November 11, 2009

Why Auto Insurance And Health Insurance Aren't The Same, Mr. President

On Monday, President Barack Obama did an interview with ABC News' Jake Tapper wherein he was pressed on the penalties contained in the House health care reform bill, which passed the House 220 to 215 on Saturday night. The bill contains financial fines and even jail time for Americans without health insurance who refuse to get insurance. It's not clear to me if this business will be incorporated in the Senate's version of health care reform or if it will be in whatever eventual House-Senate bill is agreed to in conference.

It's a controversial measure of the House bill, but it's something President Obama defended to Tapper, arguing as he has before that forcing people to have health insurance is just like when the several states force car owners to have auto insurance. Specifically, the President said:

"What I think is appropriate is that in the same way that everybody has to get auto insurance and if you don't, you're subject to some penalty, that in this situation if you have the ability to buy insurance, it's affordable and you choose not to do so, forcing you and me and everyone else to subsidize you, you know, there's a thousand dollar hidden tax that families all across America are--are burdened by because of the fact that people don't have health insurance, you know, there's nothing wrong with a penalty."

I've never heard him make that $1,000 claim before and it strikes me as a stretch. But his larger claim that forcing people to have health insurance just like states force them to have auto insurance is a surprising one coming from a former Constitutional law professor. I was going to write about this back in September when he used the auto insurance analogy in an address to Congress, but things were so heated in the wake of that speech that I decided to wait.

Anyway, as I understand the law, driving a car on public roadways is not a Constitutional right but a privilege controlled by the states. Each state can determine its own conditions for extending that privilege to its citizens, and 49 states do require auto insurance for car owners.

But health insurance mandated by the Feds is not a power enumerated to either the Congress or the President under the Constitution. What's more, the Feds would be forcing you and I to buy a service that affects our bodies and minds and thus crashes right into our rights to personal liberty and privacy. I know there are Constitutional scholars out there who agree and disagree with me on this point (the LA Times has a round up of opinions here) and I know the insurance mandate will get tested in a court somewhere in 2013 or so, but I keep coming back to the language of Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion in the US.

In it, the Supreme Court found the (I'm using the Wikipedia entry for Roe v. Wade):

"'[R]ight of privacy, whether it be founded in the Fourteenth Amendment's concept of personal liberty and restrictions upon state action, as we feel it is, or, as the District Court determined, in the Ninth Amendment's reservation of rights to the people, is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.'"

If Constitutional guarantees of personal liberty and privacy are broad enough to protect citizens from governmental interference in terminating a pregnancy, then I think those same rights are broad enough to trump the government's ability to force you and I into buying health insurance. But that's just my opinion.

Either way, I wish the President would ditch the auto insurance analogy since it flat out doesn't work. It's interesting to me that the mainstream media--aside from Fox News--hasn't called the President out on this. I wonder why.

Posted by Philip Dawdy at November 11, 2009 12:03 AM
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Philip - I hope the headache stays away. --You mentioned some thing called the "constitution." You must have missed out on Obama's slogan, Hope and Change. This includes changing the constitution. He has clearly stated that this is his belief, despite swearing to uphold and defend the constitution: from wallsteetjournal: "In a Sept. 6, 2001, interview with Chicago Public Radio station WBEZ-FM, Mr. Obama noted that the Supreme Court under Chief Justice Earl Warren "never ventured into the issues of redistribution of wealth and sort of more basic issues of political and economic justice in this society," and "to that extent as radical as I think people tried to characterize the Warren Court, it wasn't that radical." "
Also, Obama's regulatory Czar, Sunstein, another constitutional lawyer, has written extensively - several published books - about the belief that the constitution needs to be revised extensively. That is why sunstein named one book "The Partial Constitution" - Sunstein believes it is partial. Not complete. Additionally, oddly enough, by some sheer coincidence, a lawyer named Barbara Herlihy, who happens to work for a law firm connected to Obama, Kirkland & Ellis LLP, by at least one K&E person - Bruce I. Ettelson - happend to publish a law article in 2006 in the Kent Law Review entitled "Amending the Natural Born Citizen Requirement..." - in which she argues that the constitution should be rewritten so that a non-native born person can be elected prez. ---So, take all of that for what you will. But it does not really seem like Obama is too worried that some people believe that powers not assigned to the fed govt are left to the states.

Posted by: medsvstherapy at November 11, 2009 06:20 AM

You're right, obviously.

What bothers me, too, is that the law would be forcing us to patronize a for profit corporation's wares, and essentially be a subsidy to private business. Definitely unprecedented.

Meanwhile, here's a great new, musical anti-psych-med video to cheer us all up:http://www.youtube.com/watch?v=18Y8dMIPXIk

Posted by: Miranda at November 11, 2009 06:49 AM

The mandatory health insurance requirement stinks. The idea that the uninsured are the cause of rising health care costs is as much a myth as the idea that welfare mothers ruin the economy by getting more Velveeta than they are entitled too.

But the fight is coming from the right and I'm glad to see someone arguing against the mandatory insurance requirement. And I agree about Roe v. Wade. What is odd is that this is court that will possibly overturn Roe v. Wade, especially if Ginsburg steps down for health reasons.

It would be odd to see right wing lawyers arguing against privacy for abortion and for it for health care, and interesting to see what happens. I hope this bill doesn't make it out of the Senate.

Posted by: Sally at November 11, 2009 07:03 AM

The 1,000 dollar claim doesn't seem like to much of a stretch. Hospitals lose lots of money on uninsured (and medicaid) patients. They make this money up by charging higher rates to their paying customers (ie those with private insurance). The people that get really screwed are those with no insurance but still some money (lower-middle class) who are stuck paying inflated prices.

I do agree that this motion does seem to grant the federal government more power and is likely constitutionally vague (if it was done at the state level it would be a-okay as there are large state powers to prevent "public nuisances). One way around this is to have strong incentives for the states to adopt the program (ie the current status with medicaid).

As to whether it is "fair" to require insurance. It's quite obvious that people will not obtain it unless it is given to them or they are forced to. I have friends/acquaintances (with insurance through the university) that bitch about their co-pays/medical bills for routine preventative care. When I point out that (even counting in the cost of obtaining the health insurance) they pay less for their health than they do their car (gas, car payments, insurance, repairs) they usually have no response and just get mad. People think medical care should be free. As such we have 3 options:

1. get rid of EMTLA and let people who can't pay die on the streets (doesn't seem too good to me).

2. Make everyone get insurance (ala Switzerland/this proposal)

3. go to a national health system (would be okay with this).

Anything else just creates a system that hurts those who "want to do the right thing" and awards irresponsibility.

Posted by: David Huss at November 11, 2009 07:40 AM

I'm curious about the reasoning behind this. In Canada, health plans are provincial. In my province (BC), at least, anyone over the age of 18 can opt out. Since it costs about $55 a month (and is free for low income earners), I don't know why people would choose to do so but apparently some do.

If we're going to use auto insurance as a comparison, the appropriate analogy would be collision insurance (optional), not liability insurance (mandatory).

Posted by: Francesca Allan at November 11, 2009 08:44 AM

Miranda,

The musical anti psych youtube video http://www.youtube.com/watch?v=18Y8dMIPXIk you posted did indeed cheer me up. Thanks.

Posted by: Sally at November 11, 2009 12:06 PM

Baeraech O'Bama said:
"...families all across America are--are burdened by because of the fact that people don't have health insurance, you know, there's nothing wrong with a penalty."

LOL. Anatoly France said something along the lines of "the Law, in its majestic equality, forbids both rich and poor alike from stealing bread, sleeping under bridges and begging in the streets"!

In other words, Mr O'Bama, there's nothing wrong with a penalty, just as long as there's no chance that one will have to suffer it.

Matt

Posted by: Matthew Holford at November 11, 2009 01:56 PM

Hoping it is a Fox bait and switch. Gotta keep them gnawing on something.

Posted by: JJ at November 11, 2009 03:05 PM

Incidentally, I agree that the parallel drawn between car insurance and health insurance is, erm, poor. One is required to insure one's vehicle, for a bunch of reasons. First, if one is judged to have caused an accident, one's mandatory third party liability will cover the innocent party's costs. Second, insurance is tied into other things - one's tax disc, for example, which provides that a vehicle is not only adequately covered by insurance, but is less likely to cause accidents because it has been assessed as roadworthy by a responsible agent, because in order to get the tax disc, one must present a valid MOT certificate and cover note.

This triplet of MOT, tax and insurance have the effect of making the roads safer, in theory. Car insurance, then, contributes to guarding against crap drivers and deathtrap vehicles.

Health insurance guards against... Erm... Not being able to afford the cost of being ill. There is no risk to others, aside from the cost of their tax dollars. The world is not a safer place as a consequence of health insurance. Least of all for the person paying the premium, given that palliative care (eg, longterm cancer, AIDS, even asthma), where there is no hope of cure, is generally not covered.

One purpose of health insurance, I suspect, is to protect the public purse, to some degree. A possible side benefit being the additional revenue headed the way of insurance companies. The benefit to the individual is more difficult to assess, because the benefit is only drawn when one becomes ill.

Matt

Posted by: Matthew Holford at November 11, 2009 03:25 PM
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