Northwest Reading

This opinion is by Duff McKee, a former Idaho district judge. He originally posted it on Facebook.

The continued diatribe from the extreme right wing, the incessant drumbeat that Obamacare must be repealed in its entirety, and the more recent attempts to emasculate or nullify the act by withholding state participation, defy reason and common sense to the point of becoming ridiculous.

The plain fact is that under any fair evaluation the Affordable Health Care Act, or Obamacare, when taken in its entirety, is a moderate compromise of policies embracing traditional values and views of both the right and the left. Obamacare is not a federal take-over of health care, it is an overhaul of health insurance. It is not an irresponsible give-away to benefit one segment of society at the expense of another, it is a compendium of moderate policies and methods to benefit all of society, methods that have long been recognized and used by both left and right. To call it Socialism or Marxism is uneducated – showing a lack of understanding of either the fundamentals of Socialism or the teachings of Karl Marx. To make these arguments pejoratively, as though the Act is an evil encroachment upon our freedom, demonstrates a blatant ignorance of how our government and economy actually work.

The plain fact is that every president beginning with Truman – both Republican and Democrat alike – has tried to secure passage of some form of universal healthcare. The parties have and do differ of aspects of policy, but both parties have long considered healthcare to be a matter of legitimate concern to the government.

Over the years we have seen the arrival of expansive programs extending government involvement into the delivery of health care, some after significant debate and others with broad bipartisan sponsorship — Social Security’s SSI, Medicare, Medicaid, Prescription Drug Benefits, and Children Health Insurance Programs identify the main programs, but there are many more. These programs have been fully assimilated into our society and are now endorsed by both parties. There are differences, certainly, and both sides continue to propose adjustments and modifications, but with the exception of a very few extremists, nobody argues that any of these programs should be abandoned. Government participation in healthcare is here to stay as an essential ingredient of government service.

Obamacare is an exemplar of a middle-of-the-road compromise, embracing principles dear to the heart of both sides. While the overall objective of universal healthcare is a long-held liberal tenet, the framework of Obamacare may have been inspired by the national insurance plan suggested by Nixon in the 1970s. Parts of Obamacare mirror research in the late 1980s by the Heritage Foundation, a deep red conservative think tank. The concepts were fashioned into the program adopted and successfully implemented in Massachusetts in 2006, which has been operating without any of the dire consequences suggested by the right wing ever since.

Obamacare caters to the right in that it is based upon private insurance, issued by private companies, through private premiums, and with plenty of room for individual selection. The foundation of the plan continues to be employer sponsored health insurance for as many as possible. It answers the goals of the left by providing machinery to make coverage available to all through premium subsidies and expanded Medicaid. And it provides a network of regulation over the insurance industry to prevent abuse and assure availability by including such provisions as a baseline of minimum coverage, elimination of lifetime ceilings, elimination of preexisting condition exclusions, inclusion of appeal processes and other means of dispute resolution, making coverage non-cancelable, and regulating the percentage of premium dollars that can be absorbed by administration and profit.

The act does mandate compliance and impose sanctions, but this is not contrary to our society or our freedom or our theory of government. We have long had mandatory automobile liability insurance, mandatory workers compensation insurance, and the extraordinarily popular mandatory retirement insurance. We require that our young be schooled, that our minorities be treated fairly, that our workplaces be free of avoidable hazards, and that we be paid a minimum wage for our efforts. We insist on quality and safety in the milk we drink, the meat we eat, the cars we drive, the planes we fly, the new houses we buy, and the bridges we cross. Sanctions are imposed for infractions in all of these. Obamacare presents nothing new.

As the parts Obamacare have been rolled out, most of us applaud what we have seen. That we may keep our children on insurance until age 26 has been a tremendous boon to worried parents. Putting limits on the amount of premium dollars that can be siphoned away for marketing or retained as profit resulted in refund dividends to thousands. That children’s coverage is now guaranteed, portable and non-cancelable has provided relief and freedom from future worry to many. As Obamacare continues to roll out, most of us will continue to appreciate the features that begin to appear. Those that are affected will appreciate the features of portability, unlimited ceilings and elimination of exclusions first introduced in children’s insurance becoming available to all. Those gainfully employed but at the lower end of the pay scale will begin to see coverage in an increasing number of jobs, with subsidies to smaller employers and with a sliding scale of premium assistance for those seeking individual policies. State exchanges will provide smaller employers and individuals with resources to seek out economical coverage. The poorest among us will begin to see significant differences as Medicaid expansion fills in many gaps.

The argument that employers will suffer is not supported by fact or theory. The argument that jobs will be lost is a blatant misstatement of facts developed by the CBO. It is of note here that none of this happened when the state program was adopted in Massachusetts. The reality is overwhelming that employment decisions – how many to employ and how much to pay — are driven by demand, not payroll benefit cost. An employer will not hire a single employee until and unless his business demands that he has to, and when his business does so demand, he will hire as many as needed at whatever the going rate. There is no competent evidence that any legitimate business will ignore the actual economic demands of growth just to avoid paying an employee benefit, and any argument otherwise is pure sophistry.

The argument that we cannot afford Obamacare is completely misplaced. Healthcare is not a matter of choice; we do not choose to be sick or injured, and decisions on cost can seldom be postponed. Society, as a whole, already pays the entire cost of its healthcare now, with no opportunity to postpone or pick or choose. The problem is that the costs are determined and allocated among us randomly, unfairly and unreasonably, imposing untold financial hardships upon millions of us, and causing untold misery and even death to the very poor. It is not a question of whether we can afford the cost, it is a matter of how the cost should be allocated among us.

We are the only industrialized nation in the world that does not provide healthcare to all of its citizens without exception, as a public service, at the common expense, and as a matter of routine governance. It is unconscionable to argue that this country should now reject our first steps into recognizing this fundamental responsibility, and return to a system where those least able are abandoned to the catastrophic burdens of poor health or serious injury.