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)



  1. Aliagins says:

    I appre­ci­ated the quote from The Mes­sage of Proverbs 24:11–12.  
    The Mes­sage also does a nice job with Matthew 25.  The Sheep and the Goats.  Jesus is very clear who the sheep and the goats are and the result is that they are sep­a­rated and it is the sheep that go into the kingdom.  Jesus is also very clear about the whys so there need be no dis­cus­sion about it.   Jesus will tell the sheep that they get to “take what’s com­ing to you in this king­dom and that it has been ready for you since the world’s foundation.”

    I was hun­gry and you fed me.  I was thirsty and you gave me a drink.  I was home­less and you gave me a room.  I was shiv­er­ing and you gave me clothes.  I was sick and you stopped to visit.  I was in prison and you came to me.“ 
    Inter­est­ing that the sheep ques­tion when they ever did those things to Jesus.  And his won­der­ful reply…‘I’m telling the solemn truth: When­ever you did one of these things to some­one over­looked or ignored, that was me—you did it to me.’

    Well the story that he tells goes on with the goats being sent to burn.  They miss out on the King­dom and he makes it clear that the rea­son for this is that those things that the sheep did…they did not do.  Is it really too much bother to be kind and Christlike?

    I remem­ber the Adven­tist church that I grew up in.  Not a wealthy church.  But peo­ple brought their offer­ings for the poor and for missions.  I remem­ber when my mother would give offer­ing for Loma Linda to grow so that the young men and women of the church would be able to get an edu­ca­tion in the med­ical arts so they would be pre­pared to HELP a sin sick world.  Not so they would become wealthy doc­tors of the world.  I won­der if Loma Linda would have grown and sur­vived with­out all those offer­ings so long ago.  I am always inter­ested in the scene that is out­side the church in Loma Linda of the rich pass­ing on by the wounded Jew but the Samar­i­tan comes to his aid.  We talk the talk that’s for sure.  But has becom­ing a Con­ser­v­a­tive stopped many from walk­ing the walk?

    What is sad to me is the fact that this Adven­tist church that was all about being like Jesus has in many parts become self­ish and Con­ser­v­a­tive to the point where words like social jus­tice have become fight­ing words.  Hear­ing Adven­tists rail against “oba­macare” is a mind bog­gler for me.  Hear­ing peo­ple talk as if Ayn Rand and the Ayn Ran­dian mind set of the Tea Party were gospel is astonishing.  Well, it would be aston­ish­ing except for The Great Con­tro­versy where all this is laid out for one and all to see.

    We are going to wit­ness con­ser­v­a­tive SDA’s vot­ing for Romney.  And at the core the very heart of their votes will be an atti­tude of ‘me first’.  The idea that when you work for your wages you get to keep them all to your­self and not share with those dead beats and has beens.  When did that become  gospel to the Adven­tist church members?

    My daugh­ter who is 52 has come home to live with me.  She has worked all her life but lost two jobs.  She had returned to school and now at 52 owes money on stu­dent loans.  She will prob­a­bly die before they are paid off.  She has NO health insurance.  NONE at 52.  Her spirit is bro­ken and she is hav­ing a very hard time com­ing to terms with what has hap­pened to her. 
    This is hap­pen­ing in home after home all over this rich land.  The church I attend has sev­eral fam­i­lies that can not pay the rent or are very close to not being able.  One young fam­ily has a dad that has hurt his back and now is out of a job.  He gets 400 every other week.  How can they pay rent and buy food and health care?  You are pay­ing for it and you are pay­ing more than if we had every­one on Medicare.  Between wars that we should not be involved in and the health care sys­tem and the do noth­ing Con­gress the very rich­est get­ting even richer can’t we all see that this is a time to get our own per­sonal lives in order.  Now is not the time to begrudge any­one health care or food and clothing.  It is NOT time to become a goat!

    (edited for brevity)

  2. MattM says:

    Looks like the Court approved Oba­maCare but tor­pe­doed the indi­vid­ual man­date as the lat­ter was not part of the intent of the Com­merce Clause.

%d bloggers like this: