So many of life's decisions rest on the smallest turns of fate. The same could be said of the fate of the Patient Protection and Affordable Care Act.
The fulcrum of the administration's case before the court last month in the argument over the individual mandate lies in the notion that everyone is a health care consumer. And the arguments the left and the right make over this otherwise parenthetical notion rest on whether we're active or passive (or potential) health consumers.
And, in truth, slightly more than half of us make up less than 3 percent of health care expenditures, making most of us passive consumers. But as anyone in underwriting will tell you, insurance companies need the passive—or near non-consumers, as some call them—to fill the risk pool to pay for everyone else. It's why the mandate is so pivotal to the rest of the law, as flawed as it might be.
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Now is that fair? Not necessarily, but as my stepfather used to always assure me, "life ain't fair or easy."
There's something else to consider. As Americans, our sense of entitlement tends to override our sense of personal responsibility.
"I'll eat, drink or smoke whatever I want, but if I get sick, someone else should pay for it," could very well be our 21st century national motto. How else do you explain a nearly 38 percent obesity rate? A nearly 20 percent adult smoking rate? Or a 67 percent adult drinking rate? I just saw a new study that revealed more than 21 percent of health care costs can be attributed to obesity alone. God knows how much more drinking and smoking costs us. We love to live fast, but we've got a real problem with dying young.
I'm still torn on the individual mandate. I bristle at the thought of Big Brother or Uncle Sam or, hell, anyone, telling me to buy health insurance. But the alternative is a single-payer system, and that's even worse. With a mandate, we're at least spreading the risk pool and keeping insurance in the private market. And when those passive (and often-uninsured) consumers suddenly find themselves active participants in the system, they usually turn to emergency rooms, the most expensive health care providers we have.
And who do you think pays for that?
On a side note: A colleague of mine argued this week that the president "bullied" the court in a recent Rose Garden address where he argued the court would not (or should not) take the "unprecedented" step of overturning PPACA because Congress passed the bill by an overwhelming margin at the behest of of the majority of the American people. I'm paraphrasing somewhat, but there are a litany of problems with the former Constitutional law professor's argument.
For starters, the bill barely passed the House, along strict party lines. So that's hardly overwhelming. And poll after poll shows us that even at its most popular, the bill flirted with an even spilt among the American people.
Never mind that it continues to slide in popularity in most polls—much like the president himself. And to say that the Supreme Court wouldn't take the "unprecedented" step of overruling an act of Congress displays a willfully partisan ignorance of American history. I can name at least half a dozen cases off the top of my head, and I never went to law school (much to my aunt's chagrin).
The president should—and almost certainly does—know better. But he's not a professor anymore. He's still a lawyer and a politician, so calling him a liar is a lot like calling Mitt Romney a capitalist: redundant and irrelevant. He can pontificate all he wants, as is his right, but it's the court that will have the last word. It's not like he can take their lunch money.
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