The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

I’m Just Sitting on a Fence

Posted by Alan on June 28, 2012


Hello. As you may have noticed, this blog has been dark a lot longer than the month or two I thought it would be. But what’s 10 months among friends? I haven’t made it back to regular blogging because things at SeeChange Health have simply been too busy. We’ve launched statewide in California back in September, have grown very consistently since then (thanks to all of you supporting our approach to health insurance) and we’re waiting on regulators in Colorado to begin selling there. All of which has kept me away from this blog.

But how can I ignore what’s happening in Washington today? With the U.S. Supreme Court ready to announce their decision in just a few minutes, I thought I’d return for one more day of comment. So like much of the industry, I’ll be tuning in to SCOTUSblog¬†for their live coverage and I’ll be back to provide whatever insight I can add as soon as the Supremes do their thing. Later tonight I’ll try to offer a more considered evaluation.

One quick observation first: what’s amazing about all this is that the Supreme Court’s decision concerning the Patient Protection and Affordable Care Act will be based on the constitutionality¬†of the individual mandate. A provision that, in practical terms, is hardly a mandate at all. The fine/tax/penalty/whatever-you-want-to-call-it in the PPACA is so modest as to be all but meaningless. Yet whether a mandate in concept (if not fact) is constitutional will have tremendous impact.

As far as predictions go? I’m with the Rolling Stones on this one: “I’m just sittin’ on a fence You can say I got no sense Trying to make up my mind Really is too horrifying So I’m sittin on a fence.”

Be back soon.

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One Response to “I’m Just Sitting on a Fence”

  1. When I heard the ruling that this was a tax, not a fee, I immediately harkened back to President George H. W. Bush who proclaimed: “Read my lips, no new taxes.” He then reneged on the pledge and paid the price in 1992.

    In September 2009, President Obama was interviewed by George Stephanopoulos and here is a excerp of the interview:

    ABC News Interview
    GEORGE STEPHANOPOULOS: …during the campaign. Under this mandate, the government is forcing people to spend money, fining you if you don’t. How is that not a tax?

    OBAMA: Well, hold on a second, George. Here – here’s what’s happening. You and I are both paying $900, on average – our families – in higher premiums because of uncompensated care. Now what I’ve said is that if you can’t afford health insurance, you certainly shouldn’t be punished for that.
    That’s just piling on. If, on the other hand, we’re giving tax credits, we’ve set up an exchange, you are now part of a big pool, we’ve driven down the costs, we’ve done everything we can and you actually can afford health insurance, but you’ve just decided, you know what, I want to take my chances. And then you get hit by a bus and you and I have to pay for the emergency room care, that’s …

    STEPHANOPOULOS: That may be, but it’s still a tax increase.

    OBAMA: No. That’s not true, George. The – for us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase. What it’s saying is, is that we’re not going to have other people carrying your burdens for you anymore than the fact that right now everybody in America, just about, has to get auto insurance. Nobody considers that a tax increase. People say to themselves, that is a fair way to make sure that if you hit my car, that I’m not covering all the costs.

    STEPHANOPOULOS: But it may be fair, it may be good public policy …

    OBAMA: No, but – but, George, you – you can’t just make up that language and decide that that’s called a tax increase. Any …

    STEPHANOPOULOS: Here’s the …

    OBAMA: What – what – if I – if I say that right now your premiums are going to be going up by 5 or 8 or 10 percent next year and you say well, that’s not a tax increase; but, on the other hand, if I say that I don’t want to have to pay for you not carrying coverage even after I give you tax credits that make it affordable, then …

    STEPHANOPOULOS: I – I don’t think I’m making it up. Merriam Webster’s Dictionary: Tax – “a charge, usually of money, imposed by authority on persons or property for public purposes.”

    OBAMA: George, the fact that you looked up Merriam’s Dictionary, the definition of tax increase, indicates to me that you’re stretching a little bit right now. Otherwise, you wouldn’t have gone to the dictionary to check on the definition. I mean what …

    STEPHANOPOULOS: Well, no, but …

    OBAMA: … what you’re saying is …

    STEPHANOPOULOS: I wanted to check for myself. But your critics say it is a tax increase.

    OBAMA: My critics say everything is a tax increase. My critics say that I’m taking over every sector of the economy. You know that. Look, we can have a legitimate debate about whether or not we’re going to have an individual mandate or not, but …

    STEPHANOPOULOS: But you reject that it’s a tax increase?

    OBAMA: I absolutely reject that notion.

    I guess the Supreme Court has spoken: If it walks like a duck, quacks like a duck, and looks like a duck, its a duck! It will be interesting to see how the American people respond to what may now only be perceived as political double speak.

    The beat goes on!

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