Unfortunately, the Supreme Court ruling was only the beginning. Now the hard part begins. We can expect nonstop heated debate in the coming months. Republicans are going to do everything they can to repeal the law and are already beating the “anti-tax” drums.
So you may be surprised to learn, as I was, that Republicans used to support the individual mandate. Mitt Romney may be the most famous one, but he’s far from alone. The individual mandate was introduced as Republican legislation in 1993, as a rebuke of President Clinton’s single payer proposal. A terrific Ezra Klein article in the New Yorker lays out the history (and political cognitive dissonance) extremely well. If you support the AHA, you might want to ask your Republican House and Senate representatives what’s changed. I certainly plan to ask mine.
You also may not be aware that the right to emergency care is already law. I had no idea about this until I read an LA Times article reprinted in my local paper yesterday. The Emergency Medical Treatment and Active Labor Act became law (under a bipartisan Congress) in 1986. For 26 years, the law of the land has been for hospitals to treat emergency patients regardless of their insurance status or ability to pay. This is the right and humane thing to do, but we never figured out who is supposed to pay for it. Those of you who don’t like the idea of a medical insurance “tax” are already being taxed for it when hospitals shift the costs of treating these patients.
The third thing you should know is that the debate is about more than health care. It’s about what kind of nation we want to be and how we care for the least among us. In a brilliant New Yorker piece, Dr. Atul Gawande explains the history and trajectory of social change as it applies to “wicked problems”–complex social problems such as poverty and yes, health care. He explains the “rhetoric of intransigence” used to argue against basic social advances and how it is being applied to the health care debate. Dr. Gawande also points out that every major social advance of the last 300 years has meant widening our sphere of moral inclusion.
Dr. Donald Berwick, former head of the Centers for Medicare and Medicaid Services, said much the same in a recent speech to graduates of Harvard Medical School. He dedicated his moving, eloquent speech to Isaiah, a patient killed not by leukemia, but by the hopelessness caused by poverty. He said it is time to recover and celebrate a moral vocabulary in our nation–one that speaks without apology or hesitation of the right to health care–the human right–and against blindness to the needs of the powerless. (And if you think of the powerless as “other,” you shouldn’t. Too many of us are just a layoff away from medical bankruptcy.)
Dr. Berwick spoke of the special obligation of doctors by virtue of their oath. But I think we all bear responsbility for understanding what’s at stake, and for speaking up. Every single one of us is going to need health care at some point in our lives. It’s too important to leave to partisan politics.