Would it be OK for local governments to penalize residents for not buying health insurance?

Wait; WHAT!!! That was a working system???

Oh, I’m sorry. Name five. I mean, there are plenty, right?

Are you sure? 'Cos put me in office & I’ll vote for that law right now. Outlaw all health insurance, from now on fee-for-service upon delivery, howaboutit?

Cute cite. Spontaneous social order is, as your cite shows, a fantastical invention of Western anarchists co-opted for political reasons by Western capitalists seeking to defend their own privilege. Simply looking at that Wikipedia page convinced me the Marxists are more credible. I suppose you also believe in the totally consensual society.

In any case, if you’re equating Soviet-style central planning to a public-private system with private companies selling insurance to persons who can pay a fine rather than buy it (except for employers with group plans, who are locked in, & I thought that was a bad idea too), well…

Actually, it might be an insult to actual central planning. The New Deal engaged in actual price controls, & that seems to have worked out quite well.

It worked fine for the health insurance companies.

Good lord…you are really serious. You have just shown that you have absolutely no idea what you are talking about.

The states have general police power. That means that they have the power to do anything that is not prohibited to them by the Federal constitution (or by the Federal government under one of its constitutional powers). The Federal government has limited power. It can only do things which the Federal constitution empowers it to do. It may help to think of the states and Feds as coming from the opposite ends of the power spectrum (or maybe not, that might just muddy things).

This necessarily means that states are going to be empowered to do things the Feds aren’t empowered to do (and vice-versa). Here are some caveats:

  1. The Feds have general police power in all non-state territory, with perhaps the exception of territory subject to treaty restrictions.

  2. Various states usually restrict their general police power through their own constitutions.

You know, if you’re going to lecture us about markets, you should at least understand the basics of how markets work. No, markets don’t necessarily have more information. Some markets have fundamental problems with propagating information (see, for example, this Wiki article on information asymmetry).

Health-care markets have huge information asymmetry problems, large portions have inelastic supply-demand curves, portions of it exhibit monopolistic or oligopolistic behavior, and there are negative externalities associated with certain individual health-care choices (such as failure to immunize). When you have a market like that, saying you want market mechanisms to handle everything has very specific consequences, which are namely that a lot of people will not be able to afford health care or that they will not have adequate information to make cost-beneficial health-care decisions or that they will be able to shift the costs of bad health care decisions onto others. Now, if you have a personal preference for that, or you don’t think that those specific issues are problematic, then that’s one thing. But pretending that those advocating for UHC don’t understand how markets work is quite another. The fact that you didn’t even acknowledge the issue of information asymmetry in your post indicates to me that you are simply ignoring well-studied issues in the health-care market, rather than acknowledging that they exist and what the implications of those issues are.

Yes market failures exist but their extent can be exaggerated. Many markets would appear to be unable to function yet function quite well; all the arguments you levy can be levied against many perfectly normal markets as well. There are information asymmetries in the used-car market too, yet manufacturers and consumers have settled on a means to mutually verify quality, so that the market isn’t an irretrievable trainwreck.

I note that you neglect the public choice problems of government intervention as well. Unless there are good arguments that the healthcare market is unusually incapable of functioning without government intervention, then, the default should be to let consumers decide how much healthcare they want to purchase. And so far in this thread, the arguments have been underwhelming: 1. We should force the young to subsidize the sick old, even though the latter may be rich, and 2. Mandatory purchase of insurance is merely a self-transfer from young self to old self, which is something I see no reason we should generally enforce.

It is not sufficient to grasp randomly at whatever imperfections there are in a market you don’t like. You have to show that regulation - realistic, interest-group-befouled, regulatory-capture-vulnerable regulation, is actually better than the alternative paths.

The penalty provisions are amendments to the Internal Revenue Service Code (see here. Do a find for the words “Requirement to maintain minimum essential coverage” to find the appropriate section.

In the US, cars have to be one of the most heavily regulated consumer products for correcting information problems (both on a Federal and state level). Used car regulation tends to fall to a state level, but I’m unaware of any major state which doesn’t significantly regulate this market. (There are also all sorts of rent-seeking regulation in this particular market, but let’s avoid that topic, since I don’t advocate in favor of rent-seeking regulation). Pointing at the used-car market just bolsters my argument, not yours.

The question isn’t whether the market is capable of functioning. Markets are always capable of doing something. The question is what end is the market functioning towards? As a society, we don’t care if anyone can afford a ping-pong table, and if the market ends up at a place where lots of people can’t afford ping-pong tables, we shrug our shoulders and think it’s fine. The concern here is whether there is a market mechanism which will provide a base-level of health care to everyone in the most efficient manner possible.

While I’m not a fan of the exchange approach, this approach is the attempt to structure a market which will provide health care to everyone in a cost-effective manner, while still allowing currently insured people to maintain their existing coverage mechanisms. And it’s not something that was pulled out of thin air. It’s a version of the Swiss system, which achieves universal health care while spending around half of the government funds per-capita (IIRC) that our current system does.

Well, I don’t know why people are making these subsidy arguments. The mandate requirement, IMO, is a mechanism to prevent a free-rider problem in an exchange market which requires the insurers to accept everyone regardless of pre-existing condition. You could have an exchange which didn’t have a mandate, but then you’d have to drop the pre-existing condition provision. And if you did that, and then dropped the requirement that hospitals have to treat people who show up in emergency conditions, then you’d have a market where the governments only role was to correct information problems. And in that market, some people, maybe a lot, wouldn’t be able to afford health care, so you wouldn’t get UHC.

Right now, we have a UHC system, because anyone who shows up at an emergency room gets treatment. But our government expenditures per-capita far exceed everyone else in the developing world and on average our system achieves worse health care outcomes (some people, of course, get very good health care outcomes). So, we know that our current implementation of UHC is completely inefficient. The exchanges are an attempt to create a structured market to produce a more cost-efficient health care system which achieves better health care outcomes while still providing UHC.

If you don’t think UHC is something valuable, if you don’t think people who show up at an emergency room should get life-saving treatment or that people with pre-existing conditions should get treatment, then okay, the debate is easy. But if you do want those outcomes, then you have to figure out how to structure the system to achieve them.

You can also just search for ‘1501’ to find the same section.

Interestingly, it includes:

*SEC. 1501. <<NOTE: 42 USC 18091.>> REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

(a) Findings.--Congress makes the following findings:

        (1) In general.--The individual responsibility requirement 
    provided for in this section (in this subsection referred to as 
    the ``requirement'') is commercial and economic in nature, and 
    substantially affects interstate commerce, as a result of the 
    effects described in paragraph (2).

        (2) Effects on the national economy and interstate 
    commerce.--The effects described in this paragraph are the 
    following:

I just noticed, I said “developing world” when I meant “developed world” in my previous post.

Why do you start out mentioning an argument about whether or not the mandate is constitutional and then at the end switch to asking if it’s OK? Do you mean “is it OK” as synonymous for “constitutional?”

If you do, then the answer is simple. States have plenary power, so absent any federal issues and assuming it didn’t violate the state’s constitution in some way, it would certainly be constitutional for a state to force you to buy insurance.

Since cities derive their power from the state, then there is no constitutional bar to a city doing the same thing. Many states follow a form of Dillion’s Rule, which limits municipal government to those powers explicitly granted by the state, so obviously in those cases, it would NOT be permissible unless the state had first authorized the city to do so.

Whether any of this is wise social policy is a different story.

He doesn’t.

But in fairness, you didn’t respond to his challenge, either. While I agree his incredulity at this somewhat basic concept of limited, enumerated federal powers and plenary state powers is… rather extraordinary… the way to rebut it is by example.

So, here are some things that Congress can’t do but states can:

[ol]
[li]Create, for victims of gender-motivated violence, a civil cause of action – that is, give them the right to sue their attackers in court specifically for gender-based violent acts[/li][li]Criminalize possession of a firearm on school property[/li][li]Regulate or require permits for dumping of material into isolated waters – that is, waters that are not navigable or interstate, nor tributaries thereof, nor adjacent to any of these[/li][li]Force a sex offender already living in one state to register as a sex offender there if he had prior offenses in another state [/li][/ol]

OK, Bricker gave me good answers. I understand better now.

But that leaves the question of whether the states’ plenary power could be used to force persons to buy a product from a private firm. And the answer seems to be yes, they could.

So what protects us from a law that every man, woman, & child in the state of Illinois must purchase a brand-new Buick every five years? Only the good sense of the lawmakers. Which good sense presumably also protects us from bad federal laws.

Which is important. All the cited privileges of state plenary power could be taken away without repealing the Tenth Amendment. The states may have courts to say they have plenary power, but they are in no way sovereign.

You may be able to get a court to strike down a law on the basis of some “constitutional” theory, but those have changed before. Remember “freedom of contract”? So it’s not really a matter of the inviolable Tenth, but a matter of using the Tenth as part of a political theory–& that theory as an excuse in place of a real objection on grounds of “good sense,” to manipulate the courts. If this is struck down, it’s just another case of (arguably overreaching) common law, like Roe or Plessy. You may want to pretend there’s a hidden truth in the Constitution, but it will be legislation by the courts, pure & simple.

From a general powers perspective, yes. There might be other federal constitutional barriers to this kind of thing; such a law would have to pass the rational basis test, for instance. But yes: as a matter of “do they have the power, even though it’s not written anywhere?” the answer is that states do and the feds don’t.

And the rational basis test. And maybe the substantive due process analysis of the Fourteenth Amendment.

No. They are in every way sovereign. They have sovereign immunity, for example. You can’t sue a state unless it’s consented to be sued, or unless federal law creates the specific cause of action.

This statement shows either a tremendous disregard for the history of our dual-sovereign federal system, or dramatic ignorance of it.

When do you imagine we switched away from the states being sovereign, anyway?

The federal constitution has since its inception defined a federal government of limited, listed powers, supreme where it reaches but impotent where it does not. Freedom to contract doesn’t particularly fit this story no matter which side of it you might be on; it was an attempt in Lochner v. New York to use the due process clause to create a federal right. Yes, those have changed before. What has not changed is the concept that the federal government must be able to point to the section of the Constitution that gives it power to legislate in a given area, whereas states have always been able to legislate in any area.

What has also changed over the years is how elastic we picture the Commerce Clause to be, since it’s true that a broad interpretation of “interstate commerce” gives Congress quite a substantial reach. But even then, Congress cannot dispense with the requirement; the Violence Against Women Act started out with a finding that violence against women affected interstate commerce. The courts didn’t buy that, which is why they struck it down… but my point is that Congress didn’t attempt to simply create the law without even referring to the fiction of interstate commerce.

Interesting, since I used a bat I bought in Nevada to beat the shit of a a woman just last night…

Here’s the thing, I don’t want to buy any insurance.

If insurance were a great thing, people would buy it voluntarily, instead of having heavily invested politicians vote to make it a requirement, while exempting themselves in many cases. I mean any of it–house, car.

We have all written off the cost of auto insurance as a cost of owning a car, because it’s not a choice. In my state, and most states, it’s a law. Even so, in a lot of reported accident cases, the driver at fault is reported to be uninsured.

Now we will all have to write off the cost of buying health insurance as just another cost of being alive, I guess.

In case you didn’t know, there are people who never go to doctors. There are people who never get sick. There are people who get sick rarely and don’t go to the doctor when they do. There are people who go to naturopaths or homeopaths or acupuncturists who do not accept insurance, and for whose services insurance will not pay. There are people who don’t involve their medical insurance co. in their mental health treatments because then the mental health professional will have to give some kind of diagnosis, and it will be around forever, possibly to their detriment.

There are also things insurance won’t pay for. Maybe you’d like a breast augmentation but you can’t afford it, but you could if you weren’t paying $6000 a year for your health insurance that doesn’t cover it. Maybe you’d like an abortion, but you can’t afford it, but you could if you weren’t paying $600 a month for your health insurance. Maybe you’d like a more effective migraine treatment that doesn’t make you woozy, but your insurance only pays for the prescription that does make you woozy.

And, here’s the one that happens all the time: What if you think you are sick and in need of health care, but your insurance company thinks otherwise?

I know a woman who fell, and even though she was right by the phone, she stayed right there on the floor for four days because she wasn’t sure if Medicare would pay for her ambulance ride. (In fairness, she had some mental issues, too.) She knew that if it turned out she had a broken hip that Medicare would pay, but she wasn’t convinced her hip was broken because it didn’t hurt. (It was broken.)

Two things about insurance. One, if you have it, you are going to be much more likely to want to use it and to go to the doctor for every little thing. TWO, for regular, predictable things–like checkups, or acupuncture if that’s your thing–why can’t people figure out if they can afford it, and budget for it? Mostly I don’t think I will have to be put down like a lame horse if I get ill, because absent other people fucking around with my money, I have enough for the things I need, and can save up for things I want that I can’t immediately afford, and no burden to anyone else, either.

I have been paying into Medicare my whole working life. What I predict is its total dissolution just as I get old enough to see some benefit from all this money.

So yes, it’s about the insurance. I have enough money but not an unlimited amount. I can afford insurance but maybe I’d rather spend the money on a cruise. Or take six months off and go around the world–and what happens with the state-mandated health care insurance I’ve already paid for when I get sick in New Zealand? I’m pretty sure that’s going to be out of network.

As soon as the War Between the States got named the American Civil War in the history books. If it’s a civil war, it’s within a sovereignty by definition.

If the courts still embrace a fiction that the states have anything more than a suzerainty granted by the actual national government, I feel sorry for my country. The “states” have no power to control their own money supply, to enter into treaties, to act independently as states on the global stage, to even control their own borders. There are no citizens of any state in the Union, not even Texas & Alaska, whatever they may think of themselves. There are only American citizens.

You can call the rights granted to the states (which are actually provinces, & nothing more) “sovereignty” but every state west of the Appalachians was created by the federal government & Yankee nation, is utterly a part of same, & underneath it. To protest “state” sovereignty is to distort the word beyond belief.

Maybe it’s a midwestern thing. I was never taught to pledge allegiance to Missouri. I have never met a Hoosier or Ohioan who had any idea that he was not really an American, period. You may as well claim that St. Louis or Indianapolis is sovereign.

So law & tradition may claim that they are sovereign, but the people know that they are part of a whole. The formal definition in law & tradition is wrong in fact, & in fact ridiculous beyond belief. This is a simple fact. America is one sovereign nation, has been since before you & I were born.

Then it’s time we changed that formally.

Then Congress is wrong. Wrong to even pay homage to a right-wing idea of the ridiculous, outdated, superseded Tenth Amendment. USA is not a commercial treaty organization, & “nullifiers” need to man up & try to secede from the Union or go pound sand.

Oh, brilliant idea, lets just throw the entire federal Constitution as it exists today out the window in the biggest power grab in the history of your country. What could possibly go wrong?

Careful…your mask is starting to slip off.