By: Tamzin A. Rosenwasser, M.D.
While the supposed purpose of an exchange is to help consumers find the health insurance product that best meets their needs, such a product is not likely to be found there. Rather, the exchange will just offer a limited line of government-approved products—rather like a store that sells only various sizes of blue pajama-like garments in a totalitarian state.
The ObamaCare bill requires states to satisfy the Federal government that they are setting up these exchanges by 2013, or the Federal government will force the state to use a national exchange, created and run by the Federal government. In either case, insurance companies will be companies in name only, their directors, pawns of the government. A name for that type of arrangement is Fascism.
Regardless of which entity sets up the exchange, the Department of Health and Human Services is given power to determine minimum requirements for medical services of all kinds, including the people who provide the services, as well as what the patient pays. The head of the National Association of Insurance Commissioners task force on exchanges has called for banning the sale of individual insurance policies, possibly because these exchanges bring new complexities of security, integration, processing, updating and verifying information concerning eligibility, income, billing, and exemptions, among companies, states and state agencies, the IRS, Department of Health and Human Services, and the Social Security Administration, just to name some of the complexities.
Eligibility for ObamaCare’s health insurance subsidies depends on income, so there will be an intrusive verification of income, family size, smoking status, and so on.
The exchanges themselves cost tax money to set up, but the bill requires them to be self-sustaining. Since the bill mandates requirements that many companies and customers will likely find distasteful, the exchanges embody a fundamental instability, which nothing but force can resolve.
If ObamaCare persists, exchanges will be bureaucratic nightmares. If it is repealed or declared unconstitutional by the U.S. Supreme Court, states that set up exchanges will just have wasted time, money, and effort.
These are good reasons for not establishing exchanges, but there is another still more compelling. The sovereign states are not supposed to be agents of the federal government. It is properly the other way around.
The Articles of Confederation stipulated that each state retains its sovereignty, freedom, and independence. When the Constitutional Convention convened in 1787, to rework the Articles of Confederation, those sovereign states created the Federal government. The states do not, anywhere in the Constitution, surrender their sovereignty. In the Constitution, they merely delegate certain enumerated powers to the Congress, President, and courts.
The only reason the states created the Federal government was to be their agent in cases in which it would be more advantageous to have the states act in concert. Thus, the Federal government is properly subservient to the states in all matters in which they did not delegate powers to it. This relationship has been seriously disturbed in recent years, a reminder of Jefferson’s words that “The natural progress of things is for liberty to yield, and government to gain ground.”
Nowhere in the Constitution is government authorized or allowed to claim power over individual citizens’ medical care. Since medical care is an intensely personal thing, it does not lend itself to governmental direction, not even if the citizens are willing to allow themselves to be wards of the Government, from which they will devolve to being the equivalent of livestock on a government ranch, if government is allowed to intervene in their medical care.
It has been argued that the “necessary and proper” clause allows Congress to intervene in medical care, but that clause reads “…To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.” However, those powers are the enumerated powers, only, and they do not include overseeing the medical care of the sovereign citizens. The same restriction applies to the “General Welfare” clause in the preamble.