As three days of oral arguments began before the U.S. Supreme Court with regard (primarily) to the constitutionality of the individual mandate in the Affordable Care Act, the following is a response I composed to an article posted on Alternet.org about the legal issues of the President's most prominent legislative success, as well as some of the pros and cons of the arguments being offered 'in favor' or 'against' the health insurance reform bill. After reaching the comment's conclusion, I realized that I was, perhaps, a bit too verbose for a commentary posting on a blog site. So, I instead decided I would post my response here, seeing how I believe that much of the opinions I offer are of sufficient merit to stand on-their-own in the ongoing health care insurance and access debate. Here is a link to the article which I was responding to: http://www.alternet.org/story/154662/the_court_battle_over_health_care_is_a_struggle_for_a_future_vision_for_america%3A_6_things_you_need_to_know?akid=8473.968479.0oyEAW&rd=1&t=2
In many respects it was a foregone conclusion, before the Affordable Care Act was even drafted (let alone introduced to Congress), that elements like true Universal Care and a Single-Payer system would never see the light of day. The political will to fundamentally change how health care is distributed in the U.S. simply does not exist. While most who favor the two aforementioned options place responsibility for their fairly square on the President's shoulders (which is where a good deal of the responsibility should rightfully lie), it's important to remember that at the time of the bill's formulation, debate in Congress and eventual passage that many Democrats were more-than-unwilling to sign-on to the level of restructuring of the health insurance industry which Universal Care and Single-Payer would require. If the President is unable to count on the support of members of Congress from his own party, it's a bit disingenuous to suggest that he bear sole responsibility for the failure of those two important elements to be included in the legislation. Sure, there were a relatively small number of Democrats (especially in the Senate) who loudly called for Universal Coverage and Single-Payer. But there was never the vocal support for those two principles upon which the President, or anyone for that matter, could or should have staked the passage of some kind of reform on. It simply wouldn't have happened (reform) had it been done.
Like many Progressives, I am not particularly proud of the ACA. I would have hoped for, and infinitely preferred, reform that would have made significant in-roads toward wresting control of the health care industry from the hands of health insurers. But I do believe that what was passed opens some doors for those not able to obtain coverage to gain access to insurance. And, it also begins to put the onus of paying for health care provided to those without insurance on those who receive that care. As someone who has faced huge medical expenses in the past while covered by health insurance, it is easy to see how someone without coverage could quickly find themselves in serious financial difficulties should they face a medical emergency. But while I don't believe that a person or family should be forced into taking bankruptcy over medical bills (there's something inherently immoral about devastating an person or family because they simply wanted to have an illness or injury treated), I also believe that those individuals not covered should at least make some effort to pay for the care they do receive. Studies have shown that a majority of those who receive care while not covered by insurance make little or no effort to reimburse the hospital for the care provided. Granted, the amount uninsured patients are charged for services rendered is exponentially greater than the costs charged to insurance companies and their policyholders. But self-responsibility should have some place in the health care conversation.
I have no illusions about my ability to 'foresee' how the US Supreme Court will decide the legal issues before it about the ACA. I do believe that should a majority decide that the individual mandate is unconstitutional, it could well undo established precedence that could affect much more than simply whether or not it is within the federal government's purview to require all Americans be covered by some form of health insurance. I also see problems with the position held by opponents of the ACA that the law violates states rights. With all due respect, it doesn't take any great leap of intellectual ability for anyone to see that health care costs continue to increase at a rate that far outpaces inflation for other consumer goods and services. It also doesn't require any significant intellectual gymnastics to recognize that if the collective states recognized that a problem with regard to access to health care and/or insurance and chose to fix that problem, they well could have. In fact, should have. But the overwhelming majority did not. When the citizens of our nation endure a problem which affects each and every one of them to one degree or another, and the states refuse to marshal their respective (or even collective) resources to combat the problem(s) at state level, then it falls to the federal government to become involved and at least attempt to address the issue. And honestly, it is pretty difficult to argue that access to health care and health insurance is somehow a unique privilege that should only be offered to those residents of one state or another. While the ACA
And I would be remiss if I did not briefly bring-up the irresponsibility of those clamoring for a single-payer system, who would, if they had their way, agree to the elimination of the majority of private health insurance companies. A single-payer system WOULD be more efficient. It WOULD provide more equitable coverage at more affordable rates to most Americans. It WOULD help to rein-in health care costs. But it is important to remember that the health insurance industry is a multi-billion dollar industry that is responsible for a not-small portion of our nation's total GDP. Just as many Americans were up-in-arms at the willingness of some politicians to see the automotive industry be thrown to the economic wolves, so too should they be concerned that some politicians and a sizable number of Progressives see little wrong with the federal government telling the private health insurance industry (not a company or two, or even three, but the entire industry), "Thank you but no thank you." It is one thing to provide access to insurance, and thereby medical care. A true Universal Care program would do that. It is something entirely different to consign millions of Americans employed in the health insurance industry to the unemployment rolls because their industry has been deemed unwelcome and unnecessary. Believe me; I am not a huge proponent of the health insurance industry. As mentioned before, I, too, have seen bills totalling in the tens of thousands of dollars as a result of medical care I received WHILE covered by health insurance. But I am not willing to support the federal government wresting trillions of dollars of health insurance business from private companies without any meaningful consideration of what to do about/with the millions of average Americans employed by the private health insurance industry whose livelihoods would largely cease to exist. If any politician or Progressive had put-forth a plan that would create single-payer while also addressing (in humane and ethical and moral ways) the dismantling of huge portions of the private health insurance industry, then I would be much more willing to support such a proposal. Doing the right thing sometimes means helping those who you might otherwise wish to fend for themselves. And I've yet to see any real demonstrations of politicians on the Left to step-up and do the right thing with regard to how the dismantling of the private health insurance industry would be done in a just, reasonable and fair way.