Prop 8 was overturned today because it was held to violate the 14th Amendment. The one that was passed in 1869 to make sure newly freed slaves weren't being murdered and robbed. Here's the relevant text:
"No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."
There are two ways of implementing this: What did this mean when they adopted it, or what does it mean today.
No one seriously argues that when it was adopted it was designed to legalize gay marriage, so I'll move on to the next point.
What does it mean today? It means a million things to a million people. But that doesn't mean its entirely unreasonable to think that the "values of the people" expressed in the Constitution are evolving values that change when the values of the people change. So we have to ask, how much do the values of the people need to change before they should be recognized by the Constitution? If only three or four people agree, does that change "the values of the people"? Does 51% dictate the "values of the people?" People who believe in the living Constitution have to wrestle with this idea.
Unsurprisingly, the Framers already thought it through. Article V, in relevant part, reads:
"The Congress, whenever two thirds of both Houses shall deem it necessary, shall propose Amendments to this Constitution, or, on the Application of the Legislatures of two thirds of the several States, shall call a Convention for proposing Amendments, which, in either Case, shall be valid to all Intents and Purposes, as Part of this Constitution, when ratified by the Legislatures of three fourths of the several States or by Conventions in three fourths thereof, as the one or the other Mode of Ratification may be proposed by the Congress;"
Three fourths of the several States. That's 75%. Much more than 48%, that voted against Prop 8. More broadly, if you believe the Constitution embodies our values, why does it take less to make our values enforced de facto, rather than de jure? Why make two ways to amend the constitution that require wildly different amounts of support?
Apple really surprised me with the iPad. Aside from it being manufactured by unicorns and fairies, what surprised me most was the name. I mean really? I can't imagine all the confusion while talking to a support rep. Especially for us foreigners.
India Phone Rep (IPR): "Sir, you are having difficulties with your iPo/ad?"
Me (Me): "What? No! I said I can't turn on my iPo/ad?"
IPR: "Sir, thank you for correcting me. Now what difficulties are you having with your iPo/ad"
Me: "BAH!"
Maybe this is their crafty way to force people to visit the Apple Stores for support to turn some more revenue.
The secretary of state in MA has said he won't certify the election results until mid-February if Brown wins. Do you think the Democrats will push through the health care bill before Brown is seated if he wins? Or are the political consequences too high? Have they already signed up for what comes despite the consequences? Will a loss cause blue dogs to drop their support?
While not wishing to concede to the idea that a publicly run health insurance option would not lower health care costs and that the current insurance status of Americans is adequate, for the sake of discussion, I will temporarily grant an acceptance, and ask that you consider what is commonly referred to as signal-payer health care or how I learned to stop worrying and accept government run health care.
My keystone premise consists of the notion that adequate health care is a common good: a good that is limited but from which an individual cannot (or should not) be excluded. Moreover, I suggest that as a society we are not currently ensuring that individuals have access to this common good. I will employ an analogy to police protection to illustrate why single-payer health care is necessary.
Like basic police protection, basic health care is used by everyone in a society, often without recognition. You may have never had direct need of a police officer, but the mere existence of that officer's work benefits you constantly. We recognize this, and require all to pay a share of the cost through taxes. Should you need direct services, say to file a report of a robbery, they are available to you at no extra charge to encourage active enforcement. If you feel that because of certain circumstances you deserve and can pay for additional protection that does not withdraw the resources from others, you can hire additional private security. Now imagine a system where all are afforded an equal access to health care.
In this system, individuals would benefit constantly from the security of knowing that if they or their families need medical assistance, it is available to them. Moreover, their neighbors, friends and coworkers receive needed care. And at some point in time, it is likely that the majority of individuals will need significant care, and so everyone pays through the tax system. While the level of care is not what some want (we can't all have a police officer next door), society decides what is adequate (Paul's previous post suggested that care is already rationed through the emergency room structure; I argue that explicit rationing is more efficient and humane). Finally, even if laws are created to limit the domestic ability to acquire private care, the privileged will (and always have) found away to purchase what they want, perhaps internationally. This system does come with obvious inefficiencies.
One could argue that unlimited health care a no extra charge to the individual creates a moral hazard. If fact, that is a current argument for why employer-subsidized health care drives up costs. It is not possible to completely eliminate some sense of this moral hazard, but I believe that if adequate care is available, it will be minimal. Adequate police protection could cause one to negligently leaves the car key in the ignition, but the individual opportunity costs associated with the ordeal are very high, even if the car is recovered. Opportunity costs will also eventually limit moral hazard associated with available health care. But will government run health care be able to control costs?
A single-payer health care system will control costs better than the current system. Care will be better rationed and wages will be brought down. An automobile theft usually does not require the SWAT or special forensic analysis, and headaches do not require a CAT scan. As mentioned earlier, the system already rations care to many by making care less accessible. Opportunity costs are significant with emergency rooms, and emergency room doctors are much less likely to request a CAT scan for a headache than a specialist would (just guessing). I am inclined to sympathize with the notion that Americans will never accept explicit rationing, but that shouldn't limit our discussion of what would be optimal. Speaking to wages, the current system pays doctors, nurses, and hospitals too much, and I reject the notion that qualified folks won't do it for less. Most doctors are much more interested in helping folks and prestige than they are with pay. Being the only game in town doesn't prevent police agencies from finding detectives.
A society that does not have the ability to provide police protection may be close to not being a society. For the same reason, our nation should act to provide health care to all by providing a single government sponsored health care system to all.
The last post addressed the costs of health care. This will address the number of uninsured.
There are three types of uninsured.
Those who are uninsurable (pre-existing conditions)
Those who are insurable and can afford it but choose not to
Those who can't afford it
The Uninsurable
Congress is hoping to solve this by eliminating rejections based on pre-existing conditions. Another option is to simply require insurers to offer insurance but allow carve-outs for the pre-existing conditions.
Requiring coverage for pre-existing conditions would be a disaster. Health insurance works because people pay premiums whether or not they are sick. If there is no limit on pre-existing conditions, why wouldn't I just wait until I'm sick to get healthcare coverage and then sign up? I'd save on premiums while I'm healthy. Congress' plan doesn't sufficiently clarify why this won't happen.
If we allowed insurance companies to exclude coverage for the pre-existing condition but provide coverage elsewhere, it would eliminate the incentive to only be insured when you need to make a claim.
Of course, you're probably thinking "what about emergencies?" The only dangerous activities I do are driving, and my auto insurance covers me there. Rolling the dice on emergencies seems like a good bet.
Those who can afford to buy insurance but don't
Why is this a problem? It's gotten a lot of coverage lately because Congress can make the bill sound better if they say an additional 20 million people will have insurance, even if most of these are folks who have just decided not to and the bill only changes that by forcing them to.
The only real concern I've heard about these uninsured people is that when they are sick they go to the emergency room and the costs are passed on to the rest of us. But if they are financially stable enough to afford insurance, they will be more likely to pay some of the costs. We don't even need to collect the full debt. If they were insured, we'd pay a share of their costs and in exchange they'd pay their premiums. So as long as we can collect the amount of premiums they would have paid then we're just as well off even if they default on the rest of the costs.
Some argue that the use of emergency services drives up the costs because it's less efficient. I haven't heard a good argument yet on why this is less efficient---it seems to me that this has been a long-term problem so the staffing administrators probably take it into account, and on the other cost side, an hour of a doctor's time is an hour of a doctor's time, whether in the emergency room or the urgent care center.
But even if we assume emergency rooms are more costly, the argument is too narrow. People with insurance go to the hospital more. Those without insurance go less. So because they go less, it lowers the demand for resources and lower demand means lower prices for the insured.
(You might argue that because they miss preventative care long-term costs are higher. When someone comes down with something awful we all pay for it whether they are insured or uninsured. My sense is that many of these folks are younger, and the only preventative care that's really cost effective for young folks is losing weight and quitting smoking. The rest doesn't actually lower costs overall.)
(You might also argue that they will just declare bankruptcy, citing Elizabeth Warren's report that x% of all bankruptcies are caused by medical bills. In short, this is very exaggerated. I looked at these in a research project in my undergrad and most of the time you'd see $200 of medical bills and $60,000 in debt to Visa and Sears. Her criteria for "medically caused bankruptcy" was absurdly broad, which made the study loose its meaning.)
The uninsured who can't afford coverage
Like the insured who can afford coverage, these folks will go to the hospital less, but go to the emergency room more. So it's another balance between emergency room costs and lowering demand. Here, though, you can also just recognize that society is going to pick up the bill here one way or the other. If we give them insurance or subsidies, we pay for them with our taxes. If we don't, we still pay with our higher insurance premiums to cover their costs. So the only real issue here is how broad we want to make the collection base. The middle-class and union workers would help pay if it's through premiums. The rich will pay if it's through taxes. Unions vote Democrat. Decisions, decisions.
