The innate contradictions of Obamacare | Eastern North Carolina Now

    I agree with the legislative intent to expand healthcare coverage to the 40 million uninsured Americans and preclude discrimination against Americans with preexisting conditions who are seeking coverage within the individual market. However, Obamacare, as it was passed, is problematic and rife with contradictions. The Supreme Court devoted March 27th towards oral arguments concerning the constitutionality of the individual mandate, and indeed, the mandate has been the chief focus of opposition efforts, yet I see additional problems and points of hypocrisy. Opponents of Obamacare decry the act as an attempt to redistribute wealth, but this argument fails to engender the sympathies of liberals who believe that income inequality should be righteously rectified. And to those liberals, I say this - never mind the wealth transfer; by supporting Obamacare, you are supporting the geographic transfer of poverty.

    The website for the U.S. Department of Health & Human Services states, "The Affordable Care Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country. Most adults under age 65 with incomes up to 133 percent of the federal poverty level (FPL) - $14,500 for an individual and $29,700 for a family of four in 2011 - will be eligible for Medicaid." These Medicaid eligibility requirements do not take into account the geographically varying cost of living. Cost of living is substantially higher in cities. Therefore, poor individuals and families teetering on the upper edge of the eligible income bracket could stay in the city and be forced, under penalty of a fine, to devote a portion of their already constrained income to health insurance payments. Or they could stay in the city and deliberately limit their own earnings. Or they could move elsewhere and restrict their own career potential in order to ensure that their children are able to receive health insurance without it constraining the family budget. In essence then, the lack of a cost of living adjustment could result in a dependence on an entitlement program, a geographic dislocation of a family, and a corresponding hindrance on the parents' ability to pursue administrative and executive positions that are often only available in cities. GOP candidates in the primary debates talked about the metaphorical "magnet" that attracts illegal immigration - but the lack of cost of living adjustments in the Medicaid income eligibility level could result in a new magnet that draws poor families out of cities and away from their ambitions of upward social mobility.

    Any hope for a cost of living adjustment rests on SEC. 1416, which calls for a report evaluating the "feasibility" of applying this basic level of fairness: "The Secretary shall conduct a study to examine the feasibility and implication of adjusting the application of the Federal poverty level under this subtitle (and the amendments made by this subtitle) for different geographic areas so as to reflect the variations in cost-of-living among different areas within the United States. [...] The Secretary shall submit to Congress a report on such study and shall include such recommendations as the Secretary determines appropriate."

    But that isn't the only problem. Obamacare deters ambition across the board. The IPAB will exert subjective control over the medical marketplace by setting reimbursement rates for healthcare providers and others, as part of an effort to achieve savings in Medicare. This arbitrary gateway to the marketplace could discourage venture capital funding for medical innovation. Cures for cancer, heart disease, and Alzheimer's could be delayed or remain undiscovered as the result of a component of legislation that is purportedly compassionate.

    Is there not a touch of irony to the fact that legislation passed ostensibly for the benefit of the poor and the sick could produce unintended consequences that would keep poor people poor and sick people sick? I am not discounting that this legislation could have many positives if enacted, but I am suggesting that the aforementioned ironic attributes and the lack of long-term thinking are indicative of the haste and recklessness with which the Obama administration approached healthcare reform. Members of the left are claiming that this bill is a blessing and its opponents lack compassion, but professed benevolence should not be used to provide simplistic justification for convoluted legislation. When good intention is facilitated by government without the guidance of constitutional restraints, without being preceded by an honest national discussion about budgetary priorities, and without sufficient time for the legislative bodies to tailor nuances and calculate the potential incentives and deterrents that would be posed to citizens and medical innovators alike, the inevitable results are almost certain to differ wildly from the intent. And I do think that the individual mandate sets a bold precedent with a poorly articulated and arbitrary limiting principle. This act effectively paves a path of unknown consequence. This act could provide justification for future intrusions upon liberty within the context of commerce and within the context of mangled interpretations of what constitutes prevalent or inevitable commerce.

    Donald Verrilli, Solicitor General of the United States, said that the health insurance market is uniquely qualified for regulation because of "the cost shifting to other market participants" that occurs when uninsured people receive treatment under the 1986 Emergency Medical Treatment and Active Labor Act. Verrilli stated, "That is definitely a difference that distinguishes this market and justifies this as a regulation." At a later point in the oral arguments, Justice Alito asked, "Are you denying this? If you took the group of people who are subject to the mandate and you calculated the amount of health care services this whole group would consume and figured out the cost of an insurance policy to cover the services that group would consume, the cost of that policy would be much, much less than the kind of policy that these people are now going to be required to purchase under the Affordable Care Act?" Verrilli replied, "They are going to be on the other side of that actuarial equation at some point. And of course you don't know which among that group is the person who's going to be hit by the bus or get the definitive diagnosis." Justice Kagan put it more simply: "The subsidizers eventually become the subsidized." But the argument that time and gradual health degradation would eventually apply fairness to this form of subsidization lost all credibility when Justice Roberts observed, "It seems to me that you cannot say that everybody is going to need substance use treatment or pediatric services, and yet that is part of what you require them to purchase."

    Justice Roberts's observation deflates two of Verrilli's primary justifications. Firstly, Verrilli justified Obamacare as being valid regulation of existing commerce by stating that virtually everybody is in the healthcare market or will be in the market - yet some individuals susceptible to the mandate will be paying for services that they will never be in the market for. Secondly, the minimum coverage provision that Verrilli characterizes as "necessary to carry into execution [these] insurance reforms" provides far more than catastrophic care coverage precisely because it seeks to raise funds from young healthy people to balance out everyone else's costs. Under intense questioning from Justice Alito, the following words slipped out of Verrilli's lips: "It would be unusual to say that it's an illegitimate exercise of the commerce power for some people to subsidize others."

    And thus, the hypocritical core of the legislation is revealed. The mandate does not exist to prevent cost shifting, because the mandate, by Verrilli's own admission, ensures that the newly insured individuals will subsidize others, in essence, causing cost shifting. The feigned sense of injustice at the cost shifting that happens as a result of the 1986 Emergency Medical Treatment and Active Labor Act suddenly vanishes from the administration's perspective once the administration is able to direct the cost shifting in the manner that it deems just. Once you examine this undeniable contradiction, it becomes apparent that this legislation is about enhancing government control of the market in an unprecedented way that Verrilli himself describes as "a novel exercise of power."

    This legislation is based upon contradictions and mischaracterizations. One reason why not every American can be rightly characterized as being in the healthcare market is because many Americans travel abroad to partake in medical tourism. They receive healthcare that is substantially less expensive partly due to the fact that the costs of foreign healthcare haven't been driven up by excessive malpractice lawsuits. Yet Obamacare didn't include a single attempt at malpractice/tort reform to reduce medical costs within our borders.

    Christian Scientists typically practice abstinence from Western medicine, preferring instead to use methods of Christian healing. Obamacare offers an exemption for Christian Scientists who could not be fairly mandated to buy insurance as a prerequisite for a market they would not engage in. But this religious conscience exemption provides a legal loophole for others. Will insincere Christian Scientists become the new draft dodgers? We can refer to them as mandate dodgers. When a frugal young mandate dodger gets hit by a bus and winds up in a hospital without health insurance, he will say, "Oh, the good Lord knocked some sense into me! A public transportation vehicle was the mechanism by which He delivered His message! I am not a Christian Scientist anymore. Please provide me with information about other denominations whilst carefully placing my organs back inside of my body." At this point, if we then require him to purchase insurance at the point of sale, prior to receiving care, would the guaranteed-issue provision mean that he must receive coverage in spite of any pre-existing conditions - such as the condition of having his spleen hanging out of his stomach as the result of a gory bus collision? Would he receive care but pay a minor fine? Or would he be signed up for insurance as part of a high risk pool, then and there at the hospital? When the latter option was proposed by Paul Clement as an alternative to the mandate, Verrilli called it "utterly unrealistic."

    Many Americans desperately need healthcare reform that considers both short-term and long-term effects - and Obamacare falls short of meeting that need. It is riddled with contradictions. Ideological politicians tend to have blind spots. This results in ineffective legislation. We cannot allow this to happen any longer - our very health and wellbeing is at stake. We need independent-thinking politicians. The next time a candidate for the White House promises to make bipartisan efforts, remember this - We don't need a bipartisan President. We need a nonpartisan President. Become a registered independent today. Or, you could start pretending to be a Christian Scientist if you think that the mandate is going to negatively affect you. Your call. If you don't earn a lot of money and are in need of healthcare services at this moment, you can locate a Community Health Center near you that offers free or low-cost care: http://findahealthcenter.hrsa.gov/Search_HCC.aspx

    To find out more about my thoughts, ideas, and creative projects, visit me on the web at www.pring-mill.com and sign up for the newsletter. Follow my tweets at www.twitter.com/davesaidso.