Healthcare update

How can supporters of healthcare individual mandate make the constitutional case for their side?

The real difference between liberals and conservatives is that liberals admit that in the pursuit of a fairer and more equitable society, they make judgment calls about the balance between freedom and providing for the general welfare. Conservatives borrow the thoughtful anti-statism of their libertarian allies, right up until they endorse the coercive power of the state to manipulate Americans into doing everything from buying homes to getting married. They admit no contradictions between decrying the overreach of the federal government and demanding it prevent gays and lesbians from marrying or imitate Arizona's descent into a virtual police state. Their choices between adhering to free-market principles or deciding to provide for the general welfare far too often seems to hinge on which choice best enhances or preserves the power of an entrenched financial, religious, ethnic, or cultural hegemony.

...

"Liberals should take a page from the Tea Partiers and wave their pocket Constitutions around and ask, what part of regulating commerce between the states don't you understand?" Balkin says. "What part of tax and provide for the general welfare don't you understand?"

The phrases "necessary and proper" and "provide for the general welfare" might be somewhat disquieting to conservatives. But those phrases are as much a part of the Constitution as the "right of the People to keep and bear arms." The Constitution meant to grant "limited and enumerated powers" to the federal government actually grants some pretty broad ones. But that's exactly why, as former Supreme Court Justice David Souter has explained, constitutional interpretation is about the difficult task of reconciling the Constitution's conflicting values, not simply obtuse readings of the parts we like.

Top Spine Surgeons Reap Royalties, Medicare Bounty

Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.

The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.

Medtronic and the surgeons say the payments are mostly royalties they earned for helping the company design one of its best-selling spine products.

...

According to the Journal's analysis of Medicare claims, the procedure went from costing Medicare $343 million in 1997 to $2.24 billion in 2008. Adjusted for inflation, that's nearly a 400% increase. A large portion of that money flowed back to device makers, whose expensive implants eat up most of Medicare's reimbursement for the procedure.

Spinal implants became big profit generators for device makers. The screws used to drill into bone, known as pedicle screws, sell for $1,000 to $2,000 apiece but cost less than $100 to make. A bone-growth protein used to help vertebrae fuse can sell for more than $5,000 a pack, depending on the size.

"You can easily put $30,000 worth of hardware in a person during a fusion surgery," says Charles Rosen, a spine surgeon at the University of California, Irvine School of Medicine who created a group called the Association for Medical Ethics to combat what it sees as conflicts of interest in spine surgery.

Ezra Klein argues that the healthcare individual mandate makes all the difference. The whole thing is worth your time, so I'm not going to quote from it.

Another excellent column discussing the healthcare individual mandate.