>So here’s my question: what, if any, mechanisms of enforcement would be constitutional at the federal level?
They could certainly buy the insurance for you and tax you to pay for it without breaking any new ground constitutionally.
Just like auto insurance. The health insurers have a national database. Anytime you’re late for a payment on your insurance, they put a note on your record. Thereafter, anytime you go to a dcotor or get stopped by the cops for any reason, they run a records check. If your number comes up, you get fined/arrested/whatever depending on how late you are with your payments.
One way to do this constitutionally is to have the program administered by the states and to require the states to mandate coverage in exchange for funding, for either this program or other programs such as Medicare, or even unrelated programs.
Good question. I believe Clinton’s plan includes measures that would force companies to insure you. Though I have no idea how that would work.
I thought as much. NJ does the same thing with the auto insurance industry. Basically, in order to sell any insurance in NJ, the company must agree to insure a certain percentage of drivers from the high-risk pool as well. NJ also has the highest auto insurance rates in the country.
Do you want to go without insurance or are you making a calculation based on your age and the cost? You would ,I suspect 'feel a little more secure if you had it. Remember accidents happen.
Most bankruptcies are caused by illnesses. So do not be sure you are safe. Note ,they do not just pick up your cost.
Certainly I’d prefere to have insurance rather then not, but while I could afford it, it would strain my already pretty thin budget and require moving into a smaller apartment and other sacrifices. So I take a calculated risk and hope I can do without for a few years till I start making more money or get a job that provides benefits. My impression is that a lot of twentysomethings (and probably some thirty and fourtysomethings as well) rightly or wrongly make the same calculation, and so your statement that people are only without insurance if they can’t afford it is incorrect. If a law was passed that made it more expensive to not have insurance through fining the uninsured, I would probably tighten my belt and buy it (though this point is partly moot in anycase because as I noted, the Massachsettes model would probably also subsidize or completely cover my insurance, or require my employer to cover it).
Yea, I didn’t mean to give the impression I had illusions that everything would be hunky-dorry if I got sick. I’m sure it would wipe me out, I’m just saying that I’m fairly certain if I start spewing blood from my ears I can go get treated at the ER despite my inability to pay. I’m sure I’d still have to fork over what I have and have my credit rating ruined, etc etc. As I said, its a gamble.
The case with Health Insurance is somewhat different though. For starters, as I mentioned in my last post, a lot of the uninsured are actually low-risk folks like myself, so forcing them to get insurance should actually lower the cost. Secondly, the biggest group of highrisk folks (the elderly) are already insured by medicaid, so this plan won’t make any difference to them.
Finally, while in the case of auto insurance, uninsured high risk folks are (in theory, anyways) unable to drive, high-risk people without health insurance are still quite able to get sick. And when they show up at the ER with blood coming out the ears, someone foots the bill, and that cost gets passed to a combination of tax-payers and the insured. So in theory anyways, forcing insurance companies to insure them shouldn’t do as much to raise insurance rates as forcing auto-insurance companies to insure people who are at high-risk to get in an auto-accident.
Are we talking specifically about the federal government? Because many states mandate drivers to have autombile insurance and there apparently has been no constituional challenge.
Yeah, we’re talking about the federal government. Although, as has been mentioned, one thing they could do is provide some carrots/stricks to states to make states do the dirty work.
IANAL but it seems to me that here is the wayit used to go:
Congress: We want to pass a law that goes beyond what we are allowed to do by the Constitution.
SCOTUS: You can’t. That would violate the tenth amendment
Congress: Awww shucks.
Then when FDR tried his court-packing scheme, SCOTUS decided to play along to get along. Starting with National Labor Relations Board v. Jones & Laughlin Steel Corporation, the conversation was
Congress: We want to pass a law that goes beyond what we are allowed to do by the Constitution.
SCOTUS: You can’t. That would violate the tenth amendment
Congress: Ummmmmmm . . . since the number of lampshade sales in Wyoming affects the price of pants in Vermont, we’re invoking the Interstate Commerce Clause.
SCOTUS: <sigh> Fine. Go ahead.
Since this is so common we just cut out that whole inconvienence of the tenth amendment.
Congress: We want to pass a law that goes beyond what we are allowed to do by the Constitution.
SCOTUS: <sigh> Fine. Go ahead.
But you see, that is not the only tool the the Federal Government arsenal. States could force mandatory health care (depending on the state’s constitution). Here’s how that conversation would go:
Feds: We want you to force everyone in your state to have health insurance.
State: We’d rather not.
Feds: If you don’t, you will never see another dime from us again.
State: You can’t do that!
Feds: South Dakota v. Dole
State: <sigh> You win (again)
Personally, I don’t see Lopez or Morrison having any impact on such a law since those dealt with the criminality of acts. In this case it’s a monetary issue and as we all know, if it involves money the Feds have the final say.
Or, after Raich, one could read the modern principle as this: the IC clause will be used to stop those policies with which the court disagrees. So maybe they’d reject universal health care. (Unless it’s done using a change in tax policy).
I don’t mind going without insurance. When I worked for a company where the premiums kept getting higher and higher on account of we were a very small pool with a lot of employees with long-term medical issues (like MS and cancer), I opted out and went with a higher FSA, and that works for me. I can manage my own care, thank you very much. I don’t need a third-party managed-care provider. I mean, I could afford it, I just didn’t see much point in pouring $600 a month into a thing I was never going to use. If I could have saved it up to use on my final illness it would have been different.
Word. They can’t really mess with the historical aspects of the IC, as it underpins so much of civil rights legislation, and they don’t want to touch that. Doesn’t mean I trust them to be consistent on an ongoing basis.
Too bad they haven’t been asked that question in one of the umpteen debates. I understand it was one of the questions that Fox News was planning to ask. 
Well, I’m sure the National Enquirer would ask interesting questions too. But in the serious media’s defense, candidates on both sides are rarely asked about the specifics of their proposed policies. The very fact that the issue has been discussed in enough depth to determine their respective positions on mandates is a miracle of specificity for a presidential election.
But (at least in Texas) you aren’t required to have automobile insurance unless you have a vehicle. So if you don’t want to pay for auto insurance, you can refuse simply by virtue of not buying a vehicle.
Would there be more governmental control on the insurance companies to keep them from gouging customers? How would they punish you for refusing or being unable to buy it? What if the only insurance you can get is far beyond your financial means?
Assuming we’re basing this on the Massachusettes plan, you would end up paying more in taxes if you choose to go without insurance.
Again, in Massachusettes, there will be gov’t assistence for those who are unable to afford their own insurance.
I don’t see how this would be one of the enumerated powers of Congress, but that horse left the barn a long time ago…
The McCarran-Ferguson Act , gives control over insurance to the individual states.
A Cato article on McCarran-Fergusson
http://www.cato.org/pubs/regulation/reg15n2b.html
The Mass Health plan is a promising plan on a state level. It would not work on a federal level.
This link provides information on Mass Health
I believe the founding fathers would have wanted health care to be distributed as locally as possible. It it easier to customize to a regions needs and capabilities.