Home designs for humanitarian crises, or "What do IDPs and hipsters have in common?"

A friend at school asked for a book suggestion last December as part of her effort to find the perfect Christmas present for her architecture and development inclined SO. By chance, I actually had a book on hand for exactly this situation! Architecture for Humanity collected information on dozens of innovative, low-cost, "sustainable" designs for habitable structures back in 2006 and featured them in a handbook called Design Like You Give a Damn.

Someone had bought it, presumably used it, and discarded it at the end of my freshman year of college at Santa Clara. After haggling with the book-nazi in the basement of our student center (not the nice gray-haired woman, the other old guy that didn't smile) to sell back my calculus text for more than $10 - and failing - I found this gem on the FREE table. It was brilliant. I read the book cover to cover and shared it with a few people, and I wound up working on our school's Solar Decathlon team the next year because I thought the whole idea was so nifty. After suggesting the book I read through it again, and I've been following their work for the past few months.

Economic inequality and development, or "This is where Occupy should have started"

I have spent a lot of time graphing Lorenz curves. It's a requirement of getting my degree. I hated drawing distributions of income/land/wealth and working out the calculations and derivatives by hand, but in retrospect this practice seriously matured my academic understanding of the effects of economic inequality (especially radical inequality) on the overall well-being and economic efficiency of a society. Greater inequality reduces domestic consumption, decreases political participation and representation, increases statutory penalties and abuses of police power, inhibits the accumulation of human capital necessary for advanced production and services, etc etc. All of these things are clearly established correlations, and many of them have substantial data to support causal relationships.

You can maybe imagine then, how strange it is to turn this critical perspective back onto the United States. Instead of starting with "greater inequality reduces well-being and economic performance" and "what can we do about it", domestic political conversations have to begin with a tedious explanation of why treating "economic inequality" is not the same thing as "envy of the rich", "commi-socialism" and "class warfare".

What Kind of Country, or "This American Life Presents..."

With the downturn of the global economy in 2007-2008, Americans were quickly faced with fiscal austerity decisions in their local and state governments. With less money on their books, cities like Trenton, NJ and Colorado Springs and, yes, even old homesteads like San Francisco and San Jose were forced to acknowledge  new realities that they could no longer afford the same kinds of services and benefits that were once routine. While cities, counties and states - and eventually even the federal government - grappled with technical tweaks to revenue streams and budgets cuts, residents began to confront expectations about what their governments could and should be doing. By the time we were fighting about healthcare reform in the US, it was apparent that these issues were digging at something deeper - questions like what is government, and what is the public community that we live in? Who belongs in it? What do we want from it? What does it want from us? We all began arguing about political philosophy (though not always well).

In a recent episode "What Kind of Country", Public Radio International's "This American Life" explored what these question mean to us through three stories from the across the US of how reforms have, and sometimes haven't, taken residents where they hoped.

Graduate finals, or "Undergrads"

UPDATE 12/13/2011: I have searched for several days now for a new place to settle in and convert to a dystopian Man Cave. My criteria are simple: a comfortable seat, a large space to lay out my dozens of papers and books (so that I can look at them all simultaneously, if need be), some mellow and indistinguishable background white noise, a large drawing space for erasable markers, and a stark absence of undergraduate students. I do not include this final criterion out of any sense of blind prejudice or hypocritical elitism (though I guess that last part is debatable...), but rather out of an earnest effort to avoid conflict during those manic periods of finals at around 7-9pm, 11:30-12pm, 2-4am and 1 hour after dawn  - when the beauty has worn off and you realize that it is indeed very, very early and you didn't get to sleep and your marginal productivity is slipping again.

P.S. The study rooms are not for drinking Diet Dr. Pepper and Malibu while playing a harmonica. Why are you even awake?! Go home!

Subjective Well-Being, or "Measuring Happiness and Opportunity as a Benchmark for Policy"

“When we think about policy then I think we need to make some normative choices about what versions of happiness societies care about… I certainly think that the US, which has the pursuit of happiness in the declaration, and has traditionally emphasized opportunities over outcomes, would opt for an Aristotelian definition [of life-fulfillment]. If we went as far as to say that happiness is a benchmark for policy and we have an Aristotelian definition allowing citizens to lead fulfilling lives, then promising happiness in that sense as a policy objective requires providing all citizens with the agency to pursue it.”

In recent years, a number of countries have begun to incorporate measures of subjective well-being – or “happiness” – into their benchmarks for development and national progress. Even in the United States, policymakers and academics are beginning to consider the merits of measuring happiness and its role in public discourse. This is great part because of the work of Carol Graham and her colleagues.

What a US default would mean, and why you really need to care

*I'm going to preface this with a request. If anyone reading this can provide me with a good explanation of the GOP perspective, I will be incredibly grateful.*


The general media has thrown around words like “apocalypse” and “destitution” and “bluff” in the face of federal default, while a minority of the GOP has seriously suggested that it could even be a good thing for the nation – an opportunity to sober up government and reduce unbalanced spending.

That sounds nice, but absolutely absurd. I don’t mean to be partisan most of the time, but with an honest look at our prospects in the wake of 4 failed negotiations this week, there isn't really an alternative. Yes the government spends A LOT of money, and Yes it needs reforms to reach sustainable limits, but the debt ceiling is now too serious a trigger to be used as a bargaining chip in budget negotiations.

BOND RATINGS (OH HOW EXCITING)

If the federal government fails to pay its dues and the US bond rating is reduced from AAA to B-plus, you can bet your ass we’ll have a fiscal crisis on our hands, as well as a tremendous shockwave throughout the entire national economy that would almost certainly cripple any recovery that we’ve managed to eek out so far.

Clearly the GOP/Tea Party Caucus has never taken a course in macroeconomics (which from me is saying something!) You see, it’s not just about a decreased bond rating from Moody’s – most people don’t even know what that means. Those that do increasingly counter that these large rating agencies gave companies like Leman Brothers high marks before their inevitable collapse, and so why should anyone trust their ratings now?

Digestible explanation of international austerity and debt, or "The myth of Austerity"

Okay, so this may not seem to have a lot to do with LOCAL politics - but trust me, it does. (And even if it didn't it's still worth your 5 minutes!)

Mark Blyth is a professor of International Political Economy at Brown University and faculty fellow at its Watson Institute for International Studies. He is writing "Austerity: The History of a Dangerous Idea," forthcoming from Oxford University Press in 2011.

Just to tie it together a little bit, local governments are ultimately the agents responsible for administering public and social services. When national governments - or in our case, federal or state governments - cut public services and funding for support programs, it is the local governments that are squeezed most. Many times the services they provide are even mandated by local rules or legislation (i.e. the "independent socialist republic of San Francisco"), and so the services just go unfunded or the localities have to raise finances on their own. In both cases, the public takes it our on the the city/county/district first. No fair!

Quote of the day, or "Thermostat WTF"

"The US military's bill for air-conditioning in Iraq and Afghanistan each year is about $20billion - about a third of the entire UK defence budget."

סּ_סּ  http://news.bbc.co.uk/today/hi/today/newsid_9525000/9525737.stm 

Nobody's heard of evaporative cooling?

Quote of the Day

"We would like to have a laser inside the body of the animal, to generate laser light directly within the animal's tissue."

Excellent. Harvard scientists have used a genetically engineered human kidney cell as a "gain medium" to amplify light waves into a laser. It's nothing compared to the 1 megajoule power of Lawrence Livermore Labs's National Ignition Facility out here in Cali, but then again we won't be the first to get laser sharks :/

" Hundreds of different gain media have been used, including various dyes and gases [and Jell-O]. But no one has used living tissue. Mostly out of curiosity, Malte Gather and Seok-Hyun Yun of Harvard University decided to investigate with a single mammalian cell.

They injected a human kidney cell with a loop of DNA that codes for an enhanced form of green fluorescent protein. Originally isolated from jellyfish, GFP glows green when exposed to blue light and has beeninvaluable as a biological beacon, tracking the path of molecules inside cells and lighting up when certain genes are expressed.

After placing the cell between two mirrors, the researchers bombarded it with pulses of blue light until it began to glow. As the green light bounced between the mirrors, certain wavelengths were preferentially amplified until they burst through the semi-transparent mirrors as laser light. Even after a few minutes of lasing, the cell was still alive and well. "

Read the whole story at New Scientist.

Realignment and the Corrections Crisis, or "9 Fellows Walk Into a Bar..." (Pt.5)

I visited Sacramento four months ago with my fellowship cohort to meet with policy wonks, and to ask some uncomfortable questions about the state of the State. A $26B budget deficit, gridlocked politicians, a frumpy economy, a mess of jurisdictional mishaps and dozens of uncoordinated populist initiatives that don't look so hot the next morning had (and still have) all conspired to ruin everything.  Wild rumors had been flying about in San Francisco that the state was considering a wide-reaching reorientation of public services, and that local governments would expectedly "get the shaft" in these changes. That turned out to be true.

It was hailed as the great "Realignment" and in this shifting of authorities, monies and services, prison reform (kinda) made it onto the list. And rightly, considering that California has one of the largest prison populations out of any state in the Union, and that the Union has the highest per capita incarceration rate in the ENTIRE WORLD. That mean's we're the best!

My group has started working with the County Sheriff's office on a project to evaluate the levels of recidivism in San Francisco, the effectiveness of corrections programming and alternative sanctions, and CCSF's ability to adapt some of those services to a new population. It could not be timelier. The US Supreme Court last month upheld an injunction against California's Department of Corrections and Rehabilitation for civil rights violations like inadequate medical care and services, and violence, due to overcrowding (see Brown v. Plata). The number of prisoners incarcerated in California since the 1970s has increased sevenfold, and the system is now over 175% of its official inmate capacity with 143,000 prisoners (down from 173,000 in 2006). This was identified as a significant cause of the rights violations, and so the State was ordered to either (a) increase capacity and services or - since California’s annual budget is still short by several billion dollars - (b) to release or redistribute approximately 33,000 prisoners.

The ruling itself was no surprise. The case was pending for several years, and it was really a matter of time before the High Court followed up in the case - it was just a bit earlier than anyone thought. Unfortunately this means San Francisco and hundreds of other municipalities across California will be absorbing some of the State prisoners into their jails and local corrections programs. The official objective is to move low-level offenders closer to their communities, as this has shown to encourage rehabilitation and stabilization - but it's also about money and a federal injunction.

This is a new demographic for county sheriffs - more serious crimes, different affiliations, somewhat more radical behaviors, and parolees. Counties are generally ill-equipped to manage these offenders, but we have to learn. The City's expecting at least 700-800 new state prisoners next year. It's hard to know a definite number, though; the state doesn't share all inmate records that signify who's eligible for the transfer.

As a state, we need to ask some important questions, foremost of which is how our already enormous corrections system has swelled to nearly twice its official capacity. Is it the judges, or lawyers, or the police? Whoever it is, they're clearly crazy. Unfortunately the problem isn't that simple. There does not seem to be any single mechanism to blame or switch to flip that would resolve this crisis - and with costs skyrocketing, a structural state deficit, abuses gaining public attention, report after report indicating that the prison systems are often overtly and procedurally racist, and with a new court injunction, it really is a crisis for the state. 

But if I were to dismiss nuance and point to something as a fundamental structural flaw, I would start with California's infamous Three Strikes Law.

Muni "bonds", or "How I rode my bike and then caved in"

As a not-wealthy resident of San Francisco, I have a relationship with MUNI transit. It's not great, it's not (usually) terrible, but it is certainly special. The most accurate comparison would be to the relationship you might have with that college friend or roommate that always hangs around and conveniently has a car, but no one is quite sure why he's part of the group because the only time you talk about him is to talk shit or recall a ridiculous story that usually ends with someone dancing drunk on a table at a stranger's house or getting slapped in the face at a Wendy's. But still, you keep coming back for more - and part of you kind of wants to.

On Tuesday I missed the 31-Balboa inbound and chose to walk down to the 5-Fulton, as is often the case. MUNI open sourced it's vehicle tracking data and I have a nifty app that tells me when the buses come now, but to no surprise it has an incredibly difficult time keeping track of the 31 inbound. "6 minutes" it says, and then a moment later it refreshes and reads "10 minutes". Once I relax and settle into the last sips of my cofee, it tells me "12 seconds, ha ha. you're screwed I tricked you." So now my only reliable signal is the mid-pitch ZZZ-ing noise of the electric engine of a bus tearing its way down Balboa toward my apartment, past my apartment, and away from my apartment. When the winding noise first penetrates my windows in the morning, I have approximately 50 seconds to grab my gear, get down the stairs and run two blocks to the bus stop. It may or may not actually stop.

Whatever is going on here, just leave the station and walk away.

So on Tuesday I walked to the 5, boarded, and headed in to the urban core for work. The bus filled up, became full, continued to fill up until there was nowhere to move, and then a middle aged man vomited everywhere in the middle of his second bottle of gin.

On Wednesday I opted to ride my bike to work, and it was wonderful, and clean, and warm. I rode past the Conservatory of Flowers, along dirt trails, amongst giggling children playing in fields with remarkably absent parents, and I even lost a 2 1/2 mile street race through the Panhandle and down Page by several seconds with a strange hipster on another Peugeot. All this and I still got to work 20 minutes earlier. But of course, I can never stay away forever. I always come back with some rationalization, secretly curious about strangers I’d see and the next MUNI mishap that I could be part of. And in the back of my mind, I always think that it will be a little bit more convenient than another mode of transportation. After a 300 ft climb uphill on my first mile going home, dodging cars on narrow streets and bikes flying in the opposite direction, I had my justification.

For now I will split my time between the open, beautiful bikeways of Golden Gate Park and the congested anarchy of MUNI in rush hour, until the next health-hazard drives me to the streets once again. No matter the malfunctions, delays, anxiety, reckless abandonment of traffic code, claustrophobia, and generic icky-ness of certain bus lines, it seems I will always return to this awkward friend.


One writer on Muni Diaries sums up his the experience nicely, with graphics!

California CAT

I learned recently that Cap-and-Trade policy in California may not include rules for allocating emissions credits to new energy producers entering the market after initial distribution. As far as I can tell, they will have to buy them from other incumbent sources :/

I’m very curious about what this may do (?). Does this insulate the market from more competition? Would it be better to encourage the development of new companies in energy production, or would that only prop up small entities with too little capacity to adapt to fluctuating market forces and consumption demands?

Ideas are welcome.

What's the fuss with Healthcare? (A Converstion)

LET'S TALK...

After decades of arguing and arm-twisting, the passage of a new healthcare reform plan is being welcomed with something less than a grand “hoorah!”. The Patient Protection and Affordable Care Act (PPCA) was signed into law on 23 March amidst everything from cheers to resentment, and even a score of death threats to federal representatives (yay, we are so diverse!). In the past few days there have been public challenges to the Act’s constitutionality and open accusations of socialism, despite the fact that few people on either side of this issue actually seem to know what is in the new bill.

I want to think out loud on this and get some feedback from other people as i try and make sense of it, so whether its support or scolding criticism you offer, feel free to respond - it's just politics after all!

THE BASICS

I mostly support the new healthcare reform, though I am disappointed on a few points and I’m suspicious of others. And yet, overall, it seems to be progressive and necessary, and not unconstitutional. I hear a lot of opposition to one degree or another, but few if any of the arguments have really been convincing. Given the level of opposition I’ve got believe that there are at least a handful of reasonable protests, so if I miss something please just yell at me and tell me what the issue is.

I am not sure how familiar you as the reader are with the bill, but the major talking points are something like this (based on re-evaluated CBO report):

• The bill expands affordable healthcare coverage to 32 million people


• The initiatives and requirements established set the cost at approximately $940 billion (USD2010) over 10 years, but in doing so actually reduce the federal deficit by $143 billion over the first 10 years of the plan and (theoretically) another $1.2 trillion over the second ten years.


• It forbids discrimination of private health insurance coverage based on pre-existing conditions (applies to children in August, and to all adults by 2014), and allows dependent children to remain on their parents’ health insurance plan until age 26 (basically aimed at reducing costs of out-of-work college grads)


• Creates a state-based Health Insurance Exchange program, partially funded by the federal government for the first five years.


• Reforms Medicare Advantage, Medicaid, and a lot of other stuff, and with the reconciliation bill H.R. 4872 fills some gaps and mods other programs.


• The bill creates an “individual mandate” that requires every citizen and legal resident to be enrolled in a health insurance plan (except for those experiencing financial hardship, whose income is below certain levels, who have religious objections, etc.), or to pay a “tax” if they choose not to enroll and do not meet any of the exemption criteria.


• Good summary of PPCA here: Kaiser Foundation or CBS News (1) and CBS News (2)

The new reform system ultimately falls somewhere between “health insurance” and “health care”. The distinction is in more than semantics – the two systems function in different ways and with different goals, and the keystone is the individual mandate. The basic idea of insurance is that you join a risk pool, pay into the pot and then, if something expensive or unexpected happens, that pool pays for your expenses. It’s catastrophic coverage. The principle of a health care plan is that in exchange for paying into the system, you get payments for predictable events like tests, scheduled checkups or prescriptions. What we have pulled out of the so-called “debate” of past year is a compromise; instead of everyone paying a public tax to receive universal coverage for catastrophic or predictable events, we’ve created an individual mandate to require the same thing but through scores of private providers.

What came out of this argument were two clearly labeled and divided opinions of public health policy: One side suggests that healthcare is a RIGHT, and the other claims that it is merely a PRIVILEGE in our society. Both sides have a handful of talking points to support their positions, but they are often general and loaded with unspoken assumptions. I am willing to grant for the sake of debate that healthcare may not be a human right, strictly speaking, which suggests that it is universal and must be assured to all individuals in any case. However, I do believe that it has become a civil right that should be made available, affordable and accessible to all members of our society. More specifically, I believe that its unavailability compromises the access of members to other social goods that are essential to participating in the public and “political” sphere. In order to understand where I’m coming from on this, we need to take a step back to the bigger picture to clear up some assumptions ... (if you've read Walzer, just bear with me)...

A political entity is fundamentally the agency of a social compact, in which a group of individuals (i.e. all Americans) pool their resources, surrender certain rights (like killing, stealing, retribution - shifty vigilante stuff) and agree to operate within the resulting conditional authority of the political body, so that all members of the community may be afforded greater protection and opportunities. We then afford certain basic rights and liberties to all members, so that they may be considered as equal in the political sphere; that is to say, they have the same say in how the political body regulates the relationships of its members, actors, parties and other forces (other "social spheres”), as does any other single participant. It is a matter of power and of status.

This idea in itself should not really be a contested point, as it is among the fundamental principles of democracy and other forms of representative government. This is why we demand equal protection under the law, equal pay for equal work between the sexes and races, and equal say in elections – “one person, one vote”. It is why we protest when we are discriminated against for factors beyond our control, and why we object to the power of corporations in our politics. It is also why we as a nation created institutions such as Social Security – so that each member of our political community would be assured a basic (financial) security and the ability, at least in principle, to retain access to the body politic and remain an equal member of it. Laws that protect our rights not only assure us certain powers, but also assure us each the status of an equal citizen.

HEALTHCARE ACCESS AS A POLITICAL GOOD

Now, it makes sense for healthcare to be seen as a political good for couple of big reasons:

1) The first is a matter of effective public policy; the common health cannot be effectively managed or protected if not everyone is participating, or able to participate in health treatment. When it comes to communicable diseases like Avian Flu or H1N1, this even becomes a security concern. Our government may not really have the authority to force every individual to get specific preventative treatment, but it does have the authority to regulate particular key interstate markets [^1] (consider the coal market in the 1930’s), to create a new service, and to make that service available to citizens and residents, especially when it is beneficial to the majority of Americans.

2) Consider a hypothetical social contract: wouldn’t we each want the opportunity for healthcare if we were in a position where we could not otherwise afford it in an open market, especially when we know that each and all of us will need medical treatment in our lifetimes? Some of you may suggest that, like negotiating in any contract, you may not wish to agree to a condition that you do not expect to serve your needs. If so, consider two things: a) is it rational, or in your own interest, to expect that you or your dependents will always have the resources needed to afford private, free-market insurance and receive personal healthcare?, and b) is it reasonable or just to say that others who cannot afford such care do not deserve it?

3) As I suggested above, access to affordable healthcare does affect an individual’s membership status in the political community. Even a cursory glance at independent surveys supports this. For instance, a 2005 Harvard Law study found that about 50% of all declared individual bankruptcies reported that healthcare costs were a substantial contributing factor. About 70% of those declaring bankruptcy even had insurance at the time of their initial medical expenses, but had significant gaps in coverage or lost their coverage. A study in Health Affairs (2006) found that large medical debt, even among insured people, presents nearly as high a barrier to healthcare access as having no insurance [^2].True story. A recent study by the Kaiser Foundation indicates that reports of rising healthcare costs as a “barrier to needed care” have risen at an average rate of 1 million reports per year between 1997 and 2006, and that the total number of reports rose to 39 million in 2006.


What does it say about a person’s status as an “equal” member of society if he/she can be killed by a common illness or long-term injury that could otherwise be remedied or prevented if they could afford treatment? That doesn’t seem like security.

What’s more, but our government already recognizes the need for healthcare in the most impoverished demographics through Medicaid. Unfortunately this program becomes incredibly cost inefficient, such that nearly three-quarters of Medicaid funding goes to the top one-fifth who have the greatest need for remedial treatment. We then have four solutions: a) reform the program for a short-term fix to symptoms of an ineffective healthcare system, b) increase funding without addressing the cause of expenses, c) repeal Medicaid and leave the poor suckers to deal with it on their own, or d) develop and utilize a practical market for widespread preventative treatment.


THE MANDATE

There have been very public protests against the PPCA that accuse it of being “Unconstitutional!” Now, I’m all for protests and arguing that the federal government is overstepping its constitutional restraints in certain cases, but this frankly is not one of those times. I’m willing to entertain arguments to the contrary, but so far I haven’t heard any that are solid and sound. Most people accusing the government of socialism point to the individual mandate. The finer points of this will be worked out in the courts in the coming months years, but in principle this does not seem totally out of line. The justification is actually in the ban on discriminating against pre-existing medical conditions.

Health insurance providers have traditionally held the right to reject applicants who have pre-existing health conditions, citing potential costs to the provider. It is the free market after all, and companies looking for a profit should be able to negotiate contracts on their own terms – basic cost-benefit stuff. But saying this is the way it ought to be already supposes that healthcare should only be subject to the market forces and individual circumstances (this is the “privilege” side). As I’ve already argued, healthcare access has political consequences. When individuals are effectively refused access to healthcare because of pre-existing conditions, then their political access may also be jeopardized because of factors beyond their control. It is not often their fault or responsibility, but they are held responsible and denied coverage and care.

If someone is a professional daredevil with a history of failed attempts and picking fights in shifty bars, then that is one thing. But “pre-existing conditions” include anything from asthma to cancer, and in 9 states this can even include a history of domestic abuse – as the victim! A 2007 survey reported that 12.6 million non-elderly Americans were discriminated against because of a pre-existing condition between 2006 and 2009 [^3]. A similar caveat is “rescission”, in which such an insurance provider can cancel a plan when patient costs get too high. Imagine a scenario where a client is diagnosed with cancer and their treatment drags out for months, and includes expensive medication and tests. And then they get booted from their insurance coverage. This policy was legal in 45 states before the passage of the healthcare bill, including in California.

The need to exclude pre-existing conditions in health insurance seems obvious if we are aiming for a functional and just healthcare system. The immediate consequence is that, without a government managed single-payer program, and without an individual mandate, people could simply buy “insurance” after a diagnosis or catastrophic injury, and companies/government would have to accept them at default rates and a standard premium. Imagine…. (courtesy of Eric Zorn)

Operator: Acme Auto Insurance, how may I help you?
Man: I just came out of a store and found that someone plowed into my car and took off. The entire back end is crushed.
Operator: I'm sorry to hear that, sir. What's your policy number?
Man: Oh, you can tell me that later.
Operator: Sir?
Man: After I buy my policy, you can tell me the number. And you can tell me where to send the repair estimate--
Click!

This little conundrum might not immediately cause a systemic failure, but eventually the only individuals participating would be them sick folks with the most severe health costs. Providers would naturally have to raise their rates across the board (otherwise it’s back to discrimination!) until even those people with traumatic health issues couldn’t afford them, and THEN the system would collapse.

RIGHT TO HEALTHCARE vs. INSURANCE

The argument that healthcare is not a right is specious off the bat. Emergency healthcare already is a recognized civil right in almost all cases. Imagine you stumble into a hospital with a potentially fatal condition or injuries to all sorts of body parts. The law actually requires that you be treated whether you can afford it or not. This applies to you and to everyone else, legal citizen or not. Indeed the alternative is that the EMTs arriving at the scene require you to produce cash or credit, evidence of insurance coverage and legal documentation of your citizenship before helping you out of your burning car that is at that moment seriously considering a dramatic explosion. If a person ultimately can’t pay the enormous medical fees, then the cost is passed on to other patients and other clients who can pay, and to the wider public through taxes.

So to be clear, what you as the antagonist probably mean to say is that certain qualified healthcare – perhaps preventative – is not a “right”. Let’s assume you haven’t fully bought my “civil right” idea for the sake of argument; if these outrageous costs of the uninsured are being passed on to the rest of us, then don’t we as a political community have the authority to require individuals to have health insurance, or to participate in the collective healthcare system so long as they can afford it? And if they wish not to participate, do we not have the authority to require at least a small tax to cover some of their likely costs? We would end up paying into a larger pool for healthcare preemptively instead of indirectly later on so that we are each assured health services that we all will need at some point.

We already pay a universal tax for Medicare and Medicaid, and these have already passed their tests for constitutionality. And these are fully-fledged government health programs. This newest plan involves far less government direction or management, and indeed keeps with the American tradition of relying on the private health insurance system as the foundation of public health.

Lastly, Congress has the authority to regulate interstate commerce for the well being the greater national union and all of its members as granted by the Constitution (Article I, Section 8, Clause 3). The regulation of national health insurance markets arguably falls under this umbrella, as costs for healthcare transcend state lines and affect all Americans. If we are to truly reform the healthcare market, it cannot be done with a patchwork of state-by-state provisions. However, there is admittedly a rather sticky point with the federal government taxing economic inactivity, and requiring an individual to engage in a contract with a private company. But again, this could easily be avoided with the provision of a “public option” for a separate government insurance plan, for which there is plenty of precedent for taxation.


- - - - - - - - - - -

[1] Carter v. Carter Coal Co., 298 U.S. 238, 290 (1935) and Sunshine Anthracite Coal Co. v. Adkins, 310 U.S. 381, 395 (1940)
[2] Health Affairs, 25, no. 2 (2006): w89-w92
[3] Commonwealth Fund Biennial Health Insurance Survey, 2007