Earlier today Patrick Sharma posted Sorry to Say, but HCR Is Still Unpopular... Let's Gather Thoughts on How to Fix That. By a complete coincidence I had just had a conversation with a group of hard core right wingers about the ACA. I commented on that post, but feel compelled to share the experience with a diary of my own.
My day job takes me into a world almost completely devoid of progressive ideas. So, there I was, when a conversation launched about Obamacare and the current Supreme Court deliberations.
The following conversation really happened (or at least one that was very similar to this), and it seemed to meet with a lot of success.
"It's all about FAIRNESS," I began. "The problem is uninsured people needing medical attention and being unable to pay for it. "Then when I need medical attention" I said, "I have to pay MORE because they didn't pay."
Everyone seemed to understand and appreciate that.
"That's NOT fair to ME," I continued. "So, let's make everyone be personally responsible for their own needs and make them get insurance."
That sounded too much like the mandate and was met with little enthusiam, so I continued, "But some people can't even get insurance - at least not at a reasonable cost because they have pre-existing conditions. It's not their fault, but they happen to work for a company that doesn't have benefits and with their medical condition the insurance company won't even take their money."
They seemed to agree that this was a problem.
"So we passed a law that prohibited insurance companies from discriminating on the basis of pre-existing conditions. But that isn't FAIR to the insurance companies. They correctly pointed out that under that arrangement, people can choose to NOT have insurance until they get sick, pay several hundreds of dollars of premium and immediately start turning in bills for tens of thousands of dollars a month."
They all saw the problem with that.
"The original concept of insurance was one of shared risk. If only sick people pay into the system there is obviously no way the insurance companies can stay in business. We are all at risk of needing to spend a lot of money to get well. Through near universal participation in the health insurance system we all pay in a little so that those that get very sick can have medical treatment."
"So we have to make a choice. On the one hand, we could throw out the insurance companies and have the government take over the whole thing."
"That would have been far worse," someone said - already having realized something about the ACA he hadn't realized before. Others agreed.
"On the other hand, we could make everyone participate by passing the individual mandate."
Silence. So I continued.
"The mandate is what the INSURANCE COMPANIES want out of the deal. They want to have lots of customers so that they can pay the bills and still make lots of money."
Someone piped up with a common misdirection, "When I go to a car lot, I can't say I want that Tahoe over there and expect to just drive away in it without paying for it. Why is medical care any different?"
I responded, "For right or wrong, we look at medical care differently. Personally, and as a society, with life or death situations we treat health care as something that is absolutely necessary, where-as the purchase of a car is not. As long as society is going to treat health care purchase differently, we are going to have to realize that the rules are different. If we want to go down the path of treating them as the same then someone is going to have to stand at the door of the hospital saying, 'Unless you pay now, you die.'"
"That's what I would opt for," he immediately responded.
"OK," I said. "Your kids are still young, but when they grow up and they don't have a job and they are no longer eligible to be on your health insurance, so they don't have any, and they get cancer, are you going to pay the bills out of your pocket so that they can get treated?"
Crickets!!