"The Missouri Vote - What Does it Portend?"

Sydney M. Williams

Thought of the Day

“The Missouri Vote – What Does it Portend?”

August 5, 2010

Missouri, located near the center of the United States – a bellwether state – with a Democratic governor and a congressional delegation that is almost evenly divided between Democrats and Republicans, voted on Tuesday to reject a provision in U.S. healthcare bill requiring people to buy health insurance. The vote was overwhelming, 71% versus 29%.

A day earlier, Henry E. Hudson, a U.S. Federal Judge for Virginia’s Eastern District, ruled that a challenge by Virginia’s attorney general to the same provision in the healthcare bill, mandating the purchase of health insurance, could not be blocked, as the administration desired. While Judge Hudson’s decision does not address the merits of the bill, there is little question that the vote in Missouri reflects a deep antipathy toward the measure and is not simply a “Republican straw poll”, as Ethan Rome, executive director of Health Care for America Now, would have one believe.

The intricacies of the law are far beyond my capabilities, but the argument against the forcing of people to buy insurance will apparently turn on an interpretation of the interstate commerce clause, which the administration argues gives the federal government the right to mandate that individuals buy insurance, or pay a fine. In other words, the individual cannot opt out. Opponents to the measure agree with the State of Washington’s attorney general Rob McKenna who in March said that the individual mandate is “an unprecedented expansion of the federal government’s powers that deserves scrutiny by our courts.”

This provision – requiring the purchase of health insurance by all people, or pay a fine – is critical to the success of the healthcare bill, as it was passed. Without it, private insurance companies, with a government determined medical loss ratio and a requirement they must accept those with pre-existing conditions, would have to charge prohibitive rates (something the government would likely prohibit or limit). Without the latitude to raise rates, insurance companies risk bankruptcy; so they are likely to exit the business. (Only the government is in the business of operating a business at a loss, as they have tax payers as a backstop, which suggests, to me, the increasing likelihood of a public option.)

Even with the provision the insurance companies will still be at financial risk, depending on the dispensation of the “fine”, whether it is paid to the insurance companies or to the government. The consequence is likely to be a single payer – the U.S. government. In passing the bill in March, the administration assured the American public there would be no single payer. They even abandoned a “public option”, much to the dismay of liberals like Senator Jay Rockefeller. My guess is that it is coming. Either way, the costs are going to be enormous; they will only add to the future obligations of the U.S. taxpayer, and the individual will be further divorced from decision making about his or her personal health situation.

While the vote in Missouri (and expected referendums in states such as Arizona and Oklahoma scheduled for November) was welcome to those of us who feel that nationalized, centralized healthcare is a road to perdition, it is likely that any final decision will rest with the Supreme Court, which will determine the constitutionality of the federal mandate. Since the Supreme Court generally acknowledges that federal law supersedes state laws, I assume we are stuck with ObamaCare.

The administration cleverly allowed for the quick implementation of those portions of healthcare popular with the public – eliminating the ability of companies to deny coverage for pre-existing conditions and extending the age for which a young person can stay on their parents’ plan. The more controversial and onerous aspects, such as the mandate, were delayed, giving people time to become used to the generous up-front portions. And, of course, as Senator Harry Reid and Speaker, Nancy Pelosi keep reminding us, we will all like what we get once we know what is in the bill, even though they carefully excluded themselves from demands of the bill.

Unless a groundswell of opposition develops it seems likely we are on the road toward a veritable national healthcare system, with a single payer, which will prove, over time, more expensive, less personal and provide a lower quality of care. Ironically, this is all occurring as the United Kingdom’s sixty-year experiment with nationalized healthcare is beginning to unwind, reducing the bureaucracies and taking on more of the characteristics of the private sector by giving the doctors more decision making power. Lessons of history are never learned by those who put personal policy determinations ahead of the interests of the people.