December 13, 2010

"Federal Judge Invalidates Key Provision of Health Care Law."

"Breaking news."
Judge Henry E. Hudson... wrote that the law’s central requirement that most Americans obtain health insurance exceeds the regulatory authority granted to Congress under the Commerce Clause of the Constitution. The insurance mandate is central to the law’s mission of covering more than 30 million uninsured because insurers argue that only by requiring healthy people to have policies can they afford to treat those with expensive chronic conditions.

The judge wrote that his survey of case law “yielded no reported decisions from any federal appellate courts extending the Commerce Clause or General Welfare Clause to encompass regulation of a person’s decision not to purchase a product, not withstanding its effect on interstate commerce or role in a global regulatory scheme.”
It sounds as though he's adopted the reasoning that we've expected a judge striking down the provision to use.
The opinion by Judge Hudson, who has a long history in Republican politics in northern Virginia, continued a partisan pattern in the health care cases. Thus far, judges appointed by Republican presidents have ruled consistently against the Obama administration while Democratic appointees have found for it.
I like the way the NYT report doesn't say it's Hudson who decided according to political preference. There's just a "pattern" here, and the judges on both sides of the issue have followed the pattern. Maybe some, none, or all are following politics. That's the best way to report it.

ADDED: From the opinion (citations omitted), here's the key conclusion about the Commerce Clause:
The power of Congress to regulate a class of activities that in the aggregate has a substantial and direct effect on interstate commerce is well settled. This even extends to noneconomic activity closely connected to the intended market. But these regulatory powers are triggered by some type of self-initiated action. Neither the Supreme Court nor any federal circuit court of appeals has extended the Commerce Clause powers to compel and individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market.
A footnote at that point says: "The collective effect of an aggregate of such inactivity still falls short of the constitutional mark.

But what about the Necessary and Proper Clause? Orin Kerr detects an "obvious and quite significant error":
Judge Hudson assumes that the power granted to Congress by the Necessary and Proper Clause... does not expand Congress’s power beyond the Commerce Clause itself...
If a person’s decision not to purchase health insurance at a particular point in time does not constitute the type of economic activity subject to regulation under the Commerce Clause, then logically an attempt to enforce such provision under the Necessary and Proper Clause is equally offensive to the Constitution.
Judge Hudson does not cite any authority for this conclusion... The point of the Necessary and Proper clause is that it grants Congress the power to use means outside the enumerated list of of Article I powers to achieve the ends listed in Article I. If you say, as a matter of “logic” or otherwise, that the Necessary and Proper Clause only permits Congress to regulate using means that are themselves covered by the Commerce Clause, then the Necessary and Proper Clause is rendered a nullity.

134 comments:

traditionalguy said...

Federalism lives!

Jason said...

Sometimes you have to pass the bill, in order to find out how it trashes the Constitution and makes an idiot out of every drooling imbecile that supported this monstrous piece of crap.

Larry J said...

Good news to start the week

Jay said...

When will President Clinton hold a press conference about this?

Lincolntf said...

I was just reading a quick convo about the "severability" issue over at AoSHQ.
Any legal eagles want to answer my main question: If the individual mandate is ruled unconstitutional, does the rest of HCR die as a result?

Triangle Man said...

So, what's the score now? One "unconstitutional" to two "upheld"?

Lisa said...

good.

Marshal said...

We'll have to wait and see if the remainder survives, but even if so this creates tremendous pressure for large scale revision. If there were any moderate Dems left they might even support repeal.

Big step in the right direction.

MadisonMan said...

If it's not constitutional, then why the decision not to freeze implementation?

TWM said...

"Any legal eagles want to answer my main question: If the individual mandate is ruled unconstitutional, does the rest of HCR die as a result?"

Not a legal eagle, but I read a good article recently by one who stated that certain provisions could remain, although without the mandate there is simply no money for the biggies like "no pre-existing conditions." Not that finding money for it was ever a problem for the tax raising, deficit ignoring Democrats.

Jay said...

Federalism lives!

Yeah, Do you like health care? Well, get on the subway and go to Maryland.

Right Justice Breyer?

Bender said...

There is no severability provision and the individual mandate is so pervasive and crucial to the entire monstrosity that it cannot be judicially severed. In other words, the entirety of ObamaCare is struck down.

Joe said...

(The Crypto Jew)
If it's not constitutional, then why the decision not to freeze implementation?
1) Implementation occurs later, 2013/14….
2) VA only sued on the “mandate” issue, as I have read at AoSHQ

David said...

Hope someone will link the text of the decision. Most of the news summaries and commentary will be crapola. Stick with the blogosphere.

rdkraus said...

Judge Hudson. The guy has a great river. I been there.

His rationale sounds EXACTLY like what so many conservatives said long ago.

AJ Lynch said...

hahaahahahahahahahaahaha ha

Lisa said...

Insurance companies will use this as another excuse to raise premiums exorbitantly.

We needed a public option... not more rich people getting richer by refusing service to the sick.

Pogo said...

There is hope now, however small, that this socialist power grab may yet be forestalled.

God save us from yet another tyranny exercised for the good of its victims.

Jay said...

We needed a public option... not more rich people getting richer by refusing service to the sick.


Who knew that insurance companies actually treated patients!

Sixty Grit said...
This comment has been removed by the author.
Lincolntf said...

Yeah, the public option would've been so much better than private insurance companies in the free market. Just like public housing, public beaches and public schools are so superior to their private counterparts.
If you truly hate the poor, and want to get rid of as many of them as possible, support Obamacare.

David said...

My legal eagle license has been gathering dust for years, but even I know that this is only the beginning. In some form or another, this case will go up through the appellate courts and, presumably, to the Supreme Court.

(The Supremes could, I suppose, take a direct appeal without the courts of appeals, but that's a rarity and my gut tells me they won't. I must consult my gut because I don't really know what factors the Court generally uses to decide whether there should be a direct appeal.)

Constitutional law lecturer Obama may come to regret the disrespect he showed to the Supreme Court in his last State of the Union. Judges have feelings and memories too, and that moment was memorable.

Bender said...

Since the MSM won't report it --

The case is Commonwealth of Virginia, Ex Rel. Kenneth T. Cuccinelli, II v. Sebelius, 3:10-cv-00188 (E.D. Va.).

-- ORDER that Plaintiff's 88 Motion for Summary Judgment is GRANTED as to its request for declaratory relief and DENIED as to its request for injunctive relief, and Defendant's 90 Motion for Summary Judgment is DENIED. It is so ORDERED.

David said...

Lisa, you want a public option, move to Canada. They have one up there. Plus you can come back down here, like the Canadians do, when you can't get the care you need in Canada.

Seven Machos said...

Did the NYT note that any Democrats who held it constitutional were long--time Democrats and active in politics, as all judges are?

dbp said...

... not more rich people getting richer by refusing service to the sick.

Who knew there was big money in refusing service to the sick? They must pay well to be left alone.

David said...

Thanks, Bender. Glad to see that the judge denied injunctive relief. That would have been an overreach, imho.

Seven Machos said...

by refusing service to the sick

This person has never been to an an American hospital.

Marshal said...

Now is the Reps chance to push real reform.

The smart thing to do now is to hold hearings and entertain a wide variety of proposals. Be inclusive.

Like the Dems said they would before later calling people naive for believing them.

mccullough said...

I dunno. It's seems like the necessary and proper clause, combined with the commerce clause, permits the mandate. Health insurance is a trillion $$$ a year industry and, even though health insurers have to register and get approved in every state they want to sell policies, it's still an enormous interstate industry.

The better and cheaper solution would be to have the government cover health care expenses of people who can't get policies due to pre-existing conditions and charge those people (many of whom could pay something) some premiums for the coverage.

America's Politico said...

Don't worry, folks. It will be a law. We are moving fast towards spending over a billion in 2012 relection. The GOP, including their judges, will lose.

http://www.washingtonpost.com/wp-dyn/content/article/2010/12/12/AR2010121203666.html

Original Mike said...

So may I conclude that the Feds also can't make me buy a Chevy, excuse me, Chevrolet?

Marshal said...

http://online.wsj.com/public/resources/documents/121310virginiahcruling.pdf

Opinion.

Seven Machos said...

seems like the necessary and proper clause, combined with the commerce clause, permits the mandate

What does the necessary and proper clause not cover, dude? Even loony leftists don't try to bring out that one.

And, no, because insurance companies must operate in the state where you get your insurance under our byzantine system, and because every citizen belongs to one state, there is no interstate commerce. It is not interstate commerce to require a person from Illinois to make a purchase from an Illinois company -- or from any company, for that matter.

Pay attention, Kennedy. My lessons are free but invaluable.

Joe said...

(The Crypto Jew)
The better and cheaper solution would be to have the government cover health care expenses of people who can't get policies due to pre-existing conditions and charge those people (many of whom could pay something) some premiums for the coverage.
NO.

Longer answer: Do you get auto insurance AFTER you’ve gotten into an accident? Do you get home insurance AFTER the tornado has struck? So, too “pre-existing” conditions. The answer would be to require states to allow competition across boundaries, relax the definition of “insurance” and provide a voucher for citizens to purchase their own, “insurance.”

former law student said...

Unlike the Riverside DADT judge, this judge shows a becoming modesty about making decisions above his pay grade.

Marshal said...

Joe says "The answer would be to require states to allow competition across boundaries, relax the definition of “insurance” and provide a voucher for citizens to purchase their own, “insurance.”"

All good ideas, but the most important item is omitted. Eliminate employer based coverage.

garage mahal said...

How can insurance companies make any money if they have to cover sick people?

Clyde said...

It ain't over until the Supremes sing.

GMay said...

David said: "Hope someone will link the text of the decision."

You've probably already looked it up, but in case you haven't...

Here you go.

Seven Machos said...

How can insurance companies make any money if they have to cover sick people?

Indeed, Garage. How would a life insurance company make any money if it had to cover people who were about to die?

Insurance is a wager. It's not a monthly payment for unlimited health care.

But I'm proud of you. In your snark, you have identified the problem. Sad that you are too shallow to propose a solution that is workable under the Constitution and within the constraints of a free economy.

David said...

The opinion is linked at the NYT article.

The court severs it's finding of unconstitutionality of the "mandate" from the rest of the law. This means that only section 1501 (the mandate provision) and those directly related are ruled unconstitutional. His reasoning in part is that the manner of passage of the bill makes it impossible for him to determine whether the Congress would have passed the rest of the law without the individual mandate.

In other words, the judge said: Since Congress did not know what it was doing when it passed this law, I can't possibly determine what they thought they were doing.

yashu said...

Good news. Hope the whole thing unravels. Then there might be a chance (now that the GOP have more power in congress-- and Pelosi's posse has less) for some real, sensible, pragmatic, modest reform. But even no reform would be so much better than this omni-tentacled monstrosity.

Bender said...

The government's arguments on the Commerce Clause, Necessary and Proper Clause, taxation power, General Welfare Clause were all rejected.

The court DID sever the provisions, despite the government's entire argument being premised upon the mandate being the linchpin to the entire plan, because there is so much other junk in there that the court thought it was impossible to discern whether or not Congress would have passed it without the mandate.

However, without the mandate, then the entire structure fails on its own, whether officially struck down or not.

donttread2010 said...

DUH!

Marshal said...

" garage mahal said...
How can insurance companies make any money if they have to cover sick people?"

So businesses are expected to bankrupt themselves to support leftist public policy?

Alex said...

You cons make me laugh. If there was not an ObamaCare we'd have to invent one for the millions of unemployed thanks to 30+ years of toxic Raygunomics.

former law student said...

Joe said...

(The Crypto Jew)

The answer would be to require states to allow competition across boundaries,


but just minutes before he said:

When properly [abortion] was and IS an issue for states to deal with.

So why does Joe think that the Federal government must override states' regulations of health insurance for their born citizens, while that same Federal government should have nothing to say about states' regulations of what happens to the unborn? This is certainly an elastic view of Federal government power.

Joe said...

(The Crypto Jew)
All good ideas, but the most important item is omitted. Eliminate employer based coverage.
Not at all, that’s no different than mandating my having insurance….IF my employer wants to provide coverage, as a “perk” of employment, that’s fine. Who is the government to say, “No.”? Alternatively, you could mean that we should remove the EXCLUSIVE tax benefit for provision of health coverage from employers, meaning that a self-employed person could also deduct their health care costs you’d be right. As it is now, the tax code is prejudiced towards employer-provided health care coverage, when it ought not be.

Garage, step it up a notch or you’re going to get your @rse handed to you. That is the best you can do? My Yhwh if that’s the best you’ve got your side is in for a very long 2-10 years.

Alex said...

So businesses are expected to bankrupt themselves to support leftist public policy?

Yes. It's blatantly immoral to make a single dollar of profit on sick people. Europeans are still in horror that we don't have single payer like they do.

Alex said...

FLS - the cons are all for the crushing heel of government power when it suits them. They really really really hate democracy and the American people.

Joe said...

(The Crypto Jew)
So why does Joe think that the Federal government must override states' regulations of health insurance for their born citizens, while that same Federal government should have nothing to say about states' regulations of what happens to the unborn? This is certainly an elastic view of Federal government power..
I agree FLS, you are right…I concede it…so no across state competition…MAYHAP we can craft tax law that encourages it, though.

chickelit said...

Alex said:
Yes. It's blatantly immoral to make a single dollar of profit on sick people.

Hold that thought for your shrink.

donttread2010 said...

@Alex

"Yes. It's blatantly immoral to make a single dollar of profit on sick people. Europeans are still in horror that we don't have single payer like they do."

Really? So by your 'logic', doctors should be donating their services...and then we would just pay more taxes to help doctors pay off their education costs. Good grief.

Alex said...

Psychiatric services should be free to all.

donttread2010 said...

@Alex

"FLS - the cons are all for the crushing heel of government power when it suits them. They really really really hate democracy and the American people."

Have they shut down the blog comments over at the Daily Kos?

Lincolntf said...

Alex said...


Reagan was extra-sneaky when he arranged for all those lost jobs to hide until Obama took office and unemployment soared to 10%.
Tricky cons...

Ignorance is Bliss said...

The court DID sever the provisions, despite the government's entire argument being premised upon the mandate being the linchpin to the entire plan, because there is so much other junk in there that the court thought it was impossible to discern whether or not Congress would have passed it without the mandate.

Isn't that a fairly strong argument for declaring it all unconstitutional? If it does not have a severability clause, and you have no way of determining what would have passed without the portion that was struck down, then how do you keep any of it. If congress had wanted parts of it kept, they could have made it severable.

Marshal said...

"Not at all, that’s no different than mandating my having insurance….IF my employer wants to provide coverage, as a “perk” of employment, that’s fine. Who is the government to say, “No.”?"

The government is that entity which created employer based coverage in the first place, and provides the subsidies that both keep it going and distort the marketplace.

So yes, remove the subsidies. But further, restrict pricing to medically relevant factors.

Marshal said...

Alex says "Yes. It's blatantly immoral to make a single dollar of profit on sick people."

European and Canadian doctors don't get paid? How do they eat?

donttread2010 said...

@Alex

"Psychiatric services should be free to all."

And you should be the first to take advantage of it.

Ignorance is Bliss said...

How can insurance companies make any money if they have to cover sick people?

By charging people slightly more for coverage then they expect to pay out. Must-Issue can survive the lack of mandate; Must-Issue plus Community Rating cannot.

Joe said...

(The Crypto Jew)

OK, people….small words, all cap…
ALEX IS A TROLL
Again…
ALEX IS A TROLL
I would not engage Alex, and expect much…

chickelit said...

Alex said...

Psychiatric services should be free to all.

How about free food too?

Big Mike said...

A few days ago a former member of the University of Chicago Law School faculty offered his opinion that the insurance mandate was not severable. He's not a current member of the Law School faculty; his present office is on Pennsylvania Avenue in Washington, DC.

former law student said...

Is Alex a left winger every Monday?

Hoosier Daddy said...

How can insurance companies make any money if they have to cover sick people?"

If it was just about covering ‘sick people’ insurers would most likely be rolling in more money than they are now. As it is, they are also covering things like annual physicals, well baby care, immunizations and other routine medical procedures that isn’t what you’d call covering sick people. That’s why your auto insurance doesn’t cover your oil changes, or new tires, or front end alignment.

If we want to go the public option route then fine, just quit fooling yourself that somehow turning the financial responsibility over to the Federal government will fix the ‘health care crisis’.

Joe said...

(The Crypto Jew)
Is Alex a left winger every Monday?
I think there is a subtle algorithm at work…
1) “Alex” measures the sentiment of the thread, and generally runs counter to it; UNLESS
2) “Alex” decides it’s more fun to “agree” with the sentiment, in a manner that is grossly over-the-top.
So I don’t believe it matters the day of the week, merely the thread itself. But I could be wrong.

sunsong said...

Joy & Gratitude!

Original Mike said...

You guys still read Alex's posts?

sunsong said...

I figured that *real* conservatives were just fine with *activist* judges as long as the judge decides the case their way :-)

Dust Bunny Queen said...

How can insurance companies make any money if they have to cover sick people?

They can't.

That is the main point of this bill: to purposely bankrupt the private insurance industy and drive people into a government run socialized medicine program.

Covering people who are ALREADY sick is not by definition "insurance".

How can a landlord make any money when he is forced to let people live in his house for nothing.?

How can the grocery store make any money if people are allowed to grab items from the shelves and not pay?

Insurance companies are not charities.

If you want to provide for health care (note: health care is not the same thing as insurance) for people who are already ill, then set up some sort of charity and leave the rest of us out of it.

It IS NOT INSURANCE that you people are trying to ram down our throats with this monstrous bill.

It is a transfer of money from tax payers to non tax payers. It is a transfer of money from healthy to non healthy.

It is not insurance. PERIOD.

former law student said...

It is a transfer of money from tax payers to non tax payers. It is a transfer of money from healthy to non healthy.

But dbq, consider: My HMO premium is the cheapest option available to me: cheaper than the PPO and cheaper still than the conventional 80-20 insurance.

HDHouse said...

@sunsong -

the over-arching thing you must come to grips with on this blog is there are a lot of folks on here who just don't care and have no details.

for instance, ask them what parts of the bill they want to cut out and what parts they want to keep. that gets a lot of the crazies going.

then ask them why does it cost 3-4 times more per month to insure a family for health care than it does to feed them. that stumps them a bit.

oh and you can ask why we pay more for the same prescription medicines here than just about anywhere else. hmmmm a stumper.

when you get done laughing at the non-answer answers, try and remind them that preventative medicine is hugely cheaper than trying to cure someon because a problem wasn't caught early on. ohhhh i can hear it now "well just let 'em die!".

it isn't so much as there are cheap selfish bastards on this blog who are linked to the species only at the moment of birth, it is they don't like to be reminded about it.

Pogo said...

Judge Hudson wrote:
Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market...

B-b-but Judge!
Doesn't the Commerce Clause say whatever the hell they want it to say?

Pogo said...

Judge Hudson is apparently unaware that Congress can force us to buy fluorescent bulbs.

Why not compel fluorescent health insurance?

Dust Bunny Queen said...

But dbq, consider: My HMO premium is the cheapest option available to me: cheaper than the PPO and cheaper still than the conventional 80-20 insurance.


And do you know why that is?

Think about it.

Currently your insurance company can eliminate the sure thing of having to cover people who are already ill. The pool of people who are in your 'master policy' are by and large healthy or were healthy when they were pre-qualified for the insurance coverage.

The healthier the pool of insureds are and the fewer claims the less your overall premiums are going to be.

It is an actuarial thing. Less money going out (claims) versus the money coming in (premiums)= the ability to keep premiums low.

This is also why low deductible plans are more expensive than high deductible plans, which btw are going to be going bye bye if Obama and the liberals have their way.

When your HMO plan is forced to cover people with expensive illnesses that must be treated, guess what is going to happen to your lovely low HMO insurance premiums.

THINK.... try it.

garage mahal said...

That is the main point of this bill: to purposely bankrupt the private insurance industy and drive people into a government run socialized medicine program.

By giving them 30 million new customers? Good one. Actually getting rid of the mandate would be the worst news Aetna wanted to hear. They can't exclude people with pre-existing conditions, and they don't get the diversified risk pool that comes with it, leaving them with disproportionately sick share of the population. I say get rid of entirely these parasites who really contribute nothing but skimming, and go to single payer.

Hoosier Daddy said...

But dbq, consider: My HMO premium is the cheapest option available to me: cheaper than the PPO and cheaper still than the conventional 80-20 insurance.

Managed care is alway cheaper. If you're a relatively healthy individual, an HMO is probably your best value for health care.

Pogo said...
This comment has been removed by the author.
Pogo said...

"By giving them 30 million new customers? Good one."

By giving them 30 million new customers with limited premiums but unlimited demand.

See also: Ponzi scheme, Madoff, Social Security.

Dust Bunny Queen said...

then ask them why does it cost 3-4 times more per month to insure a family for health care than it does to feed them. that stumps them a bit.

First of all. That is not necessarily true. It depends on the age of the family, how many dependents, and the level of coverage that the family has chosen.

I just ran a quote for a family of 4, husband and wife age 35 with no maternity coverage, non smokers, with a HSA option and a rather high deductible. 386 a month.

It also depends on what they want to eat as well. :-)

Secondly, The reason that insurance is higher than it should be is that the policies cover things that are not necessary, not needed, not wanted and have mandates from the various States to include coverages that increase the cost in claims.

Under Obama's plan, you won't have the option to OPT OUT of certain coverage and won't have the option of an HSA high deductible plan.

Hoosier Daddy said...

then ask them why does it cost 3-4 times more per month to insure a family for health care than it does to feed them. that stumps them a bit.

I can give you an answer although I'm pretty sure you won't like it.

Dust Bunny Queen said...

By giving them 30 million new customers? Good one

Pretend we are talking about a fast food restaurant. The government mandates that you must serve 30 million more hamburgers. However, they also mandate that you must serve them at a predetermined price.

So if it costs you $2.00 to make a hamburger and you are forced to sell 30 million more at $1.50 each.....just how long do you think you will stay in business.

Volume does not equal profit.

Pogo said...

Obamacare is the Underpants Gnome method of national medical systems.

Chef Mojo said...

@HDhouse & Sunsong:

So, what's preventing you losers from just going out and adopting a family and paying for their insurance? Expecting the government to take care of something you don't have the balls to do for yourself is such a progressive sentiment, and is in and of itself the highest form of selfishness.

You both have this lovely habit of leaving your hypocritical droppings laying around. C'mon, guys. What have you done for your fellow man, lately, that didn't involve whining about someone else to take care of it. Liberals/progressives like you disgust me. You're the types that'll gladly pay for substitutes to take your place serving in wartime. Let someone else take care of it. You expect government to fulfill your shallow sense of morality so you don't have to get your precious fingers dirty.

You're laughable in your smugness.

Hoosier Daddy said...

try and remind them that preventative medicine is hugely cheaper than trying to cure someon because a problem wasn't caught early on.

I should have read the whole thing before I responded hd. Actually in a roundabout way, you hit it on the noggin with that quote right there. Preventative care is indeed cheaper but you know what, the expectation is that the insurer has to cover that too while the insured pays a $10-20 co-pay. So Acme insurance company is paying the routine physical for Insured #1 because that guy is all about preventative care and is footing the open heart surgery bill for insured #2 because he didn’t go for a physical for 15 years and had no idea he had high blood pressure and 280 cholesterol.

Again, the individual should be footing the bill for the cheap preventative medicine and counting on the insurance when, you know, the unexpected occurs.

Jay said...

then ask them why does it cost 3-4 times more per month to insure a family for health care than it does to feed them. that stumps them a bit.


Actually, it doesn't stump me at all.

The explosion in health care costs is directly attributed to government involvement.

The more the government is involved, the more the costs have gone up.

This isn't complicated, yet you're making imbecilic assertions.

garage mahal said...

However, they also mandate that you must serve them at a predetermined price.

If the mandate doesn't get enforced they will be forced to take a bunch of sick people. Instead of a bunch of people.

Again, that's fine with me. And I never liked the mandate anyway.

Alex said...

All this blathering about "preventive care" loses sight of the fact that we all get sick, mostly from causes not under out control. A compassionate society will not discriminate.

Seven Machos said...

The more the government is involved, the more the costs have gone up.

The price of any good or service that is subsidized in any way goes up. Anyone who has recently taken a 300-level microeconomics class can demonstrate this incontestable fact to you in a nifty graph.

Sadly, leftists don't believe in economics.

Jay said...

try and remind them that preventative medicine is hugely cheaper than trying to cure someon because a problem wasn't caught early on.

Your ignorance is staggering:

Congressional Budget Expert Says Preventive Care Will Raise -- Not Cut -- Costs


And,
Study Raises Questions About Cost Savings From Preventive Care


Finally,
Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.



But then again, if it weren't for baseless assertions & lies, you'd have nothing to say.

Joe said...

(The Crypto Jew)
If the mandate doesn't get enforced they will be forced to take a bunch of sick people. Instead of a bunch of people.
They also are told what services they must provide these people, whether the “people” need or want those services, and they are also told how much overhead they may charge to those people, and there may be limits on how much you can charge these people…so you keep talking about the “volume of business” to use DBQ’s terms, but you don’t discuss the costs associated with that increased volume.

And Preventive Healthcare does NOT lower costs…myth of healthcare activists….a number of studies are pointing that out, BTW. One case-in-point, PSA tests…well it turns out that finding you have prostate cancer doesn’t, necessarily, make treatment cheaper, or even desirable. Depending on your age and the nature of the cancer, you might just be as well off letting the cancer kill you as treat it…and without the “preventive medicine” it would, but now we can “treat” your cancer, even if it doesn’t really make any sense too.

Finally, the difference between the above paragraph and ObamaCare is that in it, I, the patient, can have a say as to whether I want to treat my cancer or not, whereas under ObamaCare IPAB and Rahm’s brother, Ezekiel, will have the final say…..

Jay said...

preventative medicine is hugely cheaper

Something you couldn't possibly prove.

Note:
Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical.

But what do they know, they're just doctors, not some silly, ignorant liberal Internet commenter...

New "Hussein" Ham said...

"It sounds as though he's adopted the reasoning that we've expected a judge striking down the provision to use."

No, it sounds as though he's adopted reasoning.

Period.

If Democrats can force you to purchase health insurance from their political donors, then they can force you to purchase burial insurance.

And life insurance so that those you leave behind do not become wards of the state.

And fart insurance, since you're obviously contributing to global climate change by being a human being that emits a greenhouse gas.

All these non-regulated insurance premiums, naturally, will end up in Democrat-controlled insurance companies such as Progressive Insurance. And the life insurance conglomerates owned by billionaire Warren Buffet - the man presiding over Barack Obama's economic council.

These people are robber barons - pure and simple. It is high time that we citizens take over these fucking companies and break them up and punish their shareholders.

These trusts have become too big and too powerful.

We must destroy them.

Hoosier Daddy said...

The explosion in health care costs is directly attributed to government involvement..

Yes and no. There are multiple factors that point to the increase costs and govt. is just one. Mandates are an example, such as a mandate that group health insurance cover substance abuse or non-experimental bariatric surgery (these are mandates in IN where they must be offered) so if you’re on a group plan and aren’t an alcoholic or morbidly obese, you’re paying for that coverage regardless (I won’t even get into the discussion of whether those examples should even be covered at all!)

Insurers themselves helped create this problem by offering more and more coverage thereby creating a ‘culture of entitlement’ for health care. My response to hdhouse is relevant in that even back in my childhood days, routine medical care was not covered by insurance. I had to get allergy shots for years and my parents had to cut a check each time cause insurance didn’t cover it. We were a far cry from being rich and it didn’t break the bank back then either. Tell someone now that they have to pay their annual physical out of pocket and see how that flies.

People are living longer and the older you get, the more expensive the care is as its more likely you’re going to have more ailments than the average 20 year old. Toss in innovation in medical technology, the cost of bring new drugs and technology to market in a nation of 300 million citizens and 10-12 non-citizens and, well there you go.

This isn’t unique to the US. France, Germany and the UK are also seeing huge increases in health care costs and they’re addressing them the same way insurers are here, raising taxes (premiums) and transferring more of the cost sharing on the individual.

jerryofva said...

Preventive care is not always cheaper. People who make this claim think in terms of vaccinations not healthcare issues discovered in the course of physical exams or screening procedures like mammography or colonoscopies.

For example screening everyone over 50 for colon cancer is actually fairly expensive for the number of cancers actually detected or prevented. It would be far cheaper to simply let people come down with colon cancer which would be then detected when there was little you could do about it anyway.

The reason we have a far higher cancer survival rate then the Canada, the UK or Europe is that we spend extra money to find cancers before then become deadly.

former law student said...

Again, the individual should be footing the bill for the cheap preventative medicine and counting on the insurance when, you know, the unexpected occurs.

That's why I brought up my HMO. It provides both kinds of care for less money than the conventional 80-20 insurer does. That's why I think there's an advantage to early preventative care, the oil change and tune up model.

former law student said...

The actual "annual physical" can be fairly cursory. And occult blood tests are fairly cheap these days.

Jay said...

@ Hossier Daddy:
Mandates are an example, such as a mandate that group health insurance cover substance abuse or non-experimental bariatric surgery

Where do these mandates come from?

Hoosier Daddy said...

For example screening everyone over 50 for colon cancer is actually fairly expensive for the number of cancers actually detected or prevented.

Which is why doing so is ridiculous. If you're over 50 and have a family history of colon cancer then its understandable.

Hoosier Daddy said...

Where do these mandates come from?

I think I answered that in the first sentence. Again, its not just government involvement. There are multiple factors which should be adddressed.

former law student said...

If you're over 50 and have a family history of colon cancer then its understandable.

I have a family history of everyone dying from something different.No one in my immediate family has come within a decade of collecting social security -- I'm really hoping I'm the one.

Hoosier Daddy said...

It would be far cheaper to simply let people come down with colon cancer which would be then detected when there was little you could do about it anyway.

Or it would be cheaper to screen just those individuals who are pre-disposed for that particular disease rather than include everyone.

It's called risk assessment.

Hoosier Daddy said...

I have a family history of everyone dying from something different.No one in my immediate family has come within a decade of collecting social security -- I'm really hoping I'm the one.

Maternal side has been cancer while paternal is typically a stroke. Then again they were all in their 80s and 90s so as my grandfather always said when he turned 75 was he was on bonus time.

AJ Lynch said...

FLS:

so approximately how many years do you have left [ballpark estimate is fine]?

Some of us here here would like to plan a party afterwards.

Joe said...

(The Crypto Jew)
No one in my immediate family has come within a decade of collecting social security -- I'm really hoping I'm the one.
Well that’s one way of looking at it…OTOH, you could forgo the IRA/401(k) route and take the excess money and invest it in fine whisky and the amorous companionship of your choice…Of course, that would guarantee you living to a ripe, in penurious old age.

SteveR said...

Necessary and Proper Clause?

Maybe if I were a constitutional scholar it would come across better than it sounds.

sunsong said...

Liberals/progressives like you disgust me. You're the types that'll gladly pay for substitutes to take your place serving in wartime. Let someone else take care of it. You expect government to fulfill your shallow sense of morality so you don't have to get your precious fingers dirty.

You're laughable in your smugness.


LOL - I don't think any five year old could have done better.

The trouble you've gone to to prove that you have an ability to assume and spew invective and hatred at people who disagree with you reflects soley on you. But then, you're the guy who lauds and violence and hatred.

My point is the about the hypocrisy of those who wail and ga-nash their teeth over judicial rulings in favor of gays and abortion but appear quite pleased with this one. It seems to me it's not that judges get involved that causes the angst - it's whether the judge agrees with them. Both sides act this way of course. Look at the reaction to Bush v Gore.

But nonetheless, I'm sure you're smart enough to realize that I don't care whether you're disgusted with me or whether you spend 24 hours a day hating me. Your opinion is not important to me.

Hoosier Daddy said...

Some of us here here would like to plan a party afterwards.

Come on AJ, that's mean. I mean FLS ain't my favorite commenter here but still.

Jay said...

My point is the about the hypocrisy of those who wail and ga-nash their teeth over judicial rulings in favor of gays and abortion but appear quite pleased with this one.

Alternatively,
One can understand that there actually is a constitutional issue resolved correctly in this ruling, as opposed to inventing rights for gays or aboriton.

AJ Lynch said...

Hoosier:
Yeah I know but I just couldn't resist.

Pogo said...

"...the hypocrisy of those who wail and ga-nash their teeth over judicial rulings in favor of gays and abortion..."


Which words appear in US Constitution as an enumerated right?

a) gay marriage
b) abortion on demand
c) health care
d) keep and bear arms

sunsong said...

Alternatively,
One can understand that there actually is a constitutional issue resolved correctly in this ruling, as opposed to inventing rights for gays or aboriton.


Sure :-)

As long as they agree with you and your perception of reality, right?

sunsong said...

Which words appear in US Constitution as an enumerated right?

What's an enumerated right?

Have you ever read the 9th Amendment?

mtrobertsattorney said...

But if Congress' authority to enact this mandate does not rest on the Commerce Clause, then on what other Article 1 enumerated power does it rest?

The power to "lay and collect taxes... for the general welfare"?

The problem here is that The One went out of his way countless times to assure us that the penality for violating the mandate was NOT a tax. This admission will be persuasive, if not decisive, in getting the Supreme Court to dismiss the Necessary and Proper Clause argument.

If the only possible authority for the mandate is the Commerce Clause, then the federal judge's conclusion is entirely logical.

former law student said...

Thanks Joe and Hoosier. And AJ -- unless the Senate gets cracking on dadt repeal, you won't see me around here past Christmas. I thought they would want to keep funding the military, but apparently it will all stop soon.

Joe said...

(The Crypto Jew)
What's an enumerated right?

Have you ever read the 9th Amendment?

One that’s mentioned in the Constitution, might I might just be reaching there….as to the 9th I would argue, not as a lawyer, law prof, or pundit, just a disembodied Internet Voice, that the 9th means rights as an “Englishmen” would have understood them, at the time of adoption. So you might have a “right” to travel, in that a state could not require an internal passport for you movements, but not a right to travel, in that it would require me to fund your travel. At the time of adoption NO STATE endorsed abortion, and so it would NOT be a right commonly viewed as the right of an Englishman.

Pogo said...

Answer my question, sunsong.

The right to keep and bear arms is called "enumerated" because it was expressly written into the Constitution.

The other rights I named were not, but they receive far more respect than the only one that was called by name and given its own amendment.

I find that strange, but typical.

kent said...

Psychiatric services should be free to all

... or to MSNBC's evening anchor lineup, at the very least.

jerryofva said...

On preventive medicine. The problem is that your family history database is tainted by the fact the people live longer and therefore at higher risk. The reason that one might not have a family history of say colon cancer is that they died from something else first. The heart attack at age 60 prevented them from developing colon cancer at 62.

I am not being flip. For the most part cancer is a disease of old age. Expanded longevity results in new exposure to risk.

Even so the cost of screening everyone at risk is still going to be more expensive then just letting nature takes its course. This is the logic of government healthcare that is driven by cost control. By limiting access to healthcare many people die or become untreatable before they can be screened or given treatment.

Bruce Hayden said...

But if Congress' authority to enact this mandate does not rest on the Commerce Clause, then on what other Article 1 enumerated power does it rest?

The power to "lay and collect taxes... for the general welfare"
?

The problem with using the taxing power in Article I Section 8 is that it is limited in Section 2 to recite that: "Representatives and direct taxes shall be apportioned among the several states which may be included within this union, according to their respective numbers, which shall be determined by adding to the whole number of free persons, including those bound to service for a term of years, and excluding Indians not taxed, three fifths of all other Persons." The Representation portion of this was amended by the 14th Amdt., and the taxation part by the 16th Amdt., which recites that: "The Congress shall have power to lay and collect taxes on incomes, from whatever source derived, without apportionment among the several states, and without regard to any census or enumeration."

The mandate itself, would not seem to be a tax, and the penalty for failing to comply would not seem to be directly apportioned, nor, I would suggest, a tax on income. Congress may have been able to structure it so that it might appear to be a tax on income, but I don't think that they really did so this time, with their concentration on the Commerce Clause.

Triangle Man said...

If Congress can take our money to pay for roads or any of thousands of other things. Sometimes we even get something back for our payout. I don't see why Congress should not have the power to take our money and give back health insurance in exchange.

This transaction may not appear to be as straightforward on the surface, but would there be any constitutional question whether Congress could enact a new tax which was used to pay for health insurance via private insurers?

Jay said...

Sure :-)

As long as they agree with you and your perception of reality, right?


Except it is fact, not "perception"

I know as a leftist you can't grasp these concepts.

former law student said...

would there be any constitutional question whether Congress could enact a new tax which was used to pay for health insurance via private insurers?

We should have done "Medicare for all" rather than try to cut the health insurance industry in.

No good deed goes unpunished.

Jay said...

My point is the about the hypocrisy of those who wail and ga-nash their teeth over judicial rulings in favor of gays and abortion but appear quite pleased with this one.

Uh, these "judicial rulings" as they relate to gays & abortion invent rights.

This ruling did not invent any rights.

You have no point.

Pogo said...

"We should have done "Medicare for all..."

Ahh, the "long queue" approach to health care.
Medicare patients are also beginning to face lines, as doctors increasingly prefer patients with private insurance.

AJ Lynch said...

We could have given everyone $1000 or $2000 to help them buy health insurance or beer or drugs or whatever they wanted to buy Then we could have washed our hands of the "health care crisis in America". But no that would not work because liberals don't trust people and so they won't let people do whatever they want with that money. Instead liberals chose to go with a dumb, stupid, convoluted, complex 2,000 page new law that most everyone hates. Stooopid liberals have now gotten what they deserved -a good hard comeuppance! hahahaha libruls!

Dudley Do-right said...

If the individual mandate is constitutional, it seems the gov't could insist we buy Chevys instead of Fords so as to pay off GM's debt. ...or, if we buy a Ford, we'll be subject to a GM debt retirement tax that doesn't apply to Chevys. But I think it may go well beyond even this.

What activities will be beyond the regulatory authority of the Commerce Clause if the individual mandate is declared constitutional?

Freed of any restriction, the Commerce Clause could empower every "good" intention the Left can dream up.

Dust Bunny Queen said...

We should have done "Medicare for all" rather than try to cut the health insurance industry in.

As long as ALL the people pay something towards the Medicare benefits.

ALL people pay. Medicare is not free you know. You have to pay in to the system in order to qualify for Part A to be free and Part B is about 96$ a month per person.

OR...were you thinking about welfare....Medicaid where some people pay for the program through taxes and others get a free ride leeching off the work of the taxpayers?

former law student said...

dbq: I was thinking about constitutionality. The Constitution authorizes Congress to tax and spend for the general welfare. All workers are taxed, and some old folks benefit

Hoosier Daddy said...

We should have done "Medicare for all" rather than try to cut the health insurance industry in.

I was advoocating this approach from day one. There is still an option for insurers to fill in the Medicare gap. Medicare can easily be reformed as well by eliminating some of the fluff coverage, such as Viagra for geezers or for the Scooter Store.

Even the 'socialized medicine' in France, Germany, Netherlands etc have private insurance because even they can't foot the whole bill and provide anything remotely close to quality care.

Hoosier Daddy said...

I am not being flip. For the most part cancer is a disease of old age. Expanded longevity results in new exposure to risk.

Really? Tell that to Elizabeth Edwards, oh wait. I didn't look up any stats on it and I'm guessing you didn't either but based upon just anecdotal evidence, there are plenty of kids out there suffering from cancer and all too many adults in the prime of life.

Even so the cost of screening everyone at risk is still going to be more expensive then just letting nature takes its course.

Again where do you get this screen everyone? Why? Should I get screened for breast cancer? Yes, men do get breast cancer too. Again, risk assessment. If we're going under the assumption we have to screen everyone for everything then yes, its going to unaffordable but the only one I hear advocating such an approach is you.

Bruce Hayden said...

dbq: I was thinking about constitutionality. The Constitution authorizes Congress to tax and spend for the general welfare. All workers are taxed, and some old folks benefit.

Let me add that most old people benefit. At one time, yes, most didn't live long enough, but the age for benefits has not climbed nearly as quickly as has life span.

Nevertheless, the use of the word "workers" is key here. That implies some sort of income tax, which is authorized under the 16th Amdt. But the mandate applies to everyone, whether they work or not, and whether they would otherwise have to file a return or not. It really can't be an income tax, since it applies whether or not there is any income or not. And, indeed, if you earn zero and have zero income, you may still have to pay some sort of penalty, unless some other part of the act provides subsidized insurance.