I was watching the Supreme Court oral arguments for the healthcare mandate on C-Span this morning. Now before you fall asleep, just hear me out. Seriously—stop yawning—I see you out there! More people should supplement their daily Fox News or MSNBC fixes with a side of C-Span. People would be a lot more informed rather than conditioned to think a certain way. Unfortunately, I think most people simply prefer others to do the thinking for them no matter how biased that thinking may be. But I came away with a couple of thoughts in mind. First, Antonin Scalia is so condescending, but rather entertaining. Second, I heart Ruth Bader Ginsburg. And third, that David Verrilli is leaving a lot to be desired in the defense of the healthcare act.
The constitutional point in question with the mandate is whether health insurance falls under the definition of interstate commerce. If the justices determine that it does, than the mandate would be constitutional via the commerce clause (Article 1, Section 8). If health insurance is not interstate commerce, then Congress has no right to legislate it and that part of the law would be negated. Now with that boring little technicality in mind, is this oral argument really necessary? I’m going to go out on a limb here and just predict that this decision is going to be a partisan decision. Roberts, Scalia, Alito, and Thomas will dissent. Bader Ginsburg, Kagan, Sotomayor, and Breyer will decide for the law. Kennedy will be on the fence, but will join the pro side in the end and the healthcare mandate will be upheld. Just a guess, Kennedy could go the other way.
Does anybody really think that health insurance and healthcare isn’t interstate commerce? If I get injured in Idaho, I don’t get choppered back to Maine Med to have my femur fracture repaired so I can bleed out while watching out over the plains of the Midwest. Healthcare is about 17% of our economy. It’s ridiculous to say that healthcare isn’t interstate commerce and just because you don’t like a law doesn’t make it unconstitutional.
Okay, I’m done with the boring constitutionality arguments for healthcare mandates. The Supreme Court will decide and we’ll have to live with their decision. I’d much rather talk about the healthcare debate in general. So here we go…
Let’s first ignore the conservative hypocrisy over the healthcare mandate. The mandate originated with the Heritage Foundation and was pushed for multiple times by multiple Republicans during the 1990’s. Let’s just say, for argument’s sake, that this isn’t about hypocritical partisan posturing in order to take down their enemy, Barack Obama. Let’s just say that the Republican dissent is genuinely based on a concern about government imposition on personal choices—for argument’s sake.
Conservatives are, forgive the idiom, cutting off their noses to spite their faces. They don’t think government should have the power to make them buy insurance and they don’t want to have to pay for someone else’s personal “decision” to remain out of the private insurance market. I put decision in quotations because it’s often not a decision at all. Good luck getting into the private insurance market with diabetes, heart disease, a history of cancer, or any other preexisting condition the market deems too costly for their bottom line. God forbid private insurance companies not be able to pay for their multi-million dollar executive salaries and private jets. Let’s also not forget all of those investigators hired in order to determine (without patient contact, mind you) that your medical procedure was not actually necessary so that they don’t have to make good on the service that their customer has already paid for.
Well here’s my answer to all those who cringe at the thought of paying for someone who doesn’t have insurance: YOU PAY FOR THEM ANYWAY!! Healthcare cannot be treated like a free market enterprise. People get sick whether they can afford it or not and when the uninsured get sick, we (the insured) pay for it both through government subsidies and through increased private insurance premiums.
Uninsured patients cost hospitals$49 Billion per year. Hospitals have to find some way to recover those costs. How do you think they do that? It’s all cost shifting. We’re paying for these people anyway. The uninsured are charged WAY more for their healthcare, one, in attempt to recoup the costs of those who don’t pay their bills and two, because individuals don’t have the bargaining power that private insurance and the government have. When these people go bankrupt—and many of them will—we now pay this increased cost. At least if they were insured, there could be some caps and control over inflated prices.
We’re a country that values life. I wish the rhetoric of those who say they value life the most lined up more closely with their actions and I wish that someone would remind these same pro-lifers that Jesus preached more against hypocrisy than anything else (Oh, I guess I just did that). But unfortunately, we live in a world full of hypocrites. Because we, as a society, value life we passed EMTALA regulations in 1986 (signed, BTW, by *gasp* the conservative messiah himself, Ronald Reagan).
How many of you against the individual mandate have no idea what EMTALA is? Shame, shame, shame. Well, let me help you. Very generally, EMTALA is the set of laws that require emergency rooms to accept you as a patient regardless of your ability to pay. Despite certain Republican debate audiences, most Americans think it’s a good idea that if uninsured farmer Joe has his arm chopped off in a hay baler that the emergency room can’t turn him away.
Sorry Farmer Joe. We’d sew that back on for you, but there’s no way you could afford it. Good luck. I’m sure that massive spurting, arterial bleeding will clot right up.
We passed EMTALA because we believe that even if a person made an irresponsible decision to not buy insurance we don’t want them to needlessly suffer if we have the ability to help them. We value life. When these Farmer Joe situations happen, someone has to pay for it. If we’re lucky, Farmer Joe is independently wealthy and can pay out of pocket. For the rest of the 99% of the country, the likely progression is from sickness to treatment to health to huge bills to being overwhelmed to depleted savings to losing your home and other assets to losing your retirement to claiming bankruptcy and finally to passing the bill off to you and me.
Anybody out there who thinks that the individual mandate is a government overreach must also stand up and fight for the repeal of EMTALA. Anything short is hypocrisy. EMTALA forces a hospital to provide services to customers who cannot and/or will not pay for them. It’s akin to forcing a store owner to sell a plasma TV to a customer who offers nothing but his word that he’ll eventually pay. Are you willing to let Farmer Joe bleed out in his cornfield simply because he couldn’t afford insurance?
Of course, that argument is ridiculous. Healthcare is not a product that follows market rules. It’s not supply and demand. The demand is constant—especially with the American lifestyle. People will always be sick. The real question is what do we value as a society? Should healthcare be a right or should healthcare be reserved only to those who can afford it?
Do I want to pay for somebody who is morbidly obese and refuses to eat anything green unless said food happens to be dyed that color? Do I want to pay for somebody who chooses to smoke two packs a day? Of course I don’t. But, you know what? I pay for them anyway because we, as a society, have decided that even people who make bad choices deserve treatment. You really want to control healthcare costs then you find a way to get preventable disease under control. Unfortunately, the same people who bitch the loudest about individual mandates are the same people who scream and cringe at the idea of putting nutrition facts on restaurant menus, or banning soda in school, or increased cigarette taxes. What do we call that again? Oh yeah, HYPOCRISY! These people don’t care about health, they care about bottom lines and that’s it! Until, of course, they’re the ones lying on the operating table. Everyone else is a freeloader, but when they need help, their claims are legitimate.
Healthcare should not be treated like a free market commodity because the product does not follow the rules of supply and demand. People need healthcare whether they’re rich or poor—whether they have a job or not. When we treat healthcare like a free market enterprise, we get ridiculously high prices for medical procedures, absurdly inflated salaries for insurance company executives who do nothing in terms of actually helping a patient, and a system that focuses on treating sickness rather than preventing the sickness from happening in the first place.
And the thing that hurts our wallets the most is that the sickest in our society are the ones being kept out of the market. Unfortunately, we’re beyond the point of appealing to people’s humanity. Profitability is what matters. Well, I would remind you that when the uninsured get sick, whether it’s a kid who just got off his parent’s insurance and gets into a car accident or a farmer who leaps headlong into a hay baler, you pay for them anyway. So stop cutting off your nose to spite your face! People will always make bad decisions. Most people believe they still deserve to be helped. If you don’t believe that then you need to stand up and start fighting for the repeal of EMTALA. Here’s another idiom for you if you tell your congressman to fight for EMTALA repeal: That’ll go over like a fart in church.
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