It’s been a crazy week in the world of healthcare news, with page after page of reporting and analysis on what’s been going on in the Supreme Court chambers. Some have said that the Justices seemed to be somewhat critical of the law in their questioning, but I think it’s way too early to assume that means they will strike down the individual mandate or send the healthcare reform law back to the drawing board. I would say it’s anybody’s guess at this point. The Justices asked tough questions, and both sides presented their toughest arguments. Regardless of how the Supreme Court rules in June, there’s no way to please everyone in this case. The country is deeply divided over the healthcare reform law, and a large chunk of the population will be disappointed either way.
One of the many articles I read this week had to do with the very different language that the two sides used to describe the same thing: While the lawyers opposing the ACA talked about the individual mandate and the penalties that people will incur for going without health insurance, the lawyers arguing in favor of the law describe “adverse tax consequences” if people opt to “self-insure”. I appreciate the honesty of that choice of words. Because no matter how we look at it, going without health insurance means self-insuring. Whether a person actually has the means to self-insure is another debate all together, and varies tremendously from one person to another. Rush Limbaugh? Self-insuring seems to work just fine for him, since paying “less than the price of a car” for a medical incident was no big deal at all. For most of us though, “less than the price of a car” could still be a huge strain on the budget (remember, most Americans buy cars by financing the purchase price out over at least three years).
Lawyers can argue semantics all day, but what actually happens when people choose to go without health insurance and “self-insure” despite not really having the means to cover anything more than a relatively minor medical bill? What happens if that person has a heart attack or a stroke or gets diagnosed with cancer? Overwhelmingly, the uninsured aren’t able to pay for the cost of their care if and when they do end up needing healthcare. And that can translate into a large amount of money that hospitals don’t get paid. In addition to the obvious financial ramifications, people without health insurance are also more likely to die from treatable conditions.
Although a lot of Americans have a problem with the idea of the government telling them they have to purchase a product like health insurance (and of course, there is concern that such a precedent could pave the way for other mandates that we haven’t thought of yet), the problem of providing unreimbursed healthcare for uninsured patients is a very real issue for providers. And unfortunately, the end result is that hospital overhead is higher (to cover the unreimbursed care) and those higher charges end up being passed on to health insurance carriers. Which means that health insurance premiums increase to cover the higher claims expenses. There is no “free” care. For all but the most wealthy among us, “self-insuring” really just means relying on luck. And luck doesn’t usually hold out forever.