To mandate or not to mandate: Is there a question?

The old cliché, “politics makes strange bedfellows” seems to come to mind a lot lately.  This week marked an important week for the PPACA.  In light of 11^th Circuit Court of Appeals rulings regarding the constitutionality of the PPACA, the Supreme Court has decided to take on the case.    While all 5 of the lower Appellate Courts have upheld the law in its entirety, it is the individual mandate that seems to be the pesky element that has rattled the political dialogue.  The individual mandate was deemed unconstitutional in the 11^th Circuit Court.  This ruling has sparked a debate from all angles of the political spectrum. 

 Since its passage in 2010, there are those that sit in the “anti-mandate” camp based on the grounds that the law represents government and congressional over-reach.  This argument insinuates that the mandate is unconstitutional on the grounds that the government can’t force individuals to purchase a product.  This sentiment has resonated with many of those that have supported the Tea Party movement in the past 2 years and expressed by the voters in Ohio last week.

On the other hand, another “anti-mandate” camp argues that the mandate is a reflection of the billion dollar corporate lobbying power of the health insurance industry in the writing of legislation that ultimately becomes public policy.  After all, the mandate will allow the health insurance industry to gain 32 million new unsolicited customers.  This camp argues that if the mandate is eliminated, we can ultimately get big insurance out of the game and open up the doors for “Medicare for all”.  Recently, the public hasn’t had the stomach for corporate power.  This distaste for the lobbying power of corporations is reflective in the wave of national Occupy protests. 

If only American political discourse was that simple.  In that fuzzy gray area, there are those that sit with one foot in each of the camps.  Regardless of which side of the “anti-mandate” camp you may (or may not) sit on, the reality is that large numbers of uninsured people aren’t good for anyone and it is in the national interest to improve access to healthcare.  According to the Kaiser Family Foundation, in 2009 32% of the uninsured postponed seeking treatment due to cost, 26% simply went without care due to inability to pay for it and 27% could not afford prescription drugs.  As a result, the uninsured become sicker and more costly.  In the end we all end up paying for them when they are admitted to emergency rooms and hospitals.  They go bankrupt and the insured pay the bills with our rising premiums, deductibles and copayments. 

So this brings us back to our original question. As the ranks of the uninsured have escalated in recent decades, does the existing free-market approach to accessing healthcare still remain a viable option?  Since the 1980’s, we have watched the lobbying industry balloon from a small cottage industry to a draconian giant, can we really afford to wait for our political system to change before we conquer our challenges with accessing healthcare?

The answer lies within the power of the Supreme Court.  In the end, maybe the only thing that all the camps will agree on is that this decision will go down in history as a defining moment for public health.