I read a George Will column on the Supreme Court’s review of the ACA in this morning’s Joplin Globe that prompted me to submit a letter to the editor. With apologies to those readers who have endured my essays on this before, here’s the letter:
Dear Globe Editor:
George Will declares (Globe, 3/27/2012) that the Obamacare individual mandate problem is simple: compelling people to “buy” insurance violates traditional contract law. If that principle is upheld, he says, then there would be no “stopping point” to Congress’ powers. OK, fair enough. But like his political allies, Will fails to point out an obvious inconsistency. The healthcare system is financially broken because Congress in 1986 forced it by extortion to provide services (through ER’s) to anyone who could not pay for them, the threat being that if it didn’t, Medicare and Medicaid fees would be denied. That law, “EMTALA“, is the reason 41 million people feel that health insurance is not a necessity.
EMTALA is just as much a violation of common law as the individual mandate, and probably more so, and yet no one (of either party) is calling for its repeal. Why is that? I submit that it is because the pols all understand that the electorate is self-indulgent. We love that America has “the best healthcare system in the world”, but we would rather not think about it costing 2 ½ times as much as it should.
The ACA is an improvement, but it is still unaffordable because of EMTALA. The only way out of the financial mess I can see is to make healthcare a tax-supported program like Medicare, the so-called “public option”, but it seems that will have to wait until the present system collapses, something it is now doing in slow motion.
I wanted to add more but I figured that it was about as long as the average reader will wish to spend pondering the dilemma. The few people I talk to seem to have insurance, are satisfied with it and just wish the controversy would go away. But as I said at the letter’s end, it won’t because the system is unaffordable.
EMTALA was enacted because of hospital “dumping” of impecunious patients on the diminishing number of hospital ER’s that would take them, and as a result it became probably the largest “unfunded mandate” of all time! Yet just imagine what America would feel like without EMTALA, with the sick and injured piling up on the sidewalk! Conservatives and libertarians say they want an affordable system that accommodates personal responsibility, a system wherein the marketplace controls costs according to supply and demand. GOP Rep. Paul Ryan’s plan would have done that, but it didn’t adequately fund the care that the poor and the middle class need. And, it had another problem, one I have not seen discussed. It would have greatly diminished the volume of business for the medical industry because people, being people, would have been loathe to spend their limited (only $6,000!) healthcare money until it was pressingly necessary, thus bypassing preventive care (something the ACA supplies, by the way).
Isn’t it interesting that the medical industry seems to be pretty much on the sidelines on this controversy? They have long enjoyed the business, but now are struggling as the government runs short of money. They know that the federal coffers are not bottomless. They know that something has to change, and whatever that turns out to be, it will be painful for both the industry and for the patients. If the individual mandate is overturned we will still find ourselves facing unaffordable deficits. If the GOP prevails in the election and is successful in repealing the ACA, we will probably be back to the Ryan scenario and increasing numbers of sick people stacking up.
The case before the Court is historic and its effects will be long-lasting, but no matter what the decision the problem still won’t be fixed. How the nation will face that problem, or not face it (stalemate), will be determined largely by next November’s election results.
- The Mandate Before Conservatives Became Deranged: (brothersjuddblog.com)