Health care reform: Who must buy insurance?

The Christian Science Monitor takes a simple stab at this question here.

But here’s a key thing to remember: There is a simple concept at the center of this rambling, Rube Goldbergian machine. Democratic healthcare reform would expand insurance coverage in America by requiring people to obtain it.

That’s right. The healthcare reform bill would mandate that most US citizens and legal residents purchase “minimal essential coverage” for themselves and their dependents. They can get this either through their employer, or, if their employer doesn’t offer health insurance, they can buy it through new marketplaces that will sell policies to individuals.

Those marketplaces would be called “exchanges.” We’ll talk more about them in a later story. (We’ll also cover subsidies for health insurance, when it all would take effect, how it would be paid for, and what it means for businesses.)

I feel sure that the requirement to purchase health insurance will be challenged in court. Forcing a purchase with the penalty of fines seems to compel associations which could give rise to constitutional challenges.  The forced purchases, however, are key to the provision which is attractive to most people: elimination of pre-existing conditions as a reason to refuse coverage.

Why is Congress doing this? It’s a pretty obvious way to expand coverage, for one thing. Also, it will help bring in a flood of new customers for health insurance firms, including healthy young people who might not need much healthcare.

For insurance firms, those new customers could balance out the losses they might incur if they can no longer deny coverage to people with preexisting conditions. (Yes, that’s another change the bill makes.)

And remember, many people will not be buying this coverage purely on their own. Uncle Sam will be helping them. The bookend to the individual mandate is federal subsidies for insurance purchases, which reach deep into the middle class. We’ll talk about those next.

In essence, you and I (via taxes) will be providing coverage for people who may not want it so that people who need coverage for serious conditions will have it. Insurers may still benefit by virtue of the millions of new subscribers. I suspect there will be severe fines for insurers who attempt to limit coverage or benefits. But I don’t know. And the lack of knowledge is what is politically troubling. There will be legislators who approve this bill over the weekend that have not read it.

According to the NY Times, key votes are still in play approaching a Sunday vote.

Brown wins; Dems look to nuclear option as means to get health care passed

Whether you support health care reform or not, wouldn’t the election of Republican Scott Brown in MA seem like a signal to slow things down?

Apparently Senate Democrats don’t think so. Senator Dick Durbin wants to get the bill signed before Brown can get into town and laid out a couple of ways to do it.

I suspect GOP strategists are torn. They don’t like the health care options but if the Dems ram something through, prospects for the midterm election should improve to an even more optimistic level.

Health care reform controversy comes to Grove City

Yesterday, Grove City got involved.

Americans for Prosperity rolled through town collecting signatures on a petition opposing more government control of health care.

I wrote about the visit at World Magazine, just up today. Actually, I wrote the article sitting in the Four Star Pizza. They’re all wireless and tasty in there.

gc

Unpaid protester

GC crowd

People waiting to sign the petition

AFP Bus

Americans for Prosperity bus

Cooking up an easy way to make a big impression on health care reform

How to be organized without really looking organized.

This came today:

Friend —

All throughout August, our members of Congress are back in town. Insurance companies and partisan attack groups are stirring up fear with false rumors about the President’s plan, and it’s extremely important that folks like you speak up now.

So we’ve cooked up an easy, powerful way for you to make a big impression: Office Visits for Health Reform.

All this week, OFA members like you will be stopping by local congressional offices to show our support for insurance reform. You can have a quick conversation with the local staff, tell your personal story, or even just drop off a customized flyer and say that reform matters to you.

We’ll provide everything you need: the address, phone number, and open hours for the office, information about how the health care crisis affects your state for you to drop off (with the option of adding your personal story), and a step-by-step guide for your visit.

According to our records, you live near Sen. Arlen Specter’s office in Pittsburgh, PA.

Sign up now to visit Sen. Arlen Specter’s office in Pittsburgh this week.

(Not your representative, or think there might be another office that’s easier for you to get to? Click here to find a different office.)

As you’ve probably seen in the news, special interest attack groups are stirring up partisan mobs with lies about health reform, and it’s getting ugly. Across the country, members of Congress who support reform are being shouted down, physically assaulted, hung in effigy, and receiving death threats. We can’t let extremists hijack this debate, or confuse Congress about where the people stand.

Office Visits for Health Reform are our chance to show that the vast majority of American voters know that the cost of inaction is too high to bear, and strongly support passing health reform in 2009.

Don’t worry if you’ve never done anything like this before. The congressional staff is there to listen, and your opinion as a constituent matters a lot. And if you bring a friend, you’ll have more fun and make an even greater impact.

Click below to sign up for an Office Visit for Health Reform:

http://my.barackobama.com/OfficeVisit

Wherever you live, these visits matter: Many representatives are pushing hard toward reform, and they are taking a lot of heat from special interests. They deserve our thanks and need our support to continue the fight. But those who are still putting insurance companies and partisan point-scoring ahead of their constituents must know that voters are watching — and that we expect better.

Earlier this week, the President wrote that “this is the moment our movement was built for” and asked us all to commit to join at least one event this month. This is the way to answer that call, and rise to the challenge of this moment together.

Thank you for going the extra mile when it matters the most,

Mitch

Mitch Stewart

Director

Organizing for America

When people opposed to the President’s health care reform plan show up to town hall meetings, they are minions of big insurance. When his supporters show up, they are constituents.

Please be sure to send this post to flag@whitehouse.gov

Mayo Clinic comes out against the House health care reform proposal

Just a brief post – The Mayo Clinic has been touted by the President but the clinic has come out against the House proposal.

I don’t deny the need for rational health insurance policy but I am very nervous that the White House is pushing the process too quickly. Doing something bad could be much worse than doing nothing.

I appreciate readers who believe we need a single payer. However, all we are really talking about is who brokers the payments. The inefficiencies in the system and the incentives which drive costs must be addressed. Whether government can do this is an open question – one I am skeptical about.

Health care reform: Deja vu all over again

Eleven years ago, I wrote a brief history of health insurance for the Journal of Psychology and Christianity (“Managed care: It’s like deja vu all over again,” 1998, vol. 17, 131-141) as a part of special issue on managed behavioral health care.

I thought of that article this past week while reading various news reports about President Obama’s push to enact some version of health care/health insurance reform. I argued in that paper that managed care was one on many private sector arrangements designed in part to avoid government run national health insurance (NHI).

managed care

Obama says health care reform will lower costs, however, the Congressional Budget Office says reform as envisioned will spike the deficit by over 200 billion during the next decade.

For some reason, Democrats want us to believe this:

Democrats insisted the budget analysis ignores savings and Obama’s pledge not to add red ink to the federal ledger.

For about 100 years, the debate has come and gone. When a politician or anyone really says, buy now or else you lose your change, I worry. We needed the bailout now, we needed to bail out GM now, and now health reform now

President Obama urged Congress yesterday to push past their growing doubts and pass a comprehensive health-care reform package this year, saying that a better opportunity to remake the nation’s health-care system may not arise for generations.

Here is more on the CBO estimates. If you can read this and believe the current plans will be cost neutral, then you have more faith than I do.

The concern I have at this point in history, is that the private sector seems to have rolled over and may expect that NHI is truly inevitable this go around. The hope to offset more federalization of health care probably rests with conservative Democrats and resistance to two main policy points: one, the increases to budget deficit as noted and two, the proposed inclusion of abortion in any federal plan.

Ginsburg Was Right about Abortion and Population Control

In her remarks to Emily Bazelon, which I linked to on Sunday, Justice Ruth Bader Ginsburg said the following regarding Roe v. Wade, a feminist legal agenda and population control:

Q: If you were a lawyer again, what would you want to accomplish as a future feminist legal agenda?

JUSTICE GINSBURG: Reproductive choice has to be straightened out. There will never be a woman of means without choice anymore. That just seems to me so obvious. The states that had changed their abortion laws before Roe [to make abortion legal] are not going to change back. So we have a policy that affects only poor women, and it can never be otherwise, and I don’t know why this hasn’t been said more often.

Q: Are you talking about the distances women have to travel because in parts of the country, abortion is essentially unavailable, because there are so few doctors and clinics that do the procedure? And also, the lack of Medicaid for abortions for poor women?

JUSTICE GINSBURG: Yes, the ruling about that surprised me. [Harris v. McRae — in 1980 the court upheld the Hyde Amendment, which forbids the use of Medicaid for abortions.] Frankly I had thought that at the time Roe was decided, there was concern about population growth and particularly growth in populations that we don’t want to have too many of. So that Roe was going to be then set up for Medicaid funding for abortion. Which some people felt would risk coercing women into having abortions when they didn’t really want them. But when the court decided McRae, the case came out the other way. And then I realized that my perception of it had been altogether wrong.

Except she wasn’t “altogether wrong” — at least she wasn’t wrong about Roe v. Wade being “set up for Medicaid funding” and population control. Surrounding late 1960s and through the 70s, there was much public debate about the “population explosion.” In 1965, Griswold v. Connecticut struck down a law banning contraceptives. This case helped to establish the right to privacy as based in the Constitution which, in turn, was basis for Roe v. Wade.

As an example of the zeitgeist of the time, here are some excerpts from the 1972 Rockefeller Commission Report on Population Growth and the American Future. The Commission recommended that

…present state laws restricting abortion be liberalized along the lines of the New York statute, such abortion to be performed on request by duly licensed physicians under conditions of medical safety. In carrying out this policy, the Commission recommends:

That federal, state, and local governments make funds available to support abortion services in states with liberalized statutes.

That abortion be specifically included in comprehensive health insurance benefits, both public and private.

Sarah Weddington, co-counsel with her husband Ron Weddington, submitted this report as a part of her brief supporting Roe. Ron Weddington’s views were more pointed. He wrote then President-elect Clinton in 1992 and advised the president-to-be that traditional Democratic programs would not be effective unless Clinton started “immediately to eliminate the barely educated, unhealthy, and poor segment of our country.” How did Weddington propose to implement this draconian suggestion? He wrote to Clinton:

No I’m not advocating some kind of mass extinction of these unfortunate people. Crime, drugs and disease are already doing that. The problem is that their numbers are not only replaced but increased by the birth of millions of babies to people who cannot afford to have babies.

There I’ve said it. It’s what we all know is true, but we only whisper it, because we are liberals who believe in individual rights, we view any programs which might treat the disadvantaged as discriminatory, mean-spirited and well…so Republican.

…government is going to have to provide vasectomies, tubal ligations and abortions…RU486 and conventional abortions.

Weddington ended his letter with more words of sympathy for the children of poor families—and the need to prevent their existence:

We don’t need more cannon fodder. We don’t need more parishioners. We don’t need more cheap labor. We don’t need more poor babies.

So where Ginsburg was altogether wrong was not in her understanding of one of the forces behind Roe v. Wade. Where she was wrong was in her understanding of the High Court in the subsequent decisions regarding public funding of abortion. In any case, Ginsburg has been a consistent champion of tax-payer funding for abortions, even when she thought one purpose of Roe was to curb growth of “populations that we don’t want to have too many of.”

For Weddington such a policy seemed to be “discriminatory, mean-spirited and well…so Republican.” However, Ginsburg views public financing of abortion as a way to reduce, what she perceives as, gender discrimination. Which is it?

One thing seems sure. The issue of public abortion funding is as current as now. Yesterday, the Senate Health, Education, Labor and Pensions Committee rejected a bid by GOP Senators to eliminate abortion as a benefit in any government subsidized health reform package. If abortion as a benefit survives, then it will no doubt be challenged in the courts, eventually reaching the Supreme Court.

Justice Ginsburg is ready.

UPDATE: Since it is relevant to the above topic, I want to include the entire article by Paul Kengor and I and posted at World magazine on 7/16/09. In it, we find more information about what Ginsburg may have meant by “populations that we don’t want to have too many of.”

Disturbing Declarations

As Sonia Sotomayor was readying for her confirmation hearings, The New York Times Magazine cast a loving gaze toward the lone female Supreme Court justice, Ruth Bader Ginsburg. In so doing, the Times inadvertently shed light on some remarkable thinking by Justice Ginsburg. Those thoughts are so bracing that they ought to upstage the abortion questions surrounding the Sotomayor nomination.

Ginsburg long ago declared her support for Roe v. Wade. Now, however, she has declared something more.

When the subject in her interview with the Times’ Emily Bazelon turned to abortion, Ginsburg said, “Reproductive choice has to be straightened out. There will never be a woman of means without choice anymore. . . . So we have a policy that affects only poor women, and it can never be otherwise, and I don’t know why this hasn’t been said more often.”

Bazelon then asked, “Are you talking about the distances women have to travel because in parts of the country, abortion is essentially unavailable, because there are so few doctors and clinics that do the procedure? And also, the lack of Medicaid for abortions for poor women?”

Ginsburg replied, “Yes, the ruling about that surprised me. [Harris v. McRae-in 1980 the court upheld the Hyde Amendment, which forbids the use of Medicaid for abortions.] Frankly I had thought that at the time Roe was decided, there was concern about population growth and particularly growth in populations that we don’t want to have too many of. So that Roe was going to be then set up for Medicaid funding for abortion. Which some people felt would risk coercing women into having abortions when they didn’t really want them. But when the court decided McRae, the case came out the other way. And then I realized that my perception of it had been altogether wrong.”

Ginsburg is correct in noting that concerns about population growth animated many of those who backed Roe v. Wade. For instance, Sarah Weddington, co-counsel in Roe, along with her then-husband, Ron, wrote in her book A Question of Choice that team Weddington submitted as evidence the controversial 1972 Rockefeller Commission Report on Population Growth and the American Future, which included a call for public funding of abortion.

As for Ron Weddington, his views are even more direct, as was evident in a January 1993 letter to President-elect Bill Clinton. Weddington advised Clinton to strive “immediately to eliminate the barely educated, unhealthy, and poor segment of our country.”

How did Weddington propose to implement this draconian suggestion? In his letter to Clinton, he candidly wrote, “[G]overnment is going to have to provide vasectomies, tubal ligations and abortions . . . RU486 and conventional abortions.”

Weddington ended his letter with more words of sympathy for the poor: “We don’t need more cannon fodder. We don’t need more parishioners. We don’t need more cheap labor. We don’t need more poor babies.”

A year later it was Clinton who appointed Ruth Bader Ginsburg to the Supreme Court. For Ginsburg, that path was paved with help from one of the Weddingtons. As Sarah Weddington said in a 2007 interview, “I’ve also known Ruth Bader Ginsburg for years, and helped her get her appointment.”

Thanks to The New York Times Magazine, it looks like the Weddingtons and Ginsburg may be kindred spirits more than we had realized.

In fact, the Times piece prompts us to reconsider previous Ginsburg statements relating to “populations” that the justice doesn’t “want to have too many of.”

For instance, in an April 6, 1984, address to the University of North Carolina School of Law, published in the North Carolina Law Review, Justice Ginsburg described a 1971 speech where she faced tough questions on abortion policy:

“The questions were pressed by black men. The suggestion, not thinly veiled, was that legislative reform and litigation regarding abortion might have less to do with individual autonomy or discrimination against women than with restricting population growth among oppressed minorities. The strong word ‘genocide’ was uttered more than once. It is a notable irony that as constitutional law in this domain has unfolded, women who are not poor have achieved access to abortion with relative ease; for poor women, however, a group in which minorities are disproportionately represented, access to abortion is not markedly different from what it was in pre-Roedays.”

Ironic indeed. Instead of reducing “cannon fodder and cheap labor” via abortion, as the Weddingtons of the world had hoped, the Supreme Court upheld congressional bans on federal funding of abortion. According to her recent interview, Ginsburg was surprised the court upheld such bans. She continues to lament the fact that government does not fund abortions. Why?

Ginsburg’s comments to The New York Times Magazine open a floodgate of disturbing questions regarding a sitting U.S. Supreme Court Justice. Perhaps even more amazing than her comments was the lack of clarification or follow up from theTimes. Maybe another newspaper can do the job. These questions are too serious to be left to speculation.

While I think Ginsburg would be fine with expanded access to abortion for poor women, I am not sure she believes poor women should be targeted. She believes all women should have access to abortion. She was repeating the irony that at least some of those who advocated for abortion wanted to reduce poor populations but, as it turned out, affluent women have access whereas many poor women don’t.

To me, an appropriate move would be to restrict abortion to medical necessity for rich and poor women and reject any elitist notion that poor people can be reduced by abortion. As those black men protested and Ginsburg acknowledged, such policies have unacceptable adverse effects on minorities.