House passes "repeal and replace"

[Whack-a-Mole]

@Bricker

Not at all. Please quote the post in which I argue it’s unconstitutional.

Your failure to find that post should clear up the confusion.

Ok…

@DSYoungEsq

Wait. How is it not a “federal power”? Explain why the Constitution forbids the federal government from doing this?

@Bricker

Don’t have to. The Constitution doesn’t need to forbid the federal government. The federal government doesn’t have plenary legislative power.

You want a federal law, you show me where the Constitution authorizes it.

So you are arguing the federal government does not have plenary legislative power.

Later you argued:

@QuickSilver

Federal enumerated powers as per Article I, Section 8 in the U.S. Constitution.

Plenary state power is the authority of each state to make its own laws not subject to federal gov’t review.

@Bricker

Plenary state power in our system is NOT correctly and completely described as the authority of each state to make its own laws not subject to federal government review. That doesn’t exist: state laws in a variety of areas are subject to review for the way they interact with the federal constitution and federal statutes.

The key element I want to highlight, though, is that states’ authority is not enumerated. States may legislate in any area EXCEPT those which are the exclusive domain of the federal government, but the federal government can ONLY legislate where Congress has been explicitly granted authority by the Constitution.

You see? It’s the difference between “You can do anything except what’s on this list,” and “You can do only the things on this list.”

And this which derives from the constitution and bears on the question of whether the feds can do healtcare:

@Bricker

…I’d like to ask you if you understand that the authority the federal government has is different in several key ways from the authority states have. The federal government has only enumerated powers, while the states have plenary legislative powers.

[k9bfriender]

@Slash1972

Would this Public option be mandatory if people didn’t have another form of insurance?

In my example, no. But, at the same time, if you don’t have insurance or a way to pay, then you don’t get any treatment if you need it.

So, not a mandate, but a really good idea.

@Bricker

Thumbs-up.

Here I disagree. We don’t provide this tax deduction from the same rationale as, say, individual mortgage interest deductions. The latter is an effort to encourage home ownership. But employer contributions to a plan are compensation, just like the salary and the town car, and are a business expense.

But in the case of salary compensation, the employee pays the tax. (as well as the company on their share of payroll taxes.)

In the case of the employer based, taxes are not being payed at all on the benefit given, and that is true of pretty much all non-salary based compensation, and I would be for eliminating tax deductions on all non-salary based compensations. I guess with the corporate tax rate going down to 15% (allegedly) tax breaks won’t really be all that important to a company anyway.

One of the reasons that I like to move away from employer based health insurance, is because people look at ACA plans, and think that they are more expensive than their employer based plans, but that is because they don’t see the employers contribution. At the very least, companies should be required to tell their employees the dollar value of the non-salary compensation that they receive, that way, at least they don’t think it’s free.

Wow.

I get the motive, but I’m concerned that we’re not thinking this through. What about undocumented migrants, for example?

There are people out there who cannot get effective coverage, no matter how much they try, without some kind of govt subsidized or at least implemented system. Those are the people I am worried about. If it is available and affordable to all, then those who choose not to participate, I am not worried about.

As far as undocumented immigrants, I think it should be much easier for them to become documented, but that’s a different thread, and in any case, I would allow even the undocumented to buy into the public option, though I admit the logistics of that are not easy.

Subject to the concerns I’ve laid out above, absolutely.

Great, your interview is going well so far, and you’ve moved up on a very short list for my nomination for attorney general when I am elected president.
On preview, I saw your most recent post, and I just wanted to clarify one thing.

@Bricker

It’s not clear to me why this “entanglement” is fatal to a state program, I don’t agree that national standards and uniformity are necessary, and I don’t agree that states cannot implement such programs alone. Moreover, I have objection to an interstate compact in which several states agree to jointly approach the problem.

You meant “no objection” there, right?

[Whack-a-Mole]

@Bone

But Medicare doesn’t force employers to do provide something, nor does it force people to buy a product.

How do you think Medicare is paid for?

[Bricker]

@Whack-a-Mole

Ok…

So you are arguing the federal government does not have plenary legislative power.

And it does not.

Later you argued:

And this which derives from the constitution and bears on the question of whether the feds can do healtcare:

Nope. The feds’ ability to do healthcare the way the ACA does is grounded in the taxation power. Never said otherwise. I argue it’s unwise to exercise the federal power in this way, not that it’s unconstitutional. The federal government does not have plenary legislative power, but the ACA mandate is a tax, which is within the feds’ enumerated powers.

[Bricker]

@k9bfriender

On preview, I saw your most recent post, and I just wanted to clarify one thing.

You meant “no objection” there, right?

Oops! Yes, I did.

[RickJay]

@Budget_Player_Cadet

It’s not just that government-run health care is a solution, it’s that it’s far and away, with absolutely no competition, the best solution. If free market health care worked the best, we wouldn’t even be having this conversation. But it doesn’t. The USA’s health care system sucks compared to systems across the world. It’s a straight-up laughingstock.

I am going to, as I usually do, nitpick here; there is a world of difference between government run health care and government run health insurance.

Canada has government run health insurance, or “Single payer,” as it’s usually called. It works reasonably well, and economically speaking, single payer health insurance does make sense. Canada doesn’t have, for the most part, government run health care. My doctor’s a partner in a private health care business.

This distinction is important because I think there is the impression in the USA that all the other industrialized national have adopted the same system. Nothing could be further from the truth; they’re all wildly different. Some are single payer; some are single provider; some are a mix. In some countries, insurance is privately provided but the law says you have to have it - the individual mandate, a la Obamacare. In Germany there are so many private insurance companies I don’t know how people choose one. A lot of them aren’t one system at all (Canada’s is provincial, not national, for instance.) Hell, some countries do a lot of their health spending at a municipal level.

Speaking as a Canadian, a side effect of the ongoing American health care fiasco is that it makes it much harder to improve our system. Allow me to explain; the Canadian system (again, it varies from province to province but national funding laws make them close enough to forget about that for now) is pretty good. However, it’s not perfect, and has some systemic issues, and the costs are getting dizzying.

The thing is, when it comes to health care, Canadians are the most conservative people in the world in the true sense of that word, because they want no basic element of the system to change - because with the U.S. media being such a behemoth in the discourse, many Canadians have exactly the same misapprehension; they think the Canadian way and the American way are the only possible ways it can be done, and that all other little countries in Europe do it the way we do, when in fact they almost universally don’t. IF you suggest any sort of private insurance scheme in basic medical services it’s “oh no that’s the American thing” though in fact it’s also how it’s done in France, Germany and Italy, which have systems we could really learn a thing or two from.

[Steve_MB]

@Kobal2

Axiomatically, a country benefits most when most of its citizens are healthy and financially solvent. That’s when they’re most productive, most likely to invest or become entrepreneurs and create more wealth.

The country benefits from new entrepreneurs and investors. The incumbent cartels would prefer to keep the Teeming Millions as wage slaves rather than potential competition. This is a motivation that may be just as powerful as the more obvious 1%-of-1% tax cuts.

[elucidator]

This right here, this is my point. Unless you have a solid and reasoned objection then it isn’t, this point over here, this is my point. Anyway, I win.

[Slash1972]

@Bone

None of these require a person to buy something. Medicare and VA coverage is health care/insurance and it is paid for by the feds. But Medicare doesn’t force employers to do provide something, nor does it force people to buy a product.

I’m curious about this statement. I just looked at my pay statement and right there it says “Medicare tax…$x.xx”

Isn’t that me being forced to pay for Medicare? I don’t remember opting into it.

[Slash1972]

@k9bfriender

In my example, no. But, at the same time, if you don’t have insurance or a way to pay, then you don’t get any treatment if you need it.

This seems overly harsh, even to me.

[Northern_Piper]

@RickJay

I am going to, as I usually do, nitpick here; there is a world of difference between government run health care and government run health insurance.

Canada has government run health insurance, or “Single payer,” as it’s usually called. It works reasonably well, and economically speaking, single payer health insurance does make sense. Canada doesn’t have, for the most part, government run health care. My doctor’s a partner in a private health care business.

Nitpick to a nitpick: the doctors are private business in Canada, but the hospitals are not, at least not in my province. The hospital system is operated by regional health authorities created by provincial law and which are agencies of the provincial government. They have a lot of delegated powers to run the system free of political management, but this aspect of the health care system is government run health care.

Speaking as a Canadian, a side effect of the ongoing American health care fiasco is that it makes it much harder to improve our system. Allow me to explain; the Canadian system (again, it varies from province to province but national funding laws make them close enough to forget about that for now) is pretty good. However, it’s not perfect, and has some systemic issues, and the costs are getting dizzying.

The thing is, when it comes to health care, Canadians are the most conservative people in the world in the true sense of that word, because they want no basic element of the system to change - because with the U.S. media being such a behemoth in the discourse, many Canadians have exactly the same misapprehension; they think the Canadian way and the American way are the only possible ways it can be done, and that all other little countries in Europe do it the way we do, when in fact they almost universally don’t. IF you suggest any sort of private insurance scheme in basic medical services it’s “oh no that’s the American thing” though in fact it’s also how it’s done in France, Germany and Italy, which have systems we could really learn a thing or two from.

I’ve had this thought as well. Most Canadians only know about our system, and the US system; they may have some knowledge of the UK NHS, which is a single payer with even more government control.

But given the magnitude of the US debate and its influence on our news, we generally don’t know about other options that could lead to even better outcomes. I’ve learnt far more about other health care systems here on the SDMB than I ever saw in our news media.

[Bone]

@Budget_Player_Cadet

And this is relevant because…? Hey, I’d rather have single payer as well.

Because one thing is not like the other. Do you agree?

@Whack-a-Mole

How do you think Medicare is paid for?

With taxes that are then used to pay providers.

@Slash1972

I’m curious about this statement. I just looked at my pay statement and right there it says “Medicare tax…$x.xx”

Isn’t that me being forced to pay for Medicare? I don’t remember opting into it.

That doesn’t contradict anything I said. Government collecting taxes to spend is within the powers of the spending clause. Government forcing you to buy something you don’t want to buy, that’s not government spending. There is no other product that the federal government forces you to buy. If they think it so worthwhile that people have this thing, they can provide it through entitlements.

[jasg]

@Stranger_On_A_Train

The United States is not so unique that the expression of that statement provides some kind of rationale why we shoudn’t ensure that basic health care is available and affordable for all citizens.

Here, let’s find an example. The Swiss Confederation is a federation of independently managed cantons, and has been so since 1848. It is a federal system with direct democratic elections with high measures in all freedom, security, and transparency indexes as well as some of the highest measures of infant, child, and adult health care in the world. It provides privately funded mandatory universal health care across all cantons under the Swiss Federal Law on Health Insurance Krankenversicherungsgesetz, which covers costs of medical treatment and hospitalisation with a modest annual deductable of between US$200 and US$1600, and citizens are permitted to select facilities and doctors they wish as well as purchase supplementary insurance to cover expanded hospital service and other elective procedures. Providers are only permitted to price care at cost with a controlled amount of overhead on the basic plan, but can profit on the supplementary plans which are kept in check by competition and mandated transparency in costs.

The Swiss rate their health care system very highly Their health care costs are less than 12% of GDP compared to nearly 20% in the United States. No one is denied coverage because of pre-existing conditions or due to poor life choices, and their system–a privately funded, federally regulated health care system with transparent and regulated costs–has yet to blow up on itself they way critics claim that the Affordable Care Act is perpetually on the edge of doing, although there are projections of rising costs due to the increasing age of the population and lack of medical specialists, which is an issue that nations across Europe, and pretty much the entire industrialized world, is facing.

How about we try to do at least as well for our citizens in terms of health care and medical coverage as Switzerland does for theirs, and without making health care–an issue faced by everyone regardless of political bent–some kind of absurdly partisan issue or ideological challenge by people who don’t have anything on their bookshelf but The Fountainhead and Atlas Shrugged?

Stranger

The Swiss system is also a fairly recent reform - 1996 and should be instructive to US reformers. As you note, it is far from perfect as these articles show.

IIRC, several years after the initial reform, voters were offered a ballot initiative to cancel the reforms. It was rejected by the voters - they liked the new system too much.

One point that jumped out for me in the second article is:

Importantly, the government forbids insurers to make a profit from the sale of the mandatory package, and it compels them to contract with every single health care provider in Switzerland.

However, I fear that our frontier traditions of medicine shows and snake oil salesmen precludes such a humane business approach to pain and suffering.

[QuickSilver]

@Bricker

The feds’ ability to do healthcare the way the ACA does is grounded in the taxation power. Never said otherwise. I argue it’s unwise to exercise the federal power in this way, not that it’s unconstitutional. The federal government does not have plenary legislative power, but the ACA mandate is a tax, which is within the feds’ enumerated powers.

You’ve stated that the state is in a better position to determine how to manage healthcare for its constituents than the federal government. Can you give examples of ways the state has the advantage in deciding how to care for people with pre-existing conditions?

[Northern_Piper]

@RickJay

I am going to, as I usually do, nitpick here; there is a world of difference between government run health care and government run health insurance.

Canada has government run health insurance, or “Single payer,” as it’s usually called. It works reasonably well, and economically speaking, single payer health insurance does make sense. Canada doesn’t have, for the most part, government run health care. My doctor’s a partner in a private health care business.

Nitpick to a nitpick: while it’s true that the doctors are not government run health care, the hospitals are, at least in my province. The hospitals are all run by regional health authorities, set up under provincial law, and which are provincial agencies. They have a lot of independence in running the hospitals, but they are government run health care.

Speaking as a Canadian, a side effect of the ongoing American health care fiasco is that it makes it much harder to improve our system. Allow me to explain; the Canadian system (again, it varies from province to province but national funding laws make them close enough to forget about that for now) is pretty good. However, it’s not perfect, and has some systemic issues, and the costs are getting dizzying.

The thing is, when it comes to health care, Canadians are the most conservative people in the world in the true sense of that word, because they want no basic element of the system to change - because with the U.S. media being such a behemoth in the discourse, many Canadians have exactly the same misapprehension; they think the Canadian way and the American way are the only possible ways it can be done, and that all other little countries in Europe do it the way we do, when in fact they almost universally don’t. IF you suggest any sort of private insurance scheme in basic medical services it’s “oh no that’s the American thing” though in fact it’s also how it’s done in France, Germany and Italy, which have systems we could really learn a thing or two from.

I agree with this point. Most Canadians know about our system; have heard the horror stories about the US health care “system”; and some may know a bit about the UK NHS, which is a single-payer, like the Canadian system. We don’t know that much about the other options out there, and see it as a choice between the single-payer model, and the US private insurance hell, so sensibly (based on limited information) strongly support the single-payer model.

Heck, I like to think I’m reasonably well-informed on matters of public policy, but I’ve learnt more about the worldwide diversity in UHC systems here on the SDMB that I’ve ever seen in Canadian media.

[Slash1972]

@Bone

That doesn’t contradict anything I said. Government collecting taxes to spend is within the powers of the spending clause. Government forcing you to buy something you don’t want to buy, that’s not government spending. There is no other product that the federal government forces you to buy. If they think it so worthwhile that people have this thing, they can provide it through entitlements.

Fair enough, thanks!

[Whack-a-Mole]

@Bone

That doesn’t contradict anything I said. Government collecting taxes to spend is within the powers of the spending clause. Government forcing you to buy something you don’t want to buy, that’s not government spending. There is no other product that the federal government forces you to buy. If they think it so worthwhile that people have this thing, they can provide it through entitlements.

So if the government taxed me then bought the insurance for me that extra step would make it all ok?

[QuickSilver]

@Bone

That doesn’t contradict anything I said. Government collecting taxes to spend is within the powers of the spending clause. Government forcing you to buy something you don’t want to buy, that’s not government spending. There is no other product that the federal government forces you to buy. If they think it so worthwhile that people have this thing, they can provide it through entitlements.

Isn’t this just a clever way of saying, “I don’t want people covered on my tax dime until they damn well make me by invoking a legal and legislative instrument which I’ll fight tooth and nail to oppose.”?

[DrDeth]

@jasg

Quote:
*Importantly, the government forbids insurers to make a profit from the sale of the mandatory package, and it compels them to contract with every single health care provider in Switzerland.
*
However, I fear that our frontier traditions of medicine shows and snake oil salesmen precludes such a humane business approach to pain and suffering.

That may not be Constitutional in the USA. Bricker?

[k9bfriender]

@Slash1972

This seems overly harsh, even to me.

It would essentially be an opt-out system, so if you are not covered, you chose to not be covered.

If you make the active choice not to be covered, then I see no reason to cover you anyway.

@Whack-a-Mole

So if the government taxed me then bought the insurance for me that extra step would make it all ok?

And that would be single payer.