[Dork.]

This week Obamacare goes up in front of the Supreme Court. An unusually long amount of time will be spent discussing the various challenges to Obamacare, chief among them being the requirement for everyone to buy health insurance (or face Obama's Death Panels?).

Here is some pretty good reading material explaining the topics up for discussion:
Obamacare at the Supreme Court: The Pre-Game Preview - Forbes

If you find some other good pre-game analysis (biased or not, why not?), please post them here today!

I figured it might be good to handicap the main item up for discussion before the arguments start. So here's a simple poll that we all can provide simple answers too (including Mittens!)

For the record, while I'm for the idea of Health Care for all, I'm starting to wonder whether the way the ACA accomplishes this really does pass constitutional muster. I think it does, but I'm actually going to be reading the arguments for the other side to see how persuasive they are. For now, I will vote "Yes", and see if I get to eat my words later....

(The poll is open all week, so you can listen to the arguments if so inclined before committing one way or the other.)

[Cold Warrior]

I voted no. It's a pretty big expansion that compels rather than regulates. A lot of the others stuff in there would pass, but the mandate at a federal level is a bit too far.

[besson3c]

Is it constitutional to require purchasing auto insurance?

[Uncle Skeleton]

You only have to purchase auto insurance if you drive on public roads

[besson3c]

Originally Posted by Uncle Skeleton 

You only have to purchase auto insurance if you drive on public roads

Will people eligible for Medicare be required to purchase insurance, or will they get a voucher or something? I don't remember, and I'm too lazy to look it up.

[mattyb]

Originally Posted by Uncle Skeleton 

You only have to purchase auto insurance if you drive on public roads

I seem to remember that you had to buy car insurance even if you left your car in the driveway. Maybe that was only in Florida though.

[Uncle Skeleton]

Originally Posted by mattyb 

I seem to remember that you had to buy car insurance even if you left your car in the driveway. Maybe that was only in Florida though.

I don't know about that, but how would they ever catch you? The only time you need to show proof of insurance is when you get pulled over, which can only happen on a public road.

BTW, aren't auto insurance requirements under state government, not federal?

[Chongo]

The director OMB may have complicated things by stating that it's not a tax you pay for not buying a policy.
Scott Garrett Grills Obama OMB - YouTube

BTW I voted wrong. I believe it's unconstitutional.

[OAW]

The interesting thing about all of this for me is that if the Obama Administration had pushed for what the majority of the public actually wanted ... which was a single-payer system ... then this entire question would be moot. Unfortunately, the votes just weren't there in the Senate to do that because even though there was a filibuster-proof Democratic majority at the time ... there was not a filibuster-proof progressive Democratic majority. So I supported the President's approach of going for what could actually be accomplished and not letting the perfect be the enemy of the good. But given all the dust that's been kicked up by Republicans over what is at its core a GOP plan ... I'm starting to wonder if trying to appease them with a private sector oriented approach was good short-term tactics but bad long-term strategy? While I can't see the Supreme Court striking down the legislation in its entirety, I can see the conservative majority striking down the individual mandate. After all, these are the guys that gave us Citizen's United and we are already seeing the predictable havoc being wreaked in its wake. The problem is that if you kill the individual mandate then the prohibition against denying people coverage for pre-existing conditions will cause premiums to skyrocket even more than they typically do. Then again, maybe that's been the strategy all along? Anticipate that the GOP would lose their collective minds over this legislation and then challenge it in court. If the law is upheld then great. If not, then you've just set the stage to do what the people wanted to being with and what every other civilized nation does ... which is to handle the insurance aspect of the health care system in the public sector. And if premiums have gone through the roof then the public pressure to do something will make the likelihood of getting a fundamental change in approach through Congress.

OAW

[mduell]

I think both Obamacare and SB 1070 have the same problem: no matter how much their supporters want to achieve the end result, there's no way the mechanism is constitutional.

[hyteckit]

I don't think an individual mandate to buy health insurance is constitutional.

However, I do think a single payer healthcare program is constitutional, which is basically medicare for everyone.

[Big Mac]

Wherein the Constitution is Congress given a mandated to provide every person with health coverage? I agree that a program that is universal in scope, covering all Americans, is less defective, but none of it is constitutional. Unless there was a secret amendment to the Constitution to the contrary that I haven't been made aware of.

Obamacare is unconstitutional. Medicare for all is unconstitutional. Medicare for the elderly is unconstitutional. None of those are functions the federal government was ever designed to provide for.

[Snow-i]

Can we clear something up about auto insurance real quick? Its one of the most irritating things to read in the healthcare debate.

In most (all?) states you are only require to purchase liability insurance in case of a multi-car accident. I.E. your insurance pays the other party if you're at fault. You get nothing. You are not covered with only the government requirement for auto insurance except for the damage you may do to another person and their property. You must purchase collision and comprehensive to cover yourself, your passengers and your car, which are optional in the eyes of the laws.

I'll say again, the laws do not require your car and yourself to be insured. You are only covering damage you might do to another.

One last time...the government is not requiring you to insure yourself or your property (car). Only your liability towards other motorist incase of an at-fault accident.

Also, there is no mandate that everyone must drive. If you so choose, you may not get behind the wheel - and not pay this insurance. Obamacare compels everyone to purchase insur...sorry wrong word, not insurance... Everyone to purchase a health-care subscription.

[Big Mac]

You're right about all of that Snow.

My prediction is that the Court will strike down at least the individual mandate, if not Obamacare entirely, that it will most likely be a 5-4 decision unfortunately, and that it will probably be a pretty convoluted ruling with a number of concurring and dissenting opinions on different portions. I'd love to see a more united court - even Breyer sounded reasonable today - but I'm not going to hold my breath on that aspect.

[Chongo]

The individual mandate is the lynch pin of the law. If it falls, the whole this falls

[Big Mac]

I'd like to believe that, but I don't think it's automatic death for the law if the mandate is uprooted. One can never assume that a cancerous bureaucracy tumor will die because its ostensible funding has been cut. It could just keep living in spite of it. We need to repeal and replace the SOB IMO.

[Dork.]

The only argument I've seen for the individual mandate at all is that it's not a strict mandate at all: you have the option to either go get health insurance, or pay a penalty.

The penalty is meant to cover the cost of your medical bills if you have no insurance but get into a sudden accident or develop some sudden severe medical problem. Nobody is going to check your insurance credentials before giving you CPR, after all. And if a young person who doesn't have insurance gets a tumor which has a good survival rate with treatment (which is outside the out-of-pocket cost of most people), are we, as a society, going to let them die becuase they chose not to buy health insurance?

If the Federal Government has managed to convince itself that filing income taxes is voluntary, I don't think it's that much of a stretch for it to interpret this mandate as not forcing anyone to buy anything, either.

[Uncle Skeleton]

Originally Posted by Dork. 

If the Federal Government has managed to convince itself that filing income taxes is voluntary....

Did it? The constitution gives the government the power to collect taxes, voluntary or not. The proper way to give the government more powers is through constitutional amendment, something that has been accomplished many times. The fact that one can't get an amendment passed shouldn't be an excuse to do unconstitutional things, it should be a signal that you shouldn't be doing those things.

[mduell]

Originally Posted by Chongo 

The individual mandate is the lynch pin of the law. If it falls, the whole this falls

Originally Posted by Big Mac 

I'd like to believe that, but I don't think it's automatic death for the law if the mandate is uprooted. One can never assume that a cancerous bureaucracy tumor will die because its ostensible funding has been cut. It could just keep living in spite of it. We need to repeal and replace the SOB IMO.

With no severability clause, if any provision falls it all falls.

Originally Posted by Dork. 

The only argument I've seen for the individual mandate at all is that it's not a strict mandate at all: you have the option to either go get health insurance, or pay a penalty.

The penalty is meant to cover the cost of your medical bills if you have no insurance but get into a sudden accident or develop some sudden severe medical problem.

The penalty is a joke, and anyone who is good at math and lacks employer-provided heath insurance will take it.

[Big Mac]

Originally Posted by mduell 

With no severability clause, if any provision falls it all falls.

Or so we think. I heard they're going to argue that it's still severable without the clause, but I hope you're right.

[OAW]

Originally Posted by Snow-i 

I'll say again, the laws do not require your car and yourself to be insured. You are only covering damage you might do to another.

One last time...the government is not requiring you to insure yourself or your property (car). Only your liability towards other motorist incase of an at-fault accident.

Indeed. But what's analogous here is that young person who feels that s/he is invincible and chooses not to get insurance ... then they are creating a liability towards the rest of society that is insured because if they get hit by a Mack truck the cost of their care is passed onto them in the form of higher insurance premiums. Doctors and hospitals are required BY LAW to treat the uninsured for medical emergencies. This is a fact. That cost does get passed onto those who do carry insurance. That is also a fact. During the Clinton Administration the "individual mandate" was a GOP PROPOSAL ... sponsored by GOP legislators and championed by the Heritage Foundation as a market-based alternative to a single-payer, Medicare-for-all approach and a more palatable alternative to an "employer mandate". This is a fact. Now those very same GOP legislators who remain in Congress are uniformly decrying the "unconstitutionality" of their OWN IDEA for political reasons. During the Clinton Administration they thought the "individual mandate" was a good way to eliminate the "free riders" from the insurance market. But now that the Obama Administration has actually implemented the approach they previously championed it is all of a sudden an unabridged attack on freedom and liberty. And the blatantly transparent hypocrisy of it all is the saddest fact of all.

OAW

[Snow-i]

Originally Posted by OAW 

Indeed. But what's analogous here is that young person who feels that s/he is invincible and chooses not to get insurance ...

Should live and die by their choices.

Would that not be motivation for all to have insurance without setting aside the constitution?

Seems to me there'd be a whole lot of room for NPOs and charities in that sector at that point. Look, we've created jobs too!


It boils down to this. Pick 2:

Quality HealthCare!
Free/Gov't provided HealthCare for everyone!
Avoidance of economic collapse!

We, as a society, must not mortgage our future and our freedoms to save people from themselves.

We need reform, but giving control of our health to the very people we ALL agree are corrupt and out of control is NOT the answer. Allowing American ingenuity and competition is. Allow me to purchase healthcare from whatever provider I choose. There will always be a market for it. I will make the best decision for me and my family.

[mduell]

Originally Posted by Big Mac 

Or so we think. I heard they're going to argue that it's still severable without the clause, but I hope you're right.

Yea, argument is tomorrow.

The health insurance industry is going to go batshit if the preexisting conditions stuff stays in effect and the individual mandate is dropped... time to flash crash their stock.

[CRASH HARDDRIVE]

The FACT is, young people suddenly experiencing accidents and having no insurance are a tiny fraction of the cost burden on the healthcare system. It's sad how that keeps getting tossed out there like it's the new new CRISIS(!!) everyone has to bend over for- but it's not a crisis, and never has been.

The fact of the matter is, Obamacare seeks to strap young, healthy people with a great share of the massive costs because they're strictly cash-cows, and the system DEPENDS on cash-cows like any other boondoggle. The young and healthy will pay and pay ever-increasing percentages of their income, and not receive a return anywhere near to the proportion of value they'll be giving up in order to float the elderly and others.

Of course, all healthcare insurance relies on this- except this will be a system attached to a massive already out of control government, where the whole idea of keeping costs under control is shunned. Costs? Who cares? You're not paying your fair share.

[Big Mac]

Can't the liberal justices go against type here and rule in favor of the Constitution and limited government? To do so when it really counts, a definitive ruling that will rebuff the proponents of enormous, unlimited government? It seems like they only care about limiting government power in token ways.

[mduell]

Originally Posted by Big Mac 

Can't the liberal justices go against type here and rule in favor of the Constitution and limited government? To do so when it really counts, a definitive ruling that will rebuff the proponents of enormous, unlimited government? It seems like they only care about limiting government power in token ways.

I think even the conservatives will have a hard time enforcing the constitution.

SCOTUS hasn't overturned a major piece of economic legislation on constitutional grounds since the late 1930s. The conservatives on the court appear to be truly conservative in the sense that they don’t want to rock the boat and they generally accept prior SCOTUS precedent.

[OAW]

Originally Posted by CRASH HARDDRIVE 

The FACT is, young people suddenly experiencing accidents and having no insurance are a tiny fraction of the cost burden on the healthcare system. It's sad how that keeps getting tossed out there like it's the new new CRISIS(!!) everyone has to bend over for- but it's not a crisis, and never has been.

Well I never said it was new. My only point was to outline the rationale behind it. The exact same argument can be made against auto insurance requirements. Even those individuals who are wealthy enough to pay for any damages they may cause in an accident are still required by law to have liability insurance. They are still required by law to purchase a product that they may otherwise not be inclined to have. Or maybe they don't really have resources like that and they'd just rather take their chances. Additionally, the fact that this is implemented at the state level is immaterial to the criticism being leveled because it's still "government forcing you to buy a product you don't want".

Originally Posted by CRASH HARDDRIVE 

The fact of the matter is, Obamacare seeks to strap young, healthy people with a great share of the massive costs because they're strictly cash-cows, and the system DEPENDS on cash-cows like any other boondoggle. The young and healthy will pay and pay ever-increasing percentages of their income, and not receive a return anywhere near to the proportion of value they'll be giving up in order to float the elderly and others.

Well of course it does. It's called INSURANCE ... which by definition is a racket. And even bigger racket than record labels actually. Unfortunately, insurance is a necessary evil.

OAW

[Uncle Skeleton]

Originally Posted by OAW 

Additionally, the fact that this is implemented at the state level is immaterial to the criticism being leveled because it's still "government forcing you to buy a product you don't want".

Believe it or not, lots of people don't own cars. I am one of them. No government is forcing me to buy insurance (yet).

Unfortunately, insurance is a necessary evil.

Most auto accidents are caused by human error, either through inattention or through purposefully breaking traffic laws. Accidents and by extension insurance costs/requirements could be scaled way back with the deployment of driverless cars. Insurance (in this case) isn't a necessary evil, it's a side effect of our stubborn resistance to automation.

[Chongo]

It's not a good sign when even the liberal Justices are laughing at the Solicitor General.

[CRASH HARDDRIVE]

Originally Posted by OAW 

The exact same argument can be made against auto insurance requirements. Even those individuals who are wealthy enough to pay for any damages they may cause in an accident are still required by law to have liability insurance.

This has been gone over before, and was pretty much put to rest by Snow-i. Auto insurance isn't a federal mandate, isn't required of everyone -only those that drive on the public roads- and even where mandated, only mandates liability toward damage done to others. It's a state by state issue, and isn't constitutionally forbidden because such powers are reserved to the states by the constitution.

Additionally, the fact that this is implemented at the state level is immaterial to the criticism being leveled because it's still "government forcing you to buy a product you don't want".

And once again, you're wrong.

It's not government forcing you... it's governments, as in 50 of them, as in 50 state governments exercising powers reserved for them by the constitution.

The governments of 49 other states can't force me to do jack diddly squat- because I have the choice not to live in them.

This whole issue is about the federal government overstepping its bounds, because it only has powers expressly granted to it by the constitution. It doesn't get to reserve any other powers for itself as if it were a state government. State government arguments in this are MOOT, and only the fallback of those that don't even understand the basics of the constitution- like our president and at least a good half of congress.

[Chongo]

CNN report on todays arguments:
Video - Breaking News Videos from CNN.com

[OAW]

Originally Posted by Uncle Skeleton 

Believe it or not, lots of people don't own cars. I am one of them. No government is forcing me to buy insurance (yet).

Indeed. But again ... the auto market isn't exactly like the health care market. There is no obligation on the part of any entity to provide a person "emergency transportation". However, there is a nationwide obligation on the part of hospitals and doctors to provide "emergency medical treatment". So it makes sense that the requirement to carry auto insurance only applies to those who own a vehicle. And with 40 million Americans without health insurance ... that's one helluva chunk of change that gets passed onto those who do when they have to go to the emergency room.

OAW

[hyteckit]

Originally Posted by Big Mac 

Wherein the Constitution is Congress given a mandated to provide every person with health coverage? I agree that a program that is universal in scope, covering all Americans, is less defective, but none of it is constitutional. Unless there was a secret amendment to the Constitution to the contrary that I haven't been made aware of.

Obamacare is unconstitutional. Medicare for all is unconstitutional. Medicare for the elderly is unconstitutional. None of those are functions the federal government was ever designed to provide for.

It doesn't have to be explicitly mentioned in the constitution; It can be implied.


You think anything that resembles socialism is unconstitutional.

It's constitutional because congress has the right to collect taxes to pay for common Defense and general Welfare of the US.



U.S. Constitution - Article 1 Section 8

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

[hyteckit]

The healthcare individual mandate is a Republican idea that originated from the conservative think tank called the Heritage Foundation. Republicans then promoted the individual mandate and tried to get it passed in the 1990's.

Republican senator Charles Grassley arguing for individual mandate.

Grassley Endorses Individual Mandates - YouTube

[Uncle Skeleton]

Originally Posted by OAW 

Indeed. But again ... the auto market isn't exactly like the health care market.

Bingo! They're not analogous.

[Dork.]

Originally Posted by Chongo 

CNN report on todays arguments:
Video - Breaking News Videos from CNN.com

Bah, I don't like clicking on videos. I've been going back to Forbes for some good play-by-play coverage:
Obamacare Foes Score Points, But Kennedy's A Wild Card - Forbes
Obamacare at the Supreme Court, Day Two: Rapid Reactions - Forbes

According to all accounts, the Government's solicitor was grilled hard. Everyone is identifying Justice Kennedy as the one who might decide this. The second link contains all the questions he asked yesterday, and one of them was pretty interesting:

“But the reason, the reason this is concerning, is because it requires the individual to do an affirmative act. In the law of torts our tradition, our law, has been that you don’t have the duty to rescue someone if that person is in danger. The blind man is walking in front of a car and you do not have a duty to stop him absent some relation between you. And there is some severe moral criticisms of that rule, but that’s generally the rule. And here the government is saying that the Federal Government has a duty to tell the individual citizen that it must act, and that is different from what we have in previous cases and that changes the relationship of the Federal Government to the individual in the very fundamental way.”

It's like the last episode of Seinfeld, in reverse.

If the individual mandate is turned down based on this statement, I think it means that, as a nation, we have no responsibility to help out our fellow man who is in trouble. Or, that even if we feel we have that moral responsibility, the government has no place in requiring that citizens support that. It's kind of saying "We're the government of the People (who can afford to get sick, since all the sick poors are dead already.)". I dot know about you, but what is "providing for the general welfare" if it's not providing to make sure everyone is generally well, and doesn't have their life prospects cut short due to something that is curable with money?

An individual may not have the responsibility to rescue someone in danger. Does the Government (which is composed, theoretically, of all us individuals) have that responsibility?

[mduell]

Originally Posted by Dork. 

If the individual mandate is turned down based on this statement, I think it means that, as a nation, we have no responsibility to help out our fellow man who is in trouble. Or, that even if we feel we have that moral responsibility, the government has no place in requiring that citizens support that. It's kind of saying "We're the government of the People (who can afford to get sick, since all the sick poors are dead already.)". I dot know about you, but what is "providing for the general welfare" if it's not providing to make sure everyone is generally well, and doesn't have their life prospects cut short due to something that is curable with money?

No, it means none of that hyperbole. It means the legislators picked an illegal mechanism for doing so.

"Curable with money" is a ridiculous slippery slope. Suppose there was a procedure that required microgravity, and thus launching the patient, OR, and surgical team into space at the price of several billion dollars. Should we be compelled to cover that extravagant cost to prolong a life?

Originally Posted by Dork. 

An individual may not have the responsibility to rescue someone in danger. Does the Government (which is composed, theoretically, of all us individuals) have that responsibility?

No: The Supreme Court ruled on Monday that the police did not have a constitutional duty to protect a person from harm, even a woman who had obtained a court-issued protective order against a violent husband making an arrest mandatory for a violation.

[Big Mac]

Originally Posted by mduell 

I think even the conservatives will have a hard time enforcing the constitution.

SCOTUS hasn't overturned a major piece of economic legislation on constitutional grounds since the late 1930s. The conservatives on the court appear to be truly conservative in the sense that they don’t want to rock the boat and they generally accept prior SCOTUS precedent.

I don't know about that. DC v. Heller was a particularly strong defense of the Constitution and its Second Amendment, particularly given it was a judicial front whereon the SCOTUS had seldom dared to tread for decades.

[Chongo]

Broccoli Mandate?

[Big Mac]

I really wish one of them had asked about a housing mandate. Everyone needs housing, whether it be rental or owned, we're all part of that market. We should have rental price insurance as a third party payer so that we can pay premiums to the insurer and then it can pay for our housing!

[Uncle Skeleton]

Originally Posted by Dork. 

I dot know about you, but what is "providing for the general welfare" if it's not providing to make sure everyone is generally well, and doesn't have their life prospects cut short due to something that is curable with money?

"Cut short" is a fundamental misrepresentation. ALL of our lives are currently being cut long, VERY long. The worst that will happen to any of us ever is that our lives will be cut slightly less extra extra long than they might be if we were a little bit luckier than we are, which is already very very lucky, in comparison to both the state of affairs when the phrase "providing for the general welfare" was written, as well as in comparison to the rest of the world today.

What does the phrase mean? Preventing a tragedy of the commons. Provide infrastructure like mail, roads, courts, defense of our borders, and arguably national parks and the environment. Not to construct a nurse state where we're all coddled like unaccountable babies in spite of ourselves.

The whole concept that something we've managed to live without for centuries is now a "basic right" is preposterous.
Edit: I'm receptive to the idea that new technologies can be done more efficiently by government, such as recycling service, water/power, or internet. What I object to is the suggestion that new technologies are a moral issue, and that "society" has a moral obligation to provide for the poor that which even the rich didn't have 30 years ago.

[Uncle Skeleton]

Originally Posted by Big Mac 

I really wish one of them had asked about a housing mandate. Everyone needs housing, whether it be rental or owned, we're all part of that market. We should have rental price insurance as a third party payer so that we can pay premiums to the insurer and then it can pay for our housing!

[CRASH HARDDRIVE]

Originally Posted by Big Mac 

I really wish one of them had asked about a housing mandate. Everyone needs housing, whether it be rental or owned, we're all part of that market. We should have rental price insurance as a third party payer so that we can pay premiums to the insurer and then it can pay for our housing!

And don't forget about the food mandate. While we're at it, clothing.

*GASP!* Do you realize that 300 million Americans are without food insurance?!! CRISIS!!!

[OAW]

@ Chongo, Big Mac, Uncle Skeletion, Crash et al

While I appreciate your wit and sarcasm ... there is something that is pointedly different about the analogies you are trying to make and the the individual mandate. The rationale behind the individual mandate is essentially three-fold:

A. Access to healthcare is in the common good.

B. Because healthcare is so expensive and most providers demand full payment at the time services are rendered, most people carry insurance because otherwise it would be unaffordable.

C. Emergency medical treatment is required by law nationwide even for the uninsured ... and those costs are shifted to those who are insured.

A mandate about "broccoli", "housing", "food", or "clothing" may involve A ... but none of them involve B or C.

OAW

[hyteckit]

Originally Posted by CRASH HARDDRIVE 

And don't forget about the food mandate. While we're at it, clothing.

*GASP!* Do you realize that 300 million Americans are without food insurance?!! CRISIS!!!

I guess that's why we have food stamps.

[Uncle Skeleton]

That doesn't make it constitutional. Why don't they implement government health insurance at the state level, like they do for auto insurance? I know why, it's because moral hazard would bankrupt the state, just like at the federal level :wink:

[OAW]

Originally Posted by Uncle Skeleton 

That doesn't make it constitutional. Why don't they implement government health insurance at the state level, like they do for auto insurance? I know why, it's because moral hazard would bankrupt the state, just like at the federal level :wink:

Not sure if this was directed at me or Hyteckit. But allow me to respond to your query. From a cost containment standpoint ... it simply makes no sense to have 50 sets of rules and regulations instead of 1. You'd have to have agreements between all the states on how to handle coverage between each other's residents anyway. Say for instance, a resident of California was injured or became sick in Alabama. A federal level health insurance program could also negotiate volume discounts with pharmaceutical and medical supply and equipment companies at much more favorable levels to the tax payers than the state of South Dakota ever could. Even if one were to argue that government is inherently wasteful and inefficient ... fine. So how is having 50 such realities more cost effective than 1?

OAW

[Uncle Skeleton]

Originally Posted by OAW 

Not sure if this was directed at me or Hyteckit. But allow me to respond to your query. From a cost containment standpoint ... it simply makes no sense to have 50 sets of rules and regulations instead of 1.

From a cost containment standpoint, it simply makes no sense to honor terrorism suspects' civil rights instead of torturing them for information. That's no justification for ignoring the constitution.

You'd have to have agreements between all the states on how to handle coverage between each other's residents anyway.

No different than how auto insurance currently works.

A federal level health insurance program could also negotiate volume discounts with pharmaceutical and medical supply and equipment companies at much more favorable levels to the tax payers than the state of South Dakota ever could.

What the heck are you talking about? Even the most progressive plan has the government only paying premiums, not buying medical supplies, and the topic at hand doesn't even have it paying premiums.

Even if one were to argue that government is inherently wasteful and inefficient ... fine. So how is having 50 such realities more cost effective than?

It's an exercise. Clearly you can see the problems inherent in implementing this on the scale of 1 state amidst others, but you somehow are blind to those exact same problems when implemented on the scale of 1 country amidst others.

[Chongo]

Originally Posted by OAW 

@ Chongo, Big Mac, Uncle Skeletion, Crash et al

While I appreciate your wit and sarcasm ... there is something that is pointedly different about the analogies you are trying to make and the the individual mandate. The rationale behind the individual mandate is essentially three-fold:

A. Access to healthcare is in the common good.

B. Because healthcare is so expensive and most providers demand full payment at the time services are rendered, most people carry insurance because otherwise it would be unaffordable.

C. Emergency medical treatment is required by law nationwide even for the uninsured ... and those costs are shifted to those who are insured.

A mandate about "broccoli", "housing", "food", or "clothing" may involve A ... but none of them involve B or C.

OAW

It was the Justices the mentioned broccoli, and cell phones and burial insurance, because we're all going to die.

[hyteckit]

Originally Posted by Uncle Skeleton 

That doesn't make it constitutional. Why don't they implement government health insurance at the state level, like they do for auto insurance? I know why, it's because moral hazard would bankrupt the state, just like at the federal level :wink:

Which I think is going to happen if the SCOTUS overturns the individual mandate.