http://www.csmonitor.com/2008/0326/p09s01-coop.html

The Commerce Clause really can’t be used here; it grants power to regulate interstate “commerce”, but not individuals. Health insurance is INTRA-state, to start with, so that would have to change. Regulation of commerce has never meant that government can compel someone to buy something. There are minor court cases where communities have tried to compel everyone to own a gun, and these have been struck down.

Interestingly (and, to me, distressingly), taxes to provide insurance for others would probably be legal as representation trumps the individual freedom. So a single-payer system is probably constitutional, but mandated private coverage might not be.

Nick’s assertion that we can’t get enough votes because of those damn insurance companies isn’t a good reason at all, otherwise there would be no debate about public options either. Ask

I did not mean to imply that insurance companies are the reason states keep their regulatory powers over insurance. Insurance companys are probably split on Wyden’s Amendment.

The core problem is not the insurance companies, it’s that Senators hate changing things unless several of their colleagues insist.

And the simple truth is that there is only one person in the Senate who is insisting. His name is Ron Wyden. He’s trying to create a single regulatory structure for all insurance companies nationwide (aka: the Exchange), and make everyone eligible to buy it’s insurance. This is exactly what you, Jimmy the Dhimmi, claim will save health care.

If one or two Republicans said “we won’t filibuster any bill that has our version of Wyden’s Free Choice Act in in” they’d get it in a heartbeat.

But they don’t really care about fixing health care. They care about defeating Obama. And if they don’t have a solid block of 39 to filibuster Obama wins.

Take the example of car insurance in Massachusetts. I can speak from experience that once the “de-regulation” took place, my monthly premium went down from 109$ to 86$ overnight, then I switched to Progressive (which wasn’t allowed to compete in my state before 2007) and its down to 60$.

Car insurance in Massachusetts is still heavily regulated, but simply allowing national insurance companies to compete dropped everyone’s rates, even with previously state-comissioned insurance companies.

Nick’s assertion that we can’t get enough votes because of those damn insurance companies isn’t a good reason at all, otherwise there would be no debate about public options either. Ask Pelosi, its been difficult to get enough votes for that, so I suppose Nick would then concede that a public option or pretty much any reform would be a bad idea too. Besides, where is this insurance comapany opposition to deregulation that you speak of?

…the only way you can require full coverage is to require everyone to buy it … and that is probably unconstitutional.

Which clause of the Constitution does it violate?

I looked. There is no Constitutional section that says an individual has the freedom to buy what they want. OTOH, there is a section that says Congress can regulate interstate commerce. Which the courts have said means that they can regulate any aspect of commerce engaged in by someone who engages in inter-state commerce. If you eat at McDonald’s you count because McDonald’s has locations in more than one state.

And you know I sincerely doubt that there are more than a couple people nation-wide who don’t buy anything made out of state. And those guys would be really stupid to sue because most of them probably qualify for major subsidies, meaning their insurance is free.

Then lets all get behind the idea and give it a try. What have we got to lose? Give me 1 good reason to keep state-by-state licensing of health care providers.

It’s a good reason, but the major problem would be getting to 60 in the Senate. There’s a strong constituency dead-set against it (insurance companies), and nobody whose willing to passionately argue the case for it. Except a handful of true policy dorks. Such as Ron Wyden.

So instead the Dems are proposing we put much of the health insurance market on a national exchange, of insurance plans that comply with national standards. You will note that the difference between this idea and national licensing plus a national regulations is largely semantic. And would be entirely semantic if, for example, folks who worked at Ford could dump their company-bought Blue Cross for a plan available in the Exchange.

Which explains why the only Senator whose made a fuss about there being a strong exchange is that nerdiest of nerds, Ron Wyden. He’d have a much better chance of getting that if any single Republican offered to not filibuster a bill that included it. But none of them are willing to do so, because if they did Obama would “win” on health care, and beating Obama is much more important to them than fixing health care.

I would like to see reform include making sure that folks enjoy continuity of coverage. And I think this story does in fact point at troubling aspects of our current system that require repair. Happily noticed.

But when fed anecdotes, I look for broader commonaltities, not to get caught up in the tragedy of the specific injustice. So I see this tale as yet another one where someone was dropped through a convenient crack by what has become a very baroque bureaucratic system composed of probably too many players.

It’s a real problem that folks can lose coverage, get sick, and then be unable to regain comparable coverage as reasonable cost. It’s been allowed to persist because it happens at a low enough rate that the rest of us think (mistakenly IMO) that we can afford to ignore it. So again, I hope we seek to end such discontinuities. At minimum, the reformed system should allow dislocated (via job loss or whatever) people to run a tab in order to continue coverage.

Also I do disagree with the president, and I think he’s probably just giving wordplay on this to soften people up. The only viable fix is a public option.

Instead, we get some nitpicking about recision versus exclusion and some lame attempt at defending the insurance industry because it is the state’s fault for its laws and someone using it as an excuse to bring up the same trite right wing “if only we would deregulate things MORE than everything will be all right.”

If you had actually read the story, Jimmy, you would see that Turner’s story about HIV drugs is not unusual and all allowing people to shop across state lines would do would be she would be rejected in that state to.

You know, there is a time for political dogma (well, actually there isn’t), and there is a time for a little freaking humanity. If “these darn state licensing” issues is the best you can do maybe you should just opt out of the debate.

I don’t think that insurance companies being able to operate across state lines will make a lick of difference.

Then lets all get behind the idea and give it a try. What have we got to lose? Give me 1 good reason to keep state-by-state licensing of health care providers.

The problem isn’t that there isn’t competition…

Take it up with the President, apparently he disagrees with you. Didn’t you hear what Axelrod said about the importance of competition and choice? Haven’t you heard any of Obama’s speeches about health care for the past 5 months? If there is enough competition as you say, then I guess there is no need for anti-trust laws in the first place, right?

in Alabama 89% of all health insurance is supplied a single firm, Blue Cross of Alabama while in North Dakota, it is 90%.

Again, this must end.

Period.

Agreed. We need to end state licensing of Health insurance providers.

Period.

If the people in Alabama could access health coverage provided by companies located outside of the state, that 89% number would drop dramatically overnight. No need to apply federal antitrust laws because these companies do not compete federally. Once you break down these barriers completely, then we’re talkin. But it would take quite a few decades before the 1000+ health insurance providers nationwide would merge into just a few companies, so there would be no need to enforce antitrust laws any time soon, if at all.

Watch this precious exchange between David Axelrod and Wolf Blitzer regarding this issue. God bless Blitzer for pressing him hard, because poor Axelrod just can’t find an answer to why we need state licensing (That’s because there is no answer). Someone put this on the front page, I love this video. Thoughts?

Some states do not allow exclusions for pre-existing conditions (California doesn’t in group health plans, for instance). A solution to this kind of issue would be for the state legislatures to specify that prophylactic medications subsequent to this type of exposure cannot be considered a “pre-existing condition” (rabies shots for someone bitten by a bat, rape victims given this or other medication, etc.) From the HuffPost story, the insurance company didn’t know there had been a possible rape involved, and that the drugs were given as a preventative measure when they first denied the coverage. This woman is truly a victim, and Florida residents should either allow her into the state’s high risk pool for the next few years, or change their laws.

Requiring health insurance companies to cover everyone regardless of pre-existing condition would be like requiring car insurance companies to cover everyone … even AFTER they have had a wreck. So the only way you can require full coverage is to require everyone to buy it … and that is probably unconstitutional.