Tag Archives: Obama Care

Health Insurance and Personal Responsibility

Now that Senator John McCain has torpedoed the plans of his own Republican Party to unilaterally repeal the Affordable Care Act (ACA), what comes next? How can the federal government of the United States repair a national health care system in need of modification?

Senator McCain himself may have described a “way forward” when he called for Republican leaders to invite “input from all our members, Republicans and Democrats … (to) bring a bill to the floor of the Senate …

But is such a cooperative approach possible in an era of vicious partisanship? How can the two political parties bridge the chasms that divide their respective positions about health policy? If you believe that cooperation is an impossible dream, you might wish to ponder the bipartisan origins of the ACA and its doctrine of personal responsibility.

During the early ACA debates, President Obama repeatedly praised Republican Governor Mitt Romney of Massachusetts for leading the Bay State’s successful implementation of a universal health care law. Obama directed the designers of the ACA to adopt many core principles of the Massachusetts system.

And during its earlier development, the Massachusetts law had likewise adopted many core principles of a proposal by the Heritage Foundation. The deeply conservative policy organization had suggested the introduction of an individual mandate to purchase health insurance, as a means of supporting the premise of the value of personal responsibility.

But how does an individual mandate support this premise? Well, any individual who declines to purchase medical insurance may presumedly become a “free rider” if beset by an unexpected health crisis.

Why? Let’s consider a tragic case example. Any hospital in the United States, for instance, would perform surgery on an unconscious and critically injured person who arrives in the Emergency Room with severe brain and spine damage. Even though that person may have previously declined to purchase a health insurance policy, he would receive the costly medical service any way.

And who would bear the cost of that service? The American society and its government would do so, either through the direct application of government “charity care” payments, or through indirect private sector subsidization and cost-shifting arrangements.

The Heritage Foundation, Governor Romney, and President Obama all concluded that an individual mandate to purchase medical insurance would support the doctrine of personal responsibility by discouraging “free riders” on the public purse. They decided that individuals who refuse this mandate should bear a higher tax burden to reimburse society for the cost of guaranteeing emergency medical care.

That’s a fairly simple proposition, isn’t it? And it’s a bipartisan one as well, given that the individual mandate encompasses the philosophies of both political parties.

So please don’t despair when politicians claim that the Republican and Democratic parties are too far apart for cooperative action in health policy. Instead, it may be helpful to keep in mind that those very legislators already agree on the doctrine of personal responsibility. Perhaps, from that point of agreement, a bipartisan plan may spring.

Presidential Debate: The Glaring Omission

Did you watch the U.S. Presidential Debate a couple of nights ago? NBC News moderator Lester Holt promised viewers that the candidates would “explore three topic areas tonight: achieving prosperity, America’s direction, and securing America.”

That’s an incredibly broad set of topics, isn’t it? As promised, Mr. Holt’s subjects focused on everything from the global economy to the natural environment to the sources of social strife.

There was one subject, though, that wasn’t even mentioned during the ninety minute debate. Did you notice what former hot-button topic was completely omitted from the conversation?

It was the Affordable Care Act, commonly known as Obama Care. In fact, there was no reference to any element of health care policy whatsoever. The omission was surprising, given the controversial dominance of the subject in prior elections, and considering the central importance of the industry sector to the American economy and society.

So what are we to make of it? How should we interpret this startling lack of interest in America’s system of health care? Especially given the continuing controversies over the level of access to medical products and services, and the cost of that access, throughout the United States?

One possible explanation is that the very nature of the Affordable Care Act that made it so difficult to implement in the first place is now making it easy to accept in the minds of the American public. As you may recall, although the Act was initially described as a comprehensive reconstruction of the entire health system, its primary beneficiaries were to be the relatively few individuals who desired insurance coverage but who couldn’t obtain it.

Disrupt an entire nation’s system of care to benefit a mere 24 million individuals? In a nation of 300 million citizens? Opponents of the Act portrayed such an venture as a high risk, low benefit leap into the unknown. In retrospect, it was no surprise that so many citizens shrank from it.

But now that the Act has been in effect for six years, it has become the status quo. And guess what? The health care system hasn’t crashed. It’s still plagued with problems, to be sure, but now any future modification to the industry sector can itself be portrayed as a high risk, low benefit leap into the unknown. And that may be why the possibility of repeal or significant revision has vanished from America’s political debate agenda.

Indeed, individuals who wish to engender comprehensive reconstructions of other industry sectors may take heart from the current status of the Affordable Care Act. What lesson does it teach them?

Don’t settle for small, incremental, evolutionary changes. Instead, take a deep breath, swing for the fences, ride out the inevitable backlash, and focus on integrating the changes into the industry sector so deeply that they become inseparable from the status quo.

At that point, the elements of reconstruction may simply become part of the economic and social landscape of the nation. And the public may then simply accept the changes and divert its attention to other concerns.