ObamaCare, the “Market State” and Nudge Theory

Yves here. Big decision when Lambert and I are short on bandwidth, so this is just first impressions. One striking bit is that the Supreme Court left the penalties for not obtaining insurance in place by designating it a tax, but then struck down enforcement mechanisms against states who fail to offer expanded Medicare.

Lambert highlights the fact that this decision undercuts the ability of the Federal government to use tax as a tool to promote social goals. The irony is the Obama administration was already there as far as banks are concerned. We’ve pointed out that the Administration is has refused to use widespread violations of REMIC (the tax rules that give mortgage securitizations their tax-free status) to bring miscreant banks to heel. From a 2011 post:

Now, with the Federal government under enormous budget pressure, shouldn’t the authorities be keen to go after tax cheats? The headline of a Reuters article, “IRS weighs tax penalties on mortgage securities,” would suggest so. But don’t get your hopes up. The lesson is don’t jump to conclusions when big finance is involved.

An overview from the article:

Should the IRS find reason to take tough action, the financial impact could be enormous. REMIC investments are held by pension funds, in individual retirement plans such as 401(k)s and by state and local government entities.

As of the end of 2010, investments in REMICs totaled more than $3 trillion, according to data supplied by the Securities Industry and Financial Markets Association.

In a brief statement in response to questions from Reuters, the agency said: “The IRS is aware of questions in the market regarding REMICs and proper ownership of the underlying mortgages as set out in federal tax law, and is actively reviewing certain aspects of this issue.”

This matter was raised early last year by an attorney I know with IRS, to a senior officer, not in enforcement but familiar with REMIC rules. She immediately understood the importance and nature of the violations being alleged and was keen to proceed. Having had no follow up, the attorney rang again, and the IRS officer took the call, this time reluctantly. She indicated she was not supposed to be taking to him. She said the issue had gone to the White House, where word came back that tax was not going to be used as a tool of policy.

By Lambert Strether. Cross posted from Corrente

Hasty post, as I must fly. Three bits from ScotusBlog that I would like to expand on briefly.

First, here’s the reasoning:

Essentially, a majority of the Court has accepted the Administration’s backup argument that, as Roberts put it, “the mandate can be regarded as establishing a condition — not owning health insurance — that triggers a tax — the required payment to IRS.” Actually, this was the Administration’s second backup argument: first argument was Commerce Clause, second was Necessary and Proper Clause, and third was as a tax. The third argument won.

Second, here are the implications for the role of the State as we have understood it from the New Deal onward; what Phillip Bobbitt would call a change a Constitutional Order:

The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws.

Third, here is the new Constitutional Order:

Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy proposition.

Chancy or not — and it will be the precariat that suffers mischance, and not the elite, in any case — that’s what they’re going to do.

Bobbitt defines the “market state” here (quote from The Shield of Achilles):

Whereas the nation-state, with its mass free public education, universal franchise, and social security policies, promised to guarantee the welfare of the nation, the market-state promises instead to maximize the opportunity of the [some] people and thus tends to privatize many state activities and to make voting and representative government less influential and more responsive to the market.

Using the tax code to optimize rental extraction — in this case, by health insurance companies — is the very essence of Cass, Sunstein et al’s. Nudge Theory (via Time). And even if the Hobson’s choice between paying the health insurance weasels and paying the IRS is more like a shove than a nudge, it’s not a solution that the nation-state, as Bobbitt defines it, would adopt. But it is a solution the market state would adopt. After all, you have a choice!

Oh, and all the yammering from career “progressives” about how ObamaCare is a step towards a greater reform, or even single payer/Medicare for All, obscures the central issue: The change in the constitutional order. That’s their job, of course; no harm done if you take no account of their policy decoys.

Gotta go, but FWIW that’s my take.

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  1. Pitchfork

    “The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws.

    Third, here is the new Constitutional Order:

    Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy proposition.”

    This doesn’t even make sense. If you call it a tax, Judgie John thinks Congress can do whatever they want. What’s next, taxing individuals for not holding personal, newly privatized deposit insurance? Hey, why not?

    This decision just seems bad on all levels.

    1. Walter Wit Man

      The new rules (which are basically the old rules, just stated more succinctly0:

      1. States have rights but individuals do not.
      2. Corporations have rights but individuals do not.

      So a state can’t be forced to take part in Obamacare but we individuals can be forced to take part.

      The only civil liberties left in this country are for corporations. Indeed, this is the only area where rights are expanding (well, maybe gun rights too).

      1. scraping_by

        True enough. There’s a straight-faced argument that the law exists to protect property rights, while civil rights are customs subject to public convenience.

        The agrandizement of corporate personhood continues, with nary a stumble along the way.

        1. nonclassical

          …”to protect property rights?”….

          how is it then, private property being the basis of U.S. society, that LAW (basis
          of private property rights) has done NO job at all of protecting private property-mortgages from Wall $treet corruption??

          1. scraping_by

            Probably the second statement. A corporation is a super-person, with far more rights, privileges, and powers than we mere human beings. And all from lawyers’ arguments rather than deliberation and debate. Meh.

        2. LeonovaBalletRusse

          Who will bring up the definiton of the word “person” in the OED within the Time Frame in which the Declaration, Constitution, and Bill of Rights were written, and by the time Ratification was completed?

    2. pebird

      What I don’t understand is if the Federal Government can’t enforce an expansion of Medicaid, how could it enforce Medicaid as a program in the first place?

  2. jsmith

    “Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy proposition.”

    Political environment?!!!

    I mean, at what point do people stop mealy-mouthing the fascist system we are living under?

    Other terms certainly can apply: kleptocracy, inverted totalitarianism, but fascism truly seems to gather all the terrible non-economic aspects of U.S. – e.g. nationalism, racism, etc – culture under one correct banner.

    When will the Goodmans, Madows, Stollers, et al, stop using terminology that critically misidentifies and mischaracterizes what is happening to the Western world?

    Are we so propagandized that even people who oppose what’s going on in this country can’t use certain words anymore even if those words are correct?

    “…the market-state promises instead to maximize the opportunity of the [some] people and thus tends to privatize many state activities and to make voting and representative government less influential and more responsive to the market.”

    Translation: fascism.

    People, stop playing THEIR games and at the very least take your language back.

    1. DiamondJammies

      In the case of Maddow I have to believe it’s more cyncism than naivete. Because cleary she’s a very intelligent person, more than capable of analyzing the world critically. But she’s also a wealthy tv personality, basking in her role honorary deputy spokesperson for the Pentagon (“Don’t I look adorable with these automatic weapons?”) and the Democratic Party’s “progressive” wing (a.k.a. the “far-left,” a.k.a. 1950’s Eisenhower Republicanism.) Her thing is that she does feel a deep sense of empathy for oppressed people, but currently not enough to outweigh the pleasures derived from a her fabulous bank account. My hope is that someday that will change.

      1. nonclassical

        ..radio is more “forgiving” a medium than tv, which we haven’t bothered with for over 10 years…since “Direct tv”=Murdoch pulled “International News Network”,
        channel 366 for telling the truth=international news…(Iraq, etc)

        Thom Hartman is now calling it fascism, as is Norman Goldman (one of my favorites), and Mike Malloy has been calling it fascism since the first ridiculous year of bushbama sell-out…the part where he threw his grassroots under the bus..this is NOT 1950’s, folks, and Eisenhower isn’t here, nor is “Good Night and Good Luck”…

    2. Wat Tyler

      I believe the modern term for fascism is state capitalism. Theorists might quibble with the details but there seems to be a convergence of the Chinese and American systems takings place. Still a work in progress but state capitalism seems to be the destination. Europe seems to be fighting to hold on to some form of social democracy – perhaps a losing fight.

      We shall see.


    3. Susan the other

      jsmith, I agree with what you are saying but I don’t like the word fascist. Because all people tend toward fascism. The word is almost meaningless when you consider that the German Nazis were called fascist because Mussolini had been a corporatist and threw in with them; then the Holocaust was attributed to the fascists, nevermind that there were plenty of Jewish fascists at the time… but the more rational motives of German Nationalism were not explored and are vilified to this day in a confusion of language. If we just used the legal code, and prosecuted infringements like ‘tampering with recorded instruments’ (a felony) and a hundred other statutes we would get farther faster.

    4. Up the Ante

      “People, stop playing THEIR games and at the very least take your language back. ”

      Didn’t I read that once in an Ivy League recruitment brochure ?

  3. Ms G

    In the US “free market system,” by Government Edict, citizens are now forced to give obscene percentages of their incomes to a government-protected private sector monopoly known primarily for its supreme shysterism.

    Obama, may you one day be at the mercy of a insurance company. Traitor.

    1. Capo Regime

      Yes Mrs. G.! And still the meme that we have lower taxes and better everything than other countries will continue! Gasp I already pay 6 times for heath insurance than I did in Europe and in Oz for worse care! I guess calling it a tax is progress of a sort and we can then agree we pay the highest taxes in the world given they are plain high and factoring the crappy quality of everything relative for the price–steak level taxes for spam quality services………

      1. nonclassical

        ….my wife is a nurse in Germany…it’s completely true (and documented) that
        German healthcare to cover ALL costs 85% LESS than U.S. health-profit…international healthcare cost stats…

        I taught school there-ALL Germans have the right to attend university or vocational equivalent for FREE. That’s how their schools-education remains ahead of U.S.

        And, doctor’s education is FREE….they owe their society back equivalent number of years to education in state hospital-holds down costs-new doctors make less than nurses…(Germans are quite influential in British healthcare system therefore-many doctors.)

        1. LeonovaBalletRusse

          But, but WE get doctors from third-world “developing” countries! (“equivalence”)

    2. jake chase

      Has anyone researched Roberts’ connections to the insurance industry? This decision smacks of corruption, nothing else. All you healthy people out there? Pay up. Enjoy your fourth of July. Is it true that next year everyone will have to buy a half dozen hot dogs? Why not? At least you won’t have to eat them.

      1. Mr. G

        Grammatically speaking, the sentence is in reference to “a” company, not “a” insurance”.

        Mrs. G would be correct if the sentence said “an insurance agency.” Alternatively, the sentence could of read as “a state-sponsored company”.

        But I digress. Grammar gets in the way of communication much like fascism is getting in the way of democracy. @ Walter Wit Man, Right On!

        1. Ms G

          Sir/Madam — kindly refrain from accusing people of fascism on the basis of your own poor grammar. Thank you. Over and Out.

        2. Walter Wit Man

          I know. I hate the typos and grammatical errors. I really get frustrated with myself.

          But in my other life I have to watch what I write much more closely and I get lazy here . . . and the tools are not great here . . . and we can’t edit after submitting . . . and for me the process is what I like.

          I like the stream of consciousness aspect of blogs and bouncing ideas off people. I view it as a riffing out first drafts–or exploring ideas with people–rather than a final presentation.

          But I know that if I took the time edit it would be much better. Of course it’s much more pleasant reading a well edited piece. And I should and will try to do so. When I do so in my other life I often cut my material down by 1/2 to 3/4 and I probably would benefit from that type of editing here. I know from experience the more editing and rewriting I do the better it gets.

          I beg your patience.

          1. LeonovaBalletRusse

            Ya know, folks, it could just be a “typo.” We’re typing as fast as we can, in NC’s maelstrom of free speech in print.

          2. enouf

            right …

            “Ill meet you in an hour” (not ‘a hour’), as the phonetics, not the consonant/value start of ensuing word dictates usage of a/an.

            just my take… but i also agree with leonova, ..and besides my keyboards all suck


          3. enouf

            wow, heh — yeah – there should be a 5 minute window to edit one’s own posts ;-)

            s#consonant/value#consonant/vowel# <–sed (*s*tream *ed*itor)


  4. C

    “tax was not going to be used as a tool of policy.”

    Hmm, they are again “declining to enforce” the law when they oppose it. Then there are the policy taxes they do enforce i.e. the individual mandate.

    So really this is consistent. They are willing to enforce the law on most individuals but organizations or elites are exempt.

    1. Pdx

      You didn’t need advance word. You just needed to see the palatial headquarters these companies have been building for themselves, or to get a sense for how much money they’ve spent on sales and marketing to help us ”choose”. The fix has been in for a long time.

      1. Maximilien

        Well, according to NBC News tonight, someone as “inside” as Obama himself didn’t have advance knowledge of the ruling. They reported that he was watching TV when the ruling came down, and initially thought that his law had been struck down.

        I guffawed loudly. What an unbelievable story! What a fairy tale! So funny! Except, um, NBC reported it as fact and, um, millions of Americans probably believed it. Not so funny. Shameful.

  5. Chromex

    Or if you call it a tax and can do anything you want can you impose a tax for not owning a certain type of car from a certain company? For that matter you cannot really tax a restaurant for not serving certain customers… the former limits on the constitution’s commerce power. Now most folks would say-no that’s not freedom and that’s beyond the extent of the government’s power. There is a line of cases apparently ignored by the court that states” something that would be unconstitutional if done directly does not become constitutional because it is done indirectly,” One can now see the wisdom of this line of cases.

    1. Walter Wit Man

      Yeah, they’re winging it.

      I’m sure they will quickly disavow the logical extension of their new reasoning.

  6. ltr

    Please add to this post and further explain the reasoning since this is very important to at least me to understand.

  7. kelly

    Really, a whole series on Bobbitt’s “Market State” theory of the future would be cool.

  8. Anarcissie

    I feel that the Supreme Court’s decision is being overinterpreted. The primary motives of the court were the same as the primary motives of the Obama administration, that is, to force more people to buy medical insurance, thus increasing the medical industry’s profits, and at the same time to forestall any movement toward Single Payer. There was nothing to be gained by the corps and the rich in finding the law unconstitutional. These people (the Obama administration and the Supreme Court) are mainly driven by short-term, rather local goals. I suggest you not read any more into the decision than that, regardless of the mummery which surrounds it.

    1. Strangely Enough

      All three branches of government have now chipped in to save for-profit “health care.”

    2. Ruben

      “These people (the Obama administration and the Supreme Court) are mainly driven by short-term, rather local goals.”

      I think it´s a bit more complex than that. They have to lie to themselves, at the same time that they lie to the subjects. This improves the overall quality of the lying.

      1. LeonovaBalletRusse

        Hard to control lies upon lies x lies gone exponential through the tipping point. At such times of lie-spin @ tip, chaos ensues. This is one of those times. The mostly R.C. Court is obedient, but really not that intelligent. (Let’s see, did Jesus invent Christianity or did Paul invent Christianity? Is the Pope infallible or not? Is the mother of Jesus a virgin or not? Is she Above the Trinity in sanctity or not? Is it OK to divorce or not? Is abortion covered up by priests upon payment @ $10K per head in Italy sufficiently laundered? Is homosexuality a sin, but OK if conducted between trusted priests and their acolytes, by R.C. sports coaches and their “team” or their children? It’s hard to keep the spin going in an orderly fashion; until one day …).

      2. Up the Ante

        It also increases demands upon the prospective judges to develop the quirkiest, most fly-in-the-ointment type of personal relation to the world. Very useful for aborting the Constitution.

  9. Greg T

    Many in the progressive community were concerned the ACA would be overturned. Not a chance. The private health insurance industry needs the mandates to survive. Chief Justice Roberts I’m sure understands this, hence he provided the swing vote.

    The act does very little to control the general trajectory of health care costs, and the assorted regulations included in the bill will undoubtedly be subverted by the industry. Future administrations, especially futer Republican administration won’t feel bound to enforce key provisions in the act that protect customers.

    1. LeonovaBalletRusse

      Greg, “NEEDS the mandate to survive.” This is the core of the issue of “health care in America.” Just one more example of Extraction Capitalism, blood squeezed out of the turnips We the People have become.

      1. Greg T

        Yes, Leonova. Absolutely correct. The private health insurance industry serves no useful economic purpose except as a ” toll booth ” for rentier extraction. And the media outlets pump out a ceaseless stream of propaganda equating privatization with efficiency. Health Care should not be subjected to the profit imperative. Clearly, our corporate masters have other ideas.

  10. emptyfull

    Ok. I am worried about the long-term agenda of Roberts, and I’m sure reading the dissent will send chills up my spine. But as someone living with a massive pre-existing condition that might leave me unable to work full-time in a few years, this is a huge relief for me and my family. Thank God.

    1. Walter Wit Man

      I’m glad you will get a little bit of help (but I would not be so quick to declare yourself satisfied–you haven’t danced with the devil yet).

      But I’m pissed that you were used as bait to sucker people into supporting a system that will kill far more people than it will save.

      You are not getting any more health care because of this bill. You are simply getting the “right”, and obligation, to pay corporate criminals whatever they want you to pay for their shoddy product.

      It’s not worth it. Our society would be better off with the status quo–even if a few people like yourself could not get health care insurance and had to pay out of pocket or go bankrupt. Frankly, going bankrupt is a better solution for many in your solution.

      The only real solution is single payer and/or socialized health care.

      1. emptyfull

        I’m touched you think I should go bankrupt for the sake of making things so bad that maybe we might maybe get single payer. I’m sure my children would just love that too.

        Sheesh. That’s the kind of comment I expect from card-carrying Ayn Randers. Actually, most of them are far more polite when I engage with them.

        Critique away at the faults of the ACA. I’ll probably agree with much of what you say. But please don’t forget there are real flesh and blood realities at play right now. This law makes my future more possible. Sorry if that upsets you.

        1. Walter Wit Man

          I am indeed happy YOU will have health care. My problem is that on the whole, more people will suffer from this law than will benefit from it.

          All I said is that the current system with bankruptcy is PREFERABLE to Obamacare for many people in your situation. Let that sink in. You may understand this better in a few years.

          No one should be forced to declare bankruptcy because of medical bills. And no one should be forced to do business with the medical insurance mafia. So the only possible solution I see is socialized/single payer health care. Obamacare takes us farther away from this and is not a positive step forward.

          Health care should be a right available to all. It should be socialized. And we should spend U.S. greenbacks on it (without selling bonds or taxing).

          1. emptyfull

            Hey Walter,

            Just re-read your post and realize I may have over-reacted to your “bankruptcy” paragraph. I have skin, muscle, and blood in this game, so I can take things a bit more personally than maybe I should…

          2. LeonovaBalletRusse

            emptyfull, this is a “divide & conquer sucker play. Before, you with your condition might have been treated in the emergency room of any hospital in the land, effectively “for free” if you could not pay for the visit. NO more. Now you will be forced to pay through the nose, at high premiums, which will justify higher premiums for all, and FOR-PROFIT HOSPITALS will be spared. It’s a racket. Bring RICO.

        2. Up the Ante

          I am most upset you didn’t even cover any of the points Walt presented.

          This leads me to re-formulate your “That’s the kind of comment I expect from card-carrying [Corporate Psy-Op’ers].

          fixed it for ‘ya

          I’ll also fix your username, you are now to be known as ‘fullyempty’.

          There ‘ya go.

    2. Pitchfork

      I’m happy to help people who need it. As were many hospitals. But costs have been rigged for so long that it’s easy to hold up PEC’s as the raison d’etre for Obamacare (even though it’s not).

    3. scraping_by

      Every so-called ‘benefit’ of this law has a great big built-in loophole. For preexisting conditions, it’s the ability to get out of paying in cases of fraud.

      There’s already case law that not telling an insurance company about a preexisting condition even if you didn’t know about it is fraud and is grounds to deny coverage. Given the wide range of causes and effects in medical conditions, it would be child’s play to find some aspect not stated in the initial declaration.

      Good luck and God bless.

    4. weif

      Be cautious with your assumptions based on statements from the supporters of the ACA (I actually prefer “RomneyCare” (he initially wrote it) or “The Absolutely Unaffordable Care Act” to “ObamaCare,” which is an incorrect and misleading name on so many levels). For one, the new law actually makes it easier for insurance companies to drop you in case you get sick, deny claims, or refuse coverage for pre-existing conditions. The law give insurance companies a wonderful cop-out – allowing them to cancel policies or refuse payment if the insured “makes an intentional misrepresentation of material fact as prohibited by the policy.” That is to say, the insurance company just needs to write their policies in such a way that something is most likely to be incorrectly entered by the claimant – either in the claim or in the application – and they have an out whenever they want. They are also permitted to pay for a less expensive treatment if *Social Security* states that some condition is similar to the one you received treatment for. In addition, the insurance companies can also drop you or deny coverage or deny a claim based on a section not made available to the public! (And that Senator Baucus (D. Mont), one of the sponsors of the bill, refuses to provide.)

      1. LeonovaBalletRusse

        weif, not only this, but this Absolute Road Block to Single Payer is the Road Block to any health-care UNIFICATION of We the People in collective purpose as the 99% v. the 1%.

        Now really, why would a Republican Congress want to tamper with this Cash Cow?

      2. LucyLulu

        All insurance policies, health or otherwise, have always been able to deny claims if misrepresentation was involved. They typically have to return the premium from the offending policy period however. This isn’t any special exception that applies uniquely to the ACA. What is different is that allegedly with the ACA (IIRC, this provision has not yet taken effect, with exception of children eligible for coverage under family policies), insurance carriers won’t be able to routinely deny or cancel coverage due to pre-existing conditions, as they do now for those who don’t have group (employer) sponsored policies. Yep, if you get diagnosed with an expensive illness, your private insurance will drop you like a hot potato.

    5. Lambert Strether

      That’s good, and I’m happy for you.

      * * *

      Thinking systemically (and I suppose like a Rawlsian?):

      1. It’s too bad the 26 million that won’t be covered aren’t going to be as happy;

      2. D partisans use stories like yours as a form of hostage-taking and emotional blackmail on policy;

      3. And D partisans, by taking truly universal care off the table, force the rest of into a Sophie’s Choice of killing this one person, or these other people.

      1. emptyfull

        Hey Lambert,

        I am not trying to serve as an Obama apologist. I was furious that he didn’t push a better bill through reconciliation, though my real split with him was after the HC bill passed and I realized how fully he was in bed with Wall Street (this site helped greatly with that, and I am grateful).

        But it is not just “emotional blackmail.” There are lots of people like me out there. I know many. I am visibly disabled so people always talk to me about their own health problems, insurance nightmares, etc. This is, in my understanding, a disability-rights issue. The “guarentee-coverage” provision won people with disabilities equality in terms of access-to-care. That’s huge for people like me trying to live productive lives in a system that has refused to account for the real lives of people with fallible bodies in every sort of way. This is an extroardinarily important marker in legal concept.

        So yes, let us please finally accept the reality of the ACA, defend what is good in it, fight against what is corrupt in it (I’m sure y’all will be all over it here, and I’ll learn much I didn’t want to have to) and keep trying to push our system in the right direction. This is an important step forward. I’m happy tonight. Please don’t tell me about the E.Z. Summit until tomorrow.

        1. JTFaraday

          All the foreclosure and other financial fraud there and you think your health care financing product is money good?

      2. LeonovaBalletRusse

        LS, not only that, but one Loophole is conspicuous: the healthy, young of 1%DNA can opt out of being “insured” under the system, and easily afford to “pay the tax” rather than the “protection money” to the HealthCareMafia, until such time as he/she can become insured privately by their 1% Corporate Employer, at “public expense” via “tax-exemption” largesse.

  11. readerOfTeaLeaves

    But it is a solution the market state would adopt. After all, you have a choice!

    This is probably the best analysis that I’ve read.
    As for Roberts, I assume he was more vested in legitimizing the tarnished SCOTUS than in the legal issues of the case. Perhaps Scalia’s hissy fits have helped him see the dangers a bit more clearly.

  12. PQS

    I recall when the case was first put forth thinking that this was going to be a Gordian knot for the Corpratists on the Court (the RWers and to a lesser extent the rest.) They’ve never met an extension of corporate power they didn’t like, which is pretty much the whole ACA, since it was a bailout for the completely rentier insurance industry, yet the ACA also contained some very mild restraints on corporate power (nullification of denial of pre-existing conditions, for example.)

    As usual, the Court sided with corporate power. Not without some major tantrums from Scalia, I imagine Thomas, and probably also Alito, who all seem to want to return us to the Good Old Days of 1690. Any tiny benefits such as those outlined above, IMO, are miniscule compared to the verification of the legitimacy of the Insurance Industry and their new mandated customer base.

    1. Anarcissie

      I believe they sit around and decide together what roles to play publicly, sometimes rather humorously, as in having Roberts’s ‘taxation’ joke decide the fate of the ACA.

      1. LeonovaBalletRusse

        Correct. NO doubt that Roberts was assigned this role strategically. The R.C. Court has been habituated to “just taking orders” from high priests in any disguise. They know how to roll over on command.

    2. Greg T

      Good comment. The industry still has a big problem. The ACA may buy the rentier insurance companies a little more time, but the essential problem is the unsustainable growth in health care costs. Without cost controls, more employers will disband their group plans, throwing people onto the individual market to deal with the rapacious industry cartels. Stuck in a slow growth, high unemployment economy, a large number of citizens won’t be able to afford even the IRS levy.

      The Supremes are cleverly trying to close the legal loophole for Medicare expansion, but it doesn’t matter. At the end of the day the Supreme Court doesn’t have any real power. If, as I suspect, we are headed for profound social crisis, the Court’s legitimacy, already tenuous, will collapse completely.

    3. Susan the other

      Did Colbert really describe Scalia as “four dead racoons in a black garbage bag?” Laughed so hard I wasn’t sure I even heard it.

  13. tar, etc.

    Taxes are fungible, so I see the $1400 fine-tax I pay in 2016 as doing my part to pay for the Syrian-Iran-WWIII.

  14. financial matters

    I actually thought this bill would be overturned as I don’t see it as a plus for the insurance companies. They are actually going to have to be more transparent and open their books, show how much is spent on administration, CEO pay, dividends/stock options etc vs actual medical care. And their new premium increases will be more controlled. These companies should also be run more like utilities.

    Medicaid is a tough issue and not a powerful bloc of people. But Medicaid does have negotiating power for the cost of health care services. Here state legislators will have to answer to their people.


    Eligibility requirements vary widely among states which is one thing that the health reform bill tried to address and the reason that states on the meager side of the coin or that want to decry Obamacare at any cost are calling foul…


    Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.


    Many states wanted to sue to stop the bill as it would increase their Medicaid spending. Many had eligibility requirements that were much below the proposed new standard of 133% of the poverty level and included other requirements such as having to have children.

    1. Tim

      Clearly you were not paying attention to the stock market when this law successfully passed. Anything Medical, especially insurance companies shot up and didn’t look back.

      The market knows how to smell the money and it’s said you’re wrong.

      1. financial matters

        The health care problem is amazingly complex but I think the insurance companies were having a pretty unrestrained ride pre ACA. Not even any limits on how much of their premiums they even had to actually spend on medical care?


        Health care stocks tumbled Thursday after the Supreme Court upheld most of President Barack Obama’s health care overhaul,

        Health care stocks fell 1 percent, led by sharp declines in insurers like UnitedHealth Group, WellPoint and Aetna.

        But hospitals had the opposite reaction, with stocks rising notably at Hospital Corp. of America and Community Health Systems.

        The reasons for the disparity weren’t clear cut.

        The health care law will require all Americans to carry insurance. So for hospitals and related industries, like companies that make surgical instruments or lab equipment, that can mean more customers.

        It also means more customers for insurance companies. But some of those customers won’t be as profitable as the companies might like, such as those who are already sick.

        Even with the ruling in hand, there’s plenty of uncertainty overhanging the issue. Small businesses aren’t sure how much money to set aside now that more of them will be required to insure their employees. The health care law also doesn’t address the overhanging problem of looming deficits in Medicare.

        “It’s not like we’re at the end of the road here,” said Gerard Wedig, a health care economist at the University of Rochester, “where our health care problems are solved.”

        1. Doug Terpstra

          See W.C. Varones’ link above on insider trading. This falls under the category of “buy on rumor; sell on news”. Insiders clearly got the signal resulting in a 6+% bump in HCA stock before the court decision was made public. They fell later with the overall market.

          Insider trading is illegal of course, but anyone could have predicted this one, knowing that the death-panel profiteers (aka insurance rackets) have Obama and the Supine Court on their payrolls. Even so, Varones’ chart shows instant market correlation just before the decision as strong evidence of crime. I’m sure the SEC and Eric Holder will get right on the case.

    2. LeonovaBalletRusse

      In sum, this SCOTUS verdict has opened the door to CHAOS. “Mission Accomplished.”

  15. Ned Ludd

    Last summer, Ezra Klein indicated that the long-term goal of the ACA is to “eventually migrate Medicaid and Medicare into the [ACA] system“.

    If Republicans can make their peace with the Affordable Care Act and help figure out how to make the Affordable Care Act’s exchanges work to control costs and improve quality, it’d be natural to eventually migrate Medicaid and Medicare into the system. Liberals would like that because it’d mean better care for Medicaid beneficiaries and less fragmentation in the health-care system. Conservatives would like it because it’d break the two largest single-payer health-care systems in America and turn their beneficiaries into consumers.


    So Bachmann is perhaps right to say that the president is moving us towards a day when ObamaCare – or, to put it more neutrally, “premium support” – might come to Medicare. He’s seeing whether it works in the private health-care market first and, if it does, there’s little doubt that the political pressure to extend it to other groups will be intense. The question is why Bachmann and her party are doing so much to stand in his way?

    Liberals, by embracing the ACA, have embraced making citizens into consumers and turning the nation=state into a market state.

    1. Walter Wit Man

      Ding. Ding. Ding.

      Great observation. That is indeed the end goal.

      The great unknown story the last few years has been how what you write about is already happening. Medicare has already been cut* and Medicaid is sort of being expanded in theory, but this will simply be the rationale to cut Medicaid more. So there might be more people qualifying for Medicaid but the service will be poorer.

      *These cuts go beyond the Medicare Advantage cuts, which are good cuts, and into substantive health care cuts.

      1. kelly

        Yeah, that appears to be the plan. I figure they’re figuring out how to fix their Scandinavian problem as we speak, too.

      2. LeonovaBalletRusse

        WWM, the Potemkin Finance Scene is set onstage while the curtain is down. When the orchestra and conductor are ready to play from the pit, VOILA! The curtain is raised, and “the play’s the thing.”

    2. LeonovaBalletRusse

      When they accomplish the same objective in Europe, the Universal Market State will trump all nation-states. “Mission Accomplished” indeed.

      1. LeonovaBalletRusse

        This will be the Universal .01% Rentier System beyond even Veblen’s imagination (couldn’t happen w/ technology of his day; today tech replaces troops and they don’t even have to blame larceny on “fat fingers” anymore). The Global .01% Reich owns the Universe, and the .99% Agents will serve the .01% until such time as they are deemed “too expensive. Then they fall into the set of those who cannot pay:

        When you cannot pay, you will be ushered into the Universal Defense/Security FEMA concentration camps to be fed until your organs, teeth, eyes, skin, fat, etc. are harvested to the utmost, before or after your “death.” Then your remains will be converted to “fuel” for the Rentier Class of the .01%.

        Such “efficiency” was beyond the imagination of Camus. (But not of Freud, who knew bed-rock “human nature”). So there will be no mercy, no apples laced with potassium cyanide for a quick exit. This is the “No Exit” even Sartre could not imagine.

        The Global .01% Master Race and their .99% Agents du jour: Monsters “PERFECTED” in human DNA. Is this what is meant by “the survival of the fittest?” This “breed” has evolved for a long, long, long time.

        “It’s a wonderful world.”

  16. LillithMc

    Health care in industrial countries is regulated much like utilities except in the US where they are private for-profit systems loved by Wall Street. We pay twice the price for half the care. ACA keeps the industry intact with some limited regulation. It gives the states much flexibility in how they provide health care purchases. The industry has a choice whether to make their services affordable for most of the US or continue raising prices and letting those without care die. The current course is unsustainable. Either we moderate the cost or we go to a “utility” national program (medicare for all) or we have the GOP “free to die quickly” program.

    1. James

      It’ll no doubt eventually be the latter. Remind me again, just why was it so many of us voted for OBummer? Not sure I can ever trust myself with the responsibility again.

      1. Art Eclectic

        Dude, we voted for Obama because Sarah Palin and everything she stood for scared the daylights out of us.

    2. econ

      As a Canadian I imagine there are many who despair that there was no single payer initiative from the beginning several years past. Given the comments, aside from LillithMc, concerning tax vs mandate, what do Amuricans want , free medical care?? The tax via IRS is to catch the free-loaders on the system and the mandate serves its purpose for payment of individual healthcare. Too much of the tax debate in the USA is ideological while corporations are identified as persons. What a mess in your governance via “checks and balances” structure. When Amuricans talk of “the best health care in the World”, that is really for the 10%.

  17. S Brennan

    What it means is the deconstruction of Social Security through the use of government mandated private annuities may proceed as planned.

    Meanwhile poorer/unemployed people will be fined for not buy buying high deductable insurance where even when the insurance pays [and it always tries not to] for a major illness the insured declares bankruptcy. Say you are making median wage of $26,364 [2010-HuffPo] and you have a minor heart attack with an average cost of 76,0000.00 USD [2010-CBS]. Assuming, your insurance pays [a big assumption on individual policies], your 6,000.00 USD deductable will be eaten up in one go [that’s where the good news ends], with an 80/20 split on the remaining 70,000.00 USD you will pay 14,000 in addition to the 6,000.00 for a total of 20,000.00 USD! Let’s you are 50 years old, you’ve been paying about 270.00 USD [CNN-2009] per month, or 3240.00 USD per year and lets say we split that in half, your out of pocket expense is 21,620.00 USD for the heart attack alone. That’s about 120% of your after payroll tax yearly income…off to bankruptcy court you go.

    If you own a house, you will lose it, because lost work time means you missed at least three payments, so our median wage “insured” heart attack victim losses everything under the Democratic “insurance” plan. Nice going guys!

    Not that everything is bad in the bill, it does improve around the edges, by enrolling more on Medicaid, instead of an estimated 60,000 needless deaths, we will have something closer to 35,000 needless deaths. That should thrust the US past 49th place [2010-Columbia University] in health care worldwide. But let’s be clear, by forcing additional costs onto states, who are already in financial straits, States are compelled to cut elsewhere. Gee, who do you think gets the short end of that stick? The 1 percent?

    Since the economic downturn in 2007 about 100,000 [American Progress] per week have lost their health insurance, if they have already lost everything, they can apply for Medicaid under this program, if not, they will be fined for not having insurance until they lose everything and can then apply for Medicaid. As the economy slowly improves [maybe not, we could be headed for another recession] these folks will have every incentive NOT to take work, because they would lose insurance and start paying the fine instead. Republicans will be sure to make hay out to this “free loading” and start hacking at Medicaid.

    This is what passes for wonkish “LIBERAL” health policy, no wonder the Supreme Court gave it a pass, it will gut liberal/progressive policy for the foreseeable future. When you see ignorant angry crowds of plebeians, egged on by Fox, wanting to string “Limousine Liberals” up by their necks, or voting “against their own interests” supporters of this monstrosity can be sure they played a vital role in the USA’s declining standard of living.

    Did I mention this does nothing to reduce the cost of Medical Care in the US, which is by a factor of 2, the most expensive in the world, which is the core problem? No? Sorry to go off topic, I know we don’t do solutions in the USA any more.


    1. S Brennan

      What a bunch of baloney,

      “This doesn’t affect Social Security or Medicare at all.

      “the statute reads more naturally as a command to buy insurance than as a tax, and I would uphold it as a command if the Constitution allowed it. It is only because the Commerce Clause does not authorize such a command that it is necessary to reach the taxing power question.” – Roberts goes on to say it is a tax for not purchasing a from private insurer.

      But in reality it is a fine on the poor for not having enough money to purchase an individual policy, or having lost the economic power to demand employer based health insurance. Coercion is Coercion if you can do this with one form of insurance [and SSI is insurance], you can do it with another…your supreme opinion [and nothing else] not withstanding.

      Now onto the next major falsehood in your post. Many states already have insurance pools, only the poorest of the poor qualify, most working poor are left out. If a non-profit [what the heck is Blue Cross…remind me a again] pool is all high risk individuals, [which is what it would be], where does the money come from?

      Let me restate, you seem to think that:

      Very sick, very poor people POOLED together to share the burden of health cost [even in a non-profit] is the answer.

      Why don’t you buy into that pool and let me know how it goes.

    2. Doug Terpstra

      “When you see ignorant angry crowds of plebeians, egged on by Fox, wanting to string ‘Limousine Liberals’ up by their necks …” … don’t just stand back, lend a hand and bring a rope.

  18. Mitsu Hadeishi

    I don’t think this ruling goes nearly as far as people seem to be thinking it does against the use of the Commerce Clause. The fact is, the Roberts opinion made it clear that regulation of commerce is still upheld; it’s simply using the Commerce Clause to require involvement in commerce which he saw as unconstitutional. This doesn’t affect Social Security or Medicare at all.

    Also, those of you who complain about Obamacare from a left perspective I think are missing a few crucial things in the law. It prevents insurance companies from spending more than 15% (20% in some markets) on overhead, including profit. Some might think those numbers are too big but they’re a strict, statutory limit on inefficiency and profiteering. Even the CEO of Aetna realizes this messes with their existing business model:


    Secondly, the law mandates that in every state there has to be a non-profit cooperative owned and run by the insured (by their members) to compete with for-profit insurers. If such a cooperative doesn’t exist, the Federal government is empowered to set one up. This is in many ways even better than a public option, because in most versions of the public option it could only cover the uninsured. But these cooperatives will be free to compete even in the employer market.

    This law is not perfect, but it’s not bad at all. It’s a big step forward.

    1. S Brennan

      What a bunch of baloney,

      “This doesn’t affect Social Security or Medicare at all.

      “the statute reads more naturally as a command to buy insurance than as a tax, and I would uphold it as a command if the Constitution allowed it. It is only because the Commerce Clause does not authorize such a command that it is necessary to reach the taxing power question.” – Roberts goes on to say it is a tax for not purchasing a from private insurer.

      But in reality it is a fine on the poor for not having enough money to purchase an individual policy, or having lost the economic power to demand employer based health insurance. Coercion is Coercion if you can do this with one form of insurance [and SSI is insurance], you can do it with another…your supreme opinion [and nothing else] not withstanding.

      Now onto the next major falsehood in your post. Many states already have insurance pools, only the poorest of the poor qualify, most working poor are left out. If a non-profit [what the heck is Blue Cross…remind me a again] pool is all high risk individuals, [which is what it would be], where does the money come from?

      Let me restate, you seem to think that:

      Very sick, very poor people POOLED together to share the burden of health cost [even in a non-profit] is the answer.

      Why don’t you buy into that pool and let me know how it goes.

    2. Ned Ludd

      A big step forward? Ezra Klein seems to think it’s a big step towards privatizing Medicare and Medicaid.

      Regarding the ACA regulations on the medical-loss ratio, we’ve seen how well Obama has enforced the law and regulations when it comes to financial fraud, torture, and warrantless wiretapping. And in the health insurance industry, there are plenty of ways to use creative accounting to get around the rule that limits overhead.

      Eskow described a number of ways that the industry could overcome the rules. He discussed a figure called “IBNR” – incurred but not reported medical losses. These numbers have some flexibility built into them. If the “unreported” medical losses are increased, the total amount spent on medical care would look bigger than the reality. Costs could shift across fiscal years as well, with more pushed into one year to make it look like the 85% number has been hit. Also, Eskow said, “They can – and probably will – reclassify some administrative expenses as ‘medical,’ rather than ‘non-medical.’ I’ve seen insurance companies do this in workers’ compensation. They’ll classify their own doctors, nurses, and medical paraprofessionals on staff as part of the medical expenditure in order to make their numbers look different and game the results.”

      Even worse, the rule could make medical care cost more, especially perverse since it will be the poor and middle class stuck with high deductible plans:

      Finally and perhaps most perversely, the MLR requirements could lead to higher medical costs throughout the system, or at least push the incentives in that direction. “The easiest way to maximize profit under an 85% rule would be to increase medical payouts,” Eskow said. “That’s obvious, right? If you can keep 15 cents in profit for every 85 cents spent on medical expenditure, spend more on medical. There

      If you have a high deductible plan, once you hit your deductible, you will have your claims denied – as I have personally experienced. “There are going to be a lot of denials,” said insurance industry analyst Robert Laszewski, a former health insurance executive. And if the past is prelude, now that liberals have their partisan victory, they will ignore all the people forced to buy insurance and then pushed into poverty when they need medical care and have their claims denied:

      The health committee bill would not explicitly guarantee consumers the right to an external appeal when a health plan refuses to pay for medical services.

      1. Ned Ludd

        I made a formatting error in my previous comment. The following should have been in a blockquote:

        “There are going to be a lot of denials,” said insurance industry analyst Robert Laszewski, a former health insurance executive.

      2. Capo Regime

        Oh no! The wisdom of Ezra Klein chief stenographer for Pravda on the Potomac! Even if he is correct–does it matter?

        1. Ned Ludd

          Ezra Klein is an insider who helped sell the the ACA to liberals. His article is important because – once the ACA was passed – he could be honest about the true intentions of ACA supporters such as himself: privatizing Medicare and Medicaid.

    3. scraping_by

      “It prevents insurance companies from spending more than 15% (20% in some markets) on overhead, including profit.”

      I’m reminded of the president of a pharmaceutical company who listed his limo and driver, remodeling his office,and other perks under “research” so he could claim his company was sinking millions in new products.

      With company-defined ‘patient care’ the field is wide open.

    4. tar, etc.

      Regarding coops, it’s not as good as it sounds. First, in Oregon anyway, the coop is not a “legal coop,” but an acronym for Consumer Operated and Oriented Plan. Second, the person who put it together in Oregon was an executive with Aetna and Blue Cross, so I’m skeptical as to how much of a real alternative it represents. Lastly, the non-coop is essentially a subsidy of a for-profit outfit in New York. This is the sole nontraditional insurance choice in the exchange being set up.

    5. Walter Wit Man

      Yeah, I actually agree with you a little here . . . maybe this isn’t the death knell for the commerce clause. I wrote the opposite above but I guess I overreacted on a first impression.

      I actually think the distinction about forcing someone to engage in commerce versus regulating commerce is logical.

      And I remember thinking Lopez was the death knell for the commerce clause.

    6. Walter Wit Man

      The percentage on profits is misleading because health insurance companies handle HUGE amounts of money.

      It’s like saying an armored car that hauls $100 Billion around a year only makes .001% profit because that truck only makes $100,000.*

      *I have no idea if the math is right but it looks close and you get the idea.

    7. LeonovaBalletRusse

      But “commerce” is a two-way street. This is “free trade” Victorian Reich style.

  19. Lambert Strether

    Revised IRS Form 1040

    Have you purchased the following defective products:

    [x] ObamaCare. If not, go to line …

    [x] 401(k). If not, go to line …

    [x] Food Security Insurance™. If not, go to line…

    [x] Thirst Prevention Insurance™. If not, go to line…

    There! See how easy? Social Security, food stamps, and public water utilities — all abolished!

    Not that I’m foily….

    1. K Ackermann

      My form asked if I wanted to donate $1.00 to Mrs. Paul’s Home for Battered Fish.

  20. dandelion

    Well, so much for shrinking the FIRE sector.

    What a nice massive surge of cash toward another industry that needed bailing out in 2008. I believe that the life/health insurance industry asked Obama for their own version of TARP in 2009 and Obama told them that given the reaction to the bankster’s TARP there was now way he could procure that for them. And then along came ACA.

    It’s important to remember that health insurance companies do not make their money via the loss ratio (premium in excess of claims) but via financial arbitrage, just like Jamie Dimon does.

    So ACA really is an extension of the 401K gambit — a way of channeling more of the population’s money to Wall Street.

    1. LeonovaBalletRusse

      dandelion – “financial arbitrage” is what separates “free trade” from a “utility” (which used to be called a “benevolent monopoly” over public services deemed BASIC).

      Now nothing is considered too BASIC for “free trade” resource extraction. The Declaration of Independence for the Private Groundwater Monopoly of the .01% is imminent, if not already in place behind the curtain to be raised shortly.

  21. Daily Kos

    Kos here. December 2015.

    Since December 2013, Five hundred ninety-seven thousand pieces have been processed by “the Health Care”, with no major incidents. The Health Care is experiencing record profits, however in light of observations made so far, the following technical changes are needed:

    The Kos van’s normal load is usually nine per square yard. In Kos vehicles, which are very spacious, maximum use of space is impossible, not because of any possible overload, but because loading to full capacity would affect the vehicle’s stability. So reduction of the load space seems necessary.

    The progressive goal from now must be to reduce the load space by a yard, instead of trying to solve the problem, as hitherto, by reducing the number of pieces loaded.

    Besides, this extends the operating time, as the empty void must be filled with carbon monoxide.

    On the other hand, if the load space is reduced, and the vehicle is packed solid, the operating time can be considerably shortened. The manufacturers told us during a discussion that reducing the size of the van’s rear would throw it badly off balance. The front axle, they claim, would be overloaded. In fact, the balance is automatically restored, because during “the Health Care” the merchandise aboard displays a natural tendency to rush to the rear doors, and is mainly found lying there dead at the end of the operation. So the front axle should not be not overloaded.

    Second progressive goal: The lighting must be better protected than now. The lamps must be enclosed in a steel grid to prevent their being damaged. Lights could be eliminated, since they apparently are never used. However, it has been observed that when the doors are shut, the load always presses hard against them [the doors] as soon as the Health Care sets in.

    This is because the load naturally rushes toward the light when darkness and the Health Care set in, which makes closing the doors difficult. Also, because of the alarming nature of darkness, screaming always occurs when the doors are closed. It would therefore be useful to light the lamp before and during the first moments of the Health Care.

    Third progressive goal: For easy cleaning of Kos vehicles after the Health Care there must be a sealed drain in the middle of the floor. The drainage hole’s cover, eight to twelve inches in diameter, would be equipped with a slanting trap, so that fluid liquids can drain off during the operation. During cleaning, the drain can be used to evacuate large pieces of blood and dirt.

    The aforementioned technical changes are to be made to vehicles in service only when they come in for repairs. As for the ten thousand vehicles already ordered, they must be equipped with all innovations and changes shown by use and experience to be necessary.

    Submitted for decision to the Kos Gruppenleiter II D, SS-Obersturmbannfuhrer

    Signed: SS-Obersturmbannführer Kos

  22. Capo Regime

    One wonders if ultimately the insurance companies and pharma will be subject to rate of return regulation? Nah–I bet they beat the market average and well they have to take care of stockholders……..

    1. K Ackermann

      Rate of return?

      How do you think they’ve been getting so rich? By showing a profit? How the hell are they going to charge more money next year for the same services or less?

      Be creative!

  23. Hugh

    It is important to note that all government spending and taxation have as their purpose the social welfare. In our kleptocracy, however, this has been perverted into opportunities for looting society and channeling wealth to elites and kleptocrats.

    Roberts wrote the opinion and the majority was comprised of Roberts, Ginsburg, Breyer, Sotomayor, and Kagan. I want to underline this because the opinion is very much a victory for the corporations and illustrates the corporatist nature of the so-called liberal wing of the Court.

    With a Roberts’ opinion, I expect it to be well written with good documentation, and legal thinking that looks superficially good but on further consideration is trite and reflects his political biases.

    That said, Roberts is correct that both the government’s Commerce Clause and Necessary and Proper Clause arguments fail. Obamacare sought to force a group of Americans (the uninsured) into commerce (buying insurance). Its intent was not to regulate commerce but, first to create commerce and then regulate it.

    The Constitution gives Congress the power to do certain things in certain areas of the national life. The Necessary and Proper Clause is the grant of Constitutional authority to write laws in those areas. This is where things begin to go haywire in the Roberts opinion. Roberts could have just said that if the Commerce Clause is inapplicable with regard to the individual mandate, then its enabling legislation goes by the boards as well. Or put more simply if Congress doesn’t have the authority to write legislation in a certain area, then it can’t write legislation in that area.

    But Roberts says something tellingly different. He says yes, the individual mandate is necessary to Obamacare but its mandatory nature is not proper to the enumerated power of Congress (I would assume this means the Commerce Clause) to write legislation in this area. Again this statement is superfluous because Roberts has already thrown out the Commerce Clause argument, unless Roberts means to go somewhere else with it. And he does.

    Roberts, you have to understand, is a past master of the sophistic argument. He needs a justification for the universal application of the individual mandate, and he finds one in the Taxing Clause. He does this even though he acknowledges that the Affordable Care Act law specifically calls the penalty for not buying insurance a “penalty” not a tax. Not to be hindered by anything so minor as the black letter of the law, Roberts says forget what it’s called. If it acts like a tax, that is the IRS collects it, it’s a tax. That the purpose is to force people to buy insurance is, for Roberts, beside the point.

    Now consider this a minute and the sophistry behind it. Roberts thought that the mandate’s universal application (and penalty) under both the Commerce Clause and the Necessary and Proper Clause represented a vast and inadmissible expansion of Congressional power. But call it a tax, have the IRS collect it, and he has no problem with it. Under this kind of reasoning you could penalize anyone for almost anything. You could penalize all voting age adults for not having a photo voter ID, tea drinkers for not drinking coffee, cat owners for not being dog owners. If the purpose doesn’t matter, which is Roberts’ position, there really is no limit to this. Any group could be penalized for not behaving like some other group.

    Nor do I think subtracting out the purpose of the penalty is accidental or incidental for Roberts. The whole rationale behind the mandate and its penalties is to force people to buy a product from a private corporation. And no, this is not like car insurance. It is not saying that if you drive, you must have insurance. It is saying that even if you don’t own a car, even if you don’t have a license, you must still buy car insurance or face a penalty. You see the characterization of the individual mandate penalty as a tax is completely at odds with its purpose. The tax is being levied against those who do not or refuse to engage in commerce with a private corporation. What kind of a tax is that?

    I need to do some things now so I can’t get into the issue of Medicaid expansion in the states at this point. I would just note that while Roberts is OK with vastly increasing the government’s power over individuals, he takes exactly the opposite view with regard to the states.

    1. ds

      The problem with that argument is that it rests on floodgates and floodgates alone-the law by itself and the penalties it imposes are entirely reasonable. As Roberts noted, an individual making 35k a year would face a penalty of 60 dollars a month if he were to opt out of a 400 dollar a month insurance premium. And considering that this same individual still could not be denied coverage if he later decides to opt in, one could hardly call THIS law draconian.

      Furthermore, the alternatives to the law such as Swedish-style socialized medicine, would all be permissible under the supposed action/inaction dichotomy conservatives argued for, even though those alternatives would involve a far greater degree of government intrusion than the current law allows.

      1. Eureka Springs

        Of course I can call it Draconian. You, sir, are caught up in an inhumane, entirely unnecessary ponzi scheme.

        SIngle Payer or Tri care for all. Much less expensive and far more humane. Just because the D vs R BS refuses to feature the best film doesn’t mean it doesn’t exist.

        Lambert posted this fine fact filled link recently. Among them proof we already pay more than enough health care taxes to provide care for all today.


        1. Up the Ante

          “Among them proof we already pay more than enough health care taxes to provide care for all today. ”

          /Draco Corporate Psy-Ops

      2. Walter Wit Man

        Will he be responsible for paying the medical bills? I’m guessing he pays his “tax” to the government and will be given treatment but will have to pay out of pocket because he isn’t covered?

        So this person can afford to pay his $60/mo tax as long as he doesn’t get sick. He’s not paying for health care, it’s just a tax, right?

        Many of these people are better off under the current system and declaring bankruptcy if the worst happens. Many of the people in this situation are not doing it by choice. $400/mo. to someone making $35,000 year is a lot.

        My prediction is medical debt will be made non-dischargeable in bankruptcy like student loans are. Obamacare and this decision will provide the rationale for that rule.

        1. ctct

          ‘no bankruptcy for little people’ act of 2014/ along with the ‘internment/forced labor for failure to pay student loans’ act of 2015 and the cherry on top ‘the medicare ‘modernization’ act of 2016′

      3. Walter Wit Man

        How will socialized health care involve more government intrusion?

        Here’s one idea I have for socialized health care: primary health care in public schools of a certain size.

        It seems like this may be an efficient way to provide health care for children. I don’t know how that is any more intrusive than our current system for providing care to children. Children could be seen without having to take much time from school and will have much easier access.

        I personally think a hybrid single payer/socialized system is the way to go. So maybe these clinics would be optional, or you would have to go there do get basic blood work done, etc., but if you wanted a primary doc of your choice you could have a single payer system to do that.

        Would one doc or nurse practitioner be able to serve 150 students, say?

      4. scraping_by

        The alternatives to the law such as expanding Medicare to all ages would delight them as much as it delights my Mom and her friends. The most satisfactory, efficient medical plan in the country.

    2. LucyLulu

      I haven’t read the opinion but the way health care is currently structured and will remain structured under ACA, opting out of the health care system is not an option as long as emergency care is guaranteed. Therefore somebody who pays the penalty tax is paying for and receiving a product, emergency care, that currently somebody else would be paying for, mostly the government, ie taxpayers. Having worked as a nurse for 30 years, I’ve yet to meet the patient who opted to refuse life-saving treatment due to lacking insurance to pay for it, anymore than somebody can opt out of having a car accident. And while somebody making $35K/year might be billed for the services (not sure about that), if those bills run six figures as easily happens in emergency care, it’s unlikely the bill will be collectible.

      I don’t like this bill because it does nothing to address the primary issue of out-of-control health care costs, is inadequate in addressing the uninsured, and is a gift to healthcare industries. I don’t understand why we must reinvent the wheel when we have far more successful models across the pond upon which we can draw upon, including possibly the most effective and popular government program to date, Medicare. However, I think some here have allowed their imaginations to get the best of them. Medical bankruptcies account for 50% of all bankruptcies, and most of these folks HAVE insurance. Insurance companies and bigPharma already rule the landscape and decide what care we receive. All in all, the ACA is no worse than the elitist and corrupt overpriced monstrosity we already have (best care in the world if you can afford to pay out-of-pocket), and some provisions take steps in the right direction. We don’t even have the physicians to treat the entire population. My hope is that enough controversy has been stimulated that the ACA can be used as a drawing board upon which a more comprehensive, compassionate, and cost-effective solution can ultimately be derived. Call me Pollyanna if you will.

      1. Nalu Girl

        Agreed, we should have gone with one of the overseas models of healthcare, but given with what there was to work with I thinks it’s the best we can do for now. I would like to see a provision that if someone opts out of partipating and pays the penalty, they should also have to sign a binding document that they will only receive care, for example ER care, if they pay up front.

  24. Conscience of a Conservative

    Interesting decision. On a a practical requiring Americans to get health care from a national insurance stand-point makes a great deal of sense, with regards to the commerce clause and the constitution it did not make sense at all, and by virtue of the taxing powers of the United States made no sense and came off as a decision in search of a justification. That said its quite clear we’re more polarized than ever as a country and just about every action on the left or right proves it.

  25. mac

    The move by SCOTUS is called expediency, yes the Commerce cause use was unconstitutional, but the end of the entire bill this far into it’s life was a mess in the making, sooo they found a way to at least make it sound legal.
    It seems to me that that act turned SCOTUS into a legislative body, not what it was planned to be.

    1. Conscience of a Conservative

      Robert Reich described Robert’s decision as “convoluted constitutional logic” and then said his motives for that decision lied elsewhere.

    2. LeonovaBalletRusse

      mac, right: they “made law” on the fly. But they screwed up. Dim bulbs.

    3. LucyLulu

      I disagree. SCOTUS did not legislate anything. Instead Roberts went to considerable lengths to abstain from interfering with Congress’ Constitutionally delegated legislative powers, which possibly was at least partial motivation for the ruling. Strictly legally, it was a quite clever ruling whose implications (and wisdom, peut-etre?), for that reason if no other, I suspect will become clearer over time with further unrelated decisions, and depending upon the high court’s future nominations (a couple of them are as old as molasses, or look it).

  26. Fiver

    Hurray! No, not for this ugly horse-trade, logical mash of a decision, and not for the go-ahead just given the developed world’s most obscenely profitable/expensive, least efficient and almost certainly for the typical individual least effective health care plan, but rather the reference to Bobbitt.

    Bobbitt and others of his stinking ilk, the elite crust sitting atop the US (and subordinate nations’) permanent policy establishment, have explicitly set out to produce the intellectual and policy framework for precisely what has been unfolding virtually unopposed in front of our eyes over the course of the last couple of decades – that policy is quite simple: the previous post-War US Empire (i.e., the “West”) based on a “first among equals” of “nations” is quite consciously being subsumed by an US-anchored globalist corporate superstate free from sovereign, democratically driven regulatory constraints, including US sovereign restraint with respect to “corporate” activities, with US control of markets and military power as global enforcers. Maximum power and freedom for corporations and individuals with money (THEY are Bobbitt’s “market”) against a vanishing “public” interest even in theory.

    The “best and brightest” have told us all along what they have intended to do, but as has typically been the case since the creation of mass culture, nobody but the elite policy players themselves and a few losers like me on the “fringe” thought it as important to follow as the next toy roll-out or another ode to Heroes bombing children.

    I know most on the traditional “left” decry “nationalism”, yet only via existing sovereign institutions is there any capacity whatever for mounting any sort of serious counter-attack to this intensifying global corporatist nightmare. Which is why I cannot for the life of me understand, for instance, why anyone thinks creating some bogus “United States of Europe” is anything other than a major defeat for the public interest everywhere.

    Did anyone seriously doubt this outcome? Does anyone seriously think the US will fall off a “fiscal cliff”? Not a chance. None.

    1. amspirnational

      The actual historic traditional left was and is nationalistic. The inauthentic modern dominant quasi-left is anti-national.

        1. different clue

          Didn’t nationalism in Europe begin as a middle class liberal reaction against rule by hereditary royal families in Europe? If so, it didn’t start out being authoritarian and right wing, did it?

    2. LeonovaBalletRusse

      Fiver, we are the “military enforcement” power but NOT the Boss.

      As I asked before even seeing the blank stare on Cameron’s lying face this AM, WILL the population of “Great Britain” OCCUPY the City with torches, ropes, etc? Where is the muscle of the Dispossessed Oppressed in Scotland, Ireland, Wales, Cornwall, Greater England?

      1. LucyLulu

        And who appointed us to the role of “military enforcement”? Was it a self-appointed role? I don’t recall a vote. I don’t believe it would muster popular support among the general electorate (though our Congress critters, ex-Ron Paul, will support any military endeavors enthusiastically). The Constitution certainly doesn’t endorse the above, we are only to defend against attacks by foreign nations.

        Do you think that we, or any nation, could fulfill the role of (unconstrained) “enforcer” without becoming “BOSS”? Who can make a credible demand of a military larger than the rest of the world’s combined? At least until that nation, like the ancient Greece that laid the groundwork for our great democracy, exhausts their available resources (incl. goodwill), enforcing.

  27. JGordon

    This is an excellent ruling by the Supreme Court. Because of it I have totally and completely stopped caring about what happens to America.

    When the taxes on Roman peasants became too onerous, the peasants simply walked off the land and joined the poor in the cities so they could get their free bread and circuses. That is an excellent lesson from history that all should take to heart. For myself, I am in the process of reducing my income so that I can apply for the numerous government benefits available to aid the poor people. I have calculated that after getting on the government dole, not only will I work a lot less, but I’ll also have a lot more free income to spend on things I like.

    And for those who are looking forward to the total economic collapse of America, this also significantly hastens that. Who could possible be unhappy with this Supreme Court desecion? (That might sound like sarcasm, and if so I apologize. That is my honest evaluation of the sitation after thinking about it for a bit.)

    Buy some rabbits, start growing a productive garden, and stock up on solar panels and ammo. You’re going to need them.

    1. Capo Regime

      J Gordon this is brilliant. Seriously the best way to deal with the monstrosity of that is the U.S. is to literally check out, go on the dole or ebt and just sit around. It would be a peaceful type of strike if you will. Frankly, most jobs are rather pointless and doing nothing and getting benfits not a bad way to go. Hell freaking out at work and leading them to think you are nuts is probably a good start to get home and get even SSI disability. You really are on to something here…..

      1. Capo Regime

        A sort of slacker revolution if you will. No violence or even protesting. No leadership or manifestos. Basically we all stop giving a shit and figure out ways to become dependent on the state and ultimately drive it into the ground. While we wait we work out, learn to grow things, play guitar or anything that suits our fancy. File lots of lawsuits to clog courts, ask for any and all government help, tie up all the government phone lines and websites,….I bet if just 20% of the working population checked out the thing would end in 90 days….

        1. SR6719

          Or a Bartleby (“I’d prefer not to”) revolution!

          From “Bartleby the Scrivener” by Herman Melville

          Bartleby is working for this guy and one day, when asked to copy something, Bartleby answers, “I’d prefer not to.” From then on, he just keeps saying “I’d prefer not to,” until he’s finally fired, bodily removed from his cubicle (where he’s been sleeping), and later arrested.


          1. SR6719

            An outright refusal such as “No, I don’t want to” or “I refuse” could be seen as a challenge and provoke a violent response.

            Instead Bartleby’s formula “I’d prefer not to” works as a strategy of resistance by remaining calm, composed, rational and by taking these “desired” qualities to a radical extreme.

            Deleuze wrote something about Bartleby’s formula of resistance (I think it was called “The Formula”) and I was going to link to his article, but for some reason wasn’t able to find it.

          2. Walter Wit Man

            That’s a great reference! That’s the perfect tone and response. And the boss does a really good job acting with smug expectations.

            I wonder if Bartleby was asked to write down a legal opinion that even his conscience couldn’t abide.

            I wonder if there are any scriveners serving the Court now who would prefer not to.

          3. Up the Ante

            Now, now, SR, let’s not encourage the AIDS-conspirators with such invocations !

        2. Up the Ante

          “A sort of slacker revolution if you will. No violence or even protesting. No leadership or manifestos. Basically we all stop giving a shit and figure out ways to become dependent on the state and ultimately drive it into the ground. ”

          .. yes, yes, Capo, you have coined the day! Could the Justice Dept. and its sundry lackey employees be better charaterized ??!


      2. Art Eclectic

        Even better yet, go commit a crime! Free housing and free food. The bigger the crime, the more benefits you get!

        1. JGordon

          I don’t think so. It’s far more expense to house me and feed me into the style which I am accostomed thank you.

          And because of Obamacare you will. You will. Thanks so much for your generosity Art Eclectic. Hopefully you are an especially productive member of this society. You’re performing a valuable service for the criminal kleptocratic elites and the poor who are being bribed by them alike.

      1. Ms G

        And Corrections Corporation of America is licking its chops and rubbing its hands waiting for that giant revenue stream that’s about to whoosh in with all the new “things” (see “Daily Kos” post above)that can’t make a go of life in Kleptocracy.

    1. Lambert Strether

      Glibtarian shills have ceased to amaze me.

      1. Nobody “pays for their own” until the health care needed is done. Half the medical bankruptcies (the number one cause of bankruptcy) are from people who are insured. So “I paid for my own” really means “I paid what I thought was enough until” — [flips coin] — “the insurance company screwed me.”

      2. Health care as a market has tremendous asymmetries because patients tend not to be doctors, dig? So the Randroid answer to everything — “the magick of the mawketplace” — fails, exactly when, since lives are at stake, it should succeed.

      3. Randroid “every tub on its own bottom” models of self-financed care, even leaving aside the idea that they’re just handing over money to rentiers to loot, is… Well, it’s stupid. Working people invented insurance exactly because risk has to be spread. “An injury to one is an injury to all”…

      1. LeonovaBalletRusse

        LS, most if not all M.D.’s have a “professional pact” to treat other M.D.’s and their families “for free,” as a “professional courtesy. They are out of the fascist loop.

      2. LucyLulu

        A few comments, r/t some pet peeves hit on:

        The insurance industry has built-in perverse incentives. The less product (e.g. medical care, car repairs) they provide to customers, the more profits they make. They make money when they don’t pay your claims, which they are not hesitant to take advantage of. Those who don’t routinely research denied claims or services against their policy should. I’ve been with almost every major company and they ALL play games with inappropriate denials, either intentionally or erroneously.

        LS, I agree about those who say “they pay their way”. There but for the grace of God walk them. They have been fortunate enough not to experience a catastrophic health event. In 1995 I had Humana PPO with a $4000 out-of-pocket cap (I remained in-network except for some ER care, which they attempted to erroneously charge off as out-of network….. e.g. as if I could have shopped around for radiologists) when I suffered a serious accident that cost Humana low six figures when all was said and done. My out-of-pocket expenses were $20,000 (yep, $4000 OOP limit, not all expenses count towards OOP). Had I not reviewed every claim and disputed the numerous claims that were adjusted wrong, OOP would have been at least double that. We were fortunate that we had money set aside. I’m cheap, live below my means, and squirrel it away. And my expenses weren’t THAT high. They can run to 7 figures.

        Humana also wanted to send me to a nursing home for my six weeks of physical rehab, told me my policy would not cover a spinal cord injury rehab center. That was wrong as well, and I’m positive I wouldn’t be walking today had I not requested the hospital SW to look into it (and my neurosurgeon gave them hell), esp. since it was predicted I’d never walk again anyways (but walked out of rehab, using walker, not anymore). Rationing? You betcha its already here. Has been since I started nursing in 1979. Patients are not told though that the presented options only include what insurance will cover, or that prescriptions are being changed before being filled to accommodate insurance formularies.

        The same accident left me, at the age of 37, permanently “uninsurable” unless through an employer plan. One state had a high risk pool, maybe 10 years ago, where I could have purchased mediocre coverage for $2000/mo. (single coverage). I’m lucky that I applied for SS disability immediately after my accident and was one of those rare, lucky ones who was approved on first app. That got me Medicare. Even though I’ve returned to jobs with emp. coverage and had my disability checks terminated for long periods of time, I don’t let my Medicare lapse, not for $100/mo that it costs, so that I can keep insurance for times like now. Since GFC, nurses are in low demand here……. an old nurse with tottering gait, impressive resume or not, competing with 20 young perky (and inexperienced) ones gets the “you must be kidding” raised eyebrow treatment). Knock on wood my medical expenses have been quite low the last few years. But one catastrophic event could bankrupt me. You don’t even get off cheap with Medicare, trust me, its hardly the federal BCBS plan, but its the best deal out there by far. I don’t want live on the dole, and I can’t count on being able to work.

        I’d say to those who are “paying their way” the same thing I tell myself. No particular talent or virtue separates those who can pay and those who don’t. What separates the two groups is nothing more than luck. I’ve learned how that luck can change in less than a second. How many people could suffer an accident like Christopher Reeves and “pay their way”? And having taken care of those who survive on state benefits, don’t delude yourself that its any life of luxury, and don’t believe what you see on TV. They don’t have cars or fancy clothes and jewelry, and looters are the exception, not the rule. (Most are white, too.) Instead you find kitchen cupboards and refrigerator bare 3 weeks into the month, and no means of transportation to a food pantry…..at least the ones I’ve worked with — When in KY in 90’s, some lived in homes with no indoor plumbing…. but rent for 4BR home complete w/outhouse was only $100/mo! $23K for a family of four would definitely have been at least middle class. Seriously though, its a disgrace that a wealthy nation such as the US would not only tolerate such levels of poverty, but ensure it passes onto subsequent generations. They don’t lack the moral character or ability or some other superior qualities of the “pay for myself” crowd. They only suffer the poor luck of not having been given (or born into) the resources and opportunities to pay for themselves, along with a break or two.

    1. Walter Wit Man

      Here’s the relevant part:

      “The biggest losers are Medicaid and the poor. Very quietly, the Affordable Care Act introduced a revolutionary change: All poor people in America would get Medicaid. The new law would have extended Medicaid to everyone with incomes up to 133 percent of the federal poverty line ($23,050 a year for a family of four). Aren’t the poor already covered? That depends on where they live. In New York, most adults up to 150 percent of the poverty line are covered; in Texas, Medicaid reaches only to 26 percent of the poverty line — a family of four is not eligible if they earn, say, $9,000 a year. The court ruled that Congress may not require states to expand Medicaid. States can stick to their old Medicaid programs. Stingy states may choose to stay stingy. That part of the decision flew under the media radar. But it is a significant blow to liberals who had a simple way to grow benefits by expanding programs.”

      1. Walter Wit Man

        Family of 4 making $23,100 = not poor

        And so no Medicaid for them but they will get to be one of Obama’s lucky winners!

        Not to mention applying for Medicaid is very demeaning and the system assumes you are the criminal and often has arbitrary or unjust asset rules for qualifying. They basically will make you liquidate to qualify. Which is the goal. That’s all this is about. This is about our masters harvesting us for profit.

        1. tar, etc.

          This has been totally ignored. Those falling from the middle class who look for help are instead blamed. Medicaid is means-tested, so to qualify you will first be liquidated.:

          “That’s all this is about. This is about our masters harvesting us for profit.”

          The Obama plan claims 30 million uninsured will be covered, although some estimate closer to only 16 million. That is an admission that 20 to 34 million are going to be taxed for being uninsured. Income tax is progressive in that you pay based on what you earn. This tax will be levied no matter your financial circumstance.

          1. LeonovaBalletRusse

            As American GI prisoners of war were kept in pens as cattle for “meat” harvest and cannibalistic consumption by the Japanese (truth only recently revealed), so will the “poor” be kept in FEMA camps as slave labor, and as “organ provision,” as “meat” for consumption; and THOSE FATTENED UP by Fast Foods will have their FAT liquified for “cheap FUEL” in place of “peak oil.”

            Bones can be ground into Soylent Green.

            Can’t “pay your way” in USA!USA!? See your fate. You got a problem with that?

        2. LucyLulu

          No. With SCOTUS ruling, that family of four may not now get Medicaid, depending on state. If they live in Texas, they can only earn $9000. In NC where I live, a single adult may have income of ~$12K and assets of ~2K, not incl home and car. However, they must also be deemed disabled by SSA or elderly. I could have sworn that disability/elderly/minor was a requirement in all states for Medicaid eligibility, along with limits on income/assets. The ones I’ve helped to apply, burning through assets was not an issue. They had none, hadn’t for long time, if ever. I’ve had two clients who owned their homes, one inherited theirs (worth $80K), he also had a non-running vehicle, the other was elderly, had bought home 50 years ago (home worth $30K, no, not typo … when heat, which leaked fuel in kitchen while my client sat and smoked at kitchen table, didn’t work, as often did not, they ran oven with door open, and we found the couple money to fix some structural rot of floor to ceiling between kitchen and only BR…….. husband and wife both worked all their lives in now defunct textile industry, and both had serious medical issues). With a good attorney and advanced planning, assets can be structured (through trusts, for example) such that Medicaid eligibility can be maintained while still having access to assets. With money, you can do anything you want.

          To posters below,
          While I’m no fan of the ACA, I’m equally no fan of those who complain of overtaxation. I find almost invariably those who whine the loudest are those who can most afford to pay more and historically have paid much more. The income tax is only one of many taxes we pay and is the only tax with progressive rates. What if our parents had taken the same philosophy of opting out of the system when marginal tax rates were 70% and even higher? Yet, those were our most prosperous days. Now we have rates topping out at 35% and effective tax rates coming in much, much lower due to special privileges available to many in the top bracket.

          *Yes, I pay taxes, plenty of them, for 40 yrs now (as this is when often responses are posted that obviously I must be one of the freeloaders).

          1. LeonovaBalletRusse

            LL, when North Carolina starts seeing Texas’ rejects, they may change their rules. This is going to be the Great Chaos of “State Medicaid Arbitrage” — greater than the State Corporate Tax Arbitrage we see today.

      1. kemo sabe

        While a lot of people will die of the treatment that includes unnecessary procedures, poorly research drugs that affect other bodily functions while purporting to treat one and simply from becoming penniless and heavily in debt when the system discards them (as they’re wont to do) like a used rag.

      2. Nalu Girl

        I assume from your comment that you will not get health insurance, and then when you get sick or get injured in an accident, you will, of course, refuse to be taken to the ER because you will not want the rest of us to pay for your care.

        1. Walter Wit Man

          Yeah, I’m sure that’s what he’ll be thinking about.

          As he’s in and out of consciousness in the ambulance, hoping that everything will work correctly and that he will indeed live, he’ll remember that he doesn’t have health insurance and then think about that comment he got on the internet that reminded him what a burden he is on society, and then I’m sure he’ll tell the technicians applying the IV drip and the crew speeding to the hospital:

          “Hey fellas. Just pull over and let me off. I’m racked with guilt. I don’t have health insurance. I’ll do the honorable thing. I don’t want the paying customers to feel like they got hosed, that they had to ‘pay’ for me. Just let me off here. I’ll limp home if I can, or maybe lay in the woods if I get sleepy.”

          1. JTFaraday

            That’s what I think every time I don’t use my health care financing product–“I don’t want Nalu Girl to have to pay for this!”

        2. JTFaraday

          When someone “goes to the emergency room without health insurance” they get sent a bill.

          Now piss off.

          1. Nalu Girl

            And they usually don’t pay it. It’s been shown that one of the reasons hospitals costs are so high is that they are subsidizing the costs of uninsured people who use them as a doctors office.
            By the way I DO pay my own way. And don’t you all recognize sarcasm when you see it?

          2. JTFaraday

            If ggm can’t pay his/her health care financing product ponzi scheme, and you can’t pay your medical bills–out of pocket like a big girl, instead of socializing the costs and offloading them on everyone else–then the two of you are even.

            Except that you’re a hypocritical moral scourge.

        3. JTFaraday

          The real underlying question here is why won’t Nalu Girl just pay her own medical bills like a big girl in first place?

          ggm saying his/her health care financing product costs too much money is just an extension of Nalu Girl’s original personal irresponsibility.

        4. Ms G

          We can have a conversation about people fretting about Nalu when en route to the ER two years after Obomney/Robama, Senators and Congresspeople have been mandated to buy their health insurance policies in the private market and duly experienced the process which they have now subjected take or leave 26 million Americans.

          Until then, go away.

        5. Lambert Strether

          I am happy to pay a small fraction of my taxes so that unlucky or poor people — or vicious and stone-hearted people, or even libertarians — don’t lose their lives and go without medical care.

          It’s the price of civilization; I realize that the 1% and their shills don’t agree with me. But such is life!

          NOTE To be fair, there’s something to be said for the libertarian critique, just as there is for the anarchist critique, but this going Galt crapola just pins the bogometer.

      3. LeonovaBalletRusse

        Right, you die of lack of health care, which Insurance Middlemen ensure. These “Healthcare Agents” of the .01%, by standing in the way of health care for the poor, ensure “cost savings” (by genocide of the poor) to the Corporate “Market” State of the 1%.

  28. Lambert Strether

    A must-read on the ObamaCare decision. What I reverse-engineered out of the coverage, BTD arrives from a reading of Ginsberg’s dissent:

    Justice Ginsburg is much too sanguine here. The Roberts five will tell them in later cases. The undoing of the New Deal must begin somewhere. This is not the end of the Roberts five assault on the New Deal. It is only the beginning. ….

    With no need to even opine on the Commerce and Necessary and Proper question, Chief Justice Roberts has written an unfathomable opinion whose motive can only be the laying of groundwork—the groundwork to undo the New Deal.

    Look out!

    Shorter: “Progressives” cheer Roberts as he begins to demolish the New Deal.

    1. Walter Wit Man

      You know, I agree that the Court will assist in dismantling the welfare state and imposing austerity . . . but there need not be any constitutional problems if the Democrats approached this differently.

      Everyone seems to admit that Medicare and Social Security are constitutional. These are legal, time-tested, and admired programs that easily could be expanded.

      I wonder if the Roberts Court would have the courage to strike down a Medicare for All act on constitutional grounds–it would be such a bizarre theory and reek of political motivation I think they would be hesitant to do it.

      But the elite have figured out its much easier to suck us into this debate about Medicaid and Obamacare and insurance law, etc. It really makes things complicated to have this policy fight on so many different levels.

      Scrapping everything and doing a single payer/socialized system is so obvious, simple, and effective our masters have to work really hard convincing us this is not possible.

    2. LucyLulu

      I don’t understand why Roberts is being blamed. He didn’t pass this legislation. Our president and Congress passed it. Because he allows the states to opt out of the Medicaid expansion if they don’t want to play by the rules, without losing all federal Medicaid funding? As much as I’d like to see more people insured, can readers not foresee how dangerous the use of such a coercive practice could be? The federal government could use state funding to blackmail the states into compliance with most any of its policy preferences, including draconian austerity or intrusive ones.

      Unfortunately, there are huge political obstacles blocking the path to universal health care. I predict that when and if such legislation is passed, SCOTUS will be a non-issue. Meanwhile, the House will vote again to repeal Obamacare. Issa can pursue Fast and Furious while allowing Dimon and Corzine and others to skate. Decide which programs for the needy to raid to pay for the others (the corporate needy don’t require such pay-fors). Or they could pass some more jobs, jobs, jobs (translation: abortion) bills. They have nothing better to do.

      The ACA is bad policy. We can thank our corrupt politicians who allowed the insurance and pharmaceutical industries to write the bill for what we got stuck with, along with ongoing propaganda (lies) that socialized medicine is inferior and a loss of freedom (due to inherent right to choose one’s looter, though paradoxically, no inherent right to health care required to be looted). SCOTUS rules on constitutionality issues, or is supposed to, not whether legislation is sound or will be beneficial to the public.

      The dismantling of the New Deal is already well underway.

  29. Hal Roberts

    Old Jim De Mint wants to make S.C. Opt out of the Health care plan so all us trailer park trash will have to move out of his Centrist Utopian State; if poor people Not ON Welfare need to go the doctor they will need to move to a State where they can get Health Care or die for Jim’s Morals. Good way to run all the undesirables out the State ain’t it Jim. If I understand this HC law State’s have the right to opt out.?

    1. LeonovaBalletRusse

      Hal, this is WAY easier than it was for Hitler to move the Jews to Madagascar.

    2. Ms G

      Is this where the domestic “anti dumping” wars among dumper and dumpee states begins?

      The Civil War in America’s Age of Kleptocracy?

    3. LucyLulu

      To make sure it’s clear….

      States may opt out of the expansion of Medicaid. They will still be required to administer their existing Medicaid programs, under existing rules. The consequence of opting out is the loss of additional federal funding, and the benefits they would provide…… more people insured, more clinics, programs, workers, etc.

      There were three possible options with the expansion. The most popular option, with four judges voting, was the option to 86 the entire expansion. Ginsburg and Sotomayer changed their votes, from upholding expansion in entirety (i.e. states would lose all Medicaid funding if opted out), to the final majority option.

      The rest of the ACA is unaffected. For example, SC residents will be required to buy insurance or pay tax unless below certain income.

  30. James

    And now the political take on this decision (I apologize if someone else has already covered this ground):

    Romney raises $4.3 million after Supreme Court ruling on health care

    Forgive me for saying it, but he political cynic in me can’t help but wonder if this wasn’t part of a larger strategic plan all along. This decision will most definitely energize the Repube political base either way. In a close race – which current polls say is what we’ll have – it could easily be the difference maker. I run with a pretty liberal crowd and actually work for a health care clinic, and my informal in house “polling” doesn’t suggest a lot of support for either the law or the decision.

    1. Ms G

      I had assumed that republicans would be really confused at this point — their man’s signature insurance scheme was just passed by their Democratic Devil (and judicially approved by republican friendly Supreme Court). Who was I writing a check to again?

  31. Aquifer

    From a link in Lambert’s riff in Links:

    “Rep. Raul Grijalva (D-Ariz.) said Thursday that the Supreme Court’s decision to uphold the constitutionality of President Barack Obama’s health care law means progressive lawmakers won’t be pushing for a single-payer option anymore, though the concept will live on in their minds.”

    Well, there you go – decision on the bill (like the bill itself) seems to be working as planned – put the scotch on single payer ….

    1. Walter Wit Man

      No. He didn’t. Did he?

      Jesus. These guys are evil.

      Talk about punking people. They’re like mafia dons.

      Any liberal that chooses to support or caucus with Democrats is basically providing material support to America’s enemies. These finks are outright lying to naive liberals to sucker them into accepting fascism.

      The Democrats spent the 2008 primaries promising health care reform and won a mandate. The progressive caucus, the largest caucus in the house, promised to vote against any bill that didn’t contain a public option. The Grijalva and the progressives put pressure on Democrats to support the bill they previously opposed arguing that they would make it better in the future. Now that the Supreme Court has approved it Grijalva and the Democrats no longer want to improve it.

      Scumbag Democrats.

      1. Lambert Strether

        The “public option” was a process decoy, a roach motel for progressive energy, designed to do exactly what it did: Suck all the oxygen out of the room on the left and suffocate single payer advocacy. See here:



        Career “progressives” bear an especially heavy responsibility for this, since they ran interference for ObamaCare using the “public option” throughtout. Of course, Obama had betrayed them very early in the process by selling out to Big Pharma:


        (So either the career “progressives” who advocated the public option were not as “savvy” and “pragmatic” as they presented themselves, or they were complicit. Always the stupid and/or evil, eh? Of course, their motive made no difference to the outcome.)

        Now, if the career “progressives” had focused on policy, instead of acting as an arm for Obama’s re-elect, single payer would now be “on the table” as the next step to universal coverage after ObamaCare.

        They didn’t, so we get weak sh*t like “FDR didn’t cover everybody in the beginning….” which begs the question of what the policy path forward actually should be.

        1. LeonovaBalletRusse

          Lambert: “public option” as “Hellfire Missile” by ExecuCongress as drone.

        2. Walter Wit Man

          And let’s not forget that Obama made a secret deal with Pharma as the Republicans have revealed in their investigation:

          “In a June 2009 email, President Obama’s point person on health care promised the pharmaceutical industry it would be protected against efforts to allow cheap drugs to be re-imported from Canada, because drug lobbyists had been “constructive” in their secret negotiations with White House officials.

          The email is just one of thousands that House Republicans mined through as part of a more than a year-long investigation into Obama’s closed-door deal making with PhRMA, the drug industry lobbying group.

          Though it was previously known that Obama had cut a deal with drug companies, a memo released today by the House Energy and Commerce Committee provides more specific details than have been previously reported.” http://washingtonexaminer.com/article/1322331

          1. Walter Wit Man

            Which is what you just said and posted a link on so disregard my redundant link.

            Although it’s interesting to see how the two different sides cover this information.

      2. LeonovaBalletRusse

        WWM, something tells me we think we’re seeing a race in progress, when what we’re seeing is a replay of a race already won.

        1. LucyLulu


          When D.C. is owned by, run by, and for the benefit of the rich and the corporate interests, the public option is not an option.

    2. Ms G

      “… will live on in their minds”?

      For what purpose exactly — to feel like once upon a time they promised something really great to their constituents so that cancels out their repugnant sleight of hand?

  32. Don Levit

    One of the primary reasons that Social Security passed constitutional muster was that it was designated as a tax for the general welfare. This is why the taxes went directly to the general fund of the Treasury, just like all taxes.
    And, no citizen could tie his specific taxes to his specific benefits.
    Here, the taxes may be going to the IRS, but in reality, they are going to the private insurers in the form of subsidies for already overpriced health insurance.
    This tax is going for the private benefit of a private for-profit company, and indirectly, for the welfare of the insured, which I guess could be considered the general welfare.
    Don Levit

    1. LeonovaBalletRusse

      DL, that’s why it “MUST” be eliminated: it’s for the “common good”–which “MUST” be forbidden. Those who “hated” Medicare from the start won over other “haters of the common good” via the Southern Strategy, and the Fourth Reich Fascist “Market” State globally has been accomplished.

      1. LeonovaBalletRusse

        Actually, the RUIN of the successful American Middle Class was the SINE QUA NON for the Universal omnipotence of the Victorian Holy Roman Reich IV, the Absolute Rule of the .01% and their .99% Agency du jour. This has been covered at length in You Tube videos. The strategic “outsourcing” of profitable U.S. manufacturing, and the rise of the kleptocracy through Monopoly Finance and M-I extravagance for private war profiteers, killed the “Goose that laid the golden egg”–the prosperous Middle Class in America. This killed America.

        The Absolute Corruption of Justice is the last nail in our coffin.

  33. citalopram

    A leftist libertarian perspective on Obamacare. Carson makes some good points:


    “Contrary to outraged cries from Republicans that it’s some sort of radical departure from our “free enterprise” system, Obamacare is in fact a direct continuation of the bipartisan neoliberal consensus of the past thirty years. The guiding principle of this consensus is the use of state power to protect corporate profits — which consist mostly of rents on artificial scarcity — from the radical deflationary effects of technologies of abundance. In the spirit of the original American state capitalist, Alexander Hamilton, this consensus seeks to maintain the value of the enormous concentrations of land and capital owned by the rentier classes, and guarantee the returns on them.”

    1. LeonovaBalletRusse

      citalopram, precisely: seamless transition of Reich III => Reich IV. Done.

  34. Gil Gamesh

    “…..tax was not going to be used as a tool of policy.”

    The delicious irony of the Obama White House. For over thirty years, “tax” has been a policy tool: to ensure that US investors, enjoying the twin benefits of deregulation and ZIRP, get to keep as much income as possible so that they can take care of schmucks like the Obamas, Cheney, the Clintons, etc. so on and so forth.

    No bigger tool, except the bomb.

  35. S Brennan

    A top surrogate for President Obama insisted Friday that the individual mandate in the Affordable Care Act was not a tax — despite the fact that the Supreme Court narrowly preserved the law on those grounds. Massachusetts Gov. Deval Patrick [D] told reporters “This is a penalty,” Patrick said. “It’s about dealing with the freeloaders.” In fact, in court arguments the administration said it was a tax*.

    I agree with Gov. Deval Patrick [D] contention that the administration was being deceitful in arguments before the Supreme Court, where I would beg to differ is in the characterization by this DEMOCRAT [speaking for Obama] of the working poor as “free loaders”. This statement should clarify for posterity how far removed the Democrats of 2012 are from the party of FDR.

    The former Democratic Party of FDR overcame the world wide depression, the combined military power of the Nazi’s & Imperial Empire of Japan, the scourge of segregation, all the while electrifying the nation, fighting a Nuclear Armed nation to a standstill, dramatically reducing poverty, landing a man on the moon and providing for the general welfare to such a degree that we were the envy of the world in 1969.

    The current Democratic Party, is systematically returning the nation to a pre-FDR construct, more akin to 19th century economics, minus the benefits of Mercantilism along the lines of the discredited economist Milton Friedman. What a legacy to reject, what a waste, what a disgrace to return to the corruption that was endemic to the gilded age. I pity todays children who will live in a fallen empire when it crumbles from within.

    *Solicitor General’s Third Backup Argument Is a Winner in Health Law Case, – “Solicitor General Donald Verrilli cited the taxing power in the administration’s third backup argument before the court” – American Bar Assc. Journal


    1. Ms G

      How rich to hear a high level democrat rail indignantly against “freeloaders.” I remember the days when this was the Number One Word in every republican campaign (local, state, federal) . . . but the targets of the insult were poor people on welfare. Today, it’s the Democrats’ nasty-word of choice for middle class people who can’t afford overpriced anti-health insurance policies!

      Do the Kos and NPR audiences have a clue?

      1. S Brennan

        No, today’s Democrat is an extreme right wing [ERW] character intent on extending their advantages over other people while going through elaborate cleansing rituals to avoid being tarnished as a fraud.

    1. LeonovaBalletRusse

      enouf, Rumsfeld: from Big Pharma Chief to Defense Chief in short order. Don’t you wonder how much pharmaceutical profit from Rumsfeld’s firm was from the ruined bodies and brains of soldiers in the Bush Wars?

      1. enouf

        Indeed LeonovaBR … but atleast those soldiers were *of age* (even though most were/are still youngsters) however… Unborn fetuses and unsuspecting mothers, …

        (here, see my recent post;
        (which i know you’re following anyways ;-))

        … all the Global populations/societies; from 5th world nations being raped/pillaged for their Ores/Minerals/Resources, and their populaces being subjected to CIA-backed/funded puppet regimes and marauding tribes — to innocent children being blown to smithereens in 3rd world nations — to the bleeding of the brainwashed masses of unsuspecting/ignorant citizens in 1st world nations …it all amounts to nothing short of Global Terrorism.


        1. enouf

          … and we have our USA Regulatory (and Federal) Agencies and Depts (which are nothing more than trustees for/by the Global Corporations).

          LeonovaBR ; you especially might glean some good insight from–> do a search engine search for; “DUN & BRADSTREET: ‘RATING SERVICE’ FOR ALL CORPORATE ENTITIES’_VOID FOR LEGAL CAUSE_FRAUD_ “BRUTUM FULMEN”? by ‘S'”


          1. enouf


            … and we have our USA Regulatory (and Federal) Agencies and Depts … <– to Thank for being Co-Conspirators of this living hell ..that plagues so many.


  36. stripes

    I was listening to Norman Goldman’s radio show tonight. I used to like Norm, but he has really turned my stomach lately. Tonite, he was exhalting Obama….saying that Obama is not a fascist or a commie or anti business because Wall Street has recovered from ITS LOSSES…. ! He forgot to add that has only happened because of fascism. Norm is an attorney and was educated in a Jesuit university so he is a well educated disinfo agent. Anyhoo…he probably is a Mason as well because he is a pretty good hoodwinker. He is a master at bashing the establishment and then he turns it all around…The vertigo effect.

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