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Health Care Reform Hot Button 4 - The Individual Mandate is Not Constitutional | An Independent Voters View
The Way Forward
14 December 2010 – Judge Henry E Hudson of the Federal District Court in Richmond Virginia struck down a key element of the Health Care Reform Legislation yesterday. Essentially telling the government that they had overreached in the application of the Commerce Clause in the Constitution, by including an individual mandate to buy health insurance from a private company or be fined.
I have been saying throughout the debate that this mandate was unconstitutional, as it, by force of regulation, unlawfully requires an individual to participate in commercial activity. Taken to its extreme, I could see the day that the government would require you to buy a GM automobile because “It’s good for the Country.”; after all we all own a piece of it now. Maybe requiring you to buy Government designated ‘War Bonds’ in our ‘National Security Interests’ (10% of your salary sounds reasonable eh) after all we have to control the deficit and bring it down too. Once opened this Pandora’s Box could get really scary in a hurry. I’m not going to dwell on this but the scenarios for this type of government control are endless and get more and more Orwellian as the mind wanders into the details.
This was a sound decision by Judge Hudson, but it now raises the question of, “What is the way forward?”. The Individual Mandate was a key element in the legislation that passed and the rest is now a folding house of cards as it is unsustainable without the IM. Folks that have read my views know that I generally don’t publish unless I can see an alternative way to deal with things I comment on.
First let’s do what proponents for health care reform and even those on the fence would agree on; lets get business, healthcare providers, insurers, and individuals involved in the process to reduce costs. I have been hearing since the Clinton proposals in the 90’s about the rising costs of healthcare. Some of these rising costs were self-inflicted wounds as many of the costs for all of us are tied to what the government says it will pay for goods and services. Many folks pointed out the examples of waste in the Medicare/Medicaid systems due to the prices of stuff like Surgical Sponges (a 4X4 in piece of Gauze) that you can buy at Walgreens for .25 cents, that in the 90’s Medicare was reimbursing suppliers and hospitals over $4.00 for. I know that this is just one item of many. Get some business folks, and insurers together to figure out the logistics of efficient health care supply and delivery. Yes folks it really is Logistics.
Once they have squeezed out every penny, lets look at the business of heath care insurance. Ask yourself why are certain companies more profitable than others? You will find it has much less to do with who they exclude you think, and much more to do with how well they control costs of the services delivered, and how competitive their products are. These are the folks that we have to stop demonizing and get working on a better system. We must encourage and ‘incentivize’ them to provide better products that compete for the population that tends to choose to be uninsured. One immediate way is to open markets across state lines.
Also sometime back in the 90’s and continued during the Bush Administration our congress in an effort to try to hold down costs, limited reimbursement for Doctors in a way that meant they lose money every time they see a Medicare Patient. In the years past congress in its wisdom has overridden the law and done a Doctor Fix, instead of a law fix. Not sure of the wisdom in that since every couple of years we hear about how the Docs will quit seeing Medicare Patients or retire unless they get their money. Fair enough I suppose from their point of view, after all they are running a business and you can’t do it for free. But the gripe I have is Congress has not taken the time to find out why healthcare costs continue to increase at rates exponential to inflation in general. If you come to an answer and a legislative fix to that question, the answer to Doctors pay is not far behind. One of which is outcome-based reimbursement. This idea needs some serious study and explanation to we consumers.
Once again, all of us could be involved in this fix, by monitoring our bills and claims for costs that are clearly out of whack. Health care suppliers and providers could probably reel off a list of dumb prices we authorize in current Medicare legislation and dumb stuff our insurance companies are willing or have to pay for. I would propose that Insurers and Medicare offer a bounty of say 15% of the costs saved to all beneficiaries when they identify those out of line charges to the payer.
There are many good ideas already in the health care reform bill that we may well want to keep. I certainly am for restrictions on insurers to keep people on the rolls when they encounter a life changing health event. Dropping coverage at that point is cruel. Coverage for pre-existing conditions is laudable and would and could be affordable if competition is allowed across state lines, or maybe inclusion in something like the militaries Tri-Care system, which already has a large population in it that is generally in good health. We may have to help subsidize this initially but seems even to this conservative thinker that it is the right thing to do. Better minds than mine should be dwelling on this and offering solutions.
The question we really have to ask ourselves in this continuing saga is, “What would Gillette do?” I use Gillette as the business model because this companies success is built on the safety razor, a product that folks don’t have to have (razor blades), but want and use because they are simple, cheap, and produce a result they would otherwise have to pay a professional much more to achieve. In short it was done in a uniquely American Way.
Let’s get the best of all concerned and figure this out during the next two years. If we don’t I could see the President having to run on failed signature legislation, and the Republicans trying to justify blocking solutions when this decision opens the way to do something meaningful to reduce deficit spending and tha National Debt. I would not want to be wearing those campaign shoes from either side; and I promise you here and now I will be looking and highlighting all along the way those who offer solutions and those who add to the problems.
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