In a year of sweeping overhauls in healthcare, financial reform and tax policies, critics of U.S. President Barack Obama's proposals have called them ineffective, shortsighted and misinformed.
Last week, in a case that will likely go all the way to the Supreme Court, a federal District Court judge in Virginia added the term "unconstitutional" to that pointed list.
The provision in question is part of the Patient Protection and Affordable Care Act of 2010, the U.S. healthcare reform initiative signed into law in March. It requires all Americans, unless exempted for religious or other reasons, to carry health insurance – or to pay a penalty for failing to do so.
So far, opponents have filed two-dozen lawsuits challenging the health insurance mandate's constitutionality.
One of those cases – filed by Virginia Attorney General Kenneth T. Cuccinelli II – was decided last week. Plaintiffs argued that making people get health insurance coverage simply because they exist falls outside the limits of congressional power granted by the Commerce Clause, which defines how Congress can regulate commercial activity.
Federal Judge Henry E. Hudson of the U.S. District Court for the Eastern District of Virginia agreed with the plaintiffs. In a 42-page opinion released Dec. 13, Judge Hudson said the requirement went "beyond the historical reach" of Supreme Court cases that define Congress' role in interstate economic markets, and "would invite unbridled exercise of federal police powers."
Judge Hudson, the third District Court judge to render a decision on the healthcare law, was the first to rule in the plaintiffs' favor. He said the law went beyond effective healthcare regulation and best business practices, and touched upon citizens' rights.
"At its core, this dispute is not simply about regulating the business of insurance – or crafting a scheme of universal health insurance coverage – it's about an individual's right to choose to participate," wrote Judge Hudson.
Or, as Judge Hudson said more informally at an October hearing, it's like giving Congress the ability to force Americans "to buy an automobile, to join a gym, [or] to eat asparagus."
In defense of the law, U.S. Justice Department lawyers argued that individuals who opt out of coverage are instead making a promise to pay for medical costs later, out of their own pocket. That promise makes them part of "commerce."
And since those without insurance can't guarantee they won't need medical care while uninsured, any unpaid healthcare costs they incur would be dumped on governments, medical facilities and insured Americans.
These two realities can't help but impact the healthcare industry – meaning the coverage decision should be regulated, the Justice Department lawyers said.
Advocates of the healthcare law also argue that changing the mandatory insurance requirement is playing with fire. They fear if courts do not uphold the mandate, insurance companies will retain too much power – a problem that warranted a healthcare overhaul to begin with.
This prompted last week's Money Morning "Question of the Week:" Should the U.S. government require everyone to buy health insurance? Is it constitutional, or does it extend Congress' authority too far over Americans' decision-making? Would it truly help "fix" the U.S. healthcare system, or is it an abuse of government power?
Many readers who responded were angry with the government for interfering in their healthcare decisions with a mandatory insurance requirement. Others who have lived with universal healthcare compared the disorganized U.S. health insurance system to that of other countries.
Here is a collection of those responses.
Simply put, the federal government does not have the right or power to mandate that Americans must choose healthcare coverage. The U.S. Constitution cannot be construed or twisted in any way to grant this power, as it is a document that fundamentally insures the primacy of the individual's rights and state's rights apart from any sweeping oversight by Washington. So, it is not only unethical, but more importantly–patently unconstitutional, and it directly violates individual choice…and rights.
– Van A.
No, it definitely is not right to make it mandatory to carry health insurance. This is just another grab by a police state. What next will be made mandatory? You can bet there will be a multitude of things mandated in the future if this gets passed. What a crock.
When the government is allowed to compel us to do something that we have a constitutional right to otherwise choose for ourselves, then it is violating our rights.
Obamacare is an additional attempt to enslave people to the government and to allow the government to further control our money.
Obamacare, "Give me your credit card info and I'll buy health insurance for you!"
As always, we will have the privilege of footing the bill for Obama's "largess."
– Rod S.
The judge is right, it is unconstitutional to force people to buy a product from a private company. Now, if that money was going to a government (either state or federal), it would not be unconstitutional.
Single payer was the most efficient, and legal, way to go. Too bad our legislators were bought off or we would be there, instead of in court. Hawaii has free healthcare for all its residents. They have had it for 40 years. Proof it is possible and does work.
– Doris K.
Short and sweet, mandating that the citizenry of this country purchase anything designed by the government is absolutely unconstitutional. Politicians use the Commerce Clause to fit their purposes and it was never intended that the government be our "daddy." If I choose to take care of myself, it is my freedom and prerogative as an American.
Lead by example Mr. President and Congress. Add yourselves to the system and forgo the coverage that you currently get. In fact, add yourselves to the Social Security role and pass on the lifetime pension that you get.
– Mark C
This issue is about basic freedom guaranteed by the Constitution. The people have spoken in the mid-term elections and the message is clear: get the federal government out of our lives. We the people know what's best for our family.
– Bud M.
Healthcare should be a personal responsibility, and one that is currently being completely ignored by the vast majority of Americans each time they put food in their mouths.
The government should only be involved in leveling the playing field to make it affordable for all. When it comes down to personal healthcare, no one (except the totally disabled and hopelessly indigent) is benefited by government involvement in what is first and foremost an individual personal responsibility. No amount of government dollars will improve our population's health (which should be the goal of all this!) without the sincere commitment of each person who is honest with him/herself about health matters.
I was forced to seek health solutions independently after developing a disability that eventually forced me to cease working more than ten years earlier than planned. Standard mainstream medicine offered no cure, no known cause, but did (of course) offer pharmacological pain management – commercially available on a permanent basis. I realized there was no one but myself to salvage the rest of my life. I have spent almost $3000 per year from personal funds, for the past nine years to educate myself, maintain my health and improve my condition. I have experienced remarkable, permanent improvement, although still unable to return to my former tradesman business. My general health has never been better. The point is: I accepted the responsibility for my own health.
If the "mandate" would accept proof of this sort of expenditure on health maintenance/improvement through education and personal health practices in lieu of the fine, it may well serve as an incentive to further several healthcare goals, including an alternative solution to a lifetime of perpetual danger and fear of death from drug-only treatment regimen complications, from which many thousands die each and every year. I suspect that last "cost" is not in the government's calculations.
– Mark H.
Mandatory Participation a Must
I was born and educated in Switzerland, spent one year in London/England, two and a half years in France, five years in New York, four years in Japan and otherwise traveled extensively. I now reside – thankfully – in the more civilized part of North America, namely Canada.
Yet, in no other country have I seen, noticed or experienced a more dysfunctional healthcare system as that in the United States. This is also reflected in the fact that the U.S. is by far the highest health spender at 16% of gross domestic product while all other countries hover around 10% or less. There are enough excellent models of healthcare in this world – private and public – but each and every one requires mandatory participation! How else can it be run cost effectively?
– George K.
Not a Bad Idea
It is necessary to require all citizens to pay for health insurance. Most citizens would not be able to pay for their medical bills if they had a major health issue without insurance. We as a society, to the most part, would not just let them die because they couldn't pay. If we would, we morally shouldn't.
– Dan D.
Yes, the government should require health insurance, but the individual should chose which kind. The problem with the concept for Americans is that the cost of healthcare is a stand alone topic. In the U.K. where I live, everyone pays into a government fund for all kinds of care and services.
If people cannot afford insurance then the government should take care of them – the poor are too unhealthy and as a result they and their children do not participate in economic or educational life as they should.
Options: If a person wants a kind of minimal insurance – like catastrophe insurance – then they ought to chose that. It is against the national interest to have people who are not taken care of medically.
– Constance B.
More Government, Less Freedom
Less government is better government. The dictatorial effect of mandating health care insurance purchase is counter to everything that has made America the greatest place to live on the planet – true freedom. But that is and has been eroded more and more by the socialist mentality that has overrun Europe, and now threatens to take over the U.S. government. Instead of trying to dictate to the "ignorant masses" how to micromanage their lives, why not apply some of this "big government" to achieve real merit.
I propose that a mega-million dollar commission be formed (hey, that's chump change when they're throwing around trillions!) to devise ways to achieve genuine cost reduction in healthcare delivery. If Wal-Mart can do it in retail, we can do it in health care. How about encouraging genuine competition between insurance companies, like allowing interstate policy writing. Today, Blue Cross Blue Shield can monopolize an area, dictating prices.
I was executor and power of attorney for my Dad before he died. The doctor, clinic, lab, hospital bills were like a tornado of paperwork from all different directions. Luckily, a good friend had retired as a billing chief for the UVA hospital and looked over the bills as they came in. She found over $4000 in erroneous and over charges in one year. $5.00 for a tongue depressor! Give me a break! Single payer is a good idea – just not the government. All of these bills should be coordinated by the hospital, designated agency, to provide oversight and a single bill to cover a visit or procedure. There has got to be efficiencies of operation that could save untold amounts if implemented.
If the government would put their efforts into genuinely finding cost savings in health care instead of trying to dictate how we pay for it (using 2500 pages) we can truly lower health care costs and insurance premiums to an affordable level. Honestly destitute people will still have to be accounted for by the charity systems, be it government or private.
– Lee W.
It's All in the Name
I believe the idea of making people without health insurance pay a premium with their taxes is a good policy. However, I think it is being improperly described and sold. Rather than being called a "fee," it should be called a "health insurance premium for emergency services," and it should be used transparently to reimburse medical facilities that deliver emergency services for free to uninsured people.
Why Grow a Bad System?
Conventional medicine already causes nearly 800,000 deaths annually. What happens when we force everyone into a system that is flawed? What is the purpose in having everyone insured? Is it for the well-being of the individual? If health is what we are seeking then this mandate is not the way we should go. There are too many flaws in the way medicine is practiced.
– Dr. Jonathan A.
[Editor's Note: Thanks to all who responded to last week's "Question of the Week" regarding the constitutionality of the U.S. healthcare insurance mandate.
Be sure to answer next week's question: What's the cure for deadbeat U.S. states? Do states need to raise taxes, cut programs, lay off workers, and/or slash benefits? How have you been affected by your states' poor financial condition? How concerned are you about the severity of our U.S. state budget crisis??
Send your answers to email@example.com.!
Is there a topic you want to see covered as a "Question of the Week" feature? Then let us know by e-mailing Money Morning at firstname.lastname@example.org. Make sure to reference "question of the week suggestion" in the subject line. We reserve the right to edit responses for length, grammar and clarity.
Thanks to everyone who took the time to participate – via e-mail or by posting their comments directly on the Money Morning Web site.]
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