On page 32, line 3 of the transcript, Alito says:
If you took the group of people who are subject to the mandate and you calculated the amount of services this whole group would consume and figured out the cost of an insurance policy to cover the services that group would consume, the cost of that policy would be much, much less than the kind of policy that these people are now going to be required to purchase under the Affordable Care Act.Here he is again discussing the $854/$5,800 comparison analyzed yesterday. But he also demonstrates a critical misunderstanding of who will be affected by the mandate. The mandate includes many minimum coverage requirements, including $0-copay preventive care and no annual or lifetime limits to benefits. As a result of the mandate, a huge class of people who currently have low-quality insurance will trade up to a better plan that meets these minimum requirements. 78% of people who have a medical bankruptcy have health insurance, and these people will be affected by the mandate. But Alito appears unaware that these people exist, thinking it is only the uninsured affected by the mandate and ignoring the underinsured.
Alito also draws a comparison between between burial insurance and health insurance. Most of us will get sick, and all of us will die, so if you can mandate health insurance, why can't you mandate burial insurance. This is a comparison which demonstrates ignorance of the differences between the markets. A burial costs what it's going to cost, and you know it's a cost you'll pay once and then be done with. There is no significant cost-dumping by people who aren't able to afford burial onto those who can afford it. But in health care, you don't know what your costs will be; I could consume $500 in services this year, or I could consume $500,000. If I don't have insurance and don't have $500,000, I could wind up sticking the system with hundreds of thousands of dollars in costs, shifting these costs to my fellow citizens.
Alito can't seem to grasp these distinctions. He demonstrates a fundamental lack of knowledge about health insurance and the mandate. Hopefully he will educate himself before the Court renders its judgment in June.
More generally, Alito's lack of knowledge demonstrates a huge problem in the concept of the Supreme Court as currently constituted. The Court has all these standards by which it attempts to analyze this or that aspect of a law before them, and as demonstrated by Alito, they wind up not having the knowledge necessary to render effective judgment. It's not that Alito is dumb, but it's not possible for a Justice to be an expert on everything he's asked by our system to judge.
Rather than trying to analyze every aspect of the cases they review, which is impossible to do well, the Judiciary needs to have more deference to the democratically-accountable branches of government. Justices are experts on the law, not on economics, finance, or anything else. Our system should not cause an unequipped judge to decide based on faulty understanding whether tens of millions of people will get insurance or not.