IANAL and I have not read the complete unabridged text of the bill but so far as I can tell the only piece that is likely unconstitutional is the individual mandate, correct? The commerce clause can be very powerful provided commerce is already taking place but I am not aware of precedent allowing it to coerce one into commerce in the first place.
Is there such a precedent? Would the existence of such a precedent be a good thing in the long term? I'm inclined to support this bill 100% but I just don't know what kind of effect this could have on businesses in the future.
That's an open question. The legal term is "severability". Sometimes an entire law (or contract) will be struck down if one part is found to be illegal or invalid. Other times just the invalid part will be cut out, and the rest will still be enforced. It can go either way, depending on very specific details of the law (or contract), drafting history, previous precedents, etc.
Often, a law (or contract) will contain a severability clause specifically saying what will happen. (Contracts almost always say that the contract should stand if any clause is found invalid.) The problem here is that the ACA's drafters (perhaps foolishly) did not consider the possibility of a constitutional challenge, and did not include a severability clause into the law.
If the mandate is found unconstitutional, the court will also need to rule on the severability question; it's very uncertain at this point which way they'll rule (if they have to rule at all).
(Bonus question: Do we want the ACA struck down if the mandate is struck down or not? The law does a lot of things, some of which are quite good, and would still work just fine without the mandate clause. On the other hand, guaranteed issue and community ratings without a mandate might completely destroy the health insurance market, without replacing it with anything else, which would be a disaster. The Court is highly unlikely to rule that it's partially severable, so we'll probably see the whole ACA struck down, or only the mandate. In theory, Congress could fix it either way the next day...but in practice it's likely to be terrible deadlocked. Messy.)
I rather hope the bill stands or falls as a whole. The individual mandate is one of the lynchpins of the bill. Without it, the bans on annual limits and discrimination against people with pre-existing conditions that are coming in 2014 will probably force premiums to increase considerably. Admittedly there's plenty of good stuff in the act beside all that, but I fear it's still better to lose everything in the bill than it is to lose the individual mandate but not the things that need the individual mandate to be feasible.
There are such precedents. Right wing lawyers and bloggers tend to deny that such precedents exist, and left wing lawyers and bloggers tend to say that they have more meaning than they probably do—but there are precedents.
Probably the best example in Linda Greenhouse's essay for the NYT (http://opinionator.blogs.nytimes.com/2012/03/21/never-before...) is the Emergency Medical Treatment and Labor Act (it prevents hospitals from refusing care to uninsured patients; this coerces hospitals into commerce. (That a law had to be passed to make this the standard is IMO disgusting. Obviously the Hippocratic oath applies only to doctors and not to hospital bean counters.)
It's worth noting (a few paragraphs later) that EMTLA has a knock-on effect, too: you or your employer pays for all of this uninsured/underinsured treatment through higher premiums. Greenhouse: "The uninsured don’t exist apart from commerce. To the contrary, their medical care results in some $43 billion of uncovered health care costs annually and, through cost-shifting, adds $1,000 a year to the average cost of a family insurance policy. People who don’t want to buy broccoli or a new car can eat brussels sprouts or take the bus, but those without health insurance are in commerce whether they like it or not." This 1986 law actually makes your insurance more expensive, forcing you into commerce that you may not be interested in.
The flaw with Obamacare—and the only way it could have been passed because of the complete and total insanity of American politics today—is that it doesn't actually establish universal healthcare. If the individual mandate had been instead cast as a tax which is then used by the individual to select their insurer (IIRC a key feature of the Clinton healthcare plan that was scuttled), then it would have been no different than Social Security (which has whiners saying "but I will have a better retirement plan, so why should I be paying this?"—tell that to the people living large on their Enron 401(k)) or school taxes (which has childless and empty-nest whiners saying that they don't get benefit from schools) or anything else where there's a mandate that you pay something for a benefit that you may or may not use in a particular year.
Sorry. I'm completely baffled by what's happened to American politics in the last decade. I was disgusted enough with what was going on during the Clinton years that it was an easy choice for me to emigrate to Canada (not perfect, and some of our politicians are emulating American belligerence a little too much, especially the local moronic mayor), but now I don't even recognize the country in which I was born. It saddens me.
Zero, seeing has AHCA doesn't provide universal health care either (but it's a baby step in the right direction).
According to what I understand, the U.S. has had three chances at something approaching universal healthcare—in the late 60s/early 70s around the same time that Canada was dancing around the same question; in the 90s under Clinton; and under Obama. Given that it took about fifty years after Canada[1] to even get this passed…it will likely be a long time before anything rational gets passed.
[1] Per Wikipedia, the Federal framework for jointly-funded universal healthcare in Canada was passed in 1966 under Pearson, and it was strengthened in 1984. OHIP was first created (as OMSIP) in 1966, reinvented in 1969 (as OHSIP), and finally renamed in 1972 to OHIP.
You could always go for the European-style universal healthcare, where the Government pays for everything. You'll need to have higher taxes, though, or cut some of that military/war budget.
A rarely talked about fact is that the US government already spends more per-capita on health care than European governments do. (No, really!)
So actually, it's perfectly possible for the US to enact universal healthcare and cut overall healthcare spending at the same time.
(Also, minor quibble, but when you say "Government pays for everything" you're really talking about "free at the point of use" healthcare. That's one system of universal healthcare used in Europe - and elsewhere - but not the most common one.)
Honestly, I hope America gets universal healthcare as well. I just don't get "if this is struck down, it'll pave the way for true universal healthcare." I think, logically, that universal healthcare would be more likely without the individual mandate in place. At the same time, politically, this will come as a major blow and be seen as many voters as a court rejection of socialized medicine in the US (even though that's not the conclusion will even draw).
It's not paving the way, it's removing an obstacle - this act while weakening insurance companies on one level, makes them much stronger with more guaranteed revenues, thus making their lobby stronger. A stronger insurance lobby would oppose universal health care with more determination.
Some people aren't in a position to take on the risk of entrepreneurship. Counting those with significant medical conditions among them doesn't strike me as abnormal.
If society is geared to reward risk takers who succeed, it seems that if society were then to eliminate a good deal of that risk, something in the arrangement would be lost.
How is universal healthcare any different to start ups than a government funded insurance policy that pays a modest amount when your startup fails?
My friend drives a nice sports car. He's outraged at the cost of dental work. He thinks dental care should be free to Americans. How is that any different that government subsidized sports cars?
Seriously? You can't compare a luxury item like a sports car, or a magical "government startup insurance" with medicine. Neither of those other two items realistically reduce actual pain and suffering, while providing health care universally can definitely be shown to.
I'm a Canadian and quite happy with our socialized health care. It's one of the reasons that I've been able to make the leap into entrepreneurship - I'm on my third product now. I have no pre-existing conditions, but I know that I'll receive no life-ruining bills from the government if something does change in my health situation.
The average age of a tech startup founder is 39, and a % of those have families. They should not have to risk financial ruin as a tradeoff for starting a company that could provide jobs.
Exactly. I'm in this position now: a single breadwinner with a child. As a Canadian, I don't risk financial ruin for any health-related issues (unless I travel to the US without health insurance, of course).
This was a big factor in me making the jump to founding a company from up here in Canada. Hiring folks with families in the USA was a huge pain for us, specifically because of the health care issues. We were paying a lot for them to extend their current health care from their previous employers, and one had the added stress of having a pregnant wife at the time we brought him over, with all the complications that brings to the health insurance story.
Hiring a fellow Canadian was basically a cakewalk.
Actually, I think the ACA does improve the situation he describes. Small companies, like start-ups, wouldn't be required to purchase health insurance and people whose earnings teeter at the edge of "ramen profitable" would likely be eligible for extensive subsidy.
Instead of shelling out 17k/year, get a 5k deductible policy, and pay for the doctor visits yourself. put the 5-10k you save per year in some sort of investment you can get at when you really have to. Something like an index fund if you're young, or bonds if you're older.
Those 5k deductible policies still cost $500 a month for family in a small group and leave you really exposed to 15k per person (max out of pocket) and max 45k out of pocket for the family. That's not inline with what healthcare should cost. An individual may pay $75 for that same policy but still have exposure of around 15k per year max out of pocket.
The HSA plans are just as expensive as middle of the road plans as well and are geared towards people who save a lot to begin with.
a 64 year old with a drug problem and 3 kids is looking at 31k a year (worst case, 6k best case).
what, exactly, are you looking to have happen? it's either socialized, where healthy people subsidize the sick, or it's not, or there is some gradient between the two.
I think, right now, you're looking at about 6k/year per person. you can divide that up however you want... billg pays all of it, you pay your own way, or some point on the gradient between the two. regardless, the money has to come from somewhere. I kind of like the obamacare, everybody contributes something model. I think i'd prefer it as a straight up tax, but FREE MARKET IS AMAZING, RAWR, so whatever. that's fine.
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or we just let people die. i'm not ok with that.
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I need to qualify that, this is only for people that aren't poor or old (which medicare and mediaide cover already) or for veterans (which have their own system) or kids (chips it think it's called). this is exclusively for working class kinda folks who never went to war. the other 60% are already covered by socialized medicine.
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why the hell am i participating in an /r/politics discussion on hn? i'm obviously dumb.
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Thank you for simply downvoting and not replying. this way, i can go to sleep not worrying you're expecting a reply.
Assuming this is not a blatant troll, but someone severely ignorant on why we have healthcare. If you're a troll, please excuse me for wasting my time.
So?
You think it's good for the society to operate as a lottery? Those who get sick die or endure lifelong misery, and those who don't get to enjoy a productive life. You think the sick will just disappear and stop bothering you with their constant wheezing?
Maybe you should learn from the history of humankind and what access to healthcare has done to benefit us all (and not just those who get sick).
It's probably cheaper... It certainly results in better quality of life.
Why don't we use that rationale to justify complete regulation of food consumption? Let's have the government force all citizens to eat a vegan diet. The economies of scale would certainly make it cheaper to consume. Overall health would improve. And we would all have a better quality of life...
Except for that little word "force". What if I feel like a milkshake today or a nice juicy steak every once in a while? If I can afford it, and it doesn't hurt anyone else (humans at least), I should be free to purchase those things.
When you're required to eat things, or required to pay for things... OR GO TO PRISON, you're not really free anymore, and that's why Americans don't like government programs like ACA or socialized health care. It might make sense on paper and look just like a big insurance pool, but in reality, it looks more like a centrally planned market, where price signals and efficiencies are non-existant, because when your doctor has a guaranteed paycheck from Uncle Sam, he lacks an incentive to make sure you get the best care. When medical students realize that reimbursement rates have dropped to the point that they can't afford to repay their student loan for a very long time, we'll get fewer doctors, or standards will drop.
I'd rather pay a little bit extra for poor people to get free care than to force me into a one-size fits all plan with long wait times for special procedures. Let's at least fix the problem of poor people not being able to afford a decent level of care before we force everyone into a one-size fits all government program with promises it can't keep, like Social Security and Medicare.
If this statement is a fact it will have evidence, and if it is an opinion it will have a justification. A productive discussion will necessarily have one or the other.
Is there such a precedent? Would the existence of such a precedent be a good thing in the long term? I'm inclined to support this bill 100% but I just don't know what kind of effect this could have on businesses in the future.