According to Ezra Klein, the Obama administration intends to finagle universal health care coverage out of its budget proposal, including an individual mandate:
I’ve now been able to confirm with multiple senior administration sources that the health care proposal in Obama’s budget will have a mandate. Sort of.
Here’s how it will work, according to the officials I’ve spoken to. The budget’s health care section is not a detailed plan. Rather, it offers financing — though not all — and principles meant to guide the plan that Congress will author. The details will be decided by Congress in consultation with the administration.
One of those details is “universal” health care coverage.
Some of you may recall that Obama, while in campaign mode, consistently denied that he wanted to introduce mandates as part of his health care package. Paul Krugman cited that opposition as the major difference between Obama and Hillary Clinton:
Let’s talk about how the plans compare.
Both plans require that private insurers offer policies to everyone, regardless of medical history. Both also allow people to buy into government-offered insurance instead.
And both plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.
But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn’t.
Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.
Now that he’s been elected it’s presto hope’n change-o, and voila! Mandates!
Ezra Klein notes that the difference between the pre- and post-election plans is based on one word in the budget — “universal”:
That word is important: The Obama campaign’s health care plan was not a universal health care plan. It was close to it. It subsidized coverage for millions of Americans and strengthened the employer-based system. The goal, as Obama described it, was to make coverage “affordable” and “available” to all Americans.
But it did not make coverage universal. Affordability can be achieved through subsidies. But without a mandate for individuals to purchase coverage or for the government to give it to them, there was no mechanism for universal coverage. It could get close, but estimates were that around 15 million Americans would remain uninsured. As Jon Cohn wrote at the time, “without a mandate, a substantial portion of Americans [will] remain uninsured.”
In essence, unless everyone is forced to buy insurance, there is no “universality,” and the benefits of large participation in the insurance pool cannot be realized. An even shorter version is, if healthier people opt out, then sicker people can’t sponge off them.
The budget — and I was cautioned that the wording “is changing hourly” — will direct Congress to “aim for universality.” That is a bolder goal than simple affordability, which can be achieved, at least in theory, through subsidies. Universality means everyone has coverage, not just the ability to access it. And that requires a mechanism to ensure that they seek it.
Administration officials have been very clear on what the inclusion of “universality” is meant to communicate to Congress. As one senior member of the health team said to me, “[The plan] will cover everybody. And I don’t see how you cover everybody without an individual mandate.” That language almost precisely echoes what Senate Finance Chairman Max Baucus said in an interview last summer. “I don’t see how you can get meaningful universal coverage without a mandate,” he told me. Last fall, he included an individual mandate in the first draft of his health care plan.
The administration’s strategy brings them into alignment with senators like Max Baucus. Though they’re not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody.
So it looks like you better start scarfing down those cheeseburgers, eating transfats, smoking cigarettes, or whatever it is you do that’s not considered healthy, because once the federal government pays for health care (which is what individual mandates essentially works out to), then it also has the power to determine what “healthy” means. After all, since everyone will be pulling from the same health care pot, and since each claim on that pot diminishes what someone else can get, then each claim must be a legitimate one as weighed against all the competing interests. Because the viability of the system depends on healthy people making much fewer claims than sick people against the collective health care resources, the government now has a vested interest in making people healthier, whether they like it or not.
Another way to put it is that we will have entered a Pareto optimal world where no one can change their position for the better (i.e. receive more of the pooled benefits) without hurting someone else. Whereas in a competitive market system, each person can get at least as much health care as he or she wants to buy and can afford, in a Pareto optimal world, we are competing for the same scarce resources (health care dollars), and our claims are granted based on a a third party’s (the government’) determination of worthiness. No longer can we get what we can afford, we get a predetermined portion of what the government decides to pay for. That, of course, is why there are 6+ month waiting lists for routine health care in places like Canada and the UK.
Possibly the most depressing result of yoking America with universal health care, is that we can pretty much kiss medical and pharmaceutical innovation good bye.
Government run health centralizes the risks of exploring new technologies, medicines, techniques, etc. Centralized risk translates into (i) observing a very cautious approach to advances, and (ii) the politicization of research … From a purely capitalist point of view, opportunites that might have been pursued otherwise, are foregone since those who accept the risks of pursuing them do not get to maximize their reward, so instead those advances must come from the government. With government as the sole innovator, there are now two types of risk (1) the risk of failure (i.e. spending gobs of money on something that does not deliver as promised, or that costs significantly more than the benefit), and (2) the political risks (i.e. what politicians face for advocating spending on projects that either fail or that don’t disproportionately benefit favored voters). The result is that risk is increased overall, and fewer innovations are realized.
America is pretty much the last industrialized nation to still have a (semi) private health care system, which should be understood to include the pharmaceutical industry (as a supplier of that health care system). What would happen to the growth and advances we’ve realized over the past few decades if (when?) we adopt universal health care? Where will the innovation come from? Who will take the risks? Without the proper incentives, and indeed with some of the worst possible incentives as the only driving force to creation, I fear that the scientific and medical Atlas will shrug.
I don’t mean to say that there will be no breakthroughs ever again, but the pace will be slowed dramatically. That’s because, one the government is in charge of paying for health care, it will also be in charge of paying for medicines. As we’ve already seen around the world, drug companies will be forced to sell their wares for much less than the (legal) monopoly prices they charge now. The result, therefore, will be much less risky and expensive research into new drugs that may never come to market, and much more emphasis on improving old drugs so as to continue to pay for further research.
Surely the federal government will pony up money for research into some diseases. But then the government will be in charge of picking winners and losers when it comes to whose diseases will get cures and whose won’t. To imagine what this would look like, just think back to how AIDS and breast cancer research dollars were successfully lobbied for, despite neither affecting anywhere near as many people as other deadly diseases.
In the end we will be left with less individual freedom, worse health care, and fewer prospects for any improvement in either. That is not the change I was hoping for.
UPDATE: Tom Maguire helpfully reminds us of how the health care debate progressed during the Democratic primary season:
For folks whose memories have blessedly erased any recollection of the endless Democratic candidates debates, let me toss in a brief reminder. Obama claimed that he would offer health insurance subsidies so generous that most folks would volunteer to sign up. Hillary mocked that, insisting that the young and healthy would decline to subsidize the rest of us, especially since they could not subsequently be denied coverage on the basis of pre-existing conditions; her plan included a mandate obliging everyone to buy health insurance, like it or not (as in Massachusetts). Hillary then diligently ducked the “or else” question of what penalties she would inflict on the young, helathy and recalcitrant who would prefer to hold off on buying insurance until they were sick. As a nostalgia piece here is a link to a lefty wondering why his party was so committed to forcing young, healthy members of the working class to subsidize the rest of us on health care; that seems like a good question but I am long resigned to not being smart enough to be a lefty.
Aww, Tom. You’re plenty smart enough. Just not angry, bitter or jealous enough.
As for the “or else” question, Obama and the Congress won’t be able to duck that one. I can only imagine what sort of sword they intend to dangle of recalcitrant ,
comrades citizens who refuse to sign up for the program.
This comes as close as anything I’ve seen:
[H]ate speech is an objectively meaningless concept created by ideological bigots who are incapable of defending their ideas without government intervention.
I‘ve written about this issue before, and said all I think there is to say about it. The fact is that any bill coming out of Congress granting voting rights to D.C. sua sponte is plainly unconstitutional. What’s more, Congress is already well aware of this fact. The Congressional Research Service, the legislative analysis advisors to Congress, deduced the following about H.R. 328 (the most recent precursor to current D.C. voting rights bill):
… it is difficult to identify either constitutional text or existing case law that would directly support the allocation by statute of the power to vote in the full House to the District of Columbia Delegate. Further, that case law that does exist would seem to indicate that not only is the District of Columbia not a “state” for purposes of representation, but that congressional power over the District of Columbia does not represent a sufficient power to grant congressional representation.
In particular, at least six of the Justices who participated in what appears to be the most relevant Supreme Court case on this issue, National Mutual Insurance Co. of the District of Columbia v. Tidewater Transfer Co., authored opinions rejecting the proposition that Congress’s power under the District Clause was sufficient to effectuate structural changes to the federal government. Further, the remaining three judges, who found that the Congress could grant diversity jurisdiction to District of Columbia citizens despite the lack of such jurisdiction in Article III, specifically limited their opinion to instances where the legislation in question did not involve the extension of fundamental rights. To the extent that the representation in Congress would be seen as such a right, all nine Justices in Tidewater Transfer Co. would arguably have found the instant proposal to be unconstitutional.
During hearings before Congress on the constitutionality of the D.C voting rights bill, Deputy Assistant Attorney General John P. Elwood provided an excellent breakdown of how legal authorities had consistently found that the only way to grant D.C. citizens the right to congressional representation was through a constitutional amendment or by admitting D.C. as a state. Simply passing a law would not suffice.
Despite all the analysis presented, however, Congress continues to press forward with an unconstitutional bill:
Debate opened Monday on a bill to give the 600,000 people of Washington D.C. a full vote in the House. A new Democratic president, Barack Obama, and heftier Democratic majorities in Congress have improved the prospects for the decades-long effort that would certainly ensure another Democrat lawmaker in Congress.
Democrats outnumber Republicans by some 4-to-1 in the capital.
In a bit of horsetrading to offset the Democratic pickup, the bill would award a fourth House seat to Republican-leaning Utah, which narrowly missed getting that extra seat after the 2000 national census. With the two new seats, the House would have 437 representatives.
The time is ripe, said Ilir Zherka, executive director of the advocacy group DC Vote, to end a situation where “we are the only capital of a democracy on the planet that denies voting representation in the national legislature.”
The time is ripe because Democrats have a huge majority in both houses of Congress, and control of the White House. The fact that D.C. votes reliably, and overwhelmingly, for Democrats is the real reason for the bill’s support amongst that party, and one of the main reasons for many Republicans being against it. To overcome the opposition, therefore, Democrats have thrown a sop to Utah in the way of an extra representative, which would also appear to be unconstitutional without a census. Either way, the fact that the bill is plainly contrary to Article I, Section 2 of the Constitution seems to be merely a convenient excuse for some Republicans and a minor inconvenience to some Democrats.
Jonathan Turley has consistently echoed the above, and eloquently explains why Congress should not pass this law, and why the President should not sign it:
Like many, I believe that it is a terrible injustice for the District residents not to have a vote in Congress. As Justice Black stated in Wesberry v. Sanders: “No right is more precious in a free country than that of having a voice in the election of those who make the laws under which, as good citizens, we must live. Other rights, even the most basic, are illusory if the right to vote is undermined.” However, the great wrong done to the District residents cannot be righted through the violation of the Constitution itself.
This is not a debate about the ends of legislative action but the means. In a nation committed to the rule of law it is often as important how we do something as what we do. This is the wrong means to a worthy end.
[Our Constitution] is the world’s most successful constitutional framework because it is carefully balanced with limited powers between the three branches. It is a design that can be frustrating at times when injustices demand quick action. Yet, the very stability and integrity of our system demands that we remain faithful to its provisions, even when our principles stand in the way of our passions.
Just as there is no debate over the need for a vote for the District, there is no debate that such a vote can be obtained by other means. Indeed, there is no longer any claim to be made that the District (or the Democratic Party) lacks the votes needed to take a constitutional course. The political realities and expediencies that gave raise to this idea no longer exist. With control of both houses and the White House, the sponsors can secure a lasting and unassailable vote in the House of Representatives through either retrocession or a constitutional amendment. Indeed, some republicans have expressed their support for a constitutional amendment that would allow a voting House member for the District.
Like Turley, I am in favor of D.C. residents having a vote in both the House and the Senate. And also like him, I am fervently opposed to any extra-constitutional means of accomplishing that goal. Instead, let’s draft an amendment, or begin the process of retroceding D.C. back to Maryland. Let the Maryland officials be accused of wanting to oppress D.C.’s denizens for a while, instead of those of us who simply want to uphold the Constitution.
We know how to make it happen, and yet Congress insists on doing it the wrong way. Much of it, of course, is sheer laziness and want of expediency. But that is no excuse for elected officials to blatantly disregard their roles as stewards of the contract between the people and their government, and the very source of those officials’ power. Minor as some of these indiscretions may be, when Congress takes it upon itself to decide which parts of the Constitution are worth following and which are not, then we become a rudderless ship of fools.
However it’s done, I heartily agree that we start the process of welcoming our D.C. brothers and sisters to the circus known as Congress. In order to make that welcome worth something, however, I recommend that we go about it in the way that passes constitutional muster.
UPDATE: As it turns out, a bill has been introduced by Rep. Louis Gohmert (R-TX, 1st Dist.) to retrocede D.C. back to Maryland. Funny how this bill hasn’t received any news attention.
No doubt this will somehow end up being blamed on “global warming”:
A rocket carrying a NASA global warming satellite has landed in the ocean near Antarctica after an early morning launch failure.
The mishap occurred Tuesday after the Taurus XL rocket carrying the Orbiting Carbon Observatory blasted off into the pre-dawn sky from California’s Vandenberg Air Force Base.
“Orbiting Carbon Observatory”? It is apparently now the “Submerged Carbon Observatory”.
In other climate change news, it seems the new “Climate Czar” is ready to rock and roll on the question of carbon regulation:
President Barack Obama’s climate czar said Sunday the Environmental Protection Agency will soon issue a rule on the regulation of carbon dioxide, finding that it represents a danger to the public.
The White House is pressing Congress to draft and pass legislation that would cut greenhouse gases by 80% of 1990 levels by 2050, threatening to use authority under the Clean Air Act if legislators don’t move fast enough or create strong enough provisions.
Note that last line – certainly what one would expect an unelected “czar” to do, wouldn’t you say? Note also that the EPA intends to declare CO2 a “danger to the public”. Yes friends, the gas you exhale as a part of your respiration, the one that plants use in photosynthesis, is suddenly going to be a “danger to the public”.
Officially recognizing that carbon dioxide is a danger to the public would trigger regulation of the greenhouse gas emissions from coal-fired power plants, refineries, chemical plants, cement firms, vehicles and any other emitting sectors across the economy.
All those economic sectors and industries which are supposedly going to be engaged in our recovery via infrastructure improvement, providing critical power and fuel or on the list to be rescued by bailout funds. Does that make any sense at all?
Critics of putting an expensive premium on carbon say that such a schedule may be overly optimistic given the global financial crisis and the ramifications that putting a cap on greenhouse gases would have across nearly every sector of the economy. Tough action too fast, they say, not only could curb manufacturing and create an energy crisis by halting new power plant construction, but also could force a rapid migration of businesses overseas to cheaper energy climes.
But zealots don’t really care about such things – I mean, this is about “saving the planet” you know? And this isn’t just about Browner. She has some powerful backing:
Specifically, Obama wants an economy-wide law – instead of just some major emitting sectors – and to auction off 100% of the emission credits, which analysts say could exponentially increase the cost of emitting, as well as the pay-off for low-carbon projects.
So, given this, does anyone still doubt that we’re going to be in this recession for quite some time once the Czar throws the lever on this little power play (no pun intended)?
Wait, there’s more. If you’re at all concerned with the expanded power this gives the federal government, you ain’t seen nothin’ yet:
Separately, Browner said the administration was also going to create an inter- agency task force to site a new national electricity transmission grid to meet both growing demand and the President’s planned renewable energy expansion. Siting has been a major bottleneck to renewable growth, and lawmakers and administration officials have said they’re likely to seek greater federal powers that would give expanded eminent domain authorities.
Hope and change.
And it’s about time:
State governors — looking down the gun barrel of long-term spending forced on them by the Obama “stimulus” plan — are saying they will refuse to take the money. This is a Constitutional confrontation between the federal government and the states unlike any in our time.
In the first five weeks of his presidency, Barack Obama has acted so rashly that at least 11 states have decided that his brand of “hope” equates to an intolerable expansion of the federal government’s authority over the states. These states — “Washington, New Hampshire, Arizona, Montana, Michigan, Missouri, Oklahoma, California…Georgia,” South Carolina, and Texas — “have all introduced bills and resolutions” reminding Obama that the 10th Amendment protects the rights of the states, which are the rights of the people, by limting the power of the federal government.
Although critics have panned these refusals as sour grapes by Republicans or attempts to thwart President Obama’s stimulus of the economy, in fact it is a fight the states should have undertaken years ago.
One reason is many of the laws passed at a federal level mandate funds be provided for the program at a state level as well. I’d be interested in anyone who can find Constitutional backing for such a requirement by the federal government, but it is what has happened in the past.
Secondly, there’s the matter of law. Much of what is driving this 10th Amendment movement is the realization that the Fed is attempting to extend its control deeper and deeper into the states. Many are driven by what some would call “wedge issues”, but as Bryan points out in his “MYOB” post, states more accurately reflect their citizenry than does the federal government and the imposition of “one-size-fits-all” legislation, especially when it exceeds the constitutional reach of the Federal government, is something to be resisted:
For example, Family Security Matters reports that Missouri’s “House Concurrent Resolution 0004 (2009) reasserts its sovereignty based on Barack Obama’s stated intention to sign into law a federal ‘Freedom of Choice Act’, [because] the federal Freedom of Choice Act would nullify any federal or state law ‘enacted, adopted, or implemented before, on, or after the date of [its] enactment’ and would effectively prevent the State of Missouri from enacting similar protective measures in the future.”
The resolution in Montana grew out of concerns over coming attacks on the 2nd Amendment, thus its preface describes it as, “An Act Exempting From Federal Regulation Under The Commerce Clause Of The Constitution Of The United States A Firearm, A Firearm Accessory, Or Ammunition Manufactured And Retained In Montana.”
New Hampshire’s resolution actually references certain federal actions that would be nullified within that state were they pushed by Obama’s administration, according to americandaily.com. Among these are “Any act regarding religion; further limitations on freedom of political speech; or further limitations on freedom of the press, [and any] further infringements on the right to keep and bear arms including prohibitions of type or quantity of arms or ammunition.
I sincerely hope this trend continues and that we see some states challenge the Federal government in court over 10th amendment issues in an effort to stop the mandates and the attempts to modify or change state law.
For those who have forgotten what the 10th Amendment says or aren’t familiar with it, it reserves to the states and people those powers not explicity delegated the federal government:
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
I’d also remind everyone that the 10th amendment is a part of the Constitution known as the “Bill of Rights”. As we’ve all observed over the years, the rights of states have been all but rendered null and void. To regain a semblance of the federalism under which the nation was founded, movements like this are not only critical but necessary. It is one very important way we can curb the growth of the Federal government – assuming the Supreme Court agrees (which is not at all a given) since I’m sure this argument will eventually end up being settled there.
Apparently not to the usual suspects.
Bill Ayers was interviewed:
Ayers had this to say about President Barack Obama committing an additional 17,000 troops to Afghanistan: “It’s a mistake. It’s a colossal mistake. And, you know, we’ve seen this happen before, Alan. We’ve seen a hopeful presidency, Lyndon Johnson’s presidency, burn up in the furnace of war.”
Ayers thereby joins the rest of the moonbat contingent:
“I’m very upset; he promised change, and this is not change. It’s just going to create more deaths on both sides and create more terrorists,” said Jodie Evans, co-founder of Code Pink. The group, known for protests and targeting Bush administration officials, posted a statement Thursday condemning Mr. Obama’s decision and urging him to replace the combat troops with “humanitarian troops.”
“Afghanistan needs troops of doctors, farmers, teachers, not more troops,” the statement says.
It is apparently beyond Ms. Evan’s abilities to wonder how those “troops” of doctors, farmers and teachers are supposed to do their thing when, in the absence of our troops, the countryside is controlled by the Taliban. I assume she isn’t aware of the fact that the Taiban has a tendency to behead many of those she’d commit to A’stan.
Interesting though, isn’t it? Now we’re beginning to see that many of the supposedly “anti-Iraq” crowd, were just the usual anti-war bunch.
Sen. Harry “the SURGE has failed” Reid is again in the analysis business:
Senate Majority Leader Harry Reid (D-Nev.) said on Monday that the banking industry is “very close” to being stabilized and the nation’s economy is starting to rebound.
“We tend to talk about the negative. … Things are beginning to turn and I think the American people are going to feel that very soon,” Reid said during an appearance on MSNBC’s “Morning Joe” show.
Cancel the “stimulus” and cut the deficit by 789 billion.
Fiscal responsibility somewhat restored (well, except for Social Security, Medicare and Medicaid).
Good luck searching through the omnibus spending bill:
The $500 billion omnibus spending bill to fund the most of federal government for the rest of the year will be debated in the House this week. And it has now finally been posted online.
It’s a PDF of scanned pages, meaning it can’t be searched or parsed in any other way. All 1,133 pages of it. Same with the 1,845-page explanatory statement.
That’s placing form over substance, putting a bill online in a useless format.
The bill combines spending for several agencies. On parts of the bill posted on the House Appropriations Committee website, you can literally handwritten notes and crossed out lines on various pages of the legislation. You can see an example on page 9 on the section of the bill dealing with appropriations for “Agriculture, Rural Development, Food and Drug Administration, and Related Agencies.”
You can still go through and find the pork, but the lack of a tool to search the document makes it more difficult.
“I can find no warrant for such an appropriation in the Constitution; and I do not believe that the power and duty of the General Government ought to be extended to the relief of individual suffering which is in no manner properly related to the public service or benefit. A prevalent tendency to disregard the limited mission of this power and duty should, I think, be steadily resisted, to the end that the lesson should be constantly enforced that, though the people support the Government, the Government should not support the people.” – Grover Cleveland
“We need earmark reform,” Obama said in September during a presidential debate in Oxford, Miss. “And when I’m president, I will go line by line to make sure that we are not spending money unwisely.”
President Obama should prepare to carve out a lot of free time and keep the coffee hot next week as Congress prepares to unveil a $410 billion omnibus spending bill that’s riddled with thousands of earmarks, despite his calls for restraint and efforts on Capitol Hill to curtail the practice.
The bill will contain about 9,000 earmarks totaling $5 billion, congressional officials say. Many of the earmarks – loosely defined as local projects inserted by members of Congress – were inserted last year as the spending bills worked their way through various committees.
In case you’re wondering, the highest number of earmarks in a single year is 13,997 (2005) at a cost of $27.3 billion. Though the number of earmarks dropped to 9,963 in 2006, the cost surpassed the previous year at $29 billion.
Obama has pledged to “slash earmarks to no greater than 1994 levels and ensure all spending decisions are open to the public.” This spending bill isn’t a great start on that promise.
You can read the FY 2009 Omnibus Appropriations Act here.
H/T: Club for Growth
Chrysler said the only reason it was back asking for more money so soon was that the car market was worse than it had expected two months ago.
This cavalier approach to the public purse raises a very big question. If Chrysler is really on track for a turnaround and all it needs is some financing to get over a bad patch in sales and debt markets, why doesn’t Cerberus Capital Management, which owns 80 percent of the company, put up the money itself? Why should taxpayers have to take the risk? That’s what private equity funds like Cerberus are supposed to do.
Cerberus and Daimler, which retained a stake in Chrysler, have promised to convert $2 billion in loans to Chrysler into equity, which should help reduce its debt. But Cerberus said giving fresh money would violate its fiduciary duty to investors, breaking company rules limiting how much it can commit to any given investment.
We suspect these rules would be more pliant if Cerberus deemed Chrysler to be a good deal.
It seems the secretive private-equity fund is willing to gamble on Chrysler’s survival with the taxpayer’s dime, but not its own.
The real question is, if it is violative of Cerberus management’s fiduciary duty to bail out its own company, why is it fiscally responsible for the federal government to do so?
And what does it say when the leader of liberal opinion has more qualms about a bailout than the federal government? Nothing good I would think.