In politics there are some problems that become so stigmatized that we lose sight of the core of the issue. For Obamacare (the Affordable Care Act, or ACA), the bitterly contested issue of the so-called individual mandate that every individual carry some form of health insurance is the hot topic at hand. It's so hot, in fact, that last night an effort to abolish or delay the mandate for another year led to the first federal government shutdown in 17 years.
But those who call the law socialism, and who denounce liberal federal government programs, fail to see an important point. In this particular case — the case of America’s health care reform — alternate options are not really of material difference, at least not specifically for this piece of the law.
In a nation of more than 316 million, an estimated 48 million residents are currently uninsured, according to the U.S. Census. If one of these uninsured has an accident, the rest of us end up having to pay for it through inflated medical costs and insurance premiums.
For lack of better words, the system of healthcare payment that is on its way out is one of welfare-by-the-visit. It's a de facto redistribution of resources that eluded codification or recognition by official means through some of the most shocking healthcare cost spikes in modern history.
And so as the ACA’s healthcare exchanges open in the marketplace today, and as the individual mandate starts to be enforced in 2014, this finally changes. In the simplest terms, the law seeks to require that those receiving “welfare benefits” via uninsured healthcare services pay their respective taxes.
The official name for the individual mandate is the “shared responsibility fee," and it is a fitting name. If patients are currently receiving services on our collective dime, why would anyone object to them paying into the system?
The conservative debate over the individual mandate is one largely of semantics. It assumes that if the government mandates something, that it is overreaching its power and inching the country closer to socialism.
Many times when this same argument is invoked there is validity in it, but this time it’s different. That's because the only other option as it currently stands is the abusive system that we have been dealing with — one of runaway insurance and medical costs, coupled with a growing sector of uninsured individuals.
As Whole Foods Founder John Mackey infamously commented to NPR in January, the reality of the law can actually be characterized as closer to fascism than socialism itself. “Socialism is where the government owns the means of production," he said. "In fascism, the government doesn’t own the means of production, but they do control it — and that’s what’s happening with our health care programs and these reforms.”
Mackey later walked back on his comments in an interview with CBS news, saying that he regrets likening the program to such an ugly word as fascism. But whatever it amounted to instead, he claimed, “we need a new word for it.”
For all the semantic troubles America seems to have with speaking about the individual mandate, the policy is clearly addressing an foundational struggle. That's whether we should allow the law to demand that an individual purchases insurance, or if the unorthodox healthcare market demands that we pay for uninsured individuals. Either way you go, the result is essentially the same. You are still paying for other people.
Besides, the Supreme Court has already ruled that the individual mandate is constitutional, so arguing about its “fairness” falls flat on its face.
Healthcare does not fit into the schema of a free-market economy. In a free market, if you show up to a car dealership with the intention to drive away with a new Cadillac, you simply cannot do it without paying, short of robbery.
With medical care, that is simply not the case. If you show up to an emergency room in need of care, you will not be turned away.
A 2010 study from the RAND Corporation concluded that 28 percent of acute care visits were handled by emergency physicians, a group that makes up fewer than five percent of doctors. More than half of these visits were from the uninsured, an astronomical number that the general public has to subsidize. That's not to mention the uninsured that have real emergency incidents and chronic medical conditions.
This is an economy in which, regardless of intent, we all share the risk — but one in which some escape the responsibility of putting money into the pot. As such, the only people who stand to lose much are those uninsured who have helped drive our system into a state of catastrophe.
Columnist J.D. Kleinke wrote about this in a recent in a New York Times piece titled "The Conservative Case For Obamacare." "The individual mandate recognizes that millions of Americans who could buy health insurance choose not to, because it requires trading away today’s wants for tomorrow’s needs," Kleinke wrote. "In the partisan war sparked by the 2008 election, Republicans conveniently forgot that this was something many of them had supported for years. The only thing wrong with the mandate? Mr. Obama also thought it was a good idea."
The question becomes simple: If an individual is not putting into the system that de facto protects him, then why should everyone else be footing the bill in his name? And that is the very reality that makes both sides of the political spectrum uncomfortable.
When politics divide, I would like to think that reality unites. But then again, this is 2013, and we are talking American politics here. And judging from the jokes sprinkling through my Twitter feed last night around midnight, who the hell wants reality when insanity is so much more entertaining?