July 2, 2012 | Posted By Wayne Shelton, PhD

The decision by the Supreme Court affirming the Patient Protection and Affordable Care Act (ACA) caused many who follow health care closely to breathe a sigh of relief. About 32 million more Americans will now have access to health care insurance. One sticking point that worried many of us was the mandate in the bill requiring everyone to purchase health care. It was frustrating this past March to hear in the oral arguments comparing a requirement for citizens to buy broccoli to a requirement to buy health care, as though both are the same type of market commodities. Many on the right, such as Judges Scalia, Thomas and Alito, expressed concerns that the mandate to require everyone to buy health care was a unconstitutional, a violation of the commerce clause; whereas, many others see health care as a basic public good, which unlike broccoli, everyone requires or will require sooner or later. Fortunately, a legal consensus was reached in the ruling, with Chief Justice John Roberts moving over into the majority in the 5-4 vote. In their ruling, the mandate was not viewed as an expansion of the commerce clause, but rather as a tax, which congress has a right to impose. Regardless of the final legal justification of the ruling, many of us are pleased that the most important piece of health care legislation since Medicare and Medicaid in 1965 is now the law of the land.

The issue of expanding health care has been debated for the past century. On the left the gold standard for many has been a universal single payer system, but at least making available to everyone a public option. But with the political mindset of the American public since the 1980’s moving to the right, these options have been virtually impossible as a matter of legislation as viable options. Many people who set the political agenda, particularly those in the Tea Party movement, are very suspicious of expanding government programs in an era of strong pro-market, anti-government sentiment. Yet, even in this contentious political setting, there has been an urgency to make some kind of reform in health care. 

The number of insured in 2012 has risen to over 50 million people, including many of our most vulnerable citizens. But as we know, an individual not having health care insurance does not mean that he or she will not get sick and require medical care. Sadly, too much of the access this population has to the health care system takes place in emergency rooms throughout the country, which means millions of people are getting their health care too late, when medical problems are more acute and in the most economically inefficient manner possible. The situation drives up exorbitant and needless costs to our health care system, and along with many of inefficiencies in health care, puts at risk our hospitals, especially our health science centers, as well as our entire economy. Expanding access to health care at the primary care level is morally the right thing for our nation and is also essential to help our health system function in a more efficient manner.

The ACA is indeed progress whose benefits will become more obvious to more voters. It is ironic that this bill contains a market friendly plan to private insurance companies that many conservatives on the right embraced in past years as a viable alternative to a single payer system. It should be viewed as a moderate and necessary step to expand health care insurance for more people. 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

1 comments | Topics: Bioethics and Public Policy , Bioethics and the Law , Bioethics in the Media , Health Care Policy , Health Insurance , Politics


Heddy-Dale Matthias, MD

Heddy-Dale Matthias, MD wrote on 07/13/12 1:16 PM

I have two comments.
1. Americans consume an extraordinary amount (uselessly, I might add) of healthcare. Most patients tell their doctor what test they are demanding, and physicians, who run scared because they're afraid of getting sued, or because they don't want to lose the patient, order the test. Probably 80% of MRI's for back or neck pain are unnecessary. Americans also consume too much (unnecessary) medical care at the end of life, again because physicians are afraid to stop. We must stop ignoring the overconsumption of healthcare in this country, or it will bankrupt us.

2. Many voters have run out of patience providing healthcare to able-bodied, non-working Americans. If we accept that there is a "moral contract," of sorts, to provide healthcare, I submit there is a reciprocal contract for all able-bodied Americans to contribute, in any way possible (including "work-fare") to their own entitlements.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.