J. Bradford DeLong                   July 2, 2012What Next for Health      Care Reform?1                                  ...
J. Bradford DeLong                  July 2, 2012ObamaCare and the Decision: A Precis1                                 04/1...
The Affordable Care Act ObamaCare--but also RomneyCare Leaves Medicare alone: the elderly are happy  with their health i...
The Questions Posed Is the mandate that everybody  purchase insurance a legitimate  exercise by Congress of its  power to...
The Questions Answered Four  Democratic justices say that  the mandate that individuals buy  insurance is a legitimate ex...
The Mandate ThatIndividuals Buy Insurance Roberts      agrees with the other      Republican justices that the      manda...
The Requirement ThatStates Expand Medicaid Roberts      agrees with the other      Republican justices that the      requ...
Chief Justice Roberts HasGone to Malta Republicans   are furious:  “Dishonest John” Democrats are praising Roberts  as a...
J. Bradford DeLong                    July 2, 2012       ObamaCare Is    RomneyCare: Two        Implications1             ...
The Affordable Care Act      It’s ObamaCare  It’s also RomneyCare  No Republican office holders objected to RomneyCare ...
Partisanship      The Supreme Court engages in “Constitutional       Moments”        It says that henceforth, the law wi...
The Future ObamaCare = RomneyCare It thus has RomneyCare’s weaknesses   No public option   Hands market power to many ...
Six Untested Bets to ImproveEfficiency Six         bets:        Congress will allow the tax on high-cost health plans   ...
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20120702 berkeley obama care event

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20120702 berkeley obama care event

  1. 1. J. Bradford DeLong July 2, 2012What Next for Health Care Reform?1 04/11/12 1
  2. 2. J. Bradford DeLong July 2, 2012ObamaCare and the Decision: A Precis1 04/11/12 2
  3. 3. The Affordable Care Act ObamaCare--but also RomneyCare Leaves Medicare alone: the elderly are happy with their health insurance  But does strive to make Medicare more efficient-- Independent Payment Authorization Board, etc. Medicaid expansion to cover the the near- poor Middle-class uninsured  Creates health exchanges--benefits departments for those who don’t work for a bureaucracy  Requires insurers to sell at one price to everyone in an exchange  Mandates that everybody buy health insurance07/02/12  So people don’t game the system by saving money now and only 3 2
  4. 4. The Questions Posed Is the mandate that everybody purchase insurance a legitimate exercise by Congress of its power to regulate interstate commerce? Is the requirement that states expand their Medicaid programs or lose all of their federal Medicaid funding unduly coercive?07/02/12 4 2
  5. 5. The Questions Answered Four Democratic justices say that the mandate that individuals buy insurance is a legitimate exercise of commerce-clause power, and that the requirement that states expand Medicaid is not unduly coercive. Four Republican justices say the reverse. Chief Justice Roberts thus decides  And here things get very tricky very quickly07/02/12 5 2
  6. 6. The Mandate ThatIndividuals Buy Insurance Roberts agrees with the other Republican justices that the mandate is beyond Congress’s legitimate power to regulate interstate commerce.  But Roberts then pulls a fast one  He says that the mandate is a legitimate ue of Congress’s power to tax07/02/12 6 2
  7. 7. The Requirement ThatStates Expand Medicaid Roberts agrees with the other Republican justices that the requirement is unduly coercive, and intrudes on state sovereignty.  But Roberts then pulls a fast one  He says that the cure is not to strike the Medicaid expansion provisions as unconstitutional  He says that the cure is for the Supreme Court to rewrite the law to say that states that do not expand Medicaid do not lose all their Medicaid 707/02/12 2
  8. 8. Chief Justice Roberts HasGone to Malta Republicans are furious: “Dishonest John” Democrats are praising Roberts as a fine chief justice.07/02/12 8 2
  9. 9. J. Bradford DeLong July 2, 2012 ObamaCare Is RomneyCare: Two Implications1 04/11/12 9
  10. 10. The Affordable Care Act It’s ObamaCare  It’s also RomneyCare  No Republican office holders objected to RomneyCare  Every single Republican office holder objects to ObamaCare  The key complaint is that forcing people to buy health insurance is not regulating commerce, but rather regulating the absence of commerce  But back in 2005 George W. Bush proposed, as part of his Social Security privatization effort, to require everybody to purchase a private pension account  And no Republican then complained that that mandate was an unconstitutional regulation of “inactivity”  And none of the Four Horsemen would have ever thought to find such a Republican-sponsored mandate07/02/12 to purchase a pension unconstitutional 10 2
  11. 11. Partisanship The Supreme Court engages in “Constitutional Moments”  It says that henceforth, the law will be different than it was yesterday  In such “Constitutional Moments”, the justices become moral and political actors rather than mere text- and precedent-based legal technicians  Miranda, Brown, Jones and Laughlin, Lochner, Santa Clara, Dred Scott  Past “Constitutional Moments” have been moral and political  This moment is purely partisan  The mandate that is under attack was a rock-solid conservative-Republican “personal responsibility”07/02/12 principle as recently as 2009 11 2
  12. 12. The Future ObamaCare = RomneyCare It thus has RomneyCare’s weaknesses  No public option  Hands market power to many near- monopoly insurers  Requires state-level bureaucracies to be effective when state politicians have bet their careers on the failure of reform  Huge stresses on the system from the expansion of Medicaid  Increases in efficiency rest on six largely- untested bets07/02/12 12 2
  13. 13. Six Untested Bets to ImproveEfficiency Six bets:  Congress will allow the tax on high-cost health plans  Congress will allow the IPAB to function  Evidence-based medicine will work  For-profit hospitals and others will not find new ways to game the system  That we can double the amount of health care currently received by our 40 million presently-uninsured without demand for care outstripping the ability of our doctors, nurses, and technicians to provide it.  That the health exchanges will work The first two are bets on what congress we elect Preliminary news from Massachusetts on the latter four is good07/02/12 13 2

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