Free Markets, Free People

mandates


The New York Times finally figures out why ObamaCare won’t work. The example? New York.

This info, of course, has been available for years, but those dauntless and investigative reporters within the New York Times organization have just recently stumbled upon an example which, if revealed earlier, might have derailed the ObamaCare train.  Might.  I mean, that assumes every shady technical device known to politicians wouldn’t have been used to ram it through – but who knows, it might have been enough to dampen the vote in the House had it been chronicled.

What in the world am I talking about?  Why the health care system in New York state – the one the flagship NYT suffers under.  The health care insurance system that’s been in place for years – decades even.

New York’s insurance system has been a working laboratory for the core provision of the new federal health care law — insurance even for those who are already sick and facing huge medical bills — and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients’ advocates say that New York’s extensive insurance safety net for people like Ms. Welles is falling apart.

The problem stems in part from the state’s high medical costs and in part from its stringent requirements for insurance companies in the individual and small group market. In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.

New York also became one of the few states that require insurers within each region of the state to charge the same rates for the same benefits, regardless of whether people are old or young, male or female, smokers or nonsmokers, high risk or low risk.

Healthy people, in effect, began to subsidize people who needed more health care. The healthier customers soon discovered that the high premiums were not worth it and dropped out of the plans. The pool of insured people shrank to the point where many of them had high health care needs. Without healthier people to spread the risk, their premiums skyrocketed, a phenomenon known in the trade as the “adverse selection death spiral.”

You remember the outrage when an insurance company in California tried to raise its premiums 30+%?  It cited “adverse selection death spiral” as the reason – it is covering sicker people who are much costlier while the healthier are leaving the plan due to the cost.  Massachusetts is undergoing the very same phenomenon. the four non-profit insurance providers have requested rather large premium increases (and been denied them) for the very same reason as the California company And now we discover, New York – which, as the article points out  has been a “working laboratory for the core provisions of the federal health care law” for years – is and has been playing out the precise outcome many who opposed this bill foretold.

And somehow, until now, that never managed to find its way into the pages of the Times.  As an aside, I have to say that since it has turned to advocacy journalism, it is a pale shadow of its former self and that’s one of the reasons it is headed toward ruin.

Anyway, apparently the politicians in DC learned from the New York debacle.  Thus the individual mandate and the fine on employers for not covering their employees.  Otherwise, as New York has proven:

“You have a mandate that’s accessible in theory, but not in practice, because it’s too expensive,” said Mark P. Scherzer, a consumer lawyer and counsel to New Yorkers for Accessible Health Coverage, an advocacy group. “What you get left clinging to the life raft is the population that tends to have pretty high health needs.”

And the Democrats don’t want the insurance companies to be able to charge the sick what is necessary to cover them.  Instead they want to force healthier Americans to subsidize the expense through coercive mandates and fines.

Amazing – and yet there are those among us who will look you in the eye, and with a straight face tell you this is exactly what the founders of the country envisioned when they wrote the Constitution.

~McQ


What Happened To The Mandates?

One of the more pernicious provisions of the ObamaCare bills working their way through Congress is the mandate to purchase health care insurance. It’s probably unconstitutional (arrogating to the federal government an unprecedented power to force Americans to purchase a service or product), but that isn’t going to stop it from being shoved down our collective throats anyway. According to a DKos blogger, however, the Senate bill removes the provision’s bite, which may render it constitutionally valid:

To briefly recap- the HCR requires everyone (except native americans, low income people, undocumented immigrants, followers of my cult, the grandfathered**, etc) to purchase health insurance. Violators will have to pay a $750 per head penalty on their tax returns starting in 2016. If you want to pull a Keith Olbermann and become a Mandate dodger, predictably, the HCR has this to say about it:

SEC. 5000A(g)(1)

(1) IN GENERAL.—The penalty provided by this section shall be paid upon notice and demand by the Secretary, and except as provided in paragraph (2), shall be assessed and collected in the same manner as an assessable penalty under subchapter B of 23 chapter 68.

The IRS will have your ass, etc, etc. All very predictable. UNTIL you read on to section (2):

(2) SPECIAL RULES.—Notwithstanding any other provision of law—
‘‘(A) WAIVER OF CRIMINAL PENALTIES.— In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
‘‘(B) LIMITATIONS ON LIENS AND LEVIES.—The Secretary shall not—
‘‘(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
‘‘(ii) levy on any such property with respect to such failure.

Woah!!!! The mother of all loopholes! It turns out the mandate is not mandatory because the penalty is purely voluntary! What happens if you failed to pay that penalty? Nothing! No criminal charges will be filed, no penalties will be assessed, and the IRS has no right to file any lien on you. Imagine a judge saying to a convict: “This court hereby sentences you to death. Pssss- don’t worry, son- our electric chairs are not plugged in.”

Of course, just because the teeth were removed in the Senate bill doesn’t mean that they won’t be added back in when it gets reconciled with the House version.

Nevertheless, it is interesting that the Senate would make the penalty seemingly voluntary. I say “seemingly” because the provision’s language leaves open the door to other means of exacting a penalty from non-compliers. While Section 2 negates criminal penalties and prohibits liens or levies from attaching to a taxpayer’s property, just what constitutes someone’s property isn’t spelled out. It may surprise you to learn, for example, that tax dollars are not deemed your property by the federal government, such that once they are paid (or deemed owing) you don’t have any say in how they are spent outside the ballot box. By the same token, if you were to be due a tax refund of some sort, this provision appears to allow the federal government to withhold the $750 penalty. Similarly, it could also declare certain dollar-for-dollar income deductions to be invalid (up to $750) if you refuse to abide by the mandate. My reading of the provision would allow all sorts of federal government gimmicks to be used while still remaining within the letter of the law.

Another interesting aspect of Congress placing this muzzle on the mandate, is that we know it will raise costs. Indeed, the CBO has stated about other bills that an ineffective individual mandate would make the costs skyrocket as the uninsured wait until they are sick before getting any coverage. Without paying into the system from the start, this sick population will basically just receive heavily subsidized health care, paid for by the dopes who paid while they were healthy.

In short, Congress is faced with two poison pills and must choose one: either (i) unconstitutionally force Amercians to purchase insurance, or (ii) create mandates without teeth, and ensure that the bill costs far more than promised. It will be interesting to see which of the two survives.


Health Care “Reform”: A Little History Is Always Useful

Daniel Henninger gives us a little walk down memory lane to remind us of the effect of our first attempt at “health care” reform.

Back before recorded history, in 1965, Congress erected the nation’s first two monuments to health-care “reform,” Medicaid and Medicare. Medicaid was described at the time as a modest solution to the problem of health care for the poor. It would be run by the states and “monitored” by the federal government.

The reform known as Medicaid is worth our attention now because Mr. Obama is more or less demanding that the nation accept another reform, his “optional” federalized health insurance program. He suggested several times before the AMA that opposition to it will consist of “scare tactics” and “fear mongering.”

Whatever Medicaid’s merits, this federal health-care program more than any other factor has put California and New York on the brink of fiscal catastrophe. I’d even call it scary.

Anyone who has paid any attention to the health care debate know full well that Medicare and Medicaid have become huge black holes with future funding obligations in the tens of trillions of trillions of dollars.

Now, pointing that out and doubting the government’s ability to do any better is apparently “scare tactics” and “fear mongering”. Reminds me of the AGW nonsense.

After 45 years, the health-care reform called Medicaid has crushed state budgets. A study by the National Governors Association said a decade ago that because of “new requirements” imposed by federal law — meaning Congress — “Medicaid has evolved into a program whose size, cost and significance are far beyond the original vision of its creators.”

There is nothing to convince anyone that the same won’t happen with a “public option”. And although the present plan is to have such an option pay for itself through premiums, there’s nothing to stop Congress from deciding the taxpayer should pick up the tab at some point in the future.

In his speech, Mr. Obama said the cost of the Public Option won’t add to the deficit: “I’ve set down a rule for my staff, for my team — and I’ve said this to Congress — health-care reform must be, and will be, deficit-neutral in the next decade.” If we’re honest, that means tax increases are inevitable.

The thing to remember – “deficit-neutral” doesn’t necessarily mean cuts in spending. It means that revenue must equal spending and that obviously means that spending increases must have added revenue – tax increases.

There is some resistance starting to form to the “reform”. The Democrats plan on rushing this through with limited debate. If they succeed, “Son of Medicare” will wander out the government lab and bankrupt this nation much more quickly than now anticipated.

~McQ