By Michael D. Peabody - 

Some­time this week the United States Supreme Court will decide whether the major­ity of pro­vi­sions in the Patient Pro­tec­tion and Afford­able Health Care Act are con­sti­tu­tional. Called Oba­macare, first by detrac­tors and then by sup­port­ers reclaim­ing the phrase, it promises Amer­i­cans a wide vari­ety of health care ben­e­fits. Under pro­vi­sions already in place, young peo­ple can stay on their par­ents’ health care insur­ance until age 26 and small busi­nesses can claim a tax deduc­tion for pro­vid­ing health insur­ance to their employees.

Many con­ser­v­a­tives have evis­cer­ated Oba­macare, argu­ing that it would “raise pre­mi­ums, uncon­sti­tu­tion­ally force peo­ple to buy health care, cause the deficit to sky­rocket, slash Medicare spend­ing to cre­ate a new enti­tle­ment, cause rationing, cause a sig­nif­i­cant num­ber of doc­tors to leave the prac­tice, and destroy the qual­ity of Amer­i­can health­care.”  Although I am a life­long Repub­li­can, I must respect­fully dis­agree with my con­ser­v­a­tive brethren on many of these points.

The “indi­vid­ual man­date,” the issue at the cen­ter of the Court case is the pro­vi­sion that busi­nesses, or in par­tic­u­lar indi­vid­u­als, are required to pro­vide and pay for health insur­ance. If it is not over­turned by the Court, the indi­vid­ual man­date is sched­uled to go into effect in 2014.

Avik Roy of Forbes Mag­a­zine traces the “Tor­tu­ous His­tory of Con­ser­v­a­tives and the Indi­vid­ual Man­date” in an arti­cle pub­lished in Feb­ru­ary 2012. In 1974 Richard Nixon pro­posed a national insur­ance plan that “every employer would be required to offer all full-time employ­ees the Com­pre­hen­sive Health Insur­ance Plan.” Ronald Rea­gan signed the first “indi­vid­ual man­date” into law when he approved the Con­sol­i­dated Omnibus Rec­on­cil­i­a­tion Act (COBRA) which incor­po­rated the Emer­gency Med­ical Treat­ment and Active Labor Act (EMTALA) known for allow­ing those who had lost their jobs to con­tinue to buy insur­ance through their for­mer employer’s group plan. EMTALA, which included no fed­eral bud­get fund­ing pro­vi­sions, also required hos­pi­tals to pro­vide emer­gency care to any­one who needed it, even if their immi­gra­tion sta­tus was in jeop­ardy, and they would never be able cover the cost of treat­ment. In response to EMTALA, health care providers argued that many would inten­tion­ally go with­out insur­ance know­ing that hos­pi­tals would be required to pay for treat­ment anyway.

The indi­vid­ual man­date, as opposed to an employer man­date, would pro­vide cov­er­age for the unem­ployed and make it eas­ier to switch jobs with­out los­ing insur­ance. Dur­ing the early 1990s dur­ing the Clinton“Hillarycare” debates, some Repub­li­cans in Con­gress pro­posed the Health Equity and Access Reform Today Act of 1993 (HEART) which pro­posed health insur­ance for low-income indi­vid­u­als along with an indi­vid­ual man­date. In those years, con­ser­v­a­tives favored an indi­vid­ual man­date over an employer man­date because it rec­og­nized the respon­si­bil­ity of indi­vid­u­als them­selves and avoid being a bur­den on the larger society.

Few con­ser­v­a­tives know that The Her­itage Foun­da­tion for­merly pro­moted the indi­vid­ual man­date in order to more prop­erly spread the costs of pro­vid­ing care for the unin­sured.  In 1991, Stu­art But­tler, PhD gave a lec­ture for The Her­itage Foun­da­tion (avail­able here: http://​s3​.ama​zon​aws​.com/​t​h​f​_​m​e​d​i​a​/​1​9​9​1​/​p​d​f​/​h​l​2​9​8​.​pdf )  describ­ing how his pro­posal at the time would work:

We would include a man­date in our proposal–not a man­date on employ­ers, but a man­date on heads of households–to obtain at least a basic pack­age of health insur­ance for them­selves and their fam­i­lies. That would have to include, by fed­eral law, a cat­a­strophic pro­vi­sion in the form of a stop loss for a family’s total health out­lays. It would have to include all mem­bers of the fam­ily, and it might also include cer­tain very spe­cific ser­vices, such as pre­ven­tive care, well baby vis­its, and other items.”

In 2012, The Her­itage Foun­da­tion still reports that every year, Amer­i­cans spend $2.6 tril­lion on health care which is 17% of the gross domes­tic prod­uct. It is highly reg­u­lated and the U.S. gov­ern­ment pays half of this amount through Medicare, Med­ic­aid, SCHIP and state and pub­lic health care programs.

At the same time, the major­ity of mid­dle class Amer­i­cans are only one cat­a­strophic health event away from per­sonal bank­ruptcy. When our daugh­ter was born seven weeks pre­ma­ture we thanked God every day that we had ade­quate health insur­ance to cover the six fig­ure med­ical bill that quickly accu­mu­lated through a multi-week stay in the Neona­tal Inten­sive Care Unit. We were thank­ful that we had not recently joined the ranks of the unem­ployed like so many of our neigh­bors in our tur­bu­lent econ­omy. We were the lucky ones and Sophia did not have to worry about any­thing except get­ting big and strong so that she could come home with us. We had the kind of safety net that mil­lions of work­ing Amer­i­cans could only dream about. 

There are many peo­ple who view health insur­ance as an unnec­es­sary lux­ury, believ­ing that they will be taken care of indef­i­nitely through Reagan’s EMTALA but those funds can dry up. Even The Her­itage Foun­da­tion rec­og­nizes the need for insur­ance that Amer­i­cans can take from job to job.

Unfor­tu­nately the argu­ment in the past few weeks about the reli­gious lib­erty impli­ca­tions of health care have over­come the raw need for a health­care safety net. In par­tic­u­lar the Catholic Church, which has one of the largest char­i­ta­ble health care sys­tems in the world, has protested vocif­er­ously against pro­vi­sions which would have the “net effect of man­dat­ing Catholic employ­ers to become facil­i­ta­tors of con­tra­cep­tive prac­tice” in vio­la­tion of Catholic beliefs. Pep­per­dine Pro­fes­sor of Law Doug Kmiec sub­mit­ted an excel­lent overview of the debate and argues that the Obama admin­is­tra­tion could have avoided that fight alto­gether by a vari­ety of means, includ­ing find­ing other ways to dis­trib­ute con­tra­cep­tive care with­out com­pelling the Church to do so.

Because Ronald Rea­gan signed the law requir­ing hos­pi­tals to pro­vide emer­gency treat­ment for those unable to pay, today, if you do not have insur­ance and are in an emer­gency posi­tion you can walk into a hos­pi­tal and receive med­ical care. The hos­pi­tal will then send you a bill. If you’re like most Amer­i­cans, you prob­a­bly could not finan­cially sur­vive the cost of even a day or two in the hos­pi­tal. So the gov­ern­ment reim­burses the hos­pi­tals for this treat­ment using tax dol­lars, or the hos­pi­tal sim­ply does not get paid. This sit­u­a­tion can­not con­tinue indefinitely.

Most opposed to gov­ern­ment spend­ing on insur­ance are also unwill­ing to stom­ach the social Dar­win­ist response that those unable to pay should sim­ply be left to die. So they pro­vide for emer­gency treat­ment at tax-payer expense even when it costs many times more than ongo­ing pre­ven­ta­tive care that actual health insur­ance would provide.

But with a sink­ing econ­omy this lim­ited gen­eros­ity has been slowly erod­ing. Over the last few years the tenor of debate in Amer­ica has soured and the nation has become increas­ingly divided. Social Dar­win­ism may be on the table. Last Sep­tem­ber, dur­ing a debate spon­sored by CNN, mod­er­a­tor Wolf Blitzer asked Con­gress­man Ron Paul about what he would do with an unin­sured 30-year old who had suf­fered a cat­a­strophic injury. Paul ini­tially tried to duck the ques­tion. Blitzer then asked him the direct ques­tion, “But, Con­gress­man, are you say­ing the soci­ety should just let him die?”  The Tea Party mem­bers of the crowd erupted with “Yeah!”

Some peo­ple won­der what Chris­tians should do about the indi­vid­ual man­date.  In America’s “pull your­self up by your boot­straps” mind­set, many con­ser­v­a­tives and lib­er­tar­i­ans oppose the con­cept that peo­ple some­times legit­i­mately need the help of the gov­ern­ment. If some­body falls on hard times, they feel it must be the fault of those who need ser­vices for being too lazy or per­haps act­ing out­side the will of God. This is wrong and flies in the face of Bib­li­cal teach­ings that this is a sin­ful world where bad things hap­pen and that we need to take care of peo­ple who need help. The idea that vic­tims of cir­cum­stance should be left to their fate has never been a legit­i­mate Chris­t­ian con­cept. Con­se­quences of death and poverty are not the great instruc­tor.  Rather, those who take their Chris­t­ian faith seri­ously should see in them­selves an exten­sion of the non-discriminatory and pos­i­tive heal­ing mis­sion of Christ.

Rather than engag­ing in pop­u­lar par­ti­san­ship which will delay things for gen­er­a­tions, I believe there is a place for Chris­tians to stand up and sup­port life-affirming and enhanc­ing health care reform in America.

Is Oba­macare per­fect? Absolutely not. But is major sys­temic reform needed? Absolutely.

Res­cue the per­ish­ing; 
   don’t hes­i­tate to step in and help.
If you say, “Hey, that’s none of my busi­ness,” 
   will that get you off the hook?
Some­one is watch­ing you closely, you know— 
   Some­one not impressed with weak excuses.
Proverbs 24:11–12 — The Mes­sage (MSG)