The individual mandate and the impending Supreme Court challenge

The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act (PPACA). Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.

The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage, and potentially creating an “insurance death spiral” as the higher premiums lead to increasing numbers simply dropping their coverage. (This last part is basically what we have today, but will be magnified by PPACA’s ban on preexisting condition exclusions.)

The individual mandate was preferred for obvious reasons over the alternative of a general tax offset by credits for premiums paid. Democratic lawmakers had no wish to be blamed for imposition of a new tax—no matter how reasonable the arguments in its favor. In fact, as President Obama made clear in an ABC television interview: “I absolutely reject that notion [that the penalty is a tax].”

The individual mandate has now become the centerpiece in Republicans’ legal fight against reform. Suits challenging PPACA have been filed by the attorneys general of nineteen states (with the first, in Virginia, already being argued), with the constitutionality of the mandate a key issue in every case.

A recent Health Affairs includes articles affirming and denying the mandate’s constitutionality, by Timothy Jost and Ilya Shapiro respectively. Jost argues that the mandate is covered by the commerce clause of the Constitution, allowing the government to regulate interstate commerce—broadly defined as all economic activity—since a decision not to buy insurance has an economic impact on those who do have coverage. Shapiro argues that the government’s constitutional power cannot extend to a non-activity, like not buying insurance. Both authors also discuss whether or not the mandate penalty is really a tax and, if so, whether the government can impose it. Not surprisingly, Jost concludes that the penalty is a legitimate tax, and Shapiro concludes the opposite.

The Supreme Court’s eventual response is anyone’s guess, although reform advocates might well worry about the Court’s present conservative leaning. The timing of a Court ruling is equally uncertain; Jost notes that the Court might find the issue premature until the government attempts to impose the mandate penalty on specific individuals, something that will not happen until 2015 at the earliest, while Shapiro suggests that the Court may try to find a way to duck the constitutionality issue entirely.

All this uncertainty has important implications. States involved in the various legal challenges may drag their feet in setting up the insurance exchanges, possibly leaving the federal government to step in at the last minute. Insurers, already faced with actuarial problems, will face even more uncertainty in estimating enrollment from the currently uninsured (and typically healthier) population. And individuals, of course, will have their own gamble: risk the penalty or not.

What would be the possible impact of a Supreme Court finding of unconstitutionality? The federal government will lose anticipated penalty revenues of some $10 billion a year. Insurance premiums for individuals and small groups will rise with the loss of enrollment of many younger and healthier individuals. Most important of all, the number of uninsured will be significantly higher than if the penalty were in force, somewhere between the CBO estimate (assuming mandate penalties) of 22 million and today’s 50 million.

The reactions of individual states to an unconstitutionality finding would presumably reflect their politics, with states to the right of center being able to claim a fundamental failure of reform, especially as premiums increase in the absence of new healthier enrollees. Left-leaning states might take the option, however, of imposing their own individual mandates consistent with their state constitutions—much as Massachusetts did in 2006, although possibly with a different, more effective structure that would further lower the number of uninsured. And that might make for some interesting comparisons.

Roger Collier is a consultant specializing in health care policy issues who blogs at Health Care Reform Update.

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  • http://www.twitter.com/alicearobertson Alice

    So we lose more rights under the guise of governmental income and a small minority gaining health care? I think about this……and the reflection of the Supreme Court’s cultural aspect. A case is subjective to the current mindset of the justices, which is making the law more relative, and we are losing more rights and entering bigger government with the justices green light. Ultimately, it’s the voters responsibility to understand their candidates a little better than they currently do and to stop getting caught up in some type of emotional/feel good slumber lest we lose more rights (and I speak as the mother of two children with pre-existing conditions……..who wonders if what I gain is worth what others will lose).

    • twicker

      Alice,

      Interesting that you talk about “losing rights” instead of “accepting responsibility.” Personally, when I had to purchase my own health insurance (even when I had no expectation that I would use it) — I did, since I felt a responsibility to make sure that I wouldn’t become a burden on those I love (who might otherwise have to bail me out). I also feel a responsibility to other Americans — that “minority” of about 33 million people you dismiss in your comment.

      As a society, we have accepted responsibility for making sure that, if *anyone* is in need of emergency care, then we will provide that care; we will not let a person, a fellow human, die at the door of the Emergency Dept just because he or she doesn’t have an insurance card. We will not refuse to diagnose and treat the person who shows up. However, frankly thanks to attitudes like what you appear to be displaying, we, as a society, all too often *do* then refuse to accept responsibility for paying the higher taxes that must go with providing quality emergency care — and, as a way of denying responsibility for our society, people bring up your exact argument of how we’re somehow losing “rights.” I suspect that, even if the Supreme Court strikes down the individual mandate as unconstitutional, you yourself will still expect to have the “right” to have your children treated at the ED without payment upfront, and for you yourself to be treated so that they continue to have a mother — even if you forget to carry your insurance card with you, or no one can find one after a car accident when you’re unconscious.

      Now, we could have gone down my preferred path — which would lead to a single-payer system (very distinct from a single-provider/NHS system, but that’s a different policy debate). Instead, in order to maintain the ability to have several providers of health insurance and retain choice, we have this system: you don’t pay extra taxes, but you do have to buy insurance. Your responsibility shifts from having to pay the government for your insurance to having to purchase insurance even if you’re 27, male (a.k.a. unable to become pregnant), and healthy.

      As a society, and as members of a society, we don’t only have rights; we also have responsibilities. And personally, I’m with Jost and not Shapiro (you’re obviously the reverse): we have no right to avoid our responsibility to society, and that can include purchasing insurance. Then again, I tried to enlist (I was denied due to a pre-existing condition), so I guess we just have a different view of what constitutes our responsibilities to our country and our fellow citizens.

  • BladeDoc

    If someone forces you to do it at the threat of violence it’s not “accepting responsibility”. If you don’t thing it’s at the threat of violence, try stopping them from putting you in jail when you fail to pay your taxes.

    • twicker

      Ah, the old argument that paying taxes is the “threat of violence.” So, I definitely don’t “thing” [sic] that it’s at the threat of violence, but that would be the difference between you and me.

      I fully accept that, in order to receive the services I receive (establishment of justice, insuring domestic tranquility, provision for the common defense, etc.) and live in the country in which I live (the US), there’s a cost. Part of my responsibility, and part of the responsibility of every citizen, is to bear a portion of that cost. This includes paying taxes.

      Remember that we are NOT talking about “taxation without representation” — because, except for people who live in D.C., we have representation in Congress. You may not like your representative or senator or president, but that doesn’t mean that we didn’t have an election. Our Founding Fathers knew that the government, like all governments, would indeed need revenues — and they wrote that into the Constitution (later amended to provide for further revenue). All this was approved by the representatives of the people.

      Your claim that all this is “at the threat of violence” is like claiming that you should not pass a stopped school bus because you are forced not to “at the threat of violence.” No, you should not pass a stopped school bus because you have a responsibility not to recklessly endanger the lives of children. You should buy car insurance for your car not because the police might confiscate your car “at the threat of violence,” but because you have a responsibility to, well, be responsible, including in the event that you might cause an accident (it happens) and hurt someone else. Yes, we have laws, and yes, they get enforced — but, unless you are advocating anarchy (and it sounds like you are — I’m guessing Rothbardian anarcho-capitalism, yes?), you will have laws, and they enforce what we, as a society, have determined to be both a set of rights (the Constitution is, in fact, a set of laws, including the Bill of Rights) and a set of responsibilities. Just because it’s written into law doesn’t somehow remove it from being a responsibility.

      Unless, of course, you’re actually an Ayn Randian Objectivist, and you only do that which is legally required of you, and then only to the extent that unbridled selfishness requires. Which would call into question why one would ever want to be a doctor (Ayn Rand had neither children nor compassion for anyone else, much like both Murray Rothbard and Ludwig von Mises; there’s a reason their treatises are, frankly, anti-family).

  • http://www.twitter.com/alicearobertson Alice

    Well….as much as I understand your concerns and assumptions (and believe we share the same concerns, but I think the word “dismiss” is a pretty strong assumption on your part), if you are speaking to me personally, I don’t really fit the mold. I am more of a compassionate type of conservative who does believe that people need healthcare, but I don’t like the government interference in capitalism (no, I am not an Ayn Rand type of capitalist……and fear that it’s an unfortunate consequence that the capitalists often need policing, but the government is just taking too much control with mandates). Yet, I struggle with answers that can be realistically implemented without more harm on some level. I don’t want the future to hold any type of government approvals for procedures…..it’s hard enough dealing with insurance companies. I don’t see the government as the answer, even when the capitalists are making huge profits it’s still better than the government taking more control of our lives. We have to see the whole picture, and not just that a minority will be helped. We may miss a way to help more people when we have a narrow focus. Can I ask you to expound on why you believe the 33 million will be helped figure? I have read some introspective articles that seem to discount this figure, and say they could have been helped through means already in place. Realizing there is a lot of confusion, even from reliable sources, as we muck through such an amazingly, huge bill.

    I have lived in the UK and, quite frankly, socialized medicine terrifies me. All my husband’s family still lives there, and my mom’s family, and their care is sub-standard. The government does little well except create more entitlement (I worked for two government agencies). We tried to get my mother-in-law’s medical records in the UK and we were sent to a lawyer who said for $400 she could try to get them in court, but it would be very difficult. We are shocked at how patiently our family waits for something like a mammogram (with a lump in her breast the wait was “only” three months. Lovely! Or visiting our brother-in-law in a private hospital where he was served pork chops one night, and fried chicken another night, after having his heart attack. He had no idea what his cholesterol level was…….because his doctor had only recently started to care and he had no idea it was high……lack of communication). Ack……..I could go on and on, but people say we are not heading into socialized medicine…….and they seem to completely trust the government or claim they are just so altruistic, and the conservatives are cut-throats, who only care about money. The goal seems to be to keep the naysayers on the defensive while we follow the Pied Piper’s music.

    But the reality is the bill passed, we have to learn to live with it, or change it.

    • twicker

      Alice,

      The first two most important things:
      (1) Good luck on your daughter’s surgery; I hope and pray that you come back tomorrow to let us know it went well; and
      (2) My apologies for using the term “dismiss;” you are right to call me out on it. My source for the 33 million who will have insurance under the new law was several articles I’ve read discussing the implications of the law; that said, the individual mandate itself would cover fewer people than the 33 million, since the full 33mm figure includes people like those age 18-26 who can now stay under their parents’ plans, those who would have otherwise had their insurance rescinded because of minor clerical errors or ridiculous readings of rescission actions (e.g., the woman who developed malignant melanoma and whose policy was cancelled because, as a teenager, she had acne), and those who will now be able to participate in the exchanges.

      As for defensiveness, I think everyone’s on the defensive right now, including those of us who supported this law (or, in my case, something even larger).

      On two points you made: first, while I fully understand your concerns about the NHS, I’ll let you know that one of the seminal moments in my thinking about healthcare happened when I was at a joint Republican Party-Tory Party healthcare policy conference (a Republican friend of mine invited me; I became the token moderate-liberal Democrat). We had various Republican senators/representatives and leaders of right-leaning think tanks, and their counterpart Members of Parliament from the House of Commons.

      The Republicans and their think-tank brethren railed against the evils of any sort of government-funded healthcare — either single-payer (where one party pays and then there’s competition among providers — this is my preference) or a system like the NHS (which is fully nationalized, and which I do not support in any way, shape or form).

      Later, one of the MPs in attendance took me aside and said that the Americans were … well, we’ll be generous and say, “not thinking clearly” (as I was the token Democrat, it was apparently ok to say these things to me). He said that, while the NHS had its faults (and it does), the one thing it did was that it meant that every British citizen — rich or poor, young or old — had a baseline level of healthcare, something that tied the nation together. He and his compatriots would never get rid of the NHS (and this is one of the most conservative MPs, mind you, a great friend and fan of Dame Thatcher). Try to fix it, yes, but never would he or his party think of having even one British citizen without healthcare coverage. He, and his Conservative allies, considered it an absolute, sacred responsibility to make sure that all citizens had coverage. A very different view than that of our Republican leaders.

      (and now, to your latest comment … :)

  • Doc99

    Prof. Randy Barnett, Georgetown Law:

    A”tell” in poker is a subtle but detectable change in a player’s behavior or demeanor that reveals clues about the player’s assessment of his hand. Something similar has happened with regard to the insurance mandate at the core of last month’s health reform legislation. Congress justified its authority to enact the mandate on the grounds that it is a regulation of commerce. But as this justification came under heavy constitutional fire, the mandate’s defenders changed the argument—now claiming constitutional authority under Congress’s power to tax.

    This switch in constitutional theories is a tell: Defenders of the bill lack confidence in their commerce power theory. The switch also comes too late. When the mandate’s constitutionality comes up for review as part of the state attorneys general lawsuit, the Supreme Court will not consider the penalty enforcing the mandate to be a tax because, in the provision that actually defines and imposes the mandate and penalty, Congress did not call it a tax and did not treat it as a tax.

    Read the whole thing.
    http://online.wsj.com/article/SB10001424052748704446704575206502199257916.html

  • Alice

    Okay…I must need another Constitutional quick study……how does paying taxes give me more liberties….or the willingness to pay more taxes make me a more caring citizen?

    • twicker

      To answer your questions with my personal opinion (I’d claim to be humble, but I don’t think anyone I know would buy that … ):

      We have a variety of liberties that exist because of, and not in spite of, our government. For example, we have the right to call upon the police for aide if someone breaks into our house, or if someone attacks us, etc. If another person claims that we have broken the law, we have the freedom to demand a trial by jury and to have a lawyer. If we are found guilty, we have the freedom to, say, not be put to death because we stole some grapes (and the right to not have our hands cut off, but instead to be put in jail).

      National defense costs money (preamble to the Constitution, . Having a police force that serves everyone, and not just the most wealthy, costs money (implied throughout). Judges and juries and courtrooms cost money (Amendments IV, V, VI, VII, and VIII. Jails cost money (more than stockades, and more than chopping blocks, and more than gallows — Amendment VIII). Having elections costs money (various Articles and Amendments). Making sure that no one has to suffer under slavery costs money (Amendment XIII). Allowing the female half of the adult population to vote costs money (Amendment XIX). We can’t have a Congress, and a President, etc., with And so forth. For more, see the following, and note how many actions specifically required of the government by the Constitution, and rights specifically guaranteed by the Constitution and its amendments, require money in order to enforce:
      The National Archives Charters of Freedom: The Constitution of the United States of America

      By paying taxes, we have these common liberties. By paying taxes, we ensure our rights. The argument about the Constitutionality of the mandate is an argument about whether or not this is a Constitutional part of what government can do; that’s different than either the argument about whether the government should do this, or the question of whether paying taxes provides the means for the preservation of the rights provided in the Constitution and its Amendments.

    • twicker

      As to whether paying taxes makes you a more caring citizen:
      As discussed in my other response, to have our freedoms, we have to pay taxes. If you believe other people should also enjoy those freedoms, if you care about other people enough to care whether they are able to enjoy these freedoms, if you care about the country enough to want to preserve these freedoms, then, obviously, you would want to provide for the revenues of the country — including providing for those citizens who might not be able to provide for themselves.

      Further, if you believe (as I do) that hospital emergency departments should be willing to save the life of anyone, without regard to ability to pay (including the runaway teenager, including the person who’s driving home and forgot his insurance card, including the woman who was just laid off and can’t afford COBRA or whose job never had health benefits), well — someone needs to pay those doctors, those nurses, and the rest of the people who keep the hospitals running and the EDs staffed and supplied, and someone needs to pay for the supplies. If we, as a country, as a society, decide that this is something that must be available to everyone (which we have so far), if this is one of the ways that we demonstrate that we care about people as humans and not just Homo economicus automatons, then we, as a country, as a society, must be willing to fund those activities. Caring means very little without action, and action comes at the cost of sacrifice. This primarily comes through paying taxes.

      Now, you specifically asked about “paying more taxes” (emphasis mine). Being willing to pay more doesn’t necessarily translate into caring more — if there’s a way to achieve the desired caring result without paying more. Right now, we’re in one Hades of a deficit hole, mainly because GW Bush went on one heck of a bender of jacking up spending while slashing revenues. Simply to keep what we have now would require substantial increases in taxes, especially with Medicare and Social Security. Honestly, no one has put any spending plans out there that would cut spending enough to actually do away with the deficit, much less cut into our massive debt. The closest has come from some of the Tea Partiers who have suggested completely doing away with Medicare and Social Security (which would just about do it); other than that, nothing’s going to work — except a plan that includes some level of increase in taxes.

      So, the question is: for your daughters, is it better for you to be willing to pay more in taxes now (or have an increase in the next couple of years — almost certainly within the lifetime of both of us), or should all the burden be passed on to them and their children while you and I get off free? Which is the more caring path?

  • another idea

    How about paying for what you use and there not being insurance? That would cut out a lot of the fat in healthcare.

    Yes, it would be unfortunate to have that weird cancer or disease that kills you, but if you take care of yourself the odds are heavily in your favor. Why share risk with a bunch of overweight, irresponsible (in regards to health), poor-lifestyle maintaining fellow citizens?

  • http://www.twitter.com/alicearobertson Alice

    Insurance companies are giving discounts to those who choose healthy lifestyles. My two children had cancer and they still don’t know why. Not genetics, not lifestyle….but they say my daughter somehow was exposed to radiation. We had our home tested, she isn’t fat, she is a vegetarian too. But your point out our choices are well-taken. Some employers make their employees pay a fee for smoking (my daughter’s employer makes them pay $120 a month extra).

    I am rushed to get my car fixed, but I still disagree about the taxation and liberties attachment, but I need time to pay some more taxes :) I am not against taxes, we do need them, but this paying for liberal programs all the time without accountability is too much…….it’s impeding my life and liberty.

  • Tia Shon

    Twicker,

    In the first reply of yours, you wrote that you find Alice’s comment “interesting” when she pointed out that this is all about losing rights rather than as you would like to call it, “accepting responsibility”. But she sure is correct. When something is forced upon people, losing rights becomes an important fundamental issue because it scares people in some instances, makes people angry in some other instances and saddens people at the injustice in yet other instances.

    You claim that you chose to pay money into the system because you don’t want to be a burden on your relatives. I respect that you have a choice in what you do with your loved ones. And then you go further to say that you also pay money as a gesture towards 33 million other Americans. That, too is your choice, and nobody would take that away from you. But don’t you think it’s fair to give other people their choice too?

    What is wrong is when a few people claim to know what’s the best use of other people’s hard-earned money. I would ask you, when a typical father is working long hours to feed his family, doesn’t he have the choice of what those earnings go towards as opposed to having someone else ( a bureaucrat whom they have never met and who shows no evidence of respecting the family’s happiness and who has his own political agenda ) dictate to them that they must pay money, and for what? Well most of that money goes towards administrative costs that are never held accountable in any effective way. The remainder is applied towards paying for the healthcare of others, many of whom don’t pay into this interesting system, one where money is taken by a few people from a lot of people by force.

    So, my first question to you regarding your notion of people not turning away those who need emergency help, is can’t that happen in a noble humane way, voluntarily rather than by a coercive basis? My second question is what do you see as all the other negative consequences that arise from trying to solve this problem by aggressive means rather than by voluntary means? I would be very interested to hear your view on this.

    I can tell you that when I see the outpouring of millions of dollars of charitable donations to help tsunami victims or Haiti disaster victims, it touches my heart as to the generosity of people. That is a wonderful thing!! And who is to say just how much more noble charity there would be in a world where there was significantly less taxation, corruption and waste!! It makes me sad when there are a few people who try and say that this charity concept is not as good as their way, which in their words is “for you to hand over your money to me ( no choice ) so that my buddies and I can…er… take good care to use the money in the best way possible to help those poor and needy people over there. Trust us”.

    Thanks for you opinions.

    • twicker

      Hi, Tia,

      Thanks for your reply. Some thoughts (and then I need to get to work, alas; hopefully will have time for more later):
      1. Losing rights v. accepting responsibilities:
      Actually, it’s both. If you fully accept responsibility for something, then you lose some freedom in order to fulfill your responsibilities. For example, if you accept the responsibilities of having a job, then you lose the freedom to sit around the house, devoid of any deadlines, etc. You now have to produce something for someone else, and probably do it on a schedule that is not entirely of your own choosing. Now, you gain the freedom of being able to eat, to have a house, to have a car, to have health insurance, etc., so you probably gain more liberties than you lose, but it’s undeniable that, by having a job, you do lose some of your personal freedom – because you have accepted responsibilities.

      Now, in this debate, when looking at the choice between buying X with your money v. paying taxes so that emergency departments can function and medical professionals can make a living, it’s that same kind of choice: do you take “another idea”‘s suggestion and leave it as a dog-eat-dog world where, if you can’t afford to pay the doc, then it’s just too bad that you were hit by a hit-and-run car — guess you get to die? Or do you accept that, yes, you lose a bit of freedom to have slightly lower taxes — and you fully accept the responsibility to ensure that emergency care is available for all of your fellow citizens and humans? Note that choice #2 also gives you, and all your family members, the freedom to be able to use emergency services when and if you need to, without them first asking, “Can you pay? ‘Cause, if you can’t, well, then you die.” Woe betide the poor soul who’s unconscious and was out for a run without their wallet/insurance card/credit card; suddenly, forgetting your wallet = capital offense.

      I can’t think of a single time when a person could accept responsibility for something and not lose some degree of freedom — though they often gain other degrees of freedom. You lose the ability to take a baseball bat to the car of the person you hate — but you gain the freedom of having the police arrest anyone who tries to do that to you, and the freedom that comes from living in a society where that’s really, really rare. If you have children (as Alice does) and you accept responsibility for them, then you lose the freedom to just do whatever you want with your time — because you accept responsibility for them (as Alice has with her daughter in the hospital).

      In this debate, the question comes down to: what degree of freedom are we willing to lose in order to accept what amount of responsibility for our fellow humans?

      That leads into another one of your points, and one that I’ve discussed with several of my IRL conservative friends: can’t we do all this through personal charity? Putting Haiti aside (more on that in a moment), the answer is … that’s the system we’ve had for awhile. It hasn’t worked out so well yet; I see no reason to believe that, in an age of ever-more-expensive drugs and ever-more-expensive medical care, it’s going to work any better. One of my very conservative friends (she’s both socially and economically conservative, though more socially than economically) has come to something of an interesting realization on this front: yes, religious conservatives give more than non-religious liberals (and WAY more than non-religious conservatives, the least giving of all … yay, Ayn Rand, Reason Magazine, and the Austrian Schoolies … ). However, the religious conservatives give a lot more — to their churches. She and her family left their large church because there was plenty of giving by fairly wealthy conservatives — giving to the really nice, new sanctuary, giving to the beautiful new organ, giving to the wonderful Sunday school, giving to the parking lot repaving, etc. Oh, and, yes, there was a little bit of time and money given to healthcare for the poor — in between all the capital projects, and donations for church trips, etc.

      I’m not saying that liberals are any better at charitable giving, alas (though I will say that the agnostic/atheist libertarians are by far the worst). I’m saying that we won’t solve this problem by expecting charity to bring us out of it. We have one of the most charitable, religious, and wealthy nations on the planet, and it ain’t worked yet; given that we’ve tried this and it hasn’t worked, why should we suddenly expect the same failed policy of the past to work now?

      As to Haiti: that’s a special, emergent crisis case. Yes, people poured out their hearts — we had immediate disturbing images that we could deal with and assuage our guilt by donating (and I include myself in that number: yep, I donated, and I don’t donate as much as I should, ’tis true, though I have kinda high standards for myself on that front). Confronted with a crisis, people give — and give freely (including liberals, and even some of those atheistic libertarians). Our health care crisis is a chronic crisis, not an emergent one; because it’s always here, it requires a different treatment. I’d love for it to have been solved by charitable giving that was provided without regard to citizenship or religious affiliation; hasn’t happened yet, and, frankly, with the “me first” attitude I often see expressed by the more-libertarian-minded conservatives (c.f. “another idea”‘s post above), I don’t have any faith that it will change. However, people — good people who happen not to have the resources that you or I have — still need medical care.

      Given that the charity vehicles we have haven’t worked, and that you’re opposed to a solution that, while providing for everyone, would also require sacrifice from everyone through government spending, how would you suggest changing the system so that we meet both the objectives of having a humane society and of not expanding governmental influence?

      • http://fertilityfile.com IVF-MD

        Twicker, I agree with you assertion that going out to produce something for other people is the best way to gain more freedom of choice. I’m not sure whether or not you also mean that when you produce something, it has to be voluntarily paid for by the people who pay you. Let’s not forget that important truth.

        So when you speak of loss of rights being necessary in order to assume responsibility, that’s not necessarily valid. Here’s why. In your example, the choice is still completely mine. There are no loss of rights. I can go to work and sweat and labor all day after which time, the people who benefit from my sweat and labor will pay me what they think my work was worth. There is no third party stepping in and stealing from me nor from my customer, right? I can also choose not to go to work, which means then I suffer the lost opportunity to earn money. Either way, my rights remain unmolested and intact. Of course in our current broken system, I can stay home and forcibly benefit from the fruits of other people’s labor by collecting unemployment. :)

        I also am interested in your assertion of why charity is bad. You don’t really give any reasons why you believe it doesn’t work. You just made some blanket statements that it doesn’t work because “that’s the system we’ve had for a while”. But that’s not true. The system we have had for a while is one where politicians tax our money and then redistribute it as they deem best. There are many examples of charity that DO work. I agree with you that the Haiti example is a special circumstance, but every day, looking all around, I see acts of voluntary charity all the time. In fact, charity is sometimes hindered by the actual politicians whom you tout as being the better solution.

        Here’s an example I’ll always remember. Back when I was a student, a group of doctors and us students routinely went across the border into Mexico to volunteer, giving free medical care. That played a big part in inspiring me to choose the career path that I did. After experiencing how grateful and happy the patients were, I asked our mentors why we didn’t do this back at home? His sad one-hour answer pointed out so many ways that we were actually hindered from being charitable at home. Some of the most obvious answers were fear of frivolous lawsuits and oppressive restrictions (for example we would bring to Mexico donated medications that were one month expired).

        Anyway, I still hold sacred the principle of respecting other people’s freedom and the example you cited with choosing to stay at home and work or to not work and thus not get paid is fine with me in that it respects the principle of freedom. It’s only when an intrusive third party intervenes coercively that things get worse.

        And by the way, my observations differ from yours in that I’ve seen some very large acts of charity and altruism from people who support liberty, much more than from those who support oppressive taxation. The difference is this. When those who support liberty give, they say “I am taking from my own pocket the fruits of my own hard work to give to help you.” When the people who support bureaucracy give they say “I am going to use force to take money that OTHER PEOPLE have earned to give to help you.” See the difference? It’s huge.

        • twicker

          So, about your visits to Mexico:
          First, there are, indeed, free clinics in the US (I personally think that people should have to pay at least a token amount for any care, or have to do some volunteer work for it, but that’s a different topic). So, while your mentor didn’t want to go to the trouble of abiding by the regulations, they are not so onerous as to make it impossible. It is, in fact, quite possible, and near as I can tell it happens in all 50 states (we certainly have a network here in NC). If free clinics don’t exist/can’t exist in your state, then that’s a problem with your state’s laws — not federal law.

          As for the medications — you’re correct: you can’t give expired medications to US patients. That’s certainly a regulation, but, if you wanted, we could run the thought experiment and see what would happen if the regulation went away. Well, someone would find that you’d given them expired medicine, and … right: you’d be in court. Why? Because it’s illegal to simply shoot people. I’m not being facetious: for a fairly large subset of the population, they want to be receiving the best medical care available, and they’d get incredibly upset if you gave them expired medication — whether or not it’s really ok. For them, the comparator item is unexpired medication, not a lack of medication. They’re going to be much less happy about it than people who have the option of none-or-this. I completely get what you’re saying about the expiration dates (and even what the expiration date actually means — which is not that a 2-day-past-expiration-date medicine is completely ineffective; yeah, I get it). However, you still have a group of people who believe that they should not receive anything that would not be given to other people, and you sure wouldn’t want to give those meds to anyone with good health insurance.

          About unemployment: no, you can’t just stay at home and benefit. Obviously, you’ve never been laid off. First, you have to work as an employee — otherwise, no one has ever paid any unemployment insurance for you, so you have nothing to be unemployed from. Second, you have to have worked for an extended period of time; again, otherwise, you’re not being unemployed from any place of regular employment. Third, at least in NC, you can’t have been fired for cause; you have to have been either laid off, or have the cause be in some grey area where the employer doesn’t want to fight the ESC action (remember that, for at least the first part of your time, your employer actually has to pay your unemployment — not the state). Then, you stay at home, collecting a fraction of what you made, while looking for work before your benefits run out.

          I’ve been in the tech sector; I was part of a company whose bank account went to zero (we were building a system to help doctors devise optimal treatments for patients with HIV). I’ve been laid off, and collected unemployment insurance (and it is insurance, except for the extensions), and come out the other side. No, you don’t just sit at home collecting it after having done nothing, and putting a smiley face at the end of the sentence doesn’t somehow make it true. Frankly, it sucks.

          But I digress.

          As to the loss of rights v. responsibilities: I notice you’ve taken the tack of speaking only of yourself and of being responsible for yourself and yourself alone; Murray Rothbard and the other Austrians would be proud (fun fact: he believed all children, no matter how young, have the right to run away from home and live with whomever they want. Pedophiles’ dream, that philosophy of individual above all else). I specifically mentioned the case where you accept responsibility for someone beyond yourself — as, in fact, doctors do. At that point, you do lose certain rights and freedoms.

          As a doctor, you don’t have the right to be halfway through your shift and just walk out on your patients. You have the ability, just as I have the ability to take my rifle and shoot someone, or use my car to run over someone, or smash someone’s car with a baseball bat. However, as with all the places where I have the ability to do something, you will suffer negative consequences if you decide to abrogate your responsibilities (and that’s what you’d be doing: abrogating your responsibilities).

          So, no: you can’t both retain the right to do whatever you want, whenever you want (we’ll call this Set A of rights/freedoms), and also accept responsibility for anyone else, or even for any job, or anything else. As you noted, you may gain other rights and freedoms (Set B) by accepting the responsibilities, but you’ll still have Set A curtailed.

          Give me one example where someone can take responsibility for a child, a patient — heck, a job — and not have some aspect of her or his freedom/rights curtailed, even if it’s nothing more than not having the same amount of free time you would have if you didn’t take responsibility for X.

        • twicker

          BTW, you’re putting words in my mouth with the charity thing. I never once said that charity is bad (though, as before, that does make a nice straw man, now doesn’t it?). I said that our current system relies on charity to try to plug the gap (and it does), and charity doesn’t work. Even with the religious conservatives to give of their time to charities, the effect isn’t targeted and isn’t enough to stanch the demand — and I don’t see how it ever will be. Again: free clinics exist in the US, and have for some time, and do rely on the charity of doctors. And, in this, one of the most religious, charity-giving countries on the planet, all that charity still doesn’t plug the hole.

          The reality is, not everyone expects a government handout; most people don’t. The reality is, people haven’t expected the government to solve all problems for some time now (though your reverse argument does make for a nice, emotional — if fact-free — soundbite). The reality is, the needs are such that charity can’t fill the gap, any more than bake sales or volunteering for one Saturday a month could fund the police department’s activities in just the poor sections of town or provide it with enough officers to cover those sections (assuming the wealthier would pay for private police coverage). Charity can help, but it’s a small band-aid on a pretty large abrasion.

    • http://fertilityfile.com IVF-MD

      A charity-based solution would work a lot better if so much of our heard-earned productivity today was not taken from us forcibly to do as they please by politicians. Your proposed solution would only work if tax relief became a priority, but I agree it’s the best way.

      I also agree that we should have the freedom to choose. That is an inherent human right, whether you call it God-given or universe-given. Along with freedom to choose comes an obligation to accept the consequences of our choices. It’s morally wrong to have to accept the consequences of OTHER people’s choices. That doesn’t mean we can’t voluntarily help. So if my neighbor tries to break into somebody’s house and gets hurt in the process, I should not be FORCED to pay for his medical bills. But that doesn’t mean I can’t offer to help. It’s the contrast between respecting people’s freedom of choice and it makes all the difference.

      • twicker

        Question: what if someone breaks into your neighbor’s house and your neighbor gets hurt. Do you believe that we should use taxes to pay for the investigation of the crime? Do you believe that tax money should go to help provide an ambulance for your neighbor, a hospital for your neighbor, and medical care for your neighbor? If the police arrest someone, do you believe that person has the right to an attorney and a trial, and, if s/he chooses to have both, to have each provided for her/him by tax money if the accused can’t afford it? While s/he is awaiting trial, do you believe we should use tax money to incarcerate her/him? If s/he is convicted, do you believe tax money should be used to provide the prison for him/her?

        And, if we shouldn’t use tax money for all of this — then what?

        It’s easy to use a straw man like your neighbor getting hurt while committing a crime (lots of nice emotional pulls); the real world is a bit messier and not nearly as cut-and-dry.

  • twicker

    Hi, Alice,

    So – which part of the post do you disagree with? I ask, because it sounds like you’re bringing up a question now (namely, paying for programs without accountability) that’s different from your original questions. My answers were to your original questions, not this new one, and I think that may be the source of our disagreement. Your original questions were:
    1. “how does paying taxes give me more liberties”
    2. “or the willingness to pay more taxes make me a more caring citizen?”

    My answer to #1 was that, in order to have some of your liberties (e.g., the right to a trial by jury, the right to vote), you need to pay taxes. Since you would have fewer liberties if you paid zero taxes, then paying taxes gives you these liberties. Now, whether you would be *more* free if, say, you paid no taxes (but had to hire your own police force, and your own military, and had no right to vote because we lived under anarchy) — well, you would certainly gain particular freedoms, but you would also lose others (you can’t have any sort of impartial jury if you have to pay them and the other side can pay them more). So, I don’t know about the specifics of “more,” but “different.”

    It depends on whether you value the liberties laid out in the Bill of Rights and the rest of the Constitution. If you do, then you need to be willing to pay taxes, and taxes give you those liberties. If you don’t value the Constitution or Bill of Rights, then none of this applies.

    In response to your second question, my question to you would be, how important to you is it that we reduce the deficit? Because we either have to cut government expenditures *far* more than anyone other than the most Ayn Randian Tea Partiers have proposed, *or* we have to increase taxes. I see no hope for the first part, because you have to eliminate over $1.5 trillion in spending annually (of note, that dwarfs the roughly $900 billion we spend on all forms of welfare, including Medicaid and WIC).
    Source:
    US Government Spending: FY 2010

    FYI, “liberal” programs are definitely not the only programs “without accountability.” We went into a war of choice in Iraq without a plan, without accountability, and we ended up with thousands of American soldiers dead, tens to hundreds of thousands of Iraqis dead, tens of thousands of American soldiers injured for the rest of their lives, almost a trillion dollars spent so far and several more trillion dollars to be spent on care for these soldiers in the future, etc.

    Then again, I guess we could take the philosophy of “another idea” to an extreme (possibly beyond what s/he intended, possibly not) and just deny healthcare to the wounded veterans, since they made a life choice to defend our country. Given that the real situation is that we choose to provide medical care to wounded veterans (which means we pay in taxes), we can save that tax money by letting them just fend for themselves. Which would you choose, and would one option be more caring than the other?

    Lastly, if what you want is accountability in government — then amen, sister. I’m all with you. If you believe that there’s been too little accountability in some “liberal” programs, then again — amen, sister! And that needs to change. (“liberal” in quotes only because it’s a very inexact definition, as is “conservative” for other programs). And if you then said that we need accountability in ALL programs, liberal or conservative, so we make the most efficient use of our tax dollars — then amen a third time!

    But none of that negates our current deficit and debt needs, nor the needs we have in society for some form of safety net. And those likely require taxes (certainly some of the liberties in the Bill of Rights do). More about that in a moment (and I’ll also get more on-topic with healthcare and less about the stratospheric philosophical underpinnings).

  • http://www.twitter.com/alicearobertson Alice

    Hi! I really think a debate like this is invaluable…..actually, I really enjoy it….and find it fascinating on levels when people continue a debate and don’t become so flustered, or feel so misunderstood they leave (it’s a mystery I can’t figure out. I tend to wish I knew people by their names here…but I understand the risk…and value the truth enough to know that the truth without a face is better than ignorance). I enjoy clicking on the links and seeing the blog of a poster (knowing my own is pretty empty….to much upkeep…….I prefer to just post….I keep awaiting some type of inspiration to write about my daughter’s upcoming operation..but it eludes me right now. Thank you so much for your prayers and sentiments concerning this. She is scheduled for her operation in two weeks from today. I guess in truth I am posting and looking for distractions while I wait…..so thank you for giving me much to think about).

    As I shared I am rushed today with swim team and one car, etc. but I do agree with Tia Shon that often private organizations can do a far better job than the government. I believe after hurricanes many of the victims said the churches were on the scene.

    I hope to find time to go through all the posts later, but the question running through my mind is whether one views America as a Republic or Democracy? Whether one wonders if a democracy goes hand-in-hand with socialism? And where does a type of tyranny lead to?

    I believe we have 40% of Americans who don’t pay federal taxes and have liberties, so I don’t attach liberty to taxation.

    A couple of Thomas Jefferson quotes:
    Government big enough to supply everything you need is big enough to take everything you have … The course of history shows that as a government grows, liberty decreases.

    • twicker

      Quick note:
      1) The 40% figure refers to income taxes, and refers to people who either make so little that they don’t pay income tax or have enough deductions that they don’t pay income tax. Those same folks almost invariably pay federal taxes of one sort or another, be it the tax on each gallon of gas, or indirect taxes on anything they consume (for which other people pay taxes and include the cost in the cost of the good). No one goes through life not paying taxes, unless *maybe* if they live in a tent in a federal wilderness and live off the land. Everyone else? Yep, we pay taxes.
      2) Thomas Jefferson never said the quote about “government big enough to supply everything you need.” People attribute it to him because it sounds more impressive if he said it than if it’s actual author said it — Gerald Ford:
      Monticello Th: Jefferson Encyclopedia – Spurious Quotes – Government Big Enough

      Among other things, it doesn’t pass the smell test: in Jefferson’s time, no one imagined the Soviet state or anything like it, so why would Jefferson address the issue?

      Further (and more importantly), no one here is arguing that we should have a government big enough to supply everything; that’s a straw man argument.

      Your second snippet is also not a Jefferson quotation. The closest he said to this was:
      “The natural progress of things is for liberty to yeild, and government to gain ground.” – Thomas Jefferson to Edward Carrington, Paris, 27 May 1788[2]

      Source (after a quick and easy Google search): Monticello Th: Jefferson Encyclopedia: The Natural Progress of Things. You can find your misquoted version on the same “Spurious Quotation” page as the previous non-quotation.

      3) Refer to Taleb’s The Black Swan for details about the problems of quotations — namely, that they provide cover for ideas that are often wrong, by giving those ideas the veneer of truth through reference to someone famous. And if Th: Jefferson was as perfect as all this, then what of his slave mistress? Also the embodiment of perfection? And the fact that he did not release his slaves after he passed away (unlike Washington)? Further perfection?

      My point being that Jefferson was, like all of us, human. His ideas should (and often do) stand alone on their own merits, without having to be given the veneer of being quoted. Especially when (like the first one) he didn’t actually say such a thing, or have reason to say it, or when (like the second one) he said something similar, but this was also not what he said.

  • http://www.twitter.com/alicearobertson Alice

    Twicker writes:
    Interesting that you talk about “losing rights” instead of “accepting responsibility.” [end quote]

    Alice answers: But don’t you think that is what is missing in today’s welfare state? Are we really helping others when we offer a free hand with no responsibility? I guess I tend to think the old saying about giving a man a fish and you feed him for today, but if you teach him to fish, he can eat for a lifetime.

    Twicker writes:
    As a society, we have accepted responsibility for making sure that, if *anyone* is in need of emergency care, then we will provide that care; we will not let a person, a fellow human, die at the door of the Emergency Dept just because he or she doesn’t have an insurance card. [end quote]

    Alice answers: I am certainly no expert, but it would seem to me there is care. My son didn’t have insurance when he first moved to Chicago. He needed emergency care and the bill was $8000. We were perplexed, so I told him to just call the hospital and, basically, lay himself at their mercy to set up a way to pay for it. It took a lot of time, but finally he was given to a department that said they would send him paperwork. The paperwork took hours to fill in, and he attached a type of essay. A few months later he received a letter saying the complete bill was a gift from the hospital…..a write-off. He believes he invested about four hours of his time, so we figure he made $2000 an hour, for what the hospital seemed to claim few will go through (that’s what entitlement mindset does to people. They take a hard case, then build a case upon it, sometimes we make a bad law that hurts more than it helps, then you get people who don’t view it as charity anymore….it’s an expectation with no responsibility or accountability on the receiver. And that hurts a society, and so does this socialist mindset where we claim we have such big, bleeding hearts that we don’t mind higher taxes because we want to help. It’s not that we don’t want to help, it’s that it’s a form of tyranny when the government keeps forcing higher-and-higher taxes upon us (but that’s been covered well by other posters).

    If the liberals are so altruistic then how about offering us a way to either pay the taxes, or let us work it off? Why is it money only? It would still be a mandate, but if it’s all about helping others then give us that opportunity, and get the money out of the irresponsible government handler’s hands (why do they get to choose who gets help? This would give me more options). Not a perfect solution, but a better one that we currently have.

    Personally, I take my children to volunteer (at a conservative think-tank), and we go into the ghetto, and it’s been eye-opening, but it’s our diversity in our homeschooling. I will *admit* I vote Republican (if I had to label myself it would be a pro-life, fiscal conservative with some major disgruntlement with the Republican Party and some of their candidates). I am not a Constitutionalist, although, I tend to think the libertarians have some very good ideas (not a Ron Paul supporter……just, incase…..)

    Twicker writes: I fully accept that, in order to receive the services I receive (establishment of justice, insuring domestic tranquility, provision for the common defense, etc.) and live in the country in which I live (the US), there’s a cost. Part of my responsibility, and part of the responsibility of every citizen, is to bear a portion of that cost. This includes paying taxes.

    Remember that we are NOT talking about “taxation without representation” — because, except for people who live in D.C., we have representation in Congress. You may not like your representative or senator or president, but that doesn’t mean that we didn’t have an election. Our Founding Fathers knew that the government, like all governments, would indeed need revenues — and they wrote that into the Constitution (later amended to provide for further revenue). All this was approved by the representatives of the people.

    Alice answers: Yeah, and those same representatives give themselves raises, nice health insurance, and pay no social security……..etc. I think young voters……voted irresponsibly in the last election……but they are catching on…….I believe favorability ratings are at an all-time low. And some of the newer liberal appointees didn’t even feel the need to pay their taxes (i.e. Geithner, Richardson, Solis, Daschle, just capturing the liberals who proclaim we should pay taxes but don’t would help the deficit! :) ) Hmmm……some of the Founding Fathers had some provocative things to say about taxation (there’s more, but I am running out of time):

    Thomas Jefferson
    We are all doubtless bound to contribute a certain portion of our income to the support of charitable and other useful public institutions. But it is a part of our duty also to apply our contributions in the most effectual way we can to secure this object. The question then is whether this will not be better done by each of us appropriating our whole contribution to the institutions within our reach, under our own eye, and over which we can exercise some useful control? Or would it be better that each should divide the sum he can spare among all the institutions of his State or the United States? Reason and the interest of these institutions themselves, certainly decide in favor of the former practice.

    Benjamin Franklin
    When the people find they can vote themselves money, that will herald the end of the republic.

    Benjamin Franklin:
    … as all history informs us, there has been in every State & Kingdom a constant kind of warfare between the governing & governed: the one striving to obtain more for its support, and the other to pay less. And this has alone occasioned great convulsions, actual civil wars, ending either in dethroning of the Princes, or enslaving of the people. Generally indeed the ruling power carries its point, the revenues of princes constantly increasing, and we see that they are never satisfied, but always in want of more. The more the people are discontented with the oppression of taxes; the greater need the prince has of money to distribute among his partisans and pay the troops that are to suppress all resistance, and enable him to plunder at pleasure. There is scarce a king in a hundred who would not, if he could, follow the example of Pharaoh, get first all the peoples money, then all their lands, and then make them and their children servants for ever …

    • HJ

      Alice says, “He believes he invested about four hours of his time, so we figure he made $2000 an hour, for what the hospital seemed to claim few will go through (that’s what entitlement mindset does to people.”

      And my hospital bill is increased to reflect the free care your son got.

    • twicker

      About the quotations (which I take it you are pulling from some anti-tax website; do not trust them. Again, quotations are not the same as truth):

      The Jefferson one is at least partly genuine; I don’t have a book of his actual letters, but it has parts that are similar to his letter to S. Kercheval in 1810. See: Jefferson — Quotations on Service and Charity

      The first Franklin one is, like your first Jefferson one, not an actual quote from Franklin. Ah, the wonders of being able to Google …

      The second one is a quote from Franklin — but not about taxation. It was from something he wrote in order to provide evidence for why we should not pay the President any salary. As I said, the wonders of Google:
      Avalon Project: The Madison Debates — June 2.

      More about your son, and how that is a perfect example of what I’m talking about, in a moment.

  • http://www.twitter.com/alicearobertson Alice

    Twicker writes: because you are forced not to “at the threat of violence.” No, you should not pass a stopped school bus because you have a responsibility not to recklessly endanger the lives of children. You should buy car insurance for your car not because the police might confiscate your car “at the threat of violence,” but because you have a responsibility to, well, be responsible, including in the event that you might cause an accident (it happens) and hurt someone else. Yes, we have laws, and yes, they get enforced — but, unless you are advocating anarchy (and it sounds like you are — I’m guessing Rothbardian anarcho-capitalism, yes?), you will have laws, and they enforce what we, as a society, have determined to be both a set of rights (the Constitution is, in fact, a set of laws, including the Bill of Rights) and a set of responsibilities. Just because it’s written into law doesn’t somehow remove it from being a responsibility.

    Alice answers: I don’t think anyone (particularly, doctors who see the results of bad behavior) would argue that we don’t need civil laws to control man. What is being discussed is over-and-above civil laws to curtail bad behavior. I believe the intent of the framers of the Constitution is being overlooked by the Supreme Court, and particularly, judges who want to write their own agendas into law, not what is good for the common man. The Constitution is a magnificent document, and when you read about the debates they had over how much control the government should have you are awestruck at the brilliance of the framers.

    Twicker writes: Unless, of course, you’re actually an Ayn Randian Objectivist, and you only do that which is legally required of you, and then only to the extent that unbridled selfishness requires. Which would call into question why one would ever want to be a doctor (Ayn Rand had neither children nor compassion for anyone else, much like both Murray Rothbard and Ludwig von Mises; there’s a reason their treatises are, frankly, anti-family).

    Alice answers: You and I may agree on some of these aspects, but sometimes that’s what it takes……cut throat capitalists to keep the economy going…it sure beats the government taking over our lives. At least her way I would have some options (not advocating mind you….but then again……). It’s not the government’s job to be the Virtue Police of business owners, or to limit salaries, etc. (maybe it’s their “Pursuit of Happiness?”) It hurts the economy when the government takes over and sticks their nose in private enterprise (even though capitalism has a lot of sick puppies…..it’s a moot point if the owners are of ill-character…..it may intriguing, or even disgusting how they behave, but they should have the right to create and profit with as little government regulation possible). I realize the capitalists may need some oversite at times, but why is the government being a leech and using powers they weren’t intended to have?

    Anti-family? Yeah, sometimes those capitalists are selfish creatures. I tread lightly here, but being a mom of six I know I tried to live out my pro-life convictions, and was rewarded abundantly. I just wish the government viewed stay-at-home moms as a worth to society and would give me a stinkin’ tax break. :)

  • http://www.twitter.com/alicearobertson Alice

    Twicker writes: Since you would have fewer liberties if you paid zero taxes, then paying taxes gives you these liberties [end quote]

    Alice answers: Isn’t that a fallacy? My parents pay almost no taxes except sales tax (and probably something on their license, etc.), and some of my friends say after their deductions they pay no taxes in April. Do they have less liberties? Some say we should have Tax Day on Election Day, and people would vote more responsibly. If the Income Tax wasn’t instituted until 1913 where were our liberties?

    If you go to google and place in something like “Timeline of Taxation” you will see a much larger picture, but our first Congress had no powers to tax. Did people have less liberties in 1782?

    snippet:
    1913 – Income Tax instituted. Less than 2 percent of the population had to pay it. Income up to $20,000 was taxable at 1 percent, and above $500,000 at 7 percent. It exempted the first $3,000 earned by a single person and the first $4,000 by married couples. Since the overwhelming majority of Americans supported families on less than $1,000 a year, most were exempted from the tax.

    snippet:
    1782 – The first Congress under the Articles of Confederation formed. This Congress didn’t have any taxing powers.

    1789 – Americans gave a new Congress taxing powers.
    snip
    In the mid-20th century, there was not a bank in the US that told the IRS about customer affairs, interest was not reported, withdrawals of cash were not reported, and not a thing that went through accounts were photographed. Also, real estate transactions were not reported, stock transactions weren’t reported, dividends weren’t reported, income from other sources (Form 1099) wasn’t reported, and US Customs didn’t require a declaration of cash carried.

    Before it was espionage, it was an honor system, and it functioned quite well. The deterioration that happened over the previous fifty years to the present is that anything of any fiscal significance is now reported.

    Adam Smith stated that people will evade taxes and tax laws shown no respect when there is a general suspicion of a lot of meaningless expense and a lot of misapplication of the public revenue.

    • twicker

      So, if you’ve actually read the Madison debates, then you’ll know that, indeed, people had fewer liberties in 1782 than they did after we replaced that government with the new government under the Constitution. One of the main problems of the original Articles was that exact lack of any way for the Federal Government to raise revenues. It also had a unicameral legislature with no executive and no direct election of anyone (not even electors).

      Click here for the actual Articles of Confederation

      Some liberties people did NOT have under the Articles of Confederation:
      + Freedom to directly elect national representatives (see Article I, Section 2 of the Constitution to find where The People gained this freedom);
      + Freedom from the suspension of the writ of Habeas Corpus (see Article I, Section 9 — and there are more there, such as the prohibition against ex post facto laws);
      and I could go on (I’m not even done with Article I yet), but we’d be here awhile. That said, it does seem that I would be remiss if I didn’t mention at least some of the freedoms in the Bill of Rights — again, freedoms that did NOT exist on a federal level in 1782:
      + Freedom of speech
      + Freedom of assembly
      + Freedom from quartering soldiers
      + Freedom from unreasonable searches and seizures
      + Right to a jury trial
      + Right to an attorney
      + Right to your property, except as provided by law,
      + Right to receive just compensation
      + etc.

      So, yeah — the Articles of Confederation pretty much sucked, and people were, indeed, less free then than now (for example, there was nothing preventing a state from taking your property without bothering to reimburse you — I’d call that a pretty important right, wouldn’t you?).

      And, yes, you still need to have taxes in order to have your freedoms. Now, maybe your parents don’t pay taxes; I’m going to guess that they’re on Social Security (paid for with taxes) and Medicare (paid for with taxes), so that may be the reason why they only pay sales/gas/etc. taxes. But note that they do, in fact, still pay taxes. And your friends who have the deductions may not pay any income taxes in April, but I suspect they pay them during the year — otherwise, they’re apparently not making much money at all.

      Which is fine, but that still doesn’t change the fundamental fact that, for you and me and everyone else in the US to have the right to things like a jury trial, someone has to pay taxes. I certainly do, and consider it my responsibility in order to have the freedoms I enjoy. Including the freedom to be treated at the ED of a hospital without having to pay first — like your son.

      Ok, enough American History 101 for the night. I have real work to do (and I still haven’t replied to IVF-MD).

      • http://www.twitter.com/alicearobertson Alice

        Well I have only read portions of the Madison debates, and a book on Dolly Madison :) I disagree with you about the quotes because the framers argued about just how much government is enough. They felt about government and capitalism like I do………they taught me. Yeah……..I’m pretty old! ha! Liberals keep changing the textbooks too! So there! :)

        • twicker

          “So there?” That’s an argument? Alice, that’s not an argument for anything — even on a blog post. And, while you’re right that the folks in the Constitutional Convention argued about a lot of things, that doesn’t change either the fact that you published several supposed quotations that were not said by the people you claimed said them, nor that the Franklin quote was taken out of context. And it doesn’t change the fact that the framers were, in fact, human, and known to make mistakes. Remember than a majority of those framers disagreed with Franklin’s reasoning in the long quotation you used (the one that actually came from Franklin), and instead included in the Constitution provisions for paying the President a wage. I take it that, because he lost, you therefore believe that he was wrong — since that’s what those Founding Fathers decided?

          • http://www.twitter.com/alicearobertson Alice

            I purposefully didn’t argue about those quotes because I believe they are right. I have oodles of books here to back it up. Of course the framers argued. It was a huge debate because the states were each printing their own currency and taking on powers, and they needed to work through just how much power was enough and have checks and balances, etc. I imagine everyone reading this knows all of this, so I was going to let it go.

            In truth, I tend to think many liberals want to rewrite history, and the Constitution. That makes a debate quite hard. I really think we need to go elsewhere to debate because from what I have seen even what I am saying is getting rewritten……yeah, so there! *wink* I like debate, have taught it, but let me say I struggle the train of thought where one argues from empathy of mankind….claiming the rights of individuals don’t matter, then take examples and plays kill the messenger. It takes the debate into an argument and no one wants to read that…….I really think we need to go elsewhere for this. Do you recommend another blog that sticks to political issues without a lot of drama?

  • AB

    The fact is the commerce clause doesnt provide the Federal Government the authority to force a private citizen to purchase a product. Jefferson clearly was concerned about abuse of power by the federal government which is why he spoke of nullification. Simply put if the Fed overstates its authority, it is the right and responsibility of the States to hold it in check and not abide by such laws. When the federal government requires an individual to purchase a product or service notably from a private company, its violates the consitution. Wether there is some morality involved in providing healthcare is irrelevant. The question is, is it consitutional and the answer is NO.

    • twicker

      The fact is that we’ll get to find out in court whether the commerce clause, or any other part of the Constitution, allows the Federal Government to mandate that everyone purchase or have health insurance.

      You’re absolutely right that the states do have both the right and the responsibility to hold the Federal Government in check; amen to that. Whether, in this case, these AGs are trying to perform their sworn duty, or whether they’re just trying to make some nice political hay, well … I have my own theory on that one.

      As for the Constitutionality, we actually won’t decide that on this blog; that’s something that the Supreme Court gets to decide. Unless you’re using an amazing pseudonym, I doubt that either of us are Supreme Court justices (I know I sure ain’t), so we don’t actually have the final say in whether it’s Constitutional. I say YES, it is, but, then again, my opinion is as likely to influence the actual course of events as yours likely is — which is to say, not at all.

      • http://www.twitter.com/alicearobertson Alice

        The fact is that we’ll get to find out in court whether the commerce clause, or any other part of the Constitution, allows the Federal Government to mandate that everyone purchase or have health insurance. [end quote]

        Which takes us right back to the original thread, and whether we can trust the courts to even decipher based upon intent, or how they, personally, think things should play out. With the new appointees I certainly don’t have a lot of faith in their skewed views about the law, or our liberties.

        • twicker

          Out of curiosity, which new appointees are you discussing? Roberts and Alito, I assume? Because Sotomayor hasn’t changed the voting patterns of the court, and Kagan is only likely to move it slightly to the right (few are as liberal as the outgoing Stevens). Roberts and Alito are the only appointees who have fundamentally changed the voting patterns of the court in the past 10 years, and the only ones who seem likely to in the future. If you are complaining about Roberts and Alito, then I agree with you that I fear for their impact on our liberties; however, that’s the Constitutional system we have.

          • http://www.twitter.com/alicearobertson Alice

            Did you want to discuss the appointees, or teach? Is there a politcal blog like…um….maybe Huffington Post we could chat at about this (do you get information there)? I think this is too in-depth (and political) for the healthcare debate here. I struggle with the powers of the Supreme Court on policy, wonder about lifetime appointments, etc. These are peripheral issues and I am just thinking aloud.

  • Alice

    Nope1. You gotta watch the fallacies! Your bill did not go up. That is a wrong assumption. The hospital said they write off xxx amounts to keep the tax dollars flowing. We would rather pay than hurt or cost someone else, but they said it doesn,t work that way.

    • twicker

      Alice: you’ve actually just made HJ’s point. The hospital writes off some of their activity so that the tax money will pay for part of the hospital’s bills — including the charity portion.

      That’s how the system works: SOMEBODY PAYS. As a conservative, you should know that there’s no such thing as a free lunch. Your son is, as I said, a perfect example of the emergency department providing care even when the patient in question can’t pay for it. Note that he was not asked to pay for his care at or before the time he received it — it all happened later. Again: it’s a perfect example of how, in a humane system, the treatment is made available, and then a request goes out for payment — not BEFORE treatment, but AFTER.

      As for the bill: Somebody paid the salaries of the doctors, even before they sent the bill to your son (the doctors are highly skilled professionals; don’t you think they deserve a salary?). Somebody paid the nurses — again, even before they sent you the bill. Somebody paid the ancillary staff — and, given that the bill was $8k, I’d be willing to bet there were lots of them involved directly or indirectly in his care. Somebody paid the electric company, paid the pharma companies, paid the medical device companies (those beds? Yeah, they’re medical devices — and expensive, too). Somebody paid all of these people and all of these companies. The hospital may have chalked it up to charity, but that’s because they get the money from somewhere else — in this case, from the taxes paid by the people of the State of Illinois Remember those taxes you were complaining about? Welcome to being on the receiving end of the taxes.

      HJ was spot-on. He could have gone further, because I’m sure that part of what paid for all the equipment in the hospital (as with all hospitals) was federal money — Medicare, Medicaid, etc. That would be my tax dollars, and the tax dollars of everyone else in the US who pays anything in taxes or tariffs (including duties on imports, gas taxes, etc.). Thanks for making my case for me that we need to have taxes!

      • http://www.twitter.com/alicearobertson Alice

        That’s how the system works: SOMEBODY PAYS[end quote]

        No, you are wrong…. I teach a type of literacy project and I GIVE my time. That’s what the hospital said they did, because this was of great concern to me. They claimed it was their prerogative to give xxx amount of services, but she did say to keep the federal dollars coming they had to tell the government they did xxx amount of charity which she shared didn’t really cost them much…. it was their equipment, time, and employees and they didn’t mind (that’s why there was so much paperwork and an essay where you tell them you are willing to pay….I think that was a major part of the decision). Most big corporations do this and no one claims their product costs more just because a car company gives away cars on Oprah. I think it’s common, and just part of business, particularly when tax money is attached.

        Same with hospitals who write off. I believe Cleveland Clinic wrote off millions for the lady who tragically lost her face when the chimp went beserk (their doctors are salaried, so they have the facilities to donate whatever time and talent and surgeries they want. It didn’t cross my mind that a person in need receiving care there for free was costing me money) . I, certainly, don’t think she drove up my bill (which is close to a quarter million in a few weeks. Don’t worry… between our insurance and ourselves we are paying it. I wouldn’t want one penny added to your bill, which if you divide $8000 between the patients in a year that’s probably what it would be if you are right….but you aren’t :)

        If you come to my home for dinner tonight I won’t charge you, and it doesn’t cost anyone else a dime. I work for free…….a write off. It’s common, and to claim it is costing you is just grabbing at straws (did you mention a strawman?)

        • twicker

          So, you don’t pay for your food? You don’t pay for your electricity? Your house was free? SWEET! How do I get that kind of deal? Personally, I have to work for a living in order to buy my food and pay for my electricity (got a bill just today) and pay for my housing.

          Or, wait — when you said, “and it won’t cost anyone else a dime,” did you mean that it did cost you something, but you are donating that cost? Because, if so, then it did cost someone — in this case, you — something. It may be free to me, but that doesn’t mean that no one paid, because, well, you are someone.

          Same thing with the writeoff: As I said, someone paid. However, in that case (and completely unlike your volunteer work), the doctors were at work, not doing a volunteer shift; the nurses were at work, not doing a volunteer shift; everyone was at work, and got paid their normal amounts.

          Now, yeah, the cost to the hospital was less than $8k (notice how your insurance files always show a difference between what the hospital charges and what the negotiated rate was for you? That’s where that slack comes in). That said, somebody paid for all that professional time. As to the Cleveland Clinic case, I suspect that, because of the complexity and circumstances around the case, the doctors and nurses may have volunteered their time for that one case, which is very different than what any hospital does for a normal patient. Extremely different. For normal writeoff patients, everyone still gets paid; the hospital then either just uses it strategically to make up the money elsewhere (as your hospital did — they apparently decided the revenues gained from taxes outweighed the benefit that might be gained from getting your son to pay. Somebody always pays; that’s a key part of capitalism. Are you sure you’re a capitalist?

          As for giving away cars on Oprah — seriously? Are you truly not aware that companies have marketing budgets? Someone paid for the materials and labor to make those cars; they didn’t appear for free. The companies wrote those off as a marketing business expense and reduced their taxes in the process. The company pays for the cars, hoping that the extra exposure leads to more sales; that’s pure, unbridled capitalism there.

      • http://www.twitter.com/alicearobertson Alice

        HJ was spot-on. He could have gone further, because I’m sure that part of what paid for all the equipment in the hospital (as with all hospitals) was federal money — Medicare, Medicaid, etc [end quote]

        Not if it was a research or charity hospital. I asked about this, and she was firm. There were/are programs in place that would help all those millions you say the bill will help (which is really only about 10% of Americans if it’s even right, and if we could help the bulk of them already with the taxes in place, why more taxes when more aren’t really going to be helped? It’s just more useless big government under the guise of being helpful. When the government regulates the insurance companies under we may view them with a different lens….particularly, if unemployment goes up…oops….I forgot the government will be so large they will be doing the hiring and we know government employees are often overpaid. They are usually paid at a higher rate than the same occupation is often paid in private industry, but they are not as productive. I worked for two government agencies….and because they aren’t capitalist ventures they were great jobs for the employees…….but really weren’t serving the public well).

        Ya’ know there are still people out there who give with no expectations in return. Although, admittedly there is return in charity work. I think whatever I get emotionally from it is more than I give, and no paycheck or government incentive can even come close to that.

        • HJ

          Alice says, “They claimed it was their prerogative to give xxx amount of services, but she did say to keep the federal dollars coming they had to tell the government they did xxx amount of charity which she shared didn’t really cost them much…”

          These are still my tax dollars being spent on someone who chose not to buy health insurance to cover their health care needs. Why should my tax dollars contribute to your son’s health care? Where’s my freedom?

          It seems to me with pool fees, travel to UK, that $8000 isn’t that much to pay. Why didn’t you help your son with his expenses instead of relying on tax based charity care? Where’s the responsibility?

          Why should I pay premiums to my health insurer when I can get charity care?

          So what happens when that uninsured person needs $80,000 in care instead of $8000?

          Alice says, “I wouldn’t want one penny added to your bill…”

          From:
          http://www.kff.org/uninsured/upload/The-Cost-of-Care-for-the-Uninsured-What-Do-We-Spend-Who-Pays-and-What-Would-Full-Coverage-Add-to-Medical-Spending.pdf

          -In 2004, uncompensated care is estimated to be $40.7 billion.

          -The primary source of funding for uncompensated care is government dollars. Projected federal, state, and local spending available to pay for the care of the uninsured in 2004 is $34.6 billion—about 85% of the total uncompensated care bill.

          -Over two-thirds of government spending for uncompensated care comes from the federal government, most of which goes toward payments to hospitals in the form of disproportionate share hospital (DSH) payments—payments intended to offset losses hospitals incur when large shares of their patients are unable to pay their hospital bills.

  • http://www.twitter.com/alicearobertson Alice

    British citizen — rich or poor, young or old — had a baseline level of healthcare, something that tied the nation together. He and his compatriots would never get rid of the NHS (and this is one of the most conservative MPs, mind you, a great friend and fan of Dame Thatcher). [end quote]

    Alice answers: I gotta admit this is a lofty goal, although, having lived there all I can say is I would get on a plane and come here for my daughter’s cancer treatment if I were still there (I am surmising you would want your own loved ones treated here in the states, too). My husband lives in terror of becoming sick while he visits his family there. We took out travel insurance when we brought my mother-in-law to the states and she fell her first day here. The insurance picked up her operation, and when she went home the doctors were simply amazed at what the doctors here did. She was pleasantly surprised when she was the life of the party as the doctors questioned her about her new apparatus. When she was over 80 years old she was able to get one eye cataract removed, and they said because of her advanced age that’s all she was getting. She died with one good eye and one bad one. I think the care is very basic as you shared, and actually would call it sub-standard compared to what even charity cases get here in the states.

    Our cousin is dying of cancer in Scotland, and he couldn’t even get the anti-nausea drug during his chemotherapy until he went to a private doctor. On and on and on………I don’t believe fourth stage breast cancer is treated there, and the neighbors talk in the pubs, and on the street, about this or that relative/friend that went in for a relatively small procedure and never came home. Having the government and their cost estimates seems scary…….much scarier than a private insurer (that is regulated… and competition and capitalism are good for the economy and consumer). I just think moving into this big government era has too many repercussions, and sometimes you have to have vision to see it through. So…….yes………what you propose……healthcare for all…..is worthy……..but if it’s unconstitutional we need to find another way (one that isn’t hundreds-and-hundreds of unread pages long, etc. etc.).

    I realize the stats, and Michael Moore, will share differently and place the US much lower than it really is on their scale of care (I think National Review had a medical writer cover this debacle recently), but I tend to think many of the stats are almost useless because even our unemployment stats are tampered with to bring them down (I think a site about shadow gov’t stats covers this) ……yet, it’s very hard not to quote stats that agree with our own philosophies.

    I do think the dialogue is valuable though, and I admire when someone exhibits tenacity as you have. I have been the voice in the wilderness on blogs and I am still in a bit of recovery!

  • http://www.twitter.com/alicearobertson Alice

    Twicker are you in the UK posting? Just curious about the times of your posts. I teach literature, so picking up on stuff is a habit and I like to know if I am wrong or right. I lived in London for a short while……isn’t there a stadium by that name there?

    • twicker

      Re: UK — nope; I’m in North Carolina. I have friends who live in the UK, but I don’t.

      I’ll go ahead and mention something about what you said for the UK here — which is that, as I have said before, I am not in favor of fully nationalized, NHS-style healthcare. Never have been, never will be, and the Obama package doesn’t even come close to socialized medicine. I am in favor of single-payer, but we absolutely need competition among providers. It’s more the French model than the British model (one of the few parts of the French model I’d adopt), and it works quite well. Everyone had a baseline level, everyone can supplement that baseline at will, and providers compete for your business through pricing, through convenience, through quality, etc. You ensure both that all citizens would have access to the basics, and not go bankrupt from most medical procedures, and then allow folks the freedom to purchase more insurance on top of that for either lower upfront costs or a wider range of therapies.

      It’s a safety net, not a complete provision of health care. We need a safety net; we don’t need the government, or anyone but ourselves, choosing what a total package would look like. And, if properly crafted, all current providers could continue to operate as they do now.

  • Alice

    So, you don’t pay for your food? You don’t pay for your electricity? Your house was free?
    SWEET! How do I get that kind of deal? Personally, I have to work for a living in order
    to buy my food and pay for my electricity (got a bill just today) and pay for my housing.
    [end quote]

    There is merit in what you say, but in truth I would just be sharing what I was cooking for my family. A casserole…..so there………commune style………you should understand that……..I want to dig out the James Madison quote from the Federalist 51 (it’s about angels and the role of regulation……..maybe you can quote verbatim? *wink*). We need to go back to pre-req history! :)

    Just rushed here trying to serve the needy……….and forget about the greedy……….ha! I got that British sardonic thing goin’ on……..and thanks for your location……all these anonymous posters could drive Sam Spade wild looking for the real deal.

    • twicker

      So, I do understand what a commune is, just as I understand what Ludwig von Mises was saying and how Rothbard expanded on it. For the record, though you seem to think otherwise, I’m very, very definitely not communist (I put it in the same league as I put libertarianism and anarcho-capitalism: it would be great if the world worked that way; however, we’re stuck with reality, and reality don’t work that way).

      Go back and re-read what I actually said (which never mentioned communism): it said that we would have a single-payer, supplemented by private insurers, and all paying into a competitive provider space. Not even a little communist (or socialist; social democratic, I could see, but not socialist, since the government does not have a priori ownership control over the providers).

      As for your meal: you might have been planning to do all those things anyway, but the doctor wasn’t planning to spend her or his professional time treating and diagnosing your son anyway, the nurses weren’t planning to spend their professional time treating your son anyway, etc. If your son (and others like him) hadn’t been there, then those resources would have been employed elsewhere — giving other (maybe paying) patients better care, taking a quick, well-earned break to be rested for the next patient, moving someone else’s loved one along faster. Given the $8k price tag, I’m going to assume that your son had at least an IV and/or some blood drawn — all of which used up one-time disposable materials, which, if your son hadn’t used them, would have gone to someone else.

      Treating anyone in an ED uses resources — valuable resources. Somewhere, someone pays for those resources, just like someone paid for the steel and plastic and glass and everything else that went into the Oprah cars. It’s one of the reasons you can’t really draw a comparison between one person fixing a meal for a family and then having a single guest; the amount of resource used is substantially higher. That’s the whole reason that people like your son need to have an option available to have the care provided for them; if it was a $15 meal, then most people would be able to easily afford it. But it’s not a $15 meal; it’s an $8k (or $3,000, or even $2,000) hospital visit. Completely different league.

      • http://www.twitter.com/alicearobertson Alice

        Of course the staff expected to do some work if they want to keep the money machine rolling through and their paychecks. Ever talk to a research doctor about his hospital paycheck based on grants, etc.? That’s a very interesting topic.

        You can slice my story whatever way you want, but either you are right or the hospital spokeswoman, and I tend to believe what she said. I think you are just trying to discredit the deliverer. Where I live doctors are on a salary and make the same amount no matter who comes through their door. It’s not a per patient deal, it’s a deal of being salaried and being there and working for that salary. Different hospitals are run differently. It was the hospital’s decision, we didn’t ask for it (we asked for a payment plan), so maybe your argument is with how that hospital is run (remember that was Obama’s territory…….so maybe they are so altruistic they were giving free care before the healthcare bill……indeed, if you do your homework you would see Chicago offers all kind of freebies …again pre-healthcare bill……..they offered loads of free care there……still do…they didn’t need this new regulatory mandated over-use of power).

  • http://www.twitter.com/alicearobertson Alice

    As for your meal: you might have been planning to do all those things anyway, but the
    doctor wasn’t planning to spend her or his professional time treating and diagnosing your
    son anyway, the nurses weren’t planning to spend their professional time treating your
    son anyway, etc. If your son (and others like him) hadn’t been there [end quote]

    Maybe we are talking past each other, but I thought I said the hospital needed to do xxx amount of charity work or they would lose some kind of grant (it was years ago, so I can’t call and get the exact details).

    But my point is well-taken…..there are programs in existence, we didn’t need the healthcare bill to the tune of the cost and regulation we will have to help a small minority of people. The people I know are able to get help. There is a big charity hospital in Cleveland (that I think Cleveland Clinic just purchased) and if people take the time to sit there for five hours they will help you get care, or on government help, or whatever they can do to get it retroactive, or current. Cleveland Clinic will help you with your bill even if your family makes over six figures, and that was pre-healthcare bill.

    I mean for goodness sakes why not offer those 33 million people Kaiser (and leave the rest of us and this regulation of commerce and the people alone)? That would have cost about a tenth of what our representatives rang up on that bill. Cleveland Clinic had some of the best ideas out there instead of that bill. Did you read their proposal? I am there a lot and am friends with people who work there, so it’s irritating that good ideas were buried, and that people actually defend big government…….if it’s not socialism it may very well turn into a soft type of tyranny…….then…..oh my………totalitarianism……it starts out softly with people defending why it’s for the greater good…….but how do we defend the constitutional rights of those it hurts?

    Some would say it boils down to whether healthcare is a priviledge or a right?

  • http://www.twitter.com/alicearobertson Alice

    These are still my tax dollars being spent on someone who chose not to buy health
    insurance to cover their health care needs. Why should my tax dollars contribute to your
    son’s health care? Where’s my freedom?
    [end quote]

    Are you serious? My son didn’t choose not to buy it, he was new in town and new at a job. He did get health insurance, but you have a period you don’t have it and he had no money……but you missed the point completely.

    So you are for the healthcare bill?

  • Alice

    Hi| Okay……you got me…..my son is the reason for the whole budgeting, overspending in Washington. :) My son did make a donation of several hundred dollars if that helps….but I do not usually share that. But I am so relieved that you two do not believe in any free lunches even when a donation is made.

    I guess when your kids are in college and only have catastoph

  • Alice

    Sorry…….this Droid is nice, but driving crazy……

    Okay…..when your kids only have catastrophic care if you are consistant they should refuse anything not completely paid for? My point is for those who would try there was money there to help…..I am not against all government help or agencies just abuse of governmental mandates. Good grief, if you need care or help take it and I know the vast amount of Americans do not mind helping the needy or paying something towards helping, so your point is moot. There was help in place and Washington is misusing their power under the guise of helping those who may have found help with what was already in place. Reminds me of the story about the guy on the roof looking for help, but refuses any form that doesn’t fit his own ideas.

  • Alice

    HJ are you an accountant? I haven’t been to the UK in years…..I am too fearful I would get sick there, so worrying about my travel budget or son’s gift is not reasonable. Did it occur to you that some people have travel miles while you were building your case against me? Or that my husband stays with his sister?

    Please read that I said it did not cost you one penny of your tax dollars, as discouraging as that will be to your rant we gotta ask questions before making assumptions.

    • HJ

      Alice says, “Are you serious? My son didn’t choose not to buy it, he was new in town and new at a job. He did get health insurance, but you have a period you don’t have it and he had no money……but you missed the point completely.”

      This is the point of health care reform. That someone doesn’t end up in a situation where they can’t afford health care.

      Alice says, “Good grief, if you need care or help take it and I know the vast amount of Americans do not mind helping the needy or paying something towards helping, so your point is moot.”

      First…providing care this way is inefficient and does not focus on prevention. Second, you assume that everybody wants a free ride and feels good about taking charity-I would have paid the $8000, even though it would have hurt my finances-because I know there are people out there that don’t have a car, that can’t afford pool fees, that will never be on an airplane, that don’t have an android, that don’t have a job. Third, you assume that everybody has the tenacity to fill out 4 hours of paperwork or sit in a hospital for 5 hours – and you consider it ok to treat people like this after complaining about liberal inefficiency. Fourth, I pay taxes and your son’s care was funded by taxes.

      Fifth, doctors and hospitals contract with Medicare, Medicaid and private insurers to provide care for the insured. When you get your bill, there is the doctor/hospital’s charge, the write off-20-80% of the doctor/hospital’s fee, and the amount the insurance paid, and the patient responsibility. In order to stay in business, the doctor/hospital has to make more money than it costs to provide care. To do this, the doctor charges more for those without a contract. When someone receives “free” care, the doctor/hospital charges more for those people. Perhaps the hospital will negotiate higher reimbursements from my insurance company, to cover the cost of those who get it for “free.” Hence, my comment that I pay more for health care because of those that get it for free.

  • http://www.twitter.com/alicearobertson Alice

    For those who are still reading there are two items of interest, and they don’t both agree (and cover different aspects of care). US News and World has devoted the recent issue to health care (the basis is that “people matter” which is a nice foundation to realize it’s not just a disease, it an emotional and physical journey……..one of our doctors recently said it’s obvious he isn’t a “machine” and I thought about that…….the emotional realm on both sides of the healing realtionship).

    The Cato Institute has did a good job of sharing the details about what posters here tried to share about the health care bill (of course, the blogs are all abuzz with discounting their “Nanny State” etc. but that’s what they do at Cato when they discuss our freedoms [which I am sure they took some liberties of assumption, but it's still a good read]):

    Bad Medicine: The Real Costs and Consequences of the new Health Care Law
    http://www.cato.org/pubs/wtpapers/BadMedicineWP.pdf