American Values: The Individual Mandate vs. Social Darwinism

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.amazonaws.com/thf_media/1991/pdf/hl298.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)