The stampede of media interest in the critical issue of health care policy in the United States has once again gone dormant — what “issues of the day” don’t, any more? — now that the lawyers have fled the Supreme Court chambers. Count on the whole thing resurfacing in a maniacal frenzy in about June, when the court renders a judgment.
During the recent wave of attention to the Affordable Health Care Act ( “Obamacare” is a transparently derisive label snatched up by a lazy media), I started posing a simple query about health-care policy choices on a number of platforms, from Facebook to the comments section of the Washington Post and New York Times.
Here’s the pitch:
Can anyone refute the theory that all of our national health-care choices fall under one of the following three broad propositions?
1) We can find a way to cover everyone — “health care for all.”
2) Or we accept “free riders” on the system — Most of us pay for insurance, but those who choose not to still receive health care (via the George W. Bush “emergency room” health plan).
3) Or we choose, as a society, to go back on our previous commitment to providing health care to those who need it, when they need it — turn people away from emergency rooms. (This was the choice of the cheering crowd at a Tea Party-sponsored GOP candidates’ “debate” in September. I wonder how many of those who relished the prospect of letting the uninsured die realize that the law mandating such compassionate action, the Emergency Medical Treatment and Active Labor Act, was signed into law by their hero Ronald Reagan in 1986.)
To date, I have not gotten one response that falls outside those three basic choices. There are minor variations such as kicking the issue back to the states, but the choices remain the same even at that level.
I’ve tried to contact the Mitt Romney campaign several times asking for clarification of what the candidate would do about health care, noting that I am an Extremely Important Journalist. My credentials must not be up to snuff.
But looking at his website, I see that Romney’s plan is to kill off the ACA and send the issue back to the states. Further, he would “promote free markets and fair competition” — I guess that means we’d all have the privilege of continuing to pay for 26 percent overhead in the private insurance sector (per the Journal of American Medicine), rising profits, higher premiums and more uninsured. A bright future.
Hey, I admit it: the ACA is a miserable piece of political sausage, ground by craven, money-mad politicians and contaminated with blood, bone and hair to protect the profits of private health-care barons. Still, it’s better than what we had before, and, so far as I can tell from his rather vague promises, what Romney would give us.
When a President Romney gives states the authority to ignore the ACA while he seeks to have it repealed, he will transport us back to the good ol’ days when parents couldn’t cover their children aged 18-26 on their health-care plans and those with dreaded “pre-existing” conditions, no matter how mild or inconsequential, were routinely rejected by most insurers, which presented a Hobson’s choice of crazy expensive plans or going uninsured.
A lot of people who “hate Obamacare” actually like a lot of its provisions. But mostly, they don’t know what the law contains, and they’ve gotten hung up on abstract notions of “freedom” and “liberty.” They are enraged by the piece of the legislation that’s gotten the most attention, the individual mandate. You’ve all heard, of course, that this idea originated with the conservative Heritage Foundation and was the linchpin of, ahem, Romney’s health-care reform in Massachusetts.
You’ve also heard of the radical notion that anyone who drives should be covered by insurance to protect the rest of us. And, if you paid attention to the recent Supreme Court arguments, you also heard justices cleverly inquiring as to whether the principle behind the mandate would allow the government to compel us all to eat broccoli.
The best rejoinder I’ve seen to that is “What Makes Health Care Different,” a succinct, rational op-ed piece by software company CEO Donna Dubinsky from the April 6 Washington Post (http://wapo.st/HomfFG).
Even as she blows the bogus broccoli baloney away, Dubinsky takes the Obama solicitor to the woodshed for missing a critical point in his arguments.
“(T)he court forgot that the private insurance market does not function as a normal market. If you are not employed and you want to purchase insurance in the private market, you cannot unilaterally decide to do so. An insurer has to accept you as a customer. And quite often, they don’t,” she writes.
She goes on: “The government muffed its response. There are two simple limiting conditions, both of which must be present: (1) it must be a service or product that everybody must have at some point in their lives and (2) the market for that service or product does not function, meaning that sellers turn away buyers. In other words, you need something, but you may not be able to buy it.
“Can the government force you to eat broccoli? This proposition fails on both counts. Nobody must eat broccoli during their lives, and the market for broccoli is normal. If you want broccoli, go buy it. Nothing stops you.”
I’m truncating her elegant, pellucid argument, but you get the idea.
All those rabid opponents of the ACA, most of whom are no less appalled by the idea of single payer — that’s public health insurance, not public health care or “socialized medicine,” and don’t let anyone tell you otherwise — are beholden to abstractions at the expense of real-world solutions.
And plenty of them seem to suffer from permanent teenage-itis: Insurance? I don’t need no stinking insurance! I’m indestructible. But if I do need, you can pay for me … deal? We live in bizzarro world when professed personal-responsibility conservatives are indignantly upholding the rights of leeches.
But perhaps I’m wrong. Do you have a solution that doesn’t involve universal coverage, free riders, or death in the streets? Let’s hear it.