Mod parent up. "The science is settled" trope is *exactly* the kind of ridiculous appeal to authorities cherry picking that this article warns about. The fact that "natural warming deniers" don't understand that they've got more in common with creationists, geocentrists and hollow earthers is what we call "cognitive dissonance".
a similar effect is observed in a greenhouse- even when there's snow outside, tropical plants can stay warm inside because the glass on the ceiling allows light in and keeps the heat inside.
Real life greenhouses prevent convection, which traps heat. The absorption of radiation through the glass, and the release of radiation through the glass, is not what is causing the real life greenhouse to warm up.
I think what I was trying to say (not very artfully), was that the whole "a pressurized scuba tank only gets hot for a little while" isn't a refutation of PV=nRT. The fact that a scuba tank, under pressure, cools to room temperature, does not mean that any collection of gas (say an atmosphere), will cool to the temperature of outer space.
With roughly similar masses of atmospheres, and roughly similar volumes of atmospheres, the difference between Earth and Venus is characterized by differences in pressure, which lend to differences in temperature. For a scuba tank, the reason why there is higher pressure is because we've added more mass, not because we've added more temperature.
Actually, thinking about it more, let's look again at the compressed air tanks.
We start adding more gas, which increases "n" in PV=nRT.
"V" stays the same, and as we pour in more gas, although we get a small kick up in "T", what really changes on the left hand side of the equation is "P". As mentioned by rbrander, "T" eventually reaches equilibrium with the outside of the tank. The difference we made was with "P" and "n".
So on Venus, although PV=nRT can apply in general, it's not like we increased "P" by increasing "n" (like the compressed air tank) - what we have is a system in some sort of equilibrium between P and T (since the volume of the Venusian atmosphere isn't changing, and the "n" amount of gas in the atmosphere isn't changing).
Now, if someone wants to make an assertion that the Venusian atmospheric volume is changing, or that somehow the amount of gas in the volume of that atmosphere is increasing, I'm more than happy to look at any appropriate references that address that.
No, the more energy in a weather system, you can have *more* storms with less energy each, or you can have the *same* amount of storms with more energy, or you can even have *less* storms with even more energy each. The average energy tells you nothing about its distribution.
Take the compressed air tank analogy to Venus for a sec - at the higher pressures, there is more energy to be radiated, and the lapse rate only lets so much of that out. If it wasn't for a lapse rate, every planet's atmosphere would radiate heat away until it was the temperature of outer space, right?
Glad that wikipedia thing is working out for you, though:)
Since murder is pretty rare, and a murder rate increase is a fairly useless statistic (especially if the previous year was a particularly quiet one), you'd be better off thinking of it in terms like these:
The average lifespan doesn't matter -> what matters are local conditions and specific distributions. If one area has a lower lifespan because of infant mortality, that's very different than a lower lifespan due to chronic disease -> the interventions to address the two are *incredibly* different.
Assuming that because you know average lifespan has shortened or extended that you know *why* it has, and how to properly affect the average, is a belief system, not fact.
Define "natural level" of anything. The hubris of man, to imagine that anything he does is above nature, is immense.
But I'll give you one example - at one point in time, there was very little O2 in the atmosphere. Without O2, life as we know it would not have been possible:
Thanks to the dumping of O2 into the once pristine and oxygen poor biosphere, many many times the original "natural" level, we've got life on earth as we know it.
The whole globe doesn't matter -> what matters are local conditions and specific distributions. Nobody has ever been killed because the average cyclonic activity for a year was up by 2%. Plenty of people get killed by specific storms, even when average cyclonic activity for a year was down.
Now, you may believe that an increase in average global temperature is going to specifically cause more damaging weather events where humans are -> but that's a belief system, not a fact. Put more succinctly, even without any change in the average of global temperature, you can have certain distributions that are very damaging, and other distributions that are very benign. There is no evidence that an increase of average temperature must neccessarily create a more damaging distribution of weather events.
I'm not sure if I understand what you're saying about "guaranteed payout", and, FWIW, I've worked in the health insurance industry for 15 years.
Typically, you've got monthly premiums you pay for coverage, which can be capped on an annual basis (like a $1500 dental cap each year), with other caveats like co-pays (token dollars you pay when you get service or prescriptions), or deductibles (more signifiant dollars you pay, but after which, everything is 100% covered).
The typical drivers for a health insurance company are around reducing utilization. You can get this by having a very healthy population, or putting incentives in place to avoid utilization (like copays and deductibles). The ever dreaded fear is the "death spiral", where high utilization requires you to raise prices across the board to cover it, and the people that leave are the people who are healthier (lower utilization), causing you to raise prices more, etc, etc.
So what is the link between reducing utilization and care? Frankly, not much. On the whole, we give lip service to the idea that preventative care can spend pennies up front to save dollars in the long run, but much of the preventative advice we give, especially on diet, actually *causes* disease. More often, "preventative care" is really just "chronic care", where we blithely assume that the disease or condition isn't going away, and we look for the most cost-effective way to treat the symptoms from becoming acute. This may mean prescribing drugs to maintain cholesterol levels (although in reality, the drugs are really just anti-inflammatories and the cholesterol number is a red herring), and delaying an inevitable heart attack at the cost of some pretty dreadful side-effects. Ideally, it means that the inevitable heart attack is either mild and requires only limited treatment cost, or that the inevitable heart attack is instantly fatal and no costs are incurred.
In the end, though, we've avoided actually dealing with the root cause of the problem. We've developed a health care and health insurance industry which is driven on the one hand by disease (which doctors and drug manufacturers make money off of), and on the other hand by costs (which insurance companies want to limit in order to avoid the "death spiral"). Frankly, if my advice on lowering carbohydrate intake made any serious traction, a lot of health care and health insurance providers (doctors, nurses, actuaries, drug manufacturers) would lose their jobs. Health care providers would probably fare the worst as individuals (it's hard to pay back $300,000 in medical school loans if you can't get a job as a doctor), and health insurance providers would probably take the longest to unwind (the initial bump from reduced utilization would be a windfall for them, until costs got driven down so much that they couldn't justify their continued overhead and would have to downsize).
You've got a good point, but I'll make one slight correction -> we've really tied health *insurance* with employment. All too often, the conversation goes sideways because insurance != care.
I don't know what the complete answer is, but my assertion is that addressing the causes of poor health, even if in complete isolation to other reforms, is paramount. My current understanding is that the biggest lever for that issue is reversing the dietary guidelines we've held to for 40 years in the world's most unfortunate large scale health experiment.
You're right - we could create a retirement system that only started at age 110, or 10 years before anyone's expected lifespan is supposed to come to a close...but that's not where we are today.
I'm not sure exactly what the evidence is about productive octogenarians and above, but I'd bet it's an exception rather than a rule. Even in "perfect" health, with the "perfect" diet, the ravages of age cause all kinds of productivity problems.
Part of our problem here is our tendency towards intervention, and our basic "life-at-all-costs" philosophy. With the vast majority of medical expenditures happening at the end of life, with limited quality benefit, there are a *lot* of cases where it would be beneficial both the the individual, and to society, if people were simply allowed to die. Of course, we're not ready as a society to make that kind of philosophical change either:)
Good point - although the judge mentions the criteria for determining severability as including evaluating whether or not Congress would have enacted it without it, he sidesteps that one (though truth be told, I haven't read all 2000+ pages of the bill to know what else is dependent on Section 1501).
That all being said, it's a poison pill either way - if the individual mandate falls, and the other provisions are upheld, you're talking the economic destruction of the health insurance industry, more expensive health care, and a blowback that cannot be underestimated. What will be interesting is what the SCOTUS decides to do -> will they simply affirm his ruling, or will the go further on the severability argument and remand it back to his court with more instruction? It also opens up the "extensive expert testimony and significant supplementation of the record" avenue, for further litigation to get down to the details of what should and should not be severable.
Currently, the best we can do is to put it off for a while (which does help economically as well as putting a few more decent years on everyone).
Actually, chronic disease, which doesn't kill you, but make you dependent on all kinds of medical interventions, doesn't help economically at all, especially if the extra years are non-productive ones in retirement. Keep someone alive till they're 120, collecting social security, and you're talking a significant economic toll on society.
And not everyone suffers from eating a carb-heavy diet.
I'll grant that -> but everyone who has a weight problem does. The "never-fat" people may end up suffering other effects of insulin, like cancer, heart disease, diabetes, and alzheimers....and some people might be resistant to all of those deleterious effects. But planning a national diet based on the sturdiness of a very small percentage of the population is like telling everyone to do cocaine just because there are some people out there who aren't harmed by it's chronic use.
You make a good point though about the connection between corporate government influence, and the USDA dietary recommendations - big cereal and grain companies, corn farmers, diabetes drug makers, heart surgeons, and others in this chain of causality all have significant vested interests in pushing the dietary guidelines in a specific direction, whether or not it is backed up by the science.
The science is pretty clear - lots of protein, lots of fat, just a teeny bit of carbs, is the healthiest diet to eat. People have different flavors of it (paleo, atkins, etc), but the common factor here is signifiant carbohydrate reduction.
Now do we have the political will to get the government out of our diets? Probably not. Corn farmers get lots of subsidies and donate lots of money. But as more and more people learn that the very advice they thought was "healthy" is in fact the cause of chronic disease, maybe people on the grassroots level can make a difference.
Fair enough, the capriciousness of any given court cannot be underestimated. However, I think the lack of a severability clause here places the legislation in a particularly vulnerable position, and I believe it's a clear function of the amount of horse trading that was necessary to get the bill passed in the first place. For all the licks that Obama has taken for his incompetence both domestically and abroad, he did get ObamaCare passed, by hook or by crook, and he can be proud of that exercise of power, even if it costs in him 2012.
My bet, for those watching, is that it'll be 5-4 at the SCOTUS against ObamaCare, and when the whole law goes down the toilet, another few billion dollars will be spent undoing the computer programming necessary to support ObamaCare at your average HMO.
Let me also point out that the U.K. has an obesity/overweight ratio very similar to the USA, and they also have a national health care system that works.
I'm not sure if we can agree on that. Yes, they have a national health care system, but the UK has notorious problems. From the Daily Mail:
"Elderly patients are ‘parked’ in day rooms while waiting to be transferred to another hospital, and left ‘soiled and neglected’, and ‘needing fluids’. Sometimes spare beds run out – and people have to sleep on chairs or mattresses on the floor. Nearly half the nurses said patients in non-clinical areas did not have proper access to water, oxygen, suction and a call bell."
The problem here is that we're addressing *symptoms* not *causes*, but you bring up a valid point - *NO* health care system can survive ever increasing sickness amongst the population, be it a privatized one, or a government run one.
I think you're mistaken in your analysis of statutory construction. A severability clause is standard boilerplate added to legislation which protects the non-infringing parts of the legislation, if other parts are found unconstitutional. It's a signpost for legislators which clearly indicates that their vote is for any part of the bill, even if other parts are deemed unconstitutional. Without a severability clause, in general, the entire legislation succeeds or fails in its entirety.
In Buckley v. Valeo, the court stated, “Unless it is evident that the Legislature would not have enacted those provisions which are within its power, independently of that which is not, the invalid part may be dropped if what is left is fully operative as a law.” The horse trading required to get Obamacare passed is a pretty evident historical record that without the individual mandate, the legislature (or certainly a majority of the legislature at the time), would not have enacted it. It's not a question "do the new regulations require a mandate to function", the question is, "would the legislature have enacted those new regulations without the individual mandate". The prima facie answer to that is "no".
So what is wrong with universal health care? Every dumb idiot out there who isn't covered and seeing a doctor, is making me pay more out of my pocket. Because when they are sick enough, they all come to the hospital.
Well, your example is very well stated, but I think it might be a bit different if you considered it from a different angle.
The *real* problem here is people getting sick. People not paying for being sick (or costing more for being sick than they ever made), is a *symptom* of the problem, not the actually problem. Even in your alternative scenario, where Billy Bob gets preventative care, we've treated the *symptoms*, not the *causes* of his disease (and frankly, probably cost more in the long run, depending on the prescription costs).
If we want *real* health care reform, we need to start attacking the causes of disease, not the symptoms. Smoking, definitely one of them, but the real problem, the whole host of "diseases of civilization" based on diabetes (obesity, diabetes, heart disease, cancer and alzheimer's are all related), is actually exacerbated by our current federal dietary guidelines. The source of this problem is insulin, and it is made worse by the carbohydrate intake that is currently recommended by our government.
So right now, government is subsidizing corn production, telling us to eat more carbs which make us more sick, then subsidizing health insurance to take care of the sickness they created with their corn subsidies and poor dietary recommendations. Maybe if they just got out of the way things would be better.
I think the point people are trying to make here is that it is a *significant* qualifier, and that there is a qualitative difference between saying you need auto insurance only if you have a car on public roads, and saying that you need health insurance only if you're alive.
It comes down to choice, I believe -> people don't get to choose to be alive, but they do get to choose to drive cars on public roads. This distinction is *very* important, and glossing over it isn't helping your argument.
The problem is that the government recommendations on preventative care have been distinctly harmful to the population. Starting with the 1978 McGovern commission on dietary guidelines, we've been promoting a high-carb/low-fat diet to a population that is now suffering from record obesity, diabetes, heart disease, cancer, alzheimer's and other chronic diseases.
The government may have an incentive, but since they can't admit error for their recommendation of lots of carbs (oops, sorry, what we told you made you fat, unhealthy and die early!), they continue to ignore the evidence, and we continue to suffer as a nation. The terrible misapplication of the precautionary principle in terms of fat intake (which, with the exception of trans fats, are perfectly healthy for you), has caused a huge swath of unintended consequences, leading to higher and higher medical costs due to more and more sickness.
my central point to you is that if you do not have insurance, you are a freeloader
Isn't it more proper to say that if you do not pay for your own medical expenses, you are a freeloader? Insurance may be one way to pay for your own medical expenses, but it's not the only way.
FWIW, the reason why the medical system is broken in the USA is because of the terribly unhealthy advice we give for diet from the USDA. Our low-fat/high-carb dogma of the past 40 years has been the root cause of the epidemics of obesity, diabetes, heart disease, cancer, alzheimer's and other chronic diseases. You cannot fix the system until you start helping people get healthy, and that means a major overhaul of our standard dietary guidelines. Get people to start eating more fat and protein, and waaaay less carbohydrates, and you'll see a lot of the major medical costs simply disappear, instead of requiring more and more redistribution of risk.
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Mod parent up. "The science is settled" trope is *exactly* the kind of ridiculous appeal to authorities cherry picking that this article warns about. The fact that "natural warming deniers" don't understand that they've got more in common with creationists, geocentrists and hollow earthers is what we call "cognitive dissonance".
Real life greenhouses prevent convection, which traps heat. The absorption of radiation through the glass, and the release of radiation through the glass, is not what is causing the real life greenhouse to warm up.
I think what I was trying to say (not very artfully), was that the whole "a pressurized scuba tank only gets hot for a little while" isn't a refutation of PV=nRT. The fact that a scuba tank, under pressure, cools to room temperature, does not mean that any collection of gas (say an atmosphere), will cool to the temperature of outer space.
With roughly similar masses of atmospheres, and roughly similar volumes of atmospheres, the difference between Earth and Venus is characterized by differences in pressure, which lend to differences in temperature. For a scuba tank, the reason why there is higher pressure is because we've added more mass, not because we've added more temperature.
Actually, thinking about it more, let's look again at the compressed air tanks.
We start adding more gas, which increases "n" in PV=nRT.
"V" stays the same, and as we pour in more gas, although we get a small kick up in "T", what really changes on the left hand side of the equation is "P". As mentioned by rbrander, "T" eventually reaches equilibrium with the outside of the tank. The difference we made was with "P" and "n".
So on Venus, although PV=nRT can apply in general, it's not like we increased "P" by increasing "n" (like the compressed air tank) - what we have is a system in some sort of equilibrium between P and T (since the volume of the Venusian atmosphere isn't changing, and the "n" amount of gas in the atmosphere isn't changing).
Now, if someone wants to make an assertion that the Venusian atmospheric volume is changing, or that somehow the amount of gas in the volume of that atmosphere is increasing, I'm more than happy to look at any appropriate references that address that.
No, the more energy in a weather system, you can have *more* storms with less energy each, or you can have the *same* amount of storms with more energy, or you can even have *less* storms with even more energy each. The average energy tells you nothing about its distribution.
Hey, if you think you can stop the universe from changing, and prevent the next wave of evolution, more power to you! :)
Take the compressed air tank analogy to Venus for a sec - at the higher pressures, there is more energy to be radiated, and the lapse rate only lets so much of that out. If it wasn't for a lapse rate, every planet's atmosphere would radiate heat away until it was the temperature of outer space, right?
Glad that wikipedia thing is working out for you, though :)
Since murder is pretty rare, and a murder rate increase is a fairly useless statistic (especially if the previous year was a particularly quiet one), you'd be better off thinking of it in terms like these:
The average lifespan doesn't matter -> what matters are local conditions and specific distributions. If one area has a lower lifespan because of infant mortality, that's very different than a lower lifespan due to chronic disease -> the interventions to address the two are *incredibly* different.
Assuming that because you know average lifespan has shortened or extended that you know *why* it has, and how to properly affect the average, is a belief system, not fact.
Higher surface atmospheric pressure. PV = nRT.
Venus is hotter at the surface because of the atmospheric pressure, not because of CO2.
http://omniclimate.wordpress.com/2008/02/27/venus-cool-greenhouse/
Define "natural level" of anything. The hubris of man, to imagine that anything he does is above nature, is immense.
But I'll give you one example - at one point in time, there was very little O2 in the atmosphere. Without O2, life as we know it would not have been possible:
http://www.astrobio.net/exclusive/541/the-rise-of-oxygen
Thanks to the dumping of O2 into the once pristine and oxygen poor biosphere, many many times the original "natural" level, we've got life on earth as we know it.
The whole globe doesn't matter -> what matters are local conditions and specific distributions. Nobody has ever been killed because the average cyclonic activity for a year was up by 2%. Plenty of people get killed by specific storms, even when average cyclonic activity for a year was down.
Now, you may believe that an increase in average global temperature is going to specifically cause more damaging weather events where humans are -> but that's a belief system, not a fact. Put more succinctly, even without any change in the average of global temperature, you can have certain distributions that are very damaging, and other distributions that are very benign. There is no evidence that an increase of average temperature must neccessarily create a more damaging distribution of weather events.
I'm not sure if I understand what you're saying about "guaranteed payout", and, FWIW, I've worked in the health insurance industry for 15 years.
Typically, you've got monthly premiums you pay for coverage, which can be capped on an annual basis (like a $1500 dental cap each year), with other caveats like co-pays (token dollars you pay when you get service or prescriptions), or deductibles (more signifiant dollars you pay, but after which, everything is 100% covered).
The typical drivers for a health insurance company are around reducing utilization. You can get this by having a very healthy population, or putting incentives in place to avoid utilization (like copays and deductibles). The ever dreaded fear is the "death spiral", where high utilization requires you to raise prices across the board to cover it, and the people that leave are the people who are healthier (lower utilization), causing you to raise prices more, etc, etc.
So what is the link between reducing utilization and care? Frankly, not much. On the whole, we give lip service to the idea that preventative care can spend pennies up front to save dollars in the long run, but much of the preventative advice we give, especially on diet, actually *causes* disease. More often, "preventative care" is really just "chronic care", where we blithely assume that the disease or condition isn't going away, and we look for the most cost-effective way to treat the symptoms from becoming acute. This may mean prescribing drugs to maintain cholesterol levels (although in reality, the drugs are really just anti-inflammatories and the cholesterol number is a red herring), and delaying an inevitable heart attack at the cost of some pretty dreadful side-effects. Ideally, it means that the inevitable heart attack is either mild and requires only limited treatment cost, or that the inevitable heart attack is instantly fatal and no costs are incurred.
In the end, though, we've avoided actually dealing with the root cause of the problem. We've developed a health care and health insurance industry which is driven on the one hand by disease (which doctors and drug manufacturers make money off of), and on the other hand by costs (which insurance companies want to limit in order to avoid the "death spiral"). Frankly, if my advice on lowering carbohydrate intake made any serious traction, a lot of health care and health insurance providers (doctors, nurses, actuaries, drug manufacturers) would lose their jobs. Health care providers would probably fare the worst as individuals (it's hard to pay back $300,000 in medical school loans if you can't get a job as a doctor), and health insurance providers would probably take the longest to unwind (the initial bump from reduced utilization would be a windfall for them, until costs got driven down so much that they couldn't justify their continued overhead and would have to downsize).
You've got a good point, but I'll make one slight correction -> we've really tied health *insurance* with employment. All too often, the conversation goes sideways because insurance != care.
I don't know what the complete answer is, but my assertion is that addressing the causes of poor health, even if in complete isolation to other reforms, is paramount. My current understanding is that the biggest lever for that issue is reversing the dietary guidelines we've held to for 40 years in the world's most unfortunate large scale health experiment.
You're right - we could create a retirement system that only started at age 110, or 10 years before anyone's expected lifespan is supposed to come to a close...but that's not where we are today.
I'm not sure exactly what the evidence is about productive octogenarians and above, but I'd bet it's an exception rather than a rule. Even in "perfect" health, with the "perfect" diet, the ravages of age cause all kinds of productivity problems.
Part of our problem here is our tendency towards intervention, and our basic "life-at-all-costs" philosophy. With the vast majority of medical expenditures happening at the end of life, with limited quality benefit, there are a *lot* of cases where it would be beneficial both the the individual, and to society, if people were simply allowed to die. Of course, we're not ready as a society to make that kind of philosophical change either :)
Good point - although the judge mentions the criteria for determining severability as including evaluating whether or not Congress would have enacted it without it, he sidesteps that one (though truth be told, I haven't read all 2000+ pages of the bill to know what else is dependent on Section 1501).
That all being said, it's a poison pill either way - if the individual mandate falls, and the other provisions are upheld, you're talking the economic destruction of the health insurance industry, more expensive health care, and a blowback that cannot be underestimated. What will be interesting is what the SCOTUS decides to do -> will they simply affirm his ruling, or will the go further on the severability argument and remand it back to his court with more instruction? It also opens up the "extensive expert testimony and significant supplementation of the record" avenue, for further litigation to get down to the details of what should and should not be severable.
Actually, chronic disease, which doesn't kill you, but make you dependent on all kinds of medical interventions, doesn't help economically at all, especially if the extra years are non-productive ones in retirement. Keep someone alive till they're 120, collecting social security, and you're talking a significant economic toll on society.
I'll grant that -> but everyone who has a weight problem does. The "never-fat" people may end up suffering other effects of insulin, like cancer, heart disease, diabetes, and alzheimers....and some people might be resistant to all of those deleterious effects. But planning a national diet based on the sturdiness of a very small percentage of the population is like telling everyone to do cocaine just because there are some people out there who aren't harmed by it's chronic use.
You make a good point though about the connection between corporate government influence, and the USDA dietary recommendations - big cereal and grain companies, corn farmers, diabetes drug makers, heart surgeons, and others in this chain of causality all have significant vested interests in pushing the dietary guidelines in a specific direction, whether or not it is backed up by the science.
The science is pretty clear - lots of protein, lots of fat, just a teeny bit of carbs, is the healthiest diet to eat. People have different flavors of it (paleo, atkins, etc), but the common factor here is signifiant carbohydrate reduction.
Now do we have the political will to get the government out of our diets? Probably not. Corn farmers get lots of subsidies and donate lots of money. But as more and more people learn that the very advice they thought was "healthy" is in fact the cause of chronic disease, maybe people on the grassroots level can make a difference.
If you're interested, and you've got two hours, check out this lecture: http://webcast.berkeley.edu/event_details.php?webcastid=21216
Fair enough, the capriciousness of any given court cannot be underestimated. However, I think the lack of a severability clause here places the legislation in a particularly vulnerable position, and I believe it's a clear function of the amount of horse trading that was necessary to get the bill passed in the first place. For all the licks that Obama has taken for his incompetence both domestically and abroad, he did get ObamaCare passed, by hook or by crook, and he can be proud of that exercise of power, even if it costs in him 2012.
My bet, for those watching, is that it'll be 5-4 at the SCOTUS against ObamaCare, and when the whole law goes down the toilet, another few billion dollars will be spent undoing the computer programming necessary to support ObamaCare at your average HMO.
I'm not sure if we can agree on that. Yes, they have a national health care system, but the UK has notorious problems. From the Daily Mail:
"Elderly patients are ‘parked’ in day rooms while waiting to be transferred to another hospital, and left ‘soiled and neglected’, and ‘needing fluids’. Sometimes spare beds run out – and people have to sleep on chairs or mattresses on the floor. Nearly half the nurses said patients in non-clinical areas did not have proper access to water, oxygen, suction and a call bell."
The problem here is that we're addressing *symptoms* not *causes*, but you bring up a valid point - *NO* health care system can survive ever increasing sickness amongst the population, be it a privatized one, or a government run one.
I think you're mistaken in your analysis of statutory construction. A severability clause is standard boilerplate added to legislation which protects the non-infringing parts of the legislation, if other parts are found unconstitutional. It's a signpost for legislators which clearly indicates that their vote is for any part of the bill, even if other parts are deemed unconstitutional. Without a severability clause, in general, the entire legislation succeeds or fails in its entirety.
In Buckley v. Valeo, the court stated, “Unless it is evident that the Legislature would not have enacted those provisions which are within its power, independently of that which is not, the invalid part may be dropped if what is left is fully operative as a law.” The horse trading required to get Obamacare passed is a pretty evident historical record that without the individual mandate, the legislature (or certainly a majority of the legislature at the time), would not have enacted it. It's not a question "do the new regulations require a mandate to function", the question is, "would the legislature have enacted those new regulations without the individual mandate". The prima facie answer to that is "no".
Well, your example is very well stated, but I think it might be a bit different if you considered it from a different angle.
The *real* problem here is people getting sick. People not paying for being sick (or costing more for being sick than they ever made), is a *symptom* of the problem, not the actually problem. Even in your alternative scenario, where Billy Bob gets preventative care, we've treated the *symptoms*, not the *causes* of his disease (and frankly, probably cost more in the long run, depending on the prescription costs).
If we want *real* health care reform, we need to start attacking the causes of disease, not the symptoms. Smoking, definitely one of them, but the real problem, the whole host of "diseases of civilization" based on diabetes (obesity, diabetes, heart disease, cancer and alzheimer's are all related), is actually exacerbated by our current federal dietary guidelines. The source of this problem is insulin, and it is made worse by the carbohydrate intake that is currently recommended by our government.
So right now, government is subsidizing corn production, telling us to eat more carbs which make us more sick, then subsidizing health insurance to take care of the sickness they created with their corn subsidies and poor dietary recommendations. Maybe if they just got out of the way things would be better.
Check this video out for more details on the whole carbohydrate thing: http://webcast.berkeley.edu/event_details.php?webcastid=21216
I think the point people are trying to make here is that it is a *significant* qualifier, and that there is a qualitative difference between saying you need auto insurance only if you have a car on public roads, and saying that you need health insurance only if you're alive.
It comes down to choice, I believe -> people don't get to choose to be alive, but they do get to choose to drive cars on public roads. This distinction is *very* important, and glossing over it isn't helping your argument.
The problem is that the government recommendations on preventative care have been distinctly harmful to the population. Starting with the 1978 McGovern commission on dietary guidelines, we've been promoting a high-carb/low-fat diet to a population that is now suffering from record obesity, diabetes, heart disease, cancer, alzheimer's and other chronic diseases.
The government may have an incentive, but since they can't admit error for their recommendation of lots of carbs (oops, sorry, what we told you made you fat, unhealthy and die early!), they continue to ignore the evidence, and we continue to suffer as a nation. The terrible misapplication of the precautionary principle in terms of fat intake (which, with the exception of trans fats, are perfectly healthy for you), has caused a huge swath of unintended consequences, leading to higher and higher medical costs due to more and more sickness.
Stop eating carbohydrates. It's simple.
Isn't it more proper to say that if you do not pay for your own medical expenses, you are a freeloader? Insurance may be one way to pay for your own medical expenses, but it's not the only way.
FWIW, the reason why the medical system is broken in the USA is because of the terribly unhealthy advice we give for diet from the USDA. Our low-fat/high-carb dogma of the past 40 years has been the root cause of the epidemics of obesity, diabetes, heart disease, cancer, alzheimer's and other chronic diseases. You cannot fix the system until you start helping people get healthy, and that means a major overhaul of our standard dietary guidelines. Get people to start eating more fat and protein, and waaaay less carbohydrates, and you'll see a lot of the major medical costs simply disappear, instead of requiring more and more redistribution of risk.
The libertarian in me takes all three of those, and distills it down to:
A) Preserve individual liberty by protecting property rights.
Note, the government does not always do a very good job of this.