Government is already involved with the majority of health care

US District Judge George Steeh of Michigan ruled last year that the constitution permits the federal government to require individuals to obtain health insurance coverage.

This lawsuit was filed by a Christian legal organization called the Thomas More Law Center, as well as others.   Other lawsuits are in the works in numerous other states.   These suits are filed primarily by Libertarian-types who don’t want to be forced to buy health insurance if they don’t want to.  Republican leaders are jumping on this “overreaching federal government” bandwagon and playing into fears that tomorrow we will wake up and be all forced to sing the praises of Lenin, Marx, and Engels.

The funny thing is that the government already is heavily involved with the vast majority of health care delivered in this country via Medicare and Medicaid.  So this whole “government hands off my health care” crap is ridiculous.  The government is already monumentally involved and always will be.  What it needs to do it work to control costs, increase coverage, and of equal importance, increase access.  To do this people, it has to be “involved” sorry to say.  One way to do this (at least to increase coverage and control costs – increasing access is another issue), many experts agree is to mandate that all people who are financially able, to purchase insurance.  Many young otherwise health people elect not to spend money on insurance, thus leaving those with chronic diseases as the main individual purchasers.  It does not take a degree in economics to see the problem here. Anyway, these young healthies can buy plans that cover catastrophic things (like ruptured appys, and fractured limbs, etc) that would be cheap and affordable – thus spreading the risk.

Anyway, to the Libertarian/Tea Party/Everymanforhimselfers: you are part of this society and we have to work on big problems as a society, not as individuals.  If  you refuse to buy insurance, your sick countrymen (and probably sooner or later you will be in this boat – sick and screwed with no insurance) will suffer.   Now, I am not saying the health reform act was perfect – far from it, but this part, the mandate to buy insurance is probably the most important part of it  – it is the only thing that will allow those with pre-existing conditions to ever be able to buy an affordable plan.  If they can’t, guess what happens? They get sicker and sicker and eventually become disabled and get onto Medicare!  They continue to incur larger and larger costs as they deteriorate over time.   Guess who’s paying now?  All of us via our taxes!    Of course we have to work on other major social problems that feed into this (obesity, inactivity, smoking, drug abuse, poverty, etc) – but the mandate is essential.

It will be interesting to see how these other suits play out. I am sure some judges will decide the opposite of this judge, but in the end I think the mandate will stick – and we will get used to it and move on – just like we did with ending slavery, allowing women to vote, Medicare, and Social Security.

“ER Stories” is an emergency physician who blogs at his self-titled site, ER Stories.

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  • imdoc

    “Of course we have to work on other major social problems that feed into this (obesity, inactivity, smoking, drug abuse, poverty, etc)”
    No doubt we will achieve this also by the next round of government programs which redistribute our wealth, steal freedom, and tell us how to live.
    Since the 60′s there have been massive increases in the scale and reach of federal programs to address such things. I suggest they have all been abject failures which have put us in current state of near insolvency.

    • gzuckier

      Right. It’s got nothing to do with the activities of the banks once deregulated, knowing that they could always hold the economy hostage to get bailed out if they lost at the gaming tables. It was those darned greedy welfare mothers.

  • SP

    That is a vague, rhetoric filled comment. Fortunately it does not mean anything for this article. This is a good piece for the need for health insurance for everyone, and there are quite a few sociologists who will agree with no reservations.

  • Fam Med Doc

    Dear imdoc,
    “they have all been abject failures”

    Thats ridiculous. If you polled senior citizens, most would not say Medicare us an abject failure. Our senior population is so better managed medically than if there were no Medicare in our country.

    • gzuckier

      In fact, in contrast to our terrible showing relative to the rest of the industrialized world, outcomes for the US elderly population (life expectancy, etc.) are at or near the top of the list. That would, of course, be the segment of the population who receive Medicare. And that care is delivered at the cheapest rates in America, as well.

  • Rob Lindeman

    A rather sloppy caricature of the libertarian position. And phrases like “guess what?” are poor substitutes for compelling arguments. I’m not sure another libertarian would stipulate that Medicare will be there for him when he gets old and sick. I know I don’t. Furthermore, as the commenter above argues, there’s no evidence that health insurance is better than fee-for-service at delivering healthy people to age 65.

  • WhiteCoat

    ERP –
    Two problems with your analysis.
    I agree that government should provide medical care for its people. The problem is the way in which our government is addressing the issue.
    Both Medicare and Medicaid are saddled with tremendous inefficiencies. Those inefficiencies need to be addressed and resolved.
    We have to learn to say “no” to certain types of care and become comfortable doing so. As in “no” you’re not getting expensive care that has a negligible effect on medical outcomes. “No” you aren’t getting expensive medications that have little or no benefit over lesser expensive medications.

    We have to get more money into the system, but people need to perceive that they are getting something for their money. Slapping a “mandate” (read that a “tax”) on everyone without increasing access to care will only make people distrust the system more. You know and I know that Medicaid “insurance” pretty much means that you need to go to the emergency department because few other providers accept your form of “payment.” Don’t believe me? Ask any patient with a blown disk in their back how “easy” it is to get an evaluation by a neurosurgeon or how many doctors/hospitals are willing to perform nonemergent surgery on them.
    Implementing the “mandate” will only encourage everyone to game the system to get by with the cheapest route. That may be “waivers”, downsizing, religious exemptions, or whatever. Destitute companies like McDonalds, Aetna, and Cigna are already on the “waiver” list.

    Call a rose a rose. You want access to care, we need to increase your taxes. Kick up the Medicare tax deduction from everyone’s paychecks and forget about the “exemptions” and waivers. Everybody pays their fair share. Maybe we implement some type of consumption-based medical tax so that even those here illegally pay something into the system when they purchase groceries and other necessities of living.

    Then open up the VA System to every citizen in this country. Expand it. You walk in the door with your verifiable US ID, you get free care. All those taxes you paid are now funding your care. If you are visiting, you purchase insurance before your trip or you pay with a credit card. If you’re here illegally, you still get care, but then you’re getting deported once you’re discharged from the hospital. You’re breaking our laws, now we’re going to enforce them.

    There are a lot of ways to improve access to care, but – even though well-intentioned – I just don’t think that the “mandate” is one of them.

  • rezmed09

    I don’t understand how it is OK for states to mandate car insurance, but not health insurance. Somehow it is OK to mandate that ER’s and hospitals take care of uninsured patients with no ability to ever pay, but it is not OK to make patients get health insurance. Providers are under the gun to provide expensive and often futile care to patients who don’t have any skin in the game. We seem to be only looking at one side of the equation. I guess that is politics.

    • Alice

      That is a good question. I was hoping someone would answer because I am rushed and giving hurried answers that are not complete. The power of government should be limited, not used lightly or to solve every problem with man. I do tend to think the Supreme Court will agree it is unconstitutional to mandate the purchase of insurance…but then again….I have libertarian tendencies, but not the dogmaticness without logic (well….not really objective when it comes to my own thoughts….personally it grieves me to think someone could be denied care…but a closer look shows so much irresponsibility….and I have run up huge bills with cancer treatment and am so grateful we do not have the socialized medicine of Europe where I believe my daughter may have died waiting. My daughter could get free care there…her dad is a UK citizen).

      In my state you either have auto insurance or prove you can pay out of pocket. And the government isn’t paying out auto claims. They regulate…but do not financially participate with taxpayer reimbursements on our claims.

  • Rob Lindeman

    Hoo-boy, rezmed09,

    Bad analogies. Here’ why

    Please read about no-fault auto insurance here:

    As for ER/hospital’s mandate to care for people without coverage or adequate resources, see EMTALA;

    But you’re right that the patient has no so-called “skin in the game”. We all ought to ask ourselves ‘why not?’

    • gzuckier

      “Bad analogies. Here’ why

      As for ER/hospital’s mandate to care for people without coverage or adequate resources, see EMTALA;

      You mean the part that explains how hospitals are stuck with the costs of uninsured patients and have to shift the burden to any paying patients or insurers who have the bad luck to get treatment there? Not sure how that negates the original poster’s premise.

      • Alice

        Hospitals are required to give care at the ER…we are not required to pay…so many simply do not (even under threat of court….many hospitals just write it off). The government is already paying for half the medical care via Medicaid, Medicare, the VA, and state children’s medical care programs. So people get care….some great care, usually average…but our average care is much better than elsewhere in the world. The average American would be appalled to receive critical care elsewhere in the world (emphasis on critical, because basic care doesn’t have the same level of anxiety or expectations).

        How great it is to say you care…do little to help….condemn those who dare report the sad reality that is being lived out in Germany, the UK, France, etc. that the dream of great healthcare for all just can’t be sustained financially.

        Read what is going on in the UK. The surgeons and other Royal Colleges are going berserk over the harm more budget cuts will bring on an already burdened system.

        Libertarians can go too far, but most are reasonable…unlike the emptiness of liberalism that wants what cannot be sustained.

  • medical blog

    This is an issue where people already have their minds made up. Some say, “leave me alone, I can take care of myself, and don’t need or want government intervention.” We’ll never convince them. Others believe more or less what this post says, that unless everyone is insured the burden falls unevenly and mandatory insurance is better. Eventually we will come to what the rest of the world does and have a government health insurance for everyone.

    • gzuckier

      ‘Some say, “leave me alone, I can take care of myself, and don’t need or want government intervention.” ‘

      Much as the banks did, when demanding and getting deregulation. Until they needed a bailout.

      If there’s any evidence that those who eschew insurance and end up with diseases whose treatment is too expensive for them to cover are bravely sticking to their principles and dying with integrity instead of sticking the hospitals or anybody else they can with the costs, it sure isn’t visible to the enquiring mind.

      • Alice

        But this is the gist….if you have a car…do not have insurance…get in a wreck…then go and buy insurance that has to pay for the mess you created. The government has mandated this to be so…..with the pre existing condition that may or may not be our fault…but the insurance company cannot reject you.

        I have two children with pre existing conditions of cancer. One has wonderful insurance through a large employer. The other was offered insurance through her small employer (pre Obamacare). I worry that the quality of care will go down. I want the latest, and greatest care and innovation…..and I fear that will be lost in the mandates of this new legislation.

  • soloFP

    If you look at Medicare, Medicaid, Tricare, and Federal/Government employees with insurance, then likely 75% of the population already is covered by the US Government

    • Alice

      This is true..then look at the breakdown of the real numbers of the uninsured. This is off the top of my head…if you think I am wrong call me to task and I will get the exact numbers later on when I am not juggling and driving kids who talk non stop around (and the puppy isn’t chewing on me or my phone). I just read this last night, so the numbers should be very close.

      The US Census gave numbers on this. I think 5 million of the number of uninsured are illegals, about 14 million qualify for Medicaid or SCHIP (the state aid for the working poor), and 8 million children qualify but the parents have not or will not fill in the paperwork to apply (many try it retroactively). Then about 10 million who earn over $75000 will not purchase it because it is too expensive. Another maybe 6 million refuse to purchase it via their employers.

      I believe the real number of people left out in the cold is about 10 million, and they can’t be refused at an ER.

      Obamacare was supposed to lower our premiums…na da….give better care….that takes money…lots of it…and it is going to create a mess that hurts a whole lot of patients….more than now. This prescription needs recalled and reworked without the pressure to pass such mandates that ultimately fail.

    • Alice

      I think the government pays close to half now….but doctors got the temporary “Doc Fix” that restored close to a quarter trillion in Medicare that I think was going to be cut?

      If you the insurance companies are inept…don’t fool yourself…the government rejects far more claims.

      Of course, we know Big Pharma financed the bill to the tune of about a $26 million. One of the largest lobbying campaigns in history and there was the AARP, AMA and AHA behind it. Well…I will console myself that they had my best interests at heart…..sigh…..

      • pj

        Alice- RE

        “If you the insurance companies are inept…don’t fool yourself…the government rejects far more claims.”

        Do you have any evidence for this? In 15 years of medical practice in various settings, I don’t get this impression. I haven’t made it a point to quiz every biller/coder I can, but still, this defies my “common sense.”

        • Alice

          Yes…..I can get the evidence (the book I have is highly footnoted, but I am traveling a lot and preparing for surgery). Just don’t have the book here and I am fearful I will forget later. Never hesitate to remind me.

          PJ…….I really wish you would write to me. If I forget please prompt me at:

        • Alice

          PJ…..I thought I would find this with ease….but the index of my book is not helping (I am tempted to purchase the Kindle edition and use the word search….I love that aspect of the iPad….but otherwise…..).

          I did find the AMA chart that shows the government rejecting more Medicare claims than private insurers, but that is not what I read, nor the answer to your observation. I think your personal experience may not mirror those of other doctors. I would surmise the elderly have more rejections than the young?

          I assume what I read was a combination tally of the different agencies the government uses to pay claims. If I could find the Medicaid, and VA denial numbers, and Indian Health Services (I tried to help at a reservation in New York…..denials are a way of life there….even the ghetto couldn’t match the poverty I witnessed) add that to the small percentage of Medicare denials and compare it to private insurers, along with the larger numbers of let’s say….ambulance denials, etc. it would be more clear to both of us. I will try to get these, but being in the car using a cellphone the majority of time is not the way to do research. The iPad is driving me batty to….wish I had denied myself:)

          Now you have me wondering…..were they adding doctor denials of Medicaid patients to that total?

          I will share an article I read some important info from.
          National Review: Obamacare Under Attack

          Okay…..I will go through my notebooks later because the index isn’t precise enough to cover the generic quote I gave.

          Good on you PJ…..if I don’t find that quote it will be a gotcha! Hmphf! Don’t celebrate…yet!

          • Alice

            Pj…does this answer your question?  


            Moreover, Medicaid and Medicare do not provide nearly as much “security” as is commonly thought. Medicaid patients are already refused care by almost half of doctors in metropolitan areas across America, according to 2009 data from Merritt Hawkins & Associates, with some cities far exceeding that figure. And despite the administration’s vilification of private health insurers, Medicare has a higher rate of claim refusals than the major private insurers, according to the AMA National Health Insurer Report Card of 2008.
            Clearly, government insurance does not equate with access to care; given that it is also an unsustainable financial disaster, expanding it seems nonsensical. We all must realize by now how government influence on the “reimbursement” for medical care, the basis for the vast majority of charges regardless of public or private insurer, has already distorted health-care decisions, yet failed to rein in costs.

          • pj

            Alice, your diligence continues to impress! I look forward to reading the article u cited. I generally don’t worry about “gotcha” – I’m only trying to be better informed about these critical issues.


  • Hueydoc

    I always ask people when did we start having problems with our medical system.
    Then I ask them when did the government get heavily involved in healthcare ?
    The government IS the problem, not the answer.

    • gzuckier

      ??? Medicare was instituted because the elderly were bankrupted by medical costs, and because therefore providers weren’t getting paid for caring for them. Weren’t you reading the newspapers then?

      • Alice

        Won”t the participants in Medicare Advantage lose many benefits under Obamacare? Government payments are froze and I believe will be reduced?

        It has to give somewhere…doctors already take a beating on government reimbursements, so more patients and less money may be efficient government to some people….not to me.

      • Hueydoc

        Medicare was started as a program to help “widows” and was a very small program. It was NEVER intentioned to cover ALL senior citizens regardless of income level. Doctors were supposed to love it ” because now you’ll get paid for taking care of these patients instead of doing it as charity”. Like all government programs, it grew like a malignant cancer until now it is destroying the host.

        • pj

          Much worse than a benign cancer, eh HueyDoc?

          It’s called “mission creep.”

          Too bad means testing doesn’t seem to be on the table for SSI and MC, like it is for medicaid.

  • Rob Lindeman

    “You mean the part that explains how hospitals are stuck with the costs of uninsured patients and have to shift the burden to any paying patients or insurers who have the bad luck to get treatment there?”

    No, the part that requires emergency rooms to evaluate and manage all comers, according to the “reasonable layperson standard”. That essentially boils down to, if you go to the emergency room for a hang nail, we have to see you.

    I was disagreeing with rezmed09, who stipulated that we all agree the ED should see all comers. Clearly, we don’t.

  • ERP

    The government is allowed to mandate that we pay income taxes. They can mandate that we pay real-estate taxes. They can mandate we have car insurance. They can mandate that we pay for health insurance because it is for the good of the nation- or as in the Constitution, “promote the general Welfare”. Whether it is a good idea to institute is another argument altogether – but I submit that it is important to help spread out the costs and increase the pool. I agree though that it means little if you do not increase access as White Coat mentioned.

    • Alice

      I am working through this and only had a few moments before rushing to the private school we pay for (libertarian ideals of keeping my kids brains free from government mandates…so our school refuses all taxpayer money…we pay everything…it’s worth it, through good investments privately we build s gym and park lot and replaced windows and bought the bulding)

      Courageous post. Moral question: What should one do in response to a political mandate that one disagrees with in principle?

      Importantly, bear in mind the important distinction between spiritual law and political law.
      [end quote]

      And add civil law and what are the rights of man and true role og government.  Sowell has some great thoughts and asked similar questions about the types of rights of man.

      Thomas Sowell shared this in an article:  Despite these facts, most of us tend to take a somewhat more parochial view of the situation when it is we ourselves who are sick or who face a potentially fatal illness. But what if that decision is taken out of your hands under ObamaCare and is being made for you by a bureaucrat in Washington?

      From a recent interview with Sowell:

      TS:  Health care as such is not driving the federal deficit.  It is the insistence of the federal government to inject itself into the health delivery system that creates costs for the private system and then creates costs for the federal government when they insist on setting up entitlements rather than allowing these things to take care of themselves in the market.

      Another thing the government could do if it were serious, and it is one of the signs that it is not is, is simply make it much more difficult for lawyers to sue doctors and hospitals.  It is not just the multimillion dollar settlement fees they get out of these lawsuits.  It is the fact that so much of medicine has become defensive medicine — expensive tests are done that would never be done if all you were concerned about was the welfare of the patient, but which are done because the doctors and the hospitals cannot risk being ruined financially by having something happen and having some clever lawyer get up before a jury and tell them, “if only he had done this or that test we would have solved the problem.”

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