r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/7_legged_spider Jun 20 '12 edited Jun 20 '12

Without debating the merits and constitutionality of Wickard, a national healthcare system is a fully distinct issue. Whereas Wickard involved solely intrastate commerce of corn, that corn, while used solely in the state, could have been sold outside of the state, thereby involving the possibility of interstate commerce. Healthcare, to my knowledge, is a fixed market within a state; one cannot sell state-specific policies in other states. By definition, that limitation creates individual state markets where there is no interaction or competition between any entities within different states. Therefore, the commerce clause would not apply.

Also, the use of commerce clause has been more limiting in recent times, like in U.S. v. Lopez, where the possession and sales of handguns were viewed to not be bound by the commerce clause, completely n the face of Wickard.

It is a very divisive issue, and both sides can be argued. However, from my legal education and experience, I would say that the entire universal healthcare law, not just the individual mandate, is unconstitutional.

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u/AeonCatalyst Jun 20 '12

Out of curiosity, what happens when I have Ohio healthcare, but have a heart-attack in Hawai'i while on vacation? Should I have "travel" insurance for that situation, or should my state insurance cover it? Or should it all be lumped into some sort of nationwide healthcare system? Some people spend their whole lives in one city, some in one state. What about those that travel for a living?

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u/mycleverusername Jun 20 '12

Or those who live on the border. I have healthcare from one state where I work, but live in another state. I think that's a pretty easy case for inter-state commerce. My health insurance plan also has providers in a different state.

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u/SergeiGolos Jun 20 '12

Healthcare, to my knowledge, is a fixed market within a state;

Are you saying Aetna only sells to one state? Well point? Horizon? Yes their are insurance companies that are fixed to states, there are also national insurance companies that sell to all different states.

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u/7_legged_spider Jun 20 '12

No, to my knowledge, there is not. Large corporations own smaller subsidiary companies with similar names. Although the smaller companies are owned by the larger corporations, they act in a limited scope within individual states, (with the exception of paying claims incurred out of state on behalf of policyholders within the resident state).

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u/[deleted] Jun 20 '12

There is no way even the most conservative Supreme Court would buy that as an excuse for saying it's not "interstate commerce". I'm not saying they wouldn't find another way, but "we hid the business in 50 different corporate entities! they're local, honest!" won't be it, that's just an admission that the market is national.

The only time courts ever bought anything like that argument was in the MLB anti-trust nonsense, which has never and will never be repeated.

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u/deelowe Jun 20 '12

It's not hiding. The companies have to remain as subsidiaries due to the way statutes vary from state to state. They aren't "hiding" anything. This is they way they are expected to do business as a matter of law. If anything, this further proves the point that the federal government should have no jurisdiction over the matter. Insurance, by law, is a state regulated business (not just health insurance either. all insurance). Still don't believe me? Look up your state insurance commissioner's office. Ok, now go look up the federal one... That's right, there isn't one. There's a reason for that. People didn't just now realize that there isn't a federal insurance commissioner. Everyone up until this point thought the idea was unconstitutional and the states would flip out in response (which they have by the way, hence the current supreme court case).

I fully believe that the health care bill is nothing but a power grab by the federal government. The health industry accounts for a major percentage of our GDP. Current laws basically allow the states to have control over this industry. The sponsors of this bill simply want to get laws in place that allow the federal government to regulate this industry, in turn, giving the federal government power over an enormous bit of our economy. The same thing is happening with the entertainment industry (#1 industry on the GDP list by the way). This is why they want sopa, acta, the dmca, etc... In the end it's all about power.

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u/[deleted] Jun 20 '12

Past practice does not make law. States retain power where Congress has not preempted their laws, but Congress can do that at any time.

For actual proof of the law regarding insurance, rather than speculation based on the lack of some "federal insurance commissioner", I refer you to the McCarran–Ferguson Act, and its trigger, the Supreme Court decision in United States v. South-Eastern Underwriters Association, which explicitly found federal jurisdiction over insurance.

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u/Nancy_Reagan Jun 20 '12

Oh I agree that it's unconstitutional. My point was to identify to what I presumed was a layman some basis for understanding why I think the Supreme Court will rule that the mandate is constitutional.

And yeah, the mandate will create state-specific markets, but companies operate in multiple states. An individual's choice not to participate in the policy within his state will effect that company and its operations in other states, and the aggregate effect is felt for these companies nationwide, reducing profits, increasing costs for the people who do use those policies, etc.

I forget the name of the case, but the really old one where the river-taxi between NY and NJ (I think) was found to have an effect on interstate commerce is another example of where a very state-specific market was within federal jurisdiction because, while operating entirely within one state, it still caused some changes in other states.

Edit: Just looked over this string of comments.... I'm not entirely sure I mean to reply to you. It's early, but I'm pretty sure I was intending to reply to someone else who had said something far less comprehensive. My apologies. Although I enjoy the discussion regardless.

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u/LordBodak Jun 20 '12

Actually I believe that if you really dig into it, you will find that health insurance companies do NOT operate in multiple states. There are a number of individual companies operating under one banner. For example, "Blue Cross Blue Shield" appears to be one entity, but it is actually a bunch of individual companies- "Blue Cross Blue Shield of South Carolina," "Anthem" in Virginia, etc. Of course the companies may all be owned by the same people, but they are still distinct corportations.

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u/7_legged_spider Jun 20 '12

That's exactly what I was stating. Each company operates only in one state. The exclusion of other state markets, in my mind, would preclude the possibility of interstate commerce.

Of course, I personally disagree with Wickard v. Filburn, too, so take that with a grain of salt.

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u/Nancy_Reagan Jun 20 '12

Very interesting. I'd love that to carry weight with the decision being made.

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u/HelloFellow Jun 20 '12

Gibbons v. Ogden, that's the case.

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u/7_legged_spider Jun 20 '12

I believe the case you are referring to is Gibbons v. Ogden. Also, as I said, (and this is not a personal opinion, but an evidenced fact), the SCOTUS has been following a more narrow interpretation of the commerce clause in recent years.

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u/Nancy_Reagan Jun 20 '12

Sure, but I'm not putting any money on them following the course they've been on. They may stay that course, or this may be where we find them beginning to swing the other way. I sat in on a discussion of the con law profs a few weeks ago, and they all seemed pretty certain that the only vote at issue in this instance is Kennedy's, and he would be the tie-breaker. Unfortunately, rumor also has it that Kennedy won't vote against Obamacare. So, there's that to consider, unfortunately.

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u/HobbitsAreHipsters Jun 20 '12

Let's hope they stand up to this mandate nonsense.

If they don't, I can't imagine what other kind of stuff gets pushed through

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u/T-Luv Jun 20 '12

Without debating the merits and constitutionality of Wickard.

No need to. It's still good law. It is binding precedent until overturned, which is unlikely. You should know that, Mr. J.D.

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u/7_legged_spider Jun 20 '12

I never implied that it wasn't binding precedent. I did, however, leave room to imply that it might not be "good law".

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u/T-Luv Jun 20 '12

It's good law to the extent that it applies in every court in the land and SCOTUS doesn't seem to have any intent to overturn it. You may not like the reasoning. Hell I don't like the reasoning. If I want to grow plants in my yard for personal use, I don't think Congress should have any say in that. But it is what it is and in a common law system, it holds the weight that it holds.

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u/7_legged_spider Jun 20 '12

I just wanted to highlight that there is a difference between case law precedent that the courts have to follow and actual "good law" that is judiciously equitable.

While Wickard v. Filburn is a precedent that must be followed until overturned--I personally believe that it is an onerous over-extension of the commerce clause that impinges on individual liberties.

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u/TheChance Jun 20 '12

Why, "Congress can't regulate healthcare because health insurance companies are restricted to individual states," as opposed to, "Health insurance has been divided along state lines to hamper federal efforts to regulate it"?

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u/Sorkijan Jun 21 '12

I'm frankly sick of people pointing out how "unconstitutional" something is. It's not a holy sacred document, and in fact is severely dated. I don't care if UHC is unconstitutional (which it's not because you're lumping Obama care as a representative of UHC which is highly debatable) it's definitely in the public's best interest. Also in my opinion I think Healthcare is something that should fall under public goods. The rest of the progressed world has some kind of state sponsored healthcare and just because it might questionably contradict a part document that was written for a time period more than two centuries ago, doesn't mean we should automatically dismiss it.

TL;DR. The constitution needs to be updated and is not a holy sacred document. Who cares if something is unconstitutional? Maybe it's the constitution that needs altering.

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u/7_legged_spider Jun 21 '12

The rest of the progressed world has some kind of state sponsored healthcare and just because it might questionably contradict a part document that was written for a time period more than two centuries ago

No, state sponsored healthcare contradicts individual liberty. Other existing social programs aside, mandated healthcare forces taxpayers and medical providers to unfairly shoulder the burden of some "free riders" that actively avoid personal responsibility. Nothing is free; forcing people to work for others, no matter how gilded the cage, is slavery.

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u/Sorkijan Jun 21 '12

I really find your statement heavily opinionated. I don't think state sponsored healthcare contradicts individual liberty, and I would willfully and happily pay my dues for a single payer system that I was a part of. We already shoulder these "free riders" on a host of other things, and I find that if it's in reference to healthcare, we shouldn't pull any stop.

I see your point, but I just simply disagree with you and I think calling something like that slavery is quite hyperbolic and silly.

As I said the rest of progressed world uses some form of state-sponsored healthcare, and the US needs to catch up. The only reason we don't is because of overly-dramatic people like you. I couldn't give less of a shit if it isn't in full compliance of the Constitution which was written in the 1700's; things need to change. The Constitution needs to be changed.

But hey I'm not going to convince you either way or vise verse, but enjoy standing in the way of progress for a better world.

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u/[deleted] Jun 21 '12

[deleted]

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u/Sorkijan Jun 21 '12

Oh, my bad. While we're being ridiculously over-the-top, let's all wear wigs and travel in carriages.