Health Law Puts Focus on Limits of Federal Power

If the Supreme Court, as early as Monday, agrees to be the final arbiter on President Obama’s health care law, it will face the question of what the government can force people to do.

Comments: 125

  1. The real issue if the rest of us will allow people who choose not to pay for health care, if they become injured or sick, to not provide medical assistance. If our society finds it impossible to ignore the sick, and provide assistance despite their unwillingness to pay for it, then government should require them to buy insurance. The fundamental part of this issue isn't what they will pay,it is if we can stand by, do noting, & let them suffer the consequences of their own decision.

    The problem is ours not those who won't pay.

  2. If people decide not to buy health insurance and then get sick, they should be left to their own resources (and charity). Emergency rooms do not do this now, and would make mistakes if they tried, giving care to those who cannot pay and refusing care to those who are covered but cannot provide evidence. What sounds nice in theory would be a bitch to implement.

    If medical care were an entitlement paid for through taxes (a single-payer system), it would be as constitutional as fire or police protection or Social Security.

  3. It seems to me that the crowd that speaks so readily about "individual rights" forgets that there are corresponding individual rights on the other side. So, they tout the 'right' of the individual not to buy health insurance. But what about the right of those who have insurance? In the anti-mandate model, it is perfectly ok to force those who have insurance and the taxpayer to fund so-called "charity care" for the uninsured who show up at hospitals (sometimes very ill or badly injured) requiring very expensive and protracted care. Those who choose not to buy insurance count on the civility of our society and the money of the rest of us to care for them if they become ill or are injured. The law is intended to greatly reduce the number who do not have insurance because they truly cannot afford it, but it angers me that some continue to defend the 'right' of others to choose the no-pay, but receive 'charity care' when needed model.

  4. Primus inter pares -- first among equals; it seems this phrase captures well how the U.S. Constitution defines congress in relation to the executive and judiciary branches of government. As a result of this principle and the broad legislative authority the Constitution gives congress, it falls completely on the American people to control congress via the ballot box.

    Since elections do have consequences, it behooves the electorate to become well educated on political issues. Only getting your political information from simplistic, political sound bites on the radio and/or television and from like-minded people will result in a misinformed voter; one who may become filled with anger and cynicism.

  5. They say laws authorized by the Constitution’s commerce clause must concern interstate commerce--but what they circularly gloss over is that there would not have been interstate commerce in the health insurance product had the individual not be required to buy it in the first place.

    They're employing the commerce clause as a tool to force you into commerce, rather than employing it as a regulating agent of commerce.

    If that isn't specious enough, then never mind that even when she buys the stuff, federal law prevents buying that insurance across state lines from a neighboring state.

  6. The ‘Individual Mandate’ in the Affordable Healthcare Act is about ‘theft’. Currently, the uninsured in this country are stealing from the rest of us. They get their ‘healthcare’ one way or another, and the rest of us pay for it. This is theft.

    Hospitals with their ‘mandate’ to treat everyone (regardless of payment), cannot simply ‘eat their losses’. They need to get it from someone else. There are, of course, government subsidies for this ‘charity-care’ (from tax-revenues paid by all of us), but it is not enough. The rest comes from us, the paying customers.

    In sum, the current system lets the uninsured to steal from the rest of us, through taxes we pay and higher insurance premiums.

    There are also other issues. The uninsured cost the system more. Firstly, they get care through ERs, the costliest place to get health care. Further, they seek care when their diseases are more advanced – conditions that could have been detected and treated earlier in the process, if they had access to primary care.

    So, the uninsured not only steal from the rest of us, they also cost us more than they should.

    Of course, the uninsured are not a uniform group. There are those who don’t get employer provided insurance and cannot afford it on their own. There are others who refuse to buy insurance, who feel: ‘I am healthy, therefore I don’t need it!’

    The ‘Individual Mandate’ in the Affordable Healthcare Act is to stop this theft. Unless we as a society are willing to let hospitals and doctors to deny care to those unable or unwilling to buy insurance (and don’t pay for the services), there is no other way to stop this theft.

    I understand the gut-level revulsion to the idea of government forcing individuals to do something that they don’t want to do. But, it is not about that. It is about stopping some people from stealing from the rest of us.

  7. I'm not giving up on the plan!

    But it would seem that in eliminating the public option, the constitutional argument was watered down.

    Medicare is an insurance program for a subset of Americans that is sponsored by the government, but it is optional to the elderly. Social security is an insurance program that is mandatory for all Americans.

    If the government can mandate one form of insurance, the only argument for not mandating another is one of the absense of homogeneity of private plans. If there were homogeneity of government-offered health insurance, I suggest that would make mandatory insurance more palatable to the Constitution. Republican’s defeat of the private option, and Obama’s capitulation on the matter, in my view, compromises the Federal argument for constitutionality.

    Regulating private plans might create homogeneity, but ruin the freedom of privacy.

    Social security, a Federally mandated insurance, competes with other forms of retirement insurance and investing, but is mandatory for everyone. Maybe there should be a Public Option something between Medicare and Social Security Insurances, Everybody pays, like we do for Social Security Insurance and Medicare, but you can opt for a private alternative, as we can for Medicare.

    If the issue is asking that all American’s be covered for health insurance for health reasons, I think that’s covered by promoting the general welfare. There shouldn’t be a problem.

  8. The author's description of the issue betrays his right-wing mind set. The question is not what can the government force you to do (for example, by criminalizing that conduct) but instead what the government can tax. Our constitution gives the government the power to tax. The government can decide to either allow you to satisfy that tax by buying insurance or by paying it directly. Not the same thing as forcing you to do something. False frame, faulty argument. Tsk, tsk.

  9. If it isn’t ok for the government to force an individual to buy insurance so we have some sort of national healthcare, why is it ok for my cost for insurance to skyrocket to cover people without insurance to go to the emergency room for care? Isn’t this forcing me to buy insurance for those without or the scammers who could pay but choose not to?

  10. The new health care law compels consumers to pay for a private health care plan of their choice. The federal government ostensibly passed the law under its power to regulate interstate commerce. In theory, a consumer's failure to purchase health care affects the rest of the health care market and can ultimately render the interstate health care system dysfunctional. Therefore, supporters reason, forcing a consumer to buy health care is regulating interstate commerce.

    Opponents argue that this removes the last limit on the Commerce Clause--that consumers take an affirmative economic action. They urge supporters of the law to articulate exactly what is the limiting principle on federal commerce clause power; the supporters struggle to do so coherently. Therefore, opponents conclude, upholding this law would spell the end of our federalist system of limited national government.

    The author characterizes this as a slippery slope argument. This is incorrect. A slippery slope argument would be, "First Congress regulates health care, then the food we eat, then who knows what next?" Fair enough, but that's not the point critics are making. They are not saying "unlimited federal power is a bad idea"; they are not focused on consequences.

    Instead, critics are pointing out that the Constitution clearly says the federal government does not have unlimited power, whether the court thinks that's a good idea or not. The framers of the Constitution made that call (and they explained why in the Federalist papers). If Congress wants to change that system, it has to amend the Constitution. The court should not bend over backward to let a closely divided Congress avoid the amendment process.

  11. We need an affordable single payer health care system but we also need all our liberties.

  12. Most states require you carry car insurance to get your plates. What's the difference? Both revolve around liability and health benefits. If (and it remains to be seen) health insurance becomes affordable for all, provides equal benefits, and controls costs it would be a beginning to reigning in yet another corporate takeover.

  13. If the government has the power to draft you, send you off to war to kill other people, and to die, then certainly it has the power to tax you if you choose not to have health insurance.

  14. The real issue is not whether having health insurance is a good idea or not. The important point here is if this law is allowed to stand what will the next thing everyone must do for the "Common Good"? "The road to Hell is surely paved with good intentions" and it is paved one brick at a time. As the law stands today We must sell our homes for the Common Good if the Government believes the new use will generate it more in Taxes. We must buy insurance or pay the Government a much lower tax as a "penalty", again for the "Common Good". The "Lower Tax" will increase with time as do all taxes because the Government always needs more money to do more things it decides are in the "Common Good".
    What is next on the list of "Things we must do for the Common Good", will it be to address "Wealth Inequity", or "Save the Enviorment", or something not even on Our radar today? For those that believe Government and Laws passed, justly enforced or not are the final solution to every perceived problem there is no end to this list just a Next.

    That is why it is important today to place limits on the ability of Those in Goverment to create New Powers for Themselves over all of Us out of "whole cloth" and "For our Own Good because of course They know what is best for Us".

  15. There is a reason the Framers of the Constitution included the principle of Federalism; the powers of the Federal Government are limited and enumerated. Those not expressley given to the Federal Government are reserved for the the states and the people. The Framers were decidedly concerned about concentration of power, for good reason. And now, after decades of Supreme Court gerrymandering of the Commerce Clause to approve otherwise unconstitutional laws, we have finally come up against the fence and even The Times is now asking the question many of us were a long time ago.and that is, "If the health care mandate is constitutional, what exactly ARE the limits of power of the Federal Government?" and The President, a Con Law Professor knew this full well.

  16. After vehemently denying that the mandate was a tax, because the Democrats had to deny that with it they were imposing the largest tax increase in history, now the Democrats want to have it both ways and claim it is only another tax.
    It is fair to ask if they were lying then or are they lying now.

    It is fair to ask if the Constitution allows the government to tax everyone if they don't buy a Chevy pickup.
    It is fair to ask if the Constitution allows the government to tax you if you are 20 pounds overweight.
    It is fair to ask if the Constitution allows the government to compel any action it wishes by simply claiming that action falls under interstate commerce.
    The Democrats must answer yes to those questions or the mandate fails Constitutional muster.

  17. The mandate to buy healthcare rather than a universal healthcare plan, a program that would have been like like Social Security, sounds as safe as the bank bailouts turned out to be. Taxpayers ripped off, so that the one percent could rake in some cash to cushion their *fall* in the virtually permanent economic contraction we are now in. Americans should fight the change to privately purchased insurance, because it lays the groundwork for the dismantling of Social Security. Americans would be forced to purchase Individual Retirement Accounts and Social Security would then be privatized. This is the type of legislation we do not need. I wanted this healthcare plan to pass. However President Obama seems to have been a shrewd planner in dealing with the issue of healthcare before he tackled jobs. After debate Americans would have realized that they were being screwed again, right after the bank-bailout using taxpayer-dollars, rip-off. Obama screwed us then, he has screwed us with this thinly veiled attempt at privatization and his next move will be to privatize Social Security. He has not done much about creating jobs. Obama appears to think like a Republican. Unfortunately, Obama caved into the Bankers and hired people from the cohort that brought down the banks! Why should we trust him now? There is no reason. If this goes to the supreme court, it will pass. Easily. The Supreme Court is a bastion of justice for the rich and the corporate. Small businesses don't matter, American citizens don't matter, immigrants don't matter. Education, jobs, housing, focus on the environment? All do not matter. What matters is big business and America turning the corner to total privatization, so that the rich can have more new corporations to run now that their mansions and hedge funds are depleted in value. This so called *health care plan* is simply a jobs program for Harvard and Yale graduates. Just as charter schools are a jobs program for the same privileged individuals. OWS

  18. I believe that most readers will acknowledge that this is an important issue and that neither side's position is frivolous.

    The constitutional way of setting this up would have been through the taxation clause. For political reasons, the Democrats chose to ignore the constitution. Please recall that when this law was being debated, Queen Nancy Pelosi told those who questioned the constitutionality of this act that this was not a serious issue.

    This law was passed based on assurances that it was fiscally responsible. It now seems clear that the assumptions were intentionally and misleadingly flawed.

    The mandate as written appears to me to also be misleading. The price of the penalty is so low that people will soon learn that it is better to pay the penalty and get insurance only during the specific time there is an illness.

    You readers raise an important issue. In our republic, what are the responsibilities of the country to "bail out"/support/aid those who can't afford health care. How about those that can afford it and choose not to get it. What are the responsibilities of those people to the country and of the country to those people. If I might add one more point to consider: what standard of disclosure of the financial consequences of legislation do we expect from our politicians.

  19. I wonder if the Founding Fathers ever thought about the prospect that Constitutionally-mandated individual freedom might actually result in the long-term wrecking of the economy through a healthcare system where "free riders" are not held accountable for the excess costs they impose on society because of their "free choice" (ever try to price a private health insurance policy?) to avoid participation in the health insurance system and hence enter the healthcare system much sicker than they otherwise should be. I can't live with the likely 18th century practical answer to that question, which is to force the weakest in society to utterly fend for themselves in this respect.

  20. You can't have a system in which users spoiled by plans subsidized by their employers help themselves to generous portions of questionably necessary--and heavily marketed and promoted--'health' product only to discover that their own insurance rates went up because of it.

    And then they turn around for help because they drove their own costs into low earth orbit with indiscriminate use and are now attempting to dragoon their neighbors into comprehensive 'care' plans thinking it will lower their own costs.

    The people they're attempting to force into these over-the-top 'care' plans are already paying Medicaid and county health taxes, and they responsibly foot the bill out of pocket for both garden variety expenses and statistically rare greater ones.

    But now you've even taken away their ability to buy even catastrophic policies, which are now illegal. Moreover, while the Massachusetts legislature is observed adding on new nice-to-haves in every session, the U.S. government is now in on the act with requirements to add goodies like free birth control to comprehensive 'care' policies that, in the end must be payed by now-unhiring businesses or individual itinerant workers.

    It's not our responsibility to insure your stored up wealth. It's your indulgences that drove costs up for the rest of us. If you need to pay for your idea of what marketers have suckered you into what 'health' is, then you pay for it--and if you don't have jobs because of it now, then that's what bankruptcy is for. Liquidate your own stored up assets and we'll be there for you with Medicaid.

  21. Liptak frames the issue incorrectly when he informs us that the Supreme Court "will deliberate on what the government can force people to do."

    The Patient Protection and Affordable Care Act does not force anyone to get health insurance. Instead, it gives people a choice; they can either buy health insurance or pay a tax - or fine, or penalty, or whatever you want to call it. So the real issue is whether the government has the authority to tax its citizens, and that question was answered a long, long time ago.

  22. While not completely analogous, it is also interesting to consider the implications of striking down the health care law on these grounds. Could we use this precedent to argue that the government cannot compel women to have unwanted children by making a simple medical procedure unavailable or so difficult to obtain that it is effectively unavailable?

  23. When I turned 18 in 1974, I was required to register for the draft. I had to do this simply because i lived here. This made me eligible to be forced into the military, requiring that I give my "life" to the federal government for a number of years, with the foreseeable result that I might be killed while serving my country. That is more than mandatory tax or a fine by the federal government.

    The federal government requires that I pay income taxes if I earn a certain amount of money.

    And soon it will require that I pay for health insurance if I want to continue living here. I don't see it as oppressive. I see it as addressing a very serious problem (too many uninsured). Prices will go down when everyone is required to buy health insurance. So who are the ones complaining? Those who stand to profit by leaving private insurers as the only choice.

    My wife and son and I are covered by a group policy. I am self employed with 5 employees. We pay nearly $2,000 a month for our family's health insurance, and the cost goes up every year while he things covered decreases every year. I, for one, am hoping the Supreme Court upholds the federal mandate so that we will be able to afford coverage into the future.

  24. There is no question that government not only can, but has, required the purchase of insurance in order to participate in desired life activities. Think car ownership. In our state, driving a car requires annual inspection and automobile insurance. Similarly, functioning in this society should require one to participate in a national compact to share the risk and costs of health care among all citizens. It's not a hard concept!

  25. The Supreme Courts job is to decide fairness and to insure justice. Is it fair for them to decide on congress'powers unless it adversely affects the majority. The constitution is a open ended document, written to be changed as the situation and circumstance require. 200 plus years have passed since it was written and alot ha changed and the constitution was meant to change with it,allowing it protects the basic priciples of liberty, security and the prosperty of the people.
    There are those that interpt the constitution ,much the same way the do the bible, for thier own benefit and justification. The are those who misuse and manipulate its words, much as any in the GOP are guilty for, on both ends.
    We should have the right to have a one payer system, but the insurance companies (with thier lobbist) have alot of $ involved so of course they will do whatever it takes not to lose.

  26. The trick is for the government to cast rules and restrictions in terms of terrorism and homeland security -- just call health insurance an anti-terrorism measure. Then, anything goes when dealing with opponents, from imprisonment and torture without due process to assassination, with all levels of spying and invasion of privacy in between.

  27. Health care access disparities among people in the US are a direct result of income disparities. The right to a person's health is no different than the right to decent housing and an to an education. I don't get it! Where does the issue of forcing people to enroll in a health care plan come into play here? Again, this is an issue of huge profits by the insurance and pharmaceutical industry, not an issue of putting people under any kind of duress!

  28. Here's a limiting principle example sure to make everyone squirm with discomfort.

    Racisim is a persistent and major national problem. Efforts to combat racism include major distortions of the private economy, interstate commerce, and government expenditures. Therefore, using exactly the same arguments as the health coverage mandate, the US government should be authorized to pass a bill forbidding intra-racial marriage, and permitting only inter-racial marriage. After several generations of that, there will be no more races and no more racism.

  29. This Appellate panel may have handed the DOJ a left-handed victory; with review assured, basing their decision on Wickard v. Filburn (the expansive reading of the commerce clause from FDR's New Deal which created the legal fiction of purely local, intra-state, production of wheat for personal consumption as having an "substantial affect on interstate commerce" when aggregated across the entire population; which was also the basis of the medical marijuana holding) - the Judge will force the SCOTUS to reconsider this precedent & its progeny.

    The racial discrimination cases are a red herring, they rise to strict scrutiny (for a race based ban to be upheld, it must be "substantially related to a compelling governmental interest" or be struck). Most other laws must only meet a rational basis test - rationally related to a legitimate governmental interest; but even then, must be grounded in an enumerated power.

    Furthermore, this particular case was argued on the basis that compelled health insurance violated religious freedom; an argument that the panel found unpersuasive (just as anti-polygamy laws do not violate religious freedom).

    So, the D.C. panel has "teed up" the basis of Congress' authority to regulate purely personal, local, non-commercial [in]activity as having an aggregated affect on interstate commerce. The commerce clause originally authorized Congress to regulated commerce among the several States, with foreign nations and the Indian tribes. Its purpose was to stop States from enacting protectionist tariffs and schemes to benefit local business to the detriment of competing States' products. FDR threatened to "pack" the Supreme Court with like minded appointees if the then-existing panel kept striking his forays into market control as unconstitutional [nine members on the Court is just historical convention, there is nothing to stop a President from expanding the panel to 21 Justices if s/he can get them approved by the Senate].

  30. If this were a good law which had any promise of reigning in health care costs and gross manipulation by private health insurers and pharmaceutical companies the argument against the personal mandate would have much less backing. This is fundamentally an ill-conceived, lousy law, and will cripple efforts to solve our health care problems for generations.

  31. For all of the posters who support the current law, please answer this one question: Why do you support expanding a private health insurance system that for the last four decades has proved itself totally incapable, and unwilling to provide affordable, accessible healthcare for every American? If Pres. Obama had not supported this system, Rep. Ryan would have been fully behind it as it is a conservative dream. It pumps hundreds of billions of taxpayer dollars into the private health insurers' coffers through subsidies to purchase private insurance, while making sure the citizenry who has sufficient funds has no option but to pay more money to the thieves who sell private insurance. This is nothing but a glorified voucher program that the progressives reject for Medicare recipients, yet support for all of us under 65. It is a Republican dream that they only reject because Pres. Obama supports it. Only if the Court strikes it down do we have any chance of moving towards a Medicare for all system. Wake up America and put away your political allegiance when analyzing this legislation.

  32. If the self serving, lobbyist paid, millionaires in the White House and Congress would have passed single payer, Medicare for All, we would not be having this discussion. President Obama, and Congress, received a great deal of "pressure" for Health Insurance companies, the AMA, corporate medical centers and Drug companies to force through this legislation. Legislation that will not reduce health care costs in the long term.

    What we ended up with is a combination of a plan that was pushed by Newt Gingrich and Mitt Romney; a free market, Republican plan. What is next? Privatizing Social Security and forcing senior citizens, and the poor, back into the private health care system. There will be a twist, they will have to trade the basics for health insurance premiums, or pay a fine for not having health insurance. The GOP is right for the individual mandate, but for the wring reasons. The politicians showing a false split on this, because they all are supporting the 1%, themselves and the lobbyists.

    The winners? The politicians, the oligarchs, the health care industry, the 1%. The losers? The poor, the elderly, the 99%.

  33. Since those who choose to be uninsured undoubtedly cost the governement more money (either directly, or indirectly through higher costs for medicare and medicaid to offset charity care provided to the uninsured), why would they not logically be allowed to charge a tax surcharge to those who chose this path? In a simple scenario, I can think of numerous people who during their late 50's and early 60's either chose or had to forgo health insurance. When they finally made it to medicare, they had numerous problems which had been ignored for years which were undoubtedly more expensive for government to pay for.

    Because I am not a home owner, I have to pay a tax penalty (i.e. can't have a mortgage interest deduction), which makes far less sense than what is proposed with the ACA. I also have to pay a higher tax rate (which in my mind constitutes a penalty) than people much richer than I who make the bulk of their income from "dividends" (read Hedge Fund Managers). Indeed, much of what counts for tax penalties and deductions make little intuitive sense to me, but the government has decided that it is warranted. At least I understand the societal benefit to the ACA tax penalty.
    If their were criminal or civil penalties to not purchasing insurance, the concept for me would be a bit more muddy, but a tax surcharge seems wholly within the federal governments purview.

  34. I'm not a lawyer and I write from a position of ignorance, but if the SC could argue in Bush v Gore that their action did not set a precedent, why can't the WH now argue that the ACA also does not set a precedent for Congress's ability to force people to buy a product? As interesting and meaty as the doctrinal question is for the purposes of distinguishing individual rights vs congressional legislative power, wouldn't this kind of "escape hatch" provision sidestep the entire question? (Of course, why kind of precedent would that set?!)

  35. For roughly 130 years Germany has had universal health care. While it will admit that it is not perfect, Germany spends roughly half the money this nation spends on health care and achieves roughly the same health care results. If you want to enact health care reform, one should look around the world for models that actually work. In this country, we got a bill that was north of 2,000 pages and to date HHS has issued more than 3,000 pages of regulations with more to come to implement health care reform. Will the health care bill and HHS regulations bring health care costs in this country in line with health care costs in other so called advanced countries? The answer if no. This is the unspoken reality of the health care reform act that seemingly no one wants to address. If the limits of the power of government is that they cannot pass a bill that makes no sense as noted in this article, the fact that this bill does not address the fundamental problem with health care in this country should be grounds for the Supreme Court to say that it is unconstitutional. The time has come for our elected political elites to go back to the drawing board and actually pass health care reform that does in fact lower costs. It can be done but I suspect special interests of one sort or another will scream blue murder and defeat any real health care reform in this country.

  36. If a state chooses not to participate in the federal health insurance law, then the citizens of that state should not be allowed to participate in federal health programs like Medicare.It's as simple as that. Let the state pay for its citizens, but ONLY with tax dollars from that state, not monies reapppropriated from other states, like in the NOrtheast, to states that wish to tax less, because they get federal dollars collected from other states. Each state should be required to stand on its own, in this tax war. Then we will see a dramatic shift in policy, with states like NY, who send billions extra per year to Washington, able to pay for itself, and states like Texas, with no state tax, fall apart. If the program were free, would anyone be complaining? It's all about money.

  37. Legal tripe which circumvents what every other industrialized country knows: Aetna, Cigna, Humana, et al don't give a rat's tail about anything but the bottom line. People shouldn't have to "buy" health insurance from a corrupt, for-profit company. Medicare for all at a not-for-profit cost or a National Health plan is in fact what we need desperately but the Dems dumped Obama on this and the Reps were already in the pockets of big insurance companies. Cry " Socialism" and everyone runs! The Supremes have already shown they favor corporation-nation states over whatever's left of our fragmented democracy.

    I have watched patients with no insurance let a tear of a meniscus, which no a
    0rthropod would see without big bucks (and of course the improvident here in TN have a bass boat and a 4 wheeler, but don't buy health insurance) become crippling. After the condition goes on for two years the fellow is on disability for the long haul if not forever. Boy, that's a smart policy. Seen this at least 20x over the last 25 years.

    We all pay for the uninsured, and if some folks are just too stupid, or independent to recognize that we all need to be in the risk pool, then too bad. They have to participate. The right to be stupid is one that the state should mandate giving up!

  38. It seems pointless to me to speculate on Supreme Court decisions these days, with the Court's majority so wholly captured by conservative activism. I don't trust the current bench's ability to properly or fairly interpret constitutional law any more than I trust Fox to deliver real news. It's pathetic that one of the most critical decisions the modern American state will face - i.e. are we willing to join the developed world and uphold our commitments to honor basic civil liberties and rights? - will be decided by a bunch of heartless, Bush-era appointees. Let's just all pack it in now and learn how to suture ourselves.

  39. Obamacare does not require anyone to purchase health insurance! You can elect to not purchase the insurance. Electing not to have insurance will produce a penalty. Smokers pay a penalty; consumers of alcohol pay a penalty; speeders pay a penalty; drunk drivers pay a penalty; people who park in no-parking zones pay a penalty. Everyone is free to make his own choice... This is all double-talk.

  40. McDon writes: "Most states require you carry car insurance to get your plates. What's the difference?"

    Car insurance is a State's police power exercise, not the Federal government; there is no corresponding power under the Constitution. Furthermore, you can opt out by not driving/owning a car or posting a bond. Strawman argument. Just as Romneycare is ok as a State's legitimate exercise of their sovereign powers, Obamacare's Individual Mandate is not well-grounded in any enumerated power of the Federal Constitution.

    Had Pelosi & crew made the funding arrangement a tax & subsidy, ala Medicare or Social Security then the Constitutional impediment would have been avoided. Evidently the "tax & spend" label was more onerous than the Supreme Court fight that this over-reach engendered.

  41. Requiring insurance to operate a car is much different than requiring someone to buy insurance to live. life is a right not a privilege, whereas driving a car is not a right. If you don't want to pay for insurance, don't buy a car, take the bus. The question is how far does the governments power reach into our lives, the lives of humans. You say this law benefits everyone. So if the government decides broccoli is necessary for the health of the country, could they make us all buy broccoli? I believe the health care system needed an overhaul. Unfortunately what we got is not going to solve any problem. It will merely cause more. I hope this mandate is shot down and a more reasonable alternative, one that does not requiring taxing us more(something this bill was not supposed to do).

  42. Because I pay taxes I am forced every day to do business with companies I might not choose to support because they are awarded government contracts, and use of MY money. I am forced to fund weapons and war, whether I want to or not, because elected representatives decide that's how they want to spend the money. I am forced to guarantee pensions for defense contractor's employees, and probably their private health insurance, because their lobbyists managed to get those little-known benefits written into federal government contracts. In Washington state I am forced to buy auto insurance from a select group of insurers, who are authorized to do business with Washington State. It's ridiculous to me that conservatives, who pander to business interests, can't find a better argument as a way to defeat decent, affordable health care for every citizen of America. Games, games and more games that unfortunately have people's lives at stake.

  43. When I lived in Germany, a person could opt out of tax-payer-provided catastrophic medical coverage, but it was a one-time, life-long decision. There's no reason we can't do the same. No one has a right to assistance that s/he is not willing to give.

  44. The real "slippery slope" is quite the opposite: If congress can not legislate something so basic and essential as healthcare what can it legislate? Essentially every act of legislation is a mandate effecting either a specific class or the entire population. For example, federal income tax, selective service, interstate trade, air pollution, fuel tax. Even those legislations effecting a specific group invariably impacts on all. For example, fuel tax may impact only on those who use a vehicle but ultimately it adds costs to every product we buy regardles of whether we drive or not.

    Furthermore, the examples of questions raised by the lower court Justices are nonsensical. Requiring everyone to buy health insurance (or pay a substitute fee) without specifiying the provider, is quite a bit different from requiring you to buy a car from a specific manufacturer.

    This is a completely open and shut case that has only been made an issue for political purposes by the Republican/Tparty. The actual number of people who don't have insurance because they don't want to (not including those who can't afford it)is probably a few million at most.

    I would remind you that when the alternative of not mandating insurance would be letting people die in the streets the Republican/Tparty cheered. They are the real "Death Panels" and who beleive 2 cells in a womb has more rights to live then a living child or person.

  45. Let me pose a simple question: if the 'Supremes' decide against the constitutionality of the health care act, do hospitals (who now can not turn away un-insured citizens from emergency room services) have the right to refuse to provide those services? Who do you think picks up the tab at the moment?

    This is a singular issue, but is it not fair to either have the feds pay that 'tab' (to cover those who can not afford coverage) or ask the uninsured to get coverage (which ultimately will be fedearlly subsidized)? If you think not, then the rest of us who do carry coverage will continue to pay for services for those who do not have coverage.

    Why now are carriers providing coverage (with almost no questions asked) to employer covered individuals while those of us who are self-employed pay extremely high rates for high deductible policies and are constantly harassed by the 'pre-existing condition' clause and can not shop for competitive rates (at least in NH)?

    Why is there such resistance to reform when the system is so unfair to begin with? Can anyone say that the current state of affairs is equitable, fair and competitive? My wife and I (no kids) pay over $700 a month to Anthem for a $10,000 deductible policy (that's each per year BTW).

  46. While I wholly agree with the Administration's effort to extend health care to all Americans, I think Mr. Obama's approach is fundamentally flawed because there is no other instance I can think of where the government forces US citizens to buy anything from a private vendor. Some might say we are compelled to buy auto insurance, but we are not forced to drive. This is why I believe Obama was extremely short-sighted when he caved on creating a tax-based public option as an alternative to the private sector. Had he pressed for that when "his" party "controlled" the congress, we would not be forcing citizens to purchase goods from a private industry that has behaved with parasitic disregard to Public Health.

  47. Hopefully the Supreme court decision will end the arguements. It seems that this should have been decided in court before it was used to fund, organize and pass a huge law around that involves all American's and billions of dollars of Tax money.

  48. To those of you who quote Germany, a primary reason for health care cost differences are obesity rates. The US is in the 30s and Germany is around 10%. As an actuary it really bothers me that noone ever corrects for our obesity rates or the cost of our tort system when comparing the overall costs of health care across countries.

    The health care law is a price control, which I will leave up to the populace to decide if it is a good thing. It is my belief that it will not control costs.

    If the government really wanted to bring down costs then double the number of medical schools. We have a shortage of doctors which drives up prices through the laws of supply and demand of medical services.

  49. There is a crucial difference between states requiring its citizens to purchase automobile insurance and the federal government requiring its citizens to purchase health insurance. Any question in constitutional law begins with, who is doing the acting? With respect to automobile insurance, the state is the actor and can and should require state citizens to purchase insurance. The Federal government is given its power by the states and is a government of limited power. Pursuant to the Commerce Clause, the federal government CANNOT require its citizens to purchase health insurance. This is a question of Federalism which is deep rooted in our constitution.

    Congress can only regulate interstate commerce. Health insurance, by its very nature, is an inta-state activity. As a citizen of New York, I cannot go to California to buy my health insurance. The intra-state nature of health insurance is an often ignored, but important reason why the health care law is unconstitutional.

  50. The Supreme Court is composed of men - and their personal beliefs impact their decisions - they would overturn a woman's right to choose, they elected a President, they allowed unlimited corporate spending on elections. I say it's unconstitutional to force taxpayers fo pay for the people denied healthcare by insurance companies because it affects their profits. The Supreme Court will decide, not on the Constitutional rights, but on what corporate America wants. The Supreme Court is tainted - the Justices will vote according to their personal beliefs. It was interesting that Herman Cain invoked Anita Hill's name - for those who did not believe her claims against Clarence Thomas - perhaps they were wrong - times has shown that some justices have their own agendas.

  51. At least one element to the argument is whether a proposed mandatory federal program replaces another ALREADY mandatory federal program. This is the big difference between replacing Social Security with a required private program, and creating a new program to require everyone to save for college. Likewise, with health care, health care deductions are ALREADY mandated for some employees, but not all. The issue is whether to require them of everyone. Unlike a personal decision not to eat broccoli, a personal decision not to pay for health care affect everyone, since emergency health care may not be denied.

  52. We all really need to step back and take a minute to really ponder the implications of this law. In my opinion (derived from study of COTUS), the US Gov't ought not have the ability to compel anyone to buy anything. The responsibility of the gov't is not to direct behavior or compel behavior but to protect the citizenry. That's it. The government should be thought of as a guard of the house in which all Americans live.

    The implications of this law are scary. It's like the proponents of this law don't understand how laws work. If the SCOTUS rules on this law favorably it will set a precedent upon which another law can be set and yet another precedent upon which another freedom leaching law can be set thereby widening and strengthening the powers of the POTUS and the congress.

    If people can be compelled by the government to buy insurance, costs will not be controlled. They will skyrocket. It is the same issue with the America Education System. By pooling resources, the quality of education has not increased. It has plummeted.

    Please, people, think, reason, rationalize and discuss this. It is in your best interests to know the causes and the effects of the passage of this law.

  53. It appears that the right wing in this country are attempting to block very needed reform in the way health care is delivered and paid for in this country in light of the recent data that employer sponsored health insurance has dipped to a low of 44.5 %. No one seems to care what happens to the other 55.5% who do not have employer sponsored health care insurance. The recent action by Wal-Mart to stop offering health insurance to part time employees is an example of the fractured nature of health insurance coverage in the US where there is no government option available to low income, part time, and unemployed workers.

    With nearly 20% of the adult population in the US who are without health insurance coverage the relentless challenge of the new health care law by the right wing is another example of the indifferent and ignorant nature of Republican Party philosophy towards working class Americans.

    Something that should not overlooked in the 12012 elections.


  54. Perhaps I have not thought through my logic with a fine grey-matter comb, but isn't the case if we don't require a person to have health care, and they get ill, the person is served in an Emergency Room? Isn't it true that, as it stands, every American is covered by health insurance due to this fact? Who pays for the emergency services? We all do. So, an uninsured person seems to have free health insurance. If those who feel that the government forcing a person to buy a product, like health insurance, is overstepping its power, then there should also be an added clause that anyone showing up without insurance at an Emergency Room is denied service--regardless how serious the illness or injury. You didn't buy insurance, well you can't take advantage of the service. Isn't this how the marketplace works? As it stands not forcing people to buy health insurance, but still allowing the uninsured to be served in emergency rooms is an extremely poor policy, and an expensive one at that. Fact is, we all are covered, not let everyone help pay for that coverage.

  55. Restaurants or hotels are public service vendors, not individuals.

    The reference to marijuana is a red herring because there is no medical law forbidding its use, only a tax law requiring a license to use it.

    And, there is no law that forbids a farmer from growing enough wheat to support his own family.

    By ruling the government can do anything to anyone will force the Supreme Court to reject this ruling outright.

  56. Several comments here suggest that without "Individual Mandate" the uninsured will continue to cost taxpayers for their care. Some go further to say this amounts to theft, presumably implying that the government should indeed have the power to force every individual to purchase private insurance. I think this view is not only incorrect but extremely dangerous.

    It is already accepted that our government has power to collect taxes to ensure for the public welfare and to provide for a common defense. And there is nothing in the power of taxation that precludes the establishment of a publicly funded insurance option to provide for those without private insurance. Further, there is nothing to prevent the establishment of a single payer system to provide healthcare for all. Nor need there be any rationing under such systems, we could adjust associated revenue to match the desired levels of care. And so there are perfectly good and potentially efficient means to provide the mandatory care.

    But to put forth this notion that we MUST buy, under lawful mandate, from a PRIVATE insurance provider, that itself delivers no actual healthcare, with neither checks nor balances in place to insure the integrity of said provider or its excessive profit motive... this is the road to lawful corporate tyranny.

    It seems there are those who would prefer near certain corporate tyranny to the mere prospect of government tyranny, but I say with publicly funded alternatives there would at least be public choice in the matter.

    I am about as liberal in my views as one could possibly be. But this mandate to purchase from a private entity (with no publicly funded alternatives) seems to be an extremely dangerous precedent. Because it does not merely stop at insurance. It applies to retirement savings, and nearly anything else for which the corporate profit motive is desirous.

  57. If the government can force a person to pay taxes, they can force a person to buy health insurance. Even if the Court found this requirement to be unconstituional, all that the government would need to do is charge every person in the U.S. a healthcare tax of $5,000. If a person buys their own healthcare insurance, they would be able to get an exemption for the $5,000 tax. The person who decides not to buy health insurance would not get the exemption.

  58. First, requiring everyone to pay for some basic level of health care access is fair and right. We allow people who have no insurance access to emergency room care and ambulance rides from accident scenes, without asking for proof of insurance. Today, all those with insurance pay for those without insurance. Requiring people to pay for this access makes sense.

    Second, this could be collected as a tax that the government would "promise" to use to minimize the costs to those with insurance. We all know those revenues could be used for any purpose Congress wants, and the bureaucracy would add additional costs. By instead requiring people to buy their own private insurance, avoids a "government" controlled health care program, and helps fuel the private sector. No one would argue the constitutionality of a tax, so let's not throw out a better solution based on semantics.

    Finally, competition needs to be used to open up the access to health care policy options across the country. That is what will hold down costs. We have state-by-state limits on which companies can offer health care plans, and this keeps prices high and competition down. Let health care policies be accessed nationally, there are enough companies nationally in the market to create enough competition to help keep costs down.

    We should not let false ideological arguements keep us from enacting a smarter approach to a fairer health care funding system.

  59. I am not so sure that this simple, namby-pamby health care reform will pass the test of a substantial national economic interest.

    Now, if health care was to have been fully socialized under the law, there would be no question as to a substantial national economic interest: US manufacturers would instantly be on a more level playing field with their most serious overseas competitors.

  60. If the healthcare mandate is not constitutional then the uninsured walking into an emergency room expecting "free" care is unconstitutional, immoral and an undue burden on those who do pay a significant part of their healthcare bill to support many uninsured. I say, let's abolish the mandate and have everyone who declines coverage sign an affidavit that acknowledges that there is no physician nor hospital that will provide them care should the "remote" possibility occur that they need it. Of course, if they walk in with the cash to pay for their needed care, no problem. Strictly COD. Mandate sounds more reasonable to me. And, yes we have a precedent. It's working in Massachusetts.

  61. I see no difference between mandatory federal taxes to share the financial burden of public services and a federal mandate to share the burden of healthcare. Just as most of us cannot afford the entire cost of the highway system as individuals, some of us cannot afford high health insurance premiums. This argument, however, predicates that we do indeed have the right to life, liberty, etc... Emphasis on "Life."

  62. OK. Then is the requirement of most states for motorists to purchase auto insurance to obtain a motor vehicle registration unconstitutional?

  63. The requirement to purchase insurance is dead on arrival at the Supreme Court and should be if there is anything left to the foundation philosophy of our federal government. It might well be different on the state level, however. Striking down this well-meaning but politically bastardized legislation is not a bad thing. It would bring the Administration back to the public option, just as Simpson-Bowles folks is saying.

  64. It is all in how you frame the question. Whether or not health insurance should be an affordable option for everyone? Overwhelming majority would agree that affordable Health Insurance should be available to everyone. One of the reasons President Obama was elected into office.


    Whether or not health insurance should be mandatory? When the question is phrased this way, you no longer see this overwhelming majority in favor of affordable health insurance. This results in mixed signals to our elected representatives.

    There will never be a perfect model. The model picked to provide affordable health insurance is not perfect, however, neither is our current model. Everyone is concerned with this free riding problem and the greed of the current health insurance providers. The current proposed model addresses both of these issues. While not everyone will opt to have health insurance and we will continue to see people showing up at emergency rooms, in theory we should see less. Additionally, health insurance cost to the consumer continues to rise at unprecedented rates, again, in theory the proposed model should offset this by creating a competitive option to help balance out the continue spike in health insurance cost.

    We can continue to favor the current regressive model, or we can choose to move towards a progressive model. All benefits come with costs. The current costs, though, are extremely high...

  65. The starting point is what power a State government has to force me to do something. If the State has the power, then the issue is federalism (how power should be divided between State and Federal government) and not liberty. So, for example, if the State can compel me to educate my children, the ability of the federal government to do the same is not a denial of liberty.

  66. Have you all forgotten? We the People of the US in order to form a more perfect Union..... do ordain and establish this Constitution of the US of A. No state would sign the constitution until all the ammendments were agreed upon. Amendment X reads; "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the People."

    Very simply; Since the constitution did not give congress the Federal power to mandate an individual purchase of health insurance, and since this power was not forbidden to the states by the Constitution, Mr Romney as Governor of MA was legally within his Constitutional rights to introduce a health care program/law in MA. Every other Governor is also within his Constitutional legal right to so do in his own State.
    The Federal Governmant must obey the Constitution and its amendments or I fear we will not long have a United States. It is the Constitution which is holding us together as a Union. Let us continue to honour and obey it.

  67. Here's betting that the Court will take the case and declare it unconstitutional.

  68. Should affordable health insurance be available to all?
    Should everyone participate in paying for it?
    The healthcare act addresses both of these questions in the affirmative.
    The answer to these questions are self-evident yet, we have some who would say no, let them die on the sidewalk outside the hospital. Despicable!

  69. On a more practical note, if people who do not have insurance were forced to rely on charity or go without, they should not be forcibly transported by ambulance at the direction of a police officer or medical professional to the nearest hospital that will take them whenever something goes wrong. Patients in emergency situations often do not have a choice as to what care is provided or where it is provided. In this respect - and many others - our model of providing care is fundamentally broken.

    Furthermore, healthcare is not a consumer service with financial decisions made by the patient. Patients don't have any idea how much expense is being incurred until after the fact. They are merely stuck with a bill after all is said and done... whether what was done was helpful, effective, cost-efficient, requested, covered in whole or in part by insurance, or not.

  70. As I interpret the Health Care Bill,the government is not requiring that I purchase private health insurance or any other product. The law provides, rather, that if I do not have health insurance from any source, public or private, I must pay a fine -- a tax -- to cover the costs that the public may incur if I have an accident, become critically ill, or otherwise require the medical care that an emergency room or public hospital would be required to provide whether or not I had health coverage. In other words, people are being asked to bear the burden of such public costs, but are exempted if they have health insurance. Such insurance can come from any source: Veterans' Administration, a government job, Medicare, Medicaid, SCHIP, a private insurer -- it doesn't matter.

    I don't understand why oral argument in the federal courts has focused on the mandate, not the tax. It's not a mandate: nobody is making you do anything that you don't want to do. I pay school taxes whether or not I have a child in school; were I able to win exemptions from school taxes by showing that I had no children or had placed my children in private schools, could the school tax be deemed unconstitutional on the ground that the government had "mandated" that I remain childless or choose private education for my kids?

    Doesn't make sense to me. The whole argument is a political one, as far as I can see: the Republicans (and Republican judges) just don't want the government interfering with the "right" of insurance companies to decide my destiny.

  71. Really are some of these judges so stupid they cannot see the obvious differences. Here it is -- health care for (judicial) dummies.

    Health care events are generally random, commercially unwanted (at least by the patient), and frequently so expensive that satisfaction of the debt for services rendered cannot be solely borne by the service recipient and paid in full immediately (i.e., somebody else bears the cost to finance this deficiency). Nor can the recipient themselves forecast with any accuracy the cost of their future health, unless they commit themselves to live in the woods and never seek any care. Of course some make that claim (and call it individual liberty), but inevitably succumb to the will to live (because they want their liberty and that is only good alive) and then become the welfare queens they endlessly accuse of others as they seek the care they didn't or cannot pay for (while claiming they paid for it years ago in some past paycheck)

    Now saving for one's retirement is not random, is wanted, and the cost to save highly predictable and controllable by the savers themselves.

    And this highlights the problem of having a judiciary full of lawyers with little training other than reading law books with the insight of folks 200 years old. They are simply ill-equipped to adjudicate disputes in a fast-paced, highly technical, scientifically advanced world - rather like like our politicians. Instead they are the parasitic dinosaurs among us - antiquated and useless but committed to sucking the lifeblood out of a society they are ill-equipped to understand - let alone add value to.


  72. Health care is something that every single person is going to need at some point in life. People get sick. People get injured. Things happen. And when they do, we need someone there that can help us to heal and get better.
    Without such a safety net we would be unable to participate as full members of society since any health problem that gets severe enough could effectively remove us from society.

    Everyone depends on the work and sacrifice of everyone else just so we can survive. Therefore it's our responsibility to contribute what we can towards creating and sustaining a robust, responsive health care system that is not predicated on profit, but on maintaining the good health and well being of the collective.

    Life is not something to be earned. If the Creator Himself caused you to be born as you are, and never required you to earn your existence, then who are we to demand that the others around us should 'earn' their place?

    Just as nature provides us with the very reality within which we live, so we must provide support to each other, and mutually agree as individuals to guarantee our support of the collective environment (each other).

    Health care and education are excellent places to start putting the principle of mutual guarantee into practice. And in truth, mutual guarantee is the only cure for our global troubles. We would be wise to move in this direction of our own choice, before suffering forces us to see that profiting from the suffering of others only brings harm and suffering to everyone including the profiteer. We must learn to unite. Look around. What else is there to do?

    Peace to all of you and to all of yours.

  73. "He gave an example. “If it is within the scope of regulating commerce to set a minimum wage,” he said, “one might argue, then Congress could set the minimum wage at $5,000 an hour.” But that would never happen, he said, for practical, political and legal reasons. "

    probably legal constitutionally, by the existing precedents

    the med-mar ruling should be reversed absent an economic finding of interstate impact

  74. Well, the government for a long time has forced doctors and hospitals to treat patients even if those patients have no money to pay for overpriced services... so how is that different from forcing people to buy overpriced health insurance?? The "private market", absolute "first step" to finally solve America's health insurance problem starts here:

  75. Conservative and Libertarian arguments about the 'limits to federal power' are ludicrous. The federal government clearly has the power to take life and dissolve or dismember corporations; it can summon, draft, jail, and imprison. What the Conservatives are really doing is using creative constructionism (activist judicial initiatives) to enforce a 222 year old document that justified slavery, saw women as chattel, and never envisioned its own modification through the courts. For all their huffing and puffing about historical precedent, Conservatives and Libertarians are nothing less than distortionists who worship a perfect vision of America that never was.

  76. I think that the health care law is more important, and more dangerous, than anything that we have seen in some time for the precise reason that it represents the next stage of Government intrusion into the lives of citizens. I hope that SCOTUS throws it out and makes a clear statement as to where the limits of Government power over we citizens ends.

    Right now it is not looking good and that is frightening.

  77. The legislative issue cannot be separated from the political issue. The politics of mandating that health insurance be acquired by all citizens and immigrants would be much more politically palatable if Congress had the nerve to provide a public option. Would the Justices please consider outlawing cigarette smoking, frivoulus Medical Liability actions and unproductive end of life processes while they have their thinking caps on? Thank you.

  78. A new argument that could benefit both sides. In 1947 a law was enacted that prevented the federal government from regulation of the business of insurance. Is this not regulation of insurance? That law did not restrict itself to property, casualty, life, or health insurance. McCarran-Ferguson Act!

  79. The federal government is lowering premiums for a taxpayer-subsidized plan that provides health insurance for those with pre-existing conditions check "Penny Health" website

  80. Indisputably there is a need for affordable health care, and the lack of it is without question a national problem. But it is not established that forcing everyone to buy insurance will lick that problem. And even if it does, it is not established that there are not less coercive ways, that can achieve that result as well.

    We are working from the unquestioned assumption that the only way health care costs can be lowered is via a govt program. But that is not true.

    The court needs to consider that alternative approaches exist and should require their trial, before allowing a precedent so obnoxious to personal liberty. 5:03AM

  81. The fact that we pay for the health care of the indigent and poor, and those who just do not wish to purchase insurance, is a choice that society makes, a burden not imposed upon the citizen or the state by the Constitution. It is state sponsored charity when dictated to health care providers. The choice could have been the contrary, that society could have left them on their own. That society, namely the Democrats, wish to impose this cost back on the the individual, even those who do not wish to participate, is an imposition on personal freedom. Sometimes freedom means accepting risks, risks that bad actors will violate laws or become burdens on society. Freedom isn't always free.

  82. The courts ask "What's the limit on federal power?". How about the following - first the majority of 435 members of the House of Representatives have to pass a bill that doesn't offend too many of their constituents and most importantly big business. Then, 60 out of 100 senators have to vote to end cloture on a bill again without offending too many constituents and their bank rollers and then vote to pass the bill. If even one of the 100 senators decides to, he/she can gum up the works through filibuster or other procedural maneuvers which no one really understands or can explain. Then these two houses have to some how merge their passed bills into one bill and then go through the same procedure as above. The president has to sign the bill into law that ensures he can still win Florida and Ohio in the next election and keep his financial backers happy. In summary, it is easier for a camel to thread the eye of the needle then for our federal government to pass national healthcare legislation. The courts don't need to lose sleep - we don't exactly have laws being passed by King George the III here.

  83. If the federal government can mandate the purchase of health insurance then it can mandate the purchase of anything. Its power will become virtually unlimited. The Constitution was designed to curb this sort of abusive aggregation of power. Let's hope that at least five Supreme Court justices understand this.

  84. Be careful what you wish for, you might get it.

    If compulsory purchase of health insurance is found unconstitutional it may force the legislature to instead pass a taxpayer funded single-payer plan.

    A prudent solution might be to allow individual states to opt out of the requirement.

  85. All of the well-publicized political health care programs have one thing in common: They all seek to steer larger portions of Medicare and Medicaid through private insurance corporations. They differ only in their degrees of rationing, with President Obama's plan restricting rationing for profit and Rep. Paul Ryan's mandate allowing the most rationing by the health insurance industry.
    What Republicans and Democrats fail to disclose is that for more than 40 years the middle man of American health care - the private insurance industry - has failed in almost every capitalistic, economic and medical measure to deliver for the American patient.
    Unlike auto insurance, private medical insurance has failed to accept and spread risk, thereby preventing the delivery of quality, affordable health care .
    All the private health insurers have failed to prevent personal bankruptcies due to medical illness. The administrative bureaucracy of private health insurers removes $500 billion a year from health care. Managed health care brokered by private insurance companies has failed to improve medical outcomes and lower morbidity (sickness) and mortality (death rates) for all Americans regardless of income, sex or location.
    The private health insurance industry has needed massive taxpayer subsidies. It would not be profitable without a federal exemption from antitrust laws combined with a federal ban on collective bargaining by physicians. The private insurance companies would not be able to ration health care for profit without a federal law protecting the companies from malpractice lawsuits.
    For over four decades private health insurance companies have decreased reimbursements to individual doctors, hospitals and therapists for care, while failing to lower the cost of care for insured citizens and business.
    For 40 years, the private insurance industry has refused to invest in the development of integrated medical records and billing systems to prevent fraud and track outcomes and improve quality of care. Within the health insurance industry there is a failure to compete based on medical, surgical or preventative outcomes (the only product of health care). In addition, the health insurance industry has failed to operate profitably without massive diagnostic, treatment and reimbursement rationing of patient care by non-physician actuaries and insurance bureaucrats.
    Private health insurance companies have failed to deliver to Americans low-cost medicines and drugs via competitive capitalistic bidding, even with massive federal Part D subsidies. With no real interest in our future health, the private health insurance industry has failed to contribute to meaningful medical or clinical research.
    Health insurance companies can only claim success in diverting hundreds of billions of dollars of public and private money from health care providers and patients to profits and payoffs for their bondholders, shareholders, executives and political patrons.
    If any other American industry failed to competitively and profitably provide a quality product for all Americans for 40 years, it would either be outsourced to an emerging nation, or shut down.
    Health insurance companies ensure neither quality affordable health care nor quality insurance for most Americans. With no real product to sell, the private health insurance industry would fail to exist without hundreds of millions of dollars in direct and indirect payments to the elected officials in the Congress, state legislatures and the administration.
    After 40 years of market and medical failure, America needs to cut out the middle man and move to single-payer national health insurance for all Americans with private doctors, hospitals, clinics, therapists and drug companies competing based on the quality of medical, surgical and preventive outcomes.

  86. Judge Silberman's reasoning is flawed. There is a significant and material difference between requiring hotels and restaurants and other publis estabishments to permit people regardless of race, etc. to be served or housed or whatever,there is a significant and material difference between allowing people for compassionate reason to use drugs that are not approved for medical use, and there is a significant and material difference between allowing a farmer to grow wheat if this will affect the commerce in this crop AND requiring people to buy something. In the three cases presented, the people affected by the law had a choice to avoid being affected by it. That choice does not exist if the Government is allowed to force people to do something under the same legal theory. The Supremes should strike Obamacare as unconstitutional for this reason, alone.

  87. President Obama had the fortitude to attack an issue that no prior administration or Congress has found the backbone to approach. The disgrace of the United States's position regarding the lack of a national healthcare initiative relegates us to the lowest levels of compassion. The fear of "socialized medicine" has become the rallying cry for all those advocating for individual rights and denying what should be a basic human right to those unable to provide for themselves. The divisive stance taken by opponents of this first small step to help provide for universal healthcare serves only to demonstrate their lack of humanity.

  88. “How about mandatory retirement accounts replacing Social Security?” Hold on there! Wasn't the idea behind Social Security payments a mandatory form of retirement accounts? Government mandated payments that were suppose to be kept safe, appreciate, and returned to you upon retirement. And what about Medicare deductions? Another mandated payment that would presumably provide healthcare, either in times of dire need, when one became old, or disabled, or unable to afford private health insurance, as is the case with the 99% elderly today.
    Let us reflect on why these two, what the government arguably now calls "entitlement programs", are so dysfunctional. The ongoing misappropriation of funds, total lack of oversight, rampant greed, and gross manipulation of both programs.
    More importantly, Americans have great difficulty understanding why the government believes that passing the buck to the private sector; one that is entrenched in greed, manipulation, and managed by those that simply grossly overpay themselves, and milk the system for the "shareholders" (the one percent), are worthy of taking over these two well intended programs.
    Just more reasons why there is an Occupy Movement in America.
    People first, there is no longer any room for politics. Will all "Politicians" please leave the House, and the Senate.
    March On!

  89. I thought the point was that even people who don't choose to purchase health insurance have a history of imposing costs on the health care system and thus it is logical that they be required to pay into the system.

  90. The government forces us to stop at red lights for the greater good. I still have to wait for a walk signal if I dont drive. I pay taxes which is spent on things I dont approve. The role of the Federal government has been upheld in courts since the Bureau of Indian Affairs and Manifest Destiny. The big hand of government starts at the local level. Try to stop any development which increases tax revenues. If the government can spy on us under the Patriot Act we can pay for health insurance. The SC will make a political decision based on faulty legal reasoning.

  91. My simple argument is, when the governments of any country is imposed with the responsibility of ensuring the general health and well being of its population and protect them from any epidemic, why don't they have the right to mandate laws so that everyone has some sort of health care in their own as well nations interest? Should there be any politics in making this simple decision? I think not.

  92. It all depends on what we call payments required by law. If they are labeled "Compulsory Purchase of Health Insurance", you can make a case for it being unconstitutional, maybe. But call the payment a tax and the problem goes away.

    So Republicans are playing word games with my Medical Coverage. May a pox descend on their House.

  93. Senor's First Rule of Government: "Any time a governmental entity at any level claims the right to do something, there is a 100% probability that at some point it will attempt to do it." The Times favorite bete noire, Citizens United, was decided when the solicitor general's office, under questioning, told the court that the federal government had the right to suppress books published within 30 days of an election, an argument that Elena Kaga, at re-argument, did not quite repudiate. The justice department better have better answers before the Supreme Court than it did before Judge Silberman.

  94. People currently pay more federal taxes if (a) they do not have kids, (b) do not make charitable contributions, (c) do not have a mortgage (d) do not pay local property taxes. So, it doesn't seem such a stretch to pay higher federal taxes if you don't have health insurance.

  95. And fearful consumers and health workers benefiting from this can drag automobile insurance into this all they want, but the state doesn't force people into car purchases: "What do I have to do to get you into this car?"

    It also doesn't force people to buy top-shelf product comprehensively tricked out with favored options. We're being offered exchanges with Hobsons choices between luxury sedans and sport utes and nifty electric vehicles--rather than subcompact shares.

  96. The federation of the American people can mandate that everyone purchase a well regulated health insurance so that as many American people as possible are healthy for their own well being and for the well being of the society of the American people, and, so that as many American people as possible are not having to spend obscene amounts of money to be healthy.

  97. This issue is being asked within an absurd frame, as if the government doesn't already require participation in many social programs. Ever heard of Social Security, for example? Public schools? Public highways? The list goes on and on. As does the stupidity about health care.

  98. Please.

    We "force" people to pay for fire protection. We "force" people to pay for police protection. We "force" people to pay for lighting on their streets, etc... etc.... We "force" people to purchase auto insurance if they want to drive their cars on the public roads we "force" them to pay for.

    So anyone who chooses to walk around in their frail human body and chooses to live in these United States should be "forced" to pay for the medical care they will be "forced" to accept should they need assistance. Don't like it? Go live on a desert island, then.

  99. If the federal government can force people to buy health care, what else can they force people to do. You silly person you - they can force them to pay taxes. The precedent is set, action required, results scattered just as it is when the wealthiest pay less taxes than a worker, just as a Corporation becomes a person, just as the right to bare arms just so long as it isn't in front of the Supreme Court where you don't have the right to bare arms and assemble. Democracy doesn't mean its fair, it's just a name applied by the powerful to the little guy who is told every vote counts when they can't even vote, or count the votes that have been counted, or understand how the voting system works. It's a mental game - everybody gets their chance, but it doesn't have to be effective, it's like the lottery - most suckers lose, but there is always that great big one in the sky!

    Medical care - if you want it, you have to pay for it. Better yet, have a healthier living style and maybe you'll use it less, and we won't have to go through this debacle year after year after year of rising health care costs.

  100. If the Supreme Court finds mandatory health insurance unconstitutional, what about mandatory car insurance?

  101. Reading comments 1-3, I see the way we entrap citizens. First we pass a law REQUIRING that medical care be provided to everyone, even people who refuse to pay for it. Then, having passed that law, we argue that we must now force people to purchase insurance because they won't otherwise pay for health care that we are forced to provide them.

    Get rid of both laws and let people decide what they want.

    In the meanwhile, these are POLICY arguments whether you like them or not and the issue at bar is Constitutional. Quite simply, the federal government does not have the power to force anyone to purchase anything. Had this been a tax, it would be fine. The federal government has the power to tax.

    So now one can only hope that the Supreme Court is unwilling to cover up this Congressional mistake - They wanted to have it both ways and avoid the political fallout of calling this tax a "tax." In the decision described in the article, the judge made a political calculation, essentially deciding that the mandate went to far but, oh heck, lots of things do so let's keep the law. And, in fact, that's the heart of every "pro" argument mentioned in this article.

    That is, quite simply, no way to run a legal system.

    Expect the entire law to be struck down.

  102. I hope the Supreme Court smacks down Obama's give-away to Blue-Cross Blue-Bloods. In France and Germany, citizens are always in the health-care system and pay a percentage of their income when working. So they don't lose all their assets due to sickness when they are between jobs, what a concept.
    The democrats might as well find another smooth-talker for us to vote for because many people are NOT going to vote for Obama again because he did not install a Single Payer system when he had the chance. He could have gotten most of the nation on board for a Single Payer System and he instead went with corporate interests.

  103. I have a Question: If the right to be free from federal regulation is not absolute, and yields to the imperative that Congress be free to forge national solutions to national problems, no matter how local—or seemingly passive—their individual origins, as the judge Silberman so eloquently puts it is in fact the new dynamic of our once-free nation, then what protects us from tyranny? What if Congress deems that unabridged free speech is a national problem requiring a national solution? How about the current madness surrounding obesity? Gun ownership? Private property rights? The list goes on. Why did the Founding Fathers even give congress enumerated powers? Do you know what enumerated means? Why even bother? Why not just be ruled by our "betters" in Washington D.C. at every point in our lives at the barrel of a gun?

  104. What about auto insurance - we are required to purchase that.

  105. We Americans have to choose between the rights of the those who pay into the insurance system over those who do not - plain and simple...Those who don't pay should not be rewarded with free health care (payed for by the rest of us). But there are forces in our country who want to move the conversation to the issue of "passing a law that allows government to force Americans to purchase something". This is not what this Health Care Bill is about. It's about making sure everyone is paying into the system thereby lowering costs for all...It really should be in the form of a sales tax. That way no one can hide and you pay as you go..

  106. I am for Medicare for all. From cradle to grave. Funded buy a tax on earnings -- everyone is in it, and everyone is covered. To get to that we need The Supreme Court to strike down this health care law. It is a bad law. It forces people to buy for profit health insurance.

  107. It seems that Americans are loosing a cohesiveness, and the ones who are promoting it are the ones who screamed about death panels. I feel that they should die at the gates of the hospital, but that is merely momentary anger.

  108. Why do we get a job?
    Why do we even get a pay check?
    Let the government provide everything.
    How did this country get to where we are today without all the freedoms that have been taken away?
    The founding leadership has given away to the current elites of trying to provide everything in order to get elected and stay in power.
    They will step in front of any situation if it will be beneficial to their reelection. No leadership.

  109. The supreme court has decided to hear the case. The outcome,the decision, is already known. The Supreme court will strike this legislation down, 5 to 4. Period- Over.

  110. They already "elected" a fraudulent Presidency on behalf of the American People's own voice and majority, why shouldn't they decide the fate of the citizens of this great plutocracy once more?

  111. I oppose this law, and will never agree to voluntarily pay anything to a private insurance company gainst my will, as it would make me a servant of the state, and not sovereign... not free.

  112. Again, I raise the concern that Federalized mandates DO infringe on the rights of individuals. Regardless of what we think to be "right" and "just".

    Why do we believe that the Federal Government has the power to regulate the "use of resources" of any individual? Whether that resource be labor or property (money is property), these "moral mandates" DO infringe on you personal liberties, by requiring you to utilize your labor or property in as way you prefer not. Such matters should be remanded to the "state" for referendum vote by the constituents.

  113. Call it what it is, a tax. Constitutional dilemma solved!
    Let's face it, the administration messed up from a PR standpoint. They were so fearful of using the T-word, that they replaced it with the one thing Americans despise even more than taxes, being told what to do. All they had to say was that anyone "choosing" to not buy insurance would pay a tax. Instead, millions of dollars have been wasted on month after month of legal wrangling across the federal circuits.

  114. When John McCain was first talking about mandatory insurance, I was quite put out. But then I learned more about it, it seems the government forced the Navy to buy insurance. Also, it forces us to pay into SS and Medicare. So I don't see why it can't do this too.

  115. If a government of the people, by the people, for the people can draft people into war, then surely it can compel them to cough up money to pay for health-care, which we will all, at some point in our lives, need.

  116. I take good care of my health, and make minimal use of health care providers. I don't believe in treating every life-threatening illness to keep a person alive every single last possible minute. Why should I have to pay high insurance rates because every Lazy Tom, Ancient Dick and Poor Larry are also covered?

    Furthermore, why should I be legally required to pay to keep a bunch of insurance companies flush with cash?! It's not like they're non-profit organizations uninterested in overcharging customers and denying benefits to save themselves a few bucks and give their execs a big year-end bonus at my expense.

  117. For those who claim health insurance is the same as car insurance, stop and think for a minute. Do we require non-drivers or pedestrians to purchase car insurance? No, we don't. Same thing should go for health insurance. It's a choice to have it or not. Those who like to take chances or risks should be allowed to do so. Those who cannot afford it, will have (and always have had) a safety net.

  118. The inate problem with the health care bill is that it was pushed through Congress with out thought to its outcome or management. Now that it is being examined; almost insurmontable problems are coming to light. Why not use interstate commerce to allow citizens to purchase health insurance across state lines, promoting competition and reduced prices aka "free interprise". One only has to look to Europe to know that Socialized medicine and broad entitlements do not work.

  119. Provided the constitutionality of the Patient Protection and Affordable Care Act is upheld, the federal government should immediately seize upon its new constitutional powers to address other pressing national issues in an era of reduced budget deficits. The generation, transmission and purchase of electricity are intrinsically matters of interstate commerce, and every American uses electricity, thereby creating external costs in the form of globe-cooking carbon emissions. I urge every patriotic citizen to write their congressional representative to press for a new law that forces everyone to purchase solar panels or pay a fine/tax to the IRS. This would cut carbon emissions, allow the EPA to close almost as many power plants as it wants, and be entirely within the government's new power to compel the purchase of private goods, as articulated in the opinions of lower courts upholding Obamacare. If it's not too late, the law could mandate that such panels be cylindrical, thereby also saving the federal government $500 million (though, of course, the technical requirements of approved technology ultimately would depend on current and prospective campaign contributions). Other beneficial uses of this new federal power are limited only by the imaginations of lobbyists for product suppliers.

  120. They should just change it to single payer, cut out the insurance robber barons, save everyone the middle man's cut and CEO's bonuses. It is a national disgrace the way we have forced our people to be at the mercy of a health care industry that puts profits first. To be the only nation in the weatern world not to care about it's citizens health is shameful. Obama made a pact with the devil when he agreed to coop with the insurance companies. We've been sold out once again, but at least with the Supreme Court ruling that corporations are people, it doesn't come us such a surprise anymore.

  121. For the benefit of those who don't know the history of national healthcare plans in Europe, think World War II. By the end of the war in 1945, there were some two million injured civilians and numerous, almost an identical number, of wounded and injured soldiers. Europe's infrastructure was destroyed and the economies devestated by the war. The US provided $55 billion in Marshall Plan funds to help Europe get back up off the ground and this, in turn, allowed nations to adopt national healthcare systems to care for their war injured populations. As for the US, very few of our civilians were injured during the war and so, escept for beefing up veteran's health benefits, we didn't have to turn to national healthcare. Fifty years after the war, the US had one of the finest healthcare systems in the world, whereas the nations that nationalized healthcare didn't fare as well. We are about to join them in destroying our healthcare system by turning it over to the folks who run Amtrak and the Post Office. Hopefully, the Supreme Court will return us to sanity as we clean out this corrupt cabal at the White House.

  122. Where Congress accumulates a massive amount of evidence showing:

    1. eliminating the real national problem of people being denied health insurance coverage based on pre-existing condtions (which discourages people from changing jobs, impacting the national economy), and

    2. avoiding the huge increase in insurance costs to everyone which would be then caused by free-riders buying insurance only after they became sick or injured,

    Congress acts most reasonably in requiring people to contribute now for the health care (through insurance) coverage that the human condition shows the overwhelming majority will need and use over a lifetime, either through taxes paid to the government and then distributed to private insurers, or through payments directly to the private insurer of their choice. Congress is authorized to determine how to deal with national problems and does not have to accept the view of those who deny there is a national problem.

    People who try to change the subject and cry out what else can the government require of me, should be gently but firmly brought back to the subject. Those who refuse are still fighting the New Deal legislation (Social Security Act, National Labor Relations Act, etc.) that the Supreme Court ruled in the 1930's was authorized under the Constitution.

  123. The commentators who express who oppose mandate (that fattens insurance cos.) because they prefer a single-payer system are overlooking one fact.

    Their preference (single-payer system) had as much chance in 2009 of passing congress as a snowflake in hell. Democrats and Republicans would have joined to defeat it. Both parties are in the payroll of insurance companies.

    This was a compromise, not a good one in many aspects.

    But it is better than status quo that leaves 40 million Americans uninsured, costing the system more, and lets freeloaders steal from us, the paying customers.

    If it is overturned now we would slide back. If we stay with it, there is a chance of improvement, perhaps with a ‘government-option’, or even later with ‘Medicare for All’.

  124. Those who compare this mandate to auto insurance are forgetting one important aspect: auto insurance is mandated by the states, not the federal government. States are free to have mandates, which is why the health care law in Massachusetts is constitutional and the federal one is not.

    Obama knows this, he did teach constitutional law for a while. This is why he said in his campaign that he was against a mandate for people to purchase health insurance, and ridiculed Hillary for wanting a mandate. But Congress had to play with the numbers so that the plan would appear to be deficit-neutral (it is nowhere close to being deficit-neutral).

  125. In the lower Federal courts considering the health care law, there has sometimes been a search for historical legislative precedents imposing individual mandates. In the 11th Circuit, for instance, the panel majority found four such legislative personal mandates over time (“serving on juries, registering for the draft, filing tax returns, and responding to the census,” Opinion at 119), but distinguished them.

    There was another far more intrusive individual mandate, in the 1850 Second Fugitive Slave Act, a mandate that was, moreover, upheld by the Supreme Court in 1858. See