Believe it or not the issues about the Affordable Care Act have boiled down to one, whether or not it is OK to have a mandate charging those without health insurance a fee for their failure to purchase health insurance. Instead of the vicious political arguments back and forth, I believe the issue can be reframed in terms of our citizens and their values and it seems as if we might all be closer to the same side than has previously been considered.
Last night, 3/26, watching one of the dialogues on television between a supporter of the Affordable Healthcare Act and a critic, it was the critic of the Act who made a strong argument in favor of considering healthcare a right.
Unfortunately I don’t have the critic’s name but I’d be happy to include it if provided, but she stated that she didn’t want to have to buy health insurance just because she’s “here and breathing.” As the discussion proceeded about whether others should have to pay for her medical treatment she put forth the statement that treatment was always available to people because doctors take the Hippocratic Oath to treat sick people.
While the cynics might note that there would be no malpractice and no need for debates about liability limits or amounts for medical malpractice if physicians also followed the Hippocratic Oath and first did no harm, the concept presented was actually charming.
This well-intentioned spokesperson has put forth the strongest argument yet for arguing that healthcare is a right rather than a privilege to be paid for with health insurance coverage. If there are physicians and there are sick people then those sick people would be seen by a physician for treatment because the physician has taken an oath to treat sick people. Lovely.
If what this woman said was true, why would any of us purchase health insurance? If doctors treat all sick people then none of us needs health insurance. What a wonderful world that would be. We would all opt out of insurance.
Unfortunately healthcare is about money in this country. Physician salaries have gone up even during these bad economic times. (You can see for yourself by going to the Bureau of Labor Statistics, occupational employment statistics and look at the data for salaries including percentage changes.)
Physicians aren't excusing the uninsured or even those with insufficient insurance to cover the enormous medical expenses accumulated by sick individuals, they're hiring collection agencies, they're decimating people's credit, they're suing people and individuals are going into bankruptcy because of their medical bills. These facts don't turn physicians into bad guys but as a country we've got to understand that physicians are in business to make money just like other businessmen.
So where does that leave the Affordable Care Act?
Let’s get to the more basic arguments based on this woman’s criticism of the Act. Essentially her claim is: It’s not fair to be punished by the government for choosing not to have health insurance by being charged a fee. It’s a simple claim. The other side is doing its best to show that the mandate is not a punishment but that it’s not fair that some people pay nothing and others pay for health insurance coverage. The arguments are about fairness.
In this instance the Affordable Care Act itself shows a means that both sides could have been adequately considered without fragmenting the American people because there are other “voluntary” provisions of the Healthcare Act that choose to reward those who participate rather than punish those who opt out. Naturally, these provisions don’t apply to citizens but perhaps they should.
Two examples are the concept of rewarding compliance rather than punishing non-compliance are in the Act’s provisions concerning “Holding Insurance Companies Accountable for Unreasonable Rate Hikes” which is in effect since 2010 and “Encouraging Integrated Health Systems” which is effective this year.
In the first instance, “Holding Insurance Companies Accountable for Unreasonable Rate Hikes,” we see that those insurers who justify their premium increases are eligible to share in $250 million of Federal grants. If their rate hikes are determined unreasonable they “may not” be eligible to share in this money.
Similarly under the provision “Encouraging Integrated Health Systems,” through the formation of Accountable Care Organizations for Medicare patients, “If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.”
Instead of a penalty, there is a reward and instead of a mandate there is voluntary participation in these provisions. It all boils down to fairness.
By turning the purchase of health insurance into a mandate instead of a provision inviting voluntary participation the Federal government backed itself into the corner of having a punishment for its citizens in a direct opposition to its approach with health insurers and physicians. Instead it should have followed the reward principle spelled out in provisions for health insurers and physicians, “Do this and you get this.”
Nobody likes being strong-armed and instead of arguing before the Supreme Court about whether or not the Federal government can do this, Americans should be asking why the difference in approach when it comes to dealing with insurers, physicians and consumers.
It would be interesting to see both sides arguing about fairness in terms of how the Federal government could have incentivized voluntary participation instead of punishing non-participation in the health insurance market.
So perhaps the Healthcare Act should be reworded in sections including the section on the mandate. Perhaps those who purchase insurance coverage should be entitled to a tax break or a refund of a percentage of the money they save insurance companies if they get through the year without becoming sick and making claims for illness requiring insurance coverage.
It’s about fairness and in this case both sides agree.
