On Tuesday, August 3rd, Missouri will become the first state to put health care reform up to a plebiscite. The measure, officially coined the Missouri Health Care Freedom Act (Proposition C), is expected to pass based on the fact that reform is unpopular in Missouri and based on the expectation that, in an august election with low turnout, the more enthusiastic health reform opponents will show up to the polls in disproportionate numbers.
Yet Proposition C, despite the fact that it will almost certainly prevail tomorrow, is an exercise in idiocy that has all... too... familiarly... plagued my current home state of Missouri. This isn’t to say that there aren’t valid points to be made in opposition to reform, and it’s certainly not a suggestion that all opponents of reform are intellectually lazy or dishonest. But I do mean to suggest that Proposition C is based on reckless, if not willful, ignorance of our health care system, and of health care reform.
Proposition C is Blatantly Unconstitutional
The recently passed Patient Protection and Affordable Care Act (ACA) included an individual mandate that would penalize those who, by 2014, do not carry health insurance. In the relevant portion, Proposition C’s text reads:
Shall the Missouri Statutes be amended to:
• Deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services?
Because the ACA is a federal law, and Proposition C is a state law Proposition C is superseded by the ACA. Don’t take my word for it, take the Constitution’s word:
This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.
What could be more cut and dry than that? What’s more is that this kind of rhetoric, of states being able to trump federal law, has led to an enormous amount of pain in this country over the decades, from the Civil War to the Civil Rights Movement. Yet, Proposition C supporters are intent on bringing back the age old concept of "nullification" and opening these wounds once more. As State Senator Jim Lembke, a Proposition C supporter, said at a recent rally:
"This is a throw-down by the states, saying, ‘Not in our state, you don’t,’ " State Senator Jim Lembke, a Republican, said at a rally for the proposition here on Wednesday. "This health care thing is just a vehicle, a vehicle for the debate about what is the role of the federal government and what is the role of the states."
Someone should alert Mr. Lembke that we already had that "throw-down". It resulted in the deaths of hundreds of thousands of Americans at the hands of other Americans.
From a Policy Perspective Proposition C Makes Even Less Sense
If the legal grounds that Proposition C rests upon are shaky, the policy grounds it rests on are even more treacherous. Proposition C is ostensibly a movement about the role of government:
Why does Missouri need the Health Care Freedom Act?
Efforts within the Federal Government threaten to put complete control over individual’s health care in the hands of government bureaucrats, partisan politicians, and appointed "experts." Government control means you will have less freedom to make the health care choices that are best for you and your family. Patients should have the right to pay directly for medical services with their own money. That’s because when consumers control the dollars, the patient makes the medical treatment decisions.
When the government controls the dollars, they make treatment decisions based on what’s best for the government, not what’s best for the patient.
So you see, it’s a movement against government run health care. Or is it?
How will the Health Care Freedom Act affect Medicaid, SCHIP, or Medicare?
The Health Care Freedom Act WILL NOT in any way impact the funding of, or functioning of Medicaid, SCHIP, or Medicare. The ability of individuals to choose their health care providers and health care plans would be protected.
The irony here is so rich. In FAQ #3, Missourians for Health Care Freedom wants you to know, in all caps, that Proposition C won’t affect your access to precious government run health care. In FAQ #4, however, they want you to know that the entire reason why Proposition C is needed is because government run health care is a horrible thing that harms patient’s rights. What other word besides sheer idiocy could possibly fit this remarkable lack of cognitive dissonance?
Putting the hypocrisy aside for a second, the more important point is that the ACA is far from a government takeover of health care. It is not the single payer bill that many liberals wanted. It didn’t even include compromised versions of government plans such as the public option or an expansion of Medicare to people over 55. In fact, the ACA seeks to build upon and enshrine the system of private, for profit insurance by providing billions of dollars in subsidies for Americans to go out and purchase private insurance.
The only provisions even remotely resembling a "government takeover" of health care included in the ACA are the insurance reforms. These reforms include preventing insurers from dropping your coverage if you get sick, preventing insurers from denying coverage based on a pre-existing condition, and forcing insurers to use at least 80-85 cents of every premium dollar on health care. You can call that "government control". I prefer to call it common sense reforms that are extremely popular when polled individually.
An Age of Idiocy?
There are plenty of reasons to oppose the ACA, or any number of provisions within the ACA, which rest on solid intellectual and logical grounds. Proposition C, however, stands on nothing at all. It’s a legally vacuous referendum, based on internally inconsistent anti-government sloganeering. Yet, it is almost certain to pass. The question is why?
Perhaps America is entering into an age of idiocy. An age where we’ve lost our ability to dive into complex issues and sort out the sloganeering from the truth. An age where data takes backseat to intuition and personal experience:
This morning on Fox News Sunday, House Minority Leader John Boehner (R-OH), who has waffled on the impact of the stimulus, argued against the need for more stimulus funding. He claimed that he doesn’t need to listen to economists when putting together his policy agenda:
WALLACE: Congressman — a number of top economists say what we need is more economic stimulus.
BOEHNER: Well, I don’t need to see GDP numbers or to listen to economists. All I need to do is listen to the American people, because they’ve been asking the question now for 18 months, "where are the jobs?"
Later, the interview grew a bit more hostile as Wallace tried to press Boehner on the deficit-impact of his call for extending the Bush tax cuts. "Chris, you’ve been in Washington too long because that’s all a bunch of Washington talk," Boehner said dismissively. "I’m just asking a question, sir," Wallace persisted, noting the exorbitant cost of extending the Bush tax cuts for the wealthy. "This is the whole Washington mindset, all these CBO numbers," Boehner responded.
Actions have consequences, and the consequences of anti-intellectual movements such as Proposition C will come home to roost sooner or later when Proposition C supporters are confronted with reality. What will happen when those who support Proposition C wake up to a court ruling telling them that it has no legal effect? Will there be a Constitutional crisis? What will happen when it finally sinks in that Medicare, SCHIP and Medicaid are government run healthcare programs? Will Proposition C supporters seek to dismantle those programs? How far down the rabbit hole will this go?