War is Health

While we accept that the new healthcare law is an improvement over what preceded it, we’ve never been fans of the “individual mandate”. We understand the actuarial realities underpinning it, and we’re happy that those less fortunate than us will qualify for higher subsidies than we’re looking at.

But like we’ve said: Please don’t compare it to car insurance.

To which we now add: And please don’t compare it to militias.

We’re looking at you, ThinkProgress:

The truth… is that the Second Militia Act of 1792 required a significant percentage of the U.S. civilian population to purchase a long list of military equipment.

The argument is that no less a socialist than George Washington drove a tyrannical government to force its citizens to buy “a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges.”

Knapsack optional on training days, of course.

That’s a cute talking point, guys, but even a cursory look at the Militia Act makes us squeamish. And not because of the thematic dissonance, but because it effectively involved conscription — or, as it’s known in our time, The Draft.

Not exactly the precedent you want to wave at Progressives.

Surely there’s some dusty law that required everyone to buy horses? Because we’d feel just a little better if we were compelled to pay a Pony Tax.

Why George Washington would disagree with the right wing about health care’s constitutionality [ThinkProgress]

The individual mandate is what happens when you don’t have single payer. It basically all comes up the same, though. With single payer you’re “required” to buy health insurance, because you’re required to pay taxes and taxes pay for the government run insurance system under which all citizens are covered. Cost subsidies make the individual mandate even more like a single-payer tax system, given that your ultimate out-of-pocket expense for health care varies progressively with your income.

My worry about the individual mandate is that it’s easy to demagogue… hell, that’s in part how Obama defeated Hillary in the primaries.

I strongly suspect that in 2010 the GOP will run candidates who blast and promise to repeal the mandate. It would, of course, kill HCR to do so. But it would prove a popular platform for ordinary citizens who don’t quite understand the link between the mandate and the requirement that insurers not discriminate on the basis of a pre-existing condition.

As progressives, I think, it is our duty to explain the mandate, not attack it, for the whole edifice of HCR and the promise of universal coverage depends upon it.

Whether it be guns or butter, ponies or unicorns, or , Hell, hookers for David Vitter… anything that helps preserve the mandate, and by extension HCR, is fine by me.

This is why this bill is a first step.

Like I’ve said before. As a citizen of a nation who lives under the tyranny of single payer, I think you guys will like it when (!) you get it (for the most part.) We do have private insurance, but that’s just for extras the HC system will not pay for like individual rooms and drug plans. Not exactly money spinners for the shitballs of the insurance industry.

I agree this bill is the first step. 2010 probably isn’t the best time to go to a single payer system that would eliminate millions of these jobs:

a. The clerical positions in the offices of every doctor and dentist. Those (mainly) women do nothing but take care of the dizzying array of health insurance forms and requirements.

b. The insurance staff of every hospital.

c. The employees at the health insurance companies whose functions include finding loopholes to avoid paying benefits and looking for another insurance company to bill through the wonders of subrogation.

All of these positions are paid for with health care dollars and none of them have anything to do with providing health care. They won’t last much longer.

@Dave H:
But but but I thought Free Market’s didn’t allow bureaucracies!?!?

I have sympathy for a, not so much b, none for c.

In the 1999 landmark for Canada City HC study of both US and Canada City HC systems, overhead (aka bureaucracy costs) were shown to be 24-27% in the US vs 6-7% in Canada City of the Total system cost.

Washington was ahead of his time. If owners of bayonets can perform surgery, who needs to pay for doctors?

@Dave H: This is why the AMA went for it: revenge. The insurance companies have created a system that is opaque and random. Knew one GP who gave up after he calculated that 30% of his time some weeks was being absorbed by him having to shriek at insurance company ‘no monkeys’. He came an associate group of a large non-profit hospital group – and let their people do the screaming. Sister had two docs give up – GP and specialist – who went into early retirement. Their practices had become siege operations in an endless war with the no monkeys.

@FlyingChainSaw: I think Pa Nabisco looks back wistfully on the reasons he got out of the HC bidness: the cost of his insurance, i.e. malpractice. He’d go ape shit with all the paperwork his staff of one or two would have to deal with these days.

The Militia Act list and purpose reminds me of the Gun Inspection we have back home in the spring. Every able bodied male from about 13 and above has to assemble annually in the plaza of Pueblo RML with a clean rifle or bow in good working order with an adequate supply of ammunition, not less than one box of 20 cartridges in suitable caliber. The rifle is examined by the War Chief or his staff for function and the barrel inspected for fouling or obstruction. Sometimes the inspector will shoot the rifle. Slings and ammo belts are tugged on, and the owner is either praised or advised to perform some maintenance. One year they told me that the barrel on my lever action Savage 99 in .308 was so clean it looked like glass.

Speaking of dusty old laws, New Mexicans are required to permit access to watering holes on their property for travelers and their horses. Also, communists are required to register with the local county clerk.

And, btw, the Militia Act applied to militias:

“That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock .. . ,and shall appear so armed, accoutred and provided, when called out to exercise or into service . . . the commissioned Officers shall severally be armed with a sword or hanger, and espontoon . . . ”

The espontoon was a half pike carried by officers and was was used for thrusting, parrying and signaling.


May we use a different automotive analogy and compare the mandate to being forced to wear seatbelts? Yeah, yeah, you don’t have to ride in a car. I’m not a big fan of the mandate, but when I read that the penalty will be $95 or 1% of income gradually increasing to 2% or approximately $650ish, opting out doesn’t seem so onerous.

Some of my friends are discussing whether the state AGs have standing to challenge the mandate and whether the issue is even ripe. Thoughts?

@JNOV: the AGs are looking for a crazy federal judge, of whom there are many.

@JNOV: Some of my friends are discussing whether the state AGs have standing to challenge the mandate and whether the issue is even ripe. Thoughts?

In the ‘tucky, we you they have an AG just trying to line up the guns ‘n bitterz for the primaries. I know some of his current staff, good people, but same old, same old: rinse, repeat.

@Serolf Divad: Every time a Repug tries to campaign on the individual mandate, the Dems just need to keep talking about pre-existing conditions and out of work 20-somethings being on mom and dad’s insurance plan. Don’t try to counter the argument, just talk over the GOPers the way they do…except the Dems wouldn’t be lying.

@Dodgerblue: There are many crazy judges, but I don’t know how many Tenthers are out there. Or maybe I’m cautiously optimistic after Orly Taitz got slapped around by the 11th Circuit.

@JNOV: I don’t see the standing hook. If there’s standing for the states and the AGs on this, they would have standing to challenge every other federal-state program, or federal programs that condition receipt of money on changing state laws. I also don’t see how you get around supremacy and preemption arguments for the feds (notwithstanding the 12 AG’s fucked up interpretation of the 10th Amendment). Didn’t some AGs try to challenge No Child Left Behind when it was introduced and they got slapped down for standing.?

In any event, I encourage these states to secede (that goes for you too, blue state Washington, as punishment for electing an asshat for AG), or better yet, turn down all federal money going their way and to go out with jackhammers and dig up the interstate highways and airports in their states paid for by federal monies.

@SanFranLefty: That’s right, states rights fans–no air traffic controllers for you!

@SanFranLefty: The instant I figured out our asshat AG was in the lawsuit (it was when I was reading an article and some fucktard from Down South was jabbering typical far-Right crap, and said something about “Washington too” — talk about a nasty surprise), I fired off an angry missive to his office. Not sure it’ll have any effect, but I figure it’s more useful than joining a Facebook group.

He has not, otherwise, been particularly asshat-y that I’ve been aware of, so I was surprised to hear he was in on this thing.

@nojo: Wasn’t there some town in Texas a few years back that passed a law requiring everyone to own a gun?

@Serolf Divad: The cost subsidies do not go anywhere near to making this turd more like a single-payer system. The only acceptable trade-off for the individual mandate was the public option. Let’s all hold our breath for that.

I’m not going to waste much more time complaining about HCR, which may, marginally, effect a better overall outcome than what we’ve had. But it is NOT my duty, as a progressive, to explain the mandate in the absence of a truly affordable alternative insurance option.

And given the relatively (?) light penalty, how many millions will simply choose not to be covered?

@Pedonator: “And given the relatively (?) light penalty, how many millions will simply choose not to be covered?”

I would build off of JNOV‘s analogy and say that more than seat belts, this is like requiring motorcyclists or bicyclists to wear helmets. The opponents of helmet laws sound like a lot of the opponents to the HCR bill. My insurance bill or taxes are covering the jackasses who ride motorcycles or bikes without helmets and suffer traumatic brain injury in even relatively low-impact accidents.

The fee or ticket for not wearing a helmet is relatively light, but the penalty if you choose not to cover your head and you get fucked up is pretty damn high.

If the people who gamble that nothing bad will happen to them and don’t get covered with health insurance despite some of the new regulations that make it easier to get coverage (insurance cos must have at least 85% spent on medical services, no pre-existing condition requirements, no kicking people off on a pretense, cost subsidies, young adults can stay on mom and dad’s plan until 26, etc.) encounter a catastrophic injury and overwhelming medical bills, I’m going to feel about them the way I feel about people who refuse to wear a helmet and then go to the hospital with a cracked skull after falling off their bike.


I’m not going to waste much more time complaining about HCR, which may, marginally, effect a better overall outcome than what we’ve had. But it is NOT my duty, as a progressive, to explain the mandate in the absence of a truly affordable alternative insurance option

Marginally better? We’re talking about extedning coverage to a group that consists of 10% of the entire U.S. population. That’s a pretty bug deal, IMHO.

And as for what is and is not your duty: there are two kinds of ideologues. (1) those who settle for nothing less than what they want and thus effect no change except in revolutionary times of great upheaval, and (2) those who get things done and push policy in the right direction inch by inch.

@Pedonator: Wasn’t there some town in Texas a few years back that passed a law requiring everyone to own a gun?

I think so, but that’s a municipality, not the federal government.

@SanFranLefty: this is like requiring motorcyclists or bicyclists to wear helmets

Except that I’m not obligated to drive or ride a chopper.

Literally, the penalty is a tax, collected by the IRS. And while I haven’t seen the actual language, I’ll guess that having insurance will be something like a tax credit. That puts everything in the realm of the familiar (and legal), even if it’s not the Happy Pony analogy some would like.

Hey, I’ve been resigned to the Senate Bill for awhile now. Just don’t bullshit me about it.

@Serolf Divad: I’m willing to be pleasantly surprised if this does indeed result in almost everyone being covered, somehow. Meanwhile, I’m not optimistic, and therefore cannot be enthusiastic enough to feel a duty to wave this flag as a triumph of progressivism.

What I want is single-payer. What I could muster some enthusiasm for is a public option. What I’m getting is less than less than what I want. I don’t think we have time as a civilization, or even as a species, to settle for pushing policy inch by inch.

So I’m definitely not on the side of the teabaggers on this, but I’m not at all ready to celebrate HCR.

@nojo: A few months ago that birthday cake looked like bullshit.

But then it got closer and closer to my birthday, and it started to look more like cake. Because lordy, I hadn’t tasted cake in so long!

Now that the birthday party is over, I console myself for having swallowed bullshit by relishing the sickly sweet aftertaste of the frosting.

Meanwhile, the Gentleman from Oklahoma’s latest theatrical stunts are almost inspirational enough to make me join in a rousing chorus of Onward Corporatist Soldiers!

@Serolf Divad: And I would argue that there is a third type of ideologue: one who continually compromises on core principles, guided by the unproven theory that doing so is politically advantageous and allows your party Sport team to keep winning, and thus be in a position to make better policy capitulate again in the future.

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