Health care reform, revisited and judged

posted by Jeff | Thursday, June 28, 2012, 6:57 PM | comments: 0

When Congress passed the big health care reform bill two years ago, I was surprised at just how divisive it was, and less surprised at how unwilling people were to look at the underlying law itself and what it requires. I weighed in on it in March, 2010, and for the most part, my opinions about it remain essentially the same: It does a lot of good in terms of consumer protection, but the mandate requiring insurance and the funding issues are things I'm not entirely comfortable with. I'm surprised my opinion hasn't changed much, especially working in the health insurance industry now (and not with a good opinion about it).

Today, the US Supreme Court weighed in on the law, and I think to the surprise of everyone, upheld the provision that requires individuals to have health insurance or pay what amounts to an annual fine. The majority opinion, which included conservative Justice Roberts, said the mandate is essentially a tax, which is within the rights of Congress to impose. Of course, Congress insisted that it wasn't a tax, so the people who voted for it are in a pretty awkward place right now.

As I said two years ago, I'm not entirely comfortable with the mandate. One could make the logical argument that it makes sense, since no one is ever turned away from a hospital in this country, and someone eventually has to pay for that health care, so you might as well get them in the system and force their participation. We all know that real life isn't that simple.

The other issue I have is with subsidizing the insurance, partly because the government can't afford it, and partly because an entire industry is awarded new business they didn't earn. Think about the opposing moral issues there. On one hand, you're propping up private enterprise, on the other, you're requiring insurance for children who have no say who their parents are. That's why it's too hard to take a strong all-or-nothing stance on some aspects of the law.

The things that really matter, no one really talks about, or opposes. I don't think anyone is going to argue against requiring the insurance companies to pay for care on preexisting conditions. There is some good in that law.

What really sucks is that the law does nothing to address the astronomical amount of money we spend on health care relative to our overall GDP. That's why the timing of the law in particular is suboptimal. Maybe that's not even a concern of the government in the first place (though I don't think the free market is in any hurry to change it).

My annoyance is less about the law and more about the lack of intelligent discourse around it, especially on the Internet. It's just noise... "Socialism!" "Corporations!" "Middle class!" "Black guy with a funny name in the White House!" No one wants to get into the details, and everyone wants to be for or against everything. You're with me or you're against me. It's annoying. If you wonder why the United States isn't winning, look no further than this irrational division.


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