Q&A On Today's Obamacare Supreme Court Decision

Tyler Durden's picture

In about an hour, the US Supreme Court, three years after Chrysler, is about to have a profound impact on Wall Street one more time. As Goldman explains, the court is expected to release some of the final opinions of the current session, which ends this week. Rulings on the Affordable Care Act (ACA) as well as the Arizona immigration law are likely to capture the greatest amount of attention. With a number of opinions to get out, it is possible the court could wait until later this week (possibly Thursday, June 28) to release some of the remaining rulings for this term, though the court has not yet announced any additional dates for the release of opinions. Trading in the online prediction market intrade.com implies a 74% probability that the court will find the mandate unconstitutional; prior to the oral arguments in March, it implied only around a 35% probability the court would rule against the mandate. Goldman believes that the outcome is fairly unpredictable and that many market participants probably are relying too heavily on the oral arguments in trying to predict the outcome of the case.

For those curious what the long-term implications of today's ruling are, here is a complete Q&A from Goldman:

Q&A on the Upcoming Supreme Court Health Reform Decision

  • The US Supreme Court appears poised to rule on the health reform legislation enacted in 2010, the Affordable Care Act (ACA). The court has three basic options: (1) uphold the entire law; (2) strike only the aspects of the law that were under review--the individual coverage mandate or the Medicaid expansion, or (3) strike the entire law.
  • If the court strikes the key components of the law that are under review, it is unlikely that Congress will act quickly to "repair" the court's action. Such a ruling would reduce net federal spending by more than $300bn over the next ten years, and in the current fiscal environment lawmakers are less likely to want to allocate those funds to coverage expansion than they were when the law was originally enacted.
  • The court's decision, whatever it may be, should have a fairly modest effect on fiscal policy for 2013. Of the $600bn or so in policy changes that comprise the fiscal cliff, less than $50bn (0.3% of GDP) were enacted under the ACA and this fiscal restraint would only be removed if the entire law were struck down, which in our view seems less likely than the other outcomes.

Q: What does the health reform law do?

A: It provides new insurance subsidies, financed by Medicare spending cuts and tax increases. The Affordable Care Act (ACA) expands insurance coverage mainly through (1) an expansion of the existing Medicaid program for the low-income population and (2) new subsidies available through insurance "exchanges" that the law would establish in each state to facilitate enrollment in plans offered by insurance companies. To cover the cost of this expansion, the law established new taxes on individuals and several sectors of the health care industry, limited health-related tax preferences, and reduced Medicare payments to health care providers and insurers. The law also included several regulatory reforms meant to increase coverage and/or health system efficiency. The chart below shows the main components of the law, organized by the average fiscal effect from 2014 to 2019, as a share of GDP.

Q: What is the Supreme Court ruling on?

A: The court heard arguments on four questions:

  1. The individual mandate. The court is considering whether Congress exceeded its powers in mandating that virtually every individual obtain health insurance. The ACA requires most individuals to obtain insurance that meets minimum standards. Beginning in 2014, individuals who fail to obtain insurance must pay a monetary penalty (set at the greater of roughly $700 or 2.5% of income, once fully phased in). The mandate was enacted to expand the insurance risk pool to include individuals who receive uncompensated health care and, in particular, healthy individuals who might otherwise intentionally decline coverage. Several other aspects of the law either directly or indirectly relate to the coverage mandate, including a "guaranteed issue" requirement, which compels insurers to provide coverage to any eligible applicant regardless of health status and "community rating," which limits insurers' ability to price premiums based on the health risk of the applicant.
  2. Medicaid expansion. A group of states has asked the Supreme Court to invalidate the expansion of the Medicaid program on grounds that Congress has unconstitutionally coerced States into accepting conditions of the new law by threatening to withhold all federal funding for Medicaid (the largest source of federal funding for states) if they do not.
  3. Severability. If the court finds parts of the law unconstitutional, it must then also decide whether those aspects can be severed from the rest of the law, which would remain intact, or whether the entire law should be struck down. The most obvious provisions that are linked to the areas under review are the guaranteed issue and community rating requirements described above, which many view as inextricably linked to the individual coverage mandate.
  4. Whether the challenge to the mandate is barred by the Anti-Injunction Act. This is a technical question dealing with whether the court may hear a case related to a tax before the tax has actually been levied, but it could serve as a basis to delay a ruling until 2014, when the coverage mandate takes effect.

Q: When will it make its decision?

A: Most observers expect a decision the week of June 25. The ruling could come at any point, but there are two constraints on the timing. First, the court normally issues opinions on Mondays and Thursdays. Second, the court's session is scheduled to end the week of June 25. Some opinions are expected to be released this Thursday, June 21, but most observers expect the court to wait until the very end of its session, with June 25 or June 28 the most likely dates for the court to rule on the ACA.

Q: How will the court rule?

A: Anything is possible, but it looks like a close call between upholding the entire law and striking parts of it. Market participants appear to have more conviction in the likely outcome than one would expect in light of the fact that (1) most of the commentary over the last two months has been based on a few hours of oral arguments, (2) the consensus view shifted dramatically following the arguments, implying that the market has a limited ability to handicap judicial outcomes, and (3) the court is known for an absence of leaks prior to rulings so no new information has come to light since the arguments were held in late March. Despite this seemingly uncertain situation, trading in the online prediction market intrade.com implies roughly a 75% probability that the individual mandate will be struck down, up from 35% or so prior to the oral arguments and 55% about a month ago.

The ruling is likely to take one of three directions:

  1. Uphold the law in its entirety. The court could opt to leave the law unchanged. Questioning from the justices during oral arguments suggests that four of the nine justices--Breyer, Ginsburg, Kagan, and Sotomayor--might lean in this direction. Chief Justice Roberts and Justice Kennedy are seen as swing votes, while the remaining justices--Alito, Scalia, and Thomas--are generally expected to support striking down at least some parts of the law.
  2. Strike parts of the law while leaving the rest intact. It is possible that the court could decide to strike the mandate on individuals to obtain insurance and the expansion of the Medicaid program while leaving the broader law in place. A ruling against the Medicaid expansion could strike that provision from law entirely, but during oral arguments the possibility was raised of making participation in the Medicaid expansion voluntary for states as a constitutional remedy, which would stop short of completely striking the expansion. While some justices appeared to question the constitutionality of the Medicaid expansion, it seems more likely that the expansion will be upheld. The outcome regarding the individual coverage mandate is much less certain. As noted above, Justices Kennedy and Roberts appear likely to be the swing votes, but how they will rule on this issue is difficult to predict. In our view, the likelihood that the mandate will be struck down is lower than the 75% probability implied by prediction markets and is essentially a 50/50 proposition. If the mandate is struck down, the court must also decide whether to strike down the related insurance underwriting rules as well. This seems fairly likely, since several justices acknowledged the important linkage among them, and opponents of the law as well as the Obama Administration have asked that the court strike those related rules if they strike down the mandate.
  3. Strike the entire law. While certainly possible, this appears to be a less likely outcome than upholding the mandate or striking only part of the law. Some justices who appear likely to find parts of the law unconstitutional still appear to have doubts about striking the entire statute. For instance, Justice Scalia noted that "it can't be right" that the various provisions unrelated to the mandate had to fall with it, though at one point he nevertheless noted the possibility that they might have to be. Although Congress could in theory revisit the law following a court decision, justices across the ideological spectrum appeared to hold little hope that they would be able to do so.

While most commentary on the court's upcoming ruling presents these decisions as binary questions, it is also important to note that the court could split its ruling in several different ways, and while it seems unlikely following the oral arguments, it is even possible that the court could delay a decision until 2014, citing the Anti-Injunction Act noted above.

Q: If the mandate alone is struck down, how would this affect the financing of health benefits?

A: Public costs would decrease in the medium term but would also become more uncertain. If the mandate is struck down but the related insurance underwriting rules are left standing, fewer healthier individuals would purchase coverage than if the mandate were implemented. Private-sector insurance plans would be unable to turn applicants away despite pre-existing health conditions and could not price premiums according to health risk. This would be very likely to lead to an increase in health insurance premiums, which would make it even less likely that healthy individuals would enroll, thereby increasing premiums again and further reducing demand for insurance among the healthy. While there is general agreement that insurance premiums would rise under such a scenario, there is much more uncertainty regarding where this process would find equilibrium. The Congressional Budget Office estimates that non-group policies (i.e., policies purchased through newly created insurance "exchanges" or in the traditional non-group market) would increase by 15% to 20% compared with a scenario in which the mandate were fully implemented. Per-capita costs in Medicaid might also rise, though net spending in that program would also fall due to lower enrollment.

The upshot, according to CBO, is that lower enrollment at a higher per-enrollee cost would reduce net federal spending by roughly 0.16pp of GDP from 2014 (when the mandate and related provisions are scheduled to take effect), or over $300bn over the 2014 to 2022 period. If the mandate and the related underwriting rules were struck down, the reduction in net federal spending might be slightly greater, since without guaranteed access to insurance, even fewer individuals would take up the new federal subsidies.

Q: If the law is partly or entirely struck down, will a new law be enacted to replace it?

A: Not quickly and quite possibly not at all. Congress seems unlikely to quickly intervene to "repair" whatever changes the Supreme Court might order. The most important obstacle is political--the original law was passed when Democrats held the White House and both chambers of Congress, including a 60-seat majority in the Senate for most of the time the legislation was considered. This allowed them to make policy changes beyond the scope of what appears likely in the foreseeable future, when neither party appears likely to have much more than a slim majority in either chamber of Congress and a divided government is very possible. A second obstacle is fiscal--if the court strikes the mandate or even the entire law, it seems likely that lawmakers will be more interested in deficit reduction and less focused on coverage expansion than they were when the legislation was first drafted in 2009.

Q: If the court's decision reduces estimated spending, can Congress "spend" those funds on something else?

A: Not officially. Lawmakers have struggled since last year to find budgetary savings to offset the cost of new legislation and to match deficit reduction with increases in the debt limit, as was done in last year's Budget Control Act (BCA) and which House Speaker Boehner has recently proposed for the next debt limit increase. The pressure to find savings will become more intense later this year, as the debt limit approaches and Congress works to avoid, or at least reduce, the "fiscal cliff" at year end. Although the court's decision could reduce the deficit by more than $300bn over the next ten years (if it strikes the mandate or the Medicaid expansion but leaves in place the spending cuts and taxes used to finance them) Congress is unlikely to be able to use those savings to offset new spending or tax relief. Unofficially, however, it would not be surprising to see some lawmakers attempt to use a budgetary windfall created by the Supreme Court to justify delay of the scheduled spending cuts at year end (i.e., the "sequester").

Q: Is there a scenario in which a ruling would increase the projected deficit?

A: Yes, if the entire law were struck. However, the increase in the projected budget deficit would probably be fairly modest. In the next decade (i.e., from 2020), CBO has estimated the law would reduce the federal budget deficit by about 0.5pp of GDP, so repealing it would add a similar amount to long-term deficit projections. In the current decade, the fiscal effect of the legislation is close to neutral, so while repeal could increase or decrease the projected deficit in a given year, over several years there would be little effect on the projected budget balance. But it is also worth noting that while many of the provisions enacted in the ACA were extraordinary, some of the savings provisions enacted were fairly routine. For example, Congress enacts changes (usually reductions) in Medicare payments to health care providers once every few years. Were the entire law to be repealed, it seems likely that at some point in the next several years Congress would recapture the savings from at least those Medicare-related policies if they were struck by the court along with the rest of the law.

Q: If the court strikes some or all of the law, would it change the size of the "fiscal cliff" at year end?

A: It would reduce it slightly. The ACA was estimated to reduce spending and increase tax revenue by $46bn in 2013. This is mainly the result of new taxes on income over $250,000 and the implementation of Medicare payment cuts. If the court opts to strike down the entire law (scenario three above), this fiscal restraint would not occur and the deficit would rise. However, in the other scenarios in which the law is upheld in part or in whole, it is unlikely that any of the items in the ACA that affect the fiscal stance in 2013 would be affected by the decision.

Q: If the law is upheld, are changes to the law still possible?

A: Yes, either as a result of the election, a fiscal agreement in 2013, or both. If Republican presidential candidate Mitt Romney wins the White House in November, changes to the health care law--and broader entitlement programs--are possible regardless of what the court decides this month. If Republicans hold at least 50 seats in the Senate following the election and maintain control of the US House, they could pass legislation to limit or repeal the coverage expansion enacted under the ACA (the Vice President would in that case cast the tie-breaking vote), since most of those provisions could be modified using the "reconciliation" procedure that is available through the congressional budget process. That said, not all of the provisions could be dealt with using a simple majority in the Senate. The coverage mandate and other regulatory issues would most likely require 60 votes in the Senate to repeal under congressional rules and thus would be more difficult to change.

In addition to the election, there is also a possibility that the health law could be reopened during the fiscal debate that is likely to take place in 2013, assuming that the "fiscal cliff" is temporarily extended past the end of the year into the spring or summer of 2013. At that stage, Congress looks likely to debate tax reform and potentially entitlement reforms, in an effort to reach a broad-based fiscal agreement, similar to Bowles-Simpson. While this is far from guaranteed, any such agreement would almost certainly include health reform among its components, and if so it would be very difficult to meaningfully address health spending without at least indirectly reopening a few of the provisions of the ACA.

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Mad Mad Woman's picture

ACA decision will not be today. Any remaining deisions (6) will be handed down Tuesday & Thursday this week. SCOTUS will save ACA for the last day of session.

MillionDollarBonus_'s picture

Is it really surprising that libertarians are against affordable healthcare? Almost every act which is intended to make peoples' lives better, improve the economy or increase equality, libertarians are against it. Libertarians were also against the Jobs Bill, which was intended to get Americans working again and reduce unemployment, and TARP, which stimulated the economy by creating thousands of American jobs. Is it me, or do libertarians literally hate everything decent, wholesome and good in the world?

kralizec's picture

Yes, it is you.  Conservatives and maybe even a few conservative Democrats still living join with Libertarians in opposition against socialized medicine under Federal coercion.  But then that is just OK for you liberals, isn't it?!

bobnoxy's picture

So I'm guessing you clear thinking conservatives and Libertarians, on the conviction of your principles, will refuse your Social Security and Medicare, and will insist your parents do too?

dizzyfingers's picture

"So I'm guessing you clear thinking conservatives and Libertarians, on the conviction of your principles, will refuse your Social Security and Medicare, and will insist your parents do too?"

BIG BROTHER does not allow this.

bobnoxy's picture

Huh? You can't opt out of paying, but you can opt out of collecting since it's collective money paying today's benefits, not the money a retiree put in, saved in Al Gore's lock box. Sure, you can refuse benefits. They'd love it if you did, and I'd have a lot more respect for you too, not that it means anything to you, of course.

ms1408's picture

"collective money paying today's benefits"

Actually, today's benefits are being paid by unborn children, since spending programs are funded by debt. Not that it means anything to you, of course.

bobnoxy's picture

So today's benefits are being paid for by non-existing people? Er...let me work on that a bit. Okay I did. That's just plain Libertarian idiocy. Per usual.

ms1408's picture

"So today's benefits are being paid for by non-existing people?" 

Yes. The money is borrowed. Debt is repaid in the future, not present. Children are born in the future, and they will be left with the debt.


tarsubil's picture

"You can't opt out of paying, but you can opt out of collecting..." 


What a deal! In the future, the option of opting out of collecting will become required. What a country!

kralizec's picture

Thanks for confirming your pro-government coercion stance.

As to your childish diversion I suppose a phase out of other coercive acts in place is beyond your mental capacity to process.

bobnoxy's picture

If you can understand it, I'm sure anyone can. It's just so fucking stupid when you think it through, that's all, and you don't. Hey, I'd be the first to opt out of Social Security.

And when your parents are living in their cars, I'm sure some profit maximizing, unregulated contractor will give you a great deal on the addition to your house so you can accept responsibility for them and move them right in.

Then I'm sure some unregulated, profit maximizing health care company will sell you a $200, one hour class on how to wipe their asses with dignity. Which is where your ideas take us eventually.

Saddle up, Pardner.

kridkrid's picture

What do you feel when you write a sentence like "and when your parents are living in their cars...".  Does the possibility that you are nothing more than a pawn in the system creep in, at all?  The need for government to take care of us... to take care of you... your parents, my parents... where does that come from?  How does it become so pervasive that to suggest otherwise is not only wrong, but abhorrent and sadistic?  

The con that you have accepted is no different than the con that those who you believe to be "on the other side" have come to accept.  "They hate us for our freedom... we fight them there so we don't have to fight them here... the shining city on the hill"... or any of the rah-rah, false patriotism garbage accepted by those on "the other team"... it's the same false narrative.  

If I don't support your narrative, I hate old people and poor people.  If I don't support the other narrative, I hate America.  Nice racket.

ms1408's picture

So people who haven't saved for their retirement now depend on social security? Who's fault is that? Their's, or our unborn children's?

bobnoxy's picture

It's their fault, of course, unless they simply didn't earn enough to save, like our heros in the military, your favorite, dedicated grade school teacher, the cop that has the hands to get you out of trouble your hands can't handle, or the people who built the sewers system that keeps your toilets flushing, making your life a lot better.

Okay, let's do it your way. Let them die in the fucking street when they're old and too poor to afford housing, like so many of today's vets? And when it's your parents, move them in, pay for their hip replacements, their meds, food, clothing...or let them die in the streets.

Hey, they're your parents. In your Lbertarian Paradise, no one will care about them but you. And I'm not even sure about that.

kridkrid's picture

Unfortunately, what we have created is the worst of both worlds.  We have created the belief that the government can and should take care of us, but will come to find quickly that it can't.  All of the time spent assuming that the government will and can... will be forever lost.

If it makes you feel any better... it's not even really the government's fault... it's the monetary system.  The inability for government to be all things to all people was clear in the late 60's and early 70's... we could not be both a military empire and a welfare state... so the restraint on the growth of the government... convertibility to gold... was removed.  Everything since 1971 has been an inflation of a bubble... a global bubble, levered up so many time and in so many ways that we live today in a completely absurd world.  We are in our wile-e-coyote state, high above the spot where we will ultimately fall.  It's anyone's guess what that will look like when we get there.

bobnoxy's picture

''Unfortunately, what we have created is the worst of both worlds.  We have created the belief that the government can and should take care of us,''

Yeah, and who were those idjits that led us to believe in a government of, for and by the people anyway?

kridkrid's picture

clockwork.  Again... you are no different from those who you feel are so different... when in doubt, claim the authority of the founders.  Both "sides" do it... it's meaningless and very selectively applied.  Cognitive dissonance much?

The government that we have today is nothing close to what any of the founders would have envisioned.  None of them.  

LoneCapitalist's picture

and who were those idjits...  Yes, I believe it was Thomas Jefferson who signed the S. Sec. act into law. No, wait, actually it was much later.

StychoKiller's picture

"If Congress can employ money indefinitely to the general welfare, and are the sole and supreme judges of the general welfare, they may take the care of religion into their own hands; they may appoint teachers in every State, county and parish and pay them out of their public treasury; they may take into their own hands the education of children, establishing in like manner schools throughout the Union; they may assume the provision of the poor; they may undertake the regulation of all roads other than post-roads; in short, every thing, from the highest object of state legislation down to the most minute object of police, would be thrown under the power of Congress... Were the power of Congress to be established in the latitude contended for, it would subvert the very foundations, and transmute the very nature of the limited Government established by the people of America." - James Madison

The founders were neither Socialist nor Progressive.

ms1408's picture

Ok, let's extend these principles and see where they lead:

"heros in the military, your favorite, dedicated grade school teacher, the cop that has the hands to get you out of trouble your hands can't handle, or the people who built the sewers system that keeps your toilets flushing, making your life a lot better."

And to think African slaves were provided with food, transport, work and accomodation, yet they refused to appreciate any of it.


"Let them die in the fucking street when they're old and too poor to afford housing"

Old people who have kidney poisoning by no fault of their own should get to steal kidneys from their children. Oh, you think that's immoral? So you're saying they should just die in the streets of kidney failure?


"Hey, they're your parents. In your Lbertarian Paradise, no one will care about them but you."

So you're saying that children should care about their parents, yet parents are entitled to borrow and spend until their children are born into unpayable debt? So, in other words, you hold children to a higher moral standard than adults?

knightowl77's picture

Why? we pay everyday into Social Security and medicare...how are the two related at all??????????????????? They're not

bobnoxy's picture

Because your money was spent. The money you collect will come from other people, pure Socialism, no?

Lebensphilosoph's picture

No, it will come from the state which has already extorted that money from generations present and future, regardless of whether I choose to take it or not. And as an enemy of the state, I will gladly make my contribution towards bankrupting it.

bobnoxy's picture

You sound like a real patriot. Divided, your country falls, making it a great place for you to live, and doing the work outside forces probably couldn't. Super duper fucking smart there.

Lebensphilosoph's picture

'Patriot'? My 'country' is today nothing more than a socio-political construct with no meaning for me whatsoever. It's a right shit place to live due to this very fact and the government that enforces it.

Lebensphilosoph's picture

I don't know about America, but over here, given the choice between the subsidised treatment of the NHS and paying more for a private clinic, I'll choose the latter every time, as the former could very leave you with irreparable physical damage, not to mention simply kill you.

DosZap's picture

I don't know about America, but over here, given the choice between the subsidised treatment of the NHS and paying more for a private clinic, I'll choose the latter every time, as the former could very leave you with irreparable physical damage, not to mention simply kill you.

Yep, the UK admitted that over 150,000 people die from lack of care in their system yearly.

Disenchanted's picture



Cut me a check today* for the entire amount that I and my employers have paid in on my behalf for over 40 years, plus give me an opt out choice on any further FICA deductions from my present and future paychecks, and I'll walk away into the sunset no questions asked(in other words I won't feel 'entitled' to any 'socialist' payments once I reach 62, 66 1/2, 70 or whatever).




*They can take it out of the billion$ of US tax dollars going to Israel each year(or from the 'Defense' Budget). They won't miss it, and I was never given a choice on that either.

MillionDollarBonus_'s picture

If you wonder why libertarians are almost universally hated by decent, objective and open-minded people across the world, here is just a small list of the feelings that libertarians invoke in people:

  1. Anxiety
  2. Anger
  3. Insecurity
  4. Sadness

Until libertarians start considering peoples' feelings, decent people are going to continue to reject their ideas, and rightly so.


bobnoxy's picture

If they took five minutes to think through their ideas, they'd run just as far from all that dopiness too! But then, they don't really have a cohesive set of ideas anyway. Just some basic outline of less government and more freedom, while their hero, Ron Paul, keeps voting to restrict what control a woman has over her own body.


Chump's picture

Bwahahahaha...you don't even realize you're agreeing with a parody of yourself! Priceless...

bobnoxy's picture

And that, my friends, is what passes for clear headed Libertarian thinking!

kralizec's picture

"Until libertarians start considering peoples' feelings, decent people are going to continue to reject their ideas, and rightly so."


TWSceptic's picture

'And that, my friends'


You have friends here?

fuu's picture

Max really was your best one so far. I predict this one doesn't last that long at all.

CaptainObvious's picture

You've only been a member of ZH for 12 weeks and 3 days, so it is possible you don't know this, (and I'm giving you the benefit of the doubt here instead of calling you a dumbass like you truly deserve) but MDB does satire.  You did not find a fellow progressive in MDB. 

Furthermore, Ron Paul isn't voting to restrict control over a woman's body...rather, he is saying, and has been saying for years, should you care to do your research instead of repeating liberal media talking points, that abortion is a states' rights issue and not a federal government issue.  As an OBGYN by trade, of course he doesn't believe in abortion, duh.  But his strong adherence to the principles of libertarianism means that he won't legislate against it.

bobnoxy's picture

Regardless of how long I've been in here, I can read, and Ron Paul consistently votes against abortion right. You could look it up, you know?

Paul voted in favor of the federal Partial-Birth Abortion Ban Act of 2003. Yes, the FEDERAL partial birth abortion Ban.

As just one example.

Lebensphilosoph's picture

So he opposed the legalisation of infanticide. So what?

bobnoxy's picture

Let me guess. Another idiot that believes that the right to life begins at conception and ends at birth?

Lebensphilosoph's picture

Rights are concepts existing in the human mind, and begin or end wherever we want them to . You are the only moron here for being under the delusion that there is any objective status of a right, and thus a true or false perspective on where the 'right to life' begins or ends.


As for where life begins, it doesn't begin. It continues, from one cell to the next, from one organism to another, from ages lost in the mists of time and into the future.



Lebensphilosoph's picture

Under the Intact D&X method, the largest part of the fetus (the head) is reduced in diameter to allow vaginal passage. According to the American Medical Association, this procedure has four main elements.[3] Usually, preliminary procedures are performed over a period of two to three days, to gradually dilate the cervix using laminaria tents (sticks of seaweed which absorb fluid and swell). Sometimes drugs such as pitocin, a synthetic form of oxytocin, are used to induce labor. Once the cervix is sufficiently dilated, the doctor uses an ultrasound and forceps to grasp the fetus's leg. The fetus is turned to a breech position, if necessary, and the doctor pulls one or both legs out of the cervix, which some refer to as 'partial birth' of the fetus. The doctor subsequently extracts the rest of the fetus, leaving only the head still inside the uterus. An incision is made at the base of the skull, a blunt dissector (such as a Kelly clamp) is inserted into the incision and opened to widen the opening,[4] and then a suction catheter is inserted into the opening. The brain is suctioned out, which causes the skull to collapse and allows the fetus to pass more easily through the cervix. The placenta is removed and the uterine wall is vacuum aspirated using a cannula.

Lebensphilosoph's picture

Bodies are not owned except under slavery. As such, the body within her womb is not owned by the mother nor by anyone else, and is not her own.

bobnoxy's picture

So it's okay for Ron Paul to assume control over a woman's, or your body, and that's a central belief in Libertarian philosophy of more freedom and less government? And if I don't own my body, who does? See why I think the whole thing is so poorly thought out, or not thought out at all?

It's like those dumb ass teabaggers willing to fight to the death to keep the government's hands off their Social Security and Medicare. Just plain stoopid.

kridkrid's picture

The "problem" with libertarians isn't the divide on abortion... that one is easy to get your arms around... and frankly, not a very interesting debate.  It comes down to whose life... the unborn child or the mother.  I think both sides can claim the mantel of "libertarianism"... it's a very legitimate disagreement.

The problem with libertarians is really around the use of force.  Here is a good debate... anarchist vs. minarchist.  http://www.youtube.com/watch?v=2gK2xB9F9Ag - Jan is the "libertarian" here... losing badly, really, to the anarchist.

Lebensphilosoph's picture

The problem with the 'debate', and the reason why it will never be concluded, is that it's not about deciding for the truth or falsehood of a matter, because the issue is at heart one of assumed values.

I value the life of the healthy unborn child over the desire of any woman to end that life.

Those who support abortion value the latter over the former. To me such thinking is beyond the absurd, but be that as it may, what I think here is not 'wrong' or 'right', but a fundamental value of mine, and I have no compunction whatsover against curtailing the 'freedoms' of females to see it realised.

kridkrid's picture

Yeah... I agree, for the most part, though not strongly.  It's odd... sometimes I think I'm the only person who doesn't feel strongly one way or another on abortion.  I don't think abortion is a slippery slope... I can see both sides and can understand why each side feels as strongly as they do.  I'm weird this way, I think.  

Lebensphilosoph's picture

An abortion here and there matter little to me. I've simply had enough of the absolute selfishness and reckless irresponsibility of modern 'Westerners'. In this age of contraception in forms from medical procedures, to condoms, to pills, the reason for the number of abortions carried out is simply unfathomable to me, unless I ascribe it to just that: absolute selfishness and reckless irresponsibility. Abortion shouldn't have to be legislated. The moral values, motherly instincts and fatherly authority inherent in each and every healthy society in human history would be enough to make it unthinkable for most women to want to commit infanticide of a perfectly healthy child. Apparently, these no longer exist. In their place we have thoughtless indulgence, emancipated whores, and emasculated apes. And we wonder why our civilsiation is crumbling about us.

kridkrid's picture

I guess, perhaps, I think less of people than you do.  I suppose I have no reason to believe that people would be any less reckless than they are.  But I can find no fault in anything you have said here.

Nice post and thanks for the exchange.