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Why such an intense divide over health care?
March 23, 2010 8:56 AM   Subscribe

Why isn't the new U.S. health care program a good thing? I am apolitical and a registered Independent, so I'm not looking for a two-party flame war, but having just read the list of things that health care will provide, the only possibly "bad" thing I see is that some people will be forced to buy insurance or pay a fine. But otherwise, these seem to be good measures. I'm not very savvy when it comes to current events, so what am I missing? Why are some people so angry?
posted by jackypaper to Society & Culture (50 answers total) 25 users marked this as a favorite
 
http://ask.metafilter.com/148981/All-I-need-now-is-a-really-tall-ladder
posted by Jaltcoh at 8:58 AM on March 23, 2010


The sort of true answer: they fear government interference in what they consider to be private affairs.

The more true answer: they, for a variety of reasons (including #1), have put a lot of stock in opposing the bill. It's really hard to eat that sort of crow.
posted by dirtdirt at 8:59 AM on March 23, 2010 [2 favorites]


It raises taxes.
posted by mr_roboto at 8:59 AM on March 23, 2010 [3 favorites]


There are a lot of policy reasons to oppose that one could take, but people don't get tea-bag angry because of policy reasons. For example, I don't recall angry mobs and and threats over medicare part D. The anger is emotional: their side is losing, they don't like change generally, they are opposed to government protection for the "undeserving", they may believe that the act (whoop) does a lot more than it really does.
posted by a robot made out of meat at 9:03 AM on March 23, 2010 [6 favorites]


Well, the National Abortion Rights Action League is disgusted by the Nelson compromise provisions which stigmatize reproductive health / abortion coverage. Among the provisions: literally, whomever writes the check for the insurance premium must separate that portion of the payment which goes toward coverage of abortions and send in that payment in a separate check.

I think that illustrates the larger point: everyone envisions something very different when they picture a perfect health care system and the bill doesn't come close to any of those visions.
posted by crush-onastick at 9:04 AM on March 23, 2010 [5 favorites]


In addition to the other answers: progressives worry that it perpetuates, subsidizes, and even locks in to the exclusion of real change, the intrinsically flawed model of funding health care via for-profit insurers.

They will argue that for-profit insurers' need to profit creates an intrinsic conflict of interest that undermines the goal of providing the best health outcomes for their clients. By providing new clients and new government money, we bail-out this flawed and amoral system, which would otherwise soon have collapsed. Thus we delay the day when we get a real single-payer system like most other First World countries.
posted by orthogonality at 9:06 AM on March 23, 2010 [18 favorites]


There are two entirely separate groups who hate the bill for entirely different reasons: 1) Those on the right who believe that is a first step towards socialized medicine; 2) Those on the left who consider it a bailout of the insurance companies.

Speaking on behalf of group #2, I consider the individual mandate to pay a government-designated portion of one's income directly to anti-trust exempt, for-profit corporations to both morally and practically disastrous. Feel free to MeFi-mail me if you'd like a lengthier rant on the subject.
posted by Joe Beese at 9:10 AM on March 23, 2010 [10 favorites]


Some people believe that companies should not be highly regulated or essentially ever told what to do by the government. (I am not one of these people.) Their theory is that the market will take care of itself, so there need not be things like consumer protections in place. This bill puts a number of consumer protections in place, so those who do not believe in consumer protections are upset.
posted by haveanicesummer at 9:11 AM on March 23, 2010


"The bill will increase the number of people with insurance. It will increase taxes. And it will cut Medicare," Bhattacharya says. "Those things for sure will happen. Whether you think it's worth it or not will depend on who you are. Some people will feel the increase in taxes, some people will feel the increase in coverage."
posted by Comrade_robot at 9:13 AM on March 23, 2010


I think people are also afraid that it will be more difficult to see their doctor, get prompt treatment, etc now that so many more people will have access to health care. People aren't sure that our current system can handle this many people.
posted by shesbookish at 9:21 AM on March 23, 2010 [2 favorites]


And getting in to see doctors under this present system is somehow easy? Some clown at the "Just say NO desk" working for the insurance company is in the way for a lot of people right now, that hopefully goes away when the new plan is fully installed.

Raises taxes?? not on me, I'm middle class. Taxes have gone down, see the IRS news the last couple of days.

What is the true fear on the right is that this will work and people will catch on they were lied to and those same poeple will look around and say why are these other important parts of our lives controlled by the corporations without regulation? The right wing in this country like to steal, they use laws to make it safe to steal, they do not want those laws and practices changed. Criminals are like that.
posted by Freedomboy at 9:28 AM on March 23, 2010 [6 favorites]


2) Those on the left who consider it a bailout of the insurance companies.

Yes, and this: I'm going to be forced to buy insurance. So essentially, I will be forced to pay an approximately $4200/year tax that people whose employer's provide them with insurance will not have to pay. I make just enough that I won't get subsidized, and the state I live in (Texas), has already announced its intention not to participate in the insurance pools. So I will have to buy really expensive, crappy insurance.

Also, I work for a "temp" agency. It's full-time, 52 weeks a year, and its an on-going job that has so far existed for 11 years, yet my agency considers me a temporary, contract worker, so as near as I can tell, they won't be required to provide insurance. (If anyone knows different, please let me know!)

Without the public option, this thing is screwing me. I'm not ready to switch political parties, but I'm surely not happy about this.
posted by MexicanYenta at 9:30 AM on March 23, 2010 [5 favorites]


This thread will probably be more helpful if the people who oppose the bill speak for themselves rather than having folks from the other "side" provide slanted, strawmanesque versions of their arguments in an effort to make them look wrong.

Personally, I do not believe that the costs of the plan will be adequately contained and taking into account the CBO's notorious under-estimating, it seems likely to me that the costs to the US for this bill will reach into the many trillions over the course of time that the CBO claims it will be "deficit neutral", requiring drastic tax increases.

I disagree with the proposition that all of the currently uninsured deserve to be helped by the taxpayers. While I am sure there are some uninsured in sympathetic positions, I question what proportion of uninsured citizens that is.

Further, I doubt the premise that adding 10% of the population to the insurance pool will have any significant impact on the cost of care for the other 90% and, even if it does, I seriously question wether or not it will make up for all of the additional costs that those 10% will impose.

That's all before we start talking about the federal government mandated purchase of insurance, which I disagree with for political and constitutional reasons.

Like most that I know who are against the bill, I'm not opposed to healthcare reform or health insurance reform, I just think this was an exceedingly poor attempt that is going to cost us far too much.
posted by toomuchpete at 9:37 AM on March 23, 2010 [9 favorites]


(Texas), has already announced its intention not to participate in the insurance pools. So I will have to buy really expensive, crappy insurance.

I don't get how that would work. Wouldn't Texans then just opt to avoid insurance and pay the affordable "fine" on the income tax return? In that case I am not sure whether there is a backup health care plan covering them. Can someone elaborate? I myself am self-employed, though not in Texas, and I am not sure what happens if all the premium quotes we get are, say, a million dollars per year.
posted by crapmatic at 9:38 AM on March 23, 2010


Speaking on behalf of group #2, I consider the individual mandate to pay a government-designated portion of one's income directly to anti-trust exempt, for-profit corporations to both morally and practically disastrous.

A thousand times this.
posted by brundlefly at 9:43 AM on March 23, 2010 [4 favorites]


To clarify, I think the rest of the bill is... ok. Not what I would have wanted, but some steps in the right direction. The mandate, however, is a deal-breaker.

The upside: Limbaugh will be moving to Costa Rica.
posted by brundlefly at 9:45 AM on March 23, 2010


This thread will probably be more helpful if the people who oppose the bill speak for themselves rather than having folks from the other "side" provide slanted, strawmanesque versions of their arguments in an effort to make them look wrong.

I can't favorite this statement enough. Here are some reasons by an opponent from the above link.
posted by murrey at 9:51 AM on March 23, 2010


[few comments removed - this question needs to stay VERY focused and VERY non-GRAR. Don't parody the other side, don't fight with other posters' responses, thanks.]
posted by jessamyn at 9:51 AM on March 23, 2010


A great quote about the general topic of opinions vs. informed decisions came from another Metafilter user's comment that was sidebared, and has stuck around in my mind as brilliant.

So many people parrot opinions. In fact opinions are so often just a front for something else, the yawning abyss of ignorance. Very few people hold fixed opinions about things that matter deeply to them. Instead they hold nuanced and thoughtful interests....Most opinions are shallow, and the holder of them guards their superficiality with outrage and emotion to prevent you from getting close and discovering nuance. People hold opinons out of fear or loyalty. But when it comes to something you really care about, it's less about an opinion and more about the nuanced, many layered, complex fabric of knowledge, practical, theoretical, aspirational and emotional.

This bill is large, complex, nuanced, and lots of things to love and hate from every side of the political spectrum. People spewing vitriol, in general, have no idea what they are talking about or would rather stir your emotions than provoke thoughtful discourse.

I consider the prevalence of such outrage a failing of Republican leadership, wishing to gain political points through fear. However I feel the larger failing is of Democratic leadership to fully and clearly explain the bill and what their aims are. People won't fear what they understand.

And though, it's not going to be a great idea to start rebutting people in this Ask, the one tax this bill raises is not levied on individuals, and is not intended to be collected. It's a market-based cost control incentive. This is the item known as "cadillac plan tax", where employer paid insurance is, in 2018, to be taxed at 40% for every dollar over a limit which will grow at the rate of inflation, but not the rate of health care cost inflation. It will start at $27,500 annually. Combined with increased competition between companies, it behooves insurance companies to cut down costs. This means that your employer will pass more of your total wages onto you, rather than having them slowly trickle out with insurance premiums paid on your behalf, and your employer facing the situation of being a captive consumer with limited choices. I think this is the best part of the bill, and conservatives should love it for the market-based engine.

See, doesn't sound a lot less scary than "THEY TOOK UR TAXES!" or "PULL THE PLUG ON GRANNY!" ? Also, doesn't that sound terribly boring?

Welcome to the fundamental problem of American politics. Sound bite vs. ignorant/uninterested public? Sound bite wins.
posted by fontophilic at 9:58 AM on March 23, 2010 [30 favorites]


The only rational reason I've heard is from freelancers who often only get catastrophic health insurance until they get older.

Also there was a great op ed in the Times yesterday explaining the perspective that Healthcare will cost, not save, money in the long run.

Personally, I think even if you are paying more it's worth it, because now you can't be denied coverage. As far as all the people "morally outraged" above about having to buy insurance of any kind, well, I am morally outraged they expect the rest of us to pick up the tab if they get seriously hurt or sick.
posted by xammerboy at 10:30 AM on March 23, 2010 [4 favorites]


I'm a big believer in giving help directly to people who need it. Individual people know better than I do (and certainly better than some faceless bureaucracy does) what they need, so I think that once we identify someone as "needy," the best thing that we can do is give them a cash subsidy and access to a wide variety of self-improving ways to spend it (education, medical care, healthy food, substance abuse treatment, safe housing, etc.).

This program is the exact opposite of that. We've identified a group of people as needy. That group consists of people whose current income is not sufficient to meet their current or expected future medical expenses. But instead of giving them monetary assistance to afford the things that will make their lives better, we've enacted a giant bureaucracy, run by the IRS and corporations, that will tell them what they need and charge all of us, including many people who can't afford it, for the privilege of having them administer our bureaucracy. I have serious doubts that this new program will fix the basic problem (medical care is expensive and some people don't have enough money to afford the care they need), and I have little doubt that it will introduce all sorts of new problems. All because politicians don't trust individuals to make good decisions about what they need, given the resources to do so. So yeah, I'm pissed.
posted by decathecting at 10:35 AM on March 23, 2010


Because it's not a health care program -- it never was, it never will be and oh god, I'm so tired of having to repeat that.

This is a health insurance bill. Everyone, in 4 years, will be required to buy insurance. And if you don't want to play? Too bad! You will still pay in the form of a penalty, a penalty that will be handled by the IRS, for the love of pete. The IRS has been tasked with keeping track of who does and does not have health insurance coverage.

Health insurance != health care. Health insurance does nothing to insure that people go to the doctor or get regular checkups.

Real reform would be to kill off health insurance and make all services cash only, thus reducing the stratospheric costs of bureaucracy and paperwork and overhead that insurance companies introduce to the system.
posted by gsh at 10:37 AM on March 23, 2010 [4 favorites]


The upside: Limbaugh will be moving to Costa Rica.

Not surprisingly Limbaugh backtracked a bit saying he only meant he would go to Costa Rica for his health care and not that he would be moving to the country.

/derail
posted by filthy light thief at 10:42 AM on March 23, 2010


Good, simple explanation of what the bill actually does.

I kind of wish someone had maybe done this before it passed instead of letting the Republicans pack the field with free care for illegal immigrants and granny-hunting death panels.
posted by Naberius at 10:48 AM on March 23, 2010 [1 favorite]


Anything this complex involving 300 million stakeholders represented by 2 warring factions is bound to piss off a whole lot of people. We had an uproar in my office of 200 people because we got rid of paper cups. Look back at the other big bills in the past. It's the same sh*t all over again.

Watch this TED Talk and some of your confusion will be resolved.

I also think the concept of 'Not Letting perfect be the enemy of the good' and its converse explains a lot in this situation.
posted by jasondigitized at 10:51 AM on March 23, 2010 [1 favorite]


Everyone, in 4 years, will be required to buy insurance.

Just FYI, not everyone will have to buy. There are exceptions built into the bill:

American Indians don’t have to buy insurance. Those with religious objections or a financial hardship can also avoid the requirement. And if you would pay more than 8 percent of your income for the cheapest available plan, you will not be penalized for failing to buy coverage.

I do agree that this concern drives a lot of the criticism of the bill.
posted by sallybrown at 11:00 AM on March 23, 2010 [1 favorite]


There are doubtless shortcomings in the bill. Much of that can be fixed over time. The public when polled early on favored the reform. Then the health care industry (insurance groups) poured in massive amounts of money and turned many people against the plan.
What needs to be said: if the way things was done was so good, why is it that congress people against the plan use govt plan for themselves? If nothing were to be changed, all estimates are that premiums and costs will rise dramatically in the next few years and will force more and more
people to be without coverage.

A quick example of why it is good for me: Myh wife has a great insurance plan from work. Myh son is on it but will be dumped in two months when he graduates college at age 22. He may not be able to get a job in a bad economy. He may get a job and have stiff payments he is unable to afford. Now, with the bill signed today, he can stay on our plan till he is 26--by then he should be ok.

Texas et al: they will discover that federal law trumps state law. Imagine a southern state deciding to bring back slavery!
posted by Postroad at 11:01 AM on March 23, 2010


Why such an intense divide over health care?

Humans like things to stay the same. Large scale changes like this scare the willies out of everyone who has anything to lose -- not because this particular shift might be so bad, but because if we can suddenly change the rules on this scale then just about anything becomes fair game.

So people are frightened and that tends to magnify everything: people who are for the bill need to convince themselves that it is Exactly The Right Thing at Exactly The Right Time and most importantly that They're Not Fucking Up, and people who are against are pretty much sticking with Any Change Will Fuck Things Up.


(As a side note, once the bill is in place then it will become the status quo, at which point the Any Change Will Fuck Things Up crowd will support it.)
posted by Tell Me No Lies at 11:13 AM on March 23, 2010


So essentially, I will be forced to pay an approximately $4200/year tax that people whose employer's provide them with insurance will not have to pay.

This is only true if you believe that employers who provide health insurance as a benefit do so out of the goodness of their hearts and funded out of profits. Which isn't the case in any real-world firm I am aware of; any employer-paid portion of health insurance is foregone pay. The worker just doesn't see that being given and taken away.

In addition to what other people have said, there is almost certainly a strong racial component to right-wing furor about health-care reform. Most reforms, and especially subsidies, will go disproportionately to lower-income people, who are also disproportionately black.
posted by ROU_Xenophobe at 11:22 AM on March 23, 2010 [1 favorite]


And if you would pay more than 8 percent of your income for the cheapest available plan, you will not be penalized for failing to buy coverage.

This strikes me as a stunningly high percentage of income at which to have exemption kick in, especially if the "cheapest plan available" is likely to have only extremely basic coverage. Is that 8% going to include the employer-sponsored portion of premiums or only the portion paid by the employee? Will the 8% exemption rule even apply to people whose health insurance is purchased via their employer?

Will the ability to retain adult children on parents health insurance until their mid-twenties simply be an option or will it effectively become mandatory for parents to provide health insurance for their children until the cut-off age?

Will insurers be able to impose mandatory waiting periods for coverage of specific events - this is absolutely standard among private health insurers here (although most do waive some of those waiting periods a couple of times a year)?

Will the employer-sponsored portion of health insurance now become subject to a fringe benefits tax, or is there some other way in which the declaration of that information on their W2 will affect an individual's tax liability?

Those things stood out immediately for me when I read the "what changes and when" timeline and I imagine that until there is much more detail about exactly how those changes will be applied there will be a lot of assumptions about the legislation with people's relief at or criticism of the new laws being based on those assumptions about how the legislation will affect them.
posted by Lolie at 11:30 AM on March 23, 2010


Forgot to add that one criticism which I haven't really heard widely expressed yet (possibly because actual numbers weren't widely discussed before) but which I can see creating a real political divide is the fines. They seem far too low to be especially persuasive in favour of insuring - perhaps they should have been a % of taxable income close to the exemption threshold - and it isn't clear whether the money collected from fines will be specifically directed towards health services for the uninsured. That's one aspect of the legislation I can see creating a real political divide as it comes under more discussion.
posted by Lolie at 11:43 AM on March 23, 2010


Both my parents are right wing tea-bag sympathizers. Just last night, they were howling about the passage of the health care bill. One of their chief complaints was that people who can't afford to buy insurance will receive money from taxpayers for this purpose. In my parents view, a person should get only what they can pay for out of their own wallet. If you only make eight dollars an hour and can't afford insurance, that's your own fault. If you worked harder or went to school to get a degree, you'd make more money. The rest of the country owes you nothing. Handing out free or subsidized health care is, essentially, taking money away from people who worked hard to get it and giving it to those who don't deserve it.
posted by Clay201 at 11:51 AM on March 23, 2010 [2 favorites]


ROU_Xenophobe: any employer-paid portion of health insurance is foregone pay.

Mostly, but not entirely. This is one issue I wish would have received greater attention, particularly in the debate over the public option. Largish employers get much better insurance rates than individuals, principally because they have more bargaining power. That is, in fact, the main point of allowing employers to provide coverage. So while the premiums paid by employers are a form of compensation that might otherwise be paid directly to the workers, many workers who would otherwise select comparable coverage to their employer-provided plan are better off for getting that coverage through their employer. I don't entirely understand how the new "exchanges"[old link] will actually function, but they are apparently supposed to bring some of that bargaining power to smaller firms and individuals who do not get insurance from an employer (something akin to non-employer insurance pools).
posted by dilettanti at 12:04 PM on March 23, 2010


There's a lot of people vested in the status quo, and every time you say 'The US spends too much on health care' you're talking about cutting someone's livelihood. For example, insurance employs a small army of one man shops selling insurance. I can't find a cite but I recall reading that legally large carriers were prevented from cutting these guys out of the loop.

An exchange could provide two important benefits to consumers: standard contracts and public bidding. Standard contracts make it dramatically easier to compare two bids on a single variable (price), and public bidding gives information to buyers they're not currently entitled to.

Like car dealers, these people vote pro-business Republican. Some of them probably worry that this legislation is a step closer to a single payer that puts them and their friends out of business for good.
posted by pwnguin at 12:40 PM on March 23, 2010


Mostly, but not entirely. This is one issue I wish would have received greater attention, particularly in the debate over the public option. Largish employers get much better insurance rates than individuals, principally because they have more bargaining power.

That's the wrong comparison, though.

You're comparing individually purchased insurance through insurance through the employer.

I'm comparing insurance through the employer where the employee sees no paycheck deduction to insurance through the employer where the employee sees the full amount deducted from their pay.

In this case, the lower paycheck deduction is just foregone income.
posted by ROU_Xenophobe at 12:44 PM on March 23, 2010


There are a lot of things I'd like to have, or to do. I'd like to have a vacation home in the Bahamas. I'd like to have a yacht. I'd like to own a home like the one Bill Gates owns. I'd like to take vacations in all sorts of places. But I don't have enough money to afford those things. Each and every one of them is desirable, but that's beside the point: if I try to buy things I can't afford, I'll go bankrupt. I won't get those things, and I'll lose a lot else besides.

You have to tune your desires to your means. Going beyond that is a recipe for disaster.

The main reason so many people oppose this health plan is that they don't think the US can afford it. Most of what the plan offers is wonderful stuff -- but it's also grotesquely expensive. Not even the United States has that much money.

They think that if the US really pursues this plan, the result will be economic catastrophe on a national level. We won't get those things, and we'll lose a lot else besides.

Even at a national level, we must tune our desires to our means. Nations which go beyond that also face disaster.
posted by Chocolate Pickle at 2:25 PM on March 23, 2010


The main reason so many people oppose this health plan is that they don't think the US can afford it.

I think this is demonstrably false. I'm way too lazy to go searching for crosstabs or individual level data for the sake of blethering on the internet, but the number of people who state both "This would be good" and "It's too expensive" is small.
posted by ROU_Xenophobe at 3:08 PM on March 23, 2010


At the end of the day, it really boils down to a simple, undeniable set of facts: it takes an effort of will to see things from the perspective of another person, and it takes an effort of will plus an investment of time to learn about something new, or learn more about something you already know a limited amount about.

So: a person who makes the requisite efforts and investment will, presumably, take in the whole picture and (depending on their internal moral compass) lend their (implicit or explicit) support to the option that provides the best compromise for all persons impacted, or to an extreme position (due to moral imperative, or selfishness, or whatever.)

Let's say it divides as 25% each -- 25% want it to stay as-is, 25% want it to change, 25% want it to benefit them exclusively (or most), and 25% want it to benefit the worst-off (mostly). There are other positions, but let's run with those.

Now, most people won't make the requisite effort and investment, and so will take positions based on what they think they know, or on their moral imperative. Let's say those split 25% each way, too.

Finally, let's take corporations. The people who work there and who are tasked with lobbying/promoting/etc. will take the position that most benefits their company. So that's going to be 50% companies unwilling to give up existing profits, and 50% companies hoping to make more profits (directly, or by saving on health care costs.)

So you can see how a consensus is impossible. A benevolent dictator would be helpful in this circumstance, to get something done, but a lot of people will be unhappy regardless of what they chose. Instead, the government is going to fight and bicker and waver and push until there's a clear majority, even if that majority is small and short-lived, part of the ebb and flow of public opinion. At that point they'll jump on it, whatever it is, and that's that. A mandate from a brief bulge in the demand curve is still a mandate for this purpose.

Ultimately, that's it; it really doesn't have much to do with the policies themselves, which is one of the things that makes the watering-down so wearying; it's being done to attempt to provoke a brief bulge in the demand curve to enable a decision that feels like selling out (because, of course, it is.)

Put a politician/political group in place that doesn't care about re-election, and you can just get a decision without all this hoo-hah -- but somebody's not going to like it, and it might be "us" or it might be "them."
posted by davejay at 3:18 PM on March 23, 2010


It is a good thing! Not a great thing, but good. Two years ago I had a heart attack, then foolishly moved to a new state. (not allowed in the 'land of the free' if you have a 'prior condition'.) I couldn't get insurance for love or money, in three months (if the idiots that run the state I'm now in are finished with their tantrum over losing), I will be able to.

Yes, too much of it will feed the insurance companies. Yes, not everyone will be covered still. But some will be. Medical bankruptcies will decline, slowly. And, already, American health care is a little less of a world wide joke.

But mainly it is a start. For 30 years the Republican'ts have been trying to repeal Medicare and haven't. It is a start and will get better.
posted by Some1 at 3:18 PM on March 23, 2010


FWIW, and this is coming from a liberal progressive Democrat who felt elated to see the bill finally pass, some feel concern because the insurance industry supports this bill. I understand why they do - all Americans are now required to purchase their products - but if Big Tobacco was supportive of a bill that increased regulation on Big Tobacco, I would feel a little skeptical too.

And while this bill is huge, in some ways it's still a let-down. For example, I think it sucks that adults with pre-existing conditions can still be denied private health insurance. The public option is still TBD depending on whether the reconciliation bill passes (though it's likely to pass so the public option is likely to go away). Not to mention the cornhusker kickback or similar earmarks.

But also for a lot of people, this isn't about health care or health insurance. A lot of people are just scared right now because unemployment is high, their houses and 401k's just lost a lot of their value, and the national debt is at an unsustainable level. People get wacky when they're scared.
posted by kat518 at 3:20 PM on March 23, 2010


PDF: Attorneys General for 13 states have filed a lawsuit in Florida objecting to the individual mandate, and to the unfunded increase in Medicaid spending by their states required under the law, on the basis of it being a violation of the Tenth Amendment.
The Act represents an unprecedented encroachment on the liberty of individuals living in the Plaintiffs’ respective states, by mandating that all citizens and legal residents of the United States have qualifying healthcare coverage or pay a tax penalty. The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying healthcare coverage. By imposing such a mandate, the Act exceeds the powers of the United States under Article I of the Constitution and violates the Tenth Amendment to the Constitution. ...

The Act also represents an unprecedented encroachment on the sovereignty of the states. For example, it requires that Florida vastly broaden its Medicaid eligibility standards to accommodate upwards of 50 percent more enrollees, many of whom must enroll or face a tax penalty under the Act, and imposes onerous new operating rules that Florida must follow. The Act requires Florida to spend billions of additional dollars, and shifts substantial administrative costs to Florida for, inter alia, hiring and training new employees, as well as requiring that new and existing employees devote a considerable portion of their time to implementing the Act. This onerous encroachment occurs at a time when Florida faces having to make severe budget cuts to offset shortfalls in its already-strained budget, which the state constitution requires to be balanced each fiscal year (unlike the federal budget), and at a time when Florida’s Medicaid program already consumes more than a quarter of the State’s financial outlays. Plaintiffs cannot effectively withdraw from participating in Medicaid, because Medicaid has, over the more than four decades of its existence, become customary and necessary for citizens throughout the United States, including the Plaintiffs’ respective states; and because individual enrollment in Plaintiffs’ respective Medicaid programs, which presently cover tens of millions of residents, can only be accomplished by their continued participation in Medicaid.
posted by Chocolate Pickle at 4:22 PM on March 23, 2010


any employer-paid portion of health insurance is foregone pay.

Except...I'm not paid extra to make up for the fact that my employer doesn't provide insurance.
posted by MexicanYenta at 4:43 PM on March 23, 2010


any employer-paid portion of health insurance is foregone pay.

Not exactly. If in lieu of insurance the company paid you cash, you would have to pay income tax on that extra income before buying your own health insurance. If you are in the 25% tax bracket, you effectively are getting your health insurance at a 25% discount through your employer compared to someone buying their own insurance. And as others have pointed out, group insurance is much cheaper than individual insurance. Generally, you are far better off getting employer insurance rather than extra pay.
posted by JackFlash at 5:02 PM on March 23, 2010


Not exactly. If in lieu of insurance the company paid you cash, you would have to pay income tax on that extra income before buying your own health insurance.

Again, I am in no way comparing group plans to individual plans. I am arguing against the assertion Mexican Yenta made earlier that people whose employers provide their health insurance don't pay for it. They do, in foregone income.
posted by ROU_Xenophobe at 7:06 PM on March 23, 2010


It isn't a difference of group vs individual plans. It is a taxation difference. Getting insurance through the employer allows you to buy insurance with pre-tax money. If you buy it yourself it is after-tax money. That means you are only foregoing 75% of income.

Assume the employer has a choice of giving you a $1000 insurance premium or giving you $1000 cash. If she gives you the cash, then you pay $250 income tax and only have $750 left to pay for your $1000 insurance premium. You have to come up with another $250 out of pocket to buy insurance. You are $250 poorer. With employer insurance you are only foregoing 75% of your income.
posted by JackFlash at 7:37 PM on March 23, 2010


any employer-paid portion of health insurance is foregone pay.
I'm not paid extra to make up for the fact that my employer doesn't provide insurance.

On an individual basis, it's hard to tell. In aggregate though, total compensation as percent of GDP has been stable, but health insurance is cannibalizing wages.
posted by FuManchu at 8:24 PM on March 23, 2010


health insurance is cannibalizing wages.

Historically that isn't quite accurate. Work-provided health insurance began during WWII when the auto makers felt the need to give more remuneration to their employees, but war-time federal regulations didn't permit them to raise wages. So they started offering paid health insurance instead.

(And boy, I bet they came to regret it 50 years later!)
posted by Chocolate Pickle at 9:34 PM on March 23, 2010


So essentially, I will be forced to pay an approximately $4200/year tax that people whose employer's provide them with insurance will not have to pay.

I work for a large national corporation, and I pay more than that for my employer provided insurance.
posted by azpenguin at 11:13 PM on March 23, 2010


[few comments removed - this needs to not turn into a discussion of one person's health insurance - feel free to take it to email or metatalk.]
posted by jessamyn at 8:57 AM on March 24, 2010


If the question is why isn't it a good thing I'll limit my response to that.

Anyone who currently has health insurance may see their premiums increase due to mandated coverages. Now all plans must cover certain things (mental health, drug rehab, pregnancy, etc.). Getting rid of pre-existing conditions strikes many as the same as saying you could sign up for life insurance after you find out you're dying of cancer (or car insurance after a crash). Thus people expect premiums to be jacked up to cover a lot of sick people. So if the goal is reducing health care costs (which is what "health care reform" means to a lot of people), then this bill is not going to do that. If the goal is increasing access to a few more people (something that has no impact on the majority), then it does that. So perhaps there is a divide because a lot of people think they'll see only increased costs and none of the benefits (not saying they're right about that!).

Those who have Medicare Advantage plans (one out of four Medicare recipients) can expect significant premium increases, or in many cases the dissolution of their plans. They will then have to go back to Original Medicare, which for many of us is not a benefit or a good thing. With the loss of Medicare Advantage comes the loss of the convenience of only having to deal with one payer that covers dental, vision, prescriptions, hospitals, etc., free access to gyms as part of the Silver Sneakers plan (and many other benefits such as free over-the-counter drugs), and for many, lower premiums than they'd have to pay under original Medicare and Medigap plans.

Another issue. Many states already have their own reform plans in the work, including single payer reform. State-based health care reform (as opposed to federal health care reform), is preferable to many people for a number of reasons, not the least of which is that it seems more in line with those who support smaller federal government. But states are required to implement this new plan before they can pursue their own, and they cannot get a waiver to pursue their own plans until 2017. Firedoglake has an analysis of this problem.
posted by Danila at 11:25 AM on March 24, 2010


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