A Note of Apology

[anvi]

Dear Forum Community,

It may have gone unnoticed by most of you, but the last political post I put up on this forum was a fairly unpleasant rant.  I didn't mean to disparage anyone at all.  I'm not trying to attention-whore with this post; I just want to exit at least a little more gracefully than I managed to do last time.  The older I get, the more important it becomes to me to try to end things well, even though things must end.

That lousy post of last month was written in the immediate wake of the SCOTUS oral arguments about PPACA. and in a mood of despair that came over me during that week.  I'm certainly not a die-hard defender of that particular law and understand its numerous shortcomings.  But, to me, the pending decision is not just about the fate of that law.  I believe that it signals a more far-reaching outcome, in that we will simply never have universal access to insured basic health care in the United States.  I personally find that a grave shame, and I think it's very bad for our country in all kinds of ways, and is bound to get worse if a way to it is not found.

Despite those feelings, I didn't have warrant to leave with the min-rant that I did.  So, I'm sorry about that.

But, I'm sure to everyone's relief, my days of commenting on politics are done.  No more endless posts that you have to crawl through or skip over.  I've lost faith in our political processes, so I'm movin' on to other hobbies.  I'm finding recently that, if I pick up a guitar, practice long enough to put my fingers in the right places at the right time, the thing sounds good, and it can make people around me happy, no matter what they happen to believe.  I think that's a better use of my free time now.

I'll probably continue lurking, but won't comment on anything political.  I do think you all are a very cool group of people, and if anyone might be interested in being fb friends or something, please pm me and we'll arrange that.  If not, no worries.  Thanks for putting up with all my bs over the past few years, and best wishes to all.   

Cheers,
"anvi"

[anvi]

Thanks, guys.  Like I said, I'll probably continue to lurk, and, as shua suggests, I might put something up in Forum Community now and then.  But, the posts you all write are more fun to read than mine anyway.  And, jfern, we'll see about that random politician that, you know, really reaches for the icy heights of ueber-rodent behavior.  But, in the meantime, I'll be sure to keep breathing. 

[anvi]

Well, jmfcst, though I was responding to you, I wasn't mad at you; just disappointed about the way things worked out.  My expression of that disappointment was pretty poor, so, as above, I apologize.

You're right that the law in general, and the mandate in particular, are pretty unpopular in the country over all.  In some way, despite all these arguments about federalism and compulsory economic activity and all that, I'm just personally a bit baffled by that unpopularity.  I suppose I don't worry too much about my freedom being trampled when a requirement is placed upon me to do something that, so long as I was able, I would do anyway, like buy health insurance.  Particularly so if complying with that requirement meant that others, my fellow citizens, who have more dire needs than I do, could have an easier time getting access to insurance that they currently lack.  When I think of my citizenship, I suppose I just find that my responsibilities to my fellow citizens are just as important, sometimes even more so, than my own rights, and this area of life, to me, is one of those cases.  I've lived in countries where this kind of arrangement, in my opinion, works very well too--I never met anyone in Germany or Japan who felt oppressed by a health insurance mandate. 

But, those are just my personal feelings.  I'm weird.  Other people feel and believe much differently than I do, and on this issue, in this place, I appear to be outnumbered.  So, there it is.

Take care.

[anvi]

Thank you, sbane.  It's really hard for me to see how comprehensive health care reform can happen in the U.S. after SCOTUS rules that mandates are unconstitutional.  That rules out anything like Bismarck-style universal coverage, within our for-profit system, in the future.  I'm not such a fan of "single-payer" systems, but I'm sure that the U.S. would literally sink into the ocean before any such thing was ever adopted here.  There is the Torie Plan, which combines tax-credits and subsidization for basic care coverage.  But as far as I can tell, the subsidization part would require tax increases that, after campaigning so hard against the current law, being so dead-set against revenue enhancements and determined to implement cuts, I'm pretty sure the GOP would never get behind such a plan.  Then, there is what we've got, which isn't satisfactory, and as time passes, will become even less so.

The "public option" that was embedded in PPACA died an early death because of Senate Dems.  It wasn't for everyone, of course; it had eligibility caps that made it available only to very low-income citizens, so it reached a small set of the population that private insurers aren't inclined to cover anyway.  But, in 2009, I corresponded several times with Kent Conrad (as his former constituent) about the public option, and he explained and sent data to me demonstrating that the reimbursement rates that even the Senate version of the "public option" offered providers caused the latter to balk, and he and about ten other Senate Dems took it off the table quite early.  

I never minded fighting for some sort of universal coverage plan (as noted, I do believe we should do better than PPACA).  A Bismarck-style plan for the States, which would operate in the context of for-profit insurance, seemed to me for a long time like the medicine that could go down in our country the easiest.  But the pending SCOTUS strikedown will slam the door shut on that option for good.  I'm not aware of anything plausible that is left to fight for.

A hypothetical recently crossed my mind.  Let's say it's 1996.  Bill Clinton proves unable to overcome the political travails that haunted his first two years in office, and news of the Lewinsky scandal breaks during the general election campaign.  Bob Dole wins the presidency.  Instinctively drawn to Bill Krystal's famous advice and following his own inclinations, Bob Dole decides to take away the issue of comprehensive health care reform from the Democrats once and for all, and introduces his own comprehensive health care reform bill, strongly resembling the '94 Senate bill backed by the GOP.  DoleCare features an individual mandate.  It passes Congress, and Dole signs it into law in 1997.  How many states, under this scenario, would have filed lawsuits against the law, alleging that its mandate posed an immanent threat to federalism?  If former Senator Bob Bennet, a co-sponsor of the '94 GOP bill, is to be believed, my guess is probably none.  He was opposed to PPACA's costs, not its mandate.  People like Grassley, Snowe et al never raised mandate objections in 2009 either.  The mandate, after all, is what got AHIP on board for almost the entire duration of the legislative process, and they only bailed when, under pressure against the mandate which only only appeared at the end of the year from a few Senate Republicans, its enforcement provisions were stripped out.  Until very late 2009, almost every serious person interested in comprehensive reform believed that mandates were an essential piece in the puzzle, and none of them sang the special carnival tune of federalism that's been only very recently composed as the battle-hymn against Obamacare.

But, when PPACA passed Congress, the only way left to bring it down was in the courts, and that's what happened, and as you note, the dismal job Obama's lawyers did defending the mandate there brought down the sword.  All this has led us to the brink of shutting down a road toward universal coverage (again, not PPACA itself, but the one element of it under discussion) that was probably most amenable to our system, and that road ended in the middle of a field where no other roads can be found, and right at the point that the supply of construction materials also ran out.  

I wish there were something else that was actually viable left to fight for, but I can't see it.  It's just one of those things, you know--there are some things in life that, while gravely important, just turn out to be futile causes.  Universal coverage in the U.S., sadly, is one of them.              

[anvi]

Doesn't France have its own unique form of mandates?  Employer and employee contributions to the national insurance funds are required by statute, aren't they?      

[anvi]

Yes, of course.  But the French national funds are for everyone, not just pensioners. And so, effectively, the French tax system forces its citizens to buy coverage for themselves through mandated contributions adjusted to income levels, and covers citizens who can't pay at all.  I don't think the national sickness funds featured in Bismarck systems like France's will ever exist in the U.S., especially when even Democrats shoot down an analogous public fund with a low income eligibility cap, vastly limiting enrollment.  We've made the choice to use for-profit insurers in the U.S. (not my idea either), and so any universal coverage scheme in our country will require purchases of their coverage for the majority of citizens.  But, as noted, SCOTUS is about to lock that door too.     

[anvi]

What is wrong with private insurers competing for business, with subsidies on a means tested basis for the premiums? 

As I noted above, private insurers are the predominant payers in this country, so any solution that's going to work here has to work for them.  There's nothing wrong with the Torie-plan by me.  But you have to get Congress to pass it.  I genuinely wish you luck with that.

[anvi]

I guess what saddens me about this issue, Torie, is where our national priorities are in this debate.  We've got tens of millions of people, fellow citizens, in our country who lack health insurance entirely, and we have many thousands who die from treatable diseases every year because of long-term lack of insurance--these are facts.  And, laudably enough, you saying that we have to do something about it indicates that you are sensitive to that problem.  But, instead of being upset enough about that problem to do anything immediately, we are most upset about whether something is called a "penalty" or whether it's called a "tax," or whether something is called a "mandate" or a "requirement," ect. ect.  Don't get me wrong; I understand what you are saying about Obama's lack of political candor, and I agree with your derision of it, I really do.  But, if we're going to be so high and mighty about how "disingenuous" the Obama team was about their reticence to call penalties for the lack of insurance taxation, then just wait until your GOP friends in Congress hear the news that the subsidies needed to pay for poor people's premiums, especially in the environment of uncontrolled health care cost inflation, are going to need to be financed through higher taxes, and see what they say to the Torie plan then.  If we cared a tenth as much for our fellow citizens as we do for the labels we give to statutory tax provisions, I think we'd be a much better country.  That's what saddens me.         

[anvi]

I appreciate your comments, Torie.  You are a lawyer, and I'm not.  But is it after all fair to say that there is only one cogent legal view of this matter?  There are, after all, at least four expert jurists on SCOTUS who will probably vote to uphold the mandate.  With several hundred years of legal precedent regarding the Constitution, and with many different interpretations of what comports with the Constitution and these precedents, the members of SCOTUS, no matter who is in the majority, can probably come up with a legally viable defense of practically any decision they make.  On top of that, unless my ears deceived me entirely, Scalia made a number of overtly political comments in the remarks he made during oral arguments in this case.  SCOTUS too is a political body, not just a deliberative body, and its deliberations are often used to serve the purposes of the members' respective political orientations.  That's why confirmation processes have become as charged as they have, no?  This isn't anything new.  The day I think that any of the federal government's three branches is exercising actual unbiased deliberation in the service of solving a problem, I'll tune back in.