I’m a political moderate and I’m annoyed. I’ve been paying attention to the debate about the Affordable Care Act (ACA, or Obamacare, or Nationalized Romneycare) and noticed that everyone has an opinion. It’s been frustrating to hear. These opinions for the most part fall in line with party talking points presented by some affiliate fervently yakking on a news program that happens to be more about opinions than actual news. Dropping the political auspices and moving into an actual discussion requires work. I think many people who are for and against the ACA are more for or against the political side from which the idea matriculated then about the ACA itself. In fact when we remove the political subtext of who presented this idea and actually start to focus on the issue itself I find that there are a few fundamental large solutions to our healthcare issues. Ultimately though, I think the entire conversation about individual mandate, specifically, boils down to one main question and how you answer that question.
Do you think that healthcare is a right to which every person is entitled?
If you say, “No, Healthcare is not a fundamental right to every person.” then you should rightfully disagree with the individual mandate. However, you must also then support legislation that allows hospitals to turn away people at the door because as it stands now a hospital cannot deny care to an individual at the point of entry. In other words if a homeless guy is dying, he goes to the hospital, the hospital takes him in and you pay his tab through your insurance premium increasing.
One article, in Forbes, recommended a return to a completely free-market system and a completely free-market system would need to be allowed to deny care to those who can’t afford that care. I don’t see anyway for insurance premiums to go down while medical offices cannot deny care. The hard sell, politically, for this idea is that a politician cannot truly win while telling people that they can be denied care at a hospital. Chances are one of your neighbors, coworkers, or even family members may not have insurance and hence while you are sick and go to the hospital, they cannot. When a little boy and girl get denied care because they or their parents don’t have the means to cover the bill the idea of allowing hospitals to deny care to the uninsured seems a bit harsh and politically unwinnable.
The second option, is to say something along the lines of, “I don’t believe it is a right for every person but I couldn’t see denying care as a reasonable solution” or simply, "Yes." This leaves us in a position where if hospitals can’t deny care then they have to accept patients regardless of insurance or no insurance. This is part of our current predicament. We like to say that health is the responsibility of the individual and therefore should be the individual’s responsibility to get health coverage and incur the cost of his or her own health expenses, up until it is inconvenient for us to hold such a belief. That is, up until it puts us in a position where we have to be the bad guy and say, "No" or until it impacts us negatively on an individual level.
Essentially if we can’t hold the line and allow hospitals to deny care to those who cannot pay, then we are saying in some manner that every person is entitled to some sort of care. If we say that it would be unethical or unchristian or just unallowable for hospitals to deny care to a person in need then we are saying that every person is entitled to have care. This means that every person needs to help cover the cost of that care and that those who do not help to cover the cost of their care are taking advantage of the system. They are using the system with the knowledge that they cannot pay and passing that cost to someone else that can pay.
There are two ways to address this issue, one is to make everyone pay and have the government provide a standard of services to every person. This is essentially the Universal Healthcare idea, otherwise known as a “Single-Payer” system. Everyone pays through taxes for the same care and those who want better care can pay a price to have higher insurance coverage above the standard care.
The second option is to make sure that everyone pays into the system, so that there are no free-riders, but that they pay into the system by buying from the private sector. While on one hand people don’t like being told they have to buy something, on the other hand people also don’t like having any control over whether or not they pay for other people. So it follows, that it is better to ensure that everyone pays something so that some are not paying everything. Granted this does not fully control costs but it does make it so that the insurance base is widened, which means private insurers have a larger pool of applicants to charge. This is the individual mandate. The government is not in charge of service, but is playing the referee by asserting that since we can’t deny service at point of entry we need to pay for service in some way, either by buying from a private company or paying a penalty (whether you consider that a fine or a tax) that can then go back into the nation.
If the Supreme Court had struck down the individual mandate, the only two options left would have been a single-payer system or completely rely on the free-market to decide who gets service and who does not. The individual mandate strikes a balance between completely government funded and completely private sector or free-market funded healthcare. While people may not like being forced to pay for something, in the end it is better than the current system of allowing some to pay nothing while still receiving service and better than the alternative of having the government run the entire system.
In the end even if you don’t agree with this assessment of solely the individual mandate, when you remove the political subtext of what party pushed for what, the individual mandate stands as the more conservative of the two solutions for allowing everyone care. It seems the outrage against the individual mandate can be described by a quote from a great Patrick Swayze movie, “Nobody puts Baby in the corner.” We don’t like to be forced to pay for something regardless of where the idea originates or how we are impacted by one of the solutions. We also don’t like being forced to recognize that without government assistance we have to allow those conducting services to deny services to those who can’t pay.
Gallup has some great surveys they have put out. Here is one that breaks down American's views on Healthcare and here is another survey from the New York Times that shows how people don't like the mandate, but like the individual ideas that the ACA actually provides.
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