Thursday, March 29, 2012

On Government and Health Care

If you are a Supreme Court junkie, as I am, it's been a pretty interesting week.  three days of oral arguments before the court over The Patient Protection and Affordable Care Act (Obamacare) has had NPR's Nina Totenberg breathless since Monday.  I followed closely the radio and print accounts of the arguments and all of the analysis that came afterwards.

There were three basic areas of dispute.  The first, seemingly dismissed by the Court, is that the an obscure federal tax law from 1867 called the Anti-Injunction Act (AIA) essentially bars bringing a case against Obamacare.  The law prohibits tax protesters from filing suit against a tax until the tax has actually been paid.  The Supremes seems dubious that there was even a tax involved here, even given that when the act is in force those who do not have health insurance will have to pay a penalty, which the IRS will collect.  It's a fine point I guess, but that's why lawyers are involved.

The second day was really where the fireworks were, with Obamacare opponents making the argument that the law is unconstitutional because it forces everyone in America to purchase health insurance.  Their essential argument was that the constitution does not permit the government to compel a citizen to purchase anything and that if the government could do this, it could compel people to buy anything at all, including broccoli.

The government's counter to this argument was that broccoli, no matter how much you like it, does not provide for a basic human need like access to health care does and that the government certainly has the right to regulate trade in such a huge area of the economy.  The government also argued that the only wa for health insurance to work was to have everyone in it all the time or else only sick people would buy it, making the whole system a horrendously expensive mess.

The final day's arguments were based around the complaint to the states governed by Republicans that the regulations that the act placed on Medicare were an unconstitutional violation of states rights by the federal government. The states also made the argument that the entire act must be struck down if any portion of it were deemed unconstitutional.

In the end, despite favoring universal care on a human rights basis, I found the arguments presented against Obamacare to be compelling.  I specifically agreed with the idea that individuals can't be told to buy a product, no matter how useful the product is or how much the product is needed to provide for the common good.  While we all agree that everyone should have access to comprehensive, affordable healthcare, we can't provide it by requiring everyone to buy personal coverage.  It's not who we are as a nation.  We don't solve our problems by mandating behavior.

So a government-funded, single-payer insurance system like Canada's must be the answer, right? 

I will surprise my libertarian and conservative friends (and my liberal friends too, I guess) by saying no, I think that government control of the healthcare system is not the answer either.  I work in higher education, where I have seen first-hand how the government can take over programs that have some problems but are working and regulate them into a costly, inefficient mess in a matter of years. Government can't even figure out how to collect trash efficiently and we want to entrust 1/6 of the economy and our health to its organizational ability?  I think not.

The real answer is that the solution is a lot harder than a health care bill. It will added efficiency such as a realization that not every hospital needs every new device. It will take philanthropy.  One of the reasons that health care has gotten so much more expensive is that non-profits and religious groups have been driven out as healthcare mega corps have been able to outbid them for top docs, leaving only charity care for the NPOs to provide. 

America has to invest in itself to get though what I consider a health care crisis.  That means those who have resources making a concerted effort to voluntarily provide for the less fortunate though philanthropy.  It's not good enough to buy proton guns for major research hospitals.  Someone has to be willing to subsidize mammograms and and infant care for folks who can't afford it on their own.

It also has to start with individual responsibility. One of the reasons that health care is so expensive is that we are so out of shape. Obesity, heart disease and diabetes are epidemics in the country, starting with toddlers. You don't have to join an expensive gym or hire a personal trainer, but it's time to get off our butts and go for a walk, to volunteer to clean up a park, or to coach a youth team.  We're lucky enough to live in a country with abundant access to clean, fresh water.  We should be drinking more of that and a lot less soda and juice.

I know I sound a lot like a small government conservative here, but I think that a regulated private healthcare system with significant philanthropic care is the best way to solve this problem. People also have to realize that their choices affect the community at large.  The Supreme Court is going to gut Obamacare when the justices rule in June. But that's not a bad thing.  It was a bad compromise on a grand idea.  Now it's time to more forward with a better plan.

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