rickyp wrote:People do what they need to do to remain healthy. Poor people, who cabn't afford care or insurance, wait, And they end up being diagnosed later, when therapies are less likely to work....and usually end up being treated expensively in emrgency wards...
There are things that exacerbate the increased cost in the US. Pay for service (profit motive) , and defensive medicine,drive up the use of tests that are often unnecessary or even counterproductive..

Judge Vinson acknowledged that he was deviating from this practice, but he argued that this is an atypical case in which the individual mandate is so “inextricably bound” to the remaining provisions that it cannot be severed. He may well be right that the mandate is essential to guaranteeing coverage for people with pre-existing conditions because it will force healthy people into the insurance pools and thus keep premiums down. But his argument seems stretched past the breaking point.

He reads too much significance into the fact that the Democrats failed to include a “severability clause” to ensure that if any provisions were found to be invalid then the rest of the law would be unaffected. He believes this shows that Congress recognized the act wouldn’t work without the mandate. It seems much more likely that it was an error in the closing Congressional struggle.

Judge Vinson also seems wildly off-base when he speculates that Congress would not have passed the act if the individual mandate were not included. Judge Hudson said he was unable to reach that conclusion. The mandate is one of the least popular provisions of the law.

The core of these cases is whether Congress has the power to require people to buy health insurance. We believe it can do so under its power to regulate interstate commerce, to impose taxes and to pass laws that are necessary and proper to carry out its intentions.

There are principled arguments on both sides, and the issue will likely be decided by the Supreme Court. We hope the court upholds the individual mandate. But if it rules the mandate unconstitutional, we urge the justices to show modesty and leave the rest of the law intact.

rickyp wrote:And I appreciate the anecdote Archdukle that demonstrates your personal zweal in living the "free marker". But you know you are the exception. Look at medical inflation in the US versus every regulated helath industry everywhere else in the world. If there were a functioning free market prices would be lower OR someother metric would be marekdly better.

That's because people are stupid, lazy and utter lacking in any sense of personal responsibility anymore. I don't feel I should have to be penalized because others have become so acustomed to sucking off the government teat that they can't do anything for themself anymore.

rickyp wrote:People are lazy and irresponsible etc. in Denmark and France and norway too. They don't stubbornly stick to a system that underperforms in most of its objectives for health care....
At what point does evidence actually have an impact on your belief system? I ask this is the sense that at some point the failure of free markets in this area has to become apparent to a person who, from what i've seen on these discussions, has a mind open to evidence and information.

rickyp wrote:At what point does evidence actually have an impact on your belief system? I ask this is the sense that at some point the failure of free markets in this area has to become apparent to a person who, from what i've seen on these discussions, has a mind open to evidence and information.

the removal of the severability clause in the final version of the bill, and the briefs repeatedly making clear that the mandate could not be severed from the main bill — when, as Judge Vinson notes, everyone knew that would be the very first part challenged — are of a piece. Essentially, this is a gigantic game of chicken, aimed at Justice Kennedy: If you discard the mandate, you’re wrecking this giant piece of democratically-crafted legislation. I didn’t appreciate this before, but it now seems pretty clear they’re relying on Kennedy the federal-incrementalist, rather than Kennedy the who-cares-about-federalism-jurist. It’s a remarkable dare. I think it’s sort of stupid — Kennedy is a bit on the dim side, and asking him to decide not to chuck the bathwater with the baby may be beyond his intellectual grasp, though likely not his ego.

Third, I’m surprised Judge Vinson ended up with this case. For a case of this importance, I’d expect an active District Court judge to receive the assignment by hook or by crook. A senior status federal judge is on the rotation for case assignments, but they have a lot of discretion to pass on a case. Judge Vinson is happily in senior status — I believe he goes to flower competitions — I can’t imagine he’s looking forward to the inevitable death threats. I suspect the chief judge didn’t push him to recuse because his case load is so light, and Florida courts (state and federal) are so jammed right now. That’s just a hunch.

Fourth, I have to say I’m amused as Hell to see the port side suddenly so averse to forum shopping and judicial review, problems they don’t seem to register when they get a result they like invalidating a federal law or act out of a District Court in Michigan or California or Massachusetts. I think this goes to a fundamental problem their legislators had when crafting this — they believe that if something (they believe) is so important, so complex, so huge, it must not only be necessary, it must be inviolable. (I’m not sure they believe that the word “constitutional” is relevant unless abortion is involved.) If you look over the government’s briefing, and the amicus briefing, it tends to contain a fairly specific theme: The majority of the bill is constitutional and of critical national importance; the rest of the bill can’t work without the mandate; therefore, it would be judicial activism and a departure from tradition/precedent/deference to strike down the mandate. (Without reading the transcript on oral argument, I infer that they stayed on-message there.) I think this was a terribly bad tack to take with this judge, even allowing for the fact that they’re trying to play chicken with the nine judges who lie at the end of this trail; but more importantly, this insight is the key to understanding the stupid concessions and arguments made in briefing and at oral argument. (Seriously? The government can maybe regulate childbearing?)

Fifth, this was certainly a fairly decently-reasoned opinion. I don’t agree with all of its nuances, but I’m (promise) trying to keep this brief. (No pun.) However, it’s kind of hard to escape the critical question raised in the opinion, the briefing, and the oral argument: If the federal government can mandate this sort of behavior from inactivity, exactly what aggregated activity can it not? I think all of the steam expended to the effect that the government can mandate any sort of activity that in the aggregate impacts commerce (presumably not even substantially) is debatable tactics and worse strategy. If Kennedy votes to toss this, that is what he’ll focus on. They’ve basically supplied the rope, the beam, and the knot-tying directions, and presume Kennedy won’t go through with it because he hates seeing things swing.

danivon wrote:So what are the Republicans in Congress proposing to deal with the ever-rising costs of healthcare?