The Failed Argument That Won't Die: Car Insurance vs. Mandated Private Health Insurance- A Repost

[coti]

Here's the original thread, which attempted to put this one to bed once and for all back in March 2010, but since there are six billion people on Earth it will never truly end, will it?

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=8019461#8033279

Let's Stop Trying to Use the "Car Insurance" Analogy to Justify the Insurance Mandate

I think people are getting sick of having to repeatedly dispell this argument, so let's do it all in one thread. This is one pervasive, yet highly inaccurate, justification for the health insurance mandate.

There are three big reasons, each in itself effectively destroying the comparison, that the analogy between some states requiring drivers to carry car insurance and the new federal insurance mandate assuredly fails :

1) Choice. The health insurance mandate, with only few exceptions, applies to everyone living in the United States simply by virtue of their living here. Whereas requiring people to buy car insurance from a private party is a licensing issue tied to the choice of driving (and comparable to other licensing issues, such as requiring doctors to have malpractice insurance), there is no licensing or choice at issue in requiring Americans to buy health insurance from private health insurers. You live in the United States? Boom, you have to buy a product from a third party, by federal law. Yes, this is unprecedented.

Nor does the newer "Militia Act of 1792" example being offered give a better justification. That law did not apply to everyone, and required the ownership of a gun and supplies, not the year-after-year purchase of one, during the fledgling years of our country and the still-prevalent fear of it being attacked by outside forces. In fact, today such a law would likely be struck down as unconstitutional (it's no longer in-force, is it?) Can anyone say "Alien and Sedition Acts?" No, such laws do not make good constitutional precedent.

2) Rationale. The rationale behind the car liability insurance requirement (as well as other licensing issues) accounts for risk to others, not one's self. If you choose to drive on our public roads, given the heightened risk to which you are subjecting others, it is only right that you, beforehand, are required to provide at least a minimal surety against that risk. Notice that people are not required to purchase the collision or comprehensive insurance that would protect their own property. They are only required to provide protection against injury to the property and health of other people. The force of that rationale does not apply to the health insurance mandates.

3) Federalism. The insurance laws being analogized to were put in place by state governments, not the federal government. Attempting to use states' constitutional precedents to support an enormous, federal, individual-level requirement to purchase a product from a private party is at best shaky, if not totally irrelevant. The argument ignores the fact that the states and federal government play very different roles in our society- it is the states who address licensing issues, not the federal government. And this isn't even a licensing issue.


Overall, I'm seeing on this board very little critical thinking regarding or respect for the precedent being set by this health insurance mandate. I have to think that if the Bush Administration had ever tried to implement anything like this (and it was originally a Republican suggestion), there would be hell to pay. People are treating this as a political issue rather than a legitimate constitutional concern, and such blindness to the very real problem presented by this is very dangerous.

I really do have to ask- given this precedent, where does the federal government's power stop with regard to forcing people to buy products from third parties? Our "general welfare" would benefit from American citizens buying more American-made cars, rather than foreign cars. If this legislation is constitutional, what restriction would prevent the federal government from instituting a requirement that every American capable of driving (with some "merciful" exceptions or subsidies for the poor) buy an American-made car every five years, under threat of a penalty tax? It could be set up in exactly the same way, and, certainly, it would do much good for our economy, given the outsourcing of our manufacturing industries to other countries. Clearly, though, such an idea infringes on our individual freedoms.


Mostly, I'd just like to ask those who have been, to this point, arguing this bill's constitutionality more on politics than genuine legal reasoning to really think about its long-term ramifications. This law, I believe, is truly dangerous and actually gives the typically ignorant right-wingers quite good reason to be angry and plays into their characterizations of Democrats.

[JustFiveMoreMinutes]

1. Totalled Car with no injuries

$30,000 max

10 Day hospital stay. upwards over $100,000.

Persons BORN in the US or DIE in the US do not NEED 'required' Health Insurance.

Okay, the Auto Insurance maybe doesn't 'fit the bill' for equal comparison, but then again..... the two don't compare for an argument against either.

Just sayin'.

[happyslug]

2. The Militia Act of 1792 was re-worded in 1903

In 1903 with the passage of the Dick Act, the Militia was divided into two parts, the National Guard and the "Reserve Militia". Every male between the age of 18 and 45 is a member of the "Reserve Militia" to this day. No Militia has been called out since the Civil War, and no Civilian Volunteers have been permitted to reinforce Regular US Forces since the Nez Perce made they break to Canada in 1877 (Volunteers were used in WWII, but to man non-combat locations and duties).

A word about the Militia Act of 1792 and the present law in regard to the Militia. It is a UNIVERSAL SERVICE requirement, it is a demand of the Government to operate as a unit of the Government. It is NOT saying you must work for a private company or pay fees to a private company. Furthermore the weapons mentioned in the Militia Act were the standard weapons of the US Army at that time. Again a requirements of the Government that you have such weapons NOT that you buy such weapons (In the Battle of New Orleans, when General Jackson reinforced his regulars with Militia, those Militia men without weapons were formed into a reserve to be sent into any breach of the line to stop the British Attack. Such militiamen had clubs and knives to do their duty.

Anyway, the Militia is a GOVERNMENT MANDATED Function, that had existed since the Middle ages in the English speaking world. Health Insurance is not, and no one is providing any insurance via a government arsenal (as most Militia weapons came from in the 1790s).

Please note, the present Militia act does NOT mention any weapons or other gear, those are to be determined if and when the Reserve Militia is ever called into service. The reason for this was simple, by the time Congress got around to reforming the Militia Act of 1792, you had replaced Flint Lock Muskets with Percussion Muskets in the 1840s, with Rifle Muskets in the 1850s, with single shot breech-loaders in the 1860s, with the first generation of bolt action rifles in 1892 (The 1892 Krag) and had replaced the Krag with the 1903 Springfield. Five changes in weapons in 100 years (Could have been six, but the US never did adopt a tubular magazine weapon as most countries did in the 1870s).

This rapid change of weapons lead to a policy of NOT specifying the weapon in the Militia act, thus the present wording (and this in a Century where the US is still using a weapon first adopted in 1957, the M14 and still using the M16 even through it is almost 50 years since it was adopted in 1964, yes very slow weapons change compared to the 1800s).

I am surprise they are bringing out these reason as arguments for what Obama did, why not just rely on FDR, who passed two things when he had Social Security passed, first a tax, for it is clear that Congress has power to tax, then Social Security, if each state gave the Federal Government to perform that duty as the State's agent. It is still how Social Security is on the books. Any state can abolish Social Security within its border at any time and once abolished no one in that state can get Social Security. On the other hand every one in that state must continue to pay the Social Security tax even if their state say no social Security. FDR wanted to make sure everyone paid into Social Security, thus the tax. FDR wanted to avoid any challenge on the grounds something like Social Security was reserved to the States by the Constitution, so he had the States make the Federal Government their agent for Social Security. It is a system that withstood attacks from the conservative Supreme Court of the 1930s and will survive any constitutional attacks today (Attacks via congress is another ball game).

Obama should have just added Medical Care to Social Security and avoided the whole issue, but the Insurance Companies saw themselves in a Death Spiral and wanted the system that passed Congress, thus we have the system that passed Congress.

[Orsino]

14. "Obama should have just added Medical Care to Social Security and avoided the whole issue..."

Invoking his authority as Grand Poobah of the Legislative Branch, no doubt.

[damntexdem]

3. No, let's do use it. Health insurance is much more important than care insurance.

Nor in modern America, is it really a "choice" to own a car -- it is, rather, a necessity. That some do not own cars is no issue: many cannot or do not access other necessities of life, either.

Likewise, whether or not to have health insurance should not be a "choice." To choose to not be covered when one is capable of being covered is to decide to be a free rider. If one is injured or becomes deathly ill, one WILL be treated -- at public expense or at the expense of those who pay for their coverage. In any case, the costs of the free riders come out of public funds or are ultimately covered by higher private health insurance rates.

In short, the only problem with equating health coverage and auto coverage is that there is a STRONGER argument for requiring health coverage.

Does that mean that there should be an individual mandate? As is well known, and as the RW-ideologue, activist judge who declared health reform unconstitutional acknowledged, requiring acceptance of applicants for private insurance and outlawing pre-existing-condition exclusions mean that an individual mandate is essential.

So, must there be an individual mandate in health reform? No, not if there is a universal system in which everyone is enrolled -- a single-payer system. Then, individuals would not be mandated to purchase coverage because they would be automatically enrolled and taxed to pay for it. However, Congress in its non-wisdom failed to even consider single-payer. In consequence, any health reform with any value at all, no matter how minimal, MUST impose an individual mandate.

Further, because an individual mandate is a REQUIREMENT for legislating near-universal coverage without automatic enrollment. And since Congress has the power to do that, it follows that it has the power to legislate an individual mandate.

So in the latter respect, the individual mandate for health coverage is EXACTLY like that for auto insurance. The difference is that health insurance is a more-urgent need.

[coti]

5. You're making a good argument for single-payer, but you haven't

responded to the differences pointed out in the OP between requiring the purchase of car insurance after making the choice (and yes, driving is a choice- a privilege, as the government likes to put it) to drive and requiring everyone to purchase health insurance from a private insurer by virtue of being alive.

[jeff47]

9. Single-payer is a mandate

Whether you call it an 'insurance premium' or 'taxes', it's still a mandate. You are required to buy it, and penalized for not buying it.

Now, we can quibble over whether or not it's a good idea to mandate buying private insurance or have a public insurance-only system, but in either system you still have an individual mandate to buy insurance.

[coti]

12. With the huge difference that you aren't being forced to fork over your

money to a private institution whose interest it is to not pay out when the time comes, and in fact only wants to milk as much money out of its customers as it possibly can.

[jeff47]

15. Which is why you should be spending your effort on a public option.

Over the next 20 years, companies will be offloading their employees onto the exchanges. A public option in the exchanges will result in de-facto single payer. And the mandate makes it a lot easier to pass a public option.

[ThomCat]

4. Cheerleaders ignore that this was a Republican initiative.

Once Obama accepts a republican idea in one of his horrible unnecessary compromises (in order to get corporations to the table where they don't even need to be?) he then has painted himself into a corner where he has to defend a republican idea as if it was his own, and as if it was a good idea.

If he simply grew a spine and stopped issuing compromises every few moments, to open the discussion, to make the corporations show up to the table, to make the republicans show up to the table, to make them happy to be there, to convince them not to leave, to buy votes he will never get, then maybe he would realize, with that nice new spine of his that all those compromises add up to a big shiny LOSS. He gave everything away in order to get the Pyrrhic Victory of something to sign at the end.

Signing a bill just to have something to sign doesn't mean it was a good bill. Achieving very little of what you promised, and moving the goal post constantly to the right to get a final bill is not a victory.

[MadHound]

6. Not just any Republican initiative, but one of Tricky Dick's Republican initiatives n/t

[jeff47]

11. Please supply your health insurance plan

Requirements: Must outlaw pre-existing conditions and not have a mandate.

Note: Single-payer is still a mandate. UK-ians are required to buy health insurance. They just call it "taxes" instead of "insurance premium".

[Bluenorthwest]

16. That is absurd twist style you have!

A tax and a mandate to purchase for profit products are not the same thing. The fact is, Jeff, that no other nation on the planet that does mandate purchase allows profit making on the products mandated. That is the case in most European nations, the UK is an actual government owned and operated system. However, to repeat, in nations that do mandate the purchase of health insurance, it is illegal to profit from providing those mandated products. Illegal. Ours would be the first forced purchase of for profit products, and actual use of force to contribute to the profit of others.

[jeff47]

23. So you're arguing about the wrong thing?

Your objection is profit, not the mandate.

[ThomCat]

18. How does my health insurance have anything to do

with this discussion about weather or not insurance companies would be best left out of the equation all together?

:wtf:

For your information, I currently pay an exorbitant amount for COBRA, which will disappear prematurely this month because the company was bought out and no longer exists. I will no longer have any insurance for several months until I become eligible for Medicare in May.

I have several severe disabilities and I am a heavy user of insurance every month, so surviving for several months without any insurance is going to be a real hardship. In fact, honestly, we are preparing for the possibility that it might not be possible. I am on hospice level pain care every day, and have been for several years, and federal regulations mandate that I must have active medical supervision in order to receive my pain medications.

So I have been deep inside the health system and dependent upon insurance to live and breath for almost a decade. I have been researching all the options and I'm pretty sure I know what I'm talking about.

But if you want to use my situation to make some kind of cheap shot, feel free. :eyes:

[jeff47]

24. Because your previous post appeared to be railing against the mandate part of HCR (nt)

[ThomCat]

29. Um, nonsequiter?

:wtf:

Can your post make any less sense?

[jeff47]

7. Pre-existing conditions or Mandate. Pick one.

Insurance only works when people buy it when they don't need it. It's called cost-sharing. If only the sick buy insurance, there is no cost-sharing and insurance becomes useless.

The 'free market' came up with pre-existing conditions to force cost-sharing. People bought insurance out of fear they would not be covered if they bought it after getting sick. This system is obviously a bad way of doing things. So we banned pre-existing conditions.

But without a mandate, the ban on pre-existing conditions means there's no reason to buy health insurance when you're healthy. You'd just buy it in the doctor's office or ER, get your treatment, and cancel the moment the treatment is complete. The result would be no insurance at all - everyone would have to pay full price. The mandate restores cost-sharing.

If you'd prefer something like single-payer, that's still a mandate. Canadians and UK-ians are required to buy health insurance - they just call it "taxes" instead of "insurance premium". Still works the same way - the healthy are forced to buy insurance so that cost-sharing works.

Want to fix it so that you're not paying a private company? Public option. Implement it around the time that companies can offload their employees into the exchanges, and you will shortly have de-facto single-payer.

As for what would prevent the government from forcing us to buy other products, I've got two thoughts:

First, we're already forced to buy over a trillion dollars in products every year via our taxes and government procurement. I'm sure everyone can find at least one objectionable purchase in the federal budget. So I really don't see a difference between being forced to buy it directly or forced to buy it through taxes.

Second, there's one enormous brake on forcing us to buy other products. Us. Your car mandate example would result in a massive loss at the ballot box and a relatively quick repeal. Mostly because your analysis of the economic benefit is pretty bad, so even if it was passed in some massive delusional state, the benefits would not materialize.

[ThomCat]

10. False choice.

That assumes that you must keep insurance companies. There is no logical reason to mandate insurance companies and require by law that they must make profits on every health care transaction. That is obscene.

Universal public health care would have solved this problem. Other countries have proven this. They are able to provide better health care, to essentially their entire populations, for far less money per capita.

The do it by removing insurance companies from that pivotal position where they soak up all the money but provide little or nothing in return.

[jeff47]

13. Try reading my post again, because I covered your response.

Single-payer is still a mandate.

[Bluenorthwest]

17. Concentrate: the issue is not just 'mandate' it is 'mandate with

profit taking allowed'. The few single payer systems are not for profit. Those systems close to ours which do mandate the purchase of health insurance never, ever allow for making a profit from the mandated products, to do so is a crime.
The unique aspect of the US mandate is that it forces the purchase of private, for profit products, including forcing the payment of the profit portion. Forced contributions to the profit of another. Not good at all.

[jeff47]

32. Which is why I want a public option to satisfy the mandate

Public option would presumably not have a profit motive, which would keep the private insurance companies from gouging...before they left the market completely and the public option becomes de-facto single payer.

The mandate is only bad in that there is no public option, and keeping the mandate makes it easier to "finish the job" on health care reform so we end up with single payer.

Btw, if you look hard there's plenty of places where the government requires us to buy private, for profit products/services.

To go back to the car example that started this thread: the government here forbids building to enough density for there to be profitable public transit, and they won't subsidize public transit. Zoning also makes biking not an effective alternative, since commercial property must be located far from residential, and the government doesn't plow the roads such that bicycles can use them in winter. So the government is basically requiring people to own at least one car, or pay for taxi service. The government also requires that I pay a mechanic every year to inspect my car and pay a for-profit company for car insurance.

Another example from my previous career in construction: If you are going to add on to or repair a foundation, a "deputy inspector" must watch you epoxy the bolts into the old foundation. The goal is to make sure you do the job properly, and it's not possible for the government-paid building inspector to determine that after you are done. Deputy inspectors are private, for-profit.

What's new in this mandate is it applies to everyone in a sudden way, so more people notice it.

[ThomCat]

20. No, it is not.

Single payer is covered by taxes, but that does not mean it is a mandate.

Taxes are progressive. The more you earn, the more you pay, and they are allocated by the government to pay for services based on what society needs.

They are not a mandate to buy a service, paid to a private corporations, charged individually, with the cost based on your personal medical situation, age, or gender the way this current law allow. I, as a person with disabilities and pre-existing conditions could not be charged double under single payer. I can and will be under a mandate. Woman can and will be under mandate. Teens and eldery can and will be under mandate.

Thinking that a service paid for out of progressive taxes is the same as a mandate just because it is paid for is not only illogical, it is sloppy thinking.

Police Services are not paid for with a mandate. They are paid for equitably out of progressive taxes.

People who have been charged with crimes, or convicted of crimes, or living in high crime areas are not charged more for police service in their area. That would be mandates.

[jeff47]

25. Actually, you're wrong on the different rates

"Single payer is covered by taxes, but that does not mean it is a mandate."

So paying taxes is optional?

"Taxes are progressive. The more you earn, the more you pay"

Same with the mandate - low income gets subsidies/Medicaid.

"They are not a mandate to buy a service, paid to a private corporations, charged individually, with the cost based on your personal medical situation, age, or gender the way this current law allow."

Except that's not actually the case. Insurance companies will be required to use "community rating", meaning they have to charge the same price for everyone...once the exchanges are up and running.

The major flaw in the HCR legislation is the slow implementation timetable.

[ThomCat]

28. Um, wrong.

The insurance companies have already been given permission to charge people with disabilities higher rates than everyone else in the community. And women higher rates than men. Andy the insurance companies can kick out anyone they want onto Medicaid/medicare to save themselves the cost of high users, putting the cost burden of those high users who cut into their profits too much onto taxpayers.

So the whole idea of community pricing already has huge cracks, or dare it say loopholes, in it which are only getting bigger with each negotiation.

Not everything is a mandate just because it comes from the government. That term is only used to apply for requirements from the government to buy Private services. Doing your civic duty isn't a mandate, it's your civic duty. Paying taxes falls under that category of civic duty, whether you like it or not.

And, yes, the fact that taxes are progressive is an important point that is missing, very significantly missing from insurance mandates. Missing in reverse because the mandates allows charging the neediest people, those with existing health conditions MORE, so the insurance companies absolutely will take advantage of that and charge more.

[jeff47]

30. You are talking about today

I'm talking about the situation when HCR is fully in effect.

And I'm interested in your links showing they got permission to overcharge women, since that is explicitly barred today.

"Not everything is a mandate just because it comes from the government. That term is only used to apply for requirements from the government to buy Private services."

That's your definition. And it's an extremely limited narrowing of the word "mandate".

[ThomCat]

31. Explicitely barred today, where?

It was going to be, and then it was pulled in negotiations.

OB/GYN services were supposed to be covered as standard services too, and were pulled because republicans started screaming about Abortion.

There is a hell of a lot of discrimination against women built into that bill. Did you even bother to read it, or are you relying on second, or third hand reviews of it that summarize it?

Not just my definition of a mandate, that's the definition everyone has been using in every discussion. I haven't seen anyone redefine every discussion of government to start calling taxes mandates. Just because you want to start changing language doesn't mean everyone does.

[jeff47]

33. No, it wasn't pulled

Please provide the link to the story where it was.

In addition, OB/GYN is covered except for abortion.

"There is a hell of a lot of discrimination against women built into that bill. Did you even bother to read it, or are you relying on second, or third hand reviews of it that summarize it?"

Did you?

As an alternative to the links I've asked for, you can cite the specific lines in the HCR bill that do what you claim.

"I haven't seen anyone redefine every discussion of government to start calling taxes mandates."

That's because it isn't a redefinition. You have always been mandated to pay taxes.

[RegieRocker]

8. Hell have government supplied health insurance

at low cost with no conditions and call it a day. You don't want cheap insurance then pay more for private insurance. Damn

[upi402]

19. Medicare / medicaid for all = done. n/t

[coti]

21. Kick nt

[saras]

22. Single-payer, non-profit auto insurance

Obviously better than the current system, would reduce the incentive for insurance companies to claim, in advocating for traffic law changes, that more accidents is better as long as fewer of them are fatal, would increase the incentive for the government to mandate safer automobiles, would increase the incentive to charge based on the individual's actual record rather than statistical profiling.

And, as a non-driver who has to drive occasionally, I'd like to see auto insurance offer a 'trip-at-a-time' option like the insurance you get to fly in an airliner, or insurance on a rental car.

But obviously capitalism has proved itself superior to all this...

[WinkyDink]

26. The judge himself said it best, said it succinctly, and said it forcefully:

'The individual mandate applies across the board. People have no choice and there is no way to avoid it', Judge Vinson wrote.
'Those who fall under the individual mandate either comply with it, or they are penalized. It is not based on an activity that they make the choice to undertake. Rather, it is based solely on citizenship and on being alive.'

Read more: http://www.dailymail.co.uk/news/article-1352262/U-S-District-Court-Judge-set-rule-Obamas-healthcare-reform-escalating-debate.html#ixzz1CihAmM4w

[TheKentuckian]

27. Hell, not only are you required to purchase a for profit private "product"/"service"

but the vast majority will be forced to purchase a product on the open market but their EMPLOYER will decide which product they must buy, that is fucked way up.

It isn't like everyone even gets to pick their plan and shop for the best value, coverage, and company but back door fascism.

[coti]

34. Another kick, it's still around. nt