No free choice

The Patient Protection and Affordable Care Act was finally debated before the Supreme Court. The debate ranged from arguments about broccoli to whether Congress could require citizens to buy something like health insurance. Listening to and reading about the comments from those who should know what they are talking about and from people on the street is troubling.

Most people don’t seem to know the name of the legislation is actually the “Patient Protection and Affordable Care Act” and frequently refer to it as “Obamacare.” The latter is used as a derogatory reference which implies that it was President Obama alone who enacted this law. Of course, anyone who paid attention in civics class knows that a president cannot write or pass legislation. He can only sign it into law after it has been passed by both houses of Congress. In order for this piece of legislation to be passed, President Obama’s proposals to Congress were changed, added to, subtracted from and compromised to convince enough members of both the House and the Senate to get a majority vote.

I am surprised that the Act’s mandate for everyone to have insurance has raised such a furor. It seems that this perceived infringement on our rights to make decisions about our health care makes many people uncomfortable. Since the majority of people in this country are covered by health insurance provided by their employers, by Medicare or Medicaid or some other federal program, and there are exemptions, the mandate will only affect about half of the 15 percent of Americans who are uninsured. These uninsured are frequently depicted as freeloaders who cause everyone else’s cost of care to go up, so why the uproar about forcing them to buy insurance like everyone else?

Businesses and individuals are paying double digit increases in premiums for insurance that has ever increasing deductibles and co-pays, yet few feel much freedom to choose to cancel their policies. The fear of being bankrupted by a major illness keeps the majority of Americans choosing to pay insurance companies.  Even those who are uninsured do not usually make that as an exercise in free choice, but rather a choice of economics. Many people are afraid to change jobs or start their own business because they might lose their employer-funded health insurance.  What freedom of choice is being abridged?

Many of the people I have heard interviewed in the last couple of weeks seem to think this attempt to overhaul how we access medical care attribute a whole raft of evils to this legislation. Some think the government will tell their doctor what care they will receive when they are sick. Somehow that seems more threatening than having a for-profit insurance company dictating to their doctor what tests and procedures will be paid for.

Others call this socialized medicine. There is nothing socialized about this plan. There are no government owned hospitals or government paid doctors mandated. It is a very un-socialistic plan that guarantees insurance companies new customers in exchange for eliminating some of the unfair practices of the past, like denying coverage for preexisting conditions, kicking college students off their parents’ family plan, and basing premiums strictly on a person age. It is interesting that when asked about the individual provisions of the Patient Protection and Affordable Care act, the majority of Americans support them. It is only when asked if they support “Obamacare” that their answer is negative.

I am torn by the discussion. On one hand, I applaud the President and the Congress for finally trying to deal with this issue. Presidents since Teddy Roosevelt have been talking about it. No one has been able to get it done. Conversely, I do not like the idea of being forced to buy insurance from a for-profit insurance corporation. It seems wrong that so much profit should be generated from the care of the sick and dying. Doctors and nurses need to be paid. Companies which develop drugs and medical equipment need to make money. The health insurance industry, however, is gathering in record profits even as businesses and workers see their take home pay shrinking. For me it is not the requirement to have insurance that I find offensive, but the fact that I have no option other than to add to the profits of these corporations and the wealth of their corporate executives. The act does not include a public insurance (like Medicare) option.

If the Supreme Court declares the entire Patient Protection and Affordable Care Act unconstitutional, how long will it be until anyone dares put his/her political career in jeopardy by proposing new legislation to deal with the problem? Is the answer that everyone should fend for themselves? Do we continue to host pancake suppers to help even those with insurance who can’t pay their medical bills while insurance profits soar? How do we ration care to those who don’t have insurance and can’t pay their bills?

If the court decides the law requiring the purchase of health insurance is unconstitutional, they will have protected our theoretical right to choose to be uninsured. Exercising this right, however, subjects one to accusations of freeloading, the risk of bankruptcy, and being refused care other than in an emergency room. If the law is upheld, everyone else will be required by economics and fear of financial ruin to continue paying into the current system and to share in providing guaranteed profits to the insurance industry.

It’s a difficult choice and hardly free.

Copyright © 2012 Janet Jacobson and Sustaining the Northern Plains