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corneille1640 says:
Thanks for the link. I’ll try to look over it, but I guarantee that I probably won’t read the whole thing.
I am aware that long pieces of legislation lack transparency we desire in our laws, and that is probably one reason you posted the link, along with the admonition to “Have Fun!” Still, legislation is sometimes complicated. And when it’s apparently simple, such as the Sherman Antitrust law, to name a random example, it elicits pages and pages of legal commentary and interpretations trying to figure out what the heck it means and how to enforce it. Of course, a long piece of legislation has the same dangers. I guess that’s how things work.
I suppose one is darned if one does and darned if one doesn’t. Perhaps the answer is to eschew most legislation. If that’s doable, great. If not, then I guess some pieces of legislation will have to be very long.
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October 21, 2009, 8:27 amMike says:
This is an issue where I agree with you libertarians: the law should be as simple as possible. I’m actually surprised the health care bill is *only* 1500 pages. It seems to take a hundred or so pages just to declare a holiday.
Here’s a question for a bunch of lawyers: is there limit in which the tax code becomes so complicated, that it becomes unconstitutional? (Especially given that the govt does not itself determine how much you owe on your behalf?) Of course the tax code is already very complicated, but I do not mean to imply it is anywhere close to such a limit. Yet if there is such a limit, I think it’s an interesting question as to how close we are.
[A loophole on behalf of the govt, I think, is if it is easy to *overpay* taxes by not taking advantage of specialized deductions etc, and it only becomes complicated if you wish to receive those deductions. Then in some sense you are opting to make your life more difficult, in exchange for the tax reduction.]
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October 21, 2009, 8:37 amJoe says:
It is not “the” health bill in that the one that will pass the Senate (put aside signed by the President) will be different in various ways. It is “the” Finance Committee bill.
And, what sort of type is that?
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October 21, 2009, 9:07 amOren says:
Of course, 1500 pages is just the length of the bill itself. To actually understand passages like this:
In order to makes heads or tails of what that does, you’ve got to grab your Internal Revenue Code, understand the structure of that whole statute, understand the function of Section 20.6213, then read the Social Security Act until you understand what Section 2238 of that does. Then you can try to understand what this paragraph of this bill does.
When you are done, you will have read much more than 1500 pages.
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October 21, 2009, 9:23 amProf. S. says:
If it were my full time job, with lifetime pension, and I was given a staff of individuals to assist me in the process (such as summarizing what each provision does vis-a-vis other laws), then I’d be willing to do so.
Since I am private business generating money that I then use to pay for others to do that, I will probabl not get around to doing it. I don’t hire someone to mow my lawn, just to go out and then mow it again for myself.
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October 21, 2009, 9:33 amu. saldin says:
Pretty chaotic on the Hill, it’ll be changing by the hour.
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October 21, 2009, 9:36 amMark Field says:
In the spirit of the post, nobody gets to comment on the substance of the bill until they affirm that they’ve read it.
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October 21, 2009, 9:48 amJimbino says:
I can’t see where the bill provides for health care of Amerikan expatriates. The bill does propose to tax us for health care but not to actually deliver any.
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October 21, 2009, 9:49 amTamerlane says:
Check here for an eventual summary:Library of Congress-Thomas Right now only the text of the Senate Bill is reported.
HR 3200 is already summarized.
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October 21, 2009, 10:08 amDavid Nieporent says:
The health care bill isn’t actually only 1500 pages. One of the health care bills is 1500 pages. Another is 900, and the Democrats are going to try to combine them into a final bill.
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October 21, 2009, 10:10 amyao says:
Adler did happen to notice how those pages were formatted, didn’t he? Once allowances are made for line-numbers, the bill has about 250,000 words — about the length of Harry Potter and the Order of the Phoenix.
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October 21, 2009, 10:11 amkdackson says:
And the result will be close to 5,000 pages.
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October 21, 2009, 10:33 amkdackson says:
Without the plot, charater development, or story.
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October 21, 2009, 10:34 amMartinned says:
Hey, look! Someone’s actually read it!
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October 21, 2009, 10:35 amJoseph Slater says:
yao: Adler did happen to notice how those pages were formatted, didn’t he? Once allowances are made for line-numbers, the bill has about 250,000 words – about the length of Harry Potter and the Order of the Phoenix.
Without the plot, charater development, or story.
But similar intense opposition from some corners of the political right-wing!
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October 21, 2009, 10:37 amJeffH says:
I don’t know that it would ever become unconstitutional. I do think we’re approaching a point where we need to reconsider one of the essential common law principles that underlies our legal system: Ignorance of the law is not a defense. That concept is based on the legal fiction that you know, or should know, all of the laws that effect you. I believe we are already to the point where it is literally impossible for the average American to know all of the laws and regulations they are subject to. Therefore this legal fiction no longer makes any sense.
I would suggest that every criminal law and regulation on the books should require either a mens rea element, or require that the government prove that you knew of the law or regulation. In practical terms, this would mean that any law or regulation that lacks criminal intent as an element would require a person to be warned on the first offense rather than criminally prosecuted.
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October 21, 2009, 10:39 amSteve says:
But where will the Democrats find their Todd Zywicki to testify, “There is no word that I would change in this particular piece of legislation”?
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October 21, 2009, 10:41 amPlanning And Democracy: Redux « ThinkMarkets says:
[...] (HT: Volokh Conspiracy) [...]
egd says:
And once the health bills are merged, amended, passed through the Senate, amended after being voted on, and combined with the House Bill through conference committee, the finished product will look nothing like this 1500 page document. Followed by possible Presidential signing statements that could come into play.
There’s really no chance to actually review what will be the final law. That’s why I would strongly support any Senator or Representative who promises to obstruct Congress as much as possible.
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October 21, 2009, 11:01 amSome dude says:
Don’t forget, you can vote against a bill without reading it, but if you are going to vote for it, you should know what it says.
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October 21, 2009, 11:05 amLee Peters says:
In Rush to Pass 1,500-Page Health Care Bill, Congress Accidentally Enacts Walton, Indiana, Yellow Pages Parody
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October 21, 2009, 11:15 amMike McDougal says:
I think we passed that point a long time ago with respect to many federal statutory schemes.
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October 21, 2009, 11:28 amDjDiverDan says:
Just looking at the provisions imposing an excise tax on so-called “Cadillac Plans” demonstrates that the Senate (or at least the Democratic side) is populated with idiots. Under the Bill, any Insurance Plan which costs more than $8,000 per year for an individual is a “Cadillac Plan”, subject to a 40% excise tax. Any low-level moron, except, apparently, Democratic Senators, knows that health insurance plans are priced based upon age and health conditions, but this $8,000 annual trigger is a one-size fits all provision. Granted, $8,000 per year will buy a healthy 25 year-old who doesn’t smoke and has no preexisting conditions one-hell of a lot of insurance. But I’m nearly 60, overweight, with diabetes, high blood pressure, high cholesterol, and only one kidney (the other was removed because of cancer), and my middle-of the road plan costs over $9600 per year. An $8,000 annual limit will force me to a very high deductible, high co-payment, low coverage plan, while the 40% excise tax may well force me into the group of uninsureds that the so-called “Reform” effort is allegedly trying to decrease. Given the market realities of health insurance, the very fact that the Dems drafted a “one-size fits all” trigger for this ridiculous excise tax more than adequately demonstrates to my satisfaction that the Bill was very poorly though out. Is there any way we can replace the Senate with a very large number of Monkeys with Typewriters, which is almost certain to produce a better bill?
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October 21, 2009, 11:29 amMark Buehner says:
The key thing to remember is that they won’t be posting anything that will be voted on. Ergo, anything that is posted is a waste of time.
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October 21, 2009, 11:35 amMark Buehner says:
Dems will jump through any hoops necessary to avoid admitting that this hugely expensive plan is hugely expensive. If that means achieving exactly the opposite of the results everyone claims they are looking for, so be it. This bill guarantees that almost everyone’s premiums will go up, many people’s taxes will go up, and only a modest amount more uninsured will be covered.
Oh– and due perverse incentives, anyone young and healthy would be a fool to buy insurance until they get sick, at which point the insurance companies will be forced to cover them. See how that affects the premiums. A more suspicious person might suggest Congress was intentionally trying to jack up premiums to hurt insurance companies as a road to single payer. Oh wait, half the democrats admitted as much. I guess we’re the rubes.
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October 21, 2009, 11:40 amDjDiverDan says:
Just to clarify, the “one-size fits all” trigger for the 40% excise on so-called “cadillac plans” is subject to upward adjustment for:(a) retirees over 55 (no, I’m not yet retired); and (2) certain “high-risk” professionals (which doesn’t help me. So basically, anyone over 55 and in relatively poor health who buys his own insurance, and is not yet ready to retire, will be screwed. All this at the same time that the Medicare Program which he or she will have to count on after he or she reaches 65 is going to be substantially cut — perhaps to the point where no doctor will accept Medicare patients.
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October 21, 2009, 11:42 amMartinned says:
I don’t know about unconstitutional, but I think it is a fundamental principle of law that the law should be capable of being read by (the vast majority of) the people. (For the difference between constitutional and fundamental principle, cf. last week’s Audiolux ruling.) However, technically, the common law system starts from the premise that law is something unwritten that can be “discovered” by judges, including legally binding customs. (Which is why I found nothing when I quickly checked the basic principles of Roman law.)
This, of course, still implies that the law is something that is capable of being understood by the people.
However, I think there is a flaw in your argument. Taking the length of the tax code as a measure is arbitrary. Why not the entire US Code? How long are the 50 chapters combined? (I know the 35 “chapters” of the Acquis Communautaire, the much maligned full body of the law of the European Union, combine to about 85.000 pages.) Alternatively, why not talk about taxes one at a time? That would certainly reduce the page count.
Similarly, the reason why these Health Care bills are so long is because they try to do the whole thing at once. In other countries, they might start with a framework act, which sets up the general structure of the scheme, and then enact further laws to take care of the details (or delegate the power to do so). The final result may be the same, but the complexity of the task for the legislature is much lower. At what level do you do the page count?
Still, it is certainly true that there is a limit somewhere where the writing is no longer English, but instead just unintelligible jibrish, which can’t possibly be law. Fortunately for the legal profession, there is a grey area inbetween where all laws are written in unintelligible jargon, meaning that they can only be written by lawyers for the purpose of being used by other lawyers. (= $$$)
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October 21, 2009, 11:44 amOren says:
And every section of every statute that it amends, plus whatever definitions and overview of said statute are necessary to understand the operational effect of that amendment.
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October 21, 2009, 11:45 amsecond history says:
Tamerlane says:
Check here for an eventual summary:Library of Congress-Thomas Right now only the text of the Senate Bill is reported.
HR 3200 is already summarized.
Reading the summary is cheating, and the summary will inevitably leave the details out. Read the bill!
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October 21, 2009, 11:52 amDishman says:
DjDiverDan wrote:
Your early retirement will help reduce the reported unemployment rate by removing you from the workforce.
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October 21, 2009, 11:58 amSteve says:
So basically, anyone over 55 and in relatively poor health who buys his own insurance, and is not yet ready to retire, will be screwed.
The excise tax doesn’t apply to people who buy insurance in the individual market. See Section 4980I(d) of the bill.
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October 21, 2009, 12:14 pmkdackson says:
See, we have at least two people reading the bill, and they cannot come to a consensus on what it says.
Perhaps it should be renamed “The Lawyer’s Job Security Act of 2009″.
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October 21, 2009, 12:24 pmRichard Nieporent says:
yao: Adler did happen to notice how those pages were formatted, didn’t he? Once allowances are made for line-numbers, the bill has about 250,000 words – about the length of Harry Potter and the Order of the Phoenix.
Without the plot, charater development, or story.
But much more frightening!
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October 21, 2009, 12:37 pmdana says:
This is an emotional issue for many Americans. This so-called “public option” in Government run health care presents serious challenges for us. As Consumers we should be able to compare the cost and quality of health care services. How much is a specific surgery at one hospital, as compared with another? http://www.friendsoftheuschamber.com/media/
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October 21, 2009, 12:51 pmMartinned says:
Don’t even get me started on that one. I’m sure any half-decent accountant could come up with a half dozen answers if properly motivated. It just depends on your assumptions, on what you include where and how.
Besides, why does the price of a surgery matter to a consumer? Isn’t the point of insurance that you don’t have to worry about the prices of individual medical procedures?
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October 21, 2009, 1:01 pmMark Buehner says:
That has become the point. The point of insurance traditionally is to provide for a rainy day emergency. Since we treat insurance as our first line of defense instead of last, there is no incentive for the consumer to limit or drive down prices (to the contrary, you’ve ‘paid’ for your insurance so the consumer is more likely to use it as much as possible). Finding ways to give the consumer skin in the game of which provider to use, when, where, and why is the most important way to reduce healthcare costs. What is being considered now does the opposite– it disallows the kind of catastrophic coverage plan that create these kinds of downward price pressures by putting consumers in the market with the checkbook.
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October 21, 2009, 1:13 pmMartinned says:
I’m not sure where you got that idea. Both under the current system in the US and under any proposed alternative, it is the insurance companies who are supposed to “limit or drive down prices”, since they are the ones “with the checkbook”.
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October 21, 2009, 1:27 pmMark Buehner says:
As I said– that is the current system. That doesn’t make it rational. And there have been lots of proposals to go in that direction– health savings account being a great one. Current congressional bills make savings accounts and catastrophic plans subject to a fine. Instead of giving them the tax advantages the current system enjoy, we are killing them. In other words, people are frustrated that the insurance companies are responsible for controlling costs so now we are going to make the government responsible (with their amazing track record at controlling costs). There IS another way, the fact that it has been ignored (along with any other ‘non-existent’ republican solutions) doesn’t mean its not a possibility, or at least a piece of the puzzle.
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October 21, 2009, 1:31 pmTamerlane says:
I assume that either you’re spoofing or you are unfamiliar with what any piece of legislation amending the USC looks like. For one to read the bill itself with comprehension would essentially require that one memorize all aspects of the USC amended by the legislation as well as have an intimate familiarity with the judicial history of these sections.
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October 21, 2009, 1:34 pmSG says:
Both under the current system in the US and under any proposed alternative, it is the insurance companies who are supposed to “limit or drive down prices”, since they are the ones “with the checkbook”.
Exactly, which is why the current system is experiencing runaway costs and why no proposed alternative will do anything to rein in those costs.
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October 21, 2009, 1:49 pmMartinned says:
So in your analysis capitalism isn’t working here? After all, insurance companies have an incentive to drive down medical costs, so if they’re not trying to do that, what’s wrong?
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October 21, 2009, 2:02 pmMark Buehner says:
“Capitalism”, sure. Its capitalism that set up the scheme heavily favoring companies to provide health insurance in exchange for tax rebates. Its capitalism that doesnt let insurance companies compete over state lines. Its capitalism that is about to outlaw catastrophic plans.
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October 21, 2009, 2:06 pmBruce Hayden says:
Interesting that we can get arguments that insurance companies are supposed to be driving down costs because they have the checkbook, and that they make their obscene profits by denying coverage. Seems to me that you can’t have it both ways.
But, as the later posters have pointed out, the basic problem today with health care costs and health care insurance is that the consumers are the ones who can best save money, and they need to have incentives to do so. I, along apparently with a lot of others here, have an HSA that does a good job of that — and our HSAs with their high deductibles are on the way out, if this legislation passes.
If we leave the decisions to the government, or even the insurance companies, then the decisions of where to spend money on healthcare will be made in a one-size-fits-all, best for the entire population manner. Which might be fine, except that these decisions would be subject to politics, and we are already seeing the effects, with companies paying millions in lobbying costs to get Medicare approval of their products or services (I have a client flying to D.C. tomorrow for just this reason — trying to get Medicare approval of her company’s product).
There are really only two ways to limit demand. Either do it through price, which is countered by low or no co-pays, yearly limits, etc., or do it through rationing. HSAs and high deductible insurance plans do a good job based on price, which is why it is absurd that they are being effectively eliminated.
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October 21, 2009, 2:14 pmMartinned says:
OK, so maybe “capitalism” was too vague a word to use. But still, whatever the merit of the restrictions you list, ordinary economic logic suggests that insurance companies should work to drive down the costs of health care, no matter how much market power they have, since they’re the ones stuck with the bill. So are they, or aren’t they? And if not, why not?
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October 21, 2009, 2:16 pmSG says:
So in your analysis capitalism isn’t working here?
Capitalism is working. People demand more services, costs go up. The problem is that people don’t like paying high prices or being denied service, which is why there’s a constant search for someone with deeper pockets — hence the desire to get the government to pay for it.
After all, insurance companies have an incentive to drive down medical costs, so if they’re not trying to do that, what’s wrong?
No, insurance companies have a desire to make a profit. They alienate customers by denying claims, they alienate them less by raising premiums. Either one works from an insurance company standpoint. Hence, costs rise.
Also, don’t forget that HMO’s were fairly successful in containing costs, but people didn’t like the rationing aspect so they agitate for laws to be passed (patient’s bill of rights and the like) that rendered HMOs untenable.
If you want costs to drop, people need greater exposure to them. Right now most people are two levels removed from the cost of their medical care (insurance company contracted by their employer). There are no real incentives for individuals to self-ration their care. This doesn’t need to be the case, (HSAs, high-deductible catastrophic insurance, etc), but the current tax laws actively discourage this approach. And it would be a larger cultural change.
That you manage to observe a system without proper incentives that has been created by governmental tax policy that dates back to governmental wage freezes and find an indictment of captialism say a lot more about you than it does about the problem.
None of which to say that a more properly capitalistic health care system would be without flaws — only that the flaws would not have all of the same ones we’re seeing now. There needs to be reform, but the current proposals just exacerbate the problem.
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October 21, 2009, 2:23 pmMartinned says:
Sure you can: For a given insurance premium, the insurance company makes more money if it: a) drives down the costs of care or b) covers as little as possible.
Agreed, except that consumers don’t have the knowledge to take an informed decision, while they usually lack the funds to completely self-insure as well.
- consumers have autonomy (i.e. the moral right to decide what is done to them by whom), but not enough money to cover most serious procedures, nor the knowledge about medicine necessary to take an informed decision.
- insurance companies have the money, but lack the moral right to make all decisions, not to mention the detailed knowledge about what is wrong with the patient.
- docters have the knowledge, but lack the money (how cool would that be: flat fee family medicine or sth.), and should not take the decisions because they lack the moral right to and in any case are the ones who benefit from doing and prescribing too much.
Three groups (patients, docters and insurers) and three questions (Who decides? Who pays? Who knows?). My humble diagnosis is that there is no way to sort this out that is even remotely efficient. It just can’t be done. (Even apart from Baumol’s Cost disease.)
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October 21, 2009, 2:24 pmSG says:
since [insurance companies are] the ones stuck with the bill.
No, they’re not. They aggregate the bills and then pass them on in premiums. And those premiums keep rising. It’s more profitable to pass on the costs on than it is to draw a hard line on care rationing.
Now, eventually it’s likely to reach a point where the rate hikes cost more clients than the attempting to draw a hard line on claims does, but it appears we haven’t hit that point yet.
There’s no gotcha moment here, no matter how much you wish there to be one.
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October 21, 2009, 2:27 pmMark Buehner says:
Don’t forget tort reform and its effect on defensive medicine.
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October 21, 2009, 2:32 pmJeffH says:
Insurance companies have little incentive to keep prices low, because most consumers of health insurance don’t pay directly for the cost of that insurance. It’s paid for by their employer, or by the government, or it’s subsidized by tax breaks. Very few people actually shop for and buy their own insurance coverage.
That’s one of the reasons why removing the incentives to purchase insurnace through your employer is a good way to reduce costs. Encouraging people to pay-as-you-go for routine health care, and carrying only catastrophic insurance coverage, would be another way to go. The current proposals move in the opposite direction.
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October 21, 2009, 2:34 pmThe Unbeliever says:
But with all the escapism, hocus-pocus, and magical hand waving of the entire series!
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October 21, 2009, 2:46 pmMark Buehner says:
Somebody today already made the comparison of the MSM with Rita Scribner and the Daily Prophet compared to Fox News as The Quibbler. I laughed. Cant recall where I saw it though.
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October 21, 2009, 3:02 pmHey Skipper says:
SG for president.
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October 21, 2009, 3:32 pmsilverpie says:
Yikes! I’m terrified just from the headline of that section. “Treatment... as mathematical error” is the language the Internal Revenue Code uses to mean “If you do this, we can ‘correct’ what you did without any form of due process.”
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October 21, 2009, 4:13 pmJPG says:
Lets not forget insurance companies are not the only players at stake. The more uninsured patients requiring treatments there are, the greater the chances hospital bills will end up not being paid. Hospitals are then left with no choice but to over charge those who actually pay their bills. All in all, it is not necessarily in a specific insurance company’s interest to insure everyone, for it increases the likeliest they will have to insure unhealthier customers. Ironically, the collective interest of these companies is to make sure everyone’s insured in order to keep the costs as low as possible, but their specific interest stands elsewhere.
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October 21, 2009, 4:15 pmMark Buehner says:
Same goes for the government underpaying medicare. It gets passed on to the insurance folks, who have to measure accepting the bill with pissing off their customer(and ultimately ending up in front of some jackass congressman reading them the riot act). The reason insurance companies deny claims as often as they do is because they are playing a constant game of chicken with providers. If they were to take every upcharge and test without question they would be out of business in a hurry. There are just too many costs being shifted in too many directions, and amazingly its about to get worse.
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October 21, 2009, 4:24 pmEli Rabett says:
Insurance companies have an incentive to increase medical costs, they live off a percentage of the turnover.
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October 21, 2009, 4:33 pmConnie says:
Well, because there is no single price for a specific surgery at one hospital. Call your local hospital, ask how much for a knee replacement. They won’t tell you the price till you tell them what insurance you have. The price is not the price. And even when you do coax a number from them, it won’t be the whole price: the surgeon, the anesthesiologist, the drugs, the follow up therapy, the durable medical equipment, etc. are all billed separately. And afterwards, you (and the insurance company) are likely to be billed something very different from the quote.
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October 21, 2009, 10:32 pmReal American says:
All the more reason to wait and take the time to fully analyze what’s actually in this monstrosity, rather than ramming it down the throats of Americans who want nothing to do with it.
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October 21, 2009, 11:27 pmAnonymoose says:
Here’s virtually the same thing, in plain English, and about 1250 pages shorter: http://finance.senate.gov/sitepages/leg/LEG%202009/100209_Americas_Healthy_Future_Act_AMENDED.pdf
I’m not sure if that’s considered cheating, though.
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October 22, 2009, 6:52 amgullyborg says:
But... it makes no mention of deep sea fishing rights!
(bonus if you know what I am referencing — no looking it up — honor system)
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October 22, 2009, 4:12 pmMaguire says:
We really need to start facing the issue of expenditures in health care. In the words of Dr. Eva Mor, “The administration of the existing health delivery system is bloated with waste and unnecessary cost. If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives.” http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107
Money needs to be spent no matter what, if we are to get the health care system back on track. Finding a way to get literally affordable insurance to ever American is just another piece of the puzzle over time. Future generations deserve something better.
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November 12, 2009, 5:05 pmmaguire says:
There are so many aspects of this plan that the politicians keep overlooking though. The medical industry is wrought with overspending and has gone for too long without any regulation or oversight. Insurance premiums have gone up 138% for a reason and it isn’t simply corporate greed.
Private insurance companies are a part of the problem, yes. When regarding health, private insurance never should have been allowed to be profitable business in the first place. For-profit insurance means requires a need to make money and inevitably that is going to affect the quality of the insurance that people are getting from the company. Companies don’t want to spend money on an individual so they will take whatever measures necessary to ensure they don’t have to. But the medical industry has been profiting all along as well. Procedural costs, visits, even x-rays cost varying amounts state to state, city to city and practitioners are being bounced around by pharmaceutical companies to try and make money while waiting a year or more for the insurance companies to pay up.
This may be why the US was ranked #37 according to the World Health Organization. http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107
Either health care needs to become a single unit in which there are no privatized barriers or we find a way to actually bring health care back to a fair free market based standing. The entire industry is wrought with greed from every angle, physicians hiking costs, pharmaceutical companies giving incentives for pushing their products, lobbyists paid to benefit insurance companies, lobbyists paid to benefit pharmaceutical interests. Where do we draw the line? Health care has had nothing to do with actual care for well beyond two decades.
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December 19, 2009, 2:14 pm