Thursday, June 28, 2012

Supreme Court Finds Affordable Care Act Constitutional...

Shortly before 10:00am, my inbox and facebook page began to percolate as we approached zero hour for the much awaited Supreme Court decision on President Obama's Affordable Care Act. By 10:15am, I was several songs into my first performance of the day. I had my phone sitting on the edge of my mixer and every time I'd look over at it, the number of emails and facebook messages were growing quickly.

During a brief pause, I opened up my twitter feed and saw the headlines. "Obamacare Stands", "Obamacare Constitutional", etc... I finished up my hour, packed up and headed for the car trying to read through all the tweets that had come in.

My initial reaction was relief. Surprised relief.

I knew what awaited me on facebook and in emails. I knew one group would be very happy this had passed, but express this pleasure via some barbs aimed at the Right. Another group would find this decision impossible to accept and take out some of their frustration on the Left. What I knew I'd hear too little of was the better health access for all the uninsured adults and children that will benefit from this.

Its so easy to view this as a game. Its not. Health insurance plays a big part in terms of living a healthy, capable life. Having about 45-50 million uninsured people in our Country is unacceptable. We're the only industrialized Country in the Western Hemisphere that doesn't provide access to good quality, affordable healthcare for all of our citizens. For a lesser Country, that might work, but not for the richest Country in the world. It just doesn't.

Some feel their liberty and freedom were reduced because of the Court's decision today. I'm not sure what was taken away from anyone. You may not like the Individual Mandate, but in reality, it effects a fairly small number of us. If you currently have insurance, which most of us do, it doesn't effect you. If you're over 65, you're eligible for Medicare, so it doesn't effect you. If you earn below the Federal Poverty Line, there's Medicaid, so it doesn't effect you. By getting the free-riders into the pool with the rest of us, over time our premiums should drop.

Since President Reagan signed the Federal Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to provide medical services to those needing it with no regard to financial status. We don't let people die on the sidewalk. Hospitals try and collect for their services from patients with no health insurance but often, they are dealing with people who don't have the means to pay these size bills.

Let's suppose a hospitalization for an uninsured accident victim adds up $85,000. With no savings, a payment agreement of $100.00 a month would take 850 months or 70.83 years to pay off. That's crazy. So, typically the hospitals charge a large amount of the uncollectable monies back to Medicaid, which is the guarantor of the Federal Government. That was the deal Reagan made with the hospital industry. You treat everyone who needs it no matter what and if we have to, we'll step in with the bill. You know where the money comes, of course, to pay for these type situations, yes? From tax dollars that people like you and I pay to the government. Is this really the best way to spend our money? No. The mandate helps on that front as well...

The mandate forces all those who don't have insurance, yet can afford it to buy insurance (on the free market) for just such accidents. This way the amount of hospital bills we wind up having to pay gets reduced dramatically with the bulk of the costs being passed onto the health insurance companies. Don't feel too bad for the insurance companies, they are picking up over 30 million new customers. Paying customers...

You don't have to like it, but understand its not reaching into your pocket and ripping out your kids college funds or your retirement. Its a policy that was founded by the republicans during the Clinton presidency. The Heritage Foundation was heavily involved. Prominent Conservatives were on board. If it was "the right thing to do" back in the 1990's, how in the world is it the end of liberty twenty years later? Its not. 

Beyond the mandate, the rest of the Affordable Care Act polls strongly among most Americans. Kids staying on parents plans until 26, free preventive services, donut hole reduction for seniors, no lifetime caps or maximums anymore, etc. The bulk of the ACA (the exchanges) kicks in 2014. This won't cover everyone, but its a big improvement.

Its also not perfect. The mandate penalty for the first year is only $95, the donut hole isn't closed totally for several years, its not very aggressive on costs or quality, etc. Politically its been a heavy lift for this Administration and reaching for even more wasn't practical. We have a long way to go before our health care costs as a percent of GDP are in line with other industrialized countries. We have a long way to go before our outcomes compare favorably with other industrialized countries. We have a long way to go before our coverage compares favorably with other industrialized countries. But today's ruling keeps us on the path towards improving our nation's healthcare delivery system, which is something we simply must do. The previous path was fiscally unsustainable. Doing nothing wasn't an option...

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