Saturday, September 15, 2012


June 22, 2012
"I’m healthier than I’ve ever been in my life," a friend of mine told me recently. "I take care of myself. I eat right, I exercise, I keep a positive attitude, I trust in God. I’m going to live to be a hundred."

Such a wonderful spirit, I thought to myself. Her contagious optimism never fails to cheer me. She’s 63 years old, and forever young.

Still, I was troubled by the context in which those words came up.

I was asking her about health coverage.

My friend has been unemployed for over a year and can’t afford to buy insurance. "I won’t let it bother me," she said. But it bothers me.

No matter how careful you are, stuff happens. Some drunk runs a red light and plows into your car. You know the exact way to lift heavy boxes, but your back goes out anyway. You go to your doctor with the flu and find out it’s leukemia.

All this is obvious, but I will belabor the obvious here because it does not seem to be obvious to politicians and even to significant numbers of the citizenry. It’s obvious to my friend, though — she’s as practical as can be — but she knows that dwelling on things like accidents or illness will in fact make her sick. She refuses to allow herself to imagine not only the physical suffering involved, but — and perhaps even more shattering to her peace of mind — being reduced to indigence, a lifetime of the savings she hopes to lavish on herself and her children wiped out by medical bills.

She’s almost 64. If her luck holds for a little over a year, Medicare will cover her. That’s a relatively short time for luck to hold, but what about those who are younger?

According to the U.S. Census Bureau, 50 million American adults under age 65 lacked health coverage in 2010. Each one of these individuals, particularly the middle-aged and those with dependent children, faces either the anxiety over, or the reality of, losing everything in a medical crisis. In 2014, the provision of the Affordable Care Act (a.k.a. ObamaCare or National RomeyCare) mandating taxpayers to purchase health insurance if their employers don’t provide it, and subsidizing their premiums based on income level, is scheduled to take effect. It will not help those 50 million right now, but once implemented, it will go a long way towards making health coverage available to all.

Excuse me. "Once implemented" is at this moment not correct; it’s "if implemented."

Sometime this month, the United States Supreme Court is expected to rule on the constitutionality of the ACA, particularly the mandate. The constitutional issue at stake seems ridiculously unrelated to the care of the sick: the Commerce Clause. >
The question as framed by opponents of the law is this: The Constitution gives Congress the authority to regulate interstate commerce, but does that include the authority to force citizens to purchase things, including health insurance?

During the arguments before the Court in March, Justice Antonin Scalia, no foe of the flippant, reprised the worn-out green-vegetable hypothetical bandied about for months in state houses, lower courts, and the libertarian media: If Congress can make people buy health insurance, can it also make them buy broccoli?

Actually, it’s a good question, and the mandate may fall because of it. Under the present system, health insurance is a commodity to be bought and sold, really no different from broccoli.

The legal arguments on the question are exceedingly arcane, and it will be interesting, if not entertaining, to read the justices’ opinions. But the problem that the Obama administration and the Congress would not or could not address in the ACA, the problem that has brought us to this pathetic juncture, is the very concept of health coverage as a commodity. By refusing to eliminate insurance companies from the health care business, the ACA has asked for and got the broccoli argument. Had Congress simply extended the existing Medicare program to all ages, health coverage would no longer be an item of commerce but a public responsibility.

What troubles me most is not that politicians wouldn’t do this, bought as they are by the insurance business, but that so many ordinary citizens would be swayed by the old "socialized medicine" scare (while at the same time vigorously defending Medicare for the old!), when each and every one of them knows people who face, or face themselves, the possibility or reality of financial devastation from an accident or illness. It is equally surprising that businesses of all sizes would not lobby forcefully for universal health care, which would relieve them of the administrative burden of selecting health plans for their employees and the moral burden of dropping health benefits altogether, as many are now doing.

I keep thinking of my friend and the 50 million like her. Shouldn’t she, and they, and all of us be allowed to flourish in the knowledge that no matter what bad luck may befall us, our economic security will remain?

Health care, like education, infrastructure, and fire and police protection, is a universal need. How can it not be considered a universal public commitment?

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