Health care reform and the Surpremes (The government doesn't give us free broccoli)

Well the Supremes are going to be center stage this week as they consider cases on different sides of  the health care reform act Obama and Congress approved two years ago.

Key to the discussion: Can the government, under the Constitution's Commerce clause, force people to buy health insurance? It's often framed in that simplistic way, but it's much more complicated than that.

We can't compare it to anything else the government might make us buy because the circumstances are different.

 Those who try to simplify the argument (and there are many taking advantage of the average person's unwillingness to spend a lot of time understanding the issue), argue the government can't require you to buy broccoli or gasoline for that matter, so they should NOT be able to require you to buy health insurance or any other product.

Actually, they don't require you to buy it. If you don't buy it you pay a minimal surcharge of like $95 a year, which I understand escalates a bit after that but not more than say $2,200 a year for a single person making $100,000. (Which, actually would be a pretty good price for emergency health care whenever you needed it, no co-pays etc. I'll explain that next).

The argument is different because "Everyone consumes" health care or if they don't consume it they have the right -- given by Congress actually -- to consume it free of charge if you can't pay.

That law, codified under the Emergency Medical Treatment and Labor Act (EMTALA)42 USC Sec. 1395dd) was passed in 1986 by Congress and enacted "to ensure public access to emergency services regardless of ability to pay"

So, it's a law that anyone can get free health care. It reasonably follows that we all should have to pay for that, and it shouldn't be pushed on through the insurance system, but rather spread out through taxation or fines. The mandate is simply collecting a payment for what we gave away in 1986.

The Supremes could rule that since the Commerce clause allows for the providing of goods (health care)  by the government, the government should be able to require payment. Take away the guaranteed goods (health care for free) and you can take away the requirement.

The parallel argument that the government doesn't require us to buy broccoli would have to be set up to show that the government had at one time required broccoli producers to give you broccoli free if you met government's criteria.

We know that's not the case.

Good luck Supremes! Give me a call if you'd like to bounce some ideas off me.

"Death Panels" debunked: Bachmann voted for them in 2008

The old "death panel" distortions raised their ugly heads again when President Obama through legal administrative procedure recently included end-of-life planning between doctor and patient as a service that could be covered under Medicare preventive care.

The term "death panel" is a distortion. Media shouldn't even use it just like we would not use the term priest to describe a Lutheran pastor. Death panel is just not accurate. People on both sides of the political aisle have agreed this is a "hyperbolic" term, the most recent was John McCain's advisor Nancy Pfotenhauer speaking on the issue on CNN a few nights ago.

Though she called it hyperbolic she still argues that the provision puts government in control of one's end of life decision or discussion. One can debate that I suppose, but barely. There is no specific language that says government is involved at all, -- it's between doctor and patient -- and even then its totally voluntary.

But as correctly pointed out by numerous sources, the so called "death panel" provision for end of life counseling was put in Legislation passed by Democrats and Republicans in Congress in 2008 and put in place by the Bush Administration after that.

Bush vetoed the 2008 bill but mainly because it removed his planned 10.6 percent cut in Medicare payments to doctors. He was overridden by large margins of both Democrats and Republicans in the House by a vote of 383-41 and in the Senate by 70-26.

The Bush administration later incorporated the end of life provisions into its Medicare regulations and rules.

Here is the exact language from the Congressional bill tracking system.
"(This measure has not been amended since it was passed by the House on June 24, 2008. The summary of that version is repeated here.)
Medicare Improvements for Patients and Providers Act of 2008 - Title I: Medicare - Subtitle A: Beneficiary Improvements - Part 1: Prevention, Mental Health, and Marketing - (Sec. 101) Amends title XVIII (Medicare) of the Social Security Act (SSA), as amended by the Medicare, Medicaid, and SCHIP Extension Act of 2007, to cover additional preventive services."

 Here is the specific provision.

"Includes body mass index and end-of-life planning among initial preventive physical examinations."

Link to entire bill summary for skeptics.


Republicans and Democrats voted in favor of it. It might surprise you. Rep. Michele Bachmann, one of the people continually using the hyperbolic term "death panels" and expressing her vehemence against them during the health care reform debate voted with all other state Republicans as well as Democrats to override the Bush veto, and approve the Legislation with end of life voluntary planning.


Here's the House vote
Here's the Senate vote