitutional. Those who believe in limited government had better hope so, at least.

If Obamacare is struck down, the short-term implications are uncertain. Conservatives may be buoyed by an election-year victory; progressives may be energized by a ruling that looks more political than substantive. The long-term consequences, however, are obvious: Sooner or later, a much more far-reaching overhaul of the health-care system will be inevitable.
Read the rest here.

12 comments:

Chris Jones said...

The difficulty with this analysis is that there is no guarantee that single-payer will fare any better with the Supreme Court than Obamacare will have done. The underlying point at issue in this case is the commerce-clause jurisprudence that has ruled the roost at the Supreme Court since the New Deal era -- an understanding of the commerce clause which, in my view, makes a mockery of the Constitutional principle of enumerated powers. If the Roberts Court has the fortitude to overturn Obamacare, it will cut the heart out of the modern use of the commerce clause to allow the Federal government to do just about anything it wants to do, and return us to the notion of specific, enumerated powers.

If that happens I do not see any way to find in the Constitution an enumerated power to institute socialized medicine. So I would say to any liberals who secretly hope that the Court rules "against" them: be careful what you wish for. A victory for enumerated powers in this case could be a roadblock to any sort of further liberal enlargement of the Federal government, and could even put existing liberal sacred cows at risk.

Phil said...

Liberals will start pushing for a single-payer health care system no matter what happens in the SC. For that matter, Obamacare is designed to bankrupt the system so that single-payer becomes an inevitable next step.

What's hard to understand is why the country thinks like this. It seems plain to many that inserting third-party payers in the equation - an obsolete result of World War II economic controls - is a major driver of the price problems we have in health care.

Eugene Robinson completely misses the point (he wouldn't be Eugene Robinson if he didn't) when he writes: "When people talk about out-of-control government spending, they’re really talking about rising medical costs that far outpace any conceivable rate of economic growth. The conservative solution — shift those costs to the consumer — is no solution at all."

To the contrary, that is the only solution that has any chance of balancing prices people are willing to pay with the care they receive.

John (Ad Orientem) said...

Chris,
We already have a single payer system in place. It's called Medicare and it has been upheld by the court. The military medical system is also single payer government run health care. Justice Kennedy who was very skeptical in his questioning of the constitutionality of Obamacare even asked rhetorically if it would not have been smarter to have just gone with a single payer system like most countries in the developed world.

Phil said...

I'll add on to John's comment that I believe even the lawyers for the opposition conceded in oral argument that it would have been constitutional for the feds to outright nationalize the system. I personally think that's a gross distortion of the framework of enumerated powers and the original meaning of the Commerce Clause, but I agree it's less constitutionally problematic than compelling citizens to buy something they don't want.

John (Ad Orientem) said...

Phil
The current system is programmed on self destruct precisely because it relies on an ever shrinking number of customers to survive. As health insurance costs rise more and more people are dropping their insurance because it is unaffordable which in turn is driving up the cost of insurance. Its called a death spiral. In order to keep insurance rates low you have to have healthy people paying premiums to support the payouts for the sick.

There are two ways to fix this. First would be to vastly expand the pool of healthy insured people paying premiums. The second is to socialize the burden by having the government take over primary responsibility for health insurance. But the current system is simply not sustainable. It is not just driving insurance companies into a death spiral, but it is also rapidly going to bankrupt states and municipalities which have pledged to cover the health care costs of their retirees. And then there is the law that requires hospitals to treat emergency cases without consideration of their ability to pay. That simply cannot continue.

The Anti-Gnostic said...

if it would not have been smarter to have just gone with a single payer system like most countries in the developed world.

Unfortunately all those systems are broke. They operate on the premise that the young and healthy will support the old and unhealthy via the mechanism of democratic government. We know where this leads: net tax consumers come to outnumber and outvote net tax payors. Birthrates plummet as the welfare state's militant secularism takes its awful toll. The State resorts to mass immigration to try and make the books balance. Except immigrants have other priorities than paying the nursing home bills for a bunch of old strangers, and immigrants get old and sick too.

It will all end in tears.

Chris Jones said...

We already have a single payer system in place. It's called Medicare and it has been upheld by the court.

True. The constitutionality of Medicare (and Social Security and ...) is one of the fruits of the New Deal-era commerce-clause jurisprudence that I was talking about. For decades, the Court has used the commerce clause to open a hole in enumerated powers big enough to drive a truck through. But if they use this case to reverse that way of using the commerce clause, the Medicare precedent loses its force and any single-payer system has much less chance of passing Constitutional muster.

The military medical system is also single payer government run health care.

That's different. The military medical system is "single payer" in the same way any employer-paid health insurance is "single-payer." That is, the Federal government is not providing health insurance to the military qua government, but qua employer.

Justice Kennedy who was very skeptical in his questioning of the constitutionality of Obamacare even asked rhetorically if it would not have been smarter to have just gone with a single payer system like most countries in the developed world.

Of course, Obamacare will not be struck down without Justice Kennedy voting to do so; but much depends on whom Chief Justice Roberts assigns to write the majority opinion, and how narrowly or broadly drawn that opinion turns out to be. If Justice Kennedy writes the opinion I should expect it to be rather wishy-washy and not much use as a precedent. But if Scalia or Thomas (or possibly Roberts himself) writes the opinion, I should expect it to be incisive and powerful and cut to the heart of the bogus use of the commerce clause.

Phil said...

John,

True, but my contention is that the unsustainable price spiral is happening because of third-party payers: the government (distorting the market through Medicare) and employers. If individuals shopped for health care as they did everything else, much of this problem would be alleviated. This is the reform we should be seeking.

Catastrophic health care insurance coupled with consumers paying for most routine or semi-routine doctor and hospital visits is, I think the only way to have a sustainable system. There is really no reason, in my estimation, for an appointment with a doctor to cost (as billed) a couple hundred dollars for five minutes of his or her time, or for two Advil at a hospital to cost $50. And, if you or I were really doing the shopping, they wouldn't.

Both adopting single-payer and doing it my way amount to blowing up the system as we know it today, so why should the former be on the table and the latter not?

Anonymous said...

The sooner we get to single payer the better - or all of us. It has the additional imperative for readers of this blog since it is also the choice most compatible with the commands of our Lord.

Stephen said...

Anon - please explain how single payer is Lord's choice. It involves a lot of government coercion - how could the Lord want that?

Anonymous said...

Well, the present situation involves a lot of financial coercion to the degree that quite a few people cannot obtain health care. It's reminiscent of the situation described in the New Testament don't you think?

Stephen said...

To which situation in the New Testament are you referring?

Also, the present situation is the creation of government. Also, don't you mean that some people can't afford health insurance? Which is, as you know, different from health care.