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The first (successful) venture into individual mandate occurred very early in our republic (1798) to be exact, when there was a mandatory levy of one percent of merchant seamens' pay to provide a hospital system for those workers. It was An Act for the Relief of Sick and Disabled Seamen, passed originally during John Adams' administration, a noted Federalist who serves as a model for much of what today’s Tea Party finds objectionable.

Historians of that period, however, can show that Thomas Jefferson (Hamilton’s strict constructionist nemesis) also supported federal marine hospitals, and along with his own Treasury Secretary, Albert Gallatin, took steps to improve them during his presidency.

If that isn't a bipartisan solution, I don't know what is.

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The law was not only the first time the United States created a socialized medical program (The Marine Hospital Service) but was also the first to mandate that privately employed citizens be legally required to make payments to pay for health care services. Upon passage of the law, ships were no longer permitted to sail in and out of our ports if the health care tax had not been collected by the ship owners and paid over to the government – thus the creation of the first payroll tax in our nation’s history.

When a sick or injured sailor needed medical assistance, the government would confirm that his payments had been collected and turned over by his employer and would then give the sailor a voucher entitling him to admission to the hospital where he would be treated for whatever ailed him.

While a few of the healthcare facilities accepting the government voucher were privately operated, the majority of the treatment was given out at the federal maritime hospitals that were built and operated by the government in the nation’s largest ports.

As the nation grew and expanded, the system was also expanded to cover sailors working the private vessels sailing the Mississippi and Ohio rivers.

The program eventually became the Public Health Service, a government operated health service that exists to this day under the supervision of the Surgeon General.
Source You might also want to read this wherein the author states:
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But the story of the marine hospitals in the early American republic suggests that the United States has a long history of using institutions to manage public health. Through the marine hospitals, the federal government used health care to regulate a crucial labor force in an age of maritime commerce. Treating sick and disabled merchant mariners helped stabilize the maritime labor force. More broadly, through the marine hospitals, we witness the actual points of interaction between government, community, and individuals. A glimpse within hospital walls reveals the rich, diverse personal experiences of working in, or being treated in, an early federal marine hospital. To be sure the marine hospitals were effective instruments of politics and policy. But within the marine hospitals, medical practice and administration was far more than an abstract tool of political economy. Rather, the stories of sickness, injury, admission, treatment, resistance, and regulation that characterized life within the marine hospitals reveal how the federal government shaped the social, economic, and political order of the early republic to a degree scholars have only just now begun to appreciate.

The people who enacted the law included many who had been integral parts of the Constitutional Convention. One might even think that they knew what was in the minds of the founding fathers because they WERE the founding fathers.

I point out that, whether stated or not, the underlying authority stemmed, in my opinion, from the commerce clause. There were very few more important people in the commerce of our nation during that period than the merchant seamen, without whom trade would have been impossible.



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Upon passage of the law, ships were no longer permitted to sail in and out of our ports if the health care tax had not been collected by the ship owners and paid over to the government – thus the creation of the first payroll tax in our nation’s history.


There is a difference between a tax and a demand that somebody purchase a private businesses product.

I have said it repeatedly, get a national health care law passed that is paid for with tax monies. Then it would be constitutional. This give Congress unlimited power to demand, it cannot stand.


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Really, now, Ma R, please explain how it is different. Seriously, what we are really saying is, here is a tax/penalty you have to pay, but if you fit in x,y,z (q&r) categories, you are exempt. And, if you cannot afford it, we will even supplement it. Is this different from a voucher program? I mean this in all sincerity. I do not see a substantial difference between vouchers and an "individual mandate." Do you?


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Originally Posted by Ardy
Ma
Do you think that there is any feasible way to make affordable health care available to all who want it?

What if any is the role for the federal government in achieving this goal.
There is one way, pass a law that is paid for by a tax.

The question of the federal governments role in providing healthcare is a good question. Does the federal government have any greater role in healthcare as it does providing everybody with a job? Providing everybody with food? Providing everybody with beer? Providing everybody with a car?

Without a car a person might not be able to get to the hospital, so shouldn't the government provide a means of transportation? Pass a national system run by the Fed, then it would be constitutional. I think it would be very difficult to do it, but since the whole individual mandate seems to be going down in flames it might be time to start laying the groundwork for some kind of compromise.

The Federal Government's job is to protect the United States. The states job is to protect the citizens of those states. That is how it was supposed to work and that is how it should work.


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Originally Posted by NW Ponderer
Really, now, Ma R, please explain how it is different. Seriously, what we are really saying is, here is a tax/penalty you have to pay, but if you fit in x,y,z (q&r) categories, you are exempt. And, if you cannot afford it, we will even supplement it. Is this different from a voucher program? I mean this in all sincerity. I do not see a substantial difference between vouchers and an "individual mandate." Do you?

Even Justice Ginsburg indicated that the mandeate does not meet the requirement to be considered a tax. She was actually very elegant in her definition. A tax is levied to raise revenues. If the law were successful, the mandate would raise no revenue.

As for vouchers versus mandate, how about national health care policies? Where the total amount of carriers might shrink, but the costs associated with providing insurance would be less? The country's needs could be covered with 4 or 5 national carriers that are allowed to offer national pool policies, as opposed to today where each state has multiple carriers offering multiple policies in multiple states that are unique to each state.

I would suggest that that is really the only way that healthcare costs can be controlled.

Last edited by Ma_Republican; 04/05/12 07:01 PM.

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"A tax is levied to raise revenues. If the law were successful, the mandate would raise no revenue."

Patently not true. Taxes are implemented for many reasons, one of which is to impose a confiscatory level of tax to cut down on cigarette consumption. If that one is successful, there is NO revenue, now is there?

As I have said many times, one can look at the ACA as imposing a per capita tax, which tax can be ameliorated by buying your own insurance. THERE IS NO MANDATE! You are not required to buy health insurance. Strongly urged to by having to pay a fairly heft tax, but you get to make a choice. A mandate is where you have no choice.


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As for vouchers versus mandate, how about national health care policies? Where the total amount of carriers might shrink, but the costs associated with providing insurance would be less? The country's needs could be covered with 4 or 5 national carriers that are allowed to offer national pool policies, as opposed to today where each state has multiple carriers offering multiple policies in multiple states that are unique to each state.

I would suggest that that is really the only way that healthcare costs can be controlled.
As long as there is federal regulation of the national carriers that may be a good policy to implement. but without universal coverage, it doesn't get at one of the big problems -- the cost of care for the uninsured being borne by those who are insured.

And I am a bit surprised that you would make that suggestion, since it essentially semi-monopoly which I think inevitably would result in a single payer system.


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Originally Posted by Ted Remington
"A tax is levied to raise revenues. If the law were successful, the mandate would raise no revenue."

Patently not true. Taxes are implemented for many reasons, one of which is to impose a confiscatory level of tax to cut down on cigarette consumption. If that one is successful, there is NO revenue, now is there?

As I have said many times, one can look at the ACA as imposing a per capita tax, which tax can be ameliorated by buying your own insurance. THERE IS NO MANDATE! You are not required to buy health insurance. Strongly urged to by having to pay a fairly heft tax, but you get to make a choice. A mandate is where you have no choice.

I didn't make it up, it is in the transcripts. Also, even the moonbats on the SC accepted the fact that there is a mandate included in the law.

Look, my issue is the power that this law would hand to Congress. I have no doubt that at some point in the future it would be used in another dictatorial fashion to cure another supposed blight on society.

Pass the law, tax the people, that is the solution. Build the consensus needed to pass it in a way that 65% of the population accepts it rather than opposes it. I am not the one who tried to play word games inside the law. I am not the one who stated to anybody who asked that it was not a tax. The smartest President since Washington was the one who shot himself in the foot. He was the one who look at the horizon and saw fame and honor if only he could pass this law. He was the one who decided to use a budgetary gimick to pass it instead of compromising and taking what he could defend as bipartisan.

I have too tell you, I suck at Poker, but I really would like to play against Obama.


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Originally Posted by Phil Hoskins
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As for vouchers versus mandate, how about national health care policies? Where the total amount of carriers might shrink, but the costs associated with providing insurance would be less? The country's needs could be covered with 4 or 5 national carriers that are allowed to offer national pool policies, as opposed to today where each state has multiple carriers offering multiple policies in multiple states that are unique to each state.

I would suggest that that is really the only way that healthcare costs can be controlled.
As long as there is federal regulation of the national carriers that may be a good policy to implement. but without universal coverage, it doesn't get at one of the big problems -- the cost of care for the uninsured being borne by those who are insured.

And I am a bit surprised that you would make that suggestion, since it essentially semi-monopoly which I think inevitably would result in a single payer system.

Phil,
I am old enough to remember AT&T and bunny ears on TV's. ABC, CBS and NBC weren't great, but they provided what the public wanted. AT&T wasn't super, but they worked and did a pretty good job of reaching out and touching someone. Sometimes simple really is the best solution and in this case a large part of the problem is duplicate efforts provided by duplicate organizations. I understand that there would probably only be 4 or 5 biggies in the end, but if they were regulated correctly it would work. We cannot do a good job of providing any service if there are hundreds of different businesses offering essentially the same product in an environment that encourages abuse.

There are other things that would help; tort reform with arbitration instead of trials, reduced liability for medical companies that get FDA approval and that fully complied with the research and reporting rules leading up to their approval, an easier way to get a medical device a CPT code and medicare approval. Research costs are outragous, many of them stem from over regulation. I do not advocate reducing safety, just making it easier for companies to start making money off of their research earlier.

As for the single payer system, I do not think it would lead that way. I actually believe that a small pool of national providers would be able to offer services that are needed and restrict services where they feel necessary. The problem with a government run system is that services would be introduced and added at the whim of the Congress, or the lobbies or the voters, but they would never be taken away. I see it here in Moonbat Central. Romneycare was a disasetr from the beginning, IMO it was very un-Republican by nature, but the SJC demanded that the state provide a solution. Romney thought he could get elected POTUS by implementing universal HC in Massachusetts, but then the legislature got a hold of it. It will fail, it is out of control and there is no oversight of anything other than the deficit.

Who knows, maybe in another 50 years it will turn into single payer, but my guess is that it will remain a small group of providers.


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tort reform with arbitration instead of trials, reduced liability for medical companies

Tim, you've been reading too many comic books. Bush's push to limit Malpractice suit payouts went over like gangbusters in Texas.

Yep, the insurance companies promised to reduce high premiums to medical providers by 12 to 15% thus lowering direct cost to those in need of medical services. They blasted ads on TV and radio for months. Medical providers ran ads that they could lower cost, too.

Didn't happen with malpractice insurance companies...nor medical providers. Nothing changed accept the value of life in Texas, which is now about $250K a person.

Wait, something did happen. Medical care costs have gone up along with ever other state.

The only thing that is going to lower cost is that insurance companies are forced to compete...truly compete. That's been one of the long-standing issues that politicians would like to see gracefully go away.

As it is now, the top 5 health insurance companies also contract to manage Medicaid and Medicare claims...so you can imagine they aren't too worried about anything.

And the argument that insurance companies only make a about 2% net profit won't fly either.

Thanks, Tim...


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