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Friday Morning News Roundup

Friday Morning News Roundup

There are many lessons to be learned and studied from the disaster that is characterized generally as Hurricane Sandy. One of these lessons that I’ve been studying has to do with the two hospitals which were evacuated. One of the best articles that I’ve read so far was published in the New England Journal of Medicine. This is clearly worth a read.

For weeks, I’ve said that there really is no fiscal cliff. The heightened rhetoric that we’ve seen in the media by pundits and politicians can only be categorized as nauseating. First of all, Congress is already cutting $1.5 trillion in fiscal spending over the next 10 years. Secondly, non-defense discretionary spending is projected to fall to historically low levels if Congress does what it does best, which is nothing. All of the thoughtless yammering over the “devastating” impact of allowing the Bush tax cuts to expire is typical Washington hype. The percentage of small businesses which will be affected is minuscule. Yet, we are led to believe that hundreds of thousands of mom-and-pop businesses will instantly go belly up if the Bush tax cuts were allowed to expire. Horse hockey. I’m afraid that the Democrats on Capitol Hill seemed to have little or no capacity to articulate reasonable and thoughtful positions on the budget. Our argument has to consist of more than the fact that the wealthy can afford to pony up a little bit more money.

A complete Internet and cell phone blackout in Syria shows the extent that some governments will go to in order to suppress the free flow of information.

Once again, the “Stand Your Ground” law is in the news. It appears that a 45-year-old Florida man shot and killed Jordan Russell Davis over some loud music. From reports that I’ve read, it appears that Michael David Dunn approached Davis and his friends at a convenience store, asking them to turn their music down. An argument ensued and eight to ten shots were fired. Davis ended up dead. Michael David Dunn is claiming that he felt threatened and was therefore justified in using lethal force under the Stand Your Ground law. If you think aspects of this sound familiar, I think you’re exactly right. (more…)

By |2012-11-30T20:25:20-04:00November 30th, 2012|Economy, Foreign Affairs, Healthcare, Living wage, Party Politics|Comments Off on Friday Morning News Roundup

Individual Mandate

I thought that this was a particularly thoughtful commentary. It was published in the New England Journal of Medicine.

Buying Health Care, the Individual Mandate, and the Constitution

Posted by NEJM • June 23rd, 2010
Sara Rosenbaum, J.D., and Jonathan Gruber, Ph.D.

In Rashomon, a classic film that explores the concept of truth, director Akira Kurosawa presents a story about a single incident retold by four narrators, leaving the audience to figure out what is real. Litigation has a Rashomon-like quality to it: two sides meet in a courtroom and each presents its case, arguing not only that abstract legal principles favor its cause, but equally important, that its version of the event that gave rise to the dispute should be the filter through which the court decides the matter.

Three separate cases raising constitutional challenges to the Affordable Care Act (ACA) are now under way(1,2,3) and together they present issues of great legal complexity.(4) Yet although difficult legal questions must be resolved, a pivotal issue is whose version of events will serve as the judicial analytic filter. For reasons related to the very basis of Congress’s constitutional power to enact health care reform, the fight is over whether the individual mandate to purchase health insurance (or pay a tax) is about regulating individuals’ economic conduct or regulating their noneconomic status. Depending on which characterization of the facts prevails, the individual mandate either falls within or lies outside Congress’s power to act.

The Supreme Court precedents indicate that the framers of the U.S. Constitution vested Congress with enormous powers to regulate individual economic conduct, even as they limited congressional authority over noneconomic activity. The source of this power to regulate economic activity down to the individual level is found in the Constitution’s Commerce Clause (article 1, section 8, clause 3), on whose reach the legal resolution of these cases ultimately depends. This clause explicitly grants Congress the authority to regulate interstate commerce.

In Gonzalez v. Raich, a 2005 decision involving federal regulation of home-grown marijuana, the U.S. Supreme Court concluded that growing marijuana amounted to economic activity and interpreted the Commerce Clause as permitting Congress to reach the “consumption of commodities for which there is an established and lucrative interstate market.” In other cases involving the constitutionality of federal laws sanctioning individual conduct — gun possession on school grounds (in United States v. Lopez, 1995) and domestic violence (in United States v. Morrison, 2000) — the Court concluded that the specified activities did not amount to economic conduct within the definition of the Commerce Clause. To be sure, both gun possession and violence against women have economic consequences, but an indirect economic effect is insufficient to warrant congressional regulation. As a result, only states, using their police powers, can directly regulate such activity, which lies beyond the limits of Commerce Clause control.

Thus, the outcome of the battle over the individual mandate turns on whether the courts understand the ACA as a law that regulates economic conduct. Complaints recently filed by the state of Virginia and by multiple state claimants in Florida represent a direct challenge to the proposition that economic conduct is involved. In their complaint, the multistate plaintiffs argue that the law should be viewed as an attempt “to regulate and penalize Americans for choosing not to engage in economic activity.” Similarly, in his June 2010 brief, the Virginia attorney general argues that the ACA must be understood as an attempt to compel individuals to undertake economic conduct by forcing them to buy health insurance. In other words, highly cognizant of the distinction drawn in Raich between economic and noneconomic conduct, the plaintiffs argue that health care reform is a blatant attempt to force an economic undertaking; they frame the ACA as a law about status (being uninsured) rather than about economic activity. (more…)

By |2010-07-31T04:43:51-04:00July 31st, 2010|Economy, Legal|Comments Off on Individual Mandate

Health-Care Reform and Cost Control

The following was published this week in The New England Journal of Medicine. The New England Journal of Medicine is arguably the most prestigious medical journal in the country. This article was written by the White House Office of Budget and Management director Peter Orszag and Dr. Ezekiel Emanuel (author of Healthcare, Guaranteed).

From NEJM:

After nearly a century of failed attempts, comprehensive health care reform was enacted on March 23, 2010, when President Barack Obama signed the Affordable Care Act (ACA). In attempting to modernize and improve a large part of the health care system, it may be one of the most ambitious and consequential pieces of legislation in U.S. history.

Although the bill has now been signed into law, the debate over its design and intended effects has not abated. As concerns appropriately mount about the nation’s medium- and long-term fiscal situation, critics of the ACA have resurrected doubts about its cost-containment measures and overall fiscal impact. Many commentators have claimed that the bill focuses mostly on coverage and contains little in the way of cost control.

Yet we would argue that even from a purely “green eyeshade” viewpoint, the bill will significantly reduce costs. Projections suggest that with reform, total health care expenditures as a percentage of the gross domestic product will be 0.5% lower in 2030 than they would otherwise have been. In addition, although the Congressional Budget Office (CBO) expressed concern that health care costs will remain high even after reform, it also determined that the ACA will reduce the federal budget deficit by more than $100 billion over the first decade and by more than $1 trillion between 2020 and 2030. And the Commonwealth Fund recently projected that expenditures for the whole health care system will be reduced by nearly $600 billion in the firstdecade.1

But these savings will be illusory if we do not reform health care delivery to bring down the long-term growth in costs, and the ACA puts us on the path to doing just that. In fact, it institutes myriad elements that experts have long advocated as the foundation for effective cost control. More important is how the legislation approaches this goal. The ACA does not establish a rigid bureaucratic structure to be changed only episodically through arduous legislative action. Rather, it establishes dynamic and flexible structures that can develop and institute policies that respond in real time to changes in the system in order to improve quality and restrain unnecessary cost growth. (more…)

By |2010-06-19T18:15:25-04:00June 19th, 2010|Healthcare, Obama administration|Comments Off on Health-Care Reform and Cost Control
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