Friday, June 15, 2012

The Supreme Court Rules on Health Care Reform

It is expected that we will hear the Supreme Court's ruling on the Affordable Health Care Reform Bill sometime soon.  In my first blog in March, I predicted the Court would uphold the constitutionality of the individual mandate in a 5-4 split decision.  I also predicted that other rulings would uphold or strike down other various parts of this far-reaching and comprehensive set of laws.

Since then, I have grown to accept that it is more likely that the individual mandate will be struck down, again, probably in a 5-4 decision.  Strangely however, as I have considered the ramifications of this decision, I am starting to believe that this is the better decision, although not for the reasons you might think.

Before I detail why a ruling against the individual mandate might be better, let's review what I believe are the real issues that we need to be discussing in regards to our health insurance crisis.

1. Too many Americans without health insurance

2. Too many sick Americans who can't afford the insurance they need

3. Too much money being spent on everything except actual health care

At first glance, a ruling against the mandate will not address, in fact will add to all these problems because, unfortunately those without health insurance will continue to use health services.  Which means it will continue to cost those who are insured more money in higher premiums and higher provider costs, as well as more government money used to cover those individuals and companies who seek assistance to pay for the aforementioned higher costs.  As these costs rise, it will finally become clear to the majority of those who carry insurance that they are paying for people who are not doing their part and contributing some money.  And, if there is one thing we don't abide in America, it is someone getting something for nothing.  Believe it or not, that was the point of the mandate in the first place, originally a GOP idea, by the way.  Everyone should have some skin in the game, so to speak.  So, while we abhor the government telling us what to do, even when it is a wise thing, we abhor even more knowing that there are people getting something for nothing.  At this point, a work around will be devised that allows the Supreme Court to uphold its constitutionality yet still requires all Americans to get into the pool of insured with the rest of us. 

Of course, this might take a while.  It might even lead to a discussion about repealing the Reagan era law that requires hospitals, etc to provide health care services without knowing if they will be paid.  But, I remain hopeful that rather then deciding we can continue to call ourselves a Christian nation while allowing the uninsured to die in the street, we will figure out a way to continue Reagan's vision that all Americans should get health care services by expanding the means to pay for it by including all Americans. 

In the meantime, while we slog toward that day, attention will be paid to the very good aspects of the health care reform bill.  For instance, the law that prevents insurance companies from capping payouts for the really sick among us, a practice that forces the chronically ill to lose all their possessions or die.  Or the requirement that pre-existing conditions not be used to deny coverage especially in the young.  Or the law that enables young adults to stay on their parents plan until they turn 26.  Or the waiver of co-pay for routine and preventive care doctor visits.  The fact is, there are many aspects of the Affordable Care Act that are good for the middle class.   I expect that as medical costs continue to rise, more and more employers scale back or drop medical coverage for their employees, and the voting, middle class begin to realize that only the rich can afford to be sick, opposition to "Obamacare" may become muted when lawmakers are now voting to insure health care insurers a bigger profit on the backs of everyday Americans.

The reality is, the focus on the individual mandate is a red herring.  We need to accept the fact that America is aging, and that health care costs will continue to rise.  As I said in a previous blog, we can expect them to rise significantly for another 15-20 years.  We need to begin the serious debate of how we are going to pay for these costs, and everyone needs to be a part of the conversation, and a part of the solution. This means:
No free medical services, not for the uninsured, not for our government reps either.  In fact, as I already stated, no elected politician should get medical coverage from our tax dollars without contribution, and certainly not once they leave office.  (This would apply to pensions as well, but that is another topic).
Some type of required catastrophic health insurance paid by all Americans and also contributed to by the larger health care insurers.
More money devoted to preventive care which means no co pays for routine and preventive care visits.
Lower fees paid to hospitals and doctors for the high-end procedures.
Restricted payouts for medical malpractice except in the most egregious situations.
Lower malpractice costs (see item above).
Less dependence on the pharmaceutical industry to fix all our ailments.
More responsibility for each of us to know less about American Idol and more about where our local parks and recreation areas are located.
Regardless of how the Supreme Court rules, remember this.  They have health care coverage.  They have access to the best health care services in the world.  As they are important members of our society, one could argue, they deserve such peace of mind so they can litigate the most important topics of the day.  Does your local teacher, grocery clerk, firemen, day care worker, policemen, butcher, mailman, pharmacy tech, factory worker, car salesman, or neighbor deserve any less?  How about your and your children, and future grandchildren?

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