

I Hope the Supreme Court finds the Affordable Care Act Unconstitutional - merrick
http://merricklozano.com/obamacare-unconstitutional

======
gatlin
IANAL and I have not read the complete unabridged text of the bill but so far
as I can tell the only piece that is likely unconstitutional is the individual
mandate, correct? The commerce clause can be very powerful provided commerce
is already taking place but I am not aware of precedent allowing it to
_coerce_ one into commerce in the first place.

Is there such a precedent? Would the existence of such a precedent be a good
thing in the long term? I'm inclined to support this bill 100% but I just
don't know what kind of effect this could have on businesses in the future.

~~~
Lazare
That's an open question. The legal term is "severability". Sometimes an entire
law (or contract) will be struck down if one part is found to be illegal or
invalid. Other times just the invalid part will be cut out, and the rest will
still be enforced. It can go either way, depending on very specific details of
the law (or contract), drafting history, previous precedents, etc.

Often, a law (or contract) will contain a severability clause specifically
saying what will happen. (Contracts almost always say that the contract should
stand if any clause is found invalid.) The problem here is that the ACA's
drafters (perhaps foolishly) did not consider the possibility of a
constitutional challenge, and did not include a severability clause into the
law.

If the mandate is found unconstitutional, the court will also need to rule on
the severability question; it's very uncertain at this point which way they'll
rule (if they have to rule at all).

(Bonus question: Do we want the ACA struck down if the mandate is struck down
or not? The law does a lot of things, some of which are quite good, and would
still work just fine without the mandate clause. On the other hand, guaranteed
issue and community ratings without a mandate might completely destroy the
health insurance market, without replacing it with anything else, which would
be a disaster. The Court is highly unlikely to rule that it's partially
severable, so we'll probably see the whole ACA struck down, or only the
mandate. In theory, Congress could fix it either way the next day...but in
practice it's likely to be terrible deadlocked. Messy.)

~~~
bunderbunder
I rather hope the bill stands or falls as a whole. The individual mandate is
one of the lynchpins of the bill. Without it, the bans on annual limits and
discrimination against people with pre-existing conditions that are coming in
2014 will probably force premiums to increase considerably. Admittedly there's
plenty of good stuff in the act beside all that, but I fear it's still better
to lose everything in the bill than it is to lose the individual mandate but
not the things that need the individual mandate to be feasible.

------
MattLaroche
What are the chances that if the Affordable Health Care act is found
unconstitutional that America gets universal health care in the next decade?

~~~
nextparadigms
You could always go for the European-style universal healthcare, where the
Government pays for everything. You'll need to have higher taxes, though, or
cut some of that military/war budget.

~~~
Lazare
A rarely talked about fact is that the US government already spends more per-
capita on health care than European governments do. (No, really!)

So actually, it's perfectly possible for the US to enact universal healthcare
and cut overall healthcare spending at the same time.

(Also, minor quibble, but when you say "Government pays for everything" you're
really talking about "free at the point of use" healthcare. That's one system
of universal healthcare used in Europe - and elsewhere - but not the most
common one.)

------
euroclydon
Some people aren't in a position to take on the risk of entrepreneurship.
Counting those with significant medical conditions among them doesn't strike
me as abnormal.

If society is geared to reward risk takers who succeed, it seems that if
society were then to eliminate a good deal of that risk, something in the
arrangement would be lost.

How is universal healthcare any different to start ups than a government
funded insurance policy that pays a modest amount when your startup fails?

My friend drives a nice sports car. He's outraged at the cost of dental work.
He thinks dental care should be free to Americans. How is that any different
that government subsidized sports cars?

~~~
merrick
The average age of a tech startup founder is 39, and a % of those have
families. They should not have to risk financial ruin as a tradeoff for
starting a company that could provide jobs.

~~~
mmastrac
Exactly. I'm in this position now: a single breadwinner with a child. As a
Canadian, I don't risk financial ruin for any health-related issues (unless I
travel to the US without health insurance, of course).

This was a big factor in me making the jump to founding a company from up here
in Canada. Hiring folks with families in the USA was a huge pain for us,
specifically because of the health care issues. We were paying a _lot_ for
them to extend their current health care from their previous employers, and
one had the added stress of having a pregnant wife at the time we brought him
over, with all the complications that brings to the health insurance story.

Hiring a fellow Canadian was basically a cakewalk.

------
Hyena
Actually, I think the ACA does improve the situation he describes. Small
companies, like start-ups, wouldn't be required to purchase health insurance
and people whose earnings teeter at the edge of "ramen profitable" would
likely be eligible for extensive subsidy.

------
jfoutz
Your friend is doing it wrong.

Instead of shelling out 17k/year, get a 5k deductible policy, and pay for the
doctor visits yourself. put the 5-10k you save per year in some sort of
investment you can get at when you really have to. Something like an index
fund if you're young, or bonds if you're older.

~~~
merrick
Those 5k deductible policies still cost $500 a month for family in a small
group and leave you really exposed to 15k per person (max out of pocket) and
max 45k out of pocket for the family. That's not inline with what healthcare
should cost. An individual may pay $75 for that same policy but still have
exposure of around 15k per year max out of pocket.

The HSA plans are just as expensive as middle of the road plans as well and
are geared towards people who save a lot to begin with.

~~~
jfoutz
here are some real numbers:

[http://www.mrhealthinsurance.net/PDFs/Blue_Cross_Options_Blu...](http://www.mrhealthinsurance.net/PDFs/Blue_Cross_Options_Blue/optionsblue_rates.pdf)

a 64 year old with a drug problem and 3 kids is looking at 31k a year (worst
case, 6k best case).

what, exactly, are you looking to have happen? it's either socialized, where
healthy people subsidize the sick, or it's not, or there is some gradient
between the two.

I think, right now, you're looking at about 6k/year per person. you can divide
that up however you want... billg pays all of it, you pay your own way, or
some point on the gradient between the two. regardless, the money has to come
from somewhere. I kind of like the obamacare, everybody contributes something
model. I think i'd prefer it as a straight up tax, but FREE MARKET IS AMAZING,
RAWR, so whatever. that's fine.

 _edit_

or we just let people die. i'm not ok with that.

 _edit 2_

I need to qualify that, this is only for people that aren't poor or old (which
medicare and mediaide cover already) or for veterans (which have their own
system) or kids (chips it think it's called). this is exclusively for working
class kinda folks who never went to war. the other 60% are already covered by
socialized medicine.

 _edit 3_

why the hell am i participating in an /r/politics discussion on hn? i'm
obviously dumb.

 _edit 4_

Thank you for simply downvoting and not replying. this way, i can go to sleep
not worrying you're expecting a reply.

------
Kopion
Healthcare isn't a right. End of story.

~~~
MattLaroche
At the same time, America treats emergency healthcare as a right and then the
rest of society pays those bills.

It's probably cheaper for people to get care before it gets to the emergency
level. It certainly results in better quality of life.

~~~
webXL
_It's probably cheaper_... _It certainly results in better quality of life._

Why don't we use that rationale to justify complete regulation of food
consumption? Let's have the government force all citizens to eat a vegan diet.
The economies of scale would certainly make it cheaper to consume. Overall
health would improve. And we would all have a better quality of life...

Except for that little word "force". What if I feel like a milkshake today or
a nice juicy steak every once in a while? If I can afford it, and it doesn't
hurt anyone else (humans at least), I should be free to purchase those things.

When you're required to eat things, or required to pay for things... OR GO TO
PRISON, you're not really free anymore, and that's why Americans don't like
government programs like ACA or socialized health care. It might make sense on
paper and look just like a big insurance pool, but in reality, it looks more
like a centrally planned market, where price signals and efficiencies are non-
existant, because when your doctor has a guaranteed paycheck from Uncle Sam,
he lacks an incentive to make sure you get the best care. When medical
students realize that reimbursement rates have dropped to the point that they
can't afford to repay their student loan for a very long time, we'll get fewer
doctors, or standards will drop.

I'd rather pay a little bit extra for poor people to get free care than to
force me into a one-size fits all plan with long wait times for special
procedures. Let's at least fix the problem of poor people not being able to
afford a decent level of care before we force everyone into a one-size fits
all government program with promises it can't keep, like Social Security and
Medicare.

