Florida has been chosen to lead the charge because the case can be filed in the Pensacola court (part of the conservative 11th Circuit of the U.S. Court of Appeals), where it will be heard by a Republican appointee.
From the perspective of ethics and common sense, the suit comes straight out of Alice's Wonderland!
Reduced to its essence, the states are saying - "get off the backs of individuals and state governments!"
With regard to individuals, the states argue that requiring individuals to obtain health insurance or pay a health tax encroaches on basic liberties. We'll soon be seeing the pithy language on Tea Party placards:
"In effect, the Act compels said persons to have healthcare coverage, whether or not they wish to do so, or be subject to sanction. The Act thus compels persons to perform an affirmative act or incur a penalty, simply on the basis that they exist and reside in the United States."With regard to the states themselves, the argument is essentially that the Act will require substantial state effort and expenditure. This is true.
The key question is - what is the alternative to imposing requirements on individuals and state governments?
There are two essential choices. If we continued to declare that it's OK for 15 - 20% of the population to be uninsured, we wouldn't have to mandate new responsibilities for individuals and state governments. But if we elect to join the civilized world and recognize reliable access to decent health care as a societal responsibility, the only viable alternative to the Patient Protection and Affordable Care Act is a system supported by direct federal taxation. This could be a single payer Medicare for all program or a tax supported multiple insurer system.
Only wacko libertarian extremists will be ready to assert that individuals who want health care should be responsible for creating their own access, without any outside support. It's one thing to recognize the right we all have to refuse unwanted care. It's another to say "tough luck" to all those who want decent care but can't afford it.
The brief filed by the states makes no mention whatsoever of the moral requirement for a civilized society to ensure access to care for its citizens. The spirit of the argument is entirely "leave us alone." I'm sure the individuals who filed the brief are caring people in their personal lives, but the argument they make is callous and cruel.
(The 23 page suit is intelligible to the non-lawyer - if you have time I encourage you to read it. Also see Kevin Sack's informative New York Times article.)
14 comments:
Great post. It consistently amazes me that the US does not recognize a right to health.
Of course, I'm also amazed that almost the entire 08 campaign centered on health care reform and yet the right is amazed, AMAZED when we actually move toward ensuring that all Americans can receive basic medical care (let alone live in communities that set them up for a healthy life-- let's not even start on the social determinants of health).
Hi Ashley
Thanks for your comment. I share your amazement.
My speculation is that many of the Attorneys General who are bringing the suit, along with the Rush Limbaugh/Glenn Beck crowd and the political leaders who fan the flames of Tea Party anger, are motivated by economic and political ambition, and know in their hearts that they're espousing the dark side. But what Richard Hofstadter called the "paranoid style" in the American soul runs deep, so there's aready audience for their "get off my back," "socialized medicine," and Obama as Hitler messages.
I also agree that it will take us some time to get to a serious national discussion about the social determinants of health!
Best
Jim
Illogical post beginning with the basic misunderstanding between healthcare and healthcare insurance.
Then to link the 250-year-old American "Get off my back" tradition with "Obama as Hitler" is, basically, Hitlerian (or at least Gobellian)
""In effect, the Act compels said persons to have healthcare coverage, whether or not they wish to do so, or be subject to sanction."
For the life of me, I can't see how this is different from car insurance. Everyone HAS to buy insurance, otherwise, you ain't driving the car.
Now, I'll challenged any of these wackos any day, any time, any place, to argue that health is less important that a car.
Hi Anonymous -
Thanks for your comment.
I'm not sure just what point you want to make about healthcare and health insurance. Obviously we as individuals can do lots of self care without insurance. And physicians can waive the bill in a private fee for service practice. But access to costly drugs and to hospitals when they are needed are only affordable for the VERY wealthy except with insurance. In that sense, access to care depends on health insurance.
I trust that you know that opponents of health reform have used posters making Obama into Hitler. I see that a perversion of the largely constructive U.S. tradition of being suspicious of governments.
Best
Jim
Hi Anonymous -
Thanks for your comment.
I'm not sure just what point you want to make about healthcare and health insurance. Obviously we as individuals can do lots of self care without insurance. And physicians can waive the bill in a private fee for service practice. But access to costly drugs and to hospitals when they are needed are only affordable for the VERY wealthy except with insurance. In that sense, access to care depends on health insurance.
I trust that you know that opponents of health reform have used posters making Obama into Hitler. I see that a perversion of the largely constructive U.S. tradition of being suspicious of governments.
Best
Jim
Dear Anonymous
Of course I agree with you that opposing universal health insurance is ultimately a wacko perspective, largely based, I believe, on a failure to understand the need for us all to be in the insurance pool, for protection when we develop a treatable cancer, and to make insurance itself workable.
But automobile insurance differs in two ways - if we choose not to drive because we resent the requirement for insurance (a) we don't have to pay a tax penalty and (b) we don't contribute to undermining the automobile insurance process itself.
Best
Jim
First off, I am opposed to universal healthcare. The idea that healthcare is a right as freedom of speech is a right is ridiculous to me.
Healthcare, no matter how much you 'need' it, is a product like any other. You should be able to buy how much or how little you feel you require. Much like not buying and eating good food will adversely affect your health so to could not having healthcare. But the option is there.
The assumption that I see behind all the supporting comments of universal healthcare is that society must provide safety nets for people. Society has to take care of the 'what ifs' of life.
What if you lose your job, get sick, can't pay rent, or whatever. We have gone through several generations now where these social economic handouts have existed and so people stopped asking why they are there in the first place.
The bottom line is you are willing to take resources away from some people and give them to another that did not work to earn them. How many people can afford a cell phone, HBO, high-speed internet, a Playstation, taco bell, or countless other luxuries but for some reason cannot afford healthcare.
Lemme put it this way, I am all for helping our country's helpless. What I do not want to do is help out the clueless, the irresponsible, the willfully reckless.
I am 31 years old, and just might, if I was very careful with what little money I make, be able to afford healthcare. However, I don't have it. That is my choice.
I am totally prepared for the consequences of that choice. If something happens that I cannot pay for then maybe I won't life through it. So I work hard, save my money, and try to better myself so I can afford healthcare. I could have in my life, once, gotten unemployment benefits. I refused them. Mandated charity, which is what unemployment is, is immoral. Universal healthcare is no different. I won't have any part in it if I can help it.
By the way, for those that posted that teaparty people had signs of Obama looking like Hitler, would you be so kind as to toss us a link to show such a thing? I'd love to know if such a statement is legitimate.
P.S. I don't hate liberals, I just disagree with them.
Dear Flames 0042 -
I'm sorry for the delay in posting your comment - I was at my college reunion.
Thank you for your thoughtful comment. I especially appreciate your comment that "I don't hate liberals, I just disagree with them." Sadly, this kind of civilized disagreement is becoming rare, especially in the political arena.
With regard to health care as a "right," you're on to something important. I personally use the term "right" as shorthand for my view that a civilized society is obliged to ensure that all citizens have access to health care. If my neighbor falls down he doesn't have a right to my help, but I believe I have an obligation to help him.
I don't agree that health care is a commodity like any other. It's closer to the basic supports for our exercise of liberty - like education and food.
You are not alone in your feeling that "What I do not want to do is help out the clueless, the irresponsible, the willfully reckless." You are echoing the ancient distinction between the "deserving poor" (folks who try hard) and the "undeserving poor." Like you, doctors are frustrated when patients don't carry out self care that could (a) make a difference for their health and (b) reduce the cost of public programs paid for by others. I've said to patients of mine - "if doctors could sue their patients for malpractice, I'd bring a suit against you for [not caring for yourself]." But as in the parable of the Good Samaritan, it seems wrong to deny basic care to anyone in our society.
You deserve respect for consistency, as in not accepting unemployment insurance. And even though I disagree with your conclusions, I respect the thoughtful way you lay out legitimate concerns.
If you put "Obama Hitler Tea Party" into Google, you'll see lots of links to relevant stories.
Best
Jim
Jim,
Thanks for the response. There are a couple of things you said that I wish to comment on within your response to me.
There are a few key aspects of the debate that I think it all boils down to.
You said: If my neighbor falls down he doesn't have a right to my help, but I believe I have an obligation to help him.
This sentiment actually mirrors what I think. I do believe that I have a obligation to help my neighbor. That obligation comes from my own convictions and faith though. It does not come from a basic social contract.
The key difference in that will dictate how a society is formed and built.
For instance, much of the group risk management that the government is involved in now was completely unheard of during the founding of the country. The government had extremely limited taxing powers that only began to be really used until the civil war and then even lightly. It wasn't until the formal ratification of the 16th amendment in 1913 that income tax as we know it began.
So we are looking at close to 150 years of history without the modern tax system in place.
Then you have the the even later creation of the first modern government financial social service.
All of this points to the fact that our country was not designed to be a welfare state. Sadly this is what we have become. Healthcare, like social security when it was being formed, is known simply to be another system of moving money from one group of people to another.
If our country had been designed to support the kind of social services that exist today it would have been formed much differently. Our entire history is filled with the arguments of personal liberty vs group entitlement. Personal responsibility vs group risk management.
The question of legal obligation to help our neighbor vs moral obligation is what is really key. What I find interesting is that a lot of the time people that argue for healthcare site it as a moral obligation rather than a legal one.
The interesting thing about such an argument is that if you bring personal morals into play then you are forced to recognize the morals of the founding fathers, which are basic predominately on Christianity. The result of such an argument can only lead you to the point I have already made. The true moral choice is to help when you feel lead to do so. As Christ always taught that it was what was within our heart that truly mattered, not our outward actions. Even going so far as to teach that giving without the true desire to do so is completely pointless and hypocritical.
I would hope to live in a society that moves on their own to help each other out, but I cannot find it within myself to force them to do so. Freedom should always come first because nothing good or lasting will come from us if its not freely chosen.
Sustainability is another issue. The true hallmark programs of the modern liberal movement are all failing. Welfare, social security, unemployment, and medicare are not programs that can go on forever on their own but are all recognized as financially unsound.
Basic human nature in regards to work show us this. Greece is a great example. We are not just like Greece of course, but we are mirroring a lot of their bad choices financially. They have our own programs just to a greater degree, and we are sliding towards their future, just not as fast as they went.
Cont...
Great example of what I mean by all this is from where I used to work. I worked at a restaurant and a 18 year old host got fired. Months later he was hanging out in the parking lot after his friends got off work so I went and said hello. Turns out he isn't working, and had no plans to work for about a year. He found out that through extensions on unemployment he could get his benefits for about a whole year. He said at one point, why would I want to work if am making more from not working than I would from any job I can get?
I have even worked with people, and tried to report them, who bragged about getting unemployment while working full time.
Unemployment can only exist if you have enough money going into it. However, the very nature of the system encourages people to try less. Some people are ambitious, some want to do more and be more than they are, but most do not. You only have to be in a single management position ever to understand that. If people do not have to contribute, most of them will not.
Healthcare is no different. The money is moved around differently, but the underlining principle is still the same and the result will be the same. Wealth redistribution simply takes wealth out of circulation and over time it will fail.
If we teach people to fish, rather than just giving them fish we might actually be doing something worth while.
In my opinion, if you lead a horse to water, and it won't drink, at some point you have to accept that it simply doesn't have the desire to survive, and you cannot change that.
Side note: I looked up the Hitler/Obama comparisons the Tea Party people made. In every case I could find the comments they made were in regard to the fascist nature of Obama's policies and statements. In this regard I agree with them. I do not see any of them calling Obama a genocidal lunatic. Obama isn't evil he just has very different political ideas than what this country is used to.
Hi Flames0042
Thank you for the further comments.
My guess is that even though we hold very different political positions, our values are in many ways very similar. I agree with you that the behavior of the 18 year old is reprehensible. I'm glad my parents brought me up with a strong work ethic. My wife and I tried to do the same with our sons.
My impression is that you are a caring person, but that the 18 year old, and all others who act "entitled" and take from the system without giving back, lead you to reject social programs that draw on taxation. I share your critical attitude towards "entitled" behavior, but would rather see our society take the risk of being fleeced by 18 year olds like the one you describe than the risk of letting people who are trying hard lack services fundamental to liberty and well-being, like health care.
Fascism is defined (Webster) as a philosophy or regime that "exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition." This doesn't describe the Obama administration. Using health care as an example - the legislation may or may not be wise, but it is the product of democratic process, not fascism.
I continue to appreciate your thoughtful comments and your skill at combining strong disagreement with civility. That used to be more common in our government!
Best
Jim
Jim--Looking back, I realize that "health care" has been a right in the USA for many years. Ever since the law requiring emergency rooms to take all comers, health care has been a de facto right.--Eric
Hi Eric -
I think it would be most accurate to describe the situation as one of "limited rights." We do require attention and stabilization for folks who get to an emergency room, but we don't guarantee access itself. The Affordable Care Act makes us responsible for ensuring that almost all of the population has health insurance, so it's a step in the same direction. But our approach to the question of health care as a right has been very "piecemeal."
It's always good to hear from you!
Best
Jim
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