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What Passes For "Smart" Conservative Analysis Of The Affordable Care Act

Ezra Klein points to this critique of Judge Gladys Kessler's opinion (PDF) upholding the Affordable Care Act. Ezra writes:
Avik Roy argues against Judge Gladys Kessler's ruling upholding the individual mandate. I'm linking to this for two reasons: One, to remind myself to blog on it tomorrow. Two, to recommend bookmarking Roy's blog for a smart conservative take on health-care policy.
I read the critique and am still looking for the "smart." I'll explain why on the flip.

Roy writes:

Judge Gladys Kessler’s 64-page ruling in this week’s case, Mead v. Holder, hinges on two weak concepts: (1) that the “free rider” problem is fundamental to the health care market; and (2) that Congress has the power to regulate “mental activity.” Yes, you read that right. On page 45, Judge Kessler argues that the Commerce Clause of the Constitution allows Congress to regulate “mental activity”[.]

This is what Judge Kessler actually wrote:

[P]revious Commerce Clause cases have all involved physical activity, as opposed to mental activity, i.e. decision-making, there is little judicial guidance on whether the latter falls within Congress’s power. See Thomas More Law Ctr., 720 F.Supp.2d at 893 (describing the “activity/inactivity distinction” as an issue of first impression). However, this Court finds the distinction, which Plaintiffs rely on heavily, to be of little significance. It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not “acting,” especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something. They are two sides of the same coin. To pretend otherwise is to ignore reality.

(Emphasis supplied.) First, let's accept that Judge Kessler's phrase "mental activity" is unfortunate at best. (To be honest, I found much of Kessler's wording in her opinion to be wrongheaded, even though her result was ultimately correct.) But this is sheer sophistry from Roy. Kessler is saying that interstate commerce, and more specifically, economic decisions that have a substantial effect on interstate commerce, can be regulated, including decisions to not engage in commercial activity. In Thomas More Law Center v. Obama, Judge Steeh describes the issue more felicitously:

While plaintiffs describe the Commerce Clause power as reaching economic activity, the government's characterization of the Commerce Clause reaching economic decisions is more accurate.

Agree or disagree with the reasoning, the question is not one of reaching "mental activity." After all, the government is not stopping anyone from thinking they should not have to buy health insurance. What the mandate intends is to make you purchase health insurance. It does not regulate mental activity, but rather the economic decisions on purchasing (or not purchasing) health insurance.

You make think that the Commerce Clause does not empower the Congress to mandate that you purchase health insurance (I think it does), but no honest and intelligent person can pretend that the Congress is trying to regulate "mental activity."

(FTR, this entire "activity/inactivity" nonsense is all beside the point. Whether the Commerce Clause empowers Congress to impose a mandate to purchase health insurance or not, the Necessary and Proper Clause empowers the Congress to enact laws necessary to the enactment of a regime to regulate the health insurance market, regulation which no one can argue is not within the Commerce Clause power. )

So, where do we find the "smart" conservative critique of ACA? Ezra gave me a bum steer.
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    Ezra is often an object lesson for me (5.00 / 3) (#10)
    by Anne on Fri Feb 25, 2011 at 10:52:40 AM EST
    as to how faulty thinking ends up becoming conventional wisdom: you have one person who doesn't understand what he is reading - Roy, who is an equity research analyst - framing his opinion in such a way that it leads another person - Ezra - to offer an opinion that gives weight to the original faulty analysis, and before you know it, there are a whole lot of people who read one or the other or both who decide, "hey, that sounds right to me!"

    And just like that, conventional wisdom is born.

    It makes my head hurt, quite honestly, not just from the faulty analysis, but from the knowledge that once it gets lodged in people's heads, it's hard to get it out.

    Maybe Ezra wishes that I would (none / 0) (#1)
    by Militarytracy on Fri Feb 25, 2011 at 08:25:25 AM EST
    realize that I just need to stop thinking about the Obama healthcare reform and many things would be okay in the land of being a Democrat for me :)  It has worked for Republicans when dealing with their base and healthcare issues.

    no advise about (none / 0) (#2)
    by Capt Howdy on Fri Feb 25, 2011 at 08:30:27 AM EST
    where to find the smart but I was struck by that also.  
    it (the regulating mental activity part) just seems to fit so perfectly into their "they are trying to control our lives and eat our brains" (see Michelle telling us what we can eat) thing that will not die over on the yahoo side of the republican.  I am fairly sure that person does not even believe it but they think they can just put one more straw onto the breaking back of what tiny bit of sanity they still cling to.


    Kessler's opinion (none / 0) (#3)
    by Big Tent Democrat on Fri Feb 25, 2011 at 08:35:09 AM EST
    has a lot of poor phrases.

    Parent
    Yup (none / 0) (#4)
    by andgarden on Fri Feb 25, 2011 at 09:04:08 AM EST
    One footnote in particular IIRC.

    Parent
    Well, here is some (none / 0) (#5)
    by lilburro on Fri Feb 25, 2011 at 09:25:49 AM EST
    decidedly dumb analysis that I had to argue with last night (probably dumb because it wasn't analysis but rather a series of typically GOP "what if!!?" questions).  Someone - a lawyer - was making the case that the DOJ should continue defending DOMA in court because the AG must "enforce the laws passed by Congress," period.  The question I was asked is "what if the next President decides the health care law is unconstitutional and chooses not to defend it in court?"  I pointed out the differences between discrimination cases and the Commerce Clause (based on a very fresh awareness of heightened standard...thanks to andgarden).

    However Orin Kerr makes the same leap:

    If that approach becomes widely adopted, then it would seem to bring a considerable power shift to the Executive Branch. Here's what I fear will happen. If Congress passes legislation on a largely party-line vote, the losing side just has to fashion some constitutional theories for why the legislation is unconstitutional and then wait for its side to win the Presidency. As soon as its side wins the Presidency, activists on its side can file constitutional challenges based on the theories; the Executive branch can adopt the theories and conclude that, based on the theories, the legislation is unconstitutional; and then the challenges to the legislation will go undefended. Winning the Presidency will come with a great deal of power to decide what legislation to defend, increasing Executive branch power at the expense of Congress's power. Again, it will be a power grab disguised as academic constitutional interpretation.

    I don't see how this is anything other than a paranoid hypothetical, but I'd be curious to know your thoughts.

    Practically speaking (none / 0) (#6)
    by Big Tent Democrat on Fri Feb 25, 2011 at 09:36:12 AM EST
    Administrations will make some exceptions to the general rule.

    The important part is that the decision be made publically.

    Lawyers will make the arguments, someone will have standing or a court will pretend someone has standing, and it all comes out in the end.

    In truth, this is a political move, not a legal one.

    Frankly, I do not much care one way or another about this.

    A judge is going to decide whatever he/she wants to decide. Whether the Justice Department files a brief or not is not going to matter.


    Parent

    So you can forsee (none / 0) (#7)
    by lilburro on Fri Feb 25, 2011 at 10:00:02 AM EST
    a world in which President GOP's DOJ refuses to defend the health care law in court?  You can forsee a basis for that?

    I was thinking Commerce Clause and discrimination law issues were apples and oranges.  In terms of my limited understanding they seem different.  Commerce Clause seems restricted to "rational basis review" and discrimination cases can be subject to a "heightened standard."  Which makes what the Obama DOJ did more reasonable to me than some GOP President not defending the ACA in court.  

    This is interesting

    A judge is going to decide whatever he/she wants to decide. Whether the Justice Department files a brief or not is not going to matter.

    Other than politically, it just doesn't matter?

    Parent

    Suire (none / 0) (#8)
    by Big Tent Democrat on Fri Feb 25, 2011 at 10:34:14 AM EST
    and it won't matter if they do or not.

    Parent
    So then who defends the law? (none / 0) (#11)
    by lilburro on Fri Feb 25, 2011 at 10:54:53 AM EST
    Congress?  If you don't mind explaining this a little more (or pointing me to some explanation of the process) I would appreciate it.

    It seems to me that whether the President defends the law in court is different from actually enforcing it though.  It's not like the President not defending DOMA means gays can suddenly get married in Wasilla.  If President GOP decided not to defend the ACA in the courts they'd still have to go through the implementation process and maintain/enforce the law as is, correct?

    I guess it also depends on your view of what "defending" the Constitution means...


    Parent

    Here's something (5.00 / 1) (#14)
    by jbindc on Fri Feb 25, 2011 at 11:12:21 AM EST
    That may possibly answer your question (at least in part)

    Parent
    OO (none / 0) (#15)
    by lilburro on Fri Feb 25, 2011 at 11:26:44 AM EST
    yay.  Thank you.  I was reading Orin Kerr's post last night...the comments there are quite interesting.  For example:

    It seems like, from a purely pragmatic point of view, it makes a lot more sense to grant standing to others (e.g. the original sponsors of the laws in question or their party leadership) than to force the executive branch to pretend to give a serious defense of laws it believes are surely unconstitutional.

    Of course the Right is hysterical (take Jonah Goldberg's post in the NRO, which I am not even going to bother linking to).  It's interesting to me because I'm learning something new.  Most Americans probably don't know much about this either.

    Parent

    So from the Dellinger post (none / 0) (#17)
    by lilburro on Fri Feb 25, 2011 at 11:48:32 AM EST
    or more accurately the editorial Dellinger links to...

    Many people seem to believe that the law would disappear if the Justice Department refused to appeal the court order. But there are two reasons that's not the case.

    First, the government has an obligation to comply with the nation's laws, regardless of whether the president agrees with a particular statute. Doing otherwise would also set a precedent justifying similar nullifications by future administrations. The next president might, for example, decide not to enforce the recent health care reform law; all he would need would be a single ruling against the law by a single district court judge, which he would then refuse to appeal.

    Declining to appeal, moreover, wouldn't resolve the issue. The law would remain on the books, and a future president could always seek to reopen and set aside the district court's order.

    Hypothetically, a GOP President could say "f*ck this law," not defend it in court, and not comply with it?  What would happen in that case?  Could a private citizen step in to defend the law or sue the government?  How would the non-compliance with the law be handled?  Or would it just be allowed to carry on to the next election?

    Parent

    Citizens and Taxpayers in Prop 8 (none / 0) (#19)
    by jbindc on Fri Feb 25, 2011 at 12:06:17 PM EST
    How could any citizen be allowed to have standing in the Prop 8 case?  To have standing, they would have to show actual harm from the law.  How can Joe or Jane taxpayer show they will be harmed by allowing Bill and George to be married?

    Parent
    they made their best legal case (5.00 / 1) (#23)
    by CST on Fri Feb 25, 2011 at 12:36:24 PM EST
    and it was one that had some merit.  Just because they didn't win doesn't mean they were wrong to make that case.

    Personally, this argument is really lost on me "anyone wanting to claim taxpayer subsidies that is not in a presumptively procreative relationship is harming every individual taxpayers of the state" - so does that include individuals who get married over 50?  Or people who can't have kids for whatever medical reason?  It's a complete double standard.

    Parent

    If it didn't turn out that way (none / 0) (#24)
    by lilburro on Fri Feb 25, 2011 at 12:37:38 PM EST
    then your concerns here

    The logical conclusion is that the US Attorney General can get almost any law overturned by refusing to defend a challenge in court, then actively obstructing anyone else from stepping in to fill the void by arguing against their legal standing.

    are unfounded.

    Parent

    actually reading more about it (none / 0) (#25)
    by CST on Fri Feb 25, 2011 at 12:40:24 PM EST
    it seems like they are still arguing over it and haven't decided anything yet re. standing.

    Parent
    So that's the latest talking point? (none / 0) (#26)
    by sj on Fri Feb 25, 2011 at 02:00:52 PM EST
    Marriages are taxpayer subsidized.

    Lordy.

    As for this bit of nonsense:

    The citizens that stood to defend it argued that states have a legitimate secular interest in subsidizing stable procreative relationships.

    Therefore, anyone wanting to claim taxpayer subsidies that is not in a presumptively procreative relationship is harming every individual taxpayers of the state, who should all therefor have legal standing.

    In that case marriages of anyone past childbearing years should be denied.  Men who have had vasectomies and women who have undergone tubal ligation or hysterectomy should not be permitted marriage.  If already married, those marriages should be invalidated.

    What a bunch of hogwash.  The "procreation" thing is SO much hogwash.

    Parent

    well... (none / 0) (#20)
    by CST on Fri Feb 25, 2011 at 12:07:04 PM EST
    you could also consider the fact that the "citizens and texpayers" of CA do not actually have standing to defend the amendment because it doesn't affect them in any way.

    It's an actual legal argument not just a political one.

    With the health care issue, people would have stnading because they would actually be affected by it.

    Not all political positions are equal under the law.

    "In law, standing or locus standi is the term for the ability of a party to demonstrate to the court sufficient connection to and harm from the law or action challenged to support that party's participation in the case"

    Link

    Parent

    OK CST (none / 0) (#21)
    by jbindc on Fri Feb 25, 2011 at 12:08:05 PM EST
    We apparently are on a roll today!

    Parent
    Who will defend it? (none / 0) (#16)
    by Big Tent Democrat on Fri Feb 25, 2011 at 11:27:41 AM EST
    I'm sure someone will.

    Depends on the case.

    Parent

    To be clear (none / 0) (#9)
    by Big Tent Democrat on Fri Feb 25, 2011 at 10:35:23 AM EST
    issues of the constitution are really politics in a courthouse, with some extra rules.

    The Supreme Court is just another political institution.

    Parent

    Read the comment policy (none / 0) (#27)
    by sj on Fri Feb 25, 2011 at 02:05:56 PM EST
    link to the right.  You're approaching "chatterer" status, if you're not already there.

    last i checked the constitution (just now), (none / 0) (#28)
    by cpinva on Fri Feb 25, 2011 at 03:09:11 PM EST
    nowhere is the executive branch required to defend laws passed by congress. it is required to enforce them, but not defend them, the two are not, by definition, mutually inclusive.

    please provide a link to the source of your asserted estimates:

    There are estimates that Uncompensated Care totals ~$36 billion per year.

    because my guess is that the number is higher than that. i'm guessing it also fails to take into account the opportunity cost of those of us, with actual medical emergencies, incur by sitting for hours in the ER, because 50% of ER patients aren't there for other than a cold. since they have no access to a regular dr., the ER is their regular dr. at my billable hour rate, that adds up to a lot.