Judge Hudson Reminds Me: We Need Single-Payer!

I am not fond of the health insurance mandate included in the Patient Protection and Affordable Care Act. I agree with Michael Moore that people aren't cars. If health insurance is so important that it warrants a government intervention in the free market as drastic as the insurance mandate introduced to us by Republican Mitt Romney in Massachusetts, then we should skip the middle man and move straight to a universal single-payer system that would guarantee coverage for every American.

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SD Blogosphere Reaction:

• Dr. Blanchard finds Hudson's ruling reasonable but still prefers electoral to judicial remedies.
• Mr. Dahle finds Hudson getting money from a GOP PR firm.
• Mr. Woodring thinks Mr. Jefferson would be proud.
• Mr. Sanborn maintains it is unconstitutional to compel citizens to purchase anything. But does that apply to state governments, too, Michael?
  

I thus react with some ambivalence to Judge Henry Hudson's ruling in favor of the Commonwealth of Virginia challenging the insurance mandate on Constitutional grounds. The ruling is pretty thin gruel in some eyes, a thorough rejection of Obamacare in others.

Hudson rules on two key points. He accepts Virginia's argument that the enforcement of the insurance mandate is a penalty, not a tax. That may not matter to the average citizen—either way, it's money out of your pocket—but it matters to the court and the Constitution. If it's a tax, then Congress can act under the General Welfare Clause, and pretty much every court challenge to health care reform ends. If it's a penalty, then Congress is acting under the Commerce Clause.

That's where things get interesting. Virginia's challenge, like others, hinges on the idea that Congress act under the Commerce Clause to compel people to participate in interstate commerce by buying health insurance. The federal government says everyone eventually participates in the health care "market," and choosing not to buy health insurance shifts costs to everyone else in the market, so federal requirements to maintain financial responsibility for one's own health care via insurance are justified regulation of interstate commerce. Judge Hudson sides with Virginia: he says the government can regulate activity but not inactivity.

Yet state and local governments apparently retain the authority to regulate a host of other economic inactivities. South Dakota still penalizes you for not buying car insurance. The sheriff will nab you for vagrancy if you don't buy or rent a domicile of some sort, and the city or county will come after you again for nuisance violations if you don't engage in enough economic activity to maintain that domicile sufficiently. We punish parents if they don't purchase sufficient food, clothing, and shelter for their children. And not that I need much persuading, but the government will get on my case if I don't engage at some bare minimum in the clothing market.

Judge Hudson's ruling does not threaten state insurance mandates; Hudson appears concerned only with "unbridled exercise of federal police powers."

But the ruling brings me back to my basic argument for a universal single-payer health insurance system. Insurance works better when you get more people in the pool to share the risk. The best insurance possible would be the biggest pool possible: all 307 million Americans in one big pool. We all pay for one big army to protect the entire country from invaders and terrorists and other disruptive forces. We could all pay for one big army of doctors to protect us from the physical and economic devastation of disease and injury.

The right way to provide that universal protection is to stop viewing health care as a matter of commerce (health care doesn't work by free market principles) and start viewing at as a general welfare issue.

South Dakota Picks Profit over People on Health Coverage

South Dakota is suing to nullify the federal health insurance law passed this year. However, as Bob Mercer points out, South Dakota is still willing to participate in this supposed unconstitutional monstrosity by administering the high-risk pool.

Check this line from Mercer:

South Dakota already operates a risk-pool program for people who had insurance but lost it through no fault of their own. Rounds, who runs an insurance business, started the state risk pool to reduce financial responsibility of insurance companies which were pulling out of the health-coverage market in South Dakota [Bob Mercer, "State Picks and Choose on Federal Health Coverage Law," Pure Pierre Politics, 2010.07.01].

Mercer doesn't reach this conclusion, but I do: Governor Rounds and fellow defenders of the free market don't want the free market to handle all of health coverage... only the really profitable portions. They thus are happy to saddle the government with the elderly, the poor, and the sick folks who need health insurance the most. The insurance companies thus limit themselves to the young, rich, and healthy whose minimal use of health services guarantee that the house always wins in the private insurance casino.

The high-risk pool is really a safety valve for private profit. Until the ban on exclusions for pre-existing conditions kicks in in 2014, private insurers can continue to kick sick people off their plans without any prick to their conscience: "Those people won't suffer. They can just join the government high-risk pool! Besides, we're here to serve our shareholders, not the common good."

I wonder how long we'll watch this patchwork system hobble along, bankrupting and killing Americans all for the sake of protecting profit and a failing worldview, before we realize it would be a whole lot simpler for us to create one big risk pool.

Private Insurance Targets Breast Cancer Patients for Rescission; Single-Payer Now!

The new health insurance reform law will make your life better, but it still leaves too much power in the hands of private insurance corporations. We still need to work for the real solution, a single-payer system in which access to health care is a right and not a looming threat of bankruptcy and debilitation.

Private insurers can no longer be trusted to provide our health care. This Reuters report reveals that WellPoint, the biggest insurer in the nation, targets breast cancer patients to revoke their coverage by any means available:

WellPoint also has specifically targeted women with breast cancer for aggressive investigation with the intent to cancel their policies, federal investigators told Reuters. The revelation is especially striking for a company whose CEO and president, Angela Braly, has earned plaudits for how her company improved the medical care and treatment of other policyholders with breast cancer.

The disclosures come to light after a recent investigation by Reuters showed that another health insurance company, Assurant Health, similarly targeted HIV-positive policyholders for rescission. That company was ordered by courts to pay millions of dollars in settlements [Murray Waas, "WellPoint Routinely Targets Breast Cancer Patients," Reuters via Yahoo News, 2010.04.22].

Uncle Sam Insurance, whether operating as the single-payer or competing as a public option with private companies, will not and cannot rescind your coverage because you get sick. Uncle Sam Insurance doesn't seek profit; it is just you and me, fellow citizens (all fellow citizens, under single-payer), working together to keep each other well and protect our personal and economic liberty. That's the just and efficient system we need, not the current private vulture insurance that swoops down on the sick to take their money and leave them without the affordable care they thought they were paying for.

Listen to Dennis Kucinich: this year's health reform law must only be the first step, an opening to move toward the real reform we need: a single-payer health insurance system that will save money, save lives, and treat Americans as human beings, not profit points.

SD Peace &Justice: Single-Payer Best

The South Dakota Peace and Justice Center weighs on the side of socialists like Congressman Anthony Weiner and me: their August policy analysis calls for a single-payer health coverage system. SDPJC joins the myth-busting crew on three points:

1. You don't have choice under a private insurance system... unless you think "cling to my employer's health insurance or do without" is real choice.
2. You and your doctor don't have control with private insurance—ever hear of "managed care"?
3. Single-payer doesn't mean long waits... at least not any longer than you might wait now for care.

(On that third point, Erin and I have a friend who has a medical problem that could cause paralysis. This friend got a cursory interview with a surgeon, who said he'd do the surgery in six months and then didn't stick around long enough to answer questions about why that wait was acceptable. And folks say America has no waiting for health care? Riiiight.)

SDPJC holds its nose and says a strong public option—government insurance every American can buy—is an acceptable compromise. But let's remember: public option is an extreme compromise down from the successful standard of public health coverage in dozens of other countries.

Let Feds Take Over Health Insurance? Heck Yeah, Says Rep. Weiner!

Jackie's right: this interview with Rep. Anthony Weiner is great! Rep. Weiner lays it on the line: he wants Medicare for every American. No triangulation, no compromise, no muddled message, just the kind of beautifully straightforward, practical arguments that Dennis Kucinich won me over with five years ago.



Key points:

• It's not about Left or Right: it's about saving money.
• Insurance companies aren't bringing value to the transaction.
• Medicare and the VA don't exclude pre-existing conditions: government health coverage is thus clearly more humane than private for-profit insurance.

Even subpar interviewer Joe Scarborough recognizes that Weiner can take what some want to portray as an extreme position and lay it out with crystal clarity and no deceptive or flaming rhetoric. National single-payer health insurance just makes sense.

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Dems getting ready to go it alone on health care? Saddle up! Cooperatives don't appear to have the muscle to produce solutions. Why go for an ill-defined, untried compromise (that Republicans won't buy into anyway) when we could try a public option that works in some form or another in every other industrialized country? Do your own thing, Dems; besides, America loves rugged individualists... ;-)

Reich: Public Option Is "Last Stand" for Real Reform

I've argued hard here (and here, here, and here) for a public option health insurance plan (and 77% of my readers and a similar percentage of Madison residents and the American public back me). I've been willing to accept that as a compromise down from the ideal single-payer system. Now the Obama Administration is signaling it's willing to bail from even that reasonable compromise.

Howard Dean says a public option is a sine qua non of health coverage reform. I'll let Robert Reich carry the argument further:

Without a public, Medicare-like option, health care reform is a bandaid for a system in critical condition. There's no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there's no way to get overall health-care costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers -- thereby opening the way for private insurers to do the same.

It's been clear from the start that the private insurers and other parts of the medical-industrial complex have hated the idea of the public option, for precisely these reasons. A public option would cut deeply into their current profits. That's why they've been willing to spend a fortune on lobbyists, threaten and intimidate legislators and ordinary Americans, and even rattle Obama's cage to the point where the Administration is about to give up on it [Robert Reich, "The Public Option's Last Stand, and the Public's," Robert Reich's Blog, 2009.08.17].

And what of the non-profit health cooperatives being suggested as a sufficiently tolerable alternative that could pass the Senate?

Senator Kent Conrad's ersatz public option -- his regional "cooperatives" -- won't have the scale or authority to do what a public option would do. That's why some Republicans say they could buy it. What's Conrad's response? "The fact of the matter is there are not the votes in the United States Senate for a public option. There never have been," he tells "FOX News Sunday." Conrad is wrong. If Obama tells Senate Democrats he will not sign a healthcare reform bill without a public option, there will be enough votes in the United States Senate for a public option [Reich 2009.08.17].

President Obama should not have to compromise to appease opponents who are willing to use any means necessary, including manufactured rage and outright deceit, to protect a broken status quo. It's time to stand for what's right, not what polls well with lobbyists. Let's push that House vote on single-payer. Let's show just how much support there is for real health coverage reform. And let's make clear that the public option is the rock-bottom compromise position.

Mr. Obama, we did not elect you to give in to willful deceit and ignorance. Spend that political capital, fight for the public option.

(Besides, how will the Republican cries of "Socialism!" and "Tyranny!" stick if you don't create the one big government program that scares them the most? ;-) )

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Update 13:20 CDT: But I agree with Ned Hodgman of Understanding Government that President Obama at least deserves credit for making a case that puts facts and sensible policy above emotion and identity politics.

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Update 17:00 CDT: As I suspected, compromise on public option is pointless, since it won't win over Republicans anyway.