Sample – ECON200-Topic #2: Affordable Care Act (Obamacare) and the Individual Mandate

There has been a great deal of discussion recently regarding the constitutionality of the “individual mandate” in the Affordable Care Act, more commonly known as Obamacare. The most controversial part of the law is the mandate that everyone purchase a minimum health insurance policy or face escalating penalties beginning at around $700 a year. This summer, the Supreme Court will decide if the mandate to purchase insurance will remain constitutional. Additionally, the court will decide if the entire law should be struck down, or if only the mandate would be struck down. There are a lot of pieces to the ACA, such as prohibiting health insurance companies from refusing to sell exorbitantly priced policies to those with “preexisting conditions” or refusing to sell insurance to some people outright as well as mandating insurers to allow young adults to remain on their parents plans until they reach 26 years of age.

One of the biggest problems with our current health care system stems from another mandate by the Emergency Medical Treatment and Active Labor Act (EMTALA) passed in 1986 which says you cannot be denied treatment in an emergency room. Thus, if you do not have insurance, you can go to an emergency room for treatment and subsequently refuse to pay any bills or declare bankruptcy if the bills are too high for one to afford. The remaining part of the population who is insured currently picks up the tab to pay for the services of those who are uninsured. The ACA was an attempt at helping to reform this system by forcing everyone to purchase health insurance. Without the mandate to purchase coverage, individuals would be able to wait until they were diagnosed with a serious disease to purchase coverage.

The problem with a “free-market” for health insurance is what we call an adverse selection problem. Most people who are healthy would choose to not participate in a plan where they have to pay for something when they don’t need it. The only people who want to get low-cost medical benefits are those who are either sick or participate in a lot of risky behavior. If you are healthy, and afraid of the possible consequences of getting ill, you might also purchase health insurance. If the Supreme Court removed the individual mandate, but kept the “preexisiting condition” clause anyone could then purchase reasonably priced insurance after they are deemed ill.

This is obviously not how insurance is supposed to work. People pay insurance premiums on their homes to a company that collects premiums from thousands of different homeowners in many different areas. When a flood, fire, or other disaster wipes out hundreds of homes at once, the company uses the proceeds of all the collected premiums to help rebuild the destroyed areas. Health insurance works in a similar way such that a diversity of people pay into the system to help provide care to those that are ill within the group.

Congressman Paul Ryan has a proposed change to the U.S. budget that would change our system of Medicare to something similar to the ACA. Currently under Medicare, if you are over age 62, you are required to purchase coverage (at highly subsidized rates) or pay a penalty. Congressman Ryan’s plan is to instead provide a subsidy (like a negative tax) to those currently eligible for Medicare, that they could then use to purchase coverage on an open market. Think about it this way, if you do not buy insurance under Ryan’s plan, you are going to have to pay higher taxes (much higher than the proposed $700 fine in the current ACA law). If you do buy coverage, the government kicks in some money to those with lower and middle incomes to help them cover the cost of the plan. Compare this to the ACA that says you have to pay a fine if you do not buy coverage. Rather than pay higher taxes for not purchasing coverage, you are paying a fine for not purchasing coverage.

Below, I have listed a few articles to get you started thinking about this topic. You should compose your blog comment to be around 250 words in length, forming a cogent thought that is supported by some factual evidence that supports your opinion. Do not simply state your opinions, but find facts that support your opinion.

Individual Mandate Is Ryan Tax Credit by Other Name

Ryan’s Medicare reforms have become even more similar to Obamacare

Spotlight: How have states responded to health-care laws?

The bizarre calculus of emergency room charges

Obama’s insurance requirement not the only mandate

Questions you might consider:

  • Do you believe that the Supreme Court should overturn the ACA individual mandate or the entire law? Why? Do you think this is a fundamental attack on your Constitutional rights as a member of a state? You have to think about the economy and the Constitution here.
  • Do you believe health care is a good that can be regulated because it is part of “interstate commerce”, meaning it crosses state boundaries? If so, then Congress should have the right to regulate it.
  • Do you believe the Ryan plan for Medicare differs fundamentally from the ACA for non-Medicare? Think about the role that fines play in the ACA compared to tax subsidies in the Ryan plan.
  • Do you think the mandate that hospitals should have to treat all comers is legitimate? Should this act of Congress be overturned as well?

61 thoughts on “Sample – ECON200-Topic #2: Affordable Care Act (Obamacare) and the Individual Mandate”

  1. In 1986 he Emergency Medical Treatment and Active Labor Act (EMTALA) was passed the help cope with the practice of “patient dumping.” At the time EMTALA was an extremely relevant piece of legislation because of the extreme racial and socioeconomic discrimination happening within private hospitals; private hospitals often transferred patients without insurance to public hospitals with little regard to the safety of the patients. According to an article written by Joseph Zibulewsky, MD, 24% of patients transferred from one hospital in Chicago were transferred in unstable condition. The article also goes on to note that patients from this specific hospital were twice as likely to die.

    Although America is making small steps toward diminishing discrimination, it certainly still exists today. Also, there is no fiscal reason why privately owned hospitals should have to accept patients who are unable to pay for services. Because of these two reasons, the EMTALA is legitimate. Without this act many people would be turned away from medical attention they desperately need. Although the cost of an individual without insurance’s treatment is often placed on the people by making services for expensive for the insured, Congress needs to leave this act intact.

    Revoking the act would be detrimental to the overall health of the nation and affect productivity as a whole. According to Emergency Physicians Monthly many people who would be turned away from emergency rooms are employed and some even have insurance. If these citizens could be turned away, they would eventually lose their jobs if their medical emergency caused them to miss extended amounts of work due to lack of treatment.
    Instead of focusing on revoking this existing legislation, Congress needs to find a constitutional way to encourage, and make it possible for more Americans to purchase health insurance.

  2. The Constitution forbids government from forcing citizens into any private economic transaction. That being said, the Affordable Care Act requires all citizens to pay for medical insurance. To arrive at the convenient conclusion that the individual mandate is unconstitutional would be accurate, technically, but lacking in a full comprehension of all the factors at play. The individual mandate is an important component of a better healthcare system for America, and should not be overturned by the Supreme Court.
    One of the most significant problems with healthcare before the AFA was passed dealt with adverse selection. Insurance companies do not know how healthy prospective policy holders are when they enter into insurance agreements. Therefore, insurance companies have to charge premiums according to the health of the average American. But what about citizens in great health that are low risk? Their marginal cost would exceed their marginal benefit if they were to purchase healthcare. This means it is not in their best interest to purchase a policy. When the healthiest opt out, the average health of an American with insurance will decrease and the population will appear to be in worse shape. A new average will reflect the population without the healthiest people and costs reflecting that average will increase accordingly. This cycle continues until only the lowest quality Americans (in terms of their personal health) will be willing to pay for healthcare because their marginal benefit equals or exceeds their marginal cost. Adverse selection in the healthcare market incentivizes the healthier people to leave the market and not buy insurance and makes it so only high-risk individuals will be motivated to buy healthcare coverage.
    Healthcare premiums reflect the average health of Americans. These premiums are increasing because healthier people leave the market, increasing risk and pushing costs up. To decrease premiums and spread risk among a larger population, everyone needs to be forced to buy health insurance. The individual mandate will lower healthcare costs for all Americans with insurance and provide coverage for all Americans that have opted out or not bought in or cannot afford insurance.

  3. The way I see insurance is like a product. It is something you purchase and use, and I find it completely inappropriate that the government is thinking about forcing people to buy it. If the government tried to force people to buy a car to lower the costs of public transportation, almost everyone would go wild and protest. Why should health insurance be any different?
    Do I think everyone should have health insurance? Absolutely. Is it unfair that some people are “free riders” (Bloomberg article) and those of us who buy our health care have to foot the bill? Sure. But instead of getting in a rage about how much we have to pay because of people who don’t have the proper care, let’s look at why. According to Reuters (, over 40 million people cannot actually afford health care. I can understand this. Some people make minimum-wage jobs working as single parents raising two children and have no way to purchase an expensive product like health care.
    I find myself to be very fortunate – I’m from McLean, my father works for the government and my mom works for Fairfax County which provides us with Blue Cross/ Blue Shield. I went to the emergency room one late night with possible appendicitis and they ran all sorts of tests and gave me all sorts of pain and nausea medicines. Fortunately for me it wasn’t my appendix and I was allowed to go home. The point being, I managed to rack up thousands of dollars’ worth of bills that one night (and I continue to do that today with various stomach problems and a terrible immune system), but my family was only billed $45. My parents ended up paying $45 for thousands worth of hospital bills, because we’re lucky enough to have a good, reliable health care provider. Not everyone is this fortunate, and it’s something we have to remember. What if it had been appendicitis and I hadn’t had health insurance? I would have either been paying upwards of $20,000 (if not more) for surgery alone, or I would have died if the hospital had refused to treat me.
    Reading the Bloomberg article, they talk about giving tax credits for those who purchase health insurance. I think this is an excellent place to start. I’ve always found that rewards work far better than punishment when you’re trying to get someone to do something, so giving people money for having insurance instead of fining them for not having it is the way to go. If the government wants everyone to have it, they can look in Canada’s direction and work something out so that it’s free for everyone. As far as I’m concerned, health insurance is a product in a market that people can purchase – only if they want.

  4. Before reading these articles I believed that affordable heath care (ACA) was a step in the right direction for the government. But if they think that it would stop free riders they are mistaken. There are thousands of illegal immigrants who live and work in the United States. Using hospitals, because they cannot be turned away and some are not paying. I think that for the current plan to work the mandate needs to be overturned to forced people to buy health insurance. But I also think that it is unethical for hospitals to turn someone away because they don’t have health insurance. So I don’t know how they expect to stop free-riders, when the other mandate makes hospitals see patients who may not be able to afford their services. Another thing that I got from the articles was that most insurance companies and states are already adopting the policies from the ACA. I guess I don’t really understand why this is happening if it hasn’t been enacted by the federal government yet.

    If the states have to follow the constitution, then wouldn’t Virginia’s law be null and void if “obamacare” is found unconstitutional. I guess I still don’t understand why this federal law is falling on the states to enact; you would think the government would be doing something about it nationally. If they want health care to be in the responsibility of the state and not the individual, then they should allow the state to decide what’s best for them. The government could enact something similar to the No Child Left Behind, saying that each state needs to enact something to deal with health care, but give each state the freedom to decide what they want.

    Another thing that I have questions about is the whole idea of universal health insurance. In one of the articles they said that people could pay for more expensive health care, but wouldn’t this be contradicting the whole point of universal health care. Where everyone would get the same benefits and have the same prices. I don’t see how “universal health care” and being able to buy more expensive insurance can fall under the same plan is fair. Wouldn’t that just be like how the system is running now, but with more affordable health care without the penalties/taxes?

    I still believe that the idea of “universal health care” is the right decision, but I think that are a lot of flaws in the current ACA plan. Which needs to be fixed before any decision can be made.

  5. On paper, having hospitals treat all “comers” is legitimate because this is a human being’s life at stake. However, the current problem with citizens who do not have insurance exploiting citizens who do needs to be brought up in Congress. If there was a way to adhere to all citizens (not denying treatment) with stricter policies then the mandate could be legitimized in practice. Emergency room charges are extremely too expensive. Emergency bills and health care reform go hand in hand. The attempts made by the ACA to help this problem seem too forceful. If Congress could amend the original EMTALA then maybe the exploitation could be lessened. I do understand, however, that the problem will never be completely fixed because this nation is so protected by the free market system. I do not believe the act should be fully overturned because without it, there would be nothing to regulate who got treatment or not, thus leading to more corruption amongst the medical world denying patients who could really need the treatment but have no way of paying for it. Maybe set a standard that if you choose to purchase medical care, you must be of age and decide before you are diagnosed–also removing the “preexisting condition” clause from the “individual mandate” of the ACA. Using the Ella case, for example, it is not fair for her family to pay such high costs for a simple, common diagnosis. I can believe that hospitals do overcharge to compensate for people who do not pay their bills. A mandated health care would fix these problems but it does seem possible to control the problem at a lesser extent. Could it be possible to put a ban on how much you can refuse to pay? Then, better strategies could be discussed in Congress on how the repayment process could be set up in order to avoid bankruptcy. That way, more people would be wary about emergency room costs. However, this could only happen if Congress is willing to work together, rather than coming up with radical ideas in dealing with socialized health care. If nothing is done to amend the mandate, however, people will start finding more ways to get around the costs of the emergency room, decreasing our nation’s overall health; therefore, getting rid of the EMTALA would be detrimental to our nation.

  6. The case of the Affordable Care Act (“Obamacare”) is one of the most important issues of our time. It will determine the status of our entire health system and financial institutions for the coming years. Many are incredibly aggressive to the thought of being made by the government to buy something. The main argument is that it is completely unconstitutional. However, the Supreme Court should not overturn the ACA because it is the only way to regulate and standardize a financial system that is incredibly critical to the welfare of our people. Like any other business, selling insurance to people relies on basic supply and demand principles and causes companies to sell at their most profitable points. The problem is that the market prices for consumers increases and the patients have to attempt to deal with the prices because there is no way you can just not pay health care when your life is one the line. For example, John Moser, had a $5,000 deductible plan and had taken his daughter to the hospital to rule out appendicitis. Nothing serious was diagnosed, and she went home to a quick recovery. Her dad got a bill for nearly $5,000 from the hospital, as well as bills for $540 from a pathologist and $309 from the doctor who treated her” (Lopez). The process of health insurance is one filled with confusion for the consumer because of the lack of information. “Schwarzmann says, ‘I don’t know where they’re coming up with these numbers. Are they picking them out of a hat?’” (Lopez) In many ways the ACA would be a well-known tax that according to a constitutional lawyer, “promotes the general welfare because it makes health care more widely available and affordable. Under existing law, therefore, the tax is clearly constitutional” (Balkin). It is the only way to provide low prices and regulation for a public health system that should not be operating like a traditional market for selling goods.

    “The Bizarre Calculus of Emergency Room Charges” Lopez, Steve,0,6799675.column

    “Is the Health Care Law Unconstitutional?” Balkin, Jack

  7. There is a large debate saying that Obamacare is unconstitutional due to the fact that it is against the 10th amendment, stating that healthcare is not granted to the federal government nor prohibited to the States by the Constitution, therefore is reserved to the States or the people. On the other hand others are saying that the Constitution grants power to Congress the power to regulate interstate commerce. All politics aside, we must look deeper into the philosophy of our country. One of the main goals of the government is to promote general welfare of our nation. Everyone agrees that our healthcare system is not sufficient due to the confusion and free riders of the system. The healthcare reform is not a new topic. Healthcare has been trying to reform dating back to President Roosevelt’s term back in the 1930’s. It is now the time to have a bold change in how healthcare is run. It does not matter if it is Obama or Ryan’s plan. Both plans are very similar, and the fines in the ACA are pretty much the same as the tax subsidies in the Ryan plan, just in different locations. It is very intrusive for the government to force citizens pay for a good or service, but healthcare is a different story. This is due to the simple account of choice. Citizens have a choice to do many things, but one thing is for sure, citizens do not have a choice to be sick or not. In this case, it makes it completely understanding for the government to put in place an act to force all citizens to pay for healthcare. The government is already doing this by automatically taking money out of citizens Social Security to pay the Medicare premiums. Now it is time to start doing it to everyone else.

  8. When talking about the issue of health care insurance versus the uninsured, I don’t think there is anything wrong with the mandate that says hospitals should have to treat any person that enters the emergency room. I do, however, think that something should be an act in place that effects those without health care insurance enough that they would thoroughly think over entering the emergency room and letting the medical bills pile up. The fact that I think of health care as a good that can be shared over states and spread across citizens justifies that Congress would be doing the right thing if they were to regulate health care insurance. The people shouldn’t think of purchasing health insurance as a burden, especially those who are healthy and therefore against it, because health insurance is beneficial to the economy as a whole.
    With regards to the Affordable Care Act, Congress should keep the individual mandate because it is unfair to those with health insurance, which could possibly cost more than about $700 in fines charged to the uninsured. I see the other side of the argument in that some people feel that it takes away from American’s personal liberty, but that personal liberty is hurting people who have health insurance due to free riders. In the Bloomberg article that was given, Individual Mandate Is Ryan Tax Credit by Other Name, the argument is made that “under Ryan’s plan, if you don’t purchase insurance, you don’t get the credit.” This is another fact to go against Ryan’s plan. The people will overall be more hurt by the excessive tax that comes along with this reform than they would with the annual fine that comes along with the ACA. We need to consider that the opportunity cost that the ACA has for US citizens as a whole as compared to Ryan’s plan, which could hurt people’s private funds a great deal more. The Ryan plan is more negative than the ACA which comes across as trying to influence people to buy insurance to benefit them and others.

  9. Before reading the blog description and articles associated with the ACA, I did not believe that there was any way the Supreme Court could uphold a mandate that forces people to purchase health insurance. Something about the government forcing a person to do a specific act just screamed “unconstitutional” to me. After reading further into the issue, I began to realize what overturning the law could mean. Every time the Supreme Court makes a ruling it sets a precedent whereby future and past rulings will be judged. This got me thinking. If the Supreme Court overturned the mandate forcing individuals to buy insurance, would the 1986 law requiring hospitals to treat all patients be overturned as well? Surely no one thinks a hospital should be allowed to turn someone away, but if the ACA mandate is overturned, then it is possible that the 1986 law could also be repealed. What about the mandate that forces employees to pay the Medicare tax or the law requiring new mothers a guaranteed 48 hour stay in hospital after their pregnancy (AP Alonso-Zaldivar)? I can’t help but think how bad things would be if these other laws were lifted. Congressman Ryan offers an interesting approach to encourage people to buy insurance through tax incentives; however, I can’t help but think, will that really solve the problem? Isn’t the healthcare issue a double edged sword in which both healthcare reform and healthcare costs need to be addressed (LAT Lopez)? I think both areas will have to be addressed in order to solve the issue at hand. I believe the intentions behind the ACA are well intended. Given the nature of other government mandates, I now believe the ACA should be upheld. The ACA aims to make healthcare a public good which would help the economy. A country of unhealthy workers is not ideal since it would cause underperformance. In addition, workers that die because of a lack of healthcare reduce economic output. Therefore by providing those individuals with healthcare they will ultimately benefit society as a whole.

  10. I believe the mandate declaring that all hospitals must treat comers is legitimate. Treating people in cases of emergencies at hospitals is a decision more moral than political however. If people started getting turned away from hospitals because they didn’t have insurance, deaths would increase and there would be a social uproar over these deaths and mistreatment instead of the unpaid bills. A less serious example would be the mandate which requires hospitals and insurers to cover the costs of mothers and newborns for their stay in a hospital for 48 hours. Turning away these mothers who cannot afford the cost of staying in the hospital would not necessarily result in deaths, but it would still result in a negative persona of hospitals who did turn these mothers and newborns away. Even though I believe the mandate requiring care to everyone in hospitals should be upheld, changes must be made to the current system of health insurance to solve the dilemma at hand. Currently insured patients are paying the cost of their own bills and the bills of uninsured patients as well. This leads to exaggerated hospital bills to help cover these costs. An example of this is an insured man is charged $1200 for an emergency room visit but the hospital ends up settling for half that at $600. They increase this price to help cover the costs of uninsured patients. A solution to this hospital bill problem would be to make it mandatory for everyone to purchase health insurance. Thus, I believe that the mandate that all hospitals should treat all comers should be upheld, but everyone should have to get health insurance whether that comes about through the Affordable Care Act or Ryan Paul’s plan.




  11. The difference in the Ryan Plan and the ACA comes down to a cost/benefit analysis for consumers. Under the Ryan Plan, Americans will receive a tax credit for individuals or families that purchase private health insurance. In the ACA, also known as Obamacare, everyone will be required to purchase a standardized health insurance, and those who do not pay will receive a fine, known as the individual mandate. The problem with both plans is that there is no way to alleviate the problem of “free riding”. Under the ACA, those people who are unwilling to purchase health insurance in the first place will most likely refuse to pay the individual mandate. As stated in the Bloomberg article, the IRS cannot throw you in jail or dock your wages for refusing to pay this fine. Those free riders in the system can continue to avoid health insurance until they get sick. The Ryan Plan suffers from the free riding problem as well. Those people unwilling to purchase health insurance are not forced to, but instead won’t receive a tax break.

    Despite the differences in tax credits and the individual mandate, the Ryan Plan mimics the ACA in many ways. As Ezra Kline states in the Bloomberg article, the tax credit is an alternate form of the individual mandate. Kline states, “What Ryan’s plan does is raises taxes and/or cut services by the cost of his credit and then rebate the difference to everyone who signs up for health insurance. It’s essentially a roundabout version of the individual mandate, which directly taxes people who don’t buy health insurance in the first place.” Another similarity lies in the privatization of Medicare for seniors, one of the main problems with the ACA. The Ryan Plan proposes for seniors to purchase private healthcare, which in turn reduces government expenditure greatly. One of the main goals of the Ryan Plan and the ACA is to save government spending on healthcare, but in turn the costs are being pushed onto Americans. The government will subsidize the elderly and those who are more ill, but the idea of phasing out Medicare and pushing the costs to all Americans is at the core of the Ryan Plan and the ACA. These are just a few of the differences and similarities in both these plans. The fact resides that the main problems these plans were trying to address (free riding and budget saving) are either not being solved or being covered up and pushed onto Americans. As a result, one of the main questions coming out of these healthcare plans is: Does healthcare need to be reformed in the first place?


  12. Obamacare is unconstitutional because a penalty is not an income tax. The 16th Amendment to the Constitution allows Congress the power to lay and collect taxes on income. The Constitution does not authorize Congress to penalize individuals for not buying a product or service. Congress can pass laws that require additional “income taxes” on individuals who can afford, but do not buy, health insurance. Congress can pass laws that require insurance companies to cover children for preexisting conditions, extends dependent coverage, and other needed reforms. Instead, Congress passed the Affordable Care Act that has some positive reforms, but unnecessarily gives the federal government new powers at the expense of individual rights. Those who argue in favor of Obamacare’s individual mandate, such as The Associated Press article “Obama’s Insurance Requirement Not the Only Mandate”, say it is similar to Medicare. However, Medicare is a system funded by income taxes that the Constitution allows. In the Los Angeles Times article, “The Bizarre Calculus of Emergency Room Charges”, they argue insurance companies and individuals abuse the current system that allows free treatment in emergency rooms. However, according to the American College of Emergency Physicians article “Cost of Emergency Care”, emergency care is only 3% of the nation’s $2.1 trillion health care cost, and only half of the 3% goes uncollected. Therefore, emergency care is not the primary problem with our health care system. Proponents argue that the Affordable Care Act will slow the growth in health care costs. However, The Washington Post article on “What Paul Ryan Learned from Obamacare” describes the government’s finding that increasing competition saves up to 35%, but politics prevents implementation of the solutions. In summary, Obamacare has some good reforms, but does not solve the cost problem, and unnecessarily gives the federal government unconstitutional new control over individuals.

    Note 1: Costs of Emergency Care 9:18:31 AM]

    Note 2: History of the US Income Tax; The Library of Congress; 6:53:29 AM]

  13. (in regard to question #1) I think that if the Supreme Court were to rule against the individual mandate that the whole law should be overturned. The individual mandate, which states that everyone would have to pay for health insurance, is something I would definitely agree with because it would help stabilize the prices of medical services for everyone. If the whole bill were to be turned down, we’d still have the problem of helping all ER walk-in’s despite whether they have insurance, but if only the individual mandate were turned down, we’d have even more of a problem. The insurance policy can only work if everyone is using it: paying into it equally so those who get sick need help can have it. If the mandate only was turned down, the other parts of the law would still be in effect and render more problems: health insurance companies would still have to let everyone be able to buy their insurance regardless of pre-existing conditions, and prices would still be very high. If health insurance were available to everyone, but it wasn’t mandatory for everyone to purchase it, then only sick people would buy it when they absolutely need it, which can’t work because then there’d only be people taking money out instead of paying into it like mentioned above. So having the mandate would definitely solve the free-rider problem; however, people think it might be unconstitutional. I don’t think it’s an “attack” per se, but it is hard to view being forced to buy insurance or be penalized as totally constitutional. However, it’s not the same as just being forced to buy something; if you get break your back, regardless of whether you have insurance, you’re definitely going to the hospital, no way around it. So the government is imposing this mandate for the greater good, not just because they want your money. In fact it has been created in order to save money: both the mandate and the Ryan plan. In regard to the Ryan plan, I think the mandate is still the better option, because it’s mentioned in the Bloomberg article that “Ryan’s tax credit is far larger than the individual mandate’s penalty, and much easier to enforce.” Plus it said that “people seem more inclined to take action to avoid penalties than to receive benefits” so it would be more effective in reaching a larger number of people. Ultimately, the mandate should stay because if it or the whole bill fails based on the constitutionality, then the government can just easily impose a definitely constitutional, much harsher form of collecting the money they want, such as jacking up the income taxes or implementing a single payer system which would not even be as effective. The goal is to slow health care cost growth, so between the two options (Ryan plan vs. individual mandate), one can see that though they’re basically doing the same thing in different ways, the mandate is more attractive beyond the initial scare of being penalized for not buying something. The last thing that really convinced me was in the Associated Press article about how we all already pay for Medicare through our taxes, so we should be used to paying for some sort of health plan. Though it’s for the elderly and doesn’t directly affect us (yet), it’d be nice to know that we’re paying for a guaranteed government system for our own health that we can access immediately.


  14. Although the individual mandate is fining people and Ryan’s plan is rewarding people, in both situations the people who buy health insurance are being rewarded, while people who don’t buy health insurance are being penalized. According to the article by Ezra Klein, there are differences in the way people respond to each situation. Before reading the article by Klein, I thought people would be more inclined to be rewarded with tax subsidies after having to pay a higher tax- I still think this. However, Klein states that the individual mandate is considered more effective than the tax credits and that it prevents free riding more successfully. Look at it this way: if people are already being punished (having to pay higher taxes), then they should be more willing to buy health insurance and get the refundable tax credit. Sure, people try to avoid being penalized and taxed with the individual mandate but if they’re already going to be taxed, wouldn’t there be more incentive to get some of that money back? Paul Ryan’s plan may be more appealing because people don’t get the idea that they’re being “forced” to buy anything. On the other hand, I can see why it’s a lot easier to free ride. If they don’t buy health insurance, nothing happens; they’re just missing out on the tax subsidies. With the individual mandate, it angers a lot of people because no one wants to be taxed for something they didn’t want to buy in the first place- they don’t want to be punished, so they buy health insurance. However, you have to weigh the fact that Paul Ryan’s plan is a “harsher penalty” for those who don’t buy health insurance. Klein states that Paul Ryan’s plan is also much easier to enforce. All in all, although both the individual mandate and Paul Ryan’s plan are set up to achieve the same goal in very similar ways, there are huge differences in the outcomes. Maybe we should give Paul Ryan’s act a try and see how many free riders there are after a couple years when the penalties have some time to add up.


  15. Normally I would say that the government cannot force people to purchase health insurance that they do not want, need, or perhaps cannot afford. The problem is that some people are completely healthy and may not ever need the health insurance they were forced to buy, so in this case the cost of purchasing health care exceeds the benefit they will receive from having it. However I do see how this could be a solution to the current free-riding situation we currently have.
    The emergency medical treatment and active labor act says one cannot be denied treatment in an emergency room. I do agree with this act because it is (ethically/morally) wrong to let a person suffer or even die just because they might not be able to afford insurance. This act has the unfortunate side effect however of reducing the populations need to purchase health insurance and causes the free-riding situation; I cannot be denied treatment even if I don’t have health insurance so why buy it. Those who are insured end up paying for the medical bills of those who are not insured or can’t afford to pay. If everyone paid for health insurance the free-riding issue would be reduced (it would never go away entirely because people always find a way around the law).
    Another issue I could see however is dealing with people who cannot afford health insurance. We cannot and should not deny them treatment but it is also unfair for those who have insurance to pay for their medical costs. The ACA should find a way to make health insurance affordable to those less fortunate. The ACA does have flaws but I do believe it is a step in the right direction and will help in the long run.

  16. I think that Paul Ryan’s proposed plan for health care reform is the best option concerning the direction the United States should take on health care. The plan is very similar to Obama’s Affordable Care Act but differs in one key area. Obama’s plan wants all individuals that choose not to be covered to be fined. This is wrong and I feel represents the government overstepping their boundaries. In Paul Ryan’s plan, an individual can choose to not be covered but will face an increase in taxes. This is an acceptable alternative to the “fines” Obama plans to impose if the the ACA passes. Paul Ryan’s plan would stop people from abusing the emergency care system, which is possible due to the Emergency Medical Treatment and Active Labor Act (EMTALA). My dad’s friend, Dave, is one of these people. He has five children and has not paid a single dollar for the birth of one. He took his wife to the emergency room when she was going into labor, and the hospital had no choice but to admit her. When it came time for bill, he had no health insurance and would simply not pay for it. These selfish actions of people that refuse to pay for healthcare or cannot afford it cause the rates of others to increase. If Paul Ryan’s plan is passed, the people that refuse to get health care will be taxed. This tax will be a fair alternative to the proposed standard plan offered by the government. The health care system will no longer be abused and the people that do pay for health insurance will no longer be robbed with such high fees.

  17. The Idea of forcing everyone to pay for their health insurance is one that I believe is smart in principle and will help the economy as a whole. However I also believe that it is unconstitutional to force an American Citizen to pay for anything against their will. I would consider health insurance a good because you purchase it yourself, for your personal benefit. So in other words the decision to have everyone pay for health insurance would work out economically but all political parties, if they were to endorse this, might suffer because it isn’t constitutional. Forcing people to buy health insurance will ultimately lower the cost of health care for all US citizens. This is obviously a good step because of the high bills that those without insurance have to pay when they go to the ER which are then paid by those people that do have insurance. Some argue that people in their twenties or thirties wouldn’t and shouldn’t be forced to buy health insurance because they don’t need it. They will be paying for insurance which will just go to helping the sick and elderly pay for their medical bills. But I believe if everyone was forced to buy health insurance eventually it would become a cycle where although you may not need insurance now, you will need it in the future and then the generation below you will pay for your medical bills. If the government were able to continue to force people to buy health insurance under the ACA I think that this would help the economy but if they are not able to do this I think one of the better solutions that I’ve heard has to do with raising the income tax and having the government provide insurance for everyone. This is essentially doing the same thing that would be done by forcing people to pay for health insurance however it would be constitutional. This still brings up more problems though for anyone who avoids paying income tax but still has the benefits of the government provided health care. I do not envy the political leaders who need to come up with a solution to this problem but I think they should find a way to have every American own sometime of health insurance.

  18. The issue of health care in the United States has been an on-going debate and will continue to be debated over for many years to come. We have yet to find a solution that is beneficial to all Americans, but the Affordable Care Act, as well as Paul Ryan’s budget, is a step in the right direction. Although Obama and Ryan both ridicule the other, the ACA and Ryan’s Plan are very similar in the way they promote the purchase of health care. Ryan’s plan makes it seem as if policy holders are being rewarded while the ACA penalizes non-policy holders but they both yield the same results. Ryan’s plan raises taxes on those without health insurance and uses the tax gain to offer those with health insurance a subsidies that lower their taxes. Also, as states in the Bloomberg article, it “imposes…a harsher penalty [than the ACA] on those who don’t purchase health insurance,” and it is easier to enforce. The ACA uses a simpler approach and charges non-policy holders with a yearly fine that rises each year. Although it is harder to enforce, the Bloomberg article suggests that it may be more effective because people are more likely to purchase insurance to avoid a penalty rather than receive a benefit.
    Both of these plans have their benefits, but, as stated in an earlier blog, they do not eliminate free-riding. People still have the option to not purchase health care and there are still thousands of illegal immigrants that are not even able to purchase it. A way to eliminate free-riding and completely enforce either the ACA or Ryan’s plan is to eliminate the current mandate. The Emergency Medical Treatment and Active Labor Act does not allow anyone to be denied treatment in emergency rooms. Although removing this would create a huge moral debate, it would require everyone to purchase health insurance to be treated which would reinforce the ACA or Ryan’s plan. There may be other solutions to the free-riding problem, but without reforming the current proposals, this is one of the only viable solutions.


  19. The Afordable Care Act is an effort by the government to help stabilize medical prices. Why should some families have to pay for “free riders” who are living with the same luxury of health care as families paying, but not paying for it? I agree completely that everyone should buy health insurance to avoid free riders. Some people don’t purchase insurance until they are sick or injured, or they never purchase insurance at all. Some argue that it is unconstitutional to force all Americans into buying insurance. If all people bought insurance then there would be no conflict when it came to accepted all comers into the emergency room. If they for some reason were not insured, they should be treated and then fined for not being insured.
    If the government did not force all American’s into buying health insurance then they should defiantely do something to try to convince them to do so. Two other options would be to increase income taxes on families that were not insured or to give tax credits to families who were insured. Both of these solutions would eventually give families incentive to buy health insurance. If America is a place of equality, then the people should all be paying equally as well for certain luxuries.

  20. I believe that America’s health care system is complicated and faulted. I do believe that the mandate of Emergency rooms having to treat all patients is legitimate because a hospital cannot simply refuse to help a patient. That is morally and ethically ignorant. But I do think there should be a better system in place rather than the rest of heath care insurance participants pick up the tab on it, which is simply not fair. This is why I also believe that it should be a law to have health insurance, because one does not know when they will have an accident, or even get an illness. The moment they do get in an accident, and go to the hospital to receive emergency care, they will have to pay out of pocket for this care. Most people, depending on the severity of the treatment, cannot pay out of pocket. Although health care is very pricey, and some jobs don’t offer this to their workers, I think everyone should purchase it. There should be a plan designed for those of low income families, because something is better than nothing. In the case of having to pay a fine or pay higher taxes if you don’t have health care, I believe that is ignorant for someone to pay that. If they are going to pay this tax, why not put the money towards your health care, or your children’s healthcare? One of the biggest problems with health care, is it is simply to expensive for low income families to pay. This being said they cannot afford to pay this insurance, so they are forced to pay the tax. This isn’t fair to these families either. My solution, being too simple or not, there should be a health insurance policy for those who qualify medically, and financially, a policy significantly less expensive than the one we have in place now.

  21. The current debate about the Affordable Health Care Act has caused sides to be drawn while two major issues are at play: The first is the provision of the Act which forces individuals to pay a penalty if they do not purchase health insurance permitted by the Constitution. One explains that this should be done because people who do not purchase insurance must still be given care (generally in expensive emergency rooms) as required by other laws. When this happens, everyone else, through their insurance, taxes, or payments for health care services, ends up paying the bill for those who do not have insurance. Those proponents say, both the general welfare provisions and the Interstate Commerce clauses of the Constitution permit the “individual mandate.” The opposing side says no because the mandate that individuals purchase health insurance exceeds the powers granted to Congress by the Interstate Commerce Clause of the U.S. Constitution. They claim that Congress cannot force individuals to purchase something. Through the Commerce Clause the Supreme Court has ruled that Congress has broad regulatory powers, but a mandate to purchase something has never happened before. I think a better way to make insurance more affordable would be to allow insurance companies to sell across state lines.
    Because insurance companies are unable to sell across state lines, competition is decreased. The affordability of insurance would expand to more consumers if they could buy from states where policies are not laden with such expensive mandates. This would create a huge benefit of a market supply of affordable insurance. Coverage mandates cause issues in driving up insurance prices. As healthy people feel that health insurance is too expensive, not needed, and since they are healthy, they do not purchase it; this leaves a pool of older and sicker people, including the aging population of baby boomers, to purchase the insurance which allows prices to be driven up. This high-mandate is known as an “adverse selection death spiral.” Universal healthcare could also lead the country into bankruptcy. In Japan, insurance prices are kept artificially low due to strict government price controls. Japan’s health care is also universal and mandatory, but consumes about 8% of the nation’s total GDP (half as much as is consumed in the US). Japan has the oldest population in the world and it is predicted that their demand for medical care will triple in the next few decades. Without changes, Japan’s healthcare system will be unsustainable. The Supreme Court has heard oral arguments made by both sides on the case and will soon decide.


  22. The question on if the mandate that hospitals must treat all comers is legitimate should also force people to consider if Affordable Care Act is legitimate. Both mandates are requiring the best for the patients. Under the Emergency Medical Treatment and Active Labor Act, people cannot be denied treatment in the emergency room. Therefore they are saying that if you are insured or not you can be taken care of. This brings up the question of who is going to pay for these people to be taken care of if they are not insured? The answer is every taxpayer. Now the ACA is mandating that everyone purchase health insurance. To me this only seems just, if we are all able to receive medical treatment in the emergency room then we should all be required to pay for health insurance to cover the costs of being in the emergency room. It doesn’t seem fair that people with health insurance can receive emergency care and people without health insurance can also receive emergency care. Upholding both the ACA and the Emergency Medical Treatment and Active Labor Act will place everyone on level playing grounds and would be more universally fair.
    However, if both of these things are going to remain as legitimate then there must be a better regulation of the prices that are asked when insurance companies are involved. For example, it should not be ok that someone can pay $250 in cash for a surgery when the insurance was left out versus being charged $3200 for the same procedure and having the insurance pay $1500 and the person pay $1700. I feel like there needs to be some standards set for the amount that companies can charge simply because insurance is involved. There really should not be any negotiating rates because no one can tell who is really being ripped off and who is really paying an accurate amount of money for the treatment they are receiving.

    Lopez, Steve. “The Bizarre Calculus of Emergency Room Charges.” Los Angeles Times. Los Angeles Times, 31 Mar. 2012. Web. 09 Apr. 2012. .

  23. The Ryan plan and the Affordable Care Act is essentially the same thing. Obama has declared the Ryan plan as “fairly radical”. On the other hand Paul Ryan believes that Obamacare is sending the country to bankruptcy but the two plans have very many similarities. The Ryan plan is pushing for exchanges for the elderly just as the health care plan proposed. Both sides used the same argument that their plans would allow beneficiaries to choose coverage the same way members of Congress. This would allow people to choose precertified government-approved plans where the system would be adjusted to risks and ability to pay. Ryan uses the same views under the new health care law that takes into account the risks among the elderly. Now there is a difference between offering exchanges to certain persons (seniors) versus most of the population but Ryan’s proposal acknowledges that there is a consensus in sharing a risk with all of the elderly populations, which is the same thing as Medicare. The Ryan plan includes a change to Medicare that gives subsidies to the elderly that would allow them to get private coverage and penalize them if they did not participate. Those private insurers could not exclude because of risks which is exactly what Obamacare would do for those under 65. Also the House GOP budget resolution of the Ryan plan proposes significantly more regulated health insurance exchanges just like those in Obamacare. ACA supporters argue that exchanges would work to control health care costs because competition in the insurance market would control prices while having the same quality service. Ryancare makes the same argument saying that in private insurance market exchanges will make healthcare affordable because future seniors making choices when choosing insurance will benefit from private market competition. Both of those rely on the free market theory. The evidence that these two plans are fundamentally the same is outweighs the claims that they are different.
    1. Klein, Ezra. “Individual Mandate Is Ryan Tax Credit by Other Name.” Bloomberg. 28 Mar. 2012. Web. 09 Apr. 2012. .
    2. KHAN, HUMA. “Is Paul Ryan’s Medicare Proposal Like Obama’s Health Care Plan?” ABC News. ABC News Network, 22 Apr. 2011. Web. 09 Apr. 2012. .
    3. “ObamaCare, RyanCare Share Concepts.” USA Today, 30 Mar. 2012. Web. 9 Apr. 2012. .

  24. The ACA and Ryan’s Plan are similar in that if either one of these plans are put into action, a financial penalty will be imposed if a person decides against purchasing health insurance. People look at the ACA as if it is much worse and threatening to each individual because it talks about billing people who do not have health insurance while Ryan’s Plan seems to be sugar-coated to the public by saying you will get a benefit if health insurance is purchased. Either way, if you dont have health insurance, it will cost you a financial penalty. However, either one of these are not a good idea and will raise many problems that might not have been planned for or foreseen. Lets look at the positives first. If the ACA is passed, 32 million Americans who do not have health insurance at this time will be covered. Also with this bill, a reduction in our deficit is predicted to be about $143 billion dollars over the next ten years and will fix the “doughnut hole” problem – where people on Medicare are not assisted with payments of their perscriptions once the costs have accumulated to $2,830 and will not pick up payments for perscription drugs until the individual has spent $4,550 out of their own pocket. Although these seem to be leading to a good fix, there are also cons that i think overweigh the pros of the bill. The total cost of the bill over the next ten years is estimated to be $940 billion dollars which is way over any savings this bill may do for people and will result in an overall increase in the deficit. While government payments will be seen to reduce by $132 billion dollars over the next 10 years, it is due to the cuts they will make in Medicare and we will see an increase in other taxes and fees that deal with health insurance. If this bill is passed, a tanning tax will be imposed of 10% and raise $2.7 billion. Also, many employers use a flexible spending account in order to set aside money for future medical expenses and care for their dependent(s). The ACA will cut the amount you are allowed to take out of your payroll from $5,000 to $2,500 which will reduce the amount each person is able to exclude from their payroll tax and increase the amount the government will collect from each individual in taxes. Finally, while the government sees that this act is helping out the health insurers, they are going to collect money from drug manufacturers and health insurers that will result in them paying over $60 billion to the government as well. The choice that Americans have to decide how they want to spend their money and where to save it, and whether they want health insurance is being altered from the form of a choice to an enforced rule and regulation which puts the overall thought of American’s freedom of choice into question.

  25. Both of them are going to cost you in the long run. With ACA if you buy the minimal insurance you may not be charged higher taxes, but you are charged a penalty, but the point is you are still paying somewhere. Now with Ryan’s Plan let’s say you buy the insurance, okay great, but you are not necessarily saving anymore money then you would be if you didn’t purchase it. If you buy it you may get the tax cut but you are still paying out for the coverage, whereas if you don’t buy it, yes you don’t have coverage and may not get the tax cut, but you save the money anyways because you’re not paying for the insurance. So basically someone could say buying the insurance you save money on your taxes but not buying it your saving money anyways because you’re not paying for it. . . it’s the same thing. With ACA your taxes will go up, but let me then ask this, what if you don’t pay taxes anyways because you are an illegal immigrant? If I’m illegal I’m not getting fined at all, which some could say means that with ACA you need to then push for harsher immigration laws. I think a lot of people see the Ryan Plan as a better way because it gets around the “unconstitutional” aspect of it by saying that you are not REQUIRED, but in the end they are just taking out that word required, because technically you would get no coverage because the emergency room could deny you, so if you want any sort of coverage you are “required” to pay. Although, I do know one thing; it is unethical to turn people away from the ER. Doctors swear an oath to help anyone and everyone, so if they saw someone on the street (not knowing they didn’t have insurance) and they were hurt they would be required to help them, so then there is no difference between them seeing the person out in public or in the ER. The government wants to get rid of free-riders, yeah not going to happen. With ACA, illegal immigrants can get off for free or a poor person by handing payment off to someone else. One of the articles mentioned Massachusetts, and how people were more inclined to pay to avoid a penalty then receive no benefits. I believe this is because if you don’t need to, you wouldn’t buy insurance, so it doesn’t affect you, but if you were to get in trouble, then yes you would pay. The good thing about ACA is it is a minimal insurance and the good thing with the Ryan Plan there seems to be more of a choice, but only if you NEVER get sick and don’t ever need to go the ER.
    Congress should have the right to regulate insurance if they plan on helping you when you are old or in need. I believe in not denying people from the ER, but the issue is, there is no solution. Let’s say congress lets everyone gets free care in the ER, no matter what. Well where will that money come from? Taxes. So everyone’s taxes will go up, which is never good and of course people will complain about those who don’t pay taxes or will complain that they shouldn’t pay because they don’t use the ER. But if Congress plans on helping or being involved in anyway, they will need money and people need to get used to that, whether they like it or not. If Congress doesn’t get involved and lets each state pick their laws, one could argue that that isn’t constitutional because you could have the same economical standing in one state and then move and you wouldn’t be able to afford care based on their rules in another state. To make it fair then you would have to change the cost of living so it’s the same everywhere. So do I believe congress should be involved, yes for the time being, but there may never be an answer.

  26. Clearly, the opinion on the Affordable Care Act depends greatly on from where one extracts its legitimacy. It is perhaps easiest to deny the legitimacy of the ACA constitutionally, or at least its mandates. Many states including Virginia, Florida, Pennsylvania, and Texas have filed suit against “Obamacare” on the claim that it is unconstitutional to require individuals to purchase insurance and to in turn fine those who do not. The lawsuit says “The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage.” However it is important to note that it is also stated in the Constitution that federal laws trump state laws. From its name (Affordable Care Act), one can also derive its legitimacy from an economic standpoint. But who exactly would this be affordable to? First of all, as I understand it, over the past decade insurance premiums have been increasing significantly. Adding another 30 million people into the “pool” can only result in higher insurance premiums for most of Americans who already have insurance. This is especially considering the fact that a large percentage of those who did not previously have insurance were already significantly ill and thus denied insurance. Under the ACA, congress will also be cutting Medicare benefits by $500 billion which will mainly affect the baby boomer population that is now nearing retirement. It is also beyond doubt that taxes will have to increase for businesses and individuals to support this all-encompassing healthcare system. So really the people benefiting the most (monetarily) from the ACA are ill people who were previously denied insurance coverage and low-income citizens exempted from payment. I find that the strongest ground for the legitimacy of the ACA is simple morality and equality. The real aim of the ACA is to provide coverage for everyone who needs it so that necessary medical care is not there for only those who can afford it. Those who are ill will find treatment despite their income or severity of condition. I find this to be quite important especially since universal healthcare already exists in other countries. However, under this act specifically, one must be weary of what there is to give up in terms of both constitutional rights and money. There is also a concern that if so many new people are introduced into the healthcare system, its quality will go down.


  27. Obama had the right intentions when he introduced Obamacare to the states. But it is just unconstitutional to charge someone with additional income tax if they do not purchase health insurance. A simple emergency room visit can cost you thousands of dollars more if you go through insurance than if you just pay for it yourself with cash. According to The bizarre calculus of emergency room charges, a simple ultrasound can cost an individual $1,700 of their own money when they use insurance to pay for the visit after a $1,500 deductible. Paying for the visit with cash can drop the price to $250. So forcing people to buy health insurance is actually like forcing them to spend a substantially larger amount of money than not having it. Also, Paul Ryan’s plan is to place a negative tax on those who are eligible for health care but don’t purchase it. This tax would be much higher than the $700 that the ACA has in place. Although this seems unfair, the proceeds would go to help those who can’t afford health care purchase it. Either way you look at it, if you don’t get health insurance, you will be penalized. If you do, you will probably be paying more than you should in those times of need.

  28. According to the Constitution, everyone has the liberty to choose whether or not they want to invest in the security of health insurance or take the risk of potentially bankrupting themselves and their family. An individual mandate however, has the ability to eliminate numerous problems within the current healthcare system. As shown in the Los Angeles Times article about health care costs, prices have reached an unreasonably high peak. In some cases, there is no advantage in providing your insurance information versus claiming to be uninsured. If the government cannot constitutionally impose a price ceiling on medical pricing and healthcare can be argued to be considered interstate commerce, then universal healthcare can be justified. Hospitals deserve to be compensated for their services but they cannot abuse this reality by overcharging the insured. If this continues to be a free market system, costs will remain high and people will cheat the system by only purchasing when they have preexisting conditions. With extremely unreasonable healthcare costs, it is a fair proposition to encourage Americans to consume healthcare through a subsidized rate. The opportunity cost will continue to grow as an uninsured American as prices rise. This proposition becomes unconstitutional however when this forgone incentive will penalize a non-insured American through taxation or fines. Most rational people would see the value in investing in healthcare, while others simply do not have the finances available within their budget. It is Congress’s duty to look out for the general welfare for its people and health of Americans.,0,6799675.column

  29. The controversy over a national health care system has moved to the forefront of many political and economical debates. The Affordable Care Act, or Obamacare, wants to implement a mandate that every American citizen purchase health care. Paul Ryan’s counter-plan for Medicare would instead keep the privatization of healthcare and give tax subsidies to those you who do purchase health care. Fundamentally there is no difference between these two plans, however the tax subsidies may be a more practical approach. Obamacare and the Ryan plan are similar in that they create motivation, whether that is by penalty or by incentive. They differ in that the tax credit plan encourages more efforts form the free market. If people are going to benefit even more from having health insurance than they already can, they will be encouraged to go out into the market and buy, thus stimulating the economy. One of the main arguments against the Ryan plan is that the Obamacare mandate would not cost nearly as much as how much those without insurance would have to pay without the tax credit. According to the Congressional Budget Office in reality the ACA is going to end up being far more expensive. The ACA plan expects for people who are already on insurance to stay on it, and for the mandated insurance to mainly cover new people who don’t have it. Obamacare is most likely going to spiral out of control however financially because most people on insurance now will switch to the ACA because it will be cheaper for them, making the cost of public healthcare skyrocket.
    This issue shouldn’t have been debated over in the first place. Congress has no right to mandate anything of this scale. Nowhere in the Constitution does it say that the government needs to provide healthcare for all of its citizens. In reality most industries do better when the government doesn’t get involved. Typically anything the government runs that a private industry could run, tends to be more expensive and much more inefficient. For example, UPS and FedEx are much more productive than the government postal service.
    Healthcare is an issue that can’t be ignored however, health and human services are one of the biggest contributors to our national deficit. It is also true that there is a huge problem with the system in hospitals that those without insurance will still be treated and then their fees will become the burden of those with insurance and all other taxpayers. Obviously these people shouldn’t be left to die, but there needs to be some sort of system to find out what a fair contribution rate by others should be, so that those who are insured aren’t constantly being employed. A lot of problems with healthcare could probably be fixed if power was transferred from the federal level to a more local one. The federal level has to look at everyone the same, thus for example why there are such inequities in federal income tax across states, because the federal government has to acknowledge the differences in state income taxes, making people in Virginia have to pay more than someone in California where the economy is a mess. If things like healthcare were going to happen at the local level, the desire of the citizens and the real cost of living in that area would be better met. Thus a more hands off approach by the government in healthcare makes more economic sense and is more Constitutional.


    James Capretta, CBO’s Estimates of Obamacare Revisited,

    Federal Budget Spending

  30. Although similar, I believe that the Ryan Plan is a much better alternative to the individual mandate. Forcing people to buy health insurance seems unconstitutional and will provoke those unable to purchase it to find methods of avoiding the annually assessed fine. However, giving individuals and families tax credits for purchasing private health care is constitutional and gives an incentive to those who are on the brink of getting insurance or not. The real underlying problem with this situation is the rights that the private medical facilities have concerning who they can treat and who they can turn away. According to the Emergency Medical Treatment and Active Labor Act passed in 1986, if you do not have insurance, you can go to an emergency room for treatment and end up not paying bills that are deemed too high. Thus, everyone else that is insured is forced to help pay for those who do not have insurance. Many people believe that Ryan’s Plan is too similar to the current Obamacare for it to be worthwhile to institute a change. I think that Ryan needs to add some sort of clause that would help private medical practices to limit the number of people without insurance who are offered care and treatment. The ultimate shortfall of our system is that we are too focused on private profit and not on social health and wellbeing but this is a problem that will not be fixed anytime in the near future.

  31. After reading the articles I feel that it is not fair that people can walk into a hospital, without insurance and be treated. All the people who do have health insurance have to pay a much higher price to cover the people without health insurance or who are free riders. Which leads to another problem. In my opinion, most people who live in the United States should have to have some form of health insurance or should not be allowed treatment for what they need. If they are willing to pay a higher amount then a person with health insurance then they could get their treatment. Insurance is designed to save people money if they were to get sick, not to pay more when others get sick. As terrible as that sounds it is the only way for things to work out fairly. If someone were to buy a house or a car, they would have to get insurance to cover expenses if a problem were to occur. Why should health insurance be any different in that respect? It is understood that the economy is not doing as well as it has in past and many people can not afford health insurance, but hospitals can not keep giving free care to people and make people who are insured cover these exponentially high costs. Essentially, both the Ryan plan and Obamacare have a motive of slow down health costs. With the Ryan plan, there would be tax breaks for the rich, but that necessarily is not a good thing. To give tax breaks, millions of Americans would be out of health coverage leaving even more people uncovered then they are today. This ultimately would raise health insurance for people who need it in the future.


  32. I do not believe there should be a mandate for the hospital to treat every patient that comes through the ER. Because hospitals are so overpopulated, it makes sense for only people with insurance and people that can afford it to be treated. That’s how economy and real world is today basically, the ones with money go first. The hospitals are in for losing money already covering people with no insurance, so why should they get the opportunity for service without repaying the hospital?
    According to Saul Spigel, “guidelines adopted by the American Academy of Emergency Medicine, an organization of emergency room physicians, call for 2. 5 patients per physician per hour and 1. 25 patients per nurse per hour (or one nurse to three patients at a minimum)”. In no way can hospitals hire more nurses or doctors because hospitals will be losing money and having doctors leave because of low salaries. Look how many more patients could be seen if uninsured people were deneid. That 2.5 ppp would increase to atleast 3 maybe 4. Patients coming in with no insurance are causing others, that have fully paid insurance and are willing to follow the law, time and maybe severity of disorder because they are not being treated right away. I understand more lives would be lost and most governmental conflict would occur but, this is society, you must follow the law and to be successful and get treatment you must make money to get insurance.

    source: Sigel, Saul. “Emergency Room Standards”.

  33. I am in favor of the overall ACA law being allowed to stand, however, I believe the Supreme Court should decide to overturn the entire law because if only the individual mandate is overturned, free-riding would still exist because we are in a free market where everyone has to participate; the individual mandate is essential to Obamacare’s effectiveness. The purpose of overturning the entire law and not just the individual mandate is to not have people like Denzel Washington’s role in the movie John Q. In this movie, his son experienced a chronic condition and needed a heart transplant. There was no type of Obamacare enforced and Washington was a free-rider because he didn’t have the money to pay for expensive health care insurance. Free-riders put a burden on taxpayers, but more importantly, “If the mandate falls, future politicians, who will still need to fix the health-care system and address the free-rider problem, will be left with the option to move toward a single payer system or offer incredibly large, expensive tax credits in order to persuade people to do things they don’t otherwise want to do” (Bloomberg). If the individual mandate is overturned, Obama would address free-riding in a different way such as raising taxes, but Washington would hold hostages in the hospital until he gets the health care insurance he desperately wants.

    I don’t believe Obamacare is an attack on our Constitutional rights because people consider Obamacare as an attack because they are only focused on what they dislike about the bill and are mainly exposed to the “relentless bashing” (Justis) aspects of it. Obamacare is not an attack on our rights because this idea only became popular because people “don’t like when the government tells them they [have] to do something” (Justis). First of all, “Only after the mandate became the centerpiece of the Democrats’ health-care bill did its constitutionality suddenly become an issue” (Bloomberg). This clearly shows that the beliefs of Obamacare being an attack on our rights sparked because of the addition to the bill. Secondly, “The individual insurance requirement that the Supreme Court is reviewing isn’t the first federal mandate involving health care” (Pulse). There have been other mandates that have not drawn as much attention as the Obamacare mandate. For example, “there’s a Medicare payroll tax on workers and employers, and a requirement that hospitals provide free emergency services to indigents” (Pulse). I don’t understand why people reject Obamacare when it’s the same thing as “not wanting to pay state taxes and say that you will never use a public road,” knowing good and well they would use it (Justis). The health care insurance system would only function if everyone bought insurance and not just some people. Everyone in America is involved in the health care market whether they pay or not and we all will need health care at one point of our lives. Just as Donner mentioned in the Pulse article, there really is not a “difference between the mandate that workers help finance Medicare and the health care law’s requirement that nearly everyone has to have some sort of health insurance.” If you consider Obamacare as an attack on your Constitutional rights, then you might as well say state Medicare payroll tax and state taxes are an attack as well.
    Chris Justis, a junior public policy and administration major: JMU Breeze writer. Paying more to help.

  34. I believe that the Supreme Court should not overturn the law or the mandate. I believe that health care is a necessary cost all Americans should pay for, as health problems and diseases are rising significantly in the United States. Obesity costs are going up, and out population is becoming more and more obese; a new study shows obesity costs will grow to $344 Billion by 2018 (Reference 1). Whether you pay for insurance or not, you’re paying for it with either higher taxes, those fines previously mentioned, or the costs of diseases like obesity will enact later (ex: handicapped work force). The additional money pooled in from excess purchases in health care will strengthen the industry, potentially make costs lower for everyone in general, and could potentially lead to greater motivation to find cures for these various ailments. Also, the mandatory costs of health insurance will not only force low income families to have some sort of security in the event of serious illness, but it will motivate them to find work to make up for the cost of health insurance. It might indirectly increase teenage employment which has been decreasing (Reference 2). It’s arguable that the mandate at least goes against one’s constitutional rights, but again, I believe the cost is inevitable. Somehow, no matter what form that cost takes, it’s going to affect us.

    I do believe that health care is a good that can be regulated; a plan like the ACA could contribute to a more stabilized, structured system. I do not think the Ryan plan for Medicare really differs from the ACA for non-Medicare. There are costs nonetheless regardless of which way you look at it.

    I think that the ‘treat all comers’ mandate is legitimate. There is some gray area. There are some 57 million Americans struggling with medical bill debt, while 43 million of people in that group are insured (Reference 3). However, if the health care industry was better off by having more mandatory contributors, these some 57 million could be better off, and climb out of their debt to contribute more to other industries within our economy. Yes, there are those that abuse the system (get the emergency care, don’t pay the bills), but it’s very hard to regulate that. You could “apply” for emergency medical care like how you would apply for a loan, but key word: ‘emergency’. Fun thought, but that probably wouldn’t work very well.





  35. In my opinion, the Supreme Court should not overturn the ACA individual mandate, or the entire law. Both the mandate and the law are geared towards fixing a “hole” that currently exists in the health care system. The mandate shouldn’t be overturned because it is currently the most logical way to fix it. If everyone is required to purchase health care, those who currently pay more to offset the medical fees skipped out on by those who can’t pay outright, should pay less in the future, and those who currently can’t pay the monstrous bills resulting from lack of coverage, will be paying their fair share. Similarly, the law shouldn’t be struck down altogether, especially because of what it does to the younger bracket. With the current unemployment rates for college graduates, those up to age 26 should be embracing this new law. It will cover them during frictional unemployment, and begin to offset their impending costs to be paid because of the aging baby-boomers. The important thing to recognize is that the law isn’t intended to expand the powers of the government. Those who argue that the government is now trying to take control of individual Constitutional rights need to realize that this isn’t “new”. This “control” has been in effect since the 1986 EMTALA. In all honesty, I believe that the true problem here is the idea of socialism. Many Americans, especially Republicans, see this shift as a socialist policy. Yes, in some ways it is, but others need to grasp the importance of the shift to mixed economies. The days of purely free market and socialist/communist systems are fleeting. Socialist governments are adopting more and more free market policies, and vice versa. It is my faith that the US government isn’t trying to take away my Constitutional rights. Instead, it’s trying to fix an important and costly economic problem!

    Alonso-Zaldivar, Ricardo. “Obama’s Insurance Requirement Not the Only Mandate.”
    Pulse. The Associated Press, 1 Apr. 2012. Web. 5 Apr. 2012. .

  36. The current health care crisis is a problem with no definite answer. Although each view does have some truth to it, no one attitude is 100% correct in my opinion. A mix of these acts would be an ideal solution for the current health care system in the United States. The free riding that goes along with the current health care system cannot continue: it is not fair for those who pay health insurance to have to pick up the slack for those who do not have it and get injured or for those who wait until they are deathly ill before they purchase. What would be the incentive to even buy health insurance under the current system if the government will pay for emergencies anyways? I believe that there are two options: the government could repeal the EMTALA or enact the Ryan Plan, which technically would not be considered unconstitutional. Although the Ryan Plan and ACA are essentially the same in their results, the Ryan Plan is less likely to be deemed unconstitutional because, unlike the ACA, it does not directly penalize people who do not get health insurance, but rather gives them an incentive to buy insurance with lower taxes. This will eliminate free riding because the burden of the taxes wont be on the people who have insurance, but rather on people who decided to not purchase insurance. The repeal or amendment of the EMTALA would also be ideal. From a purely economic (not moral) standpoint, without this act, more people would be scared into buying insurance because, without it, they would not be saved in an emergency situation.

  37. There have been many recent debates regarding health care insurance. THere is a specific mandate that states hospitals should take care of any patient that enters into the emergency room. This is a mandate that I completely agree with. When people are in desperate need they should be treated despite their income or ability to pay. Although I beleive anyone should be treated, I do think there should be some sort of regulation, one that will make people want to purchase health insurance so their bills are not as outrageous. With that being said, I don’t think health insurance should be looked down upon. It should be seen as a benefit, that people should feel lucky to have.

    When focusing on the Affordable Care Act there are many sides to the argument. One side is that the act takes away from citizens liberty. Although I can see how that is a concern, people do not realize how the liberty of people was hurting all those who have the benefit of health insurance.With ACA there are fines for the uninsured that can reach $700; a major downfall of the act. When comparing the ACA to the “Ryan Plan” , the ACA has less of a sideaffect. With the “Ryan Plan” when insrance is not purchased there is no credit received. The tax that comes about from this plan will be much higher and can affect private funds causing more damage then the $700 that comes about from the Affordable Care Act. Overall the Ryan Plan has a more secere affect on citizens then the ACA.


  38. I personally believe that the mandate requiring everyone to purchase a minimum policy is constitutional, and should be put into place. Living in New Hampshire, I heard a lot of news about the Massachusetts health care insurance reform. This requires almost everyone in Massachusetts to purchase health care. The state regulated the minimum that was required by the law, and the state also helped out those that could not afford health insurance. This would severely decrease the cost of insurance because the insurance companies would be getting more money, and there would be fewer people walking into the ER without insurance and who do not pay (people could still come into the ER from other states, also making it interstate commerce). This way, the insurance companies would not have to pick up the bill for the people that skip out on it. This probably would never happen in my state, New Hampshire, as we have a Live Free or Die policy, and no income or sales tax, but if this was put in place on the national level, people without insurance would not be able to walk into the ER from other states that do not require their residents to have it. I realize that this may be pushing constitutional rights, but for the people that walk into the ER without insurance and do not pay, they going against the rights of the hospital, insurance companies, and those that actually do pay as they have to pick up the bill for them. Obviously, if the government does not fine the people that do not buy insurance, then this law would effectively be useless, as people would have no incentive to follow it, other than being law abiding citizens.
    “Massachusetts has the highest rate of insured residents in the nation, 98.1%. Reform has improved thousands of lives, and has only added 1% in new costs to the state budget, according to an independent analysis.”

    “Health Care Reform.” Health Connector. Massachusetts State Government. Web. .

  39. The current healthcare debate has come to be one of the most polarizing topics in American politics since Roe v. Wade, which ruled in favor of Roe saying that women have the sole right to their body. Healthcare can be thought of as a regulated good that crosses state boundaries because danger is everywhere. If insurance companies refuse to pay for injuries/health problems that occurred out of state, then they would lose a vast majority of their clients as most people pay for health insurance simply out of precaution. The purpose of health insurance is to know that they are able to receive medical help as soon as possible, no matter what the circumstance. So, if healthcare wasn’t a regulated good, and health insurance companies could not be held accountable for out of state medical problems, then there would be no point in paying for the assurance of medical help in the first place. The Constitution states that Congress has the power to regulate interstate commerce, and as described above, healthcare fits the description of a regulated good. The problem lies not in the definition of a regulated good, but the definition of who is liable to pay for that regulated good. The mandate that all hospitals cannot turn away a sick person is contrary to the U.S. economic mindset, and contrary to the economic beliefs that our country was built upon. Bostonians complained that they were tired of paying taxes to a country and king that they never saw, and never knew. The same belief lies hidden underneath the technical jargon and political controversy surrounding the ACA. We, as Americans, are tired of paying enormous amounts of money in taxes to accommodate those who abuse our system of liberty and equality, and this act sends a clear message that we will no longer tolerate those who do not contribute to the country, but reap its benefits. Therefore, the mandate that hospitals are not allowed to turn away any sick person is a load of crap. A person who does not contribute to the country that provides him/her with the most opportunities in the world to better oneself, does not deserve the generosity bestowed upon the legal inhabitants of the U.S. Congress should overturn this act as it would serve as a shocking realization to those who currently abuse the healthcare system. Ideally, the government would be smart to strike down the system that is designed to suffer economic losses and replace it with a system designed to reward the individual that follows the rules and contributes to society, rather than penalize him for doing so.

  40. According to the Constitution people have the choice in whether they want to buy health insurance or not. It is their choice as to whether they want to take that risky chance of getting sick and not having the money to secure them and their family. But I do think that the government should not take away the mandate that states that everyone should be helped when entering an emergency room, because this would lead to chaos and corruption within the medical field. But the government should help push people to buy health care and punish those who do not because it is not fair to the health care providers or the responsible people who bought health care to insure them and their family. I do not think that people should think of buying health care as a punishment or inconvenience because it is a security for them and even helps the people around them. Also, the government should not completely overturn this mandate because then people who really needed help would never receive it, but I do think they should try to regulate how and who gets the treatment and different qualifications for hospital that treat all “comers”.
    I believe that the Ryan plan for Medicare differs from the ACA for non-Medicare. The ACA gives a fine of about $700 for the uninsured however according to article Bloomberg, the Ryan Plan taxes all creditors making the fine way worse then only affecting the uninsured which the ACA does. Also according to the Bloomberg article the individual mandate is more effective then tax credits because people are more likely to want to avoid penalties then receive benefits. I believe the ACA is a reasonable act regarding health insurance because it tackles the problem more effetely by dealing with the main problem, which is the uninsured.

  41. I completely agree with the Affordable Care Act (ACA), also know as Obamacare because everyone at some point in their life is going to need health care and be in need of medical services. Although the prices of the health care act may seem steep and costly to some, it is the only fair and decent way of preventing free-riders. It is not fair for some one to choose not to pay for health insurance, and then when the time comes and they are ill go to the hospital and expect others to pay their bill. There should be a minimum price paid by every citizen weather they need health insurance or not. They should think of it no differently then paying taxes; everyone has to pay them weather they like it or not. Wealthy middle class Americans should not have to pay the toll of others who have deliberately chosen to not pay for the services. I also agree with the Emergency Medical Treatment and Active Labor Act (EMTALA), however. I agree that no person should be denied the right to medical attention weather they pay for their health insurance or not. If the ACA is taken away and people are not forced to pay for health insurance then I believe they should be mailed the bill for their services weather they can pay it or not. No one works for free, or wants to work for free, so why should you walk into the hospital knowing you aren’t going to pay for the services you will be using.

  42. Obamacare is, if anything, an optimistic but unrealistic way of approaching healthcare. It envisions a world of socialism where the citizens of the United States are always working at their most productive levels regardless of what the government is or isn’t giving them. If this world were real, the ACA would be the logical solution to America’s current healthcare problem. Unfortunately, this utopian society isn’t real and there are such people in the United States that would abuse their privileges in order to gain health insurance from the government such as illegal immigrants. I agree with the notion that it is not acceptable for a privately owned hospital to turn away a patient if they don’t have health insurance because everyone deserves equal treatment. But, instead of implementing a law where everyone must buy health insurance, a law that addresses the aftermath of the hospital visit should be considered. Although Obamacare works to make health care less expensive for everyone, those costs do not just disappear. Someone has to pay for these costly changes. Our government has been working for years, throughout the economic recession, to reduce the national debt. This new healthcare plan is not only expensive but it would place more pressure on the national debt in that manner. The government would have to find means to pay for the change in the plan, a way to organize it and have insurance companies to cooperate, and a means of constantly enforcing it. In addition, this impedes on every American citizen’s rights in forcing people to pay for health insurance. As irresponsible a decision not to buy health insurance can be, if someone is healthy and believes that they do not need it, they should not have to buy it.

  43. When President Obama was running for president back in 2007 his main goal was to make health insurance available even to those who could not afford it. As great an idea as this sounds, this act comes with an “individual mandate” which requires families to purchase minimum health insurance policies or risk the being forced to pay a fine. In my opinion this sounds like the government is going to punish people if they do not protect themselves. I believe that the Supreme Court should overturn the ACA individual mandate but not the entire law. If a person is in a car accident and a doctor can save the man’s life by performing a simple surgery why should that man dye because he did not grow up in a wealthy household and was not left a great wealth when his parent’s died. Also, today if an individual is about to die a doctor is only able to return the patient to a state of critical condition, if that individual does not have health insurance. Finally, if the Supreme Court was to declare the entire law unconstitutional, that would be hypocritical because the purpose of government is to protect its all of its citizens, not just those who can afford to be protected.

  44. I don’t think that today hospitals should have any obligation to treat every single person who walks through their doors. This mandate known as the EMTALA provides moral reasoning along with protection for every person that walks into the emergency room, whether they have insurance or not. With acts such as the ACA there are ways to approach this problem without making the solution so black and white. Health care behind food for your family should be one of the most important things to purchase. Health is something we take for granted in this country and our resources such as emergency rooms need to have a better system to avoid unfair charges that people indirectly pick up through taxes. One major issue is the bizarre numbers that seem to be given out to patients after they leave the emergency room. The confusion on where the numbers come from has been an ongoing issue. When some bills are looked at closely it becomes clear who is getting away with not having insurance and declaring bankrupt and then getting away with paying a fraction of the true total. This problem could be avoided if everyone were forced to pay for health insurance. This way there could be more concrete prices on different services and if everyone had some sort of health insurance the hospitals would be able to better predict a price for the services you have completed and people could decide less irrationally if they needed the emergency room. I think that the mandate that emergency rooms have to treat everyone should be altered with the help of the ACA. This will insure less confusion with pricing and a fairer way of dealing with patients.
    “The Bizarre Calculus of Emergency Room Charges” Lopez, Steve,0,6799675.column

  45. To start, the law that states that all patients must be treated if they go to the emergency room is legitimate and necessary. I don’t believe anything should be done to change that, because the first thing that particular emergency room should do is treat the patient because it is a so called “emergency.” The payment process should not be the first priority and this law promotes being aware of the patients’ safety before their wallets.
    I personally like the idea of the Affordable Care Act because it forces people to be covered. The emergency rooms won’t have to worry about how patients will be able to pay for their services, and instead they can focus on the task at hand. Also, if everyone is covered, the price of each emergency room visit should decrease drastically without the necessity to make up for people that can’t pay the bills. According to “The Bizarre Calculus of Emergency Room Charges,” when people tell the emergency room that they are uninsured, they end up having to pay less than if they were insured (Lopez). It states that this is because they charge people with health insurance much more thinking that the insurance will pay more than the service was worth.
    On the economic side of the things, I really agree with the ACA, but constitutionally it might not be sound. Some freedom might be taken away with the idea that Americans have to purchase healthcare or they will pay up to 2.5% percent of their income (Klein). In addition, Elizabeth Warren, a democrat contending for a spot on the US senate, says how the law might be “. . . an incursion on liberty” (Warren). This being said, it is up to the Supreme Court to decide. If it’s constitutional then I say America should employ this act.
    Lopez, Steve. “The Bizarre Calculus of Emergency Room Charges”,0,6799675.column
    Klein, Ezra “Individual Mandate Is Ryan Tax Credit by Other Name”
    Warren, Elizabeth “Warren blasts Supreme Court on health-care debate”

  46. I do not think that the Supreme Court should overturn the ACA individual mandate. What the individual mandate is doing is requiring consumers who are not covered by an employer or government sponsored insurance pay a penalty or purchase a minimal health care plan as low at $700 a year in order to eliminate those free riders. The free riders are those who wait until the last minute and then go to the hospitals and get treatment and then declare bankruptcy making the rest of the population pay for their treatment. The whole idea of free riding, in my opinion, is entirely unfair for the rest of the population who has health care. So I believe that this mandate is a good way to eliminate those unfair people who are free riding.

    It would be unconstitutional to have everyone else pay for the free riders mistake. This mandate is doing nothing but a good thing for the population. It is pushing those who aren’t insured to being insured. Why pay a tax that can equal the cost of a minimal insurance plan, you mine as well purchase the insurance which will only help you out in a multitude of ways in the long run.

    This mandate is essential to the effectiveness of the ACA. If this mandate were to be considered unconstitutional, than so should the essential regulatory protection already in place, “pre-existing conditions”. How is a “pre-existing condition” any different than a mandate? The mandate is requiring those who don’t necessarily need health care to pay a fee, and the “pre-existing conditions” is stopping those from getting health insurance who really need it. Both are controversial to one another. The “pre-existing condition” rule is really unconstitutional, and had the mandate been in place the people with these “conditions” would have been treated before they became “pre-existing”.

    Therefore, the mandate is not a fundamental attack on your constitutional rights as a member of the state. The attack on my constitutional right is the “pre-existing condition” clause currently in place. Obamacare or the Affordable Care Act in my opinion is a better, more suitable approach towards the population as a whole rather than the current one in place.

  47. One with my sources:

    I do not think that the Supreme Court should overturn the ACA individual mandate. What the individual mandate is doing is requiring consumers who are not covered by an employer or government sponsored insurance pay a penalty or purchase a minimal health care plan as low at $700 a year in order to eliminate those free riders. The free riders are those who wait until the last minute and then go to the hospitals and get treatment and then declare bankruptcy making the rest of the population pay for their treatment. The whole idea of free riding, in my opinion, is entirely unfair for the rest of the population who has health care. So I believe that this mandate is a good way to eliminate those unfair people who are free riding.

    It would be unconstitutional to have everyone else pay for the free riders mistake. This mandate is doing nothing but a good thing for the population. It is pushing those who aren’t insured to being insured. Why pay a tax that can equal the cost of a minimal insurance plan, you mine as well purchase the insurance which will only help you out in a multitude of ways in the long run.

    This mandate is essential to the effectiveness of the ACA. If this mandate were to be considered unconstitutional, than so should the essential regulatory protection already in place, “pre-existing conditions”. How is a “pre-existing condition” any different than a mandate? The mandate is requiring those who don’t necessarily need health care to pay a fee, and the “pre-existing conditions” is stopping those from getting health insurance who really need it. Both are controversial to one another. The “pre-existing condition” rule is really unconstitutional, and had the mandate been in place the people with these “conditions” would have been treated before they became “pre-existing”.

    Therefore, the mandate is not a fundamental attack on your constitutional rights as a member of the state. The attack on my constitutional right is the “pre-existing condition” clause currently in place. Obamacare or the Affordable Care Act in my opinion is a better, more suitable approach towards the population as a whole rather than the current one in place.


  48. Due to the complexity of the healthcare system in the U.S. many Americans do not understand the basics of healthcare plans let alone a nationwide amendment. The media portrays current reform use extreme terms but when comparing the U.S. to other industrialized countries the U.S. approaches 16% of the nations GDP spending and ranked 37th in 2010 according to the WHO. The top five countries spend between 8-9% of greater percentages of national coverage resulting in longer life expectancies and lower infant mortality rates. The IOM has determined that preventable medical errors is the sixth largest killer in the U.S. and coronary heart disease, a preventable disease, takes the most lives. When looking at numbers such as these the question should not be should the U.S. offer healthcare but rather how should the U.S. offer healthcare?

    One trend that I have seen through my classmates responses revolve around the concept that insurance can be sold on an open and free market. To those who say healthcare is not constitutional I raise the question, “should car insurance and other forms of insurance also become unconstitutional?” The makeup of the U.S. healthcare industry defies the principles of economics that make people act rationally in the market. Two principles easily seen that are defied in health care industries are that people act rationally and that both parties in a transaction are equally knowledgeable. Due to insurance people do not act rationally because the value of the service is not equivalent to the price due to the copayment provided by insurance companies. Secondly, when buying insurance, insurance companies, as well as employers who buy insurance on behalf of employees, are not fully knowledgeable of the how sick someone may be or their riskiness of becoming sick. Another factor impeding the ability for insurance to be traded on an open market is that many healthcare facilities exist as monopolies. Currently in Virginia there are only about 5-6 free standing hospitals, all others are systems or affiliates (i.e. RMH joining Sentera). The option for a free market insurance has already failed our system but one where the majority of citizens had insurance (the 50 million new Medicaid + employer mandate) would in the long run decrease hospital fees to the truer price without the markup for the so called “free riders”.

  49. Based on prior knowledge from government classes and various discussions/debates, I would indeed question the constitutionality of the health care reform, “Obamacare.” After reading several other blogs I found that this is a very interesting point to be brought up. My research has led me to the “The Lawfulness of the Health Care Reform” by Akhil Amar of Yale Law School, professor of constitutional law. After reading his well-written abstract for the Yale Law Journal I was able to support his stance that the Obamacare is constitutional for various reasons. Congress is given the power to “lay and collect Taxes, Duties, Imposts, and Excises,” through the Constitution with the intent to “pay the Debts and provide for the common Defense and General Welfare of the United States.” Seeing that the “penalty” can be levied as a tax makes this completely constitutional. Those who do not buy the health care can be taxed and the money that is collected by the taxes can be used to subsidize those who cannot afford the health insurance and to pay off the emergency situations in which the uninsured receive care. Another point is the fact that this mandate is an issuer of interstate commerce and national defense. The fact that all citizens most have health insurance promotes fairness among the states (responsibility of government in constitution). It also is an issue of national defense because in this day and age, it is likely that the next war may be biological, and viruses don’t stop at state borders. Everyone being insured benefits the general welfare of the country. Health insurance is also an issue of inters tae commerce and the money flow between states, which is part of national security. What happens if someone is traveling out of state and they need emergency care but they are not insured? This is an issue that Obamacare can resolve. So, given that I believe that the health care reform is Constitutional under tax powers and interstate commerce powers of Congress, and it will promote the general welfare and national security of the country, I believe it should be enforced.

    Amar, Akhil, The Lawfulness of Health-Care Reform (June 1, 2011). Yale Law School, Public Law Working Paper No. 228. Available at SSRN: or

  50. There have been many debates concerning health care plans like the Affordable Care Act (ACA) and Ryan Plan. As the ACA attempts to eliminate free-riders by requiring everyone to buy health insurance, it infringes on Constitutional rights as it violates their personal liberties (1). As the ACA tries to eliminate free-riders, this may not be achievable as people find loopholes. For example, there isn’t a clear way the government can truly enforce the mandate, as someone could continuously pay the mandate fine until they become ill enough to actually need insurance—fundamentally, they’re still free-riding (1). Knowing this, what’s the point of the mandate if there is still a loophole for free-riders? In addition, the ACA should be overturned because it may increase the nation’s deficit. The Washington Post stated that “in 2010, the CBO wrote that, absent the Medicare savings, the law would increase deficits by $226 billion through 2019.” Why would we want an act that could contribute to the country’s deficits (2)? Although it’s beneficial if everyone has health insurance, neither plan contributes a solid presentation to execute this. Rather, a combination of both plans would suit best. As Steven Pearlstein from The Washington Post details this “mixed” plan, he explains that everyone would still be required to buy insurance, but through “government-regulated exchanges” in which everyone uses vouchers to buy basic coverage plans arranged by the government that offer varying coverage depending on everyone’s needs (3). Furthermore, the vouchers received would be dependent on each family’s income, size, etc. and this process would eventually expand to other services such as Medicare (3). In conclusion, the ACA and Ryan Plan should be incorporated into one moderate plan that would provide everyone with health insurance, attempt to eliminate free-riders, and provide consumers with a choice among more and affordable health care options.





  51. Current medical care of United States is all private company based. However such private medical care is very costly, and not affordable for lower working class people. In that sense Obama-care provides very affordable medical care. However the discrepancy arises because all the United States population is required to purchase this medical care. However from those who complain, the problem should be seen from different perspective; it is same as purchasing automobile insurance, which is to prepare for unexpected incident. If the same approach is taken, spending 700 dollars per year is not a bad opportunity cost for preparing for one inevitable incident where health care comes in use. Everyone cannot live a perfectly healthy life, and for people who complain, mostly ones with higher standard of living. For them spending 700 dollars is just a mere complain such as Wall Street protest. How much would government be benefited by collecting 700 dollars each year, and provide actually expensive health care? Government wouldn’t be benefited too much because they will be spending money as well.
    South Korea is one of the countries that have government provided health care, and South Korean government requires health care to all citizens. The cost is even slightly more expensive, yet people still buy it. One of the difference that South Korean government is that they provide almost zero rate health care to elders: age of 60 or above, which is similar to Social security yet distinctive. Because of this program in South Korea, a lot of citizens are not burdened to go to hospital and even get surgery. There are certain types of treatment that are not covered by the program, yet those are surgeries such as plastic surgery.
    From the example of South Korean government health care and current unaffordable health care system, it is reasonable that the Obama-care should be regulated to the citizens with some minor discrepancy fixed.


  52. The Emergency Medical Treatment and Active Labor Act passed in 1986, declares that any single citizen can obtain care within a hospital without health insurance. After reading several articles, and discussions on this issue, it has been shown that even though this act serves as a good Samaritan for the general population, it also has the negative effects of those who work and pay taxes. When people enter an emergency room without health insurance, they are fined high amounts of money for whatever care they desire or need for their illness. However, I believe the problem does not stem from the population of non-insured citizens, but more stems from the problem of the high cost for these procedures. In the article “The Bizarre Calculus of Emergency Rooms” by Steve Lopez, many nurses and doctors argued that emergency rooms have to charge high prices because it is highly expensive to run these emergency rooms 24 hours a day. From this fact, I believe that no matter what care is proposed and passed, there will always be individuals that cannot afford health care and will be in need of a doctor. It should not be in American’s philosophy to base care on money, the root of the problem needs to be solved by reevaluating the prices of all of these procedures and tests in order to make them affordable for the general population.

  53. I believe that the ACA should be overturned in its entirety. I think that it is an unconstitutional attack on my rights as an individual. The ACA is an example of how the government is diminishing individual liberty in the United States by both the Republicans and the Democrats. The health care mandate was actually backed by “Conservatives” in the 1990’s as an alternative to Hillary Clinton’s health care proposal, and now all of a sudden it is an attack on freedom. (1) Health care should not be considered a good that can be regulated by Congress through the interstate commerce clause. The interstate commerce clause was intended for things such states placing embargo’s on other states rather than forcing individuals to enter a contract. Again, this is not a partisan issue, as Paul Ryan’s medicare plan also wants to force people to buy a product that they might deem is unnecessary. Personally if I were a doctor, I would treat someone if they need help as the Hippocratic Oath requires doctor to do. So hospitals should be required to treat people are who in serious condition. However, that individual should still be responsible for the cost.

    I would also like to respond to Latasha’s comment and the article in the breeze by Chris Justis. First off, you are absolutely right in calling out Republicans for being hypocritical for at one point being for an individual mandate and now all of a sudden being against it since it is being supported by many Democrats. However, there are those of us who are consistent and think that the mandate was wrong then and is wrong now. Also, you are correct in saying that the medicare payroll tax is also similar to ACA but many are not complaining about medicare. Again, there are those of us who think that you should be able to opt of things like medicare if you want a true free society. At the end of the day, both Conservative and Liberals claim they are for individual liberty yet they vote for things that are against freedom all the time. The Patriot Act, The National Defense Authorization Act, ACA, etc. are all examples of how the government attacks our rights.

  54. I believe the mandate, that hospitals should have to treat all comers, is legitimate. Being the type of nation that we are, always trying to help those in need, we wouldn’t allow people to be dying here and there simply because they cant afford the help because they are uninsured. These are unfortunate situations though because when these uninsured people don’t pay the bills for the services they received at the hospital, “hospitals, doctors and insurers make up the loss by raising prices for everyone else. The cost adds an estimated $1,000 a year to the average family health premium” (USA Today). This seems unfair, that people are essentially paying for other people’s hospital bills. However, there is a way to fix this: “forcing insurance companies to take all comers and drop noxious practices doesn’t work unless that comes with a requirement that just about everyone get a policy” (USA Today). This has been shown to work in Massachusetts, where “about 98% of state residents have health coverage” (USA Today). So if insurance companies partake in more fair practices, then more people would we willing to get insured, as it has been proved in Massachusetts. Then, the mandate that hospitals have to treat all comers would be even more legitimate because the number of uninsured people being treated would be so small that their bills would barely affect the price that the massive number of insured people pays.

    Editorial: Individual Mandate vs. ‘do Not Treat'” USA Today. Gannett, 29 Mar. 2012. Web. 10 Apr. 2012. .

  55. I believe that one of the fundamental issues with the current system of health care in the United States is The Emergency Medical Treatment and Active Labor Act. Economically, it costs hospitals money which inadvertently may cause less quality care. It also forces taxpayers to cover bills that people without insurance are not able to pay. However, I believe that turning people in need of immediate medical care away from the emergency room is unethical. I do not believe that medical care should be reserved only for people who are wealthy enough to afford health insurance. Because of this, I do not believe this act should necessarily be overturned, though I do believe that with the Affordable Care Act there will be less of a need for it. The current health-care system in the U.S. further demonstrates the inequality between the wealthy and poor through the astronomical prices that are quoted in the Lopez article. Though prices in the article were shown to be less for people who went to the emergency room without insurance, there are many cases in which not having health insurance would be financially debilitating, such as in cases of serious accidents, sudden cancers, or other unexpected diseases. The current problems that people with pre-existing conditions have with attaining health insurance causes even more inequality between the wealthy and lower classes, as in this case a poorer person with a pre-existing condition would not be able to afford medical care on their own. The Affordable Care Act would keep people from getting caught without insurance when they are hit with an unexpected accident or disease. I do not believe that the ACA is unconstitutional. Many republicans have come up with similar ideas in the past, including Mitt Romney in Michigan. Romney has spent much of his campaign denying this, as it is currently unpopular with republicans. Republican Paul Ryan’s idea of giving tax credits to those who purchase health insurance, which in turn raises taxes of those who do not, in essence has very similar outcomes as the Affordable Care Act. Both of these plans, as well as the Single Payer system, require government involvement. The close similarities of both Romney and Ryan’s plans to that of Obama shows me that the complaints of the Affordable Care Act being unconstitutional are more about politics than they are about a concern for the Constitution.,0,6799675.column

  56. To start off, it is crucial to consider the purpose of insurance. Whenever analyzing, asking, “Why?” is one of the most important questions to consider. “The basic purpose of insurance is to anticipate catastrophic losses that could financially impair your future.” Keyword being ‘my’ future. “An insurer is a company selling the insurance,” says Wikipedia (yes, I used Wikipedia, but the idea being proved is pretty basic). Companies sell insurance, meaning that they sell a product or service which is a crucial concept to be considered. If they sell a product or service, should people be required to purchase it? If they are, then what is the purpose of a company in the first place? That eliminates all fair competition and takes away from the free market of our economy. Maybe a small portion of the hospital bill comes out of a monthly paycheck until the balance is paid off. There are solutions available, but creating a mandatory purchase of insurance is not one of them.

    In the same way that people should not be required to purchase any other product or service, they should not, in my opinion, be required to purchase insurance. That goes against the basic principle of free trade. With this said, should people be allowed in the emergency room, regardless of whether they have insurance or not? I think there is something inherent about providing ER service to a suffering victim. And further, if we do provide uninsured victims, how will that be paid for? Should it be taken out of taxpayer dollars?

  57. While the individual mandate itself is perhaps wrong way to make up for lost hospital revenue, I don’t think the ACA is a step in the wrong direction at all. The overall goal of the new law is to lower the detrimentally increasing Medicare costs (to a growth rate of just .5 percent above the economy), which is obviously giving people a lot of problems. To me the real cause of these problems seems to derive from the fact that the medical profession and insurance companies are focused more on private profit rather than public health. The high and “random” hospital bills that patients are asked to pay are based off of the capitalistic ventures of greedy profiteers who must additionally deal with the financial setbacks the patients benefitting from the EMTALA bring. Under the EMTALA the patients who can’t afford the treatment they receive are basically allowed free service, but that shouldn’t mean that other patients who can afford healthcare should have to make up for this lost hospital revenue by being forced to pay extra on their personal bills. Furthermore, the EMTALA also shouldn’t force those who are both healthy and wealthy to pay for insurance that they don’t need. If anyone should be targeted in dealing with these issues, it should certainly be the hospitals and insurance companies themselves. Even parts of Paul Ryan’s plan, such as the idea of competitive bidding among insurance companies (which would result in lowered premiums for the insured), would tremendously lower Medicare costs to where the government could put more emphasis on dealing with the free rider problem occurring in these hospitals.
    I don’t think that the individual mandate is unconstitutional (we are forced to pay for things we don’t necessarily need anyway with taxes), but I think there could be better ways of dealing with poor people’s hospital bills. This brings us back to the original issue of “patient dumping”, but at least the ACA would be hopefully finding a solution to the problem of ever-increasing hospital costs.





  58. Perhaps, as a compassionate individual, I hold a different perspective from those who are concerned solely with arguing how “fair” might be defined. I do not believe the Ryan Plan and Obamacare differ fundamentally – through careful phrasing, Paul Ryan has adopted a plan which, in essence, requires the same thing Obamacare does, minus the in-your-face constitutional controversy. I think what many people neglect to acknowledge is that allowing people to die on the floor of the emergency room is not an option. This is errant in a moral sense, and would also reflect very poorly among developed countries in the international community (nearly all of whom have similar universal healthcare plans). People cannot be entrusted with ensuring they remain healthy – whether by poor lifestyle choices or inopportune circumstances, we all get sick or hurt eventually.
    Health insurance cannot be said to be a public good, as it is rival, but I might argue it is a common good – it cannot be excludable, as we all require it. If we have the technology and the fiscal means as a nation to treat someone in need, why wouldn’t we? If health insurance were a good, such as “broccoli,” which one could choose to consume or not without positive or negative consequences, one could argue that it might be a private good, subject to a private market solution. Unfortunately, this is a market failure – you simply cannot say our current system is working. People may not buy health insurance, but they will require healthcare at some point in their life. Those who argue that under the new healthcare law, emergency rooms will be crowded and care will be rationed, might I ask you to explain how this is different from our current situation?

  59. Health Insurance is one of the many controversial global topics of today’s time. As Klein backs up in the article, “Individual Mandate Is Ryan Tax Credit by Other Name,” the individual mandate was designed to get rid of “freeriders,” but requiring people to buy insurance breeches the citizen’s human rights. Therefore, quite an ethical dilemma is brought forth as it is not fair for those who have worked hard for their money to have to pick up the bills of people who haven’t worked hard in their life, nor is it fair for people to be forced to pay for something they don’t want and may never use. I, personally am in support of individual mandate because then everyone has to pay some. No, I don’t believe that it is necessarily a good thing to have some people pay for something they don’t want and may not need at first, but it is very possible that something unexpected may happen to that person to make them need that health insurance that they otherwise wouldn’t have had. True, some people may not ever need it, and for those people, it really would be an unnecessary loss, but when dealing with national and global issues such as this, there isn’t ever a way to make every person content. There will always be people that are inconvenienced. You have to look at the big picture and see what benefits the most people.

  60. I believe the Supreme Court should indeed overturn the ACA Individual Mandate. This act is considered unconstitutional because a United States citizen should not be forced in purchasing a product or service without their consent, especially an amount as great as $700. Yes, I believe healthcare is a good that can be regulated. However, healthcare should be regulated fairly. Yes, Ryan’s plan differs from the ACA non medicare plan. It differs in terms of the taxes that will be imposed on an individual due to their personal choices. For example, Ryan’s plan imposes a harsher tax on those who don’t purchase health insurance. I feel everyone should be seen in a hospital if absolutely necessary. However, if the individual cannot pay for their treatments, this should be a top priority in repaying the money they owe so tax payer will not be affected by this burden.

  61. After reading through the piece on ridiculous emergency room charges, it seems that even with a single payer system that on paper sounds like it should alleviate some of the mystery that goes into how insurance companies come up with their negotiated rates, the likelihood of an act like this being passed at this time does seem highly unlikely. With ridiculous stories such as the one reported in the LA times article of where if someone went through their insurance they would have to pay more than ten times the amount for a procedure if paid through cash would only cost a fraction of the price. The way that the spokesman of Cigna addressed the issue of avoiding these ridiculous costs incurred through emergency room visits was to question every procedure and to carefully consider whether the actual emergency room visit was appropriate for the situation. I personally think that in those kind of situations one would not be able to make a well-informed decision based on the fact that if you are going towards an emergency room or seeking that sort of help, you probably are not in the best shape to be making financial decisions at the time let alone any decisions other than how to get to the hospital or urgent care the fastest. Right now with the seemingly random number game that the insurance companies produce after you make a trip to the doctors or emergency room, it seems that more and more people would rather just suck it up and pay straight up cash and claim that they were uninsured.
    Recently my father (who happens to be in his 60s now) has told me that he is getting rid of the insurance he has at the moment and actually revealed to me that for pretty much the last 15 years he has been going out of country (specifically Taiwan) where he has been receiving treatment through Taiwanese hospitals and doctors for simply the fact that they are cheaper. I asked him if this was perhaps part of a so called “medical tourism” phase he was going through but he told me that he did not even acquire a medical visa to go abroad but rather just claimed that he was a tourist just visiting to have all sorts of procedures done. I believe that if healthcare reform and healthcare costs are not carefully reexamined in the coming years, we will find that even more people will be shying away from the system that the United States currently runs in terms of healthcare.,0,6799675.column


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