(Garrison, NY) As the presidential candidates clash over the fate of the Affordable Care Act (AKA "Obamacare"), a set of seven essays by legal pundits, economists, and philosophers discuss the implications of the Supreme Court's decision on the ACA and makes it clear that there is no consensus about what is economically or morally just when it comes to health care coverage in this country. The essays appear in the Hastings Center Report.
While the essays provide a range of perspectives, a few common themes emerge. Foremost among them is that the individual mandate may not work as it stands.Mark A. Hall, a professor of law and public health at Wake Forest University, argues that the Court "significantly weakened the individual mandate" by allowing Americans to opt out of insurance coverage if they are willing to pay a tax. This tax penalty leaves the mandate vulnerable because Congress could repeal it through the budget reconciliation process.
Mark V. Pauly, of the Wharton School of Business supports the idea of a mandate but says that in its present form it may not achieve its goal of getting as many people as possible to buy insurance because the penalty for not doing so is too low. Pauly is also concerned that the mandate could increase health care costs by increasing the number of procedures that the government requires insurers to cover as health care becomes a recurring political football.
Other essays raise concerns about costs. Paul T. Menzel, a philosopher at Pacific Lutheran University says mandated insurance must be for care that is disciplined and cost-effective - which is in defiance of how health care is now, it is no longer insurance, and less likely when 'all politics is local' members of Congress get to attach their own amendments. "The cost-control provisions include some laudable next steps but are generally weak," he concludes.
James Stacey Taylor, an associate professor of philosophy at The College of New Jersey, states that the ACA's benevolent appearance is deceptive and that it is "neither economically sound nor morally acceptable." He argues that simply implementing the law will require "a small army of lawyers and bureaucrats," which will raise health care costs.
Other essays examine what is morally acceptable in the health care arena. While none of them makes a moral case for health reform as a question about an individual's right to health care, they discuss other relevant values: responsibility, community, sympathy, and stewardship. Len M. Nichols, a health economist at George Mason University, focuses on stewardship over health care resources, arguing that all Americans should be assured adequate health care - an easy claim with someone else's money. Although the challenges are great, Nichols suggests we now have the opportunity to remake our health care system into one that serves everyone. "A society that aspires to morality aims higher than that, and our Supreme Court has, by the narrowest of margins, allowed us to continue to dream big," Nichols writes.
William M. Sage, a professor and Vice Provost for Health Affairs at the University of Texas at Austin's School of Law, notes that the Supreme Court decision emphasizes the value of protecting personal liberty from government dominion, but in doing so both highlights the absence of solidarity around health reform and magnifies the importance of developing it.
Timothy Stolzfus Jost, law professor at Washington and Lee University, concludes his essay with a statement that might represent the only true consensus about health care reform: "The struggle for the soul of health insurance in the United States may be far from over."