No Good Deed Goes Unpunished

English: English: Barack Obama signing the Pat...

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If you want to tick off an American, any American, young, old, male, female, just try ordering them around. Want to see real anger? Pass a law telling them what they have to buy.

mandate noun 1. an official order or commission to do something.

The primary obstacle to President Obama’s reelection is anger over the mandate of the Affordable Care Act, a.k.a., Obamacare. Here’s part of USA Today’s take on the much-excoriated ObamaCare:

In a USA TODAY/Gallup Poll of the nation’s dozen top battleground states, a clear majority of registered voters call the bill’s passage “a bad thing” and support its repeal if a Republican wins the White House in November. Two years after he signed the Patient Protection and Affordable Care Act— and as the Supreme Court prepares to hear arguments about its constitutionality next month — the president has failed to convince most Americans that it was the right thing to do.

“Mandating that you have to buy the insurance rubs me the wrong way altogether,” says Fred Harrison, 62, a horse trainer from York County, Pa., who was among those surveyed and supports repeal even though he likes some provisions of the law. “It should be my own choice.”

“It seems like it forces you to take health care (coverage), and you don’t really have a say in the matter,” says Beth Leffew, 26, a college student from Cincinnati. She says the president “didn’t really listen to people” when they objected to the proposed bill. “It seems like he just shoved it right through Congress.”

What the President and the Democratic Party tried to do with the ACA was to fix fundamental problems at the heart of our economy and our culture, and despite the perception that the ACA is “insurance”, what it really is is a social program, similar to Social Security, Medicare and Medicaid. But conservatives have successfully painted it as a financial onus forced on the public. How did we get in this mess?

It happened in 1986 when the practice of “patient dumping” was becoming common. Patient dumping is defined as: 

“. . . the transfer of patients from one hospital to another based on the patient’s inability to pay for care. Schiff (1986) reported that 250,000 inappropriate transfers of medically unstable patients occurred, resulting in increased patient morbidity and mortality.”

Human nature caused this. Uninsured patients were waiting until they were true emergencies and then throwing themselves on the mercies of ER’s. Healthcare is not a normal commodity and nobody wants to pay for expensive insurance, especially if they are healthy. It’s a long-term thing, kind of like buying life insurance or disability insurance. When you don’t need it, it’s too expensive. When you do need it, it’s a necessity, but by then it’s too late. Another analogy is saving for retirement. When it comes down to buying a big flat screen in time to watch the Superbowl or making a big contribution to one’s IRA, guess which one wins?  In Japan, it’s the IRA, but in America the flat screen wins hands down.

So, in 1986, Congress in its collective wisdom decided to fix the patient dumping problem which was rapidly becoming a national embarrassment. Now what they might have done is mandate (that word again) that everyone buy healthcare insurance, much like the ACA, but the pols of that era found a clever alternative. What they did was to force hospitals to treat uninsured people for free, in effect making about every two insured people pay for one freeloader and they did this by extortion. Congress said to the hospitals, “you can turn away anyone who can’t pay if you want to, but if you do you will get no more payments for Medicare or Medicaid”. The hospitals had no choice because almost half of their business came from Medicare and Medicaid, and that has continued in force ever since.

The legislation Congress passed in 1986 was called COBRA and the patient-dumping part was called EMTALA. It is a major reason why the cost of medical care has spiraled out of control and in turn a major reason for the nation’s towering national debt. And it’s getting worse, much worse. Fewer and fewer employers can afford to offer health insurance as a benefit and at a time when the baby boomers are getting fatter, less healthy, and are about to retire. And yet, if you ask the man in the street I’ll bet not one in a hundred knows a thing about EMTALA. Mr. Average Citizen, like the proverbial frog, is being financially boiled alive one degree at a time and he doesn’t even know the cause is EMTALA.

A CNN poll conducted in March of 2010Citation ...

Now obviously no politician is stupid enough to call for the repeal of EMTALA. Heck, I’ll bet even Ron Paul wouldn’t do that. Just picture dying patients outside the front doors of hospitals. And yet, people are mad as hell at President Obama and the Democratic leadership for trying to fix the problem by having everyone pay into the system. FREEDOM they cry! Nobody’s going to make me buy something I don’t want to buy! But these same people take their Social Security benefits happily. They rationalize that they paid for those, not recognizing that it’s the same thing. Many people die well before collecting all that they put into it, and others draw far more before they die. The money’s for “security”, not for a measured amount of product, just as the ACA is for healthcare security.

People need to wake up and get over their mad on this issue. Of course the Supreme Court is going to decide on the mandate’s constitutionality this summer, but regardless of the outcome of that, the mandate will surely remain a principal issue in the campaign. We are all in this together and if we punish a President who honestly tried to fix a festering mess by voting him out of office with an attitude of self-righteousness over the ACA, we are making a big mistake. EMTALA will still be on the books, a third of all patients will be risking their health and trying to ride the system free, and the Republicans will repeal ObamaCare.  What they replace it with, if anything, you are not going to like.

About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Democratic.
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4 Responses to No Good Deed Goes Unpunished

  1. PiedType says:

    ACA was weighing heavily against Obama in my mind … until it became apparent that the GOP is not going to nominate anyone I want in the White House.


  2. …in 1986, Congress in its collective wisdom decided to fix the patient dumping problem which was rapidly becoming a national embarrassment. Now what they might have done is mandate (that word again) that everyone buy healthcare insurance, much like the ACA, but the pols of that era found a clever alternative. What they did was to force hospitals to treat uninsured people for free, in effect making about every two insured people pay for one freeloader . . .

    Jim, I had forgotten this. If asked, I’d’ve probably said that requiring hospitals to treat everyone who comes into ER went back further than 1986. You’ve put some pieces together that were flying around loose. I’m glad for this refresher of a history lesson.


    • Jim Wheeler says:

      Thanks, Helen. The step taken by Congress in 1986 was huge and I don’t see any way short of anarchy that it will be reversed. Anger over the Obama mandate is misplaced – it should be aimed at the Congress of 26 years ago. Too late now.


  3. ansonburlingame says:


    First of all, as a conservative, I find many reasons to vote against Obama, depending of course on who the ultimate GOP candidate might be. If it becomes Santorum, I may well vote for Obama, while holding my nose, for sure. The lack of an understandable and consistent froeign policy from the current administration is at or near the top of MY list to oppose the President’s reelection, for example.

    But ACA plays a role as well.

    The typical progressive solution for almost all social problems is to call on government to fix the problems, health care today, the war on drugs during the Nixon years, the war on poverty during the Johnson years, etc., etc. However our constitution was never constructed for government to even try to solve such problems. It was designed for the freedom and liberty of “the people” to make such decisions for themselves.

    But over the last 50 years we have developed the “warfare -welfare” approach to federal government and it is breaking our financial back. Sure there are tremendous needs in any society, but government itself is not the sole solution, in my view.

    If (actually when) gas prices go “through the roof” I should not be trying to blame government. I should either “suck it up” and pay for the fuel for my current 20mpg vehicle or trade it in for a hybrid, or in the extreme go ride a bike. Same with health care. What can I do (assuming I did not have such a cushy HC policy paid for by my previous employer) to lower my HC costs. I won’t bore you with such individual choices that I could make that would not include screaming for more “free” stuff from government.

    Obama has ONLY addressed the span of coverage for HC, up to this point. He has done little to control the overall cost of HC. Typical progressive solution and I thus oppose him.



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