Monday, March 22, 2010

The 219

I don't see the passage of the HCR bill as a victory for Obama as much as a victory for the Boston-New York-San Francisco Axis of the Democratic Party. They would like to govern based on social engineering statistics: life expectancy, infant mortality, cancer survival rates, violent crime rates, etc. And freedom be damned.

“Interstate Commerce? What does that mean when people are sick?”

The federal courts have long held that insurance is a state matter and not covered by the federal power to regulate interstate commerce, because no physical product actually changes hands. Although after Raich vs. Gonzales, it seems that the feds can now use “interstate commerce” to do anything they damned well please. Angel Raich lost her appeal because the Justice Dept. argued successfully that the six marijuana plants that she grew on her back porch affected the interstate price of marijuana; even though they admitted that she had never sold any of it, and that it was for her own use.

The biggest blow is the hit to the cherished American concept of personal responsibility. It now becomes collective responsibility.

Interestingly, in Canada, with its full-on “single-payer” healthcare system, there seems to be no legal mandate for emergency rooms to treat foreign citizens. Administrators have been known to actually stop treatment for Americans injured in auto accidents until they could determine that the patient had private health insurance that the hospital could bill. On the web I found an interesting first-person account of this from an American physician who was licensed to practice in several U.S. States and Canadian provinces.

I wonder how American hospitals handle billing ER costs for Canadians injured in auto accidents in the U.S.? Anyone know?

A likely legal outcome of HCR is that the individual mandate to buy health insurance will be found to be unconstitutional. That will not affect the universal coverage requirement of HCR, so where will the money come from if the feds can't compel everyone to buy health insurance? The federal treasury, natch. One way the feds might try to make up this deficit is by raising personal income tax rates while simultaneously allowing people who have their own health insurance to deduct every penny of it on their personal income tax returns. It's already deductible now, of course, but it's “means tested” against your AGI (“Adjusted Gross Income”). Ending the “means testing” for health insurance premiums would create yet another yawning federal deficit unless there were a countervailing personal income tax increase. This would be a back door method for compelling everyone (or every tax-payer, anyway) to purchase health insurance without offending the Constitution, but it involves a tax increase, and a big one.

One of the best arguments for universal coverage (although not the HCR Act) is the high cost of the huge number of people who use emergency rooms as their personal physicians. ER care is very expensive, and many of these folks could be treated better, and much less expensively, if they had a personal physician. But federal law requires ERs to treat and stabilize every patient who shows up, irrespective of ability to pay, and the hospitals pass the costs for that on to everybody else in the form of higher overhead, higher fees for services for patients who can pay. This is one of the reasons (of many) that healthcare costs in the U.S. are as high as they are. And the theory is that once everybody is insured, hospitals will reduce their fees commensurately.

I don't think so!

I think the hospitals will keep their rates just where they are and bill the federal government for treatment of uninsured people in their ERs. No cost savings at all, just more demands on the federal treasury.

One commenter on the internet said something like:

Somewhere in America there is a 500-lb woman with diabetes who just ate half a birthday cake and smoked her fifth cigarette of the morning. She can't afford health insurance, and we're gonna buy it for her.

I predict that large numbers of uninsured people will continue to show up in ERs and experts will wonder, “How can this possibly be?” The hospital administrators will push a clipboard of forms at these people, who will fill them out with false names and addresses, and get on with their lives. They don't want the “authorities” to know where they live or where they work, because it could cost them big bucks – get their wages garnished, for example. And this, in turn will create a demand in Congress for national identity cards; it's to prevent fraud, you see? It seems that a lot of the uninsured work at a variety of “day laborer” or temporary or part-time jobs or in the “cash economy”. These folks are not eligible for health insurance from their employers now, nor will they ever be: they change jobs too frequently for that, even under the new HCR Act. They don't have bank accounts, they don't own property, and they may not even have a fixed address. The idea that the feds will somehow be able to pin these folks down and get them to contribute to the costs of the new healthcare system is laughable.

Unless the HCR Act is repealed or amended, within a few years, the Dept. of Health and Human Services will begin issuing health insurance cards to everyone. These will be personal cards, issued to every American citizen (or “resident”, and that's a whole 'nother can of worms, isn't it?) and they will be extremely tamper-resistant. They will replace your current “Blue Cross” card (“too vulnerable to fraud, you know!”) and in fact, your own insurance company will stop issuing insurance cards in favor of the HHS card. These cards will become a defacto national identity card. Soon after that, the Transportation Security Administration will announce that these cards are now accepted as personal IDs for the purpose of air travel in the U.S. Then a few years later, the TSA will declare that these cards are mandatory for air travel (“compared to driver's licenses, they're more resistant to fraud and tampering, you know!”). The feds will attach a “rider” to a state highway bill mandating that states require drivers (and later, passengers) to carry these cards when traveling in a motor vehicle. Take that, Utah! Take that, New Hampshire! You will face sanctions if you do not carry this card on your person at all times.

At that point we will have a system of “internal passports”.

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