Lesser evils, ideological compromise, and the healthcare individual mandate

I am no constitutional lawyer, but that aside I have a few things I would like to point out about the current SCOTUS debate on the Healthcare Individual Mandate. First, we progressives must set aside the demonstrably hideous hypocrisy, rampant intellectual dishonesty, and disgusting manipulation of a minimally educated, myth-intoxicated voter base that passes as statesmanship in the GOP in increasing measure with each passing election. (see what I did there?) 

Essentially there are two positions on constitutionality with regard to the commerce clause and the individual mandate. Rather than defend that constitutionally, legally, and honoring prior legal precedent (which I cannot), I'll just focus on the argument logically and from the position that recognizes the fact which the high court has encountered many thousands of times - there are no ideologically pure decisions. All things require nuance, compromise, and choosing between two (or more) less than ideal choices. Such is life.

First, I think the mandate will be ruled unconstitutional. I think the common good, and easy logic that our society is greatly improved when all citizens have healthcare and that all are required to pay for it, is going to be found distasteful to the conservative majority on the court. I think political ideology is at play, in equal measure at least, to constitutionality. I think the current majority on the court hold the view (which I disagree with) that freedom is defined as the right of individuals to be as free as possible, with little regard paid to the potential consequences on the society writ large. While I find this view unsophisticated, even somewhat barbaric, it is not without some merit as a test of reason, especially when weighing exceptions. And exceptions are unavoidable. The downsides to society of this "freedom at any cost" ideology are easy to see, and for a subset of Americans with their unbending fervor for all corner cases of freedom; ignoring all consequences of this "freedom" is demonstrably harmful. 

Examples are many, but here is one.

Unlimited access to as many guns as any individual might want, is dangerous. Allowing anyone to carry these firearms (often legally concealed) wherever they choose (including schools and even some state legislatures) is just nuts. Further passing laws like the new GOP favorite, "Stand Your Ground" that allows individuals to shoot anywhere they are legally allowed to be as long as they assert that they "felt threatened", means Trayvon Martin will not be the last innocent shot dead. I could go on, but you get the point. Freedom is something we need to be nuanced about, or we are so "free" we devolve into any number of possible dystopian societal outcomes. I believe the hypothetical freedom not to participate in the obvious benefits of healthcare and therefore refuse to bear the cost of that healthcare, is what this argument is about.

When pondering the position of those that think it possible that the mandate is constitutional, they tend to argue that healthcare markets are unique in one way. In no other market can those who refuse to buy something, pass the cost of that decision onto others who do, when all invariably use the product of that market (I'll get back to the "invariably" question in a moment). Those who choose not to buy a flat screen TV cannot force the market to give them a flat screen TV for free, simply because their team makes it to the Super Bowl and they want one - or feel they need one. There are unlimited similar market examples one could use - and not one is analogous to the healthcare market. I believe this feature of the healthcare market is unique and could be the lone exception wherein the government can mandate participation by all, or tax penalty for non-compliance. 

Simply said: If a society chooses to medically treat the uninsured, the lesser of two evils; force payment or allow deadbeats, is to force payment.

To the argument against constitutionality being made as to the fact, and I agree it's a fact, that the government created this problem by earlier mandating that the uninsured be treated, I challenge the argument that the decision to treat the uninsured is somehow flawed. It has, for sure, the unfortunate side effect on cost to the insured, however logic was invoked in the decision to treat the uninsured as well. Would we really like to live in a society that allows those with easily treated maladies to simply be turned away to infect others or to simply die? I have been to India and watched people laying in their own bodily fluids, swarmed by flies on a public train platform. I don't think it's workable to suggest that we simply reverse our decision to treat the uninsured as the best path - despite the Darwinian attraction that may hold for some. But given that the decision to treat the uninsured is a reality (in my view) of living in a civilized society, we do introduce the need to solve the problem of cost created by that decision (in my view a necessary and humane outcome) .

This is indeed a tiered decision, where we are forced to face choosing the lesser of two evils. If one chooses to treat the uninsured, we must deal with the cost in some way or we treat the insured unjustly. This causes us to find, as we must and have in many, many questions of constitutionality, that the good and just outcome may be to grant an exception to some constitutional clause for this unique circumstance alone. These interpretations and exceptions are why the high court exists after all. The court can also stipulate that this is indeed an exception, and does not necessarily imply (as some would like us to believe) that the government immediately has broad new powers to force the buying of other things. Even so, these future hypothetical transgressions by the government are subject to constitutional scrutiny, should they ever occur.

And finally, to those who challenge the assertion by the Obama administration that everyone will eventually require healthcare, I offer this challenge. It is hard to imagine many such examples of people who do not require (or decline) to use healthcare services. I can think of three:

• One can imagine a person making the (deranged?) choice to simply never be treated for any malady - which might be called mental illness and require forced treatment (but I digress). The likelihood of need for this treatment within this hypothetical persons lifetime is virtually certain. Also, even if we say that people are free to never ask for medical care and therefore should not be required to have health insurance, choosing not to treat an infected person puts the entire society (or at least the nearby society) in much greater danger of infection. Even if one stands on the purity of the ideology of allowing people to make that choice, I would guess the number of individuals to make such a choice (refuse all medical care throughout life) would be so small as to be inconsequential. But I am a progressive, after all, and therefore willing to allow some exceptions even if they offend this hypothetical (and likely deranged or possibly non-existent) person, for the common good - I assert this compromise is reasonable and the only just outcome - but clearly not satisfying to all parties - as is the very nature of compromise
• It is also possible to imagine that very wealthy people might simply choose to pay for their own treatment out-of-pocket. Surely they are not the problem in question. Also, infringing on their freedom by requiring them to purchase health insurance, is also not a heinous outcome, given the real problems of freeloaders who make a conscious choice to take advantage of the mandate to treat the uninsured. As in all things, nuance is required, freedom is not a universal right in all cases, especially corner cases, and in some circumstances, we must interpret our laws to find the least harmful middle ground
• Finally, one can imagine someone choosing never to use healthcare. We have such people, they're called Christian Scientists. I would be happy to make the decision to allow such people (Christian Scientist or otherwise) to eschew any treatment, but I would say a single transgression within their lifetime, should force that individual out of the exception for life and subject them to the "buy insurance or be taxed" majority case

In the end, we only have so many choices. We can accept a free-market solution like the Individual Mandate of the GOP think tank, The Heritage Foundation, most in the GOP for the past 20 years, including Gov. Romney, or we can choose Medicare for all, a single-payer system surely more irksome to the ideologically conservative among us. Making no choice, as Mr Romney and Senate minority leader McConnell have asserted recently, is surely not an option. One must choose, and choosing is not ideologically pure. One must, in the end, get over that. After all, it is one of the very essences of being alive.

The new and "improved" Ryan budget

What I share below on the new Ryan budget is as clearly stated as is possible in my view regarding the box GOP fiscal orthodoxy has wrought. Fortunately for all of us with already high incomes, this will range from mostly meaningless to our bottom lines to hugely and positively impactful.  If you are, like me, someone with few deductions already, and a high income, these lower rates will be quite beneficial, as they are not offsetting any large tax deductions for me, other than the mortgage interest exemptions. So I guess I should be happy, but... 

The Ryan (and Romney) economic orthodoxy, quadruples down on supply side economic theory. If they are right, we will explode with growth, if they are wrong (and almost surely the evidence supports the conclusion that they are dangerously wrong), we will slowly continue to shrink GDP, push more and more income upward to the already wealthy, and slowly the middle-class will disappear completely - dividing us into two classes; the wealthy and the not. And given the fervor to repeal the Affordable Care Act, those who fall into this "not wealthy" crevasse will likely not take care of themselves, and will flood hospitals for normal care, costing us billions in insurance premium increases in our free market healthcare system (shouldn't the GOP call that increase a hidden "Tax"?) - so we will pay for that anyway - or we can "just say no" and let people die I suppose.

So what the new and "improved" Ryan budget means for the vast majority of poorer Americans is pretty harsh - and by association - this outcome is the largest impact (a largely intellectual impact) on us in the top 5%. It begs the question, what kind of country do we want to be? But more importantly, if we sap the buying power of 60% to 70% of Americans (the hump in the income bell curve), can our free market economy really ever prosper again? After all free markets require a large base of consumers with at least some disposable income each month. It's a serious question with important implications.

This analysis from the great Ezra Klein:

I don't think Paul Ryan intended to write a budget that concentrated its cuts on the poorest Americans. Similarly, I don't think Mitt Romney intended to write a budget that concentrated its cuts on the poorest Americans. But there's a reason their budgets turned out so similar: The Republican Party has settled on four overlapping fiscal commitments that leave them with few other choices.The Republican plans we've seen share a few basic premises. First, taxes are too high, and must be cut. Second, defense spending is too low, and should be raised. Third, major changes to entitlement programs should be passed now, but they shouldn't affect the current generation of retirees. That would all be fine, except for the fourth premise, which is that short-term deficits are a serious threat to the country and they need to be swiftly cut.


The first three budget premises means that taxes and defense will contribute more to the deficit, and Medicare and Social Security aren't available for quick savings. That leaves programs for the poor as the only major programs available to bear cuts. But now cuts to those programs have to pay for the deficit reduction, the increased defense spending, and the tax cuts. That means the cuts to those programs have to be really, really, really deep. The authors have no other choice.


In Ryan's plan, for instance, revenues are approximately $2 trillion below the levels in Obama's budget, spending on defense is about $200 billion higher, Social Security is unchanged, and Medicare is about $200 billion lower. So that's approximately $2 trillion in lost revenues that need to be made up -- and then Ryan reaches for more than $3 trillion in deficit reduction atop that.


So the cuts to programs that mainly help the poor are correspondingly deep. The $1.5 trillion the Affordable Care Act was going to spend on subsidizing health insurance for low-income Americans is gone. But then Medicaid and other non-Medicare health programs take an $800 billion cut on top of that. Education and worker training loses $200 billion. Income security loses $800 billion. These are huge cuts.


And that's just in the first 10 years. As time goes on, the scheduled cuts become much deeper in programs for the poor than in programs for the rich. Medicaid, for instance, is only allowed to grow at the rate of inflation, while Medicare can grow at GDP+0.5 percent, which is substantially higher. Food stamps also see their growth capped at a low rate, while Social Security is left untouched. And while Ryan does take aim at tax breaks that he says benefits the wealthy, he intends to close them and use the proceeds to fund a tax cut.


As I said at the top; I don't take this as evidence that Paul Ryan wants to balance the budget on the backs of the poor. I take it as evidence that, given the set of commitments Republicans have made to their base, he didn't really have a choice. It was the only way to make his numbers work.


But that doesn't make the end result any different: Ryan's budget asks for enormous sacrifice from, say, disabled Medicaid beneficiaries even as it appears to provide enormous tax benefits to wealthier Americans. The same is true for Romney's budget, and, in even more exaggerated ways, for the fiscal promises made by Newt Gingrich and Rick Santorum. The Republican Party has backed itself into a fiscal strategy in which this kind of concentrated sacrifice on the part of the poor is the only possible path forward.

We are made of stars

I respect the journey that people take, even when they choose paths that I find illogical and easy to dismiss rationally. Each of us are free, especially as Americans, to select the path of our own choosing to craft our own individual journey toward life, liberty, and the pursuit of happiness. I argue that it is dangerous and even delusional to tie oneself to 5th century myths as our anchor to morality and inspiration - just look at all the death and pain these beliefs have wrought over millennia and continue to inspire today, and tomorrow. This must end if we are to survive as a species.

Still, we all have a yearning to be connected, to find brotherhood, belonging, and peace about our place in this world as alive, thinking, caring, emotional beings. I have rejected the myths of our religions, and in their place sought out the peace of knowing my place in the cosmos. That comfort, for me, is found in the awesome inspirations of science and nature. This basic fact of the very nature of who we are, who I am, was first summed up to me by reading Carl Sagan when he wrote in his epic series, Cosmos, that "we are all, literally, starstuff". The leading light in astrophysics to replace Carl after his early death is, for me, Neil DeGrasse Tyson. Watch his interview on the fact and the connection to the cosmos it brings him....and me.