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.

  • Greenflag

    I’ve no idea how this will end up but it simply doesn’t seem right that people can be forced to buy health care insurance from private health insurance companies . I suspect that this was one of the ‘trade offs’ in the health care negotiations that the Obama side offered as they hacked their way through the reforms a couple of years ago . I’m sure the private health insurance companies were projecting larger profits based on their new increased (forcibly) market share ?

    While it’s true that ALL are given a minimum level of access it’s also true that a million are forced into bankruptcy each year because of inability to pay or unwillingness to pay for medical operations .

    An American at the median income level with a family cannot afford to pay private health insurance premiums at full cost . Thus such a person must be employed by a company which as a ‘benefit/perk’ pays most of the premium or such a person should be a government employee or work in a large corporation which has the buying power to negotiate affordable health care insurance premiums .

    Given an aging population with 25 million unemployed and the ever rising cost of health care (whatever happened to the competition reducing costs theory ?) . The sad truth is that the current American Health Care System already a drag on the economy has now become an impediment to economic growth as those with ‘health insurance’ are increasingly unlikely to move to other parts of the country for fear of losing their health insurance .

    Perhaps Americans need to look at reforming their Constitution. While it’s true that the founding fathers were to the forefront of political development and freedoms for people at the end of the 18th century I’m sure they could not have conceived of the present abysmal mess that besets the current system .

    The contradictions inherent in the present system are now being made more obvious by this constitutional issue .

    Everybody will need health care sooner or later and it seems daft that some people can avoid paying into it when younger but then can choose to use it (without paying -the emergency room option ) as they get older and need it .

    A single payer system such as that in Canada could work for Americans and those who can afford it i.e those who have incomes in excess of 150,000 dollars ( or some such cut off income figure ) should be allowed to exempt themselves from a national system and pay full insurance premiums for their health care .

    Those who don’t pay into the national health care system because they are a) too healthy b) too ‘independent ‘ and ‘enterprising ‘ should find alternative health care providers other than those approved by a national health care system and thus be liable for the full costs of their treatment .

    Theres no such thing as ‘free’ health care and in this day and age even national health insurance premiums can be tailored to a person’s lifestyle ? Those who smoke or who drink to excess or are obese should pay a higher national health insurance premium than others and an annual medical exam would be the means to adding on or reducing one’s premium.

    I suspect that the court will rule the mandate as unconstitutional but although that will impact on Obama’s re-election it won’t change the other reforms made in health care such as those being denied cover because of a previous condition etc.

  • Media consensus seems to be that the Supreme Court will spit on Obamacare from their Olympian height.

    So what?

    If anything it plays to a longer-term Obama game-plan.

    It was inevitable that the conservative majority on the Bench would, sooner or later, dance to the GOP tune (as in 2000). This one couldn’t be better timed to “sell” to the Democratic faithful, particularly if it comes in on a 5-4 majority (i.e. carried by the ever-silent Associate Justice Thomas).

    As the NYT editorial (“The Supreme Court’s Momentous Test”) opines: it isn’t just Obamacare on trial here.

  • Dread Cthulhu

    Ruari: “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.”

    First of all, Obama, et al, called it a mandate and was, in fact against such a mandate when he was a candidate. Additionally, it is estimated that of the uninsured are younger folks who have voluntarily uninsured and wealthier folks who have elected to self-insure. So they *HAVE* opted out. Even the folks who Barry-O has brought up as examples of people who have been helped by Obamacare thus far were voluntarily unenrolled (i.e. employed and opted to take the money rather than insure themselves).

    Now, the problem with healthcare is the price, which, arguably, is the government’s fault for entering the market with Medicare and, through their regulations, had the unintended consequence of sky-rocketing charges. Medicare regulation require a singular charge-master for all comers, does not allow for discounts to individuals but allows for “contractual allowances” for insurance companies, including the US gov’t.

    As a consequence of changing payment systems (charges, percentage of charges and, now, a prospective payment system), the individual private payor got priced out of the market, because when the government is willing to pay 100% of charges, you raise your charges. When the government pays you a percentage of your charges, you raise you charges more to recoup the same amount of money as before. When an insurance company offers the hospital the lesser of their room charge or a fixed amount of money, the room-charge will be raised to exceed said fixed amount, all increasing charges to the point that it is almost impossible to be a non-independently wealthy private payor.