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The Only Possible First StepArticle Summary: The recent Supreme Court ruling regarding the 2010 Patient Protection and Affordable Care Act, more commonly referred to as Obamacare, has served to further widen the ideological chasm between those concerned with government intrusion, and those who feel a more progressive approach is the solution to the problem of broken healthcare. Indeed, the term 'socialized medicine' is still tossed about among the vitriol, evoking a cornucopia of anti-capitalist boogeyman imagery. The phrase was first utilized as a pejorative by a public relations firm working for the American Medical Association i
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The recent Supreme Court ruling regarding the 2010 Patient Protection and Affordable Care Act, more commonly referred to as Obamacare, has served to further widen the ideological chasm between those concerned with government intrusion, and those who feel a more progressive approach is the solution to the problem of broken healthcare. Indeed, the term "socialized medicine" is still tossed about among the vitriol, evoking a cornucopia of anti-capitalist boogeyman imagery. The phrase was first utilized as a pejorative by a public relations firm working for the American Medical Association in response to president Truman's proposal for a national healthcare system, and has had staying power for over sixty years. Many believe that the current ruling offers a slippery slope to even further government regulation, lack of choice, and is the precursor to economic ruin.

The most common argument until the recent ruling has been that Obamacare is prima facie unconstitutional due [url=http://www.jeremyparendt.com/Barbour-Paris.php]barbour france paris[/url] to a conflict with the U.S. Commerce clause. Roberts' ruling has actually strengthened the long-time conservative ambition to weaken Congress' power to regulate [url=http://www.lcdmo.com/hollister.php]hollister france[/url] the national economy, and arguably other unrelated areas. In common discourse, the Commerce Clause is usually discussed in tangent with the Necessary and Proper Clause. Congress may regulate commerce "among the several states," as well as laws that are "necessary and proper" for executing its other powers. Since the 1940s, these clauses have been interpreted broadly, extending not only to products sold across state lines, but activities that substantially affect interstate commerce. The substantive argument has been that even in combination with the necessary and proper clause, Congress is not permitted to regulate inactivity, or the desire to be left alone and take no action if one chooses. Subsequently, the "being forced to buy broccoli" controversy was introduced.

But this is a red herring. In the 1930s, the court recognized what the Depression had driven home-that in an interdependent national economy, local production affects interstate commerce, and there is no meaningful distinction between "direct" and "indirect" effect. In industrialized America, the local and national economies are inextricably linked. In support of this theory, the Supreme Court has upheld federal laws that restrict farmers' ability to [url=http://www.sandvikfw.net/shopuk.php]hollister sale[/url] grow wheat for their own consumption, or criminalize the growth of marijuana for personal medical use, even though in this instance people sought to stay out of the market (Wickard v. Filburn , 317 U.S. 111 (1942); Gonzales v. Raich , 545 U.S. 1 (2005)). It was reasoned that such personal consumption affected interstate commerce by altering supply and demand, and leaving it unregulated would undermine Congress' broader regulatory plan.

In addition, the federal government maintains the right to regulate the inactivity of those who refuse to serve on a jury by conscription. The same applies to the institution of the draft during times of war. Yet neither of these activities are deemed unconstitutional. It would follow that if economic inactivity is too far removed from actual commerce to regulate, then defense inactivity, or pacifism, would be too far from [url=http://urbangiraffe.com/plugins/comment-page-1/#comment-550081]Kettlebells - The Best New Workout - written by Phil Tucker[/url] defense to regulate. If the government can forbid pacifism to raise an army, it can also forbid economic inaction to regulate [url=http://www.rtnagel.com/louboutin.php]louboutin[/url] commerce.

But in truth, the decision to go uninsured is itself a form of action, in that the uninsured are actively choosing to pay out of pocket for care, or to let others pay for it. Considering that everyone will need health care at some point, the decision to go uninsured is not really "inactivity," but a decision as to how to finance care that will inevitably be needed. Justice Ginsberg supported this opinion, asserting that "unlike markets for most products, the inability [url=http://www.shewyne.com/woolrichoutlet.html]woolrich sito ufficiale[/url] to pay for care does not mean that an uninsured individual will receive no care. Those [url=http://www.osterblade.com]moncler outlet[/url] with health insurance subsidize the medical care of those without it." There is [url=http://www.fayatindia.com/giuseppe-zanotti.html]giuseppe zanotti pas cher[/url] no guarantee within the Constitution of the right to be a free rider and to shift the cost of one's healthcare to others, but this assertion is rooted in the same tradition of those who invoked [url=http://www.shewyne.com/hoganoutlet.html]hogan outlet[/url] states rights in order to support slavery, segregation, and deregulation of labor and consumer laws. Unfortunately, this is now a moot point in terms of how the legislation actually passed the court, as the initiative has been ruled a tax as opposed to [url=http://avisemos.com/item/206044]barbour france paris The Mass Interest in All Thin[/url] a regulation.

According to the opinion of chief Justice Roberts, the mandate may be upheld as within Congress' power to "lay and collect taxes," encapsulated within the 16th amendment. The ruling is fascinating, since it seems the Obama administration went to great pains not to represent the legislation as a tax. However, the issue at hand is not whether Congressional tax power is Constitutional (despite Rush Limbaugh's histrionics) but whether the plan can be adequately funded, and whether it is a better alternative to the existing system. As usual, much of the statistics and rhetoric in the debate are centered on whether you support or oppose the initiative. If one is opposed to taxation in any form like many conservatives or tea party members, then persuasion is likely a losing battle. Conversely, it may be difficult to point out potential flaws in the system to supporters, who have waited decades for positive change.

Conservatives have been quick to point out that PPACA represents "the most massive tax hike in [url=http://www.shewyne.com/moncleroutlet.html]moncler sito ufficiale[/url] history." This is patently false. The Federal Joint Committee on Taxation, which is a nonpartisan Congressional organization with a professional staff of economists, attorneys and accountants provided a detailed breakdown of the tax impact of the healthcare law from 2010-2019. The committee estimates that the law will bring in more than $437 billion by 2019. In consideration of a projected GDP of $21 trillion and other factors, the tax increase would amount to .49 percent of total GDP for that year. This represents about the size of the tax increases proposed and passed by President Carter in 1980, President Bush in 1990, and President Clinton in 1993. The proposal is substantially smaller than the two tax increases passed during WWII, and another passed in 1961.

But also at issue: will there be enough funding to make healthcare affordable for all concerned? According to the Congressional Budget Office, the PPACA is fully funded, will provide coverage for more than 94% of Americans, and will reduce the federal deficit by $130 billion over the next 10 years and $1.2 trillion over the following 10 years. By way of brief summary, the funding is comprised of taxes and offsets, inclusive of such things as a Medicare tax on incomes over $200,000 and $250,000 for individuals and joint filers, an annual fee on insurance providers, and a 40% tax on "Cadillac" insurance policies. In addition, there are taxes on pharmaceuticals, a 10% federal sales tax on [url=http://www.shewyne.com/woolrichoutlet.html]woolrich outlet[/url] indoor tanning services, and high-cost diagnostic equipment. The plan also includes government money, in the form of tax credits, as a subsidy for lower-income people who can't obtain insurance through their employer.

Another measure that combats unsustainable fiscal burden includes the formation of insurance exchanges to reduce underwriting and inefficient marketing practices that [url=http://www.i1717.com/home.php?mod=space&uid=85508]hollister sale Tax Software Advantages and Disadv[/url] raise costs in the small-group and individual markets. The reduction of Medicare overpayments, including those to medicare advantage plans, is also included. There is a mandate to move away from [url=http://www.gotprintsigns.com/abercrombiepascher/‎]abercrombie pas cher[/url] fee-for-volume payments to fee-for-value payments, as well as major research investments to support quality improvement and cost-control efforts. A task force to reduce fraud and waste, and measures to encourage measures to reduce malpractice burdens are also part of the proposal. PPACA recognizes that heath information technologies can markedly improve the quality and economy of medical care, and the proposal builds on last year's stimulus bill providing substantial funds for HIT. The proposal also includes substantial new incentives for physicians to provide preventative and chronic care.

Many single-payer proponents make the [url=http://www.jeremyparendt.com/Barbour-Paris.php]barbour pas cher soldes[/url] point that the crux of the problem is that healthcare is still in the hands of a private industry that makes its profit by collecting premiums and denying care, and that nationally, 78 percent of those bankrupted by illness or injury are insured at the start of their illness, inclusive of 60 percent who had private coverage. The PPACA makes a good start at rectifying this, making it illegal to deny coverage to children with a pre-existing condition, and offering coverage to adults through the Pre-existing Condition Insurance Program. Moreover, before the Affordable Healthcare Act, insurance companies spent as much as 40 percent of premiums on salaries, overhead, and other administrative costs, and could raise rates without warning or explanation. The new initiative requires that companies spend at least 80 percent of the premium on healthcare, and must justify any rate hike of more than ten percent to the state or federal rate review program.

The argument ultimately comes down to fundamental values. For those content to be opposed to taxation in any form, or those content with the current status quo, any amount of logic will be futile. At this point in time in America, a single-payer proposal still has a Hell's snowball chance of being initiated. It seems that the PPACA or a similar initiative is the only possible first step, and the only viable option to initiate positive change.
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