The Supreme Court has ruled on the Affordable Care Act, upholding the requirement that almost all citizens must purchase health insurance or pay a penalty. The court upheld the Act on the argument that the penalty is a tax thus the Act is a proper exercise in Congresses power to tax.
While Common Sense has reluctantly favored the Act I am troubled about the entire matter. The Act will result in more citizens having health care insurance and corrects some of the most egregious health insurance abuses. These are clearly improvements to health care in the United States.
Yet the Act does not effectively address the central issue of health care cost. In the United States we spend roughly twice as much money per individual as other post industrialized nations yet our health results on many metrics are relatively poor ranking 37 according to the World Health Organization. While the ranking is debatable, it is clearly true that the United States health care system is over priced and that it under performs. The Act contains some provisions designed to address cost but, significantly, does not address any of the fundamental issues that drive excessive health care cost. It address principally who pays, insurance companies, not how much is paid, cost. It does nothing to address the disparity is drug cost between the United States and other nations such as Canada. Likewise, it does nothing to address excessive health apparatus cost. It does nothing to address malpractice insurance cost. It does nothing to address the very real 10 to 20 to one cost differences for identical procedures in the United States and Europe or Asia or Central America. Thus while the act unequivocally does some good it simply doesn't effectively engage the issue of cost.
Common Sense continues to believe that we deserve much better law from our elected representatives. A health care law modeled after other countries such as Canada where cost are roughly half the United States is one clearly effective alternative.
This Supreme Court decision establishes a new federal power that troubles Common Sense. The decision's rational establishes the principal that Government can use tax to coerce an individual citizen to engage in a commercial transaction. While it is true that tax policy has long been used to shape commercial activity the Court's reasoning extends government's use of the power to tax to a level that is coercive.
There are significant differences between previous tax policies that apply to individuals to shape behavior and the Act's use of a tax penalty. For example a tax policy that gives individuals favorable tax treatment for a home purchase as we have today is clearly different than a tax policy that would increase taxes on renters since they do not purchase a home. The first kind of tax policy has long been accepted. Home ownership is widely viewed as a societal good and thus deserving of favorable tax treatment. The second kind of tax policy would doubtless generate enormous resistance just as the Act has done. It is interesting no note that while a tax credit or deduction for those with insurance is certainly conceivable Congress chose instead to impose a coercive penalty tax.
While Common Sense reluctantly favors the Affordable Care Act as a flawed improvement to a clearly broken health care system, I am very troubled by the Supreme Court's reasoning. Common Sense believes both that United States citizens deserve much better health care reform likely based on the single payer systems that have demonstrably better results, and that this Supreme Court reasoning is both flawed and ultimately dangerous.
With a nod to Thomas Paine, Baron d'Holbach, and "Captain Obvious" perspectives on what should be, but remarkably often isn't, obvious common sense.
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