The Slaughter Rule is Unconstitutional

[Mike Irwin]

"But I cannot see this particular issue anything but..."

If you can't make the differentiation between the procedural process and partisan politics, please refrain from participating in the discussion.



"One more point of note, if this passes, the government will be required to limit what the subjects can engage in as they must protect their interests. Moto-cross, skydiving and shooting can all be considered risky to the health of those directly and indirectly involved. It may not be considered a BoR issue... rather an FDA or "federal healthcare dept." issue to restrict these things.
Our rights are severely at risk in the long run."

See, you CAN make the differentiation, and this is EXACTLY the kind of issues that should be discussed.

[rantingredneck]

Brent,

I share your concerns regarding future regulation of activities justified via "it's for your own health" and "we pay for your healthcare" schemes.

As many here know, I suffered a traumatic injury 2.5 years ago while hunting. Fell 18 feet and shattered my L1 vertebra. Helicopter ride, 7 hours of surgery, 7 days in the hospital, $123,000.00 in medical bills. I was responsible for $4,000.00 of that total (1k deductible/3K out of pocket maximum). My insurance carrier did not balk at paying their share of the bills. They didn't even ask what I was doing when I fell. I got a letter in the mail asking if my fall took place on my employer's property or whether it was a work related accident. I answered no to the questions and that was the end of it. My wife got a similar letter in the mail when she broke a toe (at our home) and oddly enough I got the same type of letter in the mail recently after a trip to the urologist (not sure I wanna know how that can be work-related.....).

The question is, under a government run "option" will this morph into forbidding certain "high-risk" activities as it is now "in the public interest" to do so? (That's probably enough thread drift though.......)

Back on topic:

As to the original question on the constitutionality or no of the Slaughter Rule, I've read articles the last few days that disagree on whether it does or does not pass constitutional muster. One thing they all seem to agree on though is that "unseemly" is a mild way to describe the methods used in the furtherance of this particular piece of legislation.

If this bill (or group of bills) was popular, then we wouldn't be discussing "reconciliation", "deem and pass", "Cornhusker Kickback", and the "Louisiana Purchase" would still be thought of as something that occurred in the Jefferson Administration. The fact that all these machinations have been used to get us to this point should tell a reasonable person that this effort should be suspended in deference to exploring policy changes that will really address the problem of rising healthcare costs.

[Mike Irwin]

"The question is, under a government run "option" will this morph into forbidding certain "high-risk" activities as it is now "in the public interest" to do so? (That's probably enough thread drift though.......)"

One again, this kind of question is EXACTLY the kind of Civil Rights issue that is open for discussion here at TFL.

At what point will the government, if they are picking up your health care, will become invasive and intrusive in an effort to keep premiums down?

Will we see high risk activities outright banned?

Will we see a massive ramp up in Government-mandated health initiatives, like taxing the hell out of "junk" foods to control obesity or outlawing use of salt in food preparation (someone is trying this in New York)?

Would those types laws also have to be passed by procedural issues to get them through?

All questions that NEED to be asked.

[hogdogs]

I am not 100% educated on historic legislation. Does anyone know what procedures were used to give such extensive power to the "FDA" in deeming certain drugs as schedule 1 narcotics?

If it wasn't run through the channels we call "proper", I would be concerned the "risky behaviors" would be deemed bannable or taxable much the same way...
Brent

[BlueTrain]

If you have to buy insurance on your own outside of group health coverage, as we do, you will see that insurance companies are very interested in your risky behavior, though chiefly it is more in the nature of your smoking, drinking, body-mass index and so on. All of these are on at least one health insurance application. It would be entirely possible that the application could be denied based on your answers. Otherwise they wouldn't bother asking. But on the other hand, they don't ask if you climb mountains, play with skateboards, ride motorcycles, or use dynamite in your job.

Do not imagine that the government will be different. Group health coverage is different by nature. There is no pick and choose (of the insured) on the part of the insurer. There's more to it than that but that's the general gist. In the case of private insurance coverage (not just health insurace), there's always someone willing to insure--at a cost. That's because it is a free market, not that anything is free in a free market except maybe your choices, if you have one. In any case, there is no "requirement" that the government do anything in particular in regards to your behavior, risky or otherwise. It may be in the general public's interest that you not do things that are risky or reckless, but around here, people freely disregard the law when it comes to speed limits. Sometimes that catches up to people, too.

[Glenn E. Meyer]

So could an insurance company deny coverage based on firearms ownership? That's been hinted at.

If so, do you then have to go to a higher premium coverage. Would the NRA become like the AARP and hook up with an insurer as a profit center for the NRA?

Sorry, if this is thread hijack but it seems a possibility.

[ADB]

One more point of note, if this passes, the government will be required to limit what the subjects can engage in as they must protect their interests.

Um, no. Where would you get an idea like that? Under the proposed rules insurers have even less ability to exclude you from coverage than they currently have, not more.

BlueTrain is right on target: the things that matter (and will continue to matter) in determining your premiums are things like whether you smoke, whether you eat at McDonalds too often, and whether you exercise. Statistically speaking, those are FAR more likely to affect whether you need healthcare than whether you go mountain climbing, shooting, skateboarding, etcetera.

[rantingredneck]

Originally Posted by Mike Irwin

One again, this kind of question is EXACTLY the kind of Civil Rights issue that is open for discussion here at TFL.

Yeah, Mike I get it. The thread drift I was getting at was the drift away from discussion of the Slaughter rule and more toward the general topic of Healthcare "reform".

Originally Posted by Blue Train

Group health coverage is different by nature. There is no pick and choose (of the insured) on the part of the insurer. There's more to it than that but that's the general gist. In the case of private insurance coverage (not just health insurace), there's always someone willing to insure--at a cost. That's because it is a free market, not that anything is free in a free market except maybe your choices, if you have one. In any case, there is no "requirement" that the government do anything in particular in regards to your behavior, risky or otherwise. It may be in the general public's interest that you not do things that are risky or reckless, but around here, people freely disregard the law when it comes to speed limits. Sometimes that catches up to people, too.

Insurance is at its most basic the pooling of risk. In any risk pool, if you have X number of people in your pool and 1/4 of them engage in risky behavior that drives up their overall healthcare costs (smoking, drinking to excess, eating 4000 calories a day, falling out of trees, etc.) then the other 3/4 of X will pay increased premiums driven by the high users in the pool. If you are one of the risky 1/4 that's a pretty good deal. If you're one of the 3/4 then maybe not so much.........but the system as it stands allows you to choose a different pool, or a different insurer for the risk level of your pool.

Now when there are multiple insurance carriers around whose actuaries and underwriters make up these rules then they're all in competition to provide the best coverage at the best price to the market. As the government gets involved and regulates some of these entities out of business (which I have no doubt will happen under any version of reform currently in discussion) then the government will step in as a "public option" on the way to "single payer". Once we're at that level there's no one to compete with and they get to make the rules anyway, so.............

Even if we end up with 2 or 3 insurers existing as heavily regulated "utilities" there won't be much competition and you'll be left with fewer choices other than to pay increasingly higher costs, for increasingly worse care.

[vranasaurus]

Um, no. Where would you get an idea like that? Under the proposed rules insurers have even less ability to exclude you from coverage than they currently have, not more.

BlueTrain is right on target: the things that matter (and will continue to matter) in determining your premiums are things like whether you smoke, whether you eat at McDonalds too often, and whether you exercise. Statistically speaking, those are FAR more likely to affect whether you need healthcare than whether you go mountain climbing, shooting, skateboarding, etcetera.

I think what people are hinting at is that if those with the authority to regulate the coverage determined that a certain activity, probably one they didn't like, was so hazardous that they would then allow higher premiums for those who engage in those activities.

[Mike Irwin]

"I think what people are hinting at is that if those with the authority to regulate the coverage determined that a certain activity, probably one they didn't like, was so hazardous that they would then allow higher premiums for those who engage in those activities."

I wouldn't be so sure about that.

Insurance companies are, for the most part, for profit. They're more than willing to accept more cash for the greater risk if their actuarial tables bear out the odds.

With the government, that's not the case.

How altruistic is an insurance company?

How altruistic are some of the crackpots we've elected to the government?

I foresee a VERY rapid curve that takes us past a Government health insurance program to one that quickly becomes a government "protect the unwashed, unlearned masses from themselves" program.

Smoking? Banned.

Alcohol? Banned.

Firearms/shooting? Banned.

Fried foods? Banned.

Salt? Banned.

Runny egg yolks? Holy hell that's banned!

And so many other things that would now come under review of a government that is now totally entwined in your health to the point where you no longer make decisions. They're made for you by someone who knows better than you.

[rantingredneck]

Runny egg yolks?

Now look, taking my guns is one thing, but they can't have my over easy fried and greasy eggs gosh-darnit!!! .

Seriously, I like my eggs........

I fear though, Mike that you are correct. The trouble is that by pointing this out you and I and all who agree will be considered "obstructionist" or to be accused of wearing tinfoil hats.

I'm all for healthcare reform if it truly drives down costs and expands options, but the only path to that is a market based approach loathe to the majority of our current crop of congresscritters and I personally prefer Mylar as it blocks more of the radio waves and is 40% lighter, but to each his own......

[BlueTrain]

There's a long list of things that are banned right now, which, if what I hear is correct, are available on any street corner. If you want good moonshine, go ask the sheriff and he'll steer you in the right direction. At least that's the way it works some places.

Insurance does not change risk. It sort of pools risk and it sort of spreads risk around. In other words, everyone (in the pool) shares to cost of not the risk but of the consequences, if you follow me. Lots of insurance companies manage their risk, so to speak, by choosing who they will insure. That's the way it works for auto insurance, less so for health insurance because of group coverage. But let's say, for instance, that you lost your job because the plant closed and you can't find another job and you don't have the bus fare out of town. Some would say that is your fault and your problem and you have to take responsibility, etc., etc. Okay but in the meantime you have no insurance and no savings because you bought a Winnebago and you have to rely on the kindness of strangers who happen to be physicians if you need a doctor. That's the problem in a nutshell.

But lets go back to the beginning. Is it constitutional for the government to, well, do anything that would help and is whatever is claimed to be happening in congress constituational? I don't know but there were people who fought everything in the New Deal, including Social Security, tooth and nail as long as they could. I imagine at the moment that someone is still trying to say there is no constituitional authority for Social Security, so let's get it to the private sector toot sweet, where there is all that efficiency, competition and security and it'll all be gone in five years. But how much logic can you expect in a country that will pay $1 for a glass of water in a plastic bottle?

[Mike Irwin]

The egg yolk thing sounds silly, but New Jersey tried exactly that several years ago.

The state's health regulations mandated that restaurants and diners had to serve eggs with yolks that had been heated to 140 deg.

http://findarticles.com/p/articles/m...6/ai_11851335/

It caused something of a revolution in the state, and it was rescinded within a year after New Jersey became a laughingstock.

Currently there's a lawmaker in New York City who is trying to ban restaurants from adding any salt to food.

They've already done it with trans-fats. Straight fat is going to be there one of these days.

And some years ago New York City raised the taxes on a pack of cigarettes so that they were over $7 a pack. They said at the time it was a method of getting people to stop smoking, by taxing their vice, but so many people started going outside the city that it wasn't long before the same people who called it a health issue started crying about the lost tax revenue (pretty clear what they really wanted out of it).

I see absolutely nothing good coming out of a government mandated health system. We all know that the promises are total bull****, and that within a few years, when this fails, it will only lead to even greater incursions of the government into the healthcare system to 'make if function better,' with commensurate regulations designed to protect you from yourself.

Crap. I fear that I'm about to tip over into partisan politics... Sigh.

[M14fan]

I don't think this was ever really about healthcare. This is about a power grab and allowing the congress to run unchecked over our civil liberties. We are standing in the doorway of becoming at best a socialist nation and at worst outright communist!!! I fear greatly for the future of our second amendment rights and for the future of our republic.

[vranasaurus]

I wouldn't be so sure about that.

Insurance companies are, for the most part, for profit. They're more than willing to accept more cash for the greater risk if their actuarial tables bear out the odds.

With the government, that's not the case.

How altruistic is an insurance company?

How altruistic are some of the crackpots we've elected to the government?

I foresee a VERY rapid curve that takes us past a Government health insurance program to one that quickly becomes a government "protect the unwashed, unlearned masses from themselves" program.

Smoking? Banned.

Alcohol? Banned.

Firearms/shooting? Banned.

Fried foods? Banned.

Salt? Banned.

Runny egg yolks? Holy hell that's banned!

And so many other things that would now come under review of a government that is now totally entwined in your health to the point where you no longer make decisions. They're made for you by someone who knows better than you.

I think you misinterpreted what I wrote.

My point is along the same lines as what you are saying. The government would deem an activity to hazardous and allow higher premiums for that activity. Whether or not that activity was actually that hazardous wouldn't really matter.

[Doc Intrepid]

Originally Posted by Glenn E. Meyer

"So could an insurance company deny coverage based on firearms ownership? That's been hinted at..."

From a lawful firearms owner perspective, this is one of the issues that I find most alarming about the linkage between the Democratic administration's Health Care Reform Bill and the American Medical Association's (AMA) focus on "firearms in society as disease" analogy: the health care reform bill could easily be used to restrict firearms ownership in any number of ways, due to the relationship established by the AMA between "firearms ownership" and "U.S. Health Risks".

Skeptical? Peruse these articles:

"...(Firearms) Violence as a Public Health Problem" (AMA, JAMA 2009) -
http://virtualmentor.ama-assn.org/20...hst1-0902.html

"Under the Gun: Threat Assessment in Schools" (AMA, JAMA) -
http://virtualmentor.ama-assn.org/20...for1-0902.html

"Assault weapons as a public health hazard in the U.S." (AMA, JAMA) -
http://www.faqs.org/abstracts/Health...ed-States.html

"Doctors to Ask Patients About Gun Ownership" -
http://www.aapsonline.org/jpands/hacienda/edcor8.html


A successful effort by the U.S. government to establish a relationship with empirical linkages between 'Public Health Care' and 'Firearms Ownership' could conceivably result in increasing efforts to restrict firearms ownership in an attempt to 'make public health care more affordable'.

It's tough to predict the future - but there can be little doubt that the American Medical Association, certain political parties, and special interest groups such as Insurers or the Brady organization could create all sorts of alliances that ultimately cast a chilling effect on unrestricted firearms ownership or activities such as hunting.

FWIW.

YMMV.

[ADB]

I think most of the theories being put forward here are more than a little paranoid. Congress has barely gotten up the nerve to stop insurance companies from denying people life-saving healthcare due to pre-existing conditions, and folks here think that they're going to suddenly go off and ban booze, guns, and fried foods? Seriously?

As for higher premiums: Unless you're a moron who manages to injure yourself on a comically frequent basis, your odds of needing healthcare are actually LESS than the average if you spend your recreational time running around the woods with a gun, or skateboarding, or mountain climbing. Insurance companies love people like that, because they're fit, and even if they do get hurt it's cheap stuff like broken bones and cuts. Compare that to somebody whose rec time is on the couch jamming greasy potato chips and soda into their piehole, and who will probably end up with heart disease or diabetes before they're 40.

The fact remains that Canada has a complete public healthcare system, and one that's actually government run as opposed to our mostly private system. Nothing like what's described has happened there.

I don't think this was ever really about healthcare. This is about a power grab and allowing the congress to run unchecked over our civil liberties. We are standing in the doorway of becoming at best a socialist nation and at worst outright communist!!! I fear greatly for the future of our second amendment rights and for the future of our republic.

[Glenn E. Meyer]

The public health journals are a major source of literature describing guns as a menance. That would be a basis for rate differentials.

So wouldn't a single payer plan like Medicare for all, take care of that?

Passing anti-gun, butter, egg yolk rules would light up the Congress as the gun lobby and agricultural interests go nuts.

Now, I didn't mean throw that monkey into the wrench. Just a thought.

[BlueTrain]

I don't like to be too negative too often but I was also going to point out how some individuals see firearms as a health problem (insert lead poisoning joke here). However, someone already made the point. From an insurance standpoint, if you include old age and survivor's insurance (social security, in other words), then the government ought to encourage unhealthy behavior, just so people wouldn't live so long. Think of the savings in social security. But not everyone agrees what being healthy means.

And not everyone agrees that everyone ought to have medical care, apparently.

[Glenn E. Meyer]

then the government ought to encourage unhealthy behavior, just so people wouldn't live so long.

Then you think the government should adopt a Guns and Butter policy. Didn't that get us in trouble?

Sorry - couldn't resist. We have guns and butter in my house. I'm doing my part to avoid the trip on the ice floe (one of the health care options).

[HarrySchell]

The fact remains that Canada has a complete public healthcare system, and one that's actually government run as opposed to our mostly private system. Nothing like what's described has happened there.

And the fastest growing segment for healthcare delivery and insurance in Canada is private. People are fleeing the public system by coming here and in their own country.

See also: http://www.cato.org/pub_display.php?pub_id=6378

This describes the court case that overturned a ban on all private care arrangements on the basis that the public system performed so poorly it violated Canadian's civil and human rights, and that an alternative must exist.

Again, while this is a narrow example re healthcare, it demonstrates that government monopolies must have limits, and this conclusion applies to more than healthcare.

[Bartholomew Roberts]

Originally Posted by ADB

I think most of the theories being put forward here are more than a little paranoid. Congress has barely gotten up the nerve to stop insurance companies from denying people life-saving healthcare due to pre-existing conditions, and folks here think that they're going to suddenly go off and ban booze, guns, and fried foods? Seriously?

This is news to me. Since when were insurance companies able to deny healthcare to people? Or did you mean that insurance companies refused to cover costs for healthcare conditions that existed prior to those people buying a policy?

Because one of those I would have a problem with; but the other one strikes me as complaining that the insurance company won't let you buy a new auto policy for the car accident you already had.

[MTT TL]

Since when were insurance companies able to deny healthcare to people?

Since always. They have certain standards and of you don't meet them you don't get coverage. Same for auto insurance. You might not have had a crash you want them to pay for but if you have 4 speeding tickets good luck finding any "normal" affordable insurance. Your employer might have a contract that will cover you but not necessarily.

About the rules issue.

The constitution is clear. But this is the same woman who said "you have got to be kidding" when the constitutionality of the bill was questioned. They are not going to let a little thing like the constitution or the will of the people get in the way.

This is not a coup by the legislator either. This is a coup by certain people in the legislature and executive.

[ADB]

And the fastest growing segment for healthcare delivery and insurance in Canada is private. People are fleeing the public system by coming here and in their own country.

If they're ultra-wealthy and willing to pay three or four times the price to be catered to, sure. But on objective rankings, Canada's healthcare system scores much higher than ours does.

This is news to me. Since when were insurance companies able to deny healthcare to people? Or did you mean that insurance companies refused to cover costs for healthcare conditions that existed prior to those people buying a policy?

Insurers are also frequently in the habit of redefining what a "pre-existing condition" is, such as claiming that someone's family history of cancer constitutes grounds to deny coverage when that person gets cancer. Or cases where insurers specifically go in and cancel someone's policy for no reason other than the fact that the person's treatment is costing them money. Or they claim (almost always falsely) that the individual who becomes sick somehow violated the terms of the contract, rendering it void, a practice known as "rescission."

"Blue Cross praised employees who dropped sick policyholders, lawmaker says"

http://articles.latimes.com/2009/jun...s/fi-rescind17

"They said I never mentioned I had a back problem," said Marrari, 52, whose coverage with Blue Cross was abruptly canceled in 2006 after a thyroid disorder, fluid in the heart and lupus were diagnosed. That left the Los Angeles woman with $25,000 in medical bills and the stigma of the company's claim that she had committed fraud by not listing on a health questionnaire "preexisting conditions" Marrari said she did not know she had.

In the past 18 months, California's five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

http://www.washingtonpost.com/wp-dyn...090702455.html

The catch is that these decisions are almost always made right after the person is diagnosed with an expensive illness, and rarely if ever have anything to do with the actual illness, because these companies have set up an automatic system where anyone who's so diagnosed is subjected to an investigation looking for any excuse to cancel the policy.

Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.

The South Carolina Supreme Court, in upholding the jury's verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court's finding that Fortis destroyed records to hide the corporation's misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: "The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents" as well as the "omission" of other records regarding the decision to revoke Mitchell's insurance, constituted "evidence that Fortis tried to conceal the actions it took in rescinding his policy."

http://www.reuters.com/article/idUSTRE62G2DO20100317

This is standard practice for insurance companies.

[rantingredneck]

Since always. They have certain standards and of you don't meet them you don't get coverage.

Not to speak for Bart, but I think you're missing his point. Insurance companies can't deny you medical care. They can refuse to pay for care if you don't live up to your side of the contract, but they can't deny you care. There is a difference, though part of the strategy all along has been to blur the line between health care and health insurance.