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Obamacare upheld
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Fox



Joined: 04 Mar 2009

PostPosted: Tue Jul 03, 2012 6:59 pm    Post subject: Reply with quote

Kuros wrote:
The money at stake and the penalty provided in this act were much greater than in South Dakota v. Dole. In that case, the gov't only withheld 5% of highway funds, or less than 1% of South Dakota's budget. But Obamacare threatened to withhold ALL Medicare funding constituting at least 10% and as much as 20% of a State's budget.


Right, but it's fairly obvious that Congress could, if it so chose, abolish Medicaid entirely, which would also result in that money vanishing. As such, I don't see how the 10th Amendment can be interpreted in any fashion so as to entitle states to that money so long as the relevant laws apply to all states equally. That Congress could strip all states of Medicaid money, but they can't offer all states a choice which could result in that money being lost, seems questionable to me. You and the judges are obviously correct that judicial predecent leans in that direction, but although I can understand why the judiciary concerns itself so deeply with precedent, I also think sometimes legal scholars can become so lost in such concerns that start coming to bizarre conclusions.

I'm not saying this decision was dubious for reasons of partisan behavior, but rather, that it seems to me -- admittedly as a non-legal scholar -- that the 10th Amendment being interpretted as protecting states from being offered tough choices by the federal government seems like a stretch.
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comm



Joined: 22 Jun 2010

PostPosted: Tue Jul 03, 2012 11:22 pm    Post subject: Reply with quote

Fox wrote:
I'm not saying this decision was dubious for reasons of partisan behavior, but rather, that it seems to me -- admittedly as a non-legal scholar -- that the 10th Amendment being interpretted as protecting states from being offered tough choices by the federal government seems like a stretch.

But by that logic, the Feds could simply increase taxes to any ludicrous rate they choose and refund that ludicrous amount back... so long as the States comply with everything the Feds ever tell them to do. But then, maybe that's the precedent being set for citizens with the healthcare mandate...

Whether or not you think the Federal government should have more authority over the States than it has in the past (you know, when we followed the letter and spirit of the Constitution) I think you realize that that is a nonsensical way to increase its authority.
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Fox



Joined: 04 Mar 2009

PostPosted: Tue Jul 03, 2012 11:50 pm    Post subject: Reply with quote

comm wrote:
Fox wrote:
I'm not saying this decision was dubious for reasons of partisan behavior, but rather, that it seems to me -- admittedly as a non-legal scholar -- that the 10th Amendment being interpretted as protecting states from being offered tough choices by the federal government seems like a stretch.


But by that logic, the Feds could simply increase taxes to any ludicrous rate they choose and refund that ludicrous amount back...


Yes, this was the first thought that casually popped into my mind while trying to defend the judicial precedent in question to myself, but then I naturally realized that -- even if the people legitimately elected a government which was capable of raising taxes on the entire population to high enough levels for such a threat to enter play -- nothing about the precedent in question actually prevents what you are describing. The federal government can still raise taxes, and it can still abolish any programs it likes, it simply cannot offer states tough choices. Classifying that as a violation of sovereignty is almost Orwellian.

comm wrote:
... so long as the States comply with everything the Feds ever tell them to do. But then, maybe that's the precedent being set for citizens with the healthcare mandate...


You realize that the denizens of the states are the ones who elect the federal government, right? It is not some alien, unaccountable monstrosity; it ultimately springs from the same source as the state governments collectively. Alexander Hamilton rubbishes a worry very similar to this about abuse of tax powers in the Federalist Papers, and he was right to do so; the federal government is not going to suddenly shut the states out of taxable revenue in a wild power grab. To the extent that this issue comes up, it comes up in cases where the federal government is trying to achieve a limited, and generally positive end.

comm wrote:
Whether or not you think the Federal government should have more authority over the States than it has in the past (you know, when we followed the letter and spirit of the Constitution) I think you realize that that is a nonsensical way to increase its authority.


No authority increase is occurring under my interpretation of the constitution. The feds have the right to tax, and they have the right to disburse that money in accordance with their constitutional-mandates, which like it or not include the general welfare. It is rather the judicial precedent in question that artificially, and I suggest perhaps wrongly, restricts federal power and its natural expression, and more importantly, does so in a seemingly non-sensical way, because as I mentioned, the federal government could very clearly simply abolish Medicaid and achieve the same net state budget cuts without even offering the states themselves a choice in the matter. The notion that the federal goernment giving the states a choice -- even a tough one -- infringes upon sovereignty is bizarre when one simultaneously holds that giving the states no choice in a comparable matter is not an infringement.
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comm



Joined: 22 Jun 2010

PostPosted: Wed Jul 04, 2012 2:31 am    Post subject: Reply with quote

Fox wrote:
The notion that the federal goernment giving the states a choice -- even a tough one -- infringes upon sovereignty is bizarre when one simultaneously holds that giving the states no choice in a comparable matter is not an infringement.

Right, lets use an example then:
I'll increase Federal income taxes on everyone by 20%. And having as many children as you like is perfectly legal. However, if you have fewer than two children, that extra 20% income tax will be refunded to you. You have a choice, so it doesn't impinge on your sovereignty or liberty, right?

The important thing here is that, if States were removed from Medicare or Medicaid, their citizens would STILL be paying for it at the national level. Otherwise, the State could simply raise the funds itself and engage in its own Medicare/Medicaid program. And that, by the way, would be an excellent thing for States to be able to do.

This ruling goes beyond the letter of the law and engages the spirit of it. The spirit is "If you don't follow my rules (even though I have no formal authority to issue those rules to you) I will take punitive financial actions against you". It's the punitive taxation which is being prohibited here.
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Fox



Joined: 04 Mar 2009

PostPosted: Wed Jul 04, 2012 3:52 am    Post subject: Reply with quote

comm wrote:
Fox wrote:
The notion that the federal goernment giving the states a choice -- even a tough one -- infringes upon sovereignty is bizarre when one simultaneously holds that giving the states no choice in a comparable matter is not an infringement.

Right, lets use an example then:
I'll increase Federal income taxes on everyone by 20%. And having as many children as you like is perfectly legal. However, if you have fewer than two children, that extra 20% income tax will be refunded to you. You have a choice, so it doesn't impinge on your sovereignty or liberty, right?


Liberty and sovereignty are two different things. Only sovereignty is relevant here, and citizens do not, as individuals, have sovereignty, so this is an awkward analogy. But let's put that aside and pretend we generally have sovereignty to make the analogy work. The above-mentioned example would in no way reduce my sovereignty. My sovereignty was reduced when the government gained the right to tax me in general, not by any specific instance of taxation. Indeed, the fact that the government would have to use its right to tax me to encourage me to comply with its policies, instead of simply mandating it, emphasizes my sovereignty, because I retain the right to make a choice.

In fact, the precedent in question is ultimately arbitrary. States got by for decades without Medicaid, and could do so again. To the extent that there is a limiting factor here, it lies in the will of the people; in the fact that the electorate would boot out any state government stupid enough to give up 100% of federal medicaid funding in their little political squabble with the Obama administration. A reaction from the electorate is no violation of sovereignty.

comm wrote:
The important thing here is that, if States were removed from Medicare or Medicaid, their citizens would STILL be paying for it at the national level.


Plenty of citizens pay for the benefits of other citizens. This even occurs at a state level; rich blue states pay for the services that help keep poor red states afloat. Yes, this would be a particularly striking example of such an inequity, but the inequity would only exist because the people's elected representatives actively chose it, so I for one do not find it particularly appalling. If some punk like Rick Scott wants to screw his entire state out of Medicaid funding (as a hypothetical example, since in reality I do not think he would have the guts to give up all federal support for it), Floridans could either embrace his choice or sweep him out of office. Being insulated from tough choices is not sovereignty, it is daycare.

comm wrote:
Otherwise, the State could simply raise the funds itself and engage in its own Medicare/Medicaid program. And that, by the way, would be an excellent thing for States to be able to do.


If the states were effective at such things, the national-level programs would never have been needed. But states usually cannot manage the sort of solidly-progressive taxation systems required to raise sufficient revenues for such vast projects (as I have mentioned before, almost every states total tax system is regressive). Hell, states are going broke even with the federal government doing as much of the heavy lifting regarding gathering taxes for them as it does. If you think the states would suddenly become wildly-effective revenue raisers if only the feds got out of the way, well, I think that ignores history and, more importantly, logic. It is far easier to avoid state taxation than federal.

comm wrote:
This ruling goes beyond the letter of the law and engages the spirit of it. The spirit is "If you don't follow my rules (even though I have no formal authority to issue those rules to you) I will take punitive financial actions against you".


This is not precisely correct. Kuros posted the standards, and past judicial precednt makes it clear that there can be such punative financial action, but it cannot pass some arbitrary standard of harshness. In short, the federal government can present states with choices, but not tough ones.

comm wrote:
It's the punitive taxation which is being prohibited here.


It is actually punative withdrawl of funding that is being prohibited here. Punative taxation was explicitly upheld in Roberts' opinion.
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Kuros



Joined: 27 Apr 2004

PostPosted: Wed Jul 04, 2012 6:32 am    Post subject: Reply with quote

comm wrote:
It's the punitive taxation which is being prohibited here.


The tax was upheld because it wasn't punitive, and because it provides a genuine choice. I think Fox is addressing the Medicaid funding issue.

Fox,

Obviously, SCOTUS upheld the Medicaid funding provision (I would say 9-0 but it was never really addressed; Medicaid is constitutional and so is its expansion). The question was: can Congress TOTALLY DENY all Medicaid funding to the states which choose to opt out of the Medicaid expansion?

Fox wrote:
there can be such punative financial action, but it cannot pass some arbitrary standard of harshness. In short, the federal government can present states with choices, but not tough ones.


Ginsburg's dissent also complains that Roberts never established a line for coercion. But Medicaid is the largest single Federal-to-State subsidy out there. Medicaid/Medicare, to the average state, represents 23% of its budget. Before Obamacare, FMAP ranged between 50%-83% of State funding, depending on each State's income. Thus, high-income California receives 50% of its Medicaid funding from the Federal gov't, or $1 Federal for every state dollar. In 2012, Kentucky will receive $2.47 Federal and Mississippi $2.87 Federal for each state dollar. Even the highest income States are highly dependent upon the Federal gov't for current Medicaid funding. (Note: the Recovery Act boosted the Federal match from 2009-2011)

The Constitutional Federal Medicaid expansion will initially provide 100% of matching Medicaid funds, which will then adjust to 90% of matching Medicaid subsidies (in 2017?) to increase coverage to low-income individuals. Thus, the carrot is irresistible. Many of these people are going into hospitals for care already, what State will refuse $9 in Fed subsidies to their state dollar?

The Unconstitutional Federal Medicaid stick threatened to withhold all Federal Medicare funding should the State refuse to accept that 9-to-1 subsidy.

I wouldn't characterize either the Medicare carrot (constitutional) or the stick (unconstitutional) as a tough choice. With just the carrot, every State faces an easy choice: accept the Medicaid expansion. With just the stick, every State also had an easy choice: accept the Medicaid expansion. The difference is, the stick was like putting a gun to each State's head.

The Medicaid stick was punitive and coercive. But the Individual Mandate Tax was tailored to offer a choice.
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Fox



Joined: 04 Mar 2009

PostPosted: Wed Jul 04, 2012 3:57 pm    Post subject: Reply with quote

Kuros wrote:
I wouldn't characterize either the Medicare carrot (constitutional) or the stick (unconstitutional) as a tough choice. With just the carrot, every State faces an easy choice: accept the Medicaid expansion.


In a rational world filled with state-governments who actually cared first and foremost about their people's welfare, this would definitely be correct; the terms of what you call the "carrot" are simply too beneficial to be rationally turned down if such is your goal. In the real world, however, team-sport politics evidently turn such "easy choices" into tough ones:

Quote:
Fifteen governors reject or leaning against expanded Medicaid program

At least 15 governors have indicated they will not participate in the expansion of Medicaid under the healthcare law, striking a blow to President Obama’s promise of broader insurance coverage.

Before Thursday’s Supreme Court ruling, states had the option of either increasing their Medicaid rolls or being penalized by the federal government. The high court struck down that offer as unconstitutional.


Governors still have a financial incentive to participate in the expansion of coverage for low-income people, since the government will foot most of the bill through 2016. But the decision is also loaded with politics, particularly for Republican governors who are adamantly opposed to “ObamaCare.”

“You can make the political call real quick, but the actual decision is a complicated one,” said Matt Salo of the National Association of Medicaid Directors. “Governors are going to be looking at the numbers and asking: Does this make sense for us?”

Seven states with Republican governors have given a flat “no” to the Medicaid expansion since the Supreme Court ruling, according to reports and press statements (see list below).

States that will decline to participate include Florida, where Gov. Rick Scott (R) turned his opposition to the law into a political career, and Louisiana, where Gov. Bobby Jindal (R) has vowed to help elect Mitt Romney as president in order to repeal it.

In eight other states — seven with GOP governors — the Medicaid expansion seems unlikely, given comments from governors and their offices.

...


And the states most vehemently against it are often the ones who are most desparately in need of it. In an era where state governments are literally willing to see their people go without health care rather than give the Obama Administration the perceived victory of paying for health care for them, what should be an easy choice evidently becomes a quite difficult one for certain parties!

Kuros wrote:
With just the stick, every State also had an easy choice: accept the Medicaid expansion.


Again, in a world of rational, compassionate governance, this would definitely be correct, and in such a world the "stick" wouldn't even be needed, because it would be the rawest of raw stupidity to turn down the "carrot." But once again, back in the real world, where denying the Obama Administration any sort of perceived victory is an end in itself for certain parties, it becomes a tougher choice. Plenty of governors have outright said they'll turn down the Medicaid expansion for their citizens in service of their ideological interests, and although I think even they would balk at throwing away 100% of Medicaid funding in their little political game, I suspect there would be quite a bit of agonizing over it, since for these people the choice in a certain sense becomes a question of which is more important: remaining in office, or telling Obama to go to Hell.

Kuros wrote:
The difference is, the stick was like putting a gun to each State's head.


Is that a fair comparison? The terror of a gun to the head comes from the potential termination of your existence, and as is evinced by history, states can clearly survive without federal Medicaid funding. It would be painful, but that's what makes the choice tough for the governors in question: the pain of no Medicaid, or the pain of handing Obama a perceived victory. I don't even think it's the absence of Medicaid funding itself which would scare some of these governors; they've made it clear enough they have little concern for the poor, and if they could drop Medicaid funding for their state without getting thrown out of office in the process, it would not at all surprise me to see certain state governments do it.
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Fox



Joined: 04 Mar 2009

PostPosted: Wed Jul 04, 2012 4:13 pm    Post subject: Reply with quote

Fox wrote:

comm wrote:
Otherwise, the State could simply raise the funds itself and engage in its own Medicare/Medicaid program. And that, by the way, would be an excellent thing for States to be able to do.


If the states were effective at such things, the national-level programs would never have been needed. But states usually cannot manage the sort of solidly-progressive taxation systems required to raise sufficient revenues for such vast projects (as I have mentioned before, almost every states total tax system is regressive). Hell, states are going broke even with the federal government doing as much of the heavy lifting regarding gathering taxes for them as it does. If you think the states would suddenly become wildly-effective revenue raisers if only the feds got out of the way, well, I think that ignores history and, more importantly, logic. It is far easier to avoid state taxation than federal.


Here is a somewhat older article expanding on this a bit more:

Quote:
It is one of the happy incidents of the federal system,” Justice Louis Brandeis once mused, “that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.” Well, quite. These days we practically expect the states to try their hand at fixing tricky national problems before the federal government steps in. So to many observers, when several states recently turned their attention to providing health care for the uninsured—one of the thorniest domestic problems of all—it looked like cause for considerable optimism.

For a start, both Massachusetts (which passed a near-universal plan last year) and California (which is seriously debating one) are trying something relatively new: individual mandates that require every person in the state to have health insurance. The fact that Democratic legislatures have pushed Republican governors—one a presidential candidate (Mitt Romney), the other a celebrity (Arnold Schwarzenegger)—to back the notion of universal care has given this per-ennial liberal dream a bipartisan cachet. It has also helped revive the national conversation around universal health care by moving the discussion from airy, moral exhortations to practical examples of possible paths forward. In fact, the leading Democratic presidential candidates have all committed themselves to universal health reform, some with plans that seem more than a little influenced by those statewide R&D centers. The laboratories of democracy appear to be in fine working order.

So far, so good. But we know that the politics of health care is treacherous. In the last half century, two presidents (Truman and Clinton) mounted serious efforts to provide health care to all the uninsured and failed, while another (FDR) scotched his ambitions when he appraised the obstacles. There’s no reason to think that things will be any easier this time around. Consider this: congressional Democrats, despite their new majority, were recently unable to pass even minor tweaks to the Medicare prescription drug benefit. If a Democrat wins the presidency in 2008, he or she will face a daunting array of moneyed interests aiming to kill any universal health care program they attempt to pass.

Faced with such long odds, a conventional wisdom will soon develop that it would be better for Washington to defer efforts to pass universal health care, perhaps indefinitely, and instead just leave the problem to the states to figure out. Indeed, such arguments are already being voiced by ideological opponents of expanded federal power. “Let’s just try many different approaches in many different states and see what happens,” the Heritage Foundation’s Stuart Butler told me. “The more complex an issue is, the less possible it is to actually know the best system in advance—therefore a system of trial and error in which all these pieces work together is the best way to push forward.”

The idea of giving universal health care a little more time in the laboratories of democracy may sound tempting to certain cautious, bipartisanship-loving Beltway observers. But letting states continue to take the lead would be disastrous, for one very simple reason: providing health care for all citizens is one of those tasks, like national defense, that the states are simply unequipped to manage on their own. The history of state health reform initiatives (and there’s quite a history) is a tale of false hopes and great disappointments. The deck is stacked from the start, and the house—in this case the insurers, the providers, and other agents of the status quo—always wins. The new raft of reforms may prove different, but they probably won’t. Universal care advocates must be realistic about that, and think hard about how to convert the energy in the states into a national solution before the current crop of novel experiments fail—because fail they almost certainly will.

The current appetite for universal health care in state capitals may seem thrilling and unprecedented to some, but to those who follow the issue it carries an unsettling charge of déjà vu. Over the years, states have tried programs of many different ideological and economic persuasions. All of them failed, and not because the programs were insufficiently inventive, but because states are structurally incapable of sustaining them.

(description of various past attempts by states and why they failed)

The new crop of state health care plans are trying to avoid the failures of the past by attempting something new: individual mandates. Here, Massachusetts led the way. Its plan forces everyone in the state to have health insurance, with subsidies for those who can’t afford it. The genius of this approach is that many of those who lack health insurance aren’t poor or ailing—they’re middle-class people who have decided they’re healthy enough that they don’t need to spend money on health coverage. Forcing these people to buy insurance (like similar reforms that require all drivers to have auto insurance) has the useful effect of bringing more money into the system while spreading the risk. So far, Massachusetts is the first state to pass such a plan, but other states, including California, Illinois, New Jersey, and Connecticut, are contemplating universal plans with similar individual mandates.

And the early indicators from Massachusetts suggest that the new program might actually work—at least in Massachusetts. State officials recently announced that they expect to be able to afford sliding-scale premiums that would provide coverage—some of it bare bones, but still better than nothing—to 99 percent of adults in the state.

Alas, Massachusetts may be the exception that proves the rule, for several reasons. First, it has one of the lowest uninsured populations in the country: 10 percent compared to the nationwide average of 16 percent. Second, a relatively large portion of that 10 percent can afford to buy insurance without government subsidy, thanks to the fact that the state is one of the nation’s wealthiest, with a median household income of about $8,000 above the national average. That leaves Massachusetts with a reasonably small number of citizens who need government support to purchase health insurance. And in that regard, Massachusetts has a third advantage: a ready-made funding source. In 1988, then Governor Michael Dukakis signed a pay-or-play universal health care bill into law. Like similar laws enacted in other states, it failed, and most of its provisions were repealed a year later by his successor. But portions of it remained, including revenue streams—totaling $540 million—dedicated to reimbursing hospitals who care for the uninsured. That’s $540 million that can now go to covering the uninsured. It’s also money most other states don’t have just lying around.

...

One of the great things about state governments is that they have more freedom than the federal government does to test new policy ideas. But it pays to look honestly at what the results of those tests actually say. And in this case, the results are pretty clear: states are no good at delivering universal health care.

No one can doubt the role Massachusetts and California have played in reinvigorating the debate over national health care. And if the reforms currently percolating at the state level help provide momentum for a national health care system in the next few years, all the effort will have been worth it. If they don’t, however, they may ultimately prove detrimental. If high-profile efforts like those in Massachusetts and California can’t be properly implemented, or are launched and then collapse, they’ll become powerful weapons in the hands of protectors of the status quo. After the demise of Washington State’s plan, for instance, the Heritage Foundation published an article stating that the program “gave state legislators around the country an experimental taste of how a Clinton-style health care plan would work—or fail to work. The result was higher costs, burgeoning bureaucracy, and micromanagement.” If the example of Washington is replaced with California, this kind of attack will become far more deadly.

The rest of the industrialized world proves that nationally run care can, and does, work. But our own history proves that state-run care doesn’t, and reformers should keep that in mind. Brandeis, for all his federalism, was a realist, too. “If we would guide by the light of reason,” he said, “we must let our minds be bold.” On health reform, the light of reason is clear. We must merely be bold enough to follow it, and not settle for smaller, unsustainable victories because we fear the battle necessary for an enduring triumph.


Waxing romantically about letting the states handle this matter sounds nice, but it ignores all the data we have, and that data strongly implies that state-level health care reform is problematic at best, while national-level health care reform is wildly successful with the potential to cover entire nations full of people at much more efficient rates. Doesn't there reach a point where ideology has to give way to reality?
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Kimbop



Joined: 31 Mar 2008

PostPosted: Thu Jul 05, 2012 10:05 am    Post subject: Re: ... Reply with quote

No_hite_pls wrote:
Kimbop wrote:
Welcome FORCE via brutality. Abandon your personal liberty.

Say hi to Obamacare.


Ha Ha, Seriously? $75 fine is forced brutality. ha ha ha!

Kimbop you rock!

You do more to help the dems than any other poster I know. Keep up your good work!


The USA will not raise enough tax revenue to pay for long lineups of millions of entitled, uneducated proletariat. Social security, medicare/medicaid, drug programs, welfare, free education & healthcare for illegal immigrants, and now Obamacare. Another nail in the coffin. The USA will become Greece. Your country is doomed.

Total revenue $2.627 trillion (requested)
$2.469 trillion (enacted)

Total expenditures $3.729 trillion (requested)
$3.796 trillion (enacted)

Deficit $1.101 trillion (requested)
$1.327 trillion (enacted)
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Kuros



Joined: 27 Apr 2004

PostPosted: Thu Jul 05, 2012 4:02 pm    Post subject: Reply with quote

Fox,

Its very easy for GOP Governors to refuse Obamacare now. The first Medicaid disbursements are a few years off. And States won't have to match funds for at least another five years. Most of those Governors won't even be in power by then. Those that are still in power will quietly accept the Federal money and pay the 10 cents on the dollar.

And if you're worried about Governors refusing, be happy that Roberts struck down the coercive denial of Medicaid. After all, at least a Governor can refuse Obamacare without dismantling his State's health care subsidies altogether.

I'm not convinced the national government would administer health care any better than the States. I also think that article is bullshit. It doesn't even mention Vermont's universal healthcare plan (due in 2017). The Medicare expansion will allow States to reach universal healthcare more easily; after the poor are covered and exchanges set up, States could very easily create public options. Hell, you could really call the health care exchanges limited public options.

Wait, I just noticed it was Ezra Klein who wrote that article.

Ezra Klein wrote:
The rest of the industrialized world proves that nationally run care can, and does, work


No, Ezra, nationally funded care can, and does, work. The largest of those countries, Japan, administers healthcare at the local level. Germany integrates regulations and cost-controls at the State level (Laender). Larger countries look to states and localities for administration, if not funding. With the Obamacare model, that is where the United States is headed as well.

Ezra Klein wrote:
providing health care for all citizens is one of those tasks, like national defense, that the states are simply unequipped to manage on their own.


So good luck with your Constitutional Amendment, Ezra.
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Fox



Joined: 04 Mar 2009

PostPosted: Thu Jul 05, 2012 5:18 pm    Post subject: Reply with quote

Kuros wrote:
Those that are still in power will quietly accept the Federal money and pay the 10 cents on the dollar.


Hope so.

Kuros wrote:
I also think that article is bullshit. It doesn't even mention Vermont's universal healthcare plan (due in 2017).


This article was written in 2007, Kuros. Wasn't the Vermont law passed in 2011?

Kuros wrote:
The Medicare expansion will allow States to reach universal healthcare more easily; after the poor are covered and exchanges set up, States could very easily create public options.


So after the federal government pays for health care for all the expensive and hard to cover people, the States could probably manage to sweep up the relatively low cost people that are left over? That doesn't seem like much of a triumph for the states. Quite the opposite, it seems like an implicit admission of Ezra's point, since under such a model, the states are reliant on the federal government to even hypothetically achieve full coverage. Almost like letting your kid help you build something; you do all the real work, and then you let your kid do a few little things to make him feel like he's participating, even if he probably does it a bit worse than you would.

Kuros wrote:
No, Ezra, nationally funded care can, and does, work. The largest of those countries, Japan, administers healthcare at the local level. Germany integrates regulations and cost-controls at the State level (Laender). Larger countries look to states and localities for administration, if not funding. With the Obamacare model, that is where the United States is headed as well.


A not unvalid point, but remember that within the context of our conversation here, comm's adjuration was for the federal government to get out of the way entirely and let the states raise the money themselves.

comm wrote:
Otherwise, the State could simply raise the funds itself and engage in its own Medicare/Medicaid program. And that, by the way, would be an excellent thing for States to be able to do.
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Kuros



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PostPosted: Thu Jul 05, 2012 5:56 pm    Post subject: Reply with quote

Well, States don't have incredibly strong revenue powers. If they did, the 7-2 opinion to strike down the Medicaid stick would make little sense. We could debate whether the States lack such revenue powers because the Federal power uses its tax power too much. But frankly, the Federal power does so constitutionally. Any doubts about the Federal gov't's power to tax was laid to rest with the 16th Amendment, although I could give a spirited argument about how the Founders intended to give the United States gov't a strong taxing power following the disaster of the Articles of Confederation. At any rate, I would not wish the hell you see in Europe on our Federation. There, funds transfers from rich to poor States are politically impossible. Here, rich States such as Maryland and New Jersey regularly subsidize poorer States such as Kentucky and Mississippi through the Federal tax code.

I would argue this is the Great Compromise. The Federal power has a robust power to tax, but it should be limited in its regulatory powers to properly interstate activities. And let's face it, intrastate activities have genuinely narrowed quite a bit (although there have been absurd impositions of the Federal power on properly intrastate activities, such as criminal matters like marijuana prohibition based on thoughtless analogies with economic regulation of wheat in the 40s). The essential balance of Federalism preserves administrative decentralization while allowing governmental centralization. Thus, Obamacare permissibly establishes a Federal superstructure collecting and disbursing funds to state and local administrations. It is very fitting that like Medicare, Obamacare was justified under the Tax for the General Welfare Clause, and NOT under the Commerce Clause.

Let's not lose sight of what is happening. Businesses are dropping employees from their healthcare plans, or with turnover, are refusing to offer new hires healthcare plans. They have to, because medical costs are exploding (and not just in the US; but here healthcare economics are particularly inefficient). The Henry Ford model has just about died. The old conglomerate as benefactor mentality has eroded along with morality among businessmen. As MBA grads began to replace Liberal Arts grads in the boardroom, executives lost any sense beyond maximizing profits. Those private-sector unions have managed to hold onto it have been crushed. Obamacare shifts the burden to gov't to provide insurance. This is one of those few pro-business, non-corporatist policies. The State is in a better position to fund healthcare, anyway.

The Solicitor General was totally right, by the way. This is a national problem. He was just wrong that the entire solution must be implemented at the national level.

And for those lamenting State-funded healthcare: you're about 70 years too late. Medicare and Medicaid are as old as FDR's reign. Obamacare is the natural extension of such programs. And Obamacare will become a juggernaut entitlement much the same as Medicare and Medicaid. That will lead to a very scary fiscal predicament, but the alternative would be to let the old and the impoverished sick beg for care. That just seems unconscionable.
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northway



Joined: 05 Jul 2010

PostPosted: Thu Jul 05, 2012 6:39 pm    Post subject: Reply with quote

Kuros wrote:
And for those lamenting State-funded healthcare: you're about 70 years too late. Medicare and Medicaid are as old as FDR's reign. Obamacare is the natural extension of such programs. And Obamacare will become a juggernaut entitlement much the same as Medicare and Medicaid. That will lead to a very scary fiscal predicament, but the alternative would be to let the old and the impoverished sick beg for care. That just seems unconscionable.


That's the thing. I don't think state-funded care is ideal, but I haven't heard much in the way of alternatives. Though there was at least one ncident where some radical fringe members of the Tea Party were shouting "let them die", I have a distinct feeling those people were simply caught up in the moment. If not, I suggest we make them work the front desk in an emergency room, and they can personally turn away the uninsured.

One thing I don't understand, and perhaps I'm being obtuse: the governors complaining the most about this are, for the most part, from states that take in more from the Feds than they pay into the pot. Wouldn't expanding Medicare benefit their states without costing them more? Are they rejecting the expansion on strictly ideological grounds, or would it actually cost them more?
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recessiontime



Joined: 21 Jun 2010
Location: Got avatar privileges nyahahaha

PostPosted: Thu Jul 05, 2012 8:00 pm    Post subject: Reply with quote

Isn't this obamacare just another example of crony capitalism at play?

The handful of insurance companies weren't happy enough cornering the market and charging whatever they want. Now they have literally everyone to suscribe to them or else they will have to pay a fine to the government. Is this not another example of government dispensing favors to corporations so it can collect more taxes?

The top 5% earners pay an additional 0.9% on their taxes and the rest of the population will be coerced to get insurance or else they pay a fine.

Now the poor people that couldn't get insurance will be forced into paying insurance companies, and the rich a bit more. Seems like the US is on the brink of attaining universal healthcare through taxes. Hurray for crony capitalism induced socialism....just wait for the 6-10 hour waiting lines at the hospital to see a doctor.
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northway



Joined: 05 Jul 2010

PostPosted: Thu Jul 05, 2012 8:21 pm    Post subject: Reply with quote

recessiontime wrote:
Now the poor people that couldn't get insurance will be forced into paying insurance companies, and the rich a bit more. Seems like the US is on the brink of attaining universal healthcare through taxes. Hurray for crony capitalism induced socialism....just wait for the 6-10 hour waiting lines at the hospital to see a doctor.


Maybe, but do you have a better solution? I think while it's easy to come up with legitimate complaints about Obamacare, it's a lot more difficult to come up with legitimate alternatives.
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