The Patient Protection and Affordable Care Act Explained - The Insurance Mandate

            By far, one of the most protested components of the Patient Protection and Affordable Care Act would be the insurance mandate, which requires that all Americans must purchase insurance by 2014 or else face a penalty.  Criticisms have ranged from its constitutionality to questions over whether the government has the right to enforce such a requirement.  However, too often it seems that people misunderstand or ignore the potential benefits of this most important piece of legislation.  It is time that we put an end to the doomsday dogma surrounding this bill and take a clear, unbiased look at it.

            To start, it must first be said that the Patient Protection and Affordable Care Act is, in fact, not a Socialist bill.  Socialism would entail something like universal healthcare.  However, this is really not the case with the PPACA as it does not provide free healthcare, nor does it involve action such as nationalizing the hospital system.

            In fact, you could very well characterize the PPACA as a largely Capitalist bill.  Instead of relying on the government to provide healthcare, it uses the private market of insurance to distribute this service.  A much better example of Socialism within this country would be programs such as unemployment benefits, Medicade Medicare, and Social Security.

            Additionally, mandating insurance was originally a Republican, not a Socialist idea.  This theory can be partially traced to a 1989 Heritage Foundation report. [1]  Back in the 80s and the 90s, the Conservative idea was that everyone should be responsible and pull their own weight.  In their opinion, it was not right for some people to go through life not taking care of themselves, and thus putting their burden onto others.  Their proposed solution to this problem (explained in the Heritage Foundation report) would have been to mandate that everyone purchase insurance and to subsidize policies for those who could not afford to pay the full costs.

            However, all of this aside, in analyzing the insurance mandate more directly, it seems that those Reagan-era Republicans were correct in their original support of this idea.  The mandate can benefit society in a number of ways, some of which are not at first apparent.

            In addition to the fact that the mandate will lower most people’s insurance premiums by alleviating cost-shifting from one person to another, there will also be a decrease in the total amount of money that our country spends on healthcare.  By mandating that everyone has insurance, and that all insurance plans must cover preventative care, a number of long-term benefits will arise whereby more people are able to treat illnesses before they progress to more serious and expensive to treat versions.

            As you may well know, back in 1986, president Ronald Reagan passed the Emergency Medical Treatment and Active Labor Act, which mandated that hospitals must admit and treat all emergency-room patients, regardless of citizenship status or ability to pay.  Now, you will probably agree that this was a good and necessary bill.  Do we really want to give hospitals the right to let patients die in the waiting room?

            However, EMTALA does have a number of complicated side effects.  All too often, people go to the ER for emergency care, but then are unable to pay for the procedure.  Since the hospital was not paid, they loose that money and have to raise prices for other procedures in order to cover expenses.  This, in essence, is the basis for cost shifting.  The higher that prices get, the fewer people who can afford to pay their medical bills.  The more people who are unable to pay their medical bills, the higher prices get.  It is a downward spiral of built in inflation.

            Now, let us turn to some of the long-term benefits of this bill.

Right now, too many people forgo simple procedures (such as checkups and cancer screenings) because of the expense and the fact that they are not covered by insurance.  However, because insurance policies will now be mandated to cover preventative care, more people will be able to treat relatively minor illnesses (such as the early stages of diabetes or high blood pressure) before they develop into much more serious, and expensive to treat diseases (such as heart disease, or the advanced stages of diabetes).

I have personally seen the results of this situation and how horrible it can be.  One of my dear friends has spent the last five years in and out of the hospital due to a range of different illnesses stemming from diabetes related complications.  Now, due to his illness, he is currently on disability.  Yet, this need not be so.  If there had been a system to help prevent him from getting sick, he would likely be in a very different situation.

My friend worked all of his life, and he has been a productive member of society, but back when his illnesses first started to worsen, there were no programs to help him.  No insurance company would cover him so that he could get the care that he needed to remain healthy, and he was told that he would be ineligible for government assistance until after he progressed to a point where he was disabled.  As a result, because he was unable to afford the relatively cheap preventative care that would have helped him, he now no longer works and must rely on disability and Medicare to pay his enormous hospital expenses.  Is this the kind of situation that we, as a nation, want to promote? 

Our country needs to take steps to prevent situations like this from developing.  We are better than that.  If all Americans have access to preventative, and the ability to pay for it, fewer people will develop serious illnesses, thus reducing the total GDP that our country spends of healthcare.  However, more importantly, we will have a healthier, more productive population.  Fewer people will be sick, more people will be happy, and we will have even more reason to be proud of our great nation.

            Currently, medical expenses are one of the leading causes of bankruptcy in this country, and something needs to be done.  When some common procedures can cost more than a hundred thousand dollars, no amount of financial preparation can ever give full security to the average person.  So many people say that we should get rid of this bill, but do they have an alternative?  Our nation desperately needs to change, but until we can look across the aisle and compromise, nothing will happen.  You can argue that the PPACA is not perfect, but rather than working for its destruction, why don’t we all work together to make it better?  Would this not be the better alternative?

[1] Butler, Stuart. The Heritage Lectures - Assuring Affordable Healthcare for All Americans. Heritage Foundation. 2 Oct. 1989. Web.