This case centers on whether the ACA violates our Constitution by mandating that all Americans have health insurance either through entitlement or individual purchase. Unlike Medicare, funded through approved taxation, ACA funding by individual purchasers was not proposed as a “tax.” However, the proposed fine for failure to purchase health insurance by those deemed ineligible for subsidized health-care coverage has been construed as the equivalent of an unjust tax levy. Since health-care coverage can cross state lines, this challenge has now been raised by 26 states.
The outcome of the Supreme Court’s deliberations could affect the future of U.S. health care as much as did the original ACA legislation. If the justices rule against the ACA, then what happens next? Does the act go down in its entirety, sinking future health-care reform?
I agree that real reform in our health-care coverage and delivery systems is needed. Such reform should maximize the affordability and availability of health care. It should respect the rights of individuals not to purchase health care. It should shield hospitals and health-care providers from undue medico-legal attack. It should promote preventive measures that would foster better health for our current and future citizens.
As a world economic leader, the United States
should lead in health-care delivery to all of its citizens. No other country has such abundant resources for accomplishing this goal. However, the United States has the most expensive health-care delivery system on Earth, an issue rightfully addressed in the ACA’s 2,000-plus pages.
Regardless of the Supreme Court’s decision, addressing the issue of cost should remain a collaboration between providers and consumers of health care – tempered, when necessary, by appropriate legislation.
Lawrence D. Devoe, M.D.