{"id":1071,"date":"2012-03-28T21:07:04","date_gmt":"2012-03-29T01:07:04","guid":{"rendered":"http:\/\/www3.law.harvard.edu\/journals\/hlpr\/?p=1071"},"modified":"2015-10-02T15:23:41","modified_gmt":"2015-10-02T15:23:41","slug":"its-regulation-if-youre-already-there","status":"publish","type":"post","link":"https:\/\/journals.law.harvard.edu\/lpr\/2012\/03\/28\/its-regulation-if-youre-already-there\/","title":{"rendered":"Its ‘Regulation’ if You’re Already There"},"content":{"rendered":"

By Mark Wilson<\/p>\n

<\/em>Reading\u00a0the brief for the states opposing the Affordable Care Act<\/a>, one is properly acquainted with\u00a0the definition of a\u00a0Jeremiad<\/em><\/a>: \u201ca prolonged lamentation or complaint; also, a cautionary or angry harangue.\u201d The states\u2019 brief is lean on legal arguments and long on exhortations that, if the Supreme Court upholds the mandatory coverage provision of the Affordable Care Act, we\u2019re that much closer to a totalitarian dystopian society.<\/p>\n

The states\u2019 focus \u2014 and, it turns out,\u00a0the focus of various Justices<\/a>\u00a0\u2014 is what \u201cregulation\u201d means. The Commerce Clause authorizes Congress only to\u00a0regulate\u00a0<\/em>interstate commerce. Does this include\u00a0creating<\/em>\u00a0interstate commerce? That\u2019s the states\u2019 framing of the issue, but it\u2019s centered on a premise that may or may not be true: that people who choose not to purchase health insurance are not engaged in interstate commerce.
\n
\nDuring the Nixon Administration, the United States made a conscious, voluntary decision that health care would be paid for by private insurance. Medicare would pay for the very old, and Medicaid would pay for the very poor, but everyone else was left to fend for themselves. Insurance works by calculating, and then pooling, risk.\u00a0Pooling<\/em>is key, here: an individual can\u2019t insure himself unless he has a lot of money. For everyone who does not have a lot of money, insurance makes vicissitudes affordable. This is how insurance works.<\/p>\n

But whether or not Congress has acted, a market exists. The problem with insurance, though, is that the people explicitly inside the insurance market (people who have purchased insurance) are affected by the people explicitly outside the insurance market; that is, people who have not purchased insurance. Putting aside the fact that health care is overpriced these days (because that\u2019s the Faustian bargain we made!), your $10 co-pay not only goes towards\u00a0your<\/em>\u00a0expenses, but the expenses incurred in treating someone who has no way to pay the sticker price of an emergency room visit. On a national scale, then, everyone who uses any kind of commercial health care service is in the market, and this is the interstate commerce that Congress is regulating.<\/p>\n

In order for health insurance (as a subset of health care commerce, remember) to be affordable, health insurance\u00a0must work like insurance<\/em>. If the only people in the insurance pool are high-risk, then the price of health care, even for the insured, would be too high to afford. Low-risk people who choose not to purchase insurance (because they\u2019re low-risk, after all) thus affect those who are insured by choosing not to purchase that insurance.<\/p>\n

And health care is not like a car: all of us \u2014 every one of us, man, woman, and child \u2014 will consume health care at some point in our lives. Congress\u2019 remedy to this problem may strike some state governments as far-reaching, but Congress didn\u2019t get there first. Health care consumption already affected everyone to an \u201cunprecedented\u201d degree. Congress merely matched scope of the remedy to the scope of the problem.<\/p>\n","protected":false},"excerpt":{"rendered":"

By Mark Wilson Reading\u00a0the brief for the states opposing the Affordable Care Act, one is properly acquainted with\u00a0the definition of […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[2],"tags":[],"class_list":["post-1071","post","type-post","status-publish","format-standard","hentry","category-blog"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/peZQka-hh","_links":{"self":[{"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/posts\/1071","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/comments?post=1071"}],"version-history":[{"count":0,"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/posts\/1071\/revisions"}],"wp:attachment":[{"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/media?parent=1071"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/categories?post=1071"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/journals.law.harvard.edu\/lpr\/wp-json\/wp\/v2\/tags?post=1071"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}