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On Thursday, June 28, 2012, the Supreme Court ruled on the constitutionality of the Patient Protection and Affordable Care Act (PPACA or ACA for short).  In the ruling of a lifetime (really, how often do non-constitutional scholars get this excited about anything involving the Supreme Court?), the Court upheld the entire law as constitutional, aka, legal.  The details were very exciting, but I won’t get into them here.  That’s not what this post is about. 

This post is about the fact that certain segments of society have taken up the most selfish, bigoted, irresponsible, opportunistic, and ignorant views on this subject that it makes me embarrassed to call them fellow citizens.  It is one thing to disagree with the nuances of the law.  I certainly don’t think the law is perfect as is.  I would even understand if people openly stated that they don’t care about other people and don’t want to pay for them.  At least they’re being honest.  It’s quite another to brandish your argument in fancy words and pretend you’re all about cost control, “freedom”, and “judicial restraint”.  While I’m probably preaching to the choir, and it’s not like my blog post will reach Cantor and Co., I feel compelled to spell out two arguments for the necessity of health reform.

The moral argument: You’ve heard the statistics.  50 million people are uninsured in America.  That’s nearly 1 in 6.  Those who are insured may be underinsured, or may take a job or remain at a job because they need the healthcare provided by their employer.  Pre-“Obamacare”: Lifetime caps on coverage were instituted, making it impossible for many people to pay their medical bills, medicines were more expensive, contraception cost more money, those with preexisting conditions such as breast cancer (yes, really) were routinely denied coverage altogether, and there were gaping holes in insurance coverage for young adults and rising costs for senior citizens.  Nearly 50,000 people a year die because they don’t have health insurance.  This is a staggering number and should be unacceptable to any human being.  The United States, an industrialized country, and the wealthiest country in the world by far, has no excuse.  Politicians love to brag about how the American medical system has the finest doctors and the best technology in the world.  Yet, we charge people exorbitant amounts at the emergency room, and let tens of thousands die per year.  It’s often said that reason is the better tack to take in an argument as opposed to emotion.  In this case, there’s no way to leave emotion out of it.  Sickness and suffering is an emotional thing—especially if much of this suffering can be alleviated, and care can be provided for all.

The economic argument: For those who don’t care about the morality of the matter—or who have compassion, but “don’t think we can afford” to overhaul the healthcare system right now—there is a very strong economic argument to be made.  Currently, healthcare accounts for 18% of the country’s GDP.  To put that number in perspective, the United States government spent approximately 1% of GDP on the space program at the height of the Cold War, and that was a lot of money.  This 18% is not stagnant, either.  When people say that healthcare costs are “spiraling out of control”, and need to be contained, they mean it.  Healthcare will eat up more and more of the budget, and soon, we won’t be able to pay for anything else.  This is not meant as a scare tactic, and it’s not wild speculation.  It’s the truth.  Insuring more people, providing preventative care, preempting emergency room visits (the only way some people get treated), neutralizing risk, and creating a climate of stability will bring the costs down significantly.  Sure, it will take a few years, but inaction is worse.  If the U.S. had taken significant action on climate change decades ago…but I digress.  Doctors, hospitals, patients, and healthcare experts all agree that the fiscally responsible thing to do is to go the way of the ACA.

The free rider problem: This is about who we are, as Americans, as a society.  Like it or not, we do live in a society, and this concept carries with it certain responsibilities.  Given the choice, individuals will act in self interest, aka, not take care of someone else.  People will also not pay for things they don’t want or don’t see a need for—or, especially, if they feel the “intrusive” government is “shoving it down their throats”.  Unless that something is on an infomercial…maybe the government should’ve tried to selling healthcare reform on TV at 3 in the morning.  The point is, people need to be mandated to buy insurance to neutralize risk and to control costs for everyone.  There needs to be a penalty for noncompliance to ensure people participate and that the program is successful.  Also, it’s not as if people never get sick or hurt or old.  It’s really an investment.  Many of the people who don’t want to buy health insurance are the people who end  up needing it the most.  Those who can’t afford it will be aided.  We live in a society in which cooperation is key.  No one lives in a vacuum and became successful or self sufficient by himself or herself.  A real patriot would want to do what’s best for the people in his or her country.  Any person who wants to live in a successful society—really just an outgrowth of the idea of favorable environment—should understand and internalize this fact.  We need to work together in a society, and sorry, Ron Paul, libertarian tendencies of hoping the “members of a church” will help someone in their community who is sick is unrealistic, unpredictable, and unsustainable.

In the 2 years and 3 months since the Patient Protection and Affordable Care Act passed, it seems all Republicans have been doing is mounting a relentless P.R. campaign against the “monstrosity” they call “Obamacare”.  When the scare tactics of alleged “death panels” didn’t catch on much beyond Tea Party circles, Republicans aimed for greater legitimacy by claiming that the ACA was unconstitutional.  Eventually 26 states advanced this charge, and the healthcare law made it before the Supreme Court.  In reality, behind the scenes much debate was going on within the Republican Party.  In the last few months, talking points started to shift from “gutting the whole thing” to “of course, we’d keep the most popular parts”.  While “replace and replace” became the de facto sound bite for any politician with an “R” attached to his or her name, the issue of what to replace their dreaded Obamacare with became more real.  The sobering reality, once the Supreme Court heard arguments for and against the constitutionality of the law in March, was that the Republicans must provide a viable alternative to the “2,700 page” legislation they had worked so tirelessly to strike down.

Herein lies the issue.  As many have observed, prominent Republicans seemed to want to keep many parts of the law that proved popular.  Their main opposition (beyond some of the issues with women’s health coverage and other so-called “liberal” provisions) was to the individual mandate part of the law.  They didn’t like the loss of freedom imposed by a mandate forcing people to pay for healthcare.  Their claims about the mandate, like all of their other claims about the law, were, of course, greatly exaggerated and distorted.  Hyperbolic or not, Republicans didn’t like the idea of a penalty and infringement on individuals’ all-important “liberty”.

Cue the free rider problem.  Also, isn’t denying people healthcare coverage an infringement of their liberty?  “Life” comes before “liberty” in the Declaration of Independence.  Without life, the pursuit of liberty and happiness become nonexistent.  Besides, a lot of people are stupid.  That’s not very diplomatic, but it’s true.  When they need it, people want government to step in and protect them from their mistakes or when they’re at their most vulnerable—then it’s ok, apparently.  In addition, people’s “liberty” often adversely affects other people, and everyone would admit that security (in this case, harm minimization) is the government’s role.

You would think that Republicans would be satisfied with the law because it helps big business.  Insurance companies, overall, end up the big winners.  The ACA is nowhere near nationalized or universal healthcare.  That “Romneycare” was the blueprint for “Obamacare” need not be mentioned except to draw attention to the humor and irony involved in the opposition presidential candidate’s contortions around such a personally damaging issue.  Hypocrisy at its finest.  In fact, Romney, too, notably changed his tune in his speech following the Supreme Court decision which upheld the ACA in its entirety.  Romney wants to keep certain provisions in place such as keeping kids on their parents’ insurance until they’re 26, not denying coverage to people with preexisting conditions, and maintaining competition between plans.  Some Republican politicians have gone even further to endorse the provision of stopping lifetime caps on care.  How to pay for all of this, though, without the mandate?  The lynchpin of the law, much like the “automatic trigger” of sequestration enacted after the debt ceiling debates, was put in place to hold people accountable.  Otherwise, they will “kick the cab down the road” forever and people will not take responsibility, not individually, and certainly not for the wellbeing of society.  The conservatives, who always stress sustainability, have spit in the face of a plan whose central tenet–the individual mandate–they, themselves, designed.

Do they want freedom or security (read: liberty or sustainability)?  President Obama’s Democratically passed law provides some measure of both.  It aims to address spiraling healthcare costs and provides much choice and increased coverage for millions of people.  Almost everyone in the United States is impacted by this law.  It is by no means perfect, but it’s a step in the right direction, and if Republicans are still so up in arms about it–and not just because they’re sore losers, hate Obama, aren’t too fond of women, prefer the status quo, and will cling to power at all costs–then it’s a positive sign.

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