Thoughts on health care

A Facebook friend linked today to a blog post in which the writer quarreled with the idea that an individual mandate for health insurance (as included in the Affordable Healthcare Act, or ACA) was supported in precedent by the requirement imposed on drivers to have auto insurance. The writer of the post starts with what I think is a misstatement of ACA supporters’ case: “…since government requires people to purchase auto insurance government can also require people to purchase health insurance.”

A more accurate characterization of what some people think would be, “To say that requiring people to be insured is not new. We require people to have insurance if they drive a car so it isn’t anything bizarre or devastating to require people to carry health coverage.”

The blogger’s detailed breakdown of who requires what only muddles the argument. States require drivers to carry liability insurance while auto lenders require coverage on the car itself. And then there’s the point that even when states DO require such a thing as insurance coverage that still isn’t the federal government, thus invalidating the analogy in question.

“The auto insurance requirement serves to protect the public from catastrophic losses the insured may cause…The state isn’t concerned with how someone replaces their vehicle or pays personal medical expenses that result from their actions…Banks are lien holders with vested interests in the collateral.”

As I see it we all have a vested interest in each other’s health. Every taxpayer is already on the hook for the (sometimes catastrophic) losses incurred when an uninsured person gets sick. We all have a vested interest, from both moral and fiduciary standpoints.

The theme of personal responsibility is clear in the blog post:

“…expenses that result from their actions…protecting a person against their own actions…Personal health is an individual responsibility with the rewards and consequences of each persons [sic] decisions borne accordingly…In a free society people bear their own burdens whenever possible and seek charitable assistance when necessary. Involving government inhibits individual responsibility and encourages risky behavior.”

This is dangerous territory. Should society help uninsured people when they are smokers and contract lung cancer? Or when they are obese and develop diabetes? Or when they are crashed into by an uninsured motorist, have an accident and lose a limb?

It is easy to preach “individual responsibility” but are we really a people who will look at a 260-pound, hypertensive 30-year-old and say, “You’re on your own”? I don’t think so. I hope not.

The law of the land is that we do not turn people – any people – away from Emergency Rooms, but isn’t there a smarter, more fiscally prudent way to deliver what the law requires?

In 2007 I was in on hand when the Governor of California, to his credit, tried hard to enact universal health care in the state. It was a tremendous effort involving intense outreach but a plan was finally identified that was agreeable to insurance companies, doctors, nurses, hospitals, drug companies, patients’ rights advocates – all the stakeholders. Input was sought and received from Gov. Romney’s administration in Massachusetts, since they had come up with a health-care-for-all plan the year before. The necessary legislation had the support of the (Democratic) leaders of both houses of the California legislature and was on its way toward its next step – going for a vote by the people – when the President pro Tem of the state senate withdrew his support at the last minute, even though he was a cosponsor of the bill. Everything fell apart.

During that period I learned that an ER visit costs a minimum of $1000. (The uninsured use ERs as their first source of care.) That’s the cost for a person to walk in and be seen by a doctor and nothing more. I learned that basic assessment for many of the things these people go to ERs for could be done at a clinic for about $100. That’s the clearest indication I know of health care reform as our joint interest.

The linked article repeats a wild claim: “…the federal government is forcing us–under threat of fine or possible imprisonment–to buy personal insurance from a private company.”

PolitiFact studied the claim about imprisonment and rated it “Pants on Fire,” its lowest level for accuracy. Potential jail time for failing to buy health coverage is a myth, a fallacy, a lie. Here is an explanation.

And in case, by the way, anyone thinks that PolitiFact is universally supportive of the president, note that they’ve checked him on a considerable number of statements – over 500 – and found them only “Half True” or worse more than half the time. For 2013, in fact, they gave him their “Lie of the Year” award for claiming that if people liked their doctors or policies they could keep them. These people are not shills.

ACA was passed by Congress and has been upheld in the courts. It’s the law. I’m not a politician, elected official or constitutional lawyer (President Obama is) but it seems that the only way to undo ACA would be for Congress to pass new legislation and for the president to sign it. That’s the way the system works.

Dislike the law but don’t use shallow reasoning to dispute its merits.


My sense is that much of the opposition to ACA comes from the mere fact that it was the president’s plan and he managed to get it through Congress. I have no proof but it’s what I believe. And I acknowledge that it was a huge tactical mistake for the president ever to refer to the plan as Obamacare, which only rubbed people’s noses in it. Somebody gave him bad advice, or he didn’t take good advice.