« Continuous medical monitoring: Do you want to be tethered to your doctor? | Main | The Mandate is about Social Justice »



Feed You can follow this conversation by subscribing to the comment feed for this post.


I'd have to think more about the first part of your post, but I think your gloss on Alito's comment is right. Didn't he also press the SG for why it would be justifiable for people to pay for certain kinds of benefits (like making a single man pay for prenatal care) that they will never need to use? I suppose that within the terms that the court is deciding this issue, that is a plausible argument to make, even though it's not plausible on my own explicitly normative view of why everyone should pay for insurance (social solidarity etc.).

Brad F

You made a point I have been waiting to see for some time, mainly, most of the "unfunded" liability of care is not new money entering the system. Its money the government will collect and redistribute. My guess is, the new younger entrants into the market who previously were detached from the insurance marketplace will augment the pot of dollars by a few billion only. Not much juice for the squeeze.

Where I do see this effort paying off is setting the foundation for the day ESI and tax advantaged status of premiums goes down. Then, the potential for market collapse is great, and the nature of the discussion changes.

In your closing, I guess I would ask, if we envision a system where job lock is eliminated, and individuals are free to move from job to job, state to state, and over a lifetime, AND they keep their plan with whatever health burdens that befall them, what then is an "expected" cost of a plan (what is a risk ban, and how do you stratify risk?).

In another words, is an insurance product an all in proposition--understanding some stop-loss is necessary for outliers--and Alito's view is a misperception of optimal risk pooling for society over a lifetime. After all, virtually 100% of us will use HC before we die; if we agree we need insurance, than it is a decades long endeavor.


Paul Kelleher

Hi Brad,

You're right that *if* we assume that people will have portable coverage that "they keep...with whatever health burdens that befall them," then sure, health insurance will be "a decades long endeavor." But Alito's wants to know why society should be able to force individuals into that situation in the first place. To answer his question, we cannot assume that the forcing has already been done (and done legitimately).

Another way to put that is this: I'm not a fan of Paul Starr's alternative to the mandate, but it is an alternative, and it's an alternative that would permit health insurance to be something other than a decades long endeavor. If Paul Starr wants to allow this, surely it's reasonable for Alito to ask what the reasons for forbidding it are, and whether they are good reasons.

Brad F

Can we then deduce that when the "if" occurs, Alito would revisit his position? Or, in other words, his beliefs are not rooted Constitutionally, but with the shifting sands of what congress legislates?

Also, on Starr, both in print and in interviews, I have never heard him justify how catastrophic care will reconcile into his scheme. For those who opt out and prefer to nickel and dime their minor ailments, no harm, no foul. But ultimately, who pays for the big, unanticipated events--the events that comprise 90+% of what the lock out is attempting to prevent in the first place. It dont add up, and I question the tool as a deterrent if above is what we are looking to prevent.

(this is something of mine, very short, that embodies the same): http://www.healthcarefinancenews.com/blog/individual-mandate%E2%80%A6


Paul Kelleher

That's the thing about the supreme court: once a law or policy has been around for a long time, it's harder to touch. I'm not sure that's the best policy, there there you have it.

I assume Starr would have to support a Do Not Treat list, right?

Paul Kelleher


Your comment aligns nicely with my general take on all this, as I note in my post today.

compare health insurance

The problem with the mandate is that it basically requires everyone to have insurance. This runs into problems the second you consider the fact that many can't afford to do so.

The comments to this entry are closed.

My Photo

Become a Fan