Showing posts with label Health Insurance System. Show all posts
Showing posts with label Health Insurance System. Show all posts

A Further Response to Critics on the Founding Fathers and Insurance Mandates


Since I wrote last week about the remarkable eighteenth-century precedents for a health insurance mandate, several supporters of the challenge to Obamacare have attempted to downplay the relevance of those early mandates for today’s case. The latest is Professor Phillip Hamburger, who argues that those early statutes imposing health insurance mandates on private commercial shipowners and seamen didn’t arise under the Commerce Clause; instead, he claims, they were justified under the power to provide for the Navy because such health mandates helped ensure “a large supply of healthy seamen” for the Navy to draft in the event of war.

This argument is certainly creative, but the connection between regulating private commercial activities and the Navy power is unconvincing. By that logic, one could equally say that the Obamacare mandate is justified because it helps ensure a large supply of healthy people to draft into the Army in the event of war. Nor does his Navy clause argument seem to fit the eighteenth-century statutes, which were replete with provisions requiring written labor contracts on key terms, regulating when wages had to be paid, and providing hospital care for disabled seamen even if they were no longer able to serve—none of which were relevant to ensuring a supply of healthy seamen to draft for war.

In any event, Hamburger’s claim conflicts with Supreme Court case law, which as I have shown, does indeed hold that federal statutes regulating the duties of shipowners and seamen arose under the Commerce Clause. In contrast, I am unable to find any case holding that Congress’ power to impose duties on private commercial shipowners and seamen arose under the Navy Clause.

Remember the context: The challengers are trying to infer a constitutional ban from purported silence because their theory lacks any affirmative support in the text, history, or case law. The constitutional text does not support the challengers’ argument because, as conservative Judge Silberman held, 1780s dictionary definitions of “regulate” indicate that the plain meaning of the text giving Congress the power to “regulate commerce” does include a power to mandate purchases. Nor did any framer state that they thought the Constitution prohibited purchase mandates or any prior case so hold.

Bereft of such support, the challenge to Obamacare rests on the claim that the unprecedented nature of purchase mandates shows they were so wholly alien to the framers that they obviously would have wanted to ban them. Trying to infer a constitutional ban from a lack of precedent is dubious to begin with, since the Constitution has no anti-innovation clause, and the law presumes Congressional Acts are constitutional. But, if one is going to use that dubious method, one cannot exclude analogous precedents based on strained or technical distinctions.

Even if you do believe that these early mandates were justified under clauses other than the Commerce Clause, they demonstrate that the framers clearly thought purchase mandates were a “proper” means of executing constitutional powers. That’s enough to show that the framers would hardly have been horrified at the notion of mandating purchases—and enough to validate the Obamacare mandate under the Necessary and Proper Clause.

Good deals on dental cover needn't be like pulling teeth

 

Four in 10 people in the UK admit to skipping routine visits to the dentist because they can't afford to pay the bills, according to recent research.
Meanwhile, a Channel 4 Dispatches undercover investigation into NHS dentistry screened last month claimed to uncover evidence of a system "that often prevents the patient from getting the right treatment at the right price".
Reforms brought in five years ago were supposed to benefit patients and dentists by turning a fee-per-item system into a simple flat-rate one involving three bands of treatment but they backfired because many dentists have felt unable to justify devoting the necessary time to NHS treatment.
Tim Adlem, director of specialist financial consultancy Jelf, says: "The 2006 changes caused thousands of NHS dentists to switch to private work and, although there has been some recent improvement in the numbers available, the public is now clearly worse off than before the reforms."
Health insurer Simplyhealth's 2011 annual dental survey confirms that the quality of NHS care is deteriorating, despite a slight increase in accessibility. It found that 54% of the UK population had experienced a change in dental services in the past four years, with a reduction in the quality of treatment and lower levels of NHS cover cited as the main reasons. It also found that almost 40% say they can't afford regular trips to the dentist.
Most adults who are able to access NHS treatment still face significant costs. Band 3 treatment for crowns, dentures or bridges costs £204, and even a routine examination under Band 1 costs £17. Private treatment costs are much greater still. A crown can cost around £500, and a mere filling can easily cost more than £100.
Private insurance can therefore be worth considering, but the outlay makes it far from an open and shut case. The first step is to inquire whether you have access to cover via the workplace. Some employers provide company-paid dental insurance, and the better schemes refund the lion's share of NHS and private treatment costs. This will be taxed as a benefit in kind, but you are virtually guaranteed to use the cover, even if only for routine check-ups, so it should seem a price worth paying. Alternatively, your employer may offer you the chance to pay for voluntary cover, either via a flexible benefits programme or a standalone scheme.
Mike Izzard, managing director of Premier Choice Group, a private health and protection insurance broker, says: "Voluntary cover is not taxed as a benefit in kind and, because insurers enjoy a spread of risk through the size of scheme membership, it offers much better value than individual insurance cover. The treatment limits are much more generous and the premiums are typically 25% to 50% lower."
If no group cover is available, consider individual insurance plans offered by the likes of Simplyhealth, WPA, Universal Provident and Dencover. Costs range from £7 to £9 a month for plans covering NHS treatment only, to more than £20 a month for the most comprehensive formats that cover NHS and private.
Mark Taylor, 48, who lives in Camberley, Surrey, feels he has received good value from the family cover he has had with Simplyhealth since 2008, even though it only covers 50% of the more significant treatment costs. For a premium of £31.95 a month, it covers him, his wife Angie and their three sons: James (17), Michael (15), and Thomas (14). Although the three boys receive treatment free on the NHS because they are under 18, the plan still gives them the option to go private if, for example, they require more aesthetically pleasing braces or need to use the accident and emergency cover. When Michael chipped his tooth playing football two years ago, the plan enabled him to be seen immediately by his own dentist for extensive private treatment.
Taylor, who runs his own business, says: "Because I am self-employed I like to have the peace of mind of knowing I'm not going to get unexpected bills and my dental plan certainly provides this. Angie and I have regularly claimed for check-ups, hygienist sessions and fillings, plus occasional, more expensive items of treatment. Michael's chipped tooth cost over £300. I would say we have more than recouped our premiums, and there is never a quibble when we have to claim."
The other main private provision option is to cap the costs of regular preventative treatment by taking out a "capitation" or maintenance plan via your dentist – if they offer one. But these do not cover all dentistry costs and can be expensive. For example, Denplan's Care plan typically costs between £12 and £36 a month – and it can be significantly more if you have poor oral health – yet it doesn't cover laboratory fees, which can account for up to half of what you pay for crowns and bridges.
Those who find such costs hard to justify may also consider cash plans offered by, for example, Westfield Health, Health Shield, Simplyhealth,BHSF or Medicash. These blend minimal dental cover with cover for a range of other medical expenses such as optical costs, complementary therapies and consultation fees. But someone paying an overall cash plan premium of £12 to £15 a month may only secure dental cover of around £100 a year.