March 28, 2012

Some Brief Health Care Thoughts

With the Supreme Court winding up its massive arguments about the Affordable Care Act, I thought I’d toss out a couple of things I haven’t seen others emphasized from yesterday’s session, which focused on the individual mandate. As to the fate of the mandate itself, I’m not going to argue with court watchers who suggest that it’s in “trouble” and the case may be closer than expected. They may be right. It’s always dangerous to read into questions asked at oral argument. I’ve had judges ask me questions during an argument that made me think, “shit, I’ve lost that one,” only to have them rule my way in the end.

But that’s not really what interests me. Let’s assume the mandate goes down in flames. I wonder, at the end of the day, if the folks challenging the law will be any happier. Consider several interesting things that came up during the argument (transcript here, recording here).

First, everybody – attorneys for both sides, the justices asking questions (meaning excluding Thomas) – agreed that the Feds can, in fact, force you to purchase medical insurance, if that happens when you actually seek medical care. So, rather than require purchase ahead of time (when it would be cheaper and broaden the risk pool), purchase could be required when you arrived at the ER with a bloody stump. It might look something like this:

Second, just about everybody (and maybe everybody – it was hard to tell) agreed that in order to tackle the problem addressed by the mandate – free riders – Congress could simply tax everybody to cover the short fall.

Third, again, just about everybody, agreed that Congress could simply bypass all the nonsense and setup a national health service, paid for by broad taxation.

Whether any of those alternatives are politically viable, I have no idea. But if the mandate and the rest of the ACA goes down in flames, we may find out, ‘cause the underlying mess that his our health care system isn’t going to magically get better. I can’t imagine those other options would be any more popular amongst the Tea Party folks and others who have most vocally assailed the ACA.

The irony of one of those solutions being the final outcome is that it may come about because the conservatives grabbed the torches and pitchforks and gunned down what was their own idea, after all.

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