So there was a recent Federal district court ruling in a case referred to as Haldig that the ACA doesn’t provide for tax subsidies to citizens of states that did not set up their own health insurance exchanges. This case seems to have caused a lot of controversy considering that less than a quarter of the 50 states actually set up exchanges with the rest taking the Federal exchange route.
Part of the controversy is that a strict reading of the law appears to render such a result. Though I oppose the ACA, I am far more interested in “the letter of the law” and I agree with the decision on those terms. In any civil society, having a stable and reliable legal foundation is must in preserving order, otherwise we subject ourselves to certain amounts of uncertainty and chaos that comes with liberal interpretations of law on either side of any particular debate. The law is how our democratic process expresses its will, and deviations from that due to momentary political convenience on the part of the executive does not serve the longevity of our society as a cohesive political unit, nor does it serve the longevity of respect for the rule of law and/or the democratic process.
I see the entirety of this debate as being caused by failure of proper consideration toward the legislative language used to create it and lack of consideration of the language when voted on by the Congress, and much less to do with the opposition grasping at any straws they can find to have it overturned. When cooperation with the law is obligatory on all sides, whether spirit of the law is palatable or not, it needs to be far more thoughtfully crafted, especially when one side of the debate is relying on the opposition learning to like it over time. From my point of view, that goal has always been very unlikely simply because of the maneuvering around the minority that was fiercely opposed it took to pass it. It was far from a venture we undertook together, absent of the usual political give and take.
One of the reasons that we’ve had this court case in the first place is because the proponents of the ACA in Congress are not interested in the compromise required to fix the language, but don’t seem to realize or care that the spirit of this particular law is hardly any reason to flush 250 years of rule of law that serves as protection as well as being a blunt instrument of Congressional will down the toilet. What we need now, more than ever is compromise to protect the foundations of order. At least I want to live in a world where all the trains run on time in a legal sense, and I seriously believe that is what is at stake here.
While I oppose the ACA in the sense of take it or leave it, and would much rather leave it, some of the ideas contained in it are worth keeping. For one thing, it fixed the widespread policy of insurance carriers automatically dropping elderly patients, foisting all of their coverage on Medicare. This was something that I had noticed happing with some of the insurance plans offered by my employer, even if one is still working on their 65th birthday coverage would be terminated. The effect then, was one paying for coverage throughout their younger working years and then being dumped by the carriers as soon as the need for coverage becomes more likely, with the increased likelihood of needed coverage that comes with age being foisted on taxpayers instead.
I also think the exchanges are a great concept because I oppose the employer-provided insurance model that lacks portability and opens the door to all kinds of personal behavior-related governance and invasion of privacy by employers who pay me to do a job they need done, not to become my daddy or for me to become their slave 24/7.
The employer mandate in the ACA, however, enforces, upholds and expands the employer-provided insurance model which I find to be quite incompatible with liberal philosophy that rejects the notion of workers being forced into becoming corporate slaves. What the ACA amounts to, in effect, is a statist healthcare model that seeks to foist the bill on the private sector at the expense of personal freedoms of the employed. When I weigh whether extending coverage to millions of uninsured (some of them no doubt by choice) is worth the entirety of the cost, not just in monetary terms, I think I would rather do without with more of things I value to be gained from not cooperating with it. Nothing for everyone is better than something for everyone, quality over quantity, at that price.
There are also unintended consequences of the law as well. One that I have noticed already is the power claimed by government to dictate the types of treatments that will be available for just about any purpose that can and will be used as a tool of politics which we’ve already seen crop up in the debate over contraceptives. I don’t believe that Democrats realized the double-edged sword usurpation of that kind of decision-making by government would become. Perhaps they thought it would ensure their own longevity in power, or something. But I think we can probably count on that not being the case forever – and it doesn’t even take a vote in Congress to void availability of treatments of that sort. From a more practical view of government competence, it seems rather strange for those who understand the origins of the Great Recession to support that kind of power being in the hands of government. At least in the case of the Federal Reserve, we’re talking money – not lives when government behaves incompetently. Going back to my weighing of the overall price of the ACA that doesn’t particularly ensure quantity of life while seriously degrading quality, the supposed value proposition of the law becomes even less plausible in my eyes.
There is plenty of room for Republicans to maneuver in compromise that might result in a far more palatable solution to healthcare issues than the ACA as currently written without having to gut it entirely by leveraging some of the good points in the law to restore the majority of personal freedoms the law removes while also providing a subsidy to purchase insurance for those who need one. The exchanges could be leveraged to put an end to the employer-provided insurance model, preserving the ability of the government to use them for the purpose of means-testing and providing subsidies. If employers wish to provide healthcare-related perks to their employees, they could still do so by providing an allowance to be spent on the exchange that can be accepted or declined by the employee. For the Democrats, they still get the subsidies, and the personal mandate could be preserved without leaving such a terrible after-taste for those who are opposed to the law on philosophical and practical grounds, like me. They just have to agree to tear down and rework the governance portion regarding the choices of which treatments are available and restore the element of medical privacy the ACA destroys.
It’s true that this is probably a compromise nobody really wants, but it is one practical way of making the best out of really bad situation. I would vote for something like it over the status quo in a heartbeat.