Romneycare vs. Obama Care (Short)

I'd love to spend all day writing about this topic, but I can't. I do want to say that those arguing that what Mitt Romney did is the same as what Pelosi and President Obama did are crazy.

Two main principles:

Limited Powers and the Tenth Amendment

Police Power

The founders knew that they would never get a constitution on the books unless they made concessions with the states. The end solution was for a powerful, but very limited 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."

There are many reasons why the 10th amendment was a good idea. Among them are First, it's the reason the country survived; second, the states became laboratories for experimentation; third, freedom increased wildly because people could move to other states freely if they were looking for different laws or environments.

There are many cases which have expanded (or just interpreted) federal congressional power. The necessary and proper clause and the commerce clause are two of the main provisions that congress uses to justify it's actions. "Obamacare," at a minimum, stretches the commerce power. Many argue that the Raich court case provides a precedent to uphold the individual mandate. I think Raich was wrong, and I think this case is distinct from Raich.

By contrast, Massachussets has broader powers including a police power. Romneycare could possibly be unconstitutional under the Massachusetts constitution, and it could be argued that it violates the first, fourth, fifth, and sixth amendments to the federal bill of rights. However, Romneycare is not analyzed under the federal commerce power. The analysis would be wildly different. Furthermore, anyone who wishes not to be involved in Romneycare can move to another state, which is much easier that moving to another country.

I am moderately federalist, (meaning, I believe most decisions should be made at the lowest (local) political level possible. I want states to have more freedom because I want to have options in the future. I hope that some states can remain as havens for freedom. I hope those states offer few entitlements and require great personal responsibility. And I hope those states can prove that through freedom and responsibility, citizens may gain prosperity. Unfortunately, federal involvement in almost anything is making it nearly impossible for any states to engage in the psuedo-libertarian model.

I support what Governor Romney did even though I don't completely agree with the bill, but that doesn't mean that he would do, or be allowed to do, the same thing at the federal level.

The Individual Health Insurance Mandate

My two-year-old post on the individual health insurance mandate.

If the average patient does not know or care about the cost of her healthcare, it will never be "affordable."

But before we get to that, I need to address the core issue:

Is health care a fundamental right? I believe it is to a certain extent. We can debate that all you want, but it won't be that effective. Instead, let's talk about fundamental rights for a moment.

The Right to Privacy from unreasonable searches and seizures

You have a fundamental right to privacy under the bill of rights. Privacy from your neighbors?? Nope. Sure, you can sue someone for trespassing (probably not going to get much money) and a person can be arrested for trespassing (if a state has that law).

Your neighbor simply cannot violate your constitutional right to privacy, because the Fourth Amendment applies to intrusions from the government. The government can't search your stuff or take control of your stuff unless certain conditions are met (Ask me about this if you really want to know all the criteria).

Does the government mess with your stuff and violate the 4th Amendment sometimes? Yeah, it happens all the time. "The Constitution says they can't do that! Why didn't the cops stop them from doing that?"Because the government doesn't have to stand outside your house and make sure cops don't bust in without a warrant.

You don't have a fundamental right to a security system that will help protect your 4th amendment rights. You have the right to sue the government if they violate your rights. Additionally, the Government probably can't use the evidence they find against you if they Violated your rights.

Nobody has the job to stop the government from violating your rights, you just get a chance to use the judicial sledgehammer and smash them. Hopefully the fear of punishment will stop them from doing the same thing in the future, but there is no preemptive strike provision in the bill of rights. The government doesn't have to build a wall around your house, they don't have to give you locks for your luggage, and they don't have to make sure you have a private place.

Health Care compared to Privacy

The health care debate is very similar. The Constitution simply cannot be interpreted to guarantee that the government will proactively provide healthcare. Also, the Constitution can't possibly be interpreted to mean that the government is responsible to make sure the quality of health care is acceptable. Maybe people should be able to sue if they are not allowed to offer emergency or clinical services, but that doesn't mean they shouldn't have to pay for it later.

So then any "fundamental right" to health care must be some sort of moral human right. Some Governments have the authority to codify human rights. The U.S. Congress specifically has authority to regulate interstate commerce, and that's a big ol' umbrella that covers almost everything. (This is another complicated legal subject that requires more explanation that I don't have time for here) So this issue is a bit tricky, but lets just assume that congress has the authority under the Constitution to fine people if they don't get insurance.

Heck, let's assume congress could just create a new health care amendment like:

"No Citizen of the United States shall be denied access to care in hospitals operated by the several states"

Such an Amendment would suggest that there is some type of fundamental right to health care, or at least access to health care. I don't see how an Amendment could do much more than this.

What are you going to say? "Everyone shall get free healthcare." Well it simply can't be free. Someone has to pay for it. So basically that's the same as saying "All people who don't pay taxes shall get free health care"

Or maybe you could say "The government shall establish hospitals funded by the treasury"

Well how many hospitals? Does each city and small town need one? How far should someone have to drive for health care? "I have a fundamental right to health care within a 20 minute drive!!!"

What if the government set up a big-A hospital in washington DC, and everyone could just go there for free. Wouldn't that give everyone in the country access to health care? "But John, that hospital would be overrun. That just doesn't make sense."

So what would you have the constitution say? "The Government Shall Establish Hospitals which are solely funded by the treasury, and such hospitals shall be established within 37 'as the tire rolls' miles from every city, town, or association with a population of more than 632 citizens."

Can you see what I'm getting at here? No matter what you do, someone would be screwed. So you can't really guarantee that everyone has equal access to health care. What standard of quality would you use? Would the government have to make sure that doctors passed a federal certification to be qualified under the constitution? It would be nearly impossible to regulate.

So what does that mean.

This leads us back to where we are today. Congress realizes they can't actually guarantee any standard of quality, so they are pretty much just saying that everyone gets reimbursed for whatever health care they can find. So either the government will provide insurance, or they will just require everyone to have insurance. Sure, there will be some level of quality required before a clinic or hospital can be eligible for reimbursement. But what if a little doctor's office doesn't want to take the government insurance? (A lot of Doctor's won't take Medicaid/care)

Doesn't that mean the rich would have access to health care that the poor don't get?

Under the bill, the government will fine an individual for refusing to get eligible insurance. Even if you've self insured over the last 20 years, and you've got a "health fund" set up. Can the government fine a business for not accepting insurance? That's kind of like the government fining a private business for not taking food stamps. It's probably in their best interest because they get reimbursed for the food, but it should be up to the company.

The Power of the Consumer

Do you want the best health care in the world for free, with no lines, and close to your house?

That's impossible. Can we at least accept that?

I almost never had to pay health care bills when I had insurance at my old job. Seriously, when I wrecked my motorcycle at 75 mph, I saw amazing doctors and went to great facilities. The care was immediate and effective. (Even before they knew I had insurance)

Do you think everyone should have access to the same insurance? I don't. Why? Because that insurance sucks.

I paid about 200 bucks a month for my health coverage. The coverage was awesome; it had a super low deductible, low out-of-pocket, and great access to doctors. So I thought that was a pretty good deal. Except my company was spending $600 a month on my plan as well. $800 dollars a month? Yeah, that's $9,600 dollars that I didn't get paid, because the company was giving me the "benefit" of coverage. Don't get me wrong: I'm extremely grateful that I had insurance when I got hurt. But that accident was hopefully just a freak occurrence. And that's what I believe insurance is for.

Health Savings Plans

You just say those three words and some people stop listening. "That just won't work for the general population."

I simply don't understand why not. Maybe you can educate me.

Let's crunch the numbers.

A "deductible" in insurance is a dollar amount that you have to pay toward your healthcare every year before the insurance company starts paying. My old insurance had a deductible of $250. (That's amazing) So I had to pay the first $250, and then the insurance company paid 85% of everything after that.

A $10,000 Deductible health plan costs almost nothing. If you spread that out over a medium company, say 100 employees, the average monthly premium would be something like $65 bucks a month. Why so cheap? Because the insurance company doesn't have to pay for the first 10,000 bucks. That means most traditional procedures, pregnancies, prescriptions, and general emergency room visits wouldn't be covered by the insurance company.

Well who has 10 grand sitting around to cover that? Almost nobody.

Well my insurance cost me and the company $9,600 a year.

The new insurance would cost me and the company $780 a year. Which would leave $8,820 in savings.

What would the company do with that 8800? If I were running it you would have two options.

Option 1: A debit card loaded with $5,000 that can only be used for medical purposes, and a $3,800 raise.

Option 2: A debit card loaded with $8,800 dollars that can only be used for medical purposes.

So you would have the responsibility of covering the first $10,000 of your medical expenseseach year, but 8,800 would be covered. So if you did have a disaster, then you'd have to come up with $1,200 bucks, and that shouldn't bankrupt you (especially since you could spread it out over 24 months or whatever).

If you wanted to gamble a bit, you could choose option one. Then you might have to come up with 5,000 bucks for a disaster, but you'd have more money coming into your paycheck, and hopefully you could invest in your own health fund. Maybe you'd even be able to make some money with it.

Oh, and one more thing. THE MONEY WOULD ROLL OVER.

Under option 2, if you are healthy for 10 years, you'd have 86,000 buckaroos in your health savings account, and you'd still have insurance. In my company, as soon as you built up an amount twice the size of your deductible (or $20,000) then the rest of the contributions would go into your retirement account.

And this wouldn't cost me any more that the expensive insurance you were already getting.

The opposing argument would suggest that this strategy wouldn't work for the whole population. Some employers don't provide benefits at all, and the drop in contributions to health insurance would make insurance rates go up for everyone.

First, everyone can afford disaster insurance or get on medicaid. You can find a way.

Second, nobody can predict the exact effect on premiums, but you can bet your bottom dollar that health care costs would go down.

why? Because in the current system you don't know how much stuff costs.

The food insurance metaphor is a bit silly. "What if you had food insurance. Someone else is paying, so you'd just buy steak every time you went to the grocery store!"

Well take that and add on the fact that you have no idea how much you'll be charged until AFTER you get the care. Some people do know the price, some of the time. But most people go to the same doctor for everything. That's insane. I don't even buy all of my dairy products at the same store.

If you had a health savings account that would eventually turn into your retirement, you'd start shopping around.

Need to get a funny spot on your neck checked out? Don't just run to your regular dermatologist, call around to every dermatologist in town.

Doctors would start to run specials, they would start to compete. If quality went down, the business would disappear.

You'd find prices listed on the wall in Doctor's offices. "Strep throat test: $42.50"

"Oh, well I can go to the walgreens clinic and get that procedure for $29, bye"

"MRI that you probably only have a 1.7% chance of actually needing: $1,700"

"Need surgery, choose an anesthesiologist:

A: 2 years of experience, Utah Medical School: $1,200

B: 29 years of experience, John's Hopkins: $4,400"

Prices would start to go down because:

1: Doctor's couldn't get away with as much

2: Unnecessary procedures would be eliminated

3: Doctor's would get paid in cash and collection costs would go down, so they would have an incentive to market to these people.

4: People would be encouraged to live healthier lives in order to save money.

A big argument against me is that people would get scammed, some people would choose not to have procedures they ended up needing, and lives would inevitably be lost.

First: Is that worse than the current system? Not really.

Second: That argument works on two faulty assumptions (1) that people can't take care of themselves and (2) that people who make bad decisions shouldn't be responsible for the consequences.

I just don't think it would be that much of a problem. You'd be able to get more informed and get more involved in the process, and you'd still be able to sue people who scam you or who harm you out of negligence.

Could someone tell me where I'm wrong?