Next week the Supreme Court will finally hear arguments over the constitutionality of the Affordable Care Act. The centerpiece of the High Court’s eventual ruling will be over the individual mandate – whether or not our elected officials can compel the uninsured to buy health insurance. This is a really big deal, and it strikes at the heart of whether or not we are serious as a country about fixing our health insurance non-system.
On its surface, the arguments against the insurance mandate are deceptively simple and cloaked in American liberty and individualism. Why should the government be able to make me buy something I don’t want? They can’t regulate my” inactivity.” If I want to take the risk of getting sick and not being able to pay for care then that’s my right. Don’t tread on me…etc, etc.
All this sounds good and quintessentially American, if by America you mean a society that simply lets people die when they get into trouble. But no matter how much Republican primary voters think the uninsured ought to just die whenever they get into car wrecks or have complicated pregnancies, the fact is (with or without the Affordable Care Act) that health care providers are obligated, legally and ethically, to treat everyone in an emergency. The uninsured get medical care whether or not they can afford it, and those costs to health care providers – about $43 BILLION per year – get passed on to insurers and then to families who do have health insurance to the tune of $1000 per year per family through higher premiums.
So even if one is so callous as to think that normal, non-emergency care is a privilege of the wealthy, that still leaves the question of who ought to pick up the tab for care that everyone does get at some point. And that is one of the issues tackled by the Affordable Care Act. Let’s spread out the cost of providing a basic level of care to everyone by getting everyone to pay their fair share up front. That’s the basic economic foundation to any insurance model, and without it our health care system is doomed.
Faced with those stakes, the arguments against health insurance reform are exposed for what they are – utterly out of touch with reality, and incompatible with modern civil society.
The 6th Circuit Court already swept aside this argument about “inactivity” as being nonsense. Everyone gets health care at some point, not being able to pay effects the whole system, and that’s where the interstate commerce clause of the Constitution comes in. But I personally like Washington Post’s reporter, TR Reid, and his example better:
There are all sorts of government mandates to buy things. It’s illegal to walk down the street naked in any American city. That’s a mandate to buy clothes. People are jailed for failing to feed their children. That’s a mandate to buy food.
Now I will be the first to admit that the Affordable Care Act and the individual mandate are not a panacea for our expensive health care system. But getting everyone to have some skin in the game is an essential first step to controlling costs and increasing access. And our Republic is perfectly capable of distinguishing essential services from non-essential services such that a health insurance mandate will not open the door to edicts to buy iPads or washing machines. Let’s just hope the Supreme Court can muster a majority of justices with some common sense, and we can all keep on with the work ahead.