Obama, ObamaCare, and Health Care as a Right

By Lambert Strether of Corrente.

For Obama watchers, it seem ludicrous to imagine that he has any concern for rights whatever, in particular for the Fourth and Fifth Amendments. Be that as it may, Obama has clearly stated that health care is a right, so I’m going to take him at his word. Here he is in debate during Campaign 2008:

BROKAW: Quick discussion. Is health care in America a privilege, a right, or a responsibility?

First, as in retrospect it is obvious Obama would do, he attempts to evade:

OBAMA: Well, why don’t — why don’t — let’s talk about this, Tom, because there was just a lot of stuff out there.

Brokaw calls him back, and Obama answers:

BROKAW: Privilege, right or responsibility. Let’s start with that.

OBAMA: Well, I think it should be [note weasel “should” and not “is”] a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills — for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.

And here is Obama again on September 26, 2013:

OBAMA: In the wealthiest nation on Earth, no one should go broke just because they get sick. In the United States, health care is not a privilege for the fortunate few, it is [note change from “should”] a right.

Presumably, for Obama, ObamaCare makes the difference between 2008’s “should” and 2013’s “is.”  I don’t have a sophisticated understanding, or a theory, of rights. (Readers?) So I’m going to turn to one of the founding texts of America’s civil religion, the Declaration of Independence (slight alterations in brackets):

“We hold these truths to be self-evident, that all men [people] are created equal, that they are endowed by their Creator [of Choice, If Any] with certain unalienable rights, that among these are Life, Liberty, and the Pursuit of Happiness.”

So from the Declaration, we have these take aways. Rights (1) must be equally applied to all people, (2) cannot be transferred from one person to another (“alienated”), and (3) an example of a right is “life.” It also seems that rights are not absolute, in that (for example) the State can take life for grave crimes.

So, if health care is a right, how is ObamaCare doing on delivering it? My answer is: Very badly.** First, I’ll look at whether ObamaCare delivers the right of health care equally to all people; then I’ll look specifically how the use case the Framers chose as an example of a right: That to “life.” (Here let me note that this is not a “right to life” post, as both sides of that permathread in American politics understand the phrase.*)

ObamaCare delivers health care rights unequally by state.  The citizens of Libby, MT — their Senator, Max Baucus, was the driver for ObamaCare — are, uniquely, eligible for Medicare. They need health care, certainly, because their town was contaminated with asbestos. I’m glad they’re on Medicare; I don’t want them to suffer. But we all need health care equally; it’s a right!

ObamaCare delivers health care rights unequally by city and county. A citizen of Aroostock County, ME pays $1,000 more than a citizen of Portland, ME for the same coverage. How can those two citizens be said to have equal access to health care? In Covered California (one of ObamaCare’s state exchanges) rates vary across 19 unequal pricing regions. If health care is a right, as Obama agrees, how does that make any sense? Do I have less or more right to free speech because I live in Penobscot County and not Piscataquis or Cumberland?

ObamaCare delivers health care rights unequally by income. If your income is less than 138% of the Federal Poverty Level, you’re forced (no choice) into Medicaid, which is known for its ability to say no to care. Between 138% and 400% you’re segregated into the Exchanges, with high co-pays, high deductibles, and thin networks. Over 400%, you can buy as much care as you want And people “on the bubble” at 138% and 400% plus or minus one dollar have the privilege or pain of gaming their income to get into or out of Medicaid, or into or out of the Exchanges. In fact, ObamaCare is a gigantic Rube Goldberg device for sorting people into buckets, by income, and the more money you have, the better care you get. How can such a system claim to treat health care as a right, a perspective that Obama endorses? Do poor people have less right to avoid “cruel and unusual punishment” than rich people? No? Do poor people have less right to be “secure in their papers and effects” than rich people?*** If no and no, why doesn’t the right to health care work the same way?

ObamaCare delivers health care rights unequally by employment. Politics and drafting errors led to the debacle of Congressional staffers no longer receiving subsidies from their employers (Congress) for their health insurance. That was bad, and Obama intervened personally to “finagle a workaround” to help them. Which is great; I don’t want the staffers to suffer. So, if health care is a right, how come Obama doesn’t intervene personally to “finagle a workaround” for the unions whose Taft-Hartley plans got trashed? (And please don’t tell me about the rule of law; this is the Obama administration, after all.) And again, if health care is a right — a proposition Obama explicitly endorses — how come people who get their health care through employer-based insurance get better networks, lower co-pays, lower deductibles, and better coverage generally? It’s as if Amendment III — “No Soldier shall, in time of peace be quartered in any house, without the consent of the Owner” — only applied to people whose houses are upscale, while people who rent or live in trailers have soldiers sleeping on couches and the floors!

ObamaCare delivers health care rights unequally by age. Children under 26 get to go on their parents’ plan. Well and good; I don’t want them to suffer. But why the age cut-off? The logic is exactly the same as the 138% and 400% income cut-offs; how is it that people’s right to health care changes at some arbitrary limit? Why not 25? Why not, for Harry Potter fans, 29 and 3/4? From a public policy perspective, there may be some reason. From the rights-based perspective that Obama endorses, there’s no reason at all. And the same thing goes for Medicare; 65 is just as arbitrary a cut-off point as 26. Why doesn’t Medicare begin at 64? Or 62? Or… 0? Finally, there’s the lovely MERP clawback: If you’re over 55 and forced into Medicaid, Medicaid is a collateral loan, and a death tax on your estate. So if health care is a right, as Obama has said it is, how come the lucky duckies between 55 and 65 may be forced to trade their homes for it?

ObamaCare delivers health care rights unequally by personal habits. Finally, the smoking penalty:  

Government figures show smokers’ premiums could run as much as 50 percent higher than regular individual rates. The difference could amount to an effective smoking penalty of $1,500 or more each year.

I understand the “nudge theory” rationale for this. But if health care is a right, as Obama says it is, then ObamaCare is not where the nudge should take place; rights are for all people equally, and are not alienated because of personal characteristics or habits. Suppose we waived the right to not to be “compelled in any criminal case to be a witness against” one’s self for introverts, reasoning that they wouldn’t talk anyhow? And doesn’t the smoking penalty really turn a right into a privilege — something that authority grants only on the grounds of good behavior? And where does it end? If Mike “Mayor-for-Life” Bloomberg ever, heaven forfend, becomes President, would he be able to raise premiums for soda drinkers? Under the logic of ObamaCare, he would. Under Obama’s concept of health care as a right, he could not.

Finally, ObamaCare delivers life itself unequally, as Joe Firestone (and I) have shown. ObamaCare, even when fully implemented, will cover at best half the uninsured; the resulting excess deaths, at a rate of 1,000 for every million than in the general population, could be as many as 40,000 by 2017. In any other context, numbers like those would be regarded as a humanitarian tragedy, lesser evilism or no. Granted, the right to health care is not an absolute right, just like the right to pursuit of happiness, or indeed liberty, but 40,000 denied that right seems like a needlessly high number, and for no reason (other than, perhaps, profit). If health care were truly delivered as a right, those excess deaths would be closing in on zero.

Do Obama, Democrats, progressives, and the political class truly accept — as Obama says he accepts — that health care “is” a right? If they do, can ObamaCare be saved? My answer is no, and the conversation that needs to begin October 2 is how to replace it as soon as possible.*****

NOTE * Most of this talking points were worked out in the series “ObamaCare’s Relentless Creation of Second Class Citizens” here, here, here, here, here, and here, and in many, many posts and comment threads at Corrente.

NOTE ** Nor is this post a meta post about why this post is not a post about the “right to life,” as both sides of that permathread in American politics understand the phrase.

NOTE *** Granted, I idealize.

NOTE **** Heartbreakingly, we already have a working single payer system in the United States; even the TPers are for it! If Obama didn’t want to back HR 676, he could have backed Teddy Kennedy’s idea to gradually lower Medicare’s eligibility age ’til all were covered. But no. Here I should say that I’ve taken the point that Medicare is not a perfect program, and that the rentiers have inserted their tiny chitinous sucking mandibles into that program as well, adding fees and complexity. So, no, Medicare for All would not be ponies and rainbows. But at least, since health care is a right, equal access to all would be achieved, and with  single proven system architecture. Moreover, the insurance companies would no longer be at the heart of the program.  So making Medicare better gets easier.

***** Yes, I know ObamaCare will help some. That’s why the Republican effort to defund it is both vicious and terminally stupid. However, I want all to be helped, not just some, and equally, because — as Obama says — health care is a right.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

147 comments

  1. Dr Duh

    Your disquiet appears rooted in your understanding of the word “rights”. As your link states, there are multiple ways of conceptualizing rights. You appear to have chosen all of them.

    That is to say that you take an “instrumentalist” view, that rights exist to further the greater good, but when they are tweaked in a way that appears unfair, e.g., the smoking premium, you make an appeal to a “contractual” interpretation grounded in the Declaration of Independence. All the while your animus is really based on a “status”, i.e., natural law, based conception of rights, that decries the injustice of the situation.

    One of the measures of the rigor of an ethical system is whether obeying its logic ever forces you into actions or decisions that go against your self interest. When you seamlessly shift from one model of rights to another you can always find a reason why things should go your way.

    1. Jane Doe

      Rights do not have different meanings.

      They have different balances with other rights and practical comsiderations that either enhance or neutralize them.

      The problem are these: 1 is health care a right in a practical sense if class continues to determine access? 2 can it be a right when practically speaking we don’t contain cost ?

      1 was answered by creating a law to legitize class over health care

      2 was punted into the future with meaningless debate about premiums

  2. Ryan Langemeyer

    “Obama has clearly stated that health care is a right, so I’m going to take him at his word.”

    Only a fool would take Obama at his word.

    The man lost all credibility even before he assumed office by hiring Geitner and Summers to fix the financial mess that they personally had a big hand in making. After that, it has been all down hill.

  3. JL Furtif

    Or you could declare that all Americans are veterans of the War on Terror, and so all eligible to the Veterans’ Administration, one of the world’s most efficient single-payer systems (although menaced by the LetsPrivatizeIt virus as well).

      1. Paul P

        Single payer as used in the United States is a socialized insurance system with the delivery of health care by a private health care system.

        The VA is ..uhm ..a socialized system where the delivery of heath care is done by government employee doctors and government owned hospitals.

    1. Dr Duh

      You couldn’t pay me to get my health care through the VA.

      Even though most of the people there dote on the veterans the bureaucracy is truly incredible.

      Their computer system is retarded. It’s like early Windows 95 as implemented by someone with OCD, every time they thought of something new they just add another feature. Pretty soon it’s unusable.

      To be fair most electronic health records are terrible. My fondest dream is that Apple takes on the challenge. Also, most hospitals are bureaucratic, the public worse than private and Federal worst of all.

      The vets are everyone’s favorite patient though.

  4. Dan Kervick

    It’s hard for me to accept the idea that health care in most of its forms is any kind of natural right. For one thing, almost every form of health care is the product of human research and ingenuity, and up until some relatively recent time in the past that form of health care did not exist. For another thing, some forms of health care can be extremely costly to produce, especially if they are produced for everyone, and if they are produced that will only be because other very valuable things are not produced instead. Also, most forms of health care require the labor of others, sometimes very strenuous labor. I am very uncomfortable about the idea that I have some kind of right to the labor of others.

    If I do have a right to various specific forms of health care, it can only be by virtue of the kinds of rights that are established by contingent human institutions, not ones that exists by nature (if there are any of those). And at best, we can only have a conditional and equal right to health care: One might claim that they have a right to receive as much cancer screening as others receives, not that one has an unconditional right to cancer screening.

    Many of the appeals to rights in contemporary political discussion, particularly natural rights, strikes me as vague and unconvincing – and also not helpful or empowering. People constantly feel aggrieved that the world is not delivering to them something they think is their due. But where did these mysterious duties on the part of the world come from? I think it is more constructive attitude to start from the idea that the world, as such, doesn’t owe me anything, and that if other people owe me anything that can only be because we have, through politics, instituted systems of obligation that have brought these duties into existence. But leaving pre-existing duties aside, there are many good things out out there that we want, and we have opportunities for working with others to obtain them. In this case, we have the opportunity of working with others to build social institutions and systems of production and distribution in which everyone has equal access to all of the kinds of health care that are produced for anyone. Others are trying to build various different kinds of world, less equal ones.

    Once the technical means for the provision of different forms of health care are perfected, there are many choices to make about how and under what it will be produced and distributed. Making these choices has to do with what kind of society we want to live in. I tend to think that there is a binding pre-existing charter that determines what we are entitled to get is illusory.

    1. financial matters

      From the discussion of Victor Quirk yesterday..

      http://bilbo.economicoutlook.net/blog/?p=13140

      “” the abstraction of economic aspects of behaviour from the rest of social life is a comparatively new achievement of the human intellect and its value is not self evident (Walker, 1943:4).””

      This is a point well taken but I think Graeber would actually argue that it goes back thousands of years. He talks about a ‘social currency’ that was originally used for marriages and to settle disputes etc which then ran into conflict with a ‘commercial currency’ that was largely tied in with violence and war, slavery and servitude and made for a difficult and confusing connection between the two.

      Medicine seems to be at that boundary of social and economic confusion. Trying to find the answer within the FIRE sector and Obamacare is pointing out glaring problems. It’s also a major concern relative to income inequality, retirement security, job mobility and household bankruptcy.

    2. Cynthia

      Since it looks like we won’t be able to level the playing field for all Americans by having Medicare-For-All, then we should at least level the playing field for all Americans by eliminating employer-based health insurance plans, including plans that cover government workers at all levels of government, and plans that cover career politicians, many of which are covered for life!

      It’s welfare for the rich as its worst for a multimillionaire plutocrat like Dick Cheney–who, by the way, is a war criminal in the eyes if the Hague — to be handed a million-dollar winning lottery ticket for a heart transplant, that’s paid in full by the the US taxpayers. Dick Cheney has more than enough money to pay for his own health insurance. In fact, he’s even got enough money to pay for all of his healthcare, including his million-dollar heart transplant, out of his own personal bank account.

      Another advantage to getting rid of employer-based health insurance is that that it will enable workers to move and seek employment elsewhere, or make it easier for them to strike out alone as entrepreneur without having to worry about losing their health insurance. I can’t think of a better way to support entrepreneurship, besides having Medicare-For-all, than to let employer-based health insurance go the way of the dinosaurs!

      1. Jim Haygood

        An important driver of employer-provided health insurance was wage controls during World War II. Since employers couldn’t compete on salary in a chronically labor-short economy, they piled on benefits such as health cost indemnity coverage.

        Employer-provided health coverage grew out of a temporary, government-induced economic distortion. In a normal economy it makes no sense. But the U.S. latched onto this aberration as a model, entrenching it deep into the tax code.

        No one loses their homeowners, renters or auto insurance because of changing jobs. Nor does your auto policy mandate a 72-hour minimum stay at the auto spa to heal a fender injury. Health ‘insurance’ is effed up because the federal and state governments made it that way.

        1. petridish

          “In a normal economy it makes no sense.”

          And it makes even less sense in our current abnormal, globalized economy where just getting some kind of a job is an accomplishment, let alone a job with “benefits.”

      2. Alexa

        The comparison of employer-based health insurance to the federal system is a bit off-base, IMHO. (And I know this because I have participated for many years in the FEHB program, and have also been covered for many years under a group health plan, in private industry.)

        And not to be contentious, but it appears that your concept of “group health insurance plans” is also somewhat skewed in regard to what MANY employees are now offered–at least since the passage of the ACA.

        Here’s my comment from another post, earlier today:

        Regarding the “negative” effects of the ACA on Employer-Sponsored Group Health Plans.

        I’m too pushed to elaborate a great deal right now, so here’s a brief summary of what I’m referencing.

        Mr. A’s employer attributes the almost quadrupling of our annual deductible, and the tripling of our overall group health insurance costs, to the ACA.

        Whether or not this is an “excuse,” is frankly neither here nor there–the result is still “disastrous.”

        For example, within the past decade, the annual deductible was only $250. And it did go up before the ACA was passed into law–first $500, then $750, and then to $1000.

        Since the passage of the ACA, it has shot up to just under $3800.

        But wait–that’s not the worst of it, LOL!

        We NOW (as of 2013) have a “two-track” system for out-of-pocket costs or expenses.

        Our total ANNUAL liability, including our health insurance premiums, if we must file claims for in- and out-of-network–is just under $25,000!

        Heck, this company is so aggressive on holding down costs, that they implemented the practice of NOT COVERING “working spouses,” immediately after the ACA was passed! [meaning the next “plan year”]

        I could be wrong, but I believe that the negative effects that the ACA has, and will continue to have on the group health market, will cost Dems greatly at the polls–in time.

        After all, unlike many of the potential Medicaid recipients who’ve been scr**ed over (by lack of Medicaid expansion in many states), a large number of this group of people are likely “voters.”

    3. middle seaman

      The right to security is accepted almost universally. Yet, military, police and fire fighters put their life on the line to deliver that right. Why accepting security as a right makes sense but the right to health care is problematic due to the work of others seems bizarre to me.

      1. Dan Kervick

        I don’t understand what it means to say I have a right to security. It’s an insecure world, and building security takes a lot of work. Security is something that we want, and so we work hard to organize ourselves and our resources to produce it.

        1. Banger

          And the best way to build security is to create associations with others. It is not something we can manage by ourselves.

        2. anon y'mouse

          if you didn’t have the right to expect (perhaps “having” is too much) some level of basic security, what would be the point in participating in society? isn’t this the basic social contract?

          yes, I know “state of nature” never really existed except in extreme times of chaotic war, but if we have no “right” to expect any benefits, why are we all trapped here together? best to just go off into the wilderness alone.

          I think this is one of those perfect/imperfect rights and duties problems that Kant talked about.

          http://www.rep.routledge.com/article/DB047SECT10

      2. ian

        It’s funny, I’ve never felt that I had a right to security. I am thankful that I live in a community where there are people that we pay (and can afford to pay) that provide it, but that’s about it. It’s certainly not a divine right.

    4. petridish

      Apologies to Lambert, but comments like Dan Kervick’s are the reason that arguments for “healthcare” as a “right” should never be made–in America.

      Every other “modern” or “economically developed” country in the world accepts the responsibility of providing some level of access to quality “healthcare” for all citizens, regardless of economic status, through the establishment of national healthcare systems. The question of whether or not those citizens have a “right” to this access does not come up. It’s the civilized thing to do.

      Only in America are arguments such as no right to “another’s labor” or “some forms of health care can be extremely costly to produce, especially if they are produced for everyone” considered legitimate talking points when discussing who should have access to “healthcare” and who should be denied. Economics will torpedo “rights” every time–in America.

      1. Dan Kervick

        I support a single payer plan, and in which every person receives as much access to health care as everybody else, in accordance with their needs. Seems to me this is the best and most decent way to organize a society. It has nothing to do with people possessing some sort of pre-existing claim of right on the health care.

        1. petridish

          This is my point exactly.

          Lambert, you and I, for that matter, support a single payer plan in which “every person receives as much access to health care as everybody else, in accordance with their needs.”

          Yet you still feel compelled to do a four paragraph riff on why such a policy is not a “right” complete with the obligatory (Libertarian?) part about stealing someone else’s labor. The resulting 61 or so comments concentrate on what is a right, who grants them, where they come from, creator yes or no, what did Jefferson say about them and all the attendant blah, blah, blah.

          Uh, were were talking about “healthcare.”

          Hence my advice to Lambert not to make the “rights” argument. It always gets into the weeds at warp speed and stays there forever.

            1. jrs

              At this point it’s mostly the language of trying to assert a few protections against totalitarianism and absolute police state power, via the bill of rights etc.. But yea, I don’t think healthcare discussions should go down the rights path.

          1. Lambert Strether Post author

            Hmm. It sound to me like it’s useful to understand, although as you point out, hat may imply it’s a must to avoid.

            However, the whimsical and ill-motivated inequalities work well, I think, though perhaps they should be rejiggered into another frame, like simple fairness or common human decebcy.

            1. aletheia33

              Universal Declaration of Human Rights

              …Article 25.

              (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control….

            2. petridish

              Or like a responsibility that the government of an economically developed, civilized, non-third world nation has to its citizens.

    5. Banger

      As far as I’m concerned I really like your post and the issues you bring up. You’ve attacked the great Achilles heel of leftist thought and unless the left deals with this issue it will have little appeal to most people. What is a “right” in society?

      I will try to address this just a little because this is a huge issue. Margaret Thatcher famously said that there is no such thing as society–by that she meant we are or ought to be on our own. If we don’t work then we deserve to starve, if we don’t carve out a niche in the “economy” (the right-wing version of “society”) then we should die early and often. Why does this notion offend some of us? Well we need to provide reasons why this is an appalling point of view. First, it goes against the gist of all major religions–there is no moral ideology other than Satanism that has as the highest level of morality what was once considered a vice, i.e., selfishness. Nietzsche flirted with this notion and Ayn Rand put it in writing as did, in an oblique way, Aleister Crowley. Now these notions are central to right-wing ideologues.

      However, without going into the logic of such things and the fact human societies generally function best when the have refer to a “higher” level of morality than selfishness there is also the inconvenient fact that modern social science and neuro-science has shown convincingly that we are deeply hard-wired for connection with others. Thatcher’s notion is like saying the world is flat it is utterly wrong in every way anything can be wrong. We don better when people around us are happy and less stressed and people are more stressed by inequality and equality. Our morality of selfishness is no morality at all it is sheer perversion and the very definition of evil that all spiritual traditions would agree on.

      The left needs to assert the need for morality in society and as Pope Francis has noted “morality” has virtually nothing to do with sex. The right has seized on sexual morality because the rapid changes in sexuality that we have faced have been traumatic and dramatic to all of us in some way and feeding off sexual anxieties is too easy a way to dupe people to thinking morality is only about sexuality and conformity to a set of arbitrary teachings that resemble in every detail the very teachings that Jesus condemned continually in the Gospels. Modern evangelical Christianity is the direct opposite of the actual teachings they claim to follow and they’ve given morality a bad name.

      Right-wing ideology is immoral by any standard as well as illogical and contrary to science. The left needs to capitalize on this.

  5. Chromex

    I don’t think Lambert could ever be accused at taking Obama at his word… He is merely pointing out that Obama himself cannot possibly believe what he publicly says.
    One thing that has not been mentioned is that the group of people between 55 and 65 that may be forced into medicaid is quite substantial. They are boomers, a huge demographic, and were hard hit in terms of job loss and subsequent unemployment and/or underemployment.. ie its entirely possible for a large portion of this group to be part-time workers and therefore struggling to get their income up to 138% of the poverty level.
    Which brings up a interesting question .. a boomer has lost his or her job but found part-time work. he or she has enough assets that he or she can draw down on principal and live alright but the part time worker does not pay great and the 1040 MAGI is below 138% of the poverty level.
    But this year there is no verification, you are supposed to “estimate” your income and to avoid the “medicaid asset seizure trap” our boomer does just that. Nonetheless , on April 15 2015, it is discovered that this person’s MAGI is below 138% of the poverty level. Is our boomer hauled off to jail? retroactively placed on medicaid? Just to make it fun, our boomer has purchased a “gold” plan for 2014 and had major surgery, which was covered. Now what?
    This is well beyond poor drafting.
    What if our boomer is 60 is reasonably well off. has a LOT of nonproductive assets and does not want to work ? Does he or she HAVE to go to medicaid? In 2014 this is not much of a problem- pay the penalty but what if the boomer WANTS coverage? IS it only available through the exchanges? Is medicaid it?
    IF so, how can this be constitutional? It is 5th amendment violation as well as a 13th amendment violation ( bet neither was argued in the SC case). I don’t think Roberts was correct that you can tax anything (one of the first cases law students learn is that “the power to tax is the power to destroy” and therefore has some limits) but how can you constitutionally assert what is a consequence of an income tax determination-medicaid or nothing-to take away property of a person who has assets he or she wants to protect but no income? remember he or she also wants a product that is normally available in commerce?

    1. tar, etc.

      Thank you for this post. I am such a boomer: formerly self-employed, now with income level well within Medicaid. But I am not eligible, and over my dead body will be eligible, because I used the option Congress provided me while working – an S-corporation – to pay less into SS and put the money into savings instead. Because of this, my retirement is seen as an asset that I should turn over to insurance execs who surely don’t need it. But I do! I’m counting on that to replace my water heater and such expenses beyond my smaller SS check.

      I am not eligible for Medicaid. I am not eligible for subsidy – whereas someone earning $90k is. I am, however, eligible to pay the fine for not having insurance.

      This is an absolutely cruel joke on the part of the Democrats. My immediate family, I have a sibling whose teachers union has taxpayer funded insurance, a parent on taxpayer funded Medicare, and children working for big corporations who pay for their insurance. I help provide the taxes and profits for all of them to have insurance, yet I have none myself.

      I can’t get over my amazement that the Democrats – who run around trumpeting how they are “giving” people healthcare – have let me fall through this crack. I even contacted my Democratic senator when they insisted on passing this turkey, and was told to bugger off. No seat at the table.

      “The power to tax is the power to destroy.” Boy, is it ever! The ACA is intent on asset stripping me, and I see no reason to turn the little I have over to billionaires, so I will be called a “deadbeat” and a “free rider” by snots with healthcare who have no idea what it is like to live with this fear, to be a second class citizen, and now to be taxed for it.

      Law may not have equal outcomes, but it is supposed to be applied equally. The only way to make mandatory insurance equal is to stop discriminatory insurance risk pools, and now politically connected classes in which fairly well-off families get subsidies while working poor and formerly working don’t. One pool; everyone in it.

      1. Alexa

        tar, etc.–please read my comment to Chromex.

        The “asset test” goes out the window beginning in 2014.

        If your actual annual income is less than 138% above FPL–in you go (to Medicaid)!

        And you will be subject to the Medicaid Estate Recovery Program, once you are age 55.

        1. tar, etc.

          Alexa, as far as I’ve been able to find out, half the states did away with means testing, not all. But you make it sound like a good deal to be shunted into Medicaid instead of getting a huge subsidy to buy insurance. Allegedly, the exchange exists for those between 100% and 400% of fpl. It would be a fabulous deal for me at 100% fpl as taxpayers would pay over $11k a year for my subsidy. But if you are eligible for Medicaid you canNOT do that. You have to take Medicaid.

          You make it sound like no big deal for the state to place a first lien on you, and a preemptive one at that. I refuse to do that. I want the suicide pact option, because that is the true state of healthcare I’ve had and continue to have if this is the offer: I get some care but the state owns me.

          No one on an exchange is giving insurance companies a prior, automatic lien against their estate. Negotiations can be made. I want that same right.

          1. Alexa

            I don’t believe that I “endorsed” the Medicaid Program in any way, shape, form or fashion, LOL! At least, that was not my intention.

            From “ObamaCare: The Deception”

            http://www.counterpunch.org/2013/02/05/obamacare-a-deception/

            5. MEDICAID EXPANSION AND ESTATE RECOVERY

            In order to expand Medicaid, several Medicaid regulations were changed:

            a) the income limit for eligibility was increased to 133 percent FPL, but since states must apply a 5 percent disregard, this effectively raises the eligibility to 138 percent FPL

            b) Modified Adjusted Gross Income will be used in most cases to determine eligibility (also applies to certain CHIP applicants)

            c) the age limit was increased to 64, childless adults will be eligible; and

            d) the asset test was dropped except for certain groups such as the elderly and people on Social Security Disability – BINGO!

            The fact that the asset test was dropped is very important, but before we look at why, you must first understand that if an Exchange determines you are eligible for Medicaid, you have no other choice. Code for Exchanges specifies, “an applicant is not eligible for advance payment of the premium tax credit (a subsidized plan) or cost-sharing reductions to the extent that he or she is eligible for other minimum essential coverage, including coverage under Medicaid and CHIP.” Therefore, you will be tossed into Medicaid unless there are specific rules as to why you would not be eligible. If you are enrolled in a private plan through an Exchange and have been receiving a tax credit, and your income decreases making you eligible for Medicaid, in you go. If you are allowed to opt out because you don’t want Medicaid, you will have to pay a penalty for being uninsured unless you can afford to purchase insurance in the open market.

            Just so you’re clear on this: the ACA stipulates that the system will ensure that if any individual applying to an Exchange is found to be eligible for Medicaid or a state children’s health insurance program (CHIP), the individual will be enrolled in such a plan.

            For your sake, I hope you’re right.

            Just in case, you might want to read up on the MERP. Needless to say, proponents of the ACA (which I am MOST DEFINITELY NOT) always fail to mention that all Medicaid beneficiaries over the age of 55 are subject to estate recovery.

            If I were you, I’d check with the local Medicaid office, or at least consider transferring assets.

            If we weren’t retiring outside of the US–we’d be doing that right now, LOL!

            Good luck!

    2. Alexa

      Chromex–

      There is no “asset test” for ANYONE who qualifies for Medicaid by income, beginning next year.

      That’s one of the reasons that I believe that the Dems may as well “kiss the White House” good bye after the ACA is implemented–possibly for decades to come.

      And yes–they stand to have their assets and estate seized if they receive treatment–those OVER THE AGE OF 55, that is–while enrolled in Medicaid.

      The enrollment is automatic–income based.

      There is “no choice.” (from all that I’ve read)

      Obviously, “single” people are the most disadvantaged group, since they will much sooner fall into the low income “trap,” due to an extended period of unemployment.

      1. Doug Terpstra

        “Dems may as well “kiss the White House” good
        bye … for decades to come.”

        So ACA has a very bright silver lining!

      2. tar, etc.

        Yes, I never imagined I’d feel grateful for the T-Party and shut down. Turns out they were telling the truth and it was the educated Left that wasn’t. Wait until peeps realize this new era of asset stripping also applies to Medicare.

        You thought you worked your life for your own benefit, and if you accumulated anything of worth it would go to your children or whomever you elected. Turns out, no, you paid your taxes, your SS and your Medicare, but secretly, as the government let profiteering careen out of control, it turns out that the benefits you thought you’d earned are subject to new and worse taxation.

        Which corporations will be reeling in this new business with the State? And after the generations that were able to earn something are replaced by the generations indebted from college, if not from birth, how will the State make up that deficit? Direct slavery? Cheaper to run an abattoir?

      3. tar, etc.

        Thanks, Alexa. Sorry to malign you by implying you endorse the Unaffordable Care Act.

        I would leave this sinking country if I could find another saying, “give us your tired, your ever poorer, your huddled victims of government-corporate collusion, yearning to be free.”

        The PCR piece you linked is extensive. A few more excerpts for anyone reading this who might be pondering their options:

        OBRA 1993 requires all states that receive Medicaid funding to seek recovery … (CMS) site says that states have the option of recovering payments for all Medicaid services provided. …

        at a minimum, states must pursue recoveries from the “probate estate,” which includes property that passes to the heirs under state probate law, but states can expand the definition of estate to allow recovery from property that bypasses probate. This means states can use procedures for direct recovery from bank accounts and other funds.

        Some states use recovery for RX and hospital only as required by OBRA 1993; some recover for a few additional benefits and some recover for all benefits under the state plan. Recovery provides revenue for cash-strapped states and it’s a big business.

        So what this boils down to is: if you are put into Medicaid – congratulations – you just got a mandated collateral loan if you use Medicaid benefits at age 55 or older! States keep a running tally. -end-

        So much for the benevolence of this entire charade of affordable care.

  6. glenn

    okay…this seems overly pedantic. a right? going back to the constitution for a definitions, though packed with wisdom, it’s venerable, and at a time when ‘health care’ really wasn’t a concept.
    I believe the relevant facts are thus: Currently, US health care is very unequal, and yes, unfortunately access and quality are largely class-based.
    And, just about every country in the world, richer and poorer, has a better (cheaper, less unequal, better outcomes) healthcare system than the US.
    Also, at the current rate, US healthcare spending cannot continue. People are aging, penultimate and ultimate years healthcare spending are enormous.
    So, it is desirous, perhaps even necessary for the US healthcare system to change.

    Is Obamacare perfect? No. Is it flawed? Yes. Is it better than what we currently have? Almost certainly. Do people, including politicians lie? Yes. Are people allowed to change their minds? Yes.
    Is ignoring the situation and doing nothing, like every other yellow-bellied politician acceptable? No!

    1. tar, etc.

      Lots of people want to make this excuse for this monstrosity – that’s is a step, better than what we have. I disagree. It has been a tremendous opportunity lost, has not brought real change to profiteering system, and has now added an estimated $16 billion the first year in subsidy directly to the insurers. It makes the system that much less open to reform. And no doubt its minor subsidies to higher incomes are meant to get millions to buy in, in the belief that they are saving money because their policy only cost $9k instead of $10k. It’s still a tax on the economy for a crappy product that won’t protect from bankruptcy. It would be better if those people weren’t lulled into complacency and still agitated for real reform.

  7. SallieMae

    Only anecdotal, I know, – but I have quite a few acquaintances who will be saving significant amounts of money purchasing through the new exchanges – as well as others who can now leave jobs they didn’t enjoy, but were forced to keep due to the necessity of providing insurance for their families. (I would love to know how many Americans have been forced to stay in jobs they didn’t like because of health insurance – that is an aspect of Obamacare I haven’t heard discussed often.)

    1. Lambert Strether Post author

      I have never denied, and in fact explicitly say in this post, that ObamaCare will help some. The point of the post is that ObamaCare does not help all equally, as it should, if health care is a right, as Obama says it is.

      1. Glenn

        It’s blather, Lambert, when you strain to make a very small, and frankly an obvious point, and purposely ignore larger and far more important ones. So, you’re not trying to be a journalist or even vaguely even-handed, I get it. But are you really surprised that politicians, or anyone, really, say things they don’t mean…
        Now personally, if you care to parse it, I do think cheap and equal access to decent health care is a right, and under the current system, the US falls far short. under Obamacare, it’ll get better. It certainly aims to. maybe you see that as a bad thing. I don’t.

          1. Glenn

            “All…” All? Really?! Now I know not to take you seriously.

            You’re the type that want to live in the best possible world – as they see it – but just not a better one. Such numb-skull, nose-cutting idealism. Cue tea-party tactics.

            The gains for many who need it – and life-altering improvements – just cannot be acceptable, since it’s not for everyone who needs it.
            That’s twee, Lambert. Childish, nursery-rhymish, almost charming coming from an 8 year old. But dangerously naive coming from someone with a bullhorn or a paper pulpit.

  8. Cynthia

    By designing reform that leaves the private insurers in charge, it was inevitable that their business model would be directed to selling their own insurance product by trying to keep their premiums competitive. Instead of controlling health care costs, they are shifting the costs to people who actually need health care – defeating the purpose of insurance.

    Private insurers will continue to search for innovative ways to keep their premiums competitive, such as narrow networks, high deductibles, and selling in only healthy, profitable markets. Their waste of our health care dollars can be demonstrated by last week’s report from the Office of the Actuary of CMS that projects that, in 2022, government administrative costs for health care (Medicare, Medicaid, VA, IHS, Department of Defense, etc.) will be $70 billion, whereas the administrative costs of the private insurers will be $313 billion! What a waste!

    We need to throw out the outrageously priced and administratively burdensome private insurance industry that merely screws up our health care and replace it with an improved version of Medicare that covers everyone.

    1. Banger

      There two reasons this did not happen when ACA was being debated. That is the deep and systemic corruption of both the Democratic Party and the “liberal” press. If the Democratic Party had been the party of old Medicare for all would be the law today. It is stunningly easy to make the case for it. Just use facts and logic–the majority of the American people are not ready yet to completely reject facts and logic thought there is a permanent 35% that are always prepared to do so.

  9. Greg

    This is about where we set a floor I think and not the ceiling. I dont think everyone has the right to 7 angioplasties and 400 CT scans to check out every ache and ailment but we can, as a collective, say that no one will be bankrupted by a medical condition.

    There is nothing wrong with people having some skin in the game for their health care but it should be a % of their income, maxed out at say 20%. This cost can be reduced by meeting certain health metrics like weight, personal habits etc.

    Additionally though, providers need to be compensated not by how many heart bypass operations they do but by how many people they keep from having heart crises. How we keep surgeons skills up in the face of decreasing numbers of cases seems to be something that mock surgeries using better and better simulators might address.

    1. Lambert Strether Post author

      Depending on the quantity of “skin” in “the game,” you could disincentivize people from seeking care in an epidemic or pandemic. Is that really a feature you want to build into the system?

    2. diptherio

      …we can, as a collective, say that no one will be bankrupted by a medical condition…

      There is nothing wrong with people having some skin in the game for their health care but it should be a % of their income, maxed out at say 20%.

      I got news for ya Greg, for many of your fellow Americans paying 20% of our income for health-care/insurance will bankrupt us. I live on around $15,000/yr, (which means paycheck-to-three-days-before-paycheck) a three thousand dollar medical bill would wipe out all my savings and them some. If I had also lost my job due to my health problems I would be extra screwed.

      Maybe having your med bills max out at 20% of your income sounds reasonable if you’re making good money, but plenty of us aren’t. Check out the economy and then ask yourself: how would my suggestion work out for the 12-17% of people who are un/under-employed?

      1. Greg

        DIdnt mean to suggest that everyone was 20% across the board , just that the max would be 20% on anyone. Kind of like the top tax bracket. There certainly should be, just like our income tax system, a minimum income below which you are fully subsdized for your “skin in the game”.

        However I dont think any one should be paid below 25-30k a year. Minimum wage needs to be much higher. Then we wouldnt have to subsidize as much. Make the corporations pay their peple and not foist their benefits off on the govt!

  10. Don't make Sally Struthers cry

    No need to argue from first principles, let’s start with the law, shall we? Specifically, US federal common law and the common law of every state, and customary international law of all nations. Obama knows this because the US givernment acknowledges this human right, and state obligation, in the Universal Periodic Review process, to which the US submits for compliance review.

    UDHR Article 25:
    (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and MEDICAL CARE and necessary social services, and the RIGHT TO SECURITY in the event of unemployment, SICKNESS, DISABILITY, widowhood, old age or other lack of livelihood in circumstances beyond his control.
    (2) Motherhood and childhood are entitled to special care and assistance. ALL CHILDREN, whether born in or out of wedlock, SHALL ENJOY THE SAME SOCIAL PROTECTION.

    And, since the US is a member of the Organization of American States, let’s consider The American Declaration of the Rights and Duties of Man, which is binding in the jurisprudence of the Inter-American Court of Human Rights and the decisions of the Inter-American Commission on Human Rights:

    Right to the preservation of health and to well-being.
    Article XI. Every person has the right to the preservation of his health through sanitary and social measures relating to food, clothing, housing and MEDICAL CARE, to the extent permitted by public and community resources.

    You’re making an argument from the equal protection provision of domestic law but the broader non-discrimination provisions of human rights law also apply, and, in fact, take precedence.

    Now, if the US government hopes put on its big-boy pants and attain full sovereignty under the vaunted doctrine of Responsibility to Protect, it must ratify the CESCR. Then it undertakes to accept the responsibilities defined in Article 12 and CESCR General Comment 14.

    Till then, the US government is a basket-case banana republic, like Liberia with nukes. The international community is obliged to improve the USA’s piss-poor pathetic state of underdevelopment with capacity assistance and suasion, and to acculturate its corrupt African strongman so he picks up the ethos of human rights and rule of law.

    1. Beretta34

      What happens when the non contributers multiply and become such a large part of the populus that the “system” breaks the economy by debt? That’s right, debt. There isn’t enough money out there to give all this free stuff away. So what will the government do? It will just borrow even more money. It will also effectively set wage and price controls on the labor of healthcare workers. Public benefit at private expense. You do know don’t you that all the major western countries are broke. You do know don’t you that the debt to GDP curves are all still getting worse? You do know that the medicare and social security “trust” funds are insolvent. The countries you hold up as models are in worse fiscal shape than the US.

      1. jrs

        So is your point that capitalism can’t work? Because a system that produces SO MUCH poverty inevitably breaks even minor attempts to ameliorate that poverty? Of course it may or may not inevitably break it, see that’s a monetary discussion which people so love. But if it did, it basically shows capitalism can’t work for most people even with a welfare state grafted on top of it. It’s a failed economic system.

    2. mercury loads for DoD SES scum

      Right. God Bless America can’t afford the health standards that Ugandans and Kenyans take for granted. But your bullshit failed state can afford to let General Alexander record all my phone calls so he can fap to them if they’re hot, and pay for him to build himself a star-trek fantasy starship bridge; and your underdeveloped basket-case shithole of a country can afford to give every asshole dimbulb cop a tank because he’s scared of the coeds and grannies of Occupy; and USA USA USA! can afford to give white man’s welfare to every jobless hick by putting him to work as kiddy-raping cannon fodder in 600-odd military bases and torture dungeons around the world.

      You want to fix the debt, purge the national-security parasites. Then kill them, then put their heads on sticks.

  11. Walter Map

    …a theory, of rights.

    The concept of ‘rights’ is a legal fiction. There are no ‘rights’ other than those the State is willing to support – which contradicts any conventional definition.

    In the usual theory of democracy, sovereignty lies strictly with the general population, period. Individual people have “rights”, governments have “powers” delegated by the people, and other organizations have “privileges” granted by governments acting on behalf of the people.

    In practice, literally anything goes. In practice, “sovereignty”, “rights”, “powers”, and “privileges” are null words, because in practice there is only power.

    Huxley provided an explanation of the nature of ‘rights’ to a supporter of Glenn Greenwald in response to Greenwald’s support of the Citizen’s United decision by the USSC:

    It’s clear that rights are not innate, and not granted out of kindness, but are acquired. Otherwise it would not be necessary to fight for them, or to defend them.
    With all due respect to Mr. Jefferson, there is no such thing as “inalienable rights”, except in theory. It sounds good, but it isn’t true. US history clearly shows that “rights” are very alienable …

    I think it’s glaringly obvious that any “Constitutional right” can be modified by people in the government any way they like, if they happen to have the means and the power to do so which exceeds the power of those who would oppose them.
    Legal reasoning may be useful in persuading those with power, but there’s nothing which prevents those in power from selecting “legal reasoning” which reflects their personal prejudices. Nothing compels a supreme court justice to accept an argument on its actual merits if it conflicts with their personal prejudices. Otherwise justices could not be swayed by ideology or personal interest – unless, of course, you’d like to argue that justices are always perfectly just, and have neither ideology nor personal interests …

    In practice, the rights of Americans are granted by the Constitution, but those can be expanded, reduced retail or wholesale, or restricted to certain groups by people in the government, depending on how much of the government’s power those people control. Happens all the time.

    When people in the government expand or reduce rights they aren’t constrained by the Constitution, but are only constrained by other people with power. The Constitution is just a scrap of paper used as a fig leaf to cover a power struggle. The people with power are going to do what they want and the arguments aren’t meaningful because self-interest trumps both logic and law.

    The corporation is essentially a mechanism for increasing one’s rights while decreasing one’s liabilities. The more powerful your corporation the greater your rights and the smaller your liabilities. If your corporation is sufficiently powerful you can do whatever you want and never have to answer for it, depending on how much grief you get from other people with power. For obvious reasons, criminals love corporations.

    That means anybody who is not a corporate officer is de facto and de jure a second-class citizen. This contradicts the 14th amendment “guarantee” to equal protection, but so what? See “In practice”, above.

    All this makes the whole discussion over corporations meaningless because it’s not about corporations, it’s about people who control corporations. See “The corporation”, above. Just about every post on the subject is utter twaddle, including yours, and so is Greenwald’s career here as a Constitutional blogger. See “In practice”, above. I know it, he knows it, and now you know it.
    At least your arguments are honest. But let’s not be too hard on Greenwald for selling out. He’s got to make a living too, and he’s way smart enough to know this decision serves up the country to fascism on a silver platter.

    Is it not so?

      1. Walter Map

        Possibly. But it may only seem so because you have not yet been informed who their masters may be. Their strings may be invisible, or they may have no strings at all.

        One never knows. Does one?

      1. Walter Map

        If you please, sir, that’s a complaint, not a rebuttal. Must’ve hit a nerve. Sorry. Excuse if you would. Really, apologies to all.

  12. TomDority

    Tax the rentiers. Tax unearned income.
    Untax wealth creation (wealth requires labor in it’s creation.
    A progressive tax system who’s aim is to fund projects in the public good is the way to go. One that limits predatory economic behaviour by taxing it’s gains back into the public weil.

    Make health care an infrastructure project that will lower the cost of working and doing business. As for the folks who decry government spending and poo poo public investment – well you folks ought to stop using public roads, sewers, electric infrastructure, water systems etc. instead of being hypocrites.

    As Simon Patten, the first economics professor at the nation’s first business school (the Wharton School) explained, public infrastructure investment is a “fourth factor of production.” It takes its return not in the form of profits, but in the degree to which it lowers the economy’s cost of doing business and living. Public investment does not need to generate profits or pay high salaries, bonuses and stock options, or operate via offshore banking centers.

  13. Walter Map

    Obamacare is not a “right”. That’s just the way it is framed, and the framing is quite dishonest.

    Obamacare is a legal compulsion for the general population to enrich the wealthy by requiring them to pay tribute to a cash cow “health insurance industry” controlled and skimmed by the rich.

    That is its purpose. A system which properly and efficiently serves the interests of the general population would not serve the interests of the rentier class, and it is the rentier class that is calling all the shots on its own behalf, to the exclusion of the general population.

    1. Dan Kervick

      If we are able to get rid of the role of multiple private insurance companies and replace them by a single public entity, would you accept the compulsory component?

      1. ian

        For providing some minimum level of insurance, sure, but I would reserve the right to purchase supplementary private insurance – or is an equal level of misery for all a prerequisite?

  14. Jim Haygood

    ‘In Covered California (one of ObamaCare’s state exchanges) rates vary across 19 unequal pricing regions.’

    Well, Cover Oregon easily trumps Cali’s complexity with 5,000 (five thousand) possible premiums:

    Last week, 180 staff members and consultants [at Cover Oregon] were proofing some 500,000 lines of computer code, 1,500 Web site pages and 5,000 possible premium rates that will vary depending on where people live, how old they are, how much money they make and which insurance company and plan they choose.

    http://www.nytimes.com/2013/09/30/us/as-opening-day-nears-insurance-exchanges-scramble-to-prepare.html?pagewanted=2&_r=1&hp

    To quote the Great Magoo:

    “I know you think you understand what you thought I said, but I’m not sure you realize that what you heard is not what I meant.”

    1. Walter Map

      …5,000 (five thousand) possible premiums …

      A formidable application of the “baffle them with bullshit” technique if there ever was one.

      Thieves hide in thickets, do they not?

      1. Jim Haygood

        So do Navigators.

        It’s sort of like accepting rides from guys who approach you at the airport baggage claim.

  15. Andrea

    Rights to anything – health care, a decent burial, the possibility of strolling or sleeping on public beaches, to wear goggles, and whatever one cares to mention – are entirely dependent on what a society or a community are willing to agree on as ‘rights’ and what, how, etc. they can do, and proceed to do, or not, to ensure, uphold, protect, those rights.

    Obama is simply abusing the word ‘rights’ – not new in pol discourse.

    Note how it draws rational debate away from the pertinent issues:

    – equality (not a ‘right’), health care planning and rationing, insurance co. (private) profits, the role of Big Pharma (for profit), Med personnel salaries, etc. etc.

    1. Dan Kervick

      Actually, that seems to be something like Obama’s view. He only thinks that health care “should” be a right, not that is “is” a right. But Lambert seems to think those are just weasel words.

      1. Lambert Strether Post author

        The first quote says “should.” The second says “is.” Note square bracketed notes in each case. I suggest that the differnce is that ObamaCare was passed in the interim. You haven’t read the post carefully. Please do so.

        1. Dan Kervick

          Lambert, when you introduced the “should” passage you indicated that saying that health care should be a right in response to Brokaw’s question was weaseling. I think I read that quite clearly.

          1. Lambert Strether Post author

            Dan: Please give consideration to reading the post. Brokaw asks:

            BROKAW: Quick discussion. Is health care in America a privilege, a right, or a responsibility?

            Obama (after hemming and hawing)answers, except not:

            Well, I think it should be a right for every American.

            In my book, answering an “is” with a “should” is weaseling. “Is it raining?” “Yes, it should be.” “Will you come tomorrow?” “Yes, I should be able to do that.” “Is my bicycle ready?” “Yes, it should be ready.” Your mileage may vary, and apparently does.

            1. Dan Kervick

              Lambert, I just responded to that precise passage, which I did read thank you. I disagree with you that it is weaseling. But I do credit Obama for refusing to be drawn by Brokaw with his media gotcha mentality into airy and undecidable theoretical wrangles about the metaphysics or constitutional doctrine of rights as they apply to the provision of health care. That would have been a pointless and distracting road for him to go down, and support for government regulation or provision of health care does not depend on first deciding what stance to take on that question.

      2. Joe Firestone (LetsGetitDone)

        Dan, I agree with Lambert. Brokaw was clearly asking Obama a normative question about whether he thinks health care is a right. If Obama responds with a no, then that means he’s on record saying it is not a right. If he says yes, then he’s on record saying it is a right. So, if he says no, he’s not on the hook to defend health care as a right. If he says then he is on the hook to fight for something he has acknowledged is a right.

        So, instead of answering yes or no, the weasel says:

        “Well, I think it should be a right for every American.”

        Which means, of course, I don’t want to commit to it as a right because then I’d be morally deficient if I failed to fight for people’s rights. But I also don’t want to be accuse as morally deficient because I say it’s not a right. So, what I’ll do instead is split the difference by saying “it should be a right.” Then, I’m not as committed to fight for it as I would be otherwise, and yet I’m also not pissing off people who believe it is a right.

    2. Walter Map

      Politicians blather on about “rights” for the same reason they blather on about religion: both are fictional, and therefore they can say anything they like, and those who are gullible and predisposed will believe them. Liars lie because it serves their interests, and it serves their interests because they have access to victims. It’s unnecessary to victimize everybody. Just enough to make it worthwhile.

      1. Banger

        Rights are not fictional–they have been, over time, been articulated by all kinds of entities to define the privileges of belonging to a group. You may argue about them as being universal or even whether or not they are a good thing but they exist and are written into law around the world. We have something in the U.S. called the Bill of Rights and there they are, hardly fictional.

        1. Walter Map

          Sheer humbug.

          You may lay claim to any “rights” you please, but if you lack the power to enforce them the situation is the same as if you had no “rights”.

          If you do have the power to enforce these so-called “rights”, then your “rights” are nothing more than a euphemism for the power to enforce them.

          Some of us prefer honesty and candor over duplicity and cant. You are welcome to claim “rights” as you see fit and to adopt whatever self-deceptions seem necessary to you, but they will not help your argument. They will undermine it.

          Rights are not fictional–they have been, over time, been articulated by all kinds of entities to define the privileges of belonging to a group

          You had imaginary friends as a child, didn’t you?

          Rights are not privileges. You can’t even get your terminology straight. Besides, “entities” have blathered about all sorts of fictions over the centuries. Merely talking about something doesn’t actually conjure it up in reality.

          1. Joe Firestone (LetsGetitDone)

            Haven’t we heard this argument before from Thrasymachus; a very long time ago. It is literally “sophistry.”

            Man may have created them but there are “rights.” They are normative in nature, and a claim to a right has the purpose of eliciting an obligation, if it is, indeed, a right. Not everyone may agree that the right involved is a right. After all, humans may disagree on the facts and they also may disagree on what is and is not a right. But that doesn’t mean that rights don’t exist. All it means is that there are more things in heaven and earth than are dreamt of in your philosophy of relativism.

            1. Walter Map

              Nebulous things, these “rights”. If that’s what they are.

              Not everyone may agree that the right involved is a right.

              Who decides? and how and why? You may dislike the cynicism, but these are hardly frivilous questions easily dismissed, because many people do not actually seem to have “rights” while others deny anybody has them. I’ll agree with Thoreau, and submit to my own conscience, thank you.

              Here is there, and high is low.
              All may seem undone.
              What is true no two men know.
              What is gone is gone.

        2. Walter Map

          Absurd.

          You may lay claim to any “rights” you please, but if you lack the power to enforce them the situation is the same as if you had no “rights” at all.

          On the other hand, if you have the power to enforce your “rights” then what you call “rights” become nothing more than a euphemism for the power to enforce them.

          Your “rights” are in no position to enforce themselves, now are they?

          1. Banger

            You don’t have to be so extreme in your rhetoric. I’m just saying that they exist in all societies. Whether rights are enforceable under law by the courts or police is variable. But certainly even if those rights cannot be enforced they are part of the social fabric. Perhaps the problem is with semantics.

            1. Walter Map

              Then you should consider working out the semantics. Words can be meaningful.

              Thanks for pushing back, however slightly. I’ve been hoping somebody would insist that one’s “rights” exist independently of the power to enforce them: the words have been published and accepted and precedents established. But without that insistence somebody could come along and disappear those “rights” with just a comment, with merest words, and do it easily, and make it stick. Your “rights” aren’t going to stand up for themselves, so you have to do it for them.

              Crikey, don’t you blokes read Thoreau anymore, or do you just twitter at each other?

              Universal health care will be a “right” when people insist on it and the government, which is specifically tasked to enforce the rights of the people, moves accordingly. And not until. Presently corporations have the “right” to rip off the general population under threat of debilitation and death; the people have no “right” to effective public health care because they have not made their insistence heard over the insistence of corporatists.

          2. Joe Firestone (LetsGetitDone)

            If you have the power to enforce a claim you make on others, that says nothing about whether that claim is a right. It only says something about your power. To confuse “power” with “rights” is the basis of fascist totalitarianism.

            1. Walter Map

              I’m sorry, Mr. Firestone, but you have it exactly backwards.

              Totalitarian fascism obtains when those with power deny the rights of the people and reserve all rights to the state syndicate, not when those with power support the rights of the people. Prisoners in Gitmo, abused protesters, and a population spied upon all have the same problem: they lack the means to stand on their rights. If neither congress, nor the courts, nor the Executive will stand with you, you are very much out of luck.

              Calling me a sophist and a fascist doesn’t change that, and does not constitute a valid rebuttal.

        3. Walter Map

          … written into law …

          As we have plainly seen, the law is whore to power.

          We have also plainly seen that those with power can dismiss your “rights”, and no law will prevent them. Only a countervailing power can do that.

          Amerikans have little in the way of “rights” precisely because they have little in the way of political power.

          1. Banger

            The power of the people like that of Congress is pretty strong, by historical standards. The people don’t choose to use that power and I believe elect to be ruled rather than rule themselves for a number of complicated factors including the power of the most sophisticated mind-control regime ever known to mankind. Massive Jedi-mind tricks and all that.

    3. Paul Niemi

      Can health insurance be a right? I think it boils down to a qualified yes, if the majority on behalf of We The People assert that it is a right and are willing to sacrifice to secure and defend the right. This “right” is a concession of the civil authority to the people. I’ve looked for rights, reading scripture to discern God-given rights, and found only mortality. In “so he made them mortal,” I find that no matter what happens to me, I have the right to die and go back to be with my creator. Yes, well, but what of the temporal world? Other rights, natural rights, constitutional rights, rights in common law, are/were secured through war, civil strife, or political process and must be continually defended. Once a right has been obtained and is widely recognized, then it is somewhat pointless to say the right doesn’t really exist because it can not be found in any theory or document or scripture, because the people then expect the right does exist. At the same time, when someone asserts that the people have rights that are said to be denied or are not being recognized, those words are spurs to action, challenging the status quo and intending to stimulate the people to adhere to a cause, rather than reflecting any underlying claim found in an historical source. I know this view may be disappointing to some, who are in love with the idea of natural rights, but I think it reflects the reality in which civil society is a legacy hard-won in centuries of striving.

  16. Noonan

    I don’t think the healthcare issue can be solved unless we look at it from a very basic economic viewpoint: healthcare is a resource that people have to pay for. In the end, healthcare will be rationed, either by the government or the market. Healthcare cannot be inexpensive, readily available to all, and unlimited in scope. That being said, a single-payer system would be preferable to the current situation.

    1. Walter Map

      Obamacare institutionalizes the health care industry as a channel for rent extraction. It’s purpose, like the rest of the global economy, is to enrich the wealthy to the detriment of the general population. So long as this condition obtains you will be quite unable to “solve” the health care issue.

      1. Cynthia

        So true, Walter. Insurance companies are nothing but healthcare brokers. They serve absolutely no medical purpose. All they do is make money off of you and your healthcare providers. They are like a Money Vacuum Cleaner, sucking us all dry in any way they can possibly can. Single-payer healthcare is what we need. It eliminate the useless middle man. The fact is that we all pay taxes, we all should be covered. Everyone pays taxes — yes, even those who are below the poverty line pay sales tax.

        Medicine is not supposed to be a business. It is supposed to be a service. No one should be getting rich off of peoples illness and suffering. We have to push for the Medicare-for-All. All of those currently working as healthcare brokers can work in some capacity in the single-payer system, maybe doing some actual good for people.

  17. Gerard Pierce

    My wife (separated) is on SSI due to stage III Lymphoma. While she does recieve medical care, the nature of the system is such that it turns out to be second class medical care.

    Medicare is the gold standard of current medical insurance, and it kind-a, sort-a gets the job done. Obamacare only looks good if you have nothing at all.

    Looking at Obamacare. I believe we should temporarily keep the ACA and call for Obama’s resignation. While the disaster unfolds, we might have a chance to finally force the Democrats and a few self-preserving Republican to finally do the right thing.

    I finally got fed up with my wife’s care and set up a web site to explain her prolems and to raise funds for better care. So far, results have been miniimal, probably due to the fact that I don’t know what I’m doing and I’m making it up as I go along. The site is located at ( ntlsystems(dot)com/cptr )

    I just received an email from Shelly Berkler (retired congresswoman) in support of USAction a group trying to prevent Congress from trashing medicare/medicaid. I trust Berkley which is why I pass on the name of this organization.

    I may or may not be able to join USAction. I actually hope that USAction will join me. I can be contacted thru the site.

  18. Banger

    Just a note on rights. To the extend society and government defines rights they are there to increase social cohesion and improve life. If we assume I have a right to health-care it is because denying me health-care because I have no money means that we are placing money as the final arbiter of morality. Many on the right don’t understand this is what they are doing. There are legitimate questions of how far we go in establishing how much “heroic” health care will go, i.e, should we spend a million dollars to extend my life six months—those are moral questions we ought to discuss–I suggest that if I demand that I am immoral in that request.

    All this implies that we ought to be having a moral discussion here above and beyond a political discussion.

    1. Gerard Pierce

      Beyond a moral dimension, we also have a practial dimension. Our medical testing is not all tht sound because the selection of patients for clinical trials often excludes most of the people who would benefit from a new drug.

      I left my MD in my other pants so I can only guess, but my guess is that less than half the people recieving a drug get any actual benefit from taking it. The drug testing routines are set up to make sure of efficacy in the test population, but this has f#ch-all to do with the people actually recieving the medication.

      The medical system is set up for the benefit of the medical system. I’ve been told that some emergency rooms require that the patient arrive in an ambulance. That seems unlikely and immoral, but the cost of an ambulance is important to some medical providers so it might even be true.

      When my wife got out of physical rehab, I was present for the review of her treatment with her “primary care physician”. I had been careful to insure that her medical records had been ordered from the rehab facility – prior to the appointment. Interestingly her physician was unable to answer questions about medications recieved during rehab. That information was NOT included in the medical records recieved and it might have had a great deal of importance for her future treatment.

      Years ago the big selling point for HMOs was their ability to improve care and reduce costs. In the real world, when they get involved in medical care they screw it up and reducing costs is an unfunny joke.

      1. Banger

        All systems exist first to survive or they lose integrity. The problem we have is we have unbalance the ecology of systems, i.e., our system of systems is broken so everything is crazy. Morality and ethics represent the system of systems–without this framework society degenerates that’s why it is critical to address the moral issue.

        1. anon y'mouse

          pure rational self-interest economics, aka Sociopathy, is the “morality” system that is being applied to all areas of human life now.

  19. Yancey Ward

    When people talk about “level playing fields” in goods and services usage, then you are already in the deep waters.

    The goal for universally available health care has to be a floor, and those advocating for this floor have to accept that there is going to be inequality in the provision of health care above this floor- public provision up to the floor and no more.

    The language of rights confuses the matter. I have a right not to have you punch me in the nose whenever you feel like it, but I don’t have a right for you to buy me an MRI for my bum knee. Obama is deeply confused, and Strether makes that abundantly clear, but many of the commenters here are also deeply confused.

  20. Linden

    The Constitution, not the Declaration of Independence, is the foundational document of the federal government. DofI is a purely aspirational document — it doesn’t establish any legal rights. That said, access to health care is a basic human right, but one that is not recognized in this country. I’d just as soon stay away from rights-based talk when framing the issue, because it’s too easy for health care opponents to tie up the discussion in abstract talk about what’s a right and what’s not a right. They don’t mind going onto that terrain; the right-wing think tanks already have their talking points worked out.

    1. Banger

      Excellent comment–I agree, I have wasted a bit of time in that direction today. Under the Constitution health-care is not a stated “right.” It is, however, considered by most of humanity as a right in the sense that it is good for society to provide some kind of care for all members of society.

      1. Robert Dudek

        I agree with the above.

        Most Canadians, I think, are grateful that they have universal health insurance (note the health care itself is largely provided by private practitioners). There are problems, but the political discourse is always about how to improve the efficiency of the system. Not even the right-wing governing party has ever uttered a public thought about dismantling the system, despite having a stranglehold on power. In truth, we have the “horror” stories of the US system to thank for Canadians’ fervent commitment to single payer health insurance.

        While far from the best system in the world, it has proven itself to be much more cost-effective than the mish-mash the US has.

        Why not adopt “best practices” and talk about the superior efficiency of the single payer system?

  21. AbyNormal

    “From the equality of rights springs identity of our highest interests; you cannot subvert your neighbor’s rights without striking a dangerous blow at your own.”
    Carl Schurz

    A Texas lab can’t find a frozen vial of virus that is a potential bioterror agent. Lab officials say it’s most likely the vial was accidentally destroyed inside the facility.
    http://www.usatoday.com/story/news/nation/2013/03/25/virus-sample-missing-from-galveston-national-laboratory/2018887/

    “The missing vial is likely to be merely a misinventoried vial,” Ebright said. “The incident is not remotely as significant as having inspectors who do not inspect.”

    …thats okay, free’r markets n trades will lower our tale risks

  22. Joe Firestone (LetsGetitDone)

    For Dan Kervick:

    https://www.youtube.com/watch?v=UwUL9tJmypI

    “It is our duty now to begin to lay the plans and determine the strategy for the winning of a lasting peace and the establishment of an American standard of living higher than ever before known. We cannot be content, no matter how high that general standard of living may be, if some fraction of our people—whether it be one-third or one-fifth or one-tenth—is ill-fed, ill-clothed, ill-housed, and insecure.

    This Republic had its beginning, and grew to its present strength, under the protection of certain inalienable political rights—among them the right of free speech, free press, free worship, trial by jury, freedom from unreasonable searches and seizures. They were our rights to life and liberty.

    As our nation has grown in size and stature, however—as our industrial economy expanded—these political rights proved inadequate to assure us equality in the pursuit of happiness.

    We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. “Necessitous men are not free men.”[3] People who are hungry and out of a job are the stuff of which dictatorships are made.

    In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.

    Among these are:

    The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;

    The right to earn enough to provide adequate food and clothing and recreation;

    The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;
    The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;

    The right of every family to a decent home;

    The right to adequate medical care and the opportunity to achieve and enjoy good health;

    The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

    The right to a good education.

    All of these rights spell security. And after this war is won we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being.

    America’s own rightful place in the world depends in large part upon how fully these and similar rights have been carried into practice for all our citizens.

    For unless there is security here at home there cannot be lasting peace in the world.

    I think FDR outlined the program. And I also think it’s time we finished the job. ObamaCare is a travesty that doesn’t do that. We need someting better. We need enhanced Medicare for All, HR 676.

    Btw, Lambert, great piece with an amazing amount of linky goodness.

    1. Walter Map

      The concept of “rights” is a legal fiction. Amerikans believe they have “rights” because that’s what they’ve been indoctrinated to believe.

      You can stand on your “rights” and invoke the Constitution, but I can guarantee you the Constitution will just sit there quietly and do absolutely nothing. It is a scrap of paper kept in a sealed vault under heavy guard so it won’t cause any trouble.

      Everybody needs to believe in something. I believe I’ll have the 2009 Lafite.

    2. Dan Kervick

      Agreed, Joe, we need something much better. I told people back in 2010 that when Obama said he was determined to be the last president who had to deal with health care, he was incredibly deluded. He was a conservative guy who ran on a conservative plan, and then he even traded away the most progressive element of that conservative plan to the health lobby.

      So on to the next stage in the battle. If something in ObamaCare works, keep it. If we can eventually get single payer, then let’s move on to talk about how to get from here to there.

      What I object to is the endless Tea Party-style discourse, the substitution of emotionally gratifying angry-guy ranting and backward-directed bitterness for debate and deliberation about the future. And forgive me for thinking that the idea that this is about “holding people accountable” is a crock. What are people going to do to hold Obama accountable for a half-assed health plan, un-elect him? I don’t think so. What are they doing to hold Republicans accountable for being Social Darwinists or ignorant troglodytes? Dick.

      1. Alexa

        Good luck with that sentiment.

        Just wait until the full impact on tens of millions of Americans group health plans is felt.

        Many group health plan beneficiaries don’t have a clue what is coming down the pike, for Pete’s Sake!

        Do you truly expect that folks who experience a doubling, tripling, much less quadrupling of their out-of-pocket medical expenses will simply “shut up and go away?”

        We saw our annual deductible go from $250 a decade ago, to just under $3800 for 2013 (haven’t heard what’s in store for 2014 yet).

        It was only up to $1000 when the ACA was passed, BTW.

        And our “out-of-pocket” costs are now “dual tracked”–in-network AND out-of-network.

        Employer “blames” the ACA.

        Whether or not we believe Mr A’s company has reason to blame this “cost shift” on this law, is clearly beside the point.

        It’s just as disastrous for us, regardless of the true cause.

        This ol’ girl hasn’t even started complaining, LOL!

        1. Dan Kervick

          Do you truly expect that folks who experience a doubling, tripling, much less quadrupling of their out-of-pocket medical expenses will simply “shut up and go away?”

          No, I hope what they do is organize to pass a better health care plan. Every minute spent venting at lame duck politicians is a minute wasted.

          1. Alexa

            Sorry, but we’ll have to “agree to disagree,” I suppose.

            You say:

            Every minute spent venting at lame duck politicians is a minute wasted.

            I didn’t even mention the President.

            As for organizing, I consider my contribution to be giving the “clarion call” as to what is already happening, and what quite obviously will begin to happen on a much larger scale.

            Luckily, we’re out of this mess [the US] in a couple of years.

            And anyway, we made our contribution for over a decade–fighting for single-payer in a coalition that was not taken in by the prospect of “incremental change” (i.e., the conservative “Heritage Foundation” plan).

            So, “been there, done that.”

            I will, however, “shout from hill to dale” my own experiernce in the Group Insurance Market.

            You may have noticed–this topic gets almost no coverage, even though it affects by far the largest portion of the population.

            I’m sure that the corporate media “knows better” than to tell this story.

            And I have to believe that the “Washington Elites” are praying that they won’t have to face a “Dan Rostenkowski” scenario–which hopefully, they will! ;-)

      2. jrs

        Why they’re going to elect Hillary Clinton in 2106 and believe, BELIEVE, I tell you, that wonderful things will come of it. Look forward, not back, and learn nothing.

        1. ian

          It won’t happen, the timing is all wrong. She will peak too early.
          Oh, but I forgot, you were being sarcastic?

      3. Joe Firestone (LetsGetitDone)

        Dan, You’ve shifted from the normative to the descriptive and are saying that we shouldn’t evaluate politicians in the interests of accountability because people won’t hold them accountable. This doesn’t hold up, as I think you know.

        First of all, we don’t know if people will one day hold them accountable. Not for sure. And we have the obligation to tell our version of the truth about what happened so they can come to their own of how their office holders have performed.

        Second, you, yourself, occasionally take the time to write about the banksters and the fraudsters and to call out both them and their crimes. That is an effort at evaluation in the hopes that one day people will hold them accountable.

        And, third, you say:

        “What I object to is the endless Tea Party-style discourse, the substitution of emotionally gratifying angry-guy ranting and backward-directed bitterness for debate and deliberation about the future.” And then you go on to say that what this about is figuring out how to get from here to there with enhanced Medicare for All.

        Well, I don’t think these things are in conflict, because I think the lessons of the past have a lot to do with getting from here to there. In this post and the discussion, we’ve set forth how a politician who many of us thought was for Medicare for All, actually was deceptive and planned to betray those who voted for him because they thought he supported that. Knowing how he did that is important for avoiding the same mistake in the future.

        Learning about how the Democrats failure to do away with the filibuster doomed the stimulus bill to an ineffectual half-measure, and allowed them to play kabuki games with credit card reform, health care reform, and the Dodd-Frank bill, while putting all environmental, climate change, educational reform, and infrastructure legislation on the shelf, is very instructive about what people ought to demand and what kind of people they should support next time there is an opportunity to shake up the political system.

        Also, study of the process we went through to kill Medicare for All and end up with the insurance bailout is very instructive in learning about what politicians should and should not be doing next time.

        In sum, I’m really surprised to see you say that evaluation of what was done to all of us by the political process isn’t relevant to our avoiding similar mistakes in the future. While we can’t just be fighting the last war all the time, we also can’t be ignorant of our past mistakes when we encounter new opportunities to change the system.

        1. Doug Terpstra

          Yes, we need ranting from the rooftops. Obama’s treachery and perfidy in this should be denounced loudly and often, over and over … no quarter.

  23. charles sereno

    IMO, this post has many more inarguably good points than arguably bad ones which seem to have taken up an inordinate amount of space. I’m not against philosophy but the beast requires some control.

  24. craazyboy

    This doesn’t have anything to do with O Care, but MEPS just published a new report on where the money gets spent.

    Quote from “Findings”

    “In 2009, 1 percent of the population accounted for 21.8 percent of total health care expenditures, and in 2010, the top 1 percent accounted for 21.4 percent of total expenditures with an annual mean expenditure of $87,570. The lower 50 percent of the population ranked by their expenditures accounted for only 2.9 percent and 2.8 percent of the total for 2009 and 2010 respectively. Of those individuals ranked at the top 1 percent of the health care expenditure distribution in 2009 (with a mean expenditure of $90,061), 20.5 percent maintained this ranking with respect to their 2010 health care expenditures (figure 1).”

    http://meps.ahrq.gov/mepsweb/data_files/publications/st392/stat392.shtml

    Seems ripe for case studies to see what’s going on exactly with that.

    Just curious ’cause I’ve never filed a claim, even with good $500 deductible employer insurance, and the last time I was in a hospital was when I was borne.

    1. Mcmike

      I once worked for a self-insured employer. Employed a couple hundred people in a pool with some other similars.

      There largest cost was pharmeceuticals. Blood pressure meds, anti-depressents, etc.

      That plus a major cancer every year or so accounted for a great deal of the cost.

    2. anon y'mouse

      what’s going on with that—some of us were born with problems. some of us developed problems along the way through various mechanisms (it is not ALL behavioral, and not ALL under our personal direct control, but some surely is).

      these sick people are chronically/congenitally ill and will probably never get better. they cost approx. the same every year, and always will do.

      so, what do we do? let the croak?

  25. McMike

    I am not sure that in order for it to be a right, it must be delivered equally.

    Freedom of speech does not mean the government will buy everyone a printing press.

    I think we would have more luck by adding terms like: “equal access to a baseline level” of health care. The devil would be in the details of course. Nevertheless.

    The question of risk-weighting the cost is interesting. I have no problem with people who choose certain risky behaviors like smoking to be charger more (or, on the other end, pay more for certain procedures) – it seems only fair. This method of setting premiums is not intended just to nudge behavior, but also designed to fairly allocate costs proportionally. Many government benefits are means-tested, or paid out based on your income (social security, unemployment), or based on your situation (tax deductions for dependents).

    Yes of course the devil is really in the details here, and of course, where do you draw the line?

    1. chris

      I think people who drink alcohol should pay more…

      and fat people…

      and bad drivers…

      and neo-liberal corporate overlords (who do as much if not more physical damage to people’s health than organic illness)

      hell… I think everyone who doesn’t live their life JUST LIKE I DO should pay more…

      where does one draw the line, indeed?!

  26. impermanence

    Rights are given by institutions to individuals that were denied their natural rights in the first place.

    The answer lies not in making health care a “right,” but instead, in allowing individuals to care for themselves.

    Only one medical procedure need be preformed, excising the massive metastatic tumor [government and corporations] that has strangled this country.

  27. davidgmills

    You have a right to counsel. /S/he may have just passed the bar last week and be living out of his or her car and may be drowning in $200,000 of student debt, but you have a right to him or her.

  28. Woody in Florida

    I really don’t know much about the new law, or how we will pay for it. I do know that any federal law that is not applied (by design) the same way across all the states should never have been allowed by our Supreme Court, regardless of anything else. One country, one law.

  29. Malmo

    A thought: while we’re at it, how about changing the conditions that led to our collective fucked up health in the first place. That requires a massive overhaul in how we all conduct everyday life, which includes primarily a retooling of the fucked up life that wage slavery produces…

  30. bh2

    A right is not an entitlement and not a responsibility of government to fulfill. It is only an obligation of government that it shall not abridge it.

    The right to a free press does not imply the public must buy you a printing press. The right of assembly does not mean the public must provide you a free meeting hall. The right to free exercise of religion does not mean the government must buy you a church. The right to keep and bear arms does not oblige the public to furnish you a free firearm or dagger.

    Mr. Obama and others who claim health care is a “right” are saying nothing new; you have always had the right to take care of your own health needs. What they hope to imply is that this right uniquely creates an obligation of others to fulfill. And that would be a very peculiar “right”, indeed.

  31. Joe Firestone (LetsGetitDone)

    OK. Now I see where you’re coming from. Not every post is a demand for immediate action. And I didn’t write this one for the purpose of supporting the Republican effort to defund ObamaCare. Of course, I’m opposed to that, and entirely opposed to the shutdown.

    On Obamacare, I wish it had been implemented in 2010, and certainly think it should be now. The quicker it is implemented, the quicker will become aware of its faults and the quicker it will be possible to build the Medicare for All movement once again. That said, a post like this pointing out the shortcomings of Obamacare and how far it is from what we need, helps to keep one’s eye on where we want to be and so is beneficial.

    On this site’s orientation to writing and criticism rather than organization and action, as Lambert says it’s a big Internet. If NC prefers to contribute through blogging and does that well, which I think it does, then that is a valuable contribution to moving things forward, in my view.

    Other sites, like FDL and Kos do organize. But don’t do as good a job at blogging in my view.

  32. Eleanor's haunted choppers

    …Rights are fiction [false, they are law], rights are granted by institutions [false, they are necessitated by recourse to rebellion], rights are claims on my labor [false, because one of your rights is that your work be freely chosen], rights are duties on the part of the world [false, the duty bearer is the state], rights are null [??]…

    Lots of befuddled thinking about rights here. The exact same hash of piecemeal slogans came up in Occupy meetings. This is because the US systematically miseducates its population about human rights.

    Took a stab at trying to straighten it out here, but human rights are so un-American, so profoundly alien to the US government’s totalitarian dogma, that it makes American heads pop like zits without meticulous preparation.

    So, a gingerly introduction.

    Pop quiz!
    Do you exist for the state?
    Or does the state exist for you?

    All right, Time’s up. Put your pencils down.

    For all those who answered that they exist for the state, congratulations, you get Dear Leader’s Tin Star of faithful striving in Juche class, next time you’re in Pyongyang.

    For all you who answered that the state has no reason to exist, except for you, you have hit on the basis of human rights. You are not somebody’s means to an end, you have concluded – you are not a tool.

    This, you may have noticed, is one definition of Kant’s categorical imperative, the seminal ethical precept of the modern world. All state duties flow from the international community’s adoption of Kant’s categorical imperative. Another characteristic of the categorical imperative is universality. The categorical imperative must apply to everyone.

    As soon as the world became a thing, after WWII, it went to work codifying the categorical imperative as the purpose of the state, in law, that is, (1) the ends of life: freedom and dignity; (2) the means of life: what you must have to stay alive. Then the world rolled all the ends and means up into two complementary and inseparable concepts: peace and development. Peace is the sum of all rights. Development is the sum of all rights. Every member state of the United Nations has committed to both. So the state can’t pick and choose your rights, you get them all.

    The purpose of human rights law is protecting humans from the overreaching power of states. In practice, human rights law works by luring overreaching states into agreements that constrain the states and create mounting pressure for reform. The state can’t repudiate the agreement without disgrace and loss of influence and status, so overreaching states are subjected to tension that mounts over time. It works like flypaper. The state is stuck and getting more stuck all the time.

    Pop quiz!
    Do you exist for the economy?
    Or does the economy exist for you?

    Hint: Let’s say your government tells you that the purpose of education is to make you useful to employers, with skills and work habits etc., and let’s say the government sets up a system of debt peonage to prevent any deviation from that purpose. They are telling you, are they not, that the economy does not exist for you, you exist for the economy. Now do you think that’s what they are telling the outside world? Is that what they’re telling the human-rights treaty parties and treaty bodies and charter bodies? Mais frickin non, they’re lying furiously through their shit-eating grins. Every country in the world is needling them about their illegal crap system of indoctrination, and they’re pledging allegiance to the culture of rights and peace. If you don’t think this is uncomfortable for US apparatchiks, read the transcript of any periodic review.

  33. tar, etc.

    Yes, what Eleanor and Walter said:

    Do you exist for the state, or does the state exist for you?

    and

    “The corporation is essentially a mechanism for increasing one’s rights while decreasing one’s liabilities. … That means anybody who is not a corporate officer is de facto and de jure a second-class citizen.”

    We are witnessing a power play in which our very lives are exploited for an insatiable profit machine that controls both parties. No better outcome is possible without challenging this central imbalance, which is that we are property. Rights, schmights. The word provokes a Pavlovian reaction from the rightwing, the people we need to find common ground with if we are to dethrone corporate power. Therefore, it seems better to me to talk in Eleanor’s terms of what is the proper relationship, should we accept the current abusive relationship in which government and monied power use us to create more money and power for themselves at the cost of our lives, our pursuit of our own happiness.

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