June 26, 2012 When the Blind Rule in Favor of Ignorance; Ignorance is Bliss Section. I. Health Insurance According to the Bureau of Labor Statistics health insurance premiums are defined as Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared by both the insured individual and the plan sponsor (1). Individuals, who participate in health insurance plans, in some way, shape or form, pay a premium. This money is pooled and utilized by a private company (excluding government sponsored health insurance), who assumes the risk of an individual s health in terms of medical payments. When an individual is healthy, the health insurance company benefits by increased funding and decreased expenditures within the pool. However, when an individual is not-healthy, or suffers an unforeseen sudden medical issue, the health insurance company does not benefit, because the expenditures are greater than the funding. It is this simple economic principle, that when you spend more than you take in; your books will be in the red, and the business will not sustain itself for any extended period of time. The problem: health insurance companies, as all companies, are looking at the bottom line. The top five health insurance companies in 2011 (2) generated a total of $12.788 billion dollars in net income (profit after taxes and expenditures; United Health Group: $5,142,000,000; WellPoint, Inc.: $2,646,000,000; Kaiser Permanente: $1,600,000,000; Aetna: 1,990,000,000; Humana: $1,400,000,000) (3). Now the question becomes, how can you create a larger pool of healthy individuals, to increase funding, while decreasing expenditures, in order to create a larger net income? Section. II. Campaign Finance Campaign finance has changed our republican government. Candidates no longer look to represent the state, the People; they represent a party and the money. Where does the money come from? In 2011, the health industry donated $505,253,771 in campaign contributions to help the health industry through federal legislation, since 1990, a total of $1,109,575,365 have been contributed from the health industry. Of this, Pharmaceuticals/Health products donated $240,836,544; Hospitals/Nursing homes donated $100,259,231; Health Professionals donated $80,246,752; Health Services/HMOs donated $73,504,507 (4). With the health insurance industry in need of a larger pool of individuals to pay premiums, and the availability of billions of dollars in net income, it is conceivable that they could utilize the capacity to contribute millions of dollars to federal campaigns to help alleviate roadblocks in legislation and regulation. (Although a good portion of the health industry funding comes from outside health insurance companies, the industry as a whole does have interconnections that are directly related to healthcare costs and insurance premiums based on the bottom line).
This may seem hard to imagine that politicians may not represent the People, based on press conferences and constituent emails, but the numbers are hard to deny. Would legislation be crafted any different if this money was not contributed? Could legislation become less complex, more direct, and easily read and interpreted? Section. III. Health Care v. Health Insurance Health care is defined as the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. Health insurance is defined as insurance against expenses incurred through illness of the insured (5). The political rhetoric of our current political machine has caused a misinterpretation of these two terms into one, and it can be seen within the entirety of our society. The People utilize health care services for annual check-ups (preventative services) or when they become ill. This service has a cost, and with the complexity of the medical field growing, so does this cost. Health insurance which became more prevalent in the 1920 s when the federal government froze wages; businesses began to offer health insurance as an incentive in order to hire the highest quality worker. Since then, insurance has become the predominant means of paying for health care in this country (6). Individuals utilize health care in order to prevent or treat illnesses, and health insurance, if available, to pay for the services provided. The issue that arises today is that health insurance premiums are high enough to which healthy individuals do not see the immediate benefit of securing a health insurance policy. They take the risk of having to pay for any medical expenses they incur during this time. The key component here is that the individual takes that risk, and they as the individual are accountable for these bills. This brings up two issues, (1) if an individual takes the risk of not securing health insurance, and they utilize health care, are they not paying the bill (2) how does an individual who does not pay a bill increase the health insurance premiums of individuals who participate in health insurance. The first issue has two components, the first is, identification of an individual when they receive medical treatment. This again falls into the political rhetoric as to who a medical facility can ask for documentation and who they cannot. (The issue of immigration is too vast to cover within this section, however it is important to note that (1) the federal government has a limit to the number of immigrants who can immigrate to the United States per year from Central and South America that dates back to the Cold War which may or may not lead to a lack of taking appropriate documentation for specific demographics when they visit health care facilities. (2) the idea that the reason health insurance premiums rise is not solely due to illegal immigrants utilizing the health care system. Although states are required by federal law to pay for health care costs of individuals who do not pay, and health care facilities end up cover the costs. The issue becomes health insurance companies (as well as health care facilities) look at the bottom line. If they have a specific net income goal in mind in order to keep stock prices in a specific range, the way in which they meet that target with greater expenditures is to raise rates.)
If an individual is documented as to receiving services, whether it be paid in full or paid on a monthly basis, that individual should be responsible for the entirety of that bill. This will reduce the overall costs to facilities, which may relieve additional costs to services, which will reduce expenses for health insurance payouts which should relieve premium rates. (It is important to note that although health care rates have the potential to decrease; health insurance premiums will stay at equivalent levels or go higher because again, net income is the focal point of the industry.) Without full documentation of who is not paying for their health care services and the total amount it would be hard to investigate this to any further extent to whether it is due to illegal immigration, lack of health insurance, or individuals who declare bankruptcy in order to avoid payments. The Congress has taken the stance that the reason 40 million individuals do not have access to health insurance, is because premiums are too high. To solve this problem they want to regulate the health insurance market, by mandating every individual purchase health insurance. Can the Congress make this mandate to individuals amongst the United States that benefits one market? Section. III. The Tenth Amendment The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved for the States respectively, or to the People. During the latter days of August in the first Congress as the Amendments to the Constitution were being discussed and the language to what would become the Tenth Amendment was being heavily debated upon by Thomas Tucker of South Carolina and James Madison of Virginia. Tucker stated it would be much better to leave the state governments to themselves, and not to interfere with them more than we already do, and that is thought by many to be rather too much (7). The states during this time were not blue and red, but small and large, and many wished to have their interests within the union protected under the new Constitution (the fear was that the large states would consume the small states through Congressional Acts). Thus he proposed that the Tenth Amendment should read the powers not expressively delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved for the States respectively, or to the People (8). With the inclusion of this single word, the entire history of the United States would have been significantly altered. It was the basis for the argument of Chief Justice John Marshal in McCulloch v. Maryland in which he stated had the intention been to make this clause restrictive, it would unquestionably have been so in form as well as in effect (9). (Interestingly enough James Madison was against the corporation of the Bank of the United States, It is not a general grant, out of which particular powers are excepted-it is a grant of particular powers only, leaving the general mass in other hands. So it had been understood by its friends and its foes, and so it was to be interpreted (10). This in contradiction to his belief earlier that it was equally necessary that they [the federal government] should be secured against the state governments (11); in which he fought against adding the word expressively to the Tenth Amendment).
This has been the basis for the Congress to act within implied powers of the Constitution in order to regulate what it deemed as interstate commerce. The question then becomes, what is interstate commerce, and how is it connected to the health insurance industry and the health care market. (The opinion mentioned above was written at a time when the state legislatures elected the Senators to the federal government, essentially giving the federal government the states permission and authority to act on their behalf (this principle is based on Senators voting in the way that benefited the individual state not a political party as is seen today) by passing the legislation. Thus in legislative matters that could be seen as fitting into state authority under the Tenth Amendment, the Congress was within their implied powers to do so. Would this type of decision have been handed down if Senators were elected by the People as they are since the Sixteenth Amendment?) Section. IV. Interstate Commerce Article I Section 8 of the constitution states the Congress shall have the Power To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes; With such language, the Interstate Commerce clause of the Constitution as we know it was established. When commerce is created between the several states and/or a disagreement or difference in opinions arises, the federal government has the power to regulate that commerce. The question then becomes, what is and what is not commerce, and what is and what is not commerce between the several states. Justice Kennedy states I though the answer to that was, since McCulloch versus Maryland, when the Court said Congress could create the Bank of the United States which did not previously exist, which job was to create commerce that did not previously exist (12) Commerce is then in essence, whatever the Congress wants it to be, and if a particular commerce does not exist they have the right, to create it. However, the creation of the Bank of the United States was a tool in which the Congress was able to execute their enumerated powers (to lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts, To borrow Money on the credit of the United States; To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures). Although the byproduct of the Bank of the United States is commerce, the purpose of it was not to create it. The argument in McCulloch v. Maryland was not whether Congress could create commerce; it was whether under the Constitution the Congress could create a corporation, ie the Bank of the United States. So the notion that the Congress can create commerce in order to regulate it, would be negated, although it could create tools in order to support it. Do we now go as far as to say that because the Congress created a tool, in order to support commerce, they can mandate that every individual within every state participate in a particular market of commerce, by regulation? Section. VI. State Governments
Article II. Each state retains its sovereignty, freedom and independence, and every Power, Jurisdiction and right, which is not by this confederation expressly delegated to the United States, in Congress assembled. This section of the Articles of Confederation gave states all powers not expressly delegated to the United States; the key term expressly. As previously stated, the ruling in McCulloch v. Maryland, to which Chief Justice Marshal stated that had the intention been to make this clause restrictive, it would unquestionably have been so in form as well as in effect (13) has led to the current explosion of federal jurisdiction. The issue to this is, there have been significant changes to the federal government since this ruling and the adoption of the Constitution itself. As stated in the Federalist #45 The State governments may be regarded as constituent and essential parts of the federal government; whilst the latter is nowise essential to the operation or organization of the former. Without the intervention of the State legislature, the President of the United States cannot be elected at all. They must in all cases have a great share in his appointment, and will, perhaps, in most cases, of themselves determine it. The Senate will be elected absolutely and exclusively by the State legislatures. Even the House of Representatives, though drawn immediately from the people, will be chosen very much under the influence of that class of men, whose influence over the people obtains for themselves an election into the State legislation (14). (It is important to note, that the Federalist Papers are constantly utilized to argue for powers implied to the federal government. In Federalist 45, Madison says the commerce power. That's a new power, but it's not one anyone has any apprehension about (15). Although this statement seems to be inaccurate as Madison states in the Federalist 45: The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite. The form will be exercised principally on external objects, as war, peace, negotiation, and foreign commerce; with last the power of taxation will, for the most part, be connected. The powers reserved to the several States will extend to all the objects which, in the ordinary course of affairs; concern the lives, liberties, and properties of the people, and the internal order; improvement, and prosperity of the State (16). This text expressly states foreign commerce; defined by Chief Justice Marshal, the form of this intention was on foreign commerce, not internal.) Although the state legislatures do elect the electors for the Presidency two significant events have changed since Madison wrote Federalist 45; (1) political parties have become a plague in all aspects of government, and position electors based on party lines, not good faith, to the point that in some states electors are chosen by parties, and in other states they are handpicked by candidates. (2) the state legislatures have changed state law (except for Maine and Nebraska) to utilize a winner-takes-all method. (Interestingly enough this dates back to the election of 1796 when Thomas Jefferson lost the election to John Adams by three votes (had it been winner-take-all he would have won the states of Virginia, Pennsylvania and North Carolina; but still have lost the electoral college 71 to 67).
Convinced that Virginia's method of awarding electoral votes by congressional district was the main cause of his defeat, he persuaded the state legislature to change to the "winner-take-all" method for the 1800 election and won the presidency. (17) Once the largest state in the union at the time moved to this method, other states fell in line fearing they might lose power during an election as candidates vied for votes. This is exactly what we see today with swing states as candidates flock there, as does Congressional programs and funds, in order to sway voters in one direction. If all states were to go back to the Electoral College by Congressional District, (1) the People would have their popular vote, by district, but a balanced vote based on state population in the Electoral College. (2) if you live in a state that is always blue or red (unless the adoption of Campaign Finance for the People is enacted) you may be able to have a vote in who your state elects and voter turnout rates may increase. Although Madison and Jefferson were brothers in arms, it might be interpreted unlikely that Madison would have written the Federalist 45 in such a manner had the electoral college been winner takes all in 1788, as the disposition in the people to prefer a Citizen of their own State, and the disadvantage this wd. throw on the smaller States (18). A main argument against the adoption of the Constitution was that it gave too much potential power to the federal government and removed power from the state governments, which were closer to the needs and the will of the People and allowed the smaller states to survive the larger states from enforcing their policies and beliefs upon them. If the federal government has the ability to mandate anything and everything, the People, can and cannot do; where does that leave the states? Section. VII. Where to go from here? Our nation was founded on the several states (13 at the start) holding authority of their borders in order to better meet the needs of their inhabitants. The principle that the closer government is to the People, the more it will reflect their will and within the republican form of government that was established after the American Revolution. However, with a weak central government (under the Articles of Confederation) there became a disconnect between the states and the People of each state. In order to form a more perfect union, the Constitutional Convention of 1787 decided to create a new form of government with shared powers between the states and the central governments. If under the Constitution, the Congress can regulate all interstate commerce, and by definition, everything in today s society is interstate, the federal government has removed the necessity of the state governments as the federal government can and will regulate everything; now to the point that there is a mandate that individuals participate in a specific market or be taxed for not doing so. Where does it end? If you don t buy whole milk twice a week for your children to drink two glasses a day, you can be taxed. If you don t paint your house a specific color the produces a happy mood, you can be taxed for depressing your neighbors. If you print too many pages for your document, you can be taxed for being environmentally unfriendly (unless you are Congress and create a two thousand page law).
Although the grounds for differences in opinions have changed (large state and small states to red vs blue) the principle behind them is still the same; Money and Power. We all profit from the extreme profits health insurance companies make, which in many cases, is at the decreased coverage and care of another individual. Yes, we all profit from the misfortune of others. If you do not believe that, look at your mutual fund, 401K, pension fund, and see if there are any insurance companies listed. You might be surprised to find they are heavily invested in, and for good reason; they make a lot of money. Now imagine what they ll make when everyone is mandated to have coverage. The good intentions that were originally devised by expanding the health insurance coverage to more people, has been systematically picked apart due to the vastness of the competing interests involved. So what can we do about it? 1. Create federal law which makes all health insurance companies non-for-profit. Yes, we will take a hit in our pensions, 401k s and mutual funds; but the health of our fellow man is far more important than the interests of the bottom line of a company. For all those who will say this goes against the practices of the free-market, one can only be reminded that when an item is mandated by law, it is no longer the free market. 2. Allow for the states to determine their own public health care system. This type of system is two-fold; 1. It allows for states to compete for individuals (the free-market) to reside within its borders, by allowing them to choose the state that best represents their values as well as their economic situation. 2. It allows individuals the right to leave a state (the free-market) for another that has a system in which they believe in. In this sense the free market does work for the People; just not a bottom line. 3. Enact Campaign Finance Reform for the People. There is no greater disheartening feeling than to realize that your representative is acting on behalf of a political party, a lobbyist or special interest group, or the bottom line in their financial report (which we currently cannot see if they utilize a blind trust; enact (Removal of Financial Incentives that Lead to Corruption in Government; Legislation and Debates) reform as well). 4. Enact the Trusted Voting Amendment and Electoral Votes for the People Amendments; to maintain integrity in all federal elections and that individual states or areas within a state are not motivated by federal programs (that benefit the few and not the whole) and that each district, within each state, count.
1. "Definitions of Health Insurance Terms." Healthterms. Bureau of Labor Statistics, Feb. 2002. Web. 29 Mar. 2012. <http://www.bls.gov/ncs/ebs/sp/healthterms.pdf>. 2. "Top 25 Health Insurance Companies." US News Health. US News, 2011. Web. 26 Jun 2012. <http://health.usnews.com/health-plans/national-insurance-companies>. 3. "Google Finance: Stock market quotes, news, currency conversions & more." Google Finance. Google Inc, 2011. Web. 25 Jun 2012. <http://www.google.com/finance>. 4. "Health." Open Secrets. Open Secrets, 2011. Web. 25 Jun 2012. <http://www.opensecrets.org/industries/indus.php?ind=h>. 5. "Briefing." Department of Health and Human Services, Et Al., v. Florida, Et Al.. No. 11-398. Supreme Court of the US. 26 March 2012. Web. 6. "The Free Dictionary by Farlex." health care - definition of health care). in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.. Farlex, 2011. Web. 25 Jun 2012. <http://medicaldictionary.thefreedictionary.com/health care).>. 7. Labunski, R. E. James Madison and the struggle for the bill of rights. New York, NY: Oxford University Press, USA, 2006. 228. 8. Labunski, R. E. James Madison and the struggle for the bill of rights. New York, NY: Oxford University Press, USA, 2006. 230. 9. Madison, James. Madison Writings. New York: Penguin Group, 1999. 424. 10. Madison, James. Madison Writings. New York: Penguin Group, 1999. 482. 11. Labunski, R. E. James Madison and the struggle for the bill of rights. New York, NY: Oxford University Press, USA, 2006. 228. 12. Madison, James. Madison Writings. New York: Penguin Group, 1999. 424. 13. Marshall, John. Marshall Writings. New York: Penguin Group, 2010. 14. James Madison, "Federalist #45," in The Federalist Papers, at http://thomas.loc.gov/home/fedpapers/fed_45.html 15. James Madison, "Federalist #45," in The Federalist Papers, at http://thomas.loc.gov/home/fedpapers/fed_45.html 16. James Madison, "Federalist #45," in The Federalist Papers, at http://thomas.loc.gov/home/fedpapers/fed_45.html 17. James Madison, "Federalist #45," in The Federalist Papers, at http://thomas.loc.gov/home/fedpapers/fed_45.html 18. Pitner, James D., and Connor A. Mocsny. "Electoral College Reform." University of the Pacific McGeorge School of Law. University of the Pacific McGeorge School of Law, 2008. Web. 26 Jun 2012. <http://www.mcgeorge.edu/research_centers_and_institutes/capital_center_for_public_law_and_policy_home/p ublications/california_initiative_review/california_initiative_review_reports/electorial_college_reform.htm>.