I think the world of Jon Gruber, the MIT economist who helped design both the Massachusetts Health Plan and the Health Insurance Exchange provisions of President Obama’s Affordable Care Act. So I was more than a bit dismayed to read this quote from Jon: “I’m frustrated that the future of the American health care system rests in the hands of one or two of these unelected people who might make the decision based on political grounds.” The “unelected people” that Jon is referring to are justices of the Supreme Court. Jon almost seems surprised that the Supreme Court has a say in the matter.
The Health Insurance Exchange is an idea that economists have floated for more than three decades and thanks to his hard work, that idea has become a reality in Massachusetts and perhaps the rest of the nation, provided that the Supreme Court doesn’t block this fine bit of economics. Unfortunately for supporters of the exchange (including myself) the health insurance purchase mandate – an essential element of any economically viable exchange – might be unconstitutional. God forbid that the U.S. Constitution might interfere with beautiful economic theories.
There is a solution. I am almost too modest to say it but I proposed this idea in my book Code Red long before Barack Obama put his hand on the bible to be sworn in as Regulator-in-Chief. The beauty of the solution is that it respects, nay, was inspired by Jon’s work in Massachusetts, and is constitutional to boot! The solution is in its own way conservative, because it does not mandate a single approach to health reform. Congress should have given each state a block grant conditional on expanding health insurance coverage. The states could have chosen how to proceed. The U.S. Constitution might prohibit a federal mandate to purchase insurance, but it says nothing about what the states may do.
Some states might have chosen to adopt their own versions of the Massachusetts Health Plan. A few states may have centralized insurance, creating their own versions of single payer systems. Others may have given individuals vouchers and encouraged the growth of private insurance exchanges. This would be the closest to a free market solution, keeping the government out of it, except as a vehicle for transferring wealth. Perhaps all of these ideas would have been better than the status quo. Perhaps states could have learned from each other. Even Jon Gruber might have learned something new! Through this experimentation, we could have rapidly expanded health insurance coverage and also put lots of theories to the test. I still think this is a terrific idea. But in 2009 when politicians and economists huddled together to write the Affordable Care Act, no one invited me to the party. Alas.
When it comes to research, the best economists are rather conservative. We put our own findings under the microscope, trying every which way to prove ourselves wrong. We cannot publish unless several peers have given our work the same scrutiny. But when we are given the opportunity to make policy, we often abandon this conservatism. Perhaps this is because we are so rarely given the chance to make policy. Economists like Jon Gruber were privileged to have substantial input into the future of the health care system, and may have thought that their work was done when Congress embraced their models. But that was never the end of their work. The Constitutional challenge to the insurance purchase mandate is part of a process that should have been anticipated from day one. There are no surprises here.
P.S. Jon Gruber has stated that he cannot understand why Mitt Romney is disowning the Affordable Care Act when it is modeled on the Massachusetts Health Plan. Perhaps Romney believes that the Massachusetts Health Plan is good for Massachusetts, but might not be so good for other states. I know I believe it.
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all of them including big government that even makes this possible in the first place. If the federal government would stay out of matters it has no constitutional business being in trash like him wouldn’t exist. Your never going to eliminate people like Tauzin or Obama, you can eliminate the corrupt system they feed off of though.
Not sure who you’re trying to disparage Nate, Obama, Tauzin, Republicans, or crony capitalism?
“Billy Tauzin, K-Street’s Drug Kingpin”
“When he was acting as a field marshal for the Medicare prescription drug bill, Tauzin upset the true believers on both ends of the political spectrum. Conservatives were outraged that their party was creating a new federal entitlement. Liberals fumed that the bill prohibited Medicare from using its purchasing power to negotiate prices with the drugmakers. Detractors on both sides thought the bill amounted to corporate welfare for the drug industry.”
“When Tauzin announced just weeks after its passage that he was retiring, the speculation immediately began: Would he cash out to the drugmakers?
Sure enough, Tauzin is today the chief executive officer of the drug companies’ lobby.
“Billy Tauzin, former congressman from Louisiana, is best known to us pharmascolds for his appearance in Michael Moore’s Sicko, shamelessly mugging for the camera while holding the outsized cardboard check for $2 million as he celebrated being hired by PhRMA as their CEO, immediately after he had successfully pushed Medicare Part D through Congress with multiple provisions handcrafted to suit the desires of the drug industry.”
Since the topic has been raised I’m surprised Bobby hasn’t linked this article about the evil of big business in relation to healthcare;
http://www.futureofcapitalism.com/2011/11/obama-and-billy-tauzin
Billy Tauzin, the former congressman turned pharmaceutical industry lobbyist, was paid $11.6 million in 2010, the year he brokered a deal with President Barack Obama that helped pass the health-care overhaul.
After the law was signed, Tauzin left his job as head of the Pharmaceutical Research and Manufacturers of America, or PhRMA, as the highest-paid lobbyist among groups most involved in the overhaul debate. Karen Ignagni, leader of the insurer lobby, was paid $1.5 million in 2010 while Tom Donahue at the Chamber of Commerce made $4.8 million, tax records show.
Have no interest in the above thread, but see no other recent posting that the following link would apply, so sorry for disrupting this debate, but I think the column by the author, a physician and relative of Mr Obama, has merit.
http://www.washingtontimes.com/news/2011/nov/28/bye-bye-berwick/
With all the unraveling that has transpired since the legislation was forced, er, passed and put into motion, who would want to talk about PPACA as an ally to their cause. Only the liars, cheats, and clueless.
Happy Holidays?
73 minutes on hold till the call was answered.
After a pointless coversation the question I am left with is why would any employer sponsor a healthplan when the federal government will send you threatening demand letters then garnish your account or withhold funds becuase they have poor record keeping. You are left with no choice but to spend hours on the phone dealing with these people who have no accountability or motivation to resolve problems or apply common sense or stop offering insurance to your employees.
Next time you liberals want to bad mouth employers for not offering coverage remember how impossible our government makes it.
Why Health Insurance cost as much as it does
We have a small client that has a fully insured plan. Under the carriers fully insured plan they take a little bit of the risk, i.e. they reimburse part of the employees $5000 deductible. This can be very cost effective, as long as you don’t encounter are incredibly inefficient government.
They have an employee who is dual covered with Medicare but this plan is primary. Even though we tell her every month we are prime and her providers need to bill us she has them bill Medicare.
Medicare aware that she has primary coverage, then looks to recover what they paid from the primary carrier. Being a well ran single payor governemnt plan like it is they of course go after the small employer who is liable for at most $3000 a year. An amount they have alredy paid. The amount they are looking to recover, $72,000+. We have already been over this with Medicare 3-4 times, they need to look to the insurance company. Every time they promise to fix it, every three months it starts all over again.
This latest time I have been on hold 37 minutes so far, they did warn me the hold time was over 50 minutes. This was after trying to call a few times earlier but the hold time was so long it just disconnected new callers. Think how many people are sitting on hold right now wasting time becuase of this grossly incompetent government ran insurance program.
Not only is it a failue of an insurance plan but it drags every other plan down with it. How 10s of millions of americans can support and advocate for such failure defies logic.
“the original interpretation of the Constitution”
a.k.a. The Ouija Board School of Jurisprudence.
When all else fails, Nate repeatedly reaches for the race card.
it starts with the failure of our legislature to write clear and concise laws. They purposefully write vague bills then leave the details up to the courts and bureaucracy to hash out.
There should never be court decisions like Roe v Wade. That is a clear case of something not addressed or envisioned by the original authors. Congress should be forced to sit down and deal with these issues not pass the buck.
Courts are stacked with ideologues of both persuasions and yes I would rather have federal judges get politically appointed than have to be elected and raise large amounts of funds to do so.
So you suggest that the Supreme Court shouldn’t be able to challenge/overturn laws? What exactly is your point?
Nate – I never said you wanted to bring back slavery. What I was pointing out is the original constitution, while a brilliant document, also had some major flaws something constitutional originalist rarely want to admit. And when people talk about returning to the original interpretation of the Constitution, my first reaction is you mean when ….
BTW – Your European Socialist comment was meant to get my goat but it doesn’t really bother me.
I’m done now. Have a nice day.
you shouldn’t project arguments on other people, especially cheap ones like “putting it out there” that someone wants to bring slavery back. I run my mouth plenty you don’t need to be speaking for me.
Being able to read the constitution and know what it says, good and bad, by no means implies someone wants to bring back slavery and ignore the amendments. Your smart enough to know that but were going for some cheap points. Its a very common game liberals play so I have a very effective defence for it. If you don’t want to be labeled a racist don’t drag race into arguments as a weapon.
If being a racist is so bad why were you so quick to try and label me with it? You remind me of Maggie maher and how she would label people secist because they were smarter then here in arguments. Don’t play the game you wont get hurt.
Nate – Your words – “Use to be a time you didn’t need law degree to know what the constitution said, we can thank the same people ramming this down the public’s throat for that.”
I took that to mean you want the originalist interpretation of the constitution. Sorry if I was wrong.
And you shouldn’t call people the names you are using (I won’t use them) knowing absolutely nothing about my background or family. I am about the furthest thing from the horrible description you used.
and when was the last time we had an amendment, which is the proper way to expand federal power, not through stacking the court with ideologues.
no you racist we have the 13th amendment which corrected that. There really is no place in an advanced society for raciest like you John.
Ah yes. The originalist interpretation of the constitutional. I suppose you think we should go back to the original, unamended constitution with slavery, blacks being 2/3 (or was it 3/5 people can’t remember) people, denying women the right to vote, election of Senators by state legislatures, etc.
I think it is pretty clear the founders expected the constitution would need to adapt with the times or else they wouldn’t have created the amendment process or permitted Supreme Court interpretation of the document.
And yes – I think a Medicare for All solution would probably be the most efficient way to provide healthcare in the US so I suppose that makes me a European Socialist.
“there is not a serious constitutional lawyer out there (i.e. – one who is not bought and paid for by ideological think tanks) who believes the mandate is unconstitutional.”
There is not a serious American out there, i.e. one who is not a european socialist or outright communist,) who believes it is constitutional. Pretty easy to make an argument when you frame it right.
Use to be a time you didn’t need law degree to know what the constitution said, we can thank the same people ramming this down the public’s throat for that.
I share Jon Gruber’s frustration. I have worked in health policy for over 20 yrs and spent 8+ yrs on Capitol Hill. An individual mandate was originally advocated by Republicans as an alternative to the Clinton Healthcare Reform proposal and was being pushed as recently as 4 yrs ago by Newt Gingrich as a way to deal with the uninsured. It was only after it was adopted by Obama that Republicans went nuts about it.
Also, there is not a serious constitutional lawyer out there (i.e. – one who is not bought and paid for by ideological think tanks) who believes the mandate is unconstitutional. 2 US Appeals Courts with conservative majorities have ruled that the mandate is constitutional. The idea that a highly political Supreme Court might rule the mandate unconstitutiona is scary and frustrating.
And what few people discuss is that a ruling that the HCR mandate is unconstitutional would reverse 100+ yrs of interpretation of the Commerce Clause and likely to open up the potential reversal if many other regulatory structures we take for granted. It would have a much larger impact than many people realize. This is why in the end I suspect the Supreme Court will not overturn the mandate because the impact and consequences would be very broad.
Don’t be so blind Gary. The question is not rather the federal government should have a role in making sure their 1.3 trillon is appropriately spent, the question is why they are spending 1.3 trillion in the first place. That is not the role of the federal government.
If sheep like you would stop giving the federal government the money and power to give wall street trillions of dollars we wouldn’t have to worry about wall street blowing it in the first place.
You want reform, that is exactly what I am proposing,defund DC so they can’t squander another 15 trillion of our money.
I think you hve described the Romney plan. Am I wrong?
I’ll also remind you MG until the government started tinkering with insurance it was very common for employer based plans to cover retirees and their spouse until death. Its not creating something new its returning to what was done for decades minus the government regulations that drove everyone out of it.
“Yeah, right. When you talk specifics on certain issues you make some valid points but you are often just largely full of BS and this is another example. Maybe catastrophic only coverage but how in your right mind could you up with affordable insurance for elderly people who required full-time nursing care?”
Your the one tossing out generalities, and to answer your question by not waiting until they are an elderly person in a nursing home. Use a little common sense, we sell LTC insurance now which covers old people in nursing homs. We sell million dollar life policies that pay off when old sick people in nursing homes die. If someone waits till they are at the admit counter of the nursing home to worry how they are going to pay for it they are not in search of insurance they are in search of charity. The first thing we need to change is use insurance as insurance not bastardize it as we do now.
Nate: “Government has no right nor roll [sic] in healthcare period.”
Public funds account for something approaching 50% of national health spending of $2.6 trillion and you contend that government has no role in making sure that money is appropriately spent. This is the same mindset that was satisfied paying over hundreds of billions of dollars to Wall Street crooks, guys that totally failed in managing risk, all this payout being done without the government demanding any accountability or reform even after the colossal failure.
“why would it leave out anyone? I could design insurance products that could cover anyone. I’ll guarantee you can’t come up with any scenerio where 95% of the population couldn’t have covereage tomorrow.”
Yeah, right. When you talk specifics on certain issues you make some valid points but you are often just largely full of BS and this is another example. Maybe catastrophic only coverage but how in your right mind could you up with affordable insurance for elderly people who required full-time nursing care?
“If it strikes you as foolhardy its becuase your not very informed. There is tons of fraud and harm in our current system. Look at our financial markets and in spite of all their regualtions they are full of fraud and harm. Excessive regulation breeds fraud, it provides cover for abuse and gives buyers a false sense of security. An unregulated free market where its buyer beware is always safer then an over-regualted system that codies fraud and abuse and tricks the public into thinking they are safe. Don’t be so naive and simple, just becuase there is 10000 pages of law saying you can’t rob people doesn’t mean a crook is any less likly to do so.”
I agree that just because there are laws on the books doesn’t mean that there isn’t fraud and abuse if there isn’t adequate enforcement of these laws by the proper authorities. It has been a huge problem especially with mortgage underwriting. Instead the DOJ has been trying to buy off state AGs for the past 2 years with a settlement where the mortgage underwriters would pay a lump settlements that would be in the tens of billions to avoid civil litigation by the states (and implied to avoid state criminal prosecutions too).
It is kind of funny though about how you bring up the financial system. So the financial system worked well in the late 19th century largely without huge amounts of speculation, fraud, etc? People are honest and ethical by nature and are firms and will largely due the right thing in business dealings?
“I rather know fire extinguishers are unchecked and I need to do so myself then think the government is doing their job then find out after my house burnt down that the inspector wasn’t doing their job. Couple years ago in Vegas there was a big scandal about casino’s having work done and they found out the building inspectors where incompetent. Whats worse, thinking your safe when your not or not knowing if your safe and acting accordingly?
This is just idiocy. You would check every fire extinguisher you might need to use before you ever use it/? How exactly does that work? Your stating that you would create a society where you could largely only rely upon your logic and understanding to know if a product was safe, etc By your logic, why even have zoning regulations for building? Why even have an FDA or food inspectors?
This kind of society works in a smaller society that is homogenous that isn’t complicated and is in a relatively limited geographical area. Not for a society that is approaching nearly 400M, is incredibly heterogeneous, and over such a widespread area.
“Compared to what? Where in the world would they have been better off at that time in the world? No place on the planet provided more freedom and opportunity and that is why the entire world was dieing to get here, and most still are.”
Political freedom – yes. Economic freedom – not so much unless they were willing to seek land which of course was largely enabled through wars of economic convenience and opportunity (Mexican-American War of 1846-8; varied conflicts with Indians). Americans largely just killed and took what they wanted in the way of land/resources which of course today largely isn’t permissible.
Look at where most immigration came from in the mid to late 19th century. It was European countries that were either under foreign rule (e.g., Greece, Poland, Ireland) or countries that hadn’t enacted more liberal reforms after the widespread revolutions of 1848 that wracked the continent. Immigration from more liberalized places including France, Great Britain, and Germany (after unification in 1871) that had voted in more economic reforms and basic suffrage in their home countries had very limited/limited emigration to the U.S. especially at the later part of the 19th century.
Basically it was a ‘tallest among the midgets’ argument. If you lived in a European country which didn’t have political freedom, there was widespread emigration to the U.S. but not nearly as much in countries that had male suffrage.
People aren’t coming to the U.S. either in such large numbers either of late especially Mexicans and Central Americans who have basically crawled to a trickle the past 3 years. America is still a place that lots wants to come but let’s talk facts instead of generalities.
“Why are you so opposed to work? That is what builds great nations, its what Sweden and other European nations where known for before they went soft and became weldare states. Its this aversion to work that is killing Europe. Its that aversion to work that is destroying America.”
So treating workers largely as disposable assets is an ideal model that society should seek? Workers will not tolerate too for long and will take action ranging from collective action to much more radical action including sabotage, threats of violence, and actual violence. You either work on reforms or put jackboots on people’s throats to keep them in order.
It also sounds like you advocate the late 19th century approaches by American industrialists that widely supported using private sources and state militias & federal troops when necessary to use violence & kill Americans if necessary to keep them in order if they stepped out of line. We’ll see how long that continues to work for China as they continue to largely use the rule of force and simply detain/kill workers and citizens too.
You keep ranting about the Scandinavian countries like Sweden and Norway with generic talking points which either aren’t true (Debt to GDP ratio) or without any valid assertions. I would agree that the Scandinavian models of capitalism isn’t applicable to the US largely due to the size and demographics of the countries but these countries especially Norway & Sweden have a hell of a lot more going for them than you acknowledge especially Norway with its oil reserves and large sovereign wealth fund.