Tuesday, November 15, 2011

If Supreme Court Repeals Mandate...Then What?

The United Sates Supreme Court has agreed to hear arguments on the constitutionality of a key component of President Obama’s signature domestic achievement: the Patient Protection and Affordable Health Care Act.  The Court will decide whether Congress has the power under the Constitution to mandate that Americans buy health insurance or suffer a financial penalty.  Furthermore, if the requirement to buy insurance is unconstitutional, the court will decide if the law is unconstitutional in its entirety or if portions of the law may remain in effect.
The Obama administration has been pushing hard for the Court to undertake the argument believing that they stand on strong legal ground.  On the other side of the aisle, every single contender for the GOP presidential nomination has said that they would make repealing the law their first course of business if elected.
The truth is that this is a bad law.  It is a watered down compromise that doesn’t go far enough to curb health care costs and provide coverage for 50 million Americans that live without access to health care.  But it is a start.  And many of the provisions in the law like portability, protection for people with pre-existing conditions, expanded coverage for young adults and more oversight on health insurers, are quite popular, and will be hard to repeal.
So what happens if conservatives get their way and the Court votes to repeal the law?  Then what?  Do we return to the old private health insurance system that was costing every American 18% of their paycheck…and rising?  Do we return to the old system that left 50 million Americans without coverage?  Opponents tend to forget that the old system didn’t work and its skyrocketing costs were bankrupting the country.
And here is the one major issue that no one seems to be discussing; you cannot provide health care through the current private industry system…and control costs…if you continue to provide health services to those who do not pay for it.  The system simply cannot maintain low affordable rates if you allow 50 million uninsured Americans access to health services...for free.  Someone has to pay for it. 
It seems there are two solutions.  At present those who are insured continue to pay for the uninsured through increased premiums.  The other alternative is to deny coverage to the uninsured…in essence leaving them to fend for themselves or die in the streets. Several of the GOP presidential hopefuls favor the latter alternative.
The purpose of the “mandate” is to force the uninsured to pay something into the system in order to help defray the cost of the services they receive, while at the same time holding down premiums for the rest of the buying public.  Under the current system either everybody pays or it doesn’t work.
Opponents of Obama’s health care plan have yet to offer a viable alternative.  Their one and only proposal, to cut regulations allowing private insurers to market across state lines, does nothing to solve the problem of who pays for the rapidly growing number of uninsured people in this country.
If you do away with the mandate then you have to find another solution…or we are right back where we started.        

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