The Supreme Court, Etch-A-Sketches & Obamacare

As the Supreme Court begins hearings on the constitutionality of the Affordable Care Act, aka Obamacare, the etch-a-sketch gaffe about former Massachusetts Gov. Mitt Romney’s conservative positions may best describe healthcare posturing in America.

Market-driven health care is simply the wrong. Health care is a service of altruism at its base, not another item for sale. The health insurance profit and growth model induces behaviors which are contrary to good patient care or to cost control. And, the problems created when health insurance is given to all without some incentive to get everyone to sign up, explains why Republican Romney championed near-universal healthcare, a mandate backed by other conservatives including the Heritage Foundation, until Democrats put an insurance requirement in their legislation. It’s almost like an Etch A Sketch.

Some states have passed the Health Care Compact to use funds from existing federal programs to “etch a sketch” a health care program. None of these states will pass a single payer program to provide all health care services for everyone. To avoid the budget crisis that will happen under Obamacare, they seek to establish insurance markets that cross state lines.  By promoting the sale of low-premium, lowest-common-denominator plans, they will destroy the financial security that health plans should be offering.

Most Americans have mixed feelings. Glad Obamacare guarantees insurance, even if they sustain a devastating accident or a serious illness, but two-thirds don’t like they must buy coverage. So did Obama when he was a candidate. Change like an Etch A Sketch drawing.

The Government contends that the individual mandate is “key to the viability of the Act’s guaranteed-issue and community-rating provisions”. If the Court struck down only this individual mandate, and the rest of the act lived on, Congress would have to find other ways to prevent uninsured people from free-riding on the system. There has never been a serious constitutional challenge to our tax-supported systems of health insurance, Medicare, and the services of the Veterans Health Administration system, since the Constitution unambiguously gives Congress the power to tax, therefore Congress can enact a single-payer law. Like an Etch A Sketch, “you can kind of shake it up and restart all over again.”

For a conservative Etch A Sketch, single payer reform is fiscally responsible and unlike Obamacare is financially sustainable. Nearly all of the unfunded future federal debt due to entitlements is medical debt. Eliminating the multiple, confusing payment schemes for health services eliminates the system’s perverse incentives. Single payer health system reform can reduce the costs by $1 trillion/year, relieving the tax burden. By the time today’s kindergartners are Medicare eligible, a single payer style payment mechanism would have eliminated the federal deficit. Further, it can be implemented at the state level, preserving the conservative desired, appropriate balance between national and local governing.

If the Court struck down the whole Act, the “big” shake, it would be a political blow to the Obama administration and would toss out the promise that all can get health coverage. Combining a federal minimum standard of performance with a real opportunity for improving upon Obamacare could be the opportunity to see real change, state by state, in the health care system. Both Republicans and Democrats seem to be willing to consider legislation for states to have a real opportunity at comprehensive and sustainable health system reform and states, such as those which have joined the Health Care Compact effort, seem to want such guidance. The best legislation model needs to Etch A Sketch the risk that underfunded state efforts will gut health care programs.

But the Court could well uphold the act. If it did, Congress could “reform” or Etch A Sketch any private industry – whether it be automobiles, coal, pharmaceuticals or any other – by enacting legislation requiring every that American purchase the industry’s goods or services in exchange for some perceived public good the industry provides. A conservative nightmare.

Like the reference to a children’s drawing toy that erases the last image with a simple shake, I believe the Court should uphold the ruling of the Appeals Court finding the individual mandate unconstitutional pointing out the government did not need to require citizens to purchase insurance from private companies to service the health-care needs of the populace. A conservative answer. But, we should require a conservative solution and it is a single payer system.

To quote Friedrich Hayek, one of the intellectual founders of the conservative movement “There is no reason why, in a society which has reached the general level of wealth ours has, the first kind of security should not be guaranteed to all without endangering general freedom; that is: some minimum of food, shelter and clothing, sufficient to preserve health. Nor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision”. He concludes: “In no system that could be rationally defended would the state just do nothing”.

Republicans and Democrats Etch A Sketch — clean and start anew – fiscally responsible, government healthcare for all.

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