ObamaCare

Many have asked me my opinion of the health care bills that have now come to fruition and will probably be negotiated to a complete bill for the President to sign within a week. What better topic for Christmas blogging than the health and well being of our fellow citizens?

Though the critics derisively call this effort ObamaCare (hence my title), the truth is Obama has explicitly had little to do with it: he instructed Congress to come up with something, rather than dictating to them what to do. But he will likely sign into law what they send him, so ObamaCare needn't be derisive. It could actually be one of the smartest and best legacies he leaves us. No other President has worked so hard to make it happen, yet without trying to dictate the entire process.

And that even despite insane, un-Christian opposition from Republicans violating at least half of the Ten Commandments, from taking the Lord's name in vain to bearing false witness (they've been doing quite a lot of that); there's even been some occasional adultery. And certainly no love shown for their fellow man, much less the poor among them. All they talk about is money. It's as if the Pharisees have returned.

Be that as it may, I have despaired for a while of finding out just what Congress would do, because they could never agree on anything, so there was no bill to read. It kept changing every day. I'm not averse to actually looking through all several thousand pages of the bill. For those like me who have done that before, you'll know they include a good table of contents, definitions of terms, and a fairly logical organization, so you can get a gist quickly without having to read every word. But most of all, we all depend on honest experts to tell us what they see in there, so we can weigh whether it will be a net gain for America, or a bad idea.

I have now found the best available expert discussion of what's in these bills. I highly recommend all concerned citizens read the Center on Budget's analysis of the House and Senate Health Care Bills. No hype. No bullshit. No partisan spinning. Just the facts. There you'll see why the Republicans are lying when they say these bills contain no cost controlling measures. In actual fact, that's why they are so huge: they are almost entirely composed of cost controlling measures, in fact nearly every measure that experts have been recommending, and Congress ignoring, for the last ten years.

After reviewing their analysis I have to agree this bill will be a step forward for America. It will only be a first step. I have no problem with dumping abortion coverage (and other trivia like that), even the public option, because it's easy to assuage retards with moves like that and get the first step taken with their mollified support, and then get those things back in later (if they really are that important). Because what the rest of the bill accomplishes is amazing, and very definitely necessary. It should have all our support, even with all its compromises. There is only one respect in which a reasonable person might be against it, which I'll discuss below.

It's likely a public option will even get in this time: the House bill has a brilliant compromise, and it looks like that may get left in after reconciliation (when Congress "reconciles" the two bills, producing a single bill to send to the President). They basically took a page from the government reinvention philosophy: the government will simply hire a nonprofit insurance company as a contractor, maximizing flexibility (because the government can just shop around for a good performer, and drop a bad one, year by year, and never have to micromanage the operation of the company), and minimizing costs (since the nonprofit company will have no profit margin to pursue and yet every incentive to keep costs low to prevent the government switching to a new provider, while most of its operational costs will actually come from premiums and not the government, hence it won't be a fully "socialist" health care model, except insofar as poorer citizens get government subsidies, but in doing so the free market system is left intact as those buyers can choose freely which companies to spend their subsidies on, a good example of an effective mixed system, and exactly what Republicans want to do to the education system, making them hypocrites for calling this socialism, but not that).

There have been some rumblings about this bill being unconstitutional. It isn't. Though it is a clever reinvention of what the Founders had in mind, the same can be said of our entire status quo. For they never envisioned an income tax or national parks system, either, or Medicare or Social Security or FEMA, or even, gasp, a standing army. So until constitutional purists call for the dismantling of the U.S. Army (oh, and of course, the Air Force) and the tearing up of the interstate highway system, Constitutional purity is just a lame argument against anything else.

The Constitution grants Congress power to regulate interstate trade (and to spend money in support of the "general welfare of the United States"), and all health care insurance companies engage in interstate trade (and health care regulation, like food and vehicle safety, is definitely in the interests of our "general welfare," even more so due to the severe harm health care costs are causing our economic security). Technically the Feds couldn't regulate a health insurance company that only ever sells policies within a single state, but since no one can make any money that way, it's a non issue. If such a company exists it could take their case to court (which has a mixed record of supporting even well-established states' rights), but since they are unlikely to be able to compete without becoming a part of the Federal system (e.g. to get customers who have subsidy credits to spend, to participate in the hugely cost-cutting Federal universal administration system and policy exchange, etc.), I doubt we'll see this happen.

The second challenge to its constitutionality is the fact that it appears to operate through a per capita tax (the one thing you might not like about it, as I'll discuss below), which is expressly forbidden by Article 1, Section 9 (paragraph d). However, the bill actually taxes not per capita, but the failure to purchase a product, thus it taxes behavior (i.e. you only pay the tax if you don't buy health insurance, so most people won't be paying the tax, so it isn't a per capita tax). Congress effectively (just not explicitly) has this right under Section 8 (paragraphs a and c). It is in effect constitutionally equivalent to taxing the purchase or conveyance of a product (only the exact opposite in form, but such a thing is not prohibited anywhere in Section 9). The House bill even structures this as an increase in income tax bracket, which has explicit constitutionality under the 16th Amendment.

This is the one provision of the bill that could affect you negatively: you will now be required to pay for health care, or else pay a high tax every year. But by forcing more buyers into the market, combined with all the other measures in the bill that increase competition and reduce costs, you will see health insurance available to you at much lower rates than you thought possible. All the experts are hugely underestimating this. Just look at what happened to automobile insurance in California, once it became mandated. You will soon be buying the equivalent of Geico health insurance: cut-rate, high-quality, limited service policies.

Though we will have to wait for reconciliation to see what the final law is, the House version assigns a graduated tax rate for non-compliers up to 2.5% of income (or $1250 a year per $50,000 of income), while exempting some people from this tax altogether. The Senate version has a 2% version of the same arrangement for some taxpayers, and for others a flat tax of $750 per individual (with a ceiling of $2250 per family), and other limitations. Since currently health care premiums far exceed $1250 a year (you will be lucky to find one for even as little as $4000 a year), insurance companies will have a huge incentive to reign in costs. But if they don't, it may be cheaper to pay the tax, in which event we'll get higher taxes and no health care. That's why the public option is a good idea: if private companies won't get affordable, the government can ensure a public one can. Nevertheless, you might be validly apprehensive about this new tax. Will you get stuck with it?

Probably not. For this problem will be greatly mitigated by the federal subsidy. If your family earns less than $88,000 or so a year, you will get a subsidy offsetting the cost of a policy. So the poor will easily be able to avoid paying the non-compliance tax. Only the upper middle class might find themselves in a situation of preferring to pay the tax, but it's precisely that bracket of society that drives the marketing decisions of insurance companies, hence if they start opting out, insurance companies will be compelled to get them back. So overall, the tax shouldn't hurt anyone. Those who end up paying it (if that be anyone at all) will easily afford it. Because the rest of us will get our insurance more or less paid by the government. Although how this actually works out in practice remains to be seen, my own analysis leads me to believe there is little to worry about: the worst that can happen is that our taxes go up slightly while those less fortunate than ourselves get health care. It's hard to put my mild annoyance ahead of that net benefit. If it becomes intolerable for too many, we can always repeal it.

And that's the only negative there is. In every other respect, it's all good. The Congressional Budget Office has confirmed that this bill, even after reconciliation, will actually lower the Federal budget from here on out, even with the subsidies. In other words, it not only will cost nothing, it will save money. It is therefore win-win for the United States and the people: both the uninsured (who will at long last be able to afford insurance) and the insured (who will at long last start to see their premiums go down rather than up). The only losers will be fat cat rich people who will be taxed the equivalent of pocket change, and private insurance companies who can't get their shit together and compete. They will be driven out of business (and good riddens to them), while genuinely competitive companies will get costs down and keep making money. Health care providers won't see any real change at all. They might suffer slight reductions in profits, but many aren't for-profit anyway, and those that are are only seeing bloated profits by engaging in practices they should be ashamed of anyway. And there will be no change in quality of care. To the contrary, it will improve under this system. For one very important reason...

One of the biggest elements of this Health Care bill that falls right into what I defend as an essential way to run a government in Sense and Goodness without God (pp. 381-84) is extensive provision for valid scientific research and field observation and experimentation to collect information on what works, and efficiently, and what doesn't, so reforms can be made based on a sound empirical, scientific basis, and the bill gives the appropriate agencies power to continually enact reforms on that basis. That makes it the first rational health care system in human history. For even the socialist systems of Canada and Europe don't even do half of the common sense things this bill enacts.

So I recommend you go ahead and write your Congressman and Senators and tell them this is a good bill after all, and you won't punish them for backing it.  It needn't be perfect. It just needs to be better than what we have now. It just needs to be a good strong step in the right direction. We can improve it later.