As it appears the monstrosity is on its way, I have a few questions about it.

First, what will happen when some individual mounts a court challenge of the fine for failure to carry health insurance. I know the government loves to wedge every law under the sun into the interstate commerce clause or the general welfare clause, but how on earth can they claim it is the general welfare to fine someone for failing to buy insurance? Or that my failure to purchase insurance, that is a LACK of commerce, relates to interstate commerce? I am sure the court will find a way to make this constitutional, as they always do, but it will be most interesting to see how many hoops they will have to jump through to do it? (And maybe, just maybe, they will strike it down. After all, massive abuses such as the VAWA failed to pass muster under the interstate commerce blank check, so you never know.)

Second, what if all private doctors refused to accept insurance? There is no legal requirement that they accept insurance. They are still private businesses and have every right to determine the terms of payment. Hospitals are subject to so much state and federal regulation that they will be very unlikely to make a stand, but private doctors are facing pretty bad circumstances under this bill. I know the story is insurance companies are getting a sweetheart deal, but the truth is they will be hurting pretty badly very soon (see more below) and will be cutting payments quickly. Doctors will find themselves operating on even tighter margins than usual*. So, what do they have to lose? They could all refuse to accept insurance. It would make this bill seem pretty foolish, and would flood emergency rooms with everyone who wanted to take advantage of their "free" medical care.

Third, what will happen when insurers begin to close their doors? Actually, this is what I expected all along, and no doubt what Obama wants. ("Confirmation, Yet Again", "Who Will Decide", "Can Anyone Make Sense of This?", "Private and Public Coexisting", "Government Funding and the Free Market", "The Absurdity of Mandatory Insurance") The right is claiming this is an insurance sweetheart deal, and some insurers were sold on that, as they get a captive market forced to buy insurance, but in the long run, it will bankrupt them. After all, they can no longer refuse to cover anyone, and the state has the ability to tell them how much to cover, what to cover, what to charge and so on. Does anyone think government edicts will favor insurers? Or will they play political games to buy votes and eventually drive insurers out of business? Of course, as that leaves us with their cherished "single payer system", I doubt they would shed many tears over it.

Fourth, what happens when the best and brightest decide operating for minimal pay under strong government oversight is not worth the aggravation of malpractice suits, low pay, long education, long hours, and being on constant call? In other words, what happens when being a doctor becomes as desirable as being a government clerk or public school teacher? Yes, just as in those fields we will ahve some few dedicated individuals with a true love of the field, but we will get many more time serving bureaucrats. And do you want a MVA clerk providing your health care? Oh, the supporters will claim they are just "changing how payment is made" and nothing will change for the doctors, but does anyone believe that? With the government telling what must be insured, for how much, do you think there will be less oversight? This is just the beginning, and the amount of regulation will only grow, at all levels of the system.

Finally, when the single payer utopia is reached, when the government manages to bankrupt the insurers, or drive them out of the field of insurance, and they get single payer**, what happens with malpractice suits? After all, with doctors essentially an adjunct of the government, as they would be under "single payer", lawsuits would effectively be targeting the government, as liability costs will need to be figured into the payment schedule. But lawyers are a major Democrat constituency. So, will the Demcorats finally cut loose the trial lawyers? Or will they basically provide a tax subsidy for trial lawyers at the expense of the tax payer? (Not for the first time***.)

I am sure there are many more questions, but these are the ones that occur to me at the moment. I will write more as they come to me.

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* Along with demonizing insurance companies, a lot of bile has been poured on doctors. Yet, would you want a world without them? They provide a lot of service for the cost. And, though everyone thinks "they're rich" a lot of doctors make less than people with comparable educations. Compare a 4 year BA stock broker and a 7 year MD (plus internship and residency) doctor and you'll see what I mean. A lot of doctors in private practice are far from rich. once you figure in malpractice, staff, insurance overhead, they make less than other small business owners, which is essentially what they are. Certainly less than lawyers (7 year JD with no internship or residency). So stop thinking doctors are some sort of over paid elite. They are well trained professionals, some of whom do very well, many of whom just make what one would expect, or less.

** Krugman and others have openly stated that the "universal coverage" plan is just a way to backdoor in single payer. That suggests to me they know it will eventually bankrupt the insurers. What puzzles me is how the insurers failed to see this. Then again, being so beholden to the government as they already operate in a government created cartel environment, maybe they could not object. Recallt he threats against Humana for stating the truth, our gangster government will not tolerate dissent.

*** The "super fund" for toxic waste clean up as well as the asbestos trust and a few other government "solutions" were often little more than lawyer pay days, at least in part. So the Democrats, and sadly many Republicans, have little problem feathering the nest of trial lawyers. Then again, as we have such an absurd fondness for electing lawyers ("What Makes Lawyers So Special?"), maybe that is not so surprising.

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POSTSCRIPT

My other writing on health care can be found in "A Different Look at "Health Care Reform"", "The GOP Health Care Plan", "Reviving Nonsense in the White House", "Required Waste", "Why ObamaCare Won't Get Cloture" and "Some Good News", as well as the postscripts to those posts.