Wednesday, March 28, 2012

The Great Healthcare Debate: The Personal Mandate v Broccoli

For those of you who haven’t read my original post on health care reform written a little over two years ago, please read it now. It’s the second most popular post on my site and currently generates the most traffic.

The current debate in the Supreme Court centers around the mandate in the Affordable Care Act requiring individuals to buy health insurance. There are compelling arguments for and against that will be argued before the chief justices make their decision sometime this summer – when the campaigns for the next president will be in high gear.

I debated this today on Facebook with a pretty weak premise: the requirement to buy health insurance was similar to states requiring us to buy auto insurance. It was pointed out that not all states require auto insurance – mirroring the attitude to health care reform pretty well. Some states are for it, some are against it. But the debate continued with good opinions. This got me thinking of a better premise that better fits my argument.

Before I get to the premise, I want to talk a little about choice. There are several instances where the government has made me do things without my choice that I haven’t agreed with. When I was 18, I had to drive down to our post office and register for Selective Service. This lets the government create a list of draftable young men for the military. I didn’t really want to register, but it was required by law. Consequences of not registering could be fines or jail time. All young men are required to register: regardless of their choice.

None of us really have a choice about paying taxes. There are a number of people that don’t want to. It’s one our oldest national debates. It was a leading cause in secession from England. The consequences of not paying: fines or jail time.

When it comes to taxes, we also pay into social security. In this the unretired pay for retirees and those unfortunate [destitute or debilitated] that need it earlier. While I’m sure there are a number of people that don’t believe in social security, there are more that do believe this is a good thing for our country.

There are a number of laws that are made that people don’t agree with. Most of these are aimed at the greater good of society. People may feel they are unfair, that they may impede on a personal liberty – I can’t go out and have three wives if I want to or my religion says it’s ok – we as a society have decided it’s for the greater good.

This Is About Commerce aka We Don’t Want To Be Forced To Buy Broccoli

Health care reform and the Affordable Care Act is about fairness. Those of us with health insurance pay for the uninsured through higher premiums and higher taxes. It’s not fair for us to do so, but we’ve decided as a civilized nation to not turn those that need emergency care out onto the streets if they can’t pay for it. There are places in the world where this isn’t the case, and most Americans wouldn’t want to live there.

The question becomes: how do we make this more fair? What are the interests of the greater good?

Health care reform tackled this by requiring the uninsured to buy insurance with financial assistance for those who may need it. According to the Congressional Budget Office (CBO), this will bring down the total cost of healthcare after a period of years of the plan taking effect. The secondary benefits result in us paying less because the uninsured will become insured, there will be a larger pool of people to spread the risk over – which in turn removes pre-existing conditions, yearly and lifetime caps and insures children and young adults better.

The main argument against it: Congress is forcing people to buy something they choose not to buy. The fear is that if Congress mandates we buy one thing, like health insurance, we may someday be forced to buy something else, like Broccoli, because like health care we all have to eat. It’s a little like saying gay marriage will someday lead to people wanting to marry sheep.

How Healthcare Is Different Than Broccoli

My wife and I do not have children and we don’t plan to change that. Even though I’ll never have children, my taxes pay for public schools in my area. I can’t go down to my local city hall and choose not to pay for schools. This is because we have made the conscious decision that education is something we value in our country and each and every child deserves an education. This is a non-partisan issue. Partisan politics may go into things like vouchers for private education, but the removal of public education remains a cornerstone of our society.

One way we could end this debate would be to get rid of private insurance and make health care universal run by the government. The government runs a number of health care systems with Medicare and the Veteran's Administration being two large ones that come to mind. The bones of a national insurance system are already in place and some of our neighbors have shown how successful this system can be by working and containing costs.

I’m not advocating abolishing the private insurance industry, but if we did it would cease being commerce. It would be a government service like roads, bridges, the military and many other government services that Congress authorizes. It would be like public schools.

And there in lies the rub. Some people think the quality of public education is bad, and in some places it is. The fear is that government-run public universal health care – or at least government-run universal health insurance would be horrible. I get that. Again, let’s look at the schools.

We don’t have public education exclusively in this country. We have public and private schools. Some people can only afford public schools, and for them my tax dollars help run them. Others either being better off, working harder, earning scholarships or from other means choose to send their children to private schools. Public schools may have limited choice by which district you fall into, sometimes there’s choice among them through charter, magnet or other options. Some public schools are top notch. Parents may have additional choices, based on their circumstances. Bottom line: there is a minimum level of services provided up through high school.

Health insurance should be no different. This same type of dual system: public and private insurance could have been our choice. Other countries have proved it successful. We could have a minimum level of insurance for all, whether that’s Medicare or something else and others could opt for private insurance with a higher level of service. It seemed unpopular to Congress and the American people to take the brave step for this route, so they compromised. Instead of taking the public universal coverage option, they opted for all Americans to purchase private insurance.

In a public school setting, you aren’t forced into sending your child to a charter school, you just have to send them to school. With Congress forcing you to buy medical insurance, you need to buy medical insurance, not a particular company or policy of health insurance – that would be broccoli. The analogy would be we all need to eat so Congress is mandating you need to buy food. If they were mandating a company or policy – then it would be like forcing broccoli.

We’re Having The Wrong Debate

The presidential political season is heating up and Republicans seem hell bent on repealing the Affordable Care Act and attacking it in the Supreme Court. Honestly, we’re having the wrong debate.

While the act was being written, Republicans raised many good points that were failings of the act. The act doesn’t cover torte reform, prescription medication cost controls and many other points Republicans wanted in health care reform law. Instead of demanding a repeal of the act which would be devastating to the US economy and to businesses that have spent billions reworking plans to conform to the act, they could take a leadership position by taking it further than before. As I said in my original article, health care reform isn’t going to be fixed with one bill, but many incremental ones.

The Affordable Care Act was a good bill, but not a great one. It has improved the economics of the insurance industry, the US population, businesses and the government. A good next step would be further cost controls without removing coverage. It can be done, but takes real political courage.

We all need healthcare, starting with the day we’re born until the day we die. Some of us are fortunate enough to use less than others, some have it economically ruin their lives. Repealing the act will cost us more according to the CBO. Instead of costing America more to score political points, how about introducing further cost controls and reducing costs even further. Those are political points that extend across the aisle.

For references and true stories, read my original article.


  1. I do agree that the Affordable Bill Act is a good thing to have since it helps ensure equal healthcare treatment. What I just can't figure out is what's with the mandatory purchase of health insurance. The point should be to make healthcare more affordable for all. Sadly, not everyone can afford to maintain a health insurance plan.

    private health insurance

  2. The medicare is a long time issue that until how remains unsolved. We are all hoping that the medical insurance also includes dental provisions. My Brea dentist said that we need oral health care in order to be totally healthy.

  3. Maia, I agree with you on both points. As a former employer, I can tell you dental insurance is just horrible in the country, especially for how much you pay v. how much you can get out. That is one area of insurance that clearly needs some reform.

  4. the second influencing factor is the pay. World over the healthcare professionals are paid a big fat pay cheque. This remuneration also depends upon the location, like internationally the healthcare professionals are paid well; and on the experience and their qualification.