Do you think it would be Unconstitutional if

[syrenn]

Yes, but the reason they don't go to clinics is because the clinics will not see them without insurance.

That is not the ER's problem now is it? (and by extension, mine)

No, it's a societal problem.

You know, if a really contagious nasty epidemic ever were to hit America, you might find health care is a problem that affects us all.

For these reasons we already pay taxes that pay for the other two emergency services.

An epidemic is a different thing then people using the ER's for primary care.

 

[gekaap]

And if you don't have any, you then go talk to their accounts manager, who arranges a payment plan for you.

Okay, so what's your point?

Depends on the business and the circumstances.

Okay, so what's your point? I never said there was a singular approach that every single business applies. My cable bill, for instance, demands payment for the upcoming month, not the preceding month. It's feasible for them to do this because they know what my bill is going to be, generally speaking.

Actually, my dry cleaner charges you when you drop the clothes off. It's not like he can't see what you're bringing in and figure out what it's going to cost.

Okay, what's your point? My dry cleaning usually has me pay afterward, especially when I bring in my heavy trench coat and it has several spots that need attention. My point was that certain types of business cannot always easily predict before hand what your services will cost. You can take your car to the mechanic because a hose leak is causing you to frequently overheat, and it might turn out that you now need a new thermostat also. This might cause your bill to more than double, so they're going to wait until the end to tally up your bill.

Only because you don't know how much it's going to cost until the ride is over.

That's exactly the point. Even if you're going in for a simple check up, your doctor might end up having to run a whole series of lab work and other tests if it turns out that you've been having symptoms indicating something is wrong. He might end up deciding to give you prescription medicine, and might decide that instead of actually giving you a prescription he'll just give you samples that the drug rep sold him last week. Lots of things can change the cost of your visit.

If you're having a heart attack, YOU aren't filling out your paperwork. Your family is.

Not if you dropped in the grocery store, and nobody yet knows how to contact any next of kin. Or, if you were home alone, and your closest family lives a couple hours away. Or, if you don't have family. But all of that is irrelevant. The point is that when a patient presents with life threatening symptoms, treatment cannot be delayed in order to first gather insurance or payment information. You treat first, and worry about insurance when the patient's safety allows taking time for it. That might mean having a family member fill out paperwork while the patient is being treated. That might mean waiting until the patient has been stablized to get the info from him/her.

 

[gekaap]

So tell me, what do you want the ER to do for this guy?

o_0 All I'm saying is that it makes sense that such a person might go to the ER. Whether anything useful would come of it is not what I'm talking about.

 

[PLYMCO_PILGRIM]

the Federal government required all employers to provide a minimum standard of health insurance?

I think Hawai'i has got that requirement right now. But could the Feds do it?

And I guess the bigger question is, if it is Constitutional could it be part of the answer to health care reform?

Yes that power is not granted to the Federal Government in the Constitution of the United States.

However the constitution does give STATES the authority to do so as all powers not EXPLICITLY granted to the feds are the domain of the state .

Take my state, MA, for example. Even though a judge ruled obamacare unconstitutional due to its mandate that decision does not impact my states laws mandating the citizens buy health insurance or face fines and penalties.

 

[draper]

Free clinics tend to be in urbanized areas. This is why ERs sometimes get stuck with non emergent problems.

I only used those two examples because when I was a nursing student I was made to do a "9 News Health Fair" clinic which is a free clinic run by a local TV station. I will never do it again. Two patients stick out in my memory;

The woman with the lump in her breast knew she had it and it had been diagnosed. She just couldn't find a surgeon to do anything about it. She came to us because she was panicking.

The guy with high blood pressure knew he had it too and though he had a job was not able to come up with $100 for the next months supply. He probably went through a few days if not weeks of form filling in.

For what it is worth, I do not believe the government should be requiring citizens to buy anything. I believe in universal healthcare free of insurance companies.

As most of our health care dollars are spent in the last couple of years of our lives when the government is picking up the tab anyway, why should insurance companies get mega bucks from mostly healthy people?

 

[Sheldon]

the Federal government required all employers to provide a minimum standard of health insurance?

I think Hawai'i has got that requirement right now. But could the Feds do it?

And I guess the bigger question is, if it is Constitutional could it be part of the answer to health care reform?

legally, do you think providing a minimum standard of health insurance is different from providing a minimum wage?

for the record, i'm pretty sure that any company of more than 50 employees already has to provide some type of health insurance. i could be wrong about that. it's been a while since i thought about it.

Yeah that's kind of what I was thinking. There seems to be precedent for the Feds to set minimum standards for doing business in the country. You can't have 9 year olds on the payroll. You have to follow OSHA. You can't dump toxic waste in the river.

The reason I brought this up, was because I was thinking it could have been a better way to go about the mandate. Expand Medicaid eligibility to unemployed but looking for work, require employers to provide plans, the employee could turn it down but if they didn't get insurance elsewhere then they wouldn't qualify for the tax exemption--something like that.



Health Insurance: Frequently asked questions

Here's a link that says there's no legal requirement, but most do it already to keep their workers happy, but only full-timers.

 

[Skull Pilot]

the Federal government required all employers to provide a minimum standard of health insurance?

I think Hawai'i has got that requirement right now. But could the Feds do it?

And I guess the bigger question is, if it is Constitutional could it be part of the answer to health care reform?

Employers already have to carry workman's comp to cover on the job injuries.

It's not the employer's responsibility to cover off the job injuries and illnesses.

 

[Bern80]

the Federal government required all employers to provide a minimum standard of health insurance?

I think Hawai'i has got that requirement right now. But could the Feds do it?

And I guess the bigger question is, if it is Constitutional could it be part of the answer to health care reform?

legally, do you think providing a minimum standard of health insurance is different from providing a minimum wage?

for the record, i'm pretty sure that any company of more than 50 employees already has to provide some type of health insurance. i could be wrong about that. it's been a while since i thought about it.

Yeah that's kind of what I was thinking. There seems to be precedent for the Feds to set minimum standards for doing business in the country. You can't have 9 year olds on the payroll. You have to follow OSHA. You can't dump toxic waste in the river.

The reason I brought this up, was because I was thinking it could have been a better way to go about the mandate. Expand Medicaid eligibility to unemployed but looking for work, require employers to provide plans, the employee could turn it down but if they didn't get insurance elsewhere then they wouldn't qualify for the tax exemption--something like that.



Health Insurance: Frequently asked questions

Here's a link that says there's no legal requirement, but most do it already to keep their workers happy, but only full-timers.

Ugh, you people are still thinking inside the box. The idea ought to be to work to a point where insurance and/or services in general are affordable enough that employers don't have subsidize the health care of their employees.

The second problem is the paradism you are shifting to in the employee/employer relationship. It currently is and should remain a simple business transaction where two parties agree on compensation for work provided. In an effort to entice skilled workers many businesses CHOSE to offer beneifts like health care. It is very common place now of course for employers to do that, but the employee should be under no delusion that is something an employer owes them. But that's exactly the paradigm you want to move to. One where it is no longer one being compensated for services but one where an employer becomes more responsible for your standard of living than you are. That's not why people go into business. People go into business to make money for themselves, to be respsonsible for providing for themselves, not for other people. That one's business can end up providng for others is simply a by product.

You have to look at the commentary you are essentially making on society and it's people when you do things like set min wage laws and mandate that employers MUST provide insurance benefits. What you are essentially telling a business owner who took it upon themselve to provide for themselves in the best way they saw fit is that they are also responsbile for the same of everyone that works for them. You are essentially punsihing that person for being responsible and absolving his employees of responsbility for the same. In very general terms continuing to absolve people of personal responsibility is not going to work out to well for a society.

 

[Cecilie1200]

And if you don't have any, you then go talk to their accounts manager, who arranges a payment plan for you.

Okay, so what's your point?

That you don't necessarily have to pay for your health care at the time of service. And by the way, that IS what you're doing, rather than "pre-paying": you're paying when you get the service. Yeah, they get the info before you go in, because you're going to just be sitting there, twiddling your thumbs, otherwise, but they're not billing your insurance until well after you leave the office.

Depends on the business and the circumstances.

Okay, so what's your point? I never said there was a singular approach that every single business applies. My cable bill, for instance, demands payment for the upcoming month, not the preceding month. It's feasible for them to do this because they know what my bill is going to be, generally speaking.

I love it. You start this big rant about how "only medicine requires pre-payment", and NOW you're telling me that's NOT what you were saying. So what the fuck was YOUR point?

Okay, what's your point? My dry cleaning usually has me pay afterward, especially when I bring in my heavy trench coat and it has several spots that need attention. My point was that certain types of business cannot always easily predict before hand what your services will cost. You can take your car to the mechanic because a hose leak is causing you to frequently overheat, and it might turn out that you now need a new thermostat also. This might cause your bill to more than double, so they're going to wait until the end to tally up your bill.

The point, Mr. "I start a rant, and then when I'm proven wrong, pretend I didn't say anything", is that you were wrong about only health care asking for pre-payment. Other businesses do it if they need to.

Your point was NOT "that other businesses can't charge ahead of time". Your point was that NO other businesses do so, and you were wrong, and now you're backpedaling.

Only because you don't know how much it's going to cost until the ride is over.

That's exactly the point. Even if you're going in for a simple check up, your doctor might end up having to run a whole series of lab work and other tests if it turns out that you've been having symptoms indicating something is wrong. He might end up deciding to give you prescription medicine, and might decide that instead of actually giving you a prescription he'll just give you samples that the drug rep sold him last week. Lots of things can change the cost of your visit.

Well, since you're not actually handing him cash at the start, it doesn't matter. All you're doing is telling him who to send the bill to later. So again, if "that's the point", what the fuck is it, precisely? You keep blithering hither and yon about what you were trying to say, and not making much of any point at all.

If you're having a heart attack, YOU aren't filling out your paperwork. Your family is.

Not if you dropped in the grocery store, and nobody yet knows how to contact any next of kin. Or, if you were home alone, and your closest family lives a couple hours away. Or, if you don't have family. But all of that is irrelevant. The point is that when a patient presents with life threatening symptoms, treatment cannot be delayed in order to first gather insurance or payment information. You treat first, and worry about insurance when the patient's safety allows taking time for it. That might mean having a family member fill out paperwork while the patient is being treated. That might mean waiting until the patient has been stablized to get the info from him/her.

I don't know if it's irrelevant or not, because you're not making any coherent point. You just keep yammering blindly, telling me "that's the point" or "that's irrelevant" in some vain attempt to make it sound like you're always right and have said something deeply profound.

Pick a fucking point you want to excoriate the current healthcare system about and make it, already.

 

[Sheldon]

legally, do you think providing a minimum standard of health insurance is different from providing a minimum wage?

for the record, i'm pretty sure that any company of more than 50 employees already has to provide some type of health insurance. i could be wrong about that. it's been a while since i thought about it.

Yeah that's kind of what I was thinking. There seems to be precedent for the Feds to set minimum standards for doing business in the country. You can't have 9 year olds on the payroll. You have to follow OSHA. You can't dump toxic waste in the river.

The reason I brought this up, was because I was thinking it could have been a better way to go about the mandate. Expand Medicaid eligibility to unemployed but looking for work, require employers to provide plans, the employee could turn it down but if they didn't get insurance elsewhere then they wouldn't qualify for the tax exemption--something like that.



Health Insurance: Frequently asked questions

Here's a link that says there's no legal requirement, but most do it already to keep their workers happy, but only full-timers.

Ugh, you people are still thinking inside the box. The idea ought to be to work to a point where insurance and/or services in general are affordable enough that employers don't have subsidize the health care of their employees.

The second problem is the paradism you are shifting to in the employee/employer relationship. It currently is and should remain a simple business transaction where two parties agree on compensation for work provided. In an effort to entice skilled workers many businesses CHOSE to offer beneifts like health care. It is very common place now of course for employers to do that, but the employee should be under no delusion that is something an employer owes them. But that's exactly the paradigm you want to move to. One where it is no longer one being compensated for services but one where an employer becomes more responsible for your standard of living than you are. That's not why people go into business. People go into business to make money for themselves, to be respsonsible for providing for themselves, not for other people. That one's business can end up providng for others is simply a by product.

You have to look at the commentary you are essentially making on society and it's people when you do things like set min wage laws and mandate that employers MUST provide insurance benefits. What you are essentially telling a business owner who took it upon themselve to provide for themselves in the best way they saw fit is that they are also responsbile for the same of everyone that works for them. You are essentially punsihing that person for being responsible and absolving his employees of responsbility for the same. In very general terms continuing to absolve people of personal responsibility is not going to work out to well for a society.

Don't "ugh" me!

Personally I don't have a problem with minimum wage laws, or standards of safety that employers must meet. Or state license requirements.

But I agree that this would really just be shifting deck chairs. This biggest issue is reducing the costs of health care, not the way it's paid for.

Why I was thinking about an employer mandate to provide access to plans, over an individual buy-or-get-fined scheme, would be that it could meet the same ends but would pose less of a constitutional question.

Individuals would still have the option to NOT go with the employer plans, and could shop elsewhere, or just not have insurance and then miss out on the exemption.

And the difference between an exemption and a fine is the difference between a carrot and a stick--which could be an important distinction in the legal world.

 

[Greenbeard]

Does the fed have the authority to require people to purchase things?

Phrasing the question like this misses the point. The argument in favor of the individual mandate to buy health insurance is, I believe, very simple.

1. Ignoring the individual mandate momentarily, the federal government has the authority under the Commerce Clause to do virtually everything in Title I of the ACA--the title pertaining to insurance market regulation--including creating exchanges subject to guaranteed issue and community rating rules. Both Hudson and Vinson accepted this point in their rulings, as did the plaintiffs in those cases.
2. The individual mandate, which we're considering separately from the rest of Title I (which, based on these rulings, seems to be beyond reproach), was instituted for a simple economic reason that virtually no one disputes: rules against most forms of medical underwriting threaten to destabilize insurance markets unless a replacement bulwark against adverse selection is also implemented. That's the function the individual mandate serves and that's why it's included in the ACA.
3. Current understanding of the extent of the Necessary and Proper clause is summed up succinctly by Antonin Scalia, of all people: "As the Court put it in Wrightwood Dairy, where Congress has the authority to enact a regulation of interstate commerce, 'it possesses every power needed to make that regulation effective.' 315 U.S., at 118—119."
4. Given that the insurance regulations require an additional element--some kind of deterrent to adverse selection, the function served by the individual mandate--in order to be effective at achieving their objectives, instituting a mandate in furtherance of the rest of Title I of the ACA is allowed under the N&P clause.

It doesn't follow from that argument that the government can require you to purchase just anything, precisely because the set of potential regulations that logically requires the purchase of a good as a subsidiary provision is somewhat limited; equivalents of adverse selection aren't all that common precisely because insurance markets aren't quite like most other markets (and the health insurance market has some notable distinctions that separate it even from other insurance markets). Talk about authority to mandate broccoli or tea as a result of this chain of logic simply doesn't work.

That's not true of the line of argumentation that suggests the mandate itself is an exercise of the Commerce Clause power but the N&P argument tracks the actual function of the mandate (the reason--a logical and economic imperative--it's in the ACA in the first place) so well I don't think any other line of argumentation should be needed.