Obamacare – a supreme mess

Obamacare: Is the Affordable Healthcare Act’s (AHA) “mandate” that all adult citizens must purchase private health insurance constitutional?

This week all eyes are on the US Supreme Court’s live deliberations. Regrettably, the court’s contemporary stature is diminished to such an extent that its ruling will be viewed less as an ideologically transcendent legal ruling and more as the predictable outworking of a body whose judges who are seen to serve rather than check their political allies.

Whatever the Court’s ruling, this fight is predicted to shape the election – and its losers may be the more mobilized bass.

So what’s the basic argument on the floor and reported in the press this week?

Legal technicalities aside, the left, following Team Obama’s wrongheaded approach, are attempting to justify the AHA’s “mandate”, i.e. the compulsory purchase of private health insurance by US adults, as essentially just on the grounds that it will finally ensure that the US joins the ranks of the rest of the developed world as a state wherein no citizen shall be excluded from access to affordable healthcare.

The right meanwhile is claiming that this mandate is not merely unconstitutional but, to quote defeated GOP Presidential contender Rep Michelle Bachmann, is an unprecedented overreach of federal power in the US. For a government that has mandated police with the powers to arrest escaped slaves, authorized and enforced military conscription, and mandated various government agencies to overthrow neighboring states’ elected governments, Bachmann’s claim may sound like a stretch. But let’s stay focused on the mandate at hand.

Bottom line: The left, led by Team Obama, have really screwed this one up.

Consider: The NYT’s reports “swing” Judge Kennedy asking the Obama Administration’s defense lawyer, “Can you create commerce in order to regulate it?”. Hardly encouraging for AHA supporters.

While I am, admittedly, no more trained in US federal law than your average US lawyer is trained in ethical charging rates, this line of questioning suggests an entirely mis-framed debate. “Creating commerce” implies, that the uninsured are currently not participating in the commercial health care sector. But every American, insured and uninsured is already participating in the commercial health care sector – it’s just that some are paying their way while others are not.

The desperately named “mandate” – are there any communication staff at the White House? – wrongly implies that people are being forced to buy something they could otherwise opt out of.

Naturally, the right have lassoed this perception of a government enforcing private acts of commerce by hollering, “If health insurance, what next?!”

Indeed. Why and by what constitutional authority should the US Federal Government be authorized to enforce private citizens to buy anything?

Should compulsory vegetable purchasing be mandated on grounds of improved public health outcomes and preemptive health system cost-savings? Why not make Mother’s Day cards compulsory as a route to strengthening family values ? Or the compulsory purchase of national flags as a means of manufacturing national cohesion? And so on.

But the right’s line of argument is misleading. And its President Obama’s fault.

The point is that every citizen in the US already has healthcare, whether they choose it or not. US society, through its government, permits no choice in whether one can access health care. No one is asked their opinion, everyone is given access.

True, the quality of the health care offered is much less for those who lack private health insurance but all are given a minimum level of access. Consequently, the abjectly named “mandate” is not forcing people to pay for health care access they could otherwise sacrifice and avoid. Rather, the AHA insists at its most basic level is charging people for a public good – health care provision – that they already have – whether they like it or not.

You thought that millions of Americans had no healthcare access? Wrong. This is another Democratic Party framing fail.

Every single America has healthcare access. Every American citizen can access an (expensive) Emergency Room – emergency or not.

Granted, the guaranteed treatment in the ER room may represent a terrible, incomplete and stressful form of “healthcare” for the 40-odd million Americans who lack private health insurance. (And having spent over a year in this situation, believe me when I warn you, ‘worrying’ doesn’t come close to conveying the anxiety fermented by the nagging, inescapable awareness of impending doom brought on by private health insurance inaccessibility in the US.)

While one can choose to avoid vegetables, opt to shun one’s mother on Mother’s Day or pass up the Stars and Stripes on the basis that they might clash with one’s porch decor, one cannot – repeat: cannot – opt out of access to health care in the US.

The real opt out in the current US health care system is from cost contributions, not access to health care.

In short, there is almost certainly not one single US-resident reader of this post who will not one day make use of the US health care system. The only real question is whether they will pay for their use or, if uninsured, pass the charge onto those who do have insurance. The Affordable Care Act finally ends this cost “opt out” for a service extended to all but paid for by some.

So, if the Court rules this week that mandating citizens to purchase something against their will is unconstitutional, don’t blame the court entirely. Blame the Democrats. This should never have been a debate about forcing citizens to pay for something they don’t want. It has always been a debate about charging all, and making affordable to all, a service they already have.

That and ending the scandal of 40 million Americans lacking access to a doctor not working in an ER room.

Strategic Communications Consultant, located in Washington, D.C.