Please take a few minutes to return with me to the basics of whether “ObamaCare” or an alternative universal health coverage program should exist. The underlying question is ethical and philosophical. “Are there circumstances under which a person who is uninsured and lacks money to pay for health care should receive it?” If you answer the question “yes” then we can have an intelligent discussion of who gets care and how to pay for it. If your answer is “no” and if you find yourself uninsured and critically ill, then you have a moral obligation to die without burdening others with the cost of your care.
Today, hospitals are required by law to provide emergency services without regard to a patient’s ability or willingness to pay. Hospitals are also required to force the doctors who have privileges there to serve in on-call rotations for non-paying patients. It is not free. Hospitals and doctors try to cover the cost of serving those who don’t pay by charging more to those who do pay. The system functions exactly like an invisible tax on health services but it doesn’t provide support for preventing serious illness and hospitalization by keeping people well and treating illness early. It doesn’t provide a colonoscopy to prevent colon cancer but if you are bleeding to death from advanced colon cancer, it could get you a transfusion. The law was well intended but it is irrational.
The basic principle of ObamaCare is to strongly encourage everyone to purchase health insurance either through an employer or as an individual. For those who can afford to buy insurance and choose not to, there are tax penalties. Those penalties help pay for services that some who refused to buy insurance will surely need and receive. For those who can’t afford the full cost of insurance, there is a subsidy to make it more affordable. For those who have incomes below 140% of the federal poverty level there is 100% federal funded expansion of Medicaid. In combination with Medicare and other existing programs, ObamaCare makes a reasonable level of health care available to all Americans. There are incentives built into ObamaCare that are intended to drive the cost of health care down and to improve the quality. It appears that some of them are already having a positive effect in reducing hospital readmissions, for example. And it bans insurance companies from onerous practices like not covering pre-existing conditions.
ObamaCare is not even close to perfect. The President would agree with that statement. It should not be compared to “perfect”. Americans could not even agree on a definition of perfect. Instead, ObamaCare should be compared to what we had before it passed. Those who want to repeal the law would take us back to the exploding costs and inefficiency of a non-system where every year the percentage of the population covered by private insurance went down because fewer employers and employees could afford it. Many insured employees saw no increase or even reductions in take home pay because the cost of insurance escalated so rapidly. The opponents of ObamaCare have nothing to put in its place except the failed laws of the past.
After nearly a century of debate, going back to Republican President Theodore Roosevelt, we have a start in providing universal access to some level of health care. The best part of the new law is that we finally made that commitment. ObamaCare marks the beginning of the evolution of a uniquely American health care system that emphasizes consumer choice and leaves most of the health care system in the hands of the private sector.
It is time for us to rally around the idea that all of us are going to have at least a basic level of health care. We will be forced to have the debates that have been held for generations in other democracies about what kinds of care will and will not be covered in taxpayer funded programs. Insurance market regulations will be debated and will need revisions to create health care markets that reward quality and cost, even to the extent of allowing low quality and high cost health care providers to fail financially. That, after all, is the nature of truly free markets.
I hope that attempts to obstruct the law so that it will fail or to repeal it prove futile. I know that they are counterproductive. It is long past time for opponents of universal coverage to acknowledge the end of that debate and to begin proposing their own ideas as ways to improve the law. And it is time for the North Carolina legislature and Governor to back away from their refusal to implement the Medicaid expansion. We will pay the cost of it in federal taxes regardless of what the legislature does but because of their action most of our poorest citizens will receive only emergency care. Refusing the expansion is wasteful of the tax dollars that we are already paying and mean-spirited toward those who with low incomes. It is time to quit fighting the President who finally got something done and to begin making health care better and less expensive for all Americans.