The Supreme Court has strung us along for weeks now. Their decision on the constitutionality of the Patient Protection and Affordable Care Act (“Obamacare”) was made earlier this year, allegedly the day after the oral arguments were concluded, but their ruling and full opinion will not be announced until Thursday, June 28 at 10 am Eastern. There are already countless pieces published and many more being written in preparation for the ruling, either to temper expectations, to anticipate the policy consequences, or to massage the potential political fallout, especially for the Presidential election. This is not quite one of those, but it is an effort to dispel the notion that opponents of this particular legislation are greedy, radical libertarians who are ok with people dying in the streets.
Obamacare is a massive hulk of a bill. It took a year to work its way through Congress, was read by almost no one (at least in Congress) before passage, and it regulates everything from what kind of hospitals can exist to personal insurance coverage. There are innumerable ways to improve the healthcare system. This bill is one particular attempt at it, so opposition to this particular bill as a whole does not by extension imply that its opponents are either against improving healthcare, or even against certain specific provisions of this bill.
One false premise used in arguing for this type of reform is that we even have a national healthcare system at all. Before Obamacare, we did not. After it, if it survives the Court, we do. Health insurance has always been regulated by state insurance boards. With very few exceptions, care itself is also state-regulated. I don’t believe there are any states that simply do not have such oversight and regulation, so I fail to see why this had to be upgraded to a federal issue. We can clearly see that certain states have better performance on health issues than others, so why was the effort for reform instead not contained within those particular poorly performing states rather than subjecting everyone to the same one-size-fits-all standards? Vermont has an effectively universal healthcare system, Massachusetts has an individual mandate to own private insurance, Utah reformed its system significantly under Governor Huntsman, and there are states with very little regulation. Why doesn’t this work? Why does federalism (allowing states to decide) work for so many other things (car insurance, voting, education, employment, contracts, criminal law), but it can’t be allowed to work for healthcare?
Irony of ironies is that while Obamacare takes the regulation of health insurance to the national level, it doesn’t do the one thing that could improve the market for it, which is taking the sale of insurance to the national level. One reform that has been proposed by many for years is the ability to sell insurance across state lines. All this nationalization of insurance mandates and coverage, and they didn’t even bother to do the one thing that would actually produce a national market for health insurance and give their national regulation of it some legitimacy. They instead plan to setup state insurance exchanges (starting in 2014-what do the uninsured do until then, if it was such a national emergency?), with national regulation of them. An almost universally terrible idea.
A lot of the criticism of Obamacare comes down to the individual mandate. Quite simply, does Congress have the authority to force every person in the country to purchase a product from a private company? The vast majority (72%) of the country says no. We’ll find out how many of the current Supreme Court justices agree on Thursday, which is all that really matters. But if the bill as a whole comes down to the individual mandate, this sweeping new power alone is reason enough to strike it down. There are ways to improve health and health insurance without an unconstitutional mandate that everyone buy something that costs thousands of dollars a year or face fines or jail.
So when you hear people say that opponents of Obamacare want people to die if they don’t have insurance, are social Darwinists, or don’t care about the “30 million uninsured”, don’t step in the trap. Opposition to one particular attempt at health care reform does not make one opposed to health care reform in general.