Author: Yvette Cowlishaw
Introduction
America’s movement to mandate health insurance coverage will fundamentally change the way America does business and will extend the reach of the government into American’s lives in an unprecedented manner. Since the introduction of the Interstate Commerce Act in 1887 (Nash et. al., 2011, p 515) the act has been used by the federal government to justify laws and agencies from the FDA to the Patient Protection and Affordable Care Act. Due to America’s long history of maintaining individual rights and leaving the power of the government in the hands of the people the Patient Protection and Affordable Care Act has caused concern amongst many Americans and has led to multiple court actions questioning the constitutionality of the act. Extending the reach of the American government into every American home by demanding the purchase of a product as a condition of citizenship will change the relationship of Americans with the American government.
Historical Background
For the first time in the history of America the American government has utilized the commerce clause (Article 1 Section 8 ) of the constitution to dictate to Americans that they will purchase a product. Section 1501 of the Patient Protection and Affordable Care Act (The Library of Congress) requires that each citizen of the United States is required to “maintain minimum essential coverage” and cites the Supreme Court ruling in United States v. South-Eastern Underwriters Association (322 U.S. 533(1944)) as the basis for insurance falling under the interstate commerce clause of the constitution. The most controversial part of this act is the Personal mandate that requires every American to purchase health insurance.
The Patient Protection and Affordable Care Act moves America far from the Articles of the Confederation that kept the rule of government close to the people (Skousen, 1981). Even as the American Founders moved from the Articles of the Confederation to the American Constitution they intended government to be “of the people and by the people” as President Lincoln stated in the Gettysburg Address and demonstrated by Skousen in The 5000 Year Leap (Skousen, 1981). Since the founding of America government has kept growing and in 2010 the Patient Protection and Affordable Care Act allows the federal government control over the purchasing habits of the American people in an unprecedented manner as discussed below.
Discussion and Evaluation
Supporters of the Patient Protection and Affordable Care Act claim that legislation is needed to keep insurance plans from engaging in unfair underwriting practices (Carman, 2011). Others feel that that many parts of the act, including the mandate and the dismissal of the Conscience Act (Lanham, 2011) oversteps the bounds of constitutional government reach into individual’s lives. While American healthcare needs to be reformed the reform must begin in the behaviors of the American people not in the halls of government.
The individual mandate has been brought to court by over 28 American states. As of November of 2011 the lower court decisions are evenly split and the question of the constitutionality of the mandate will ultimately be decided by the United States Supreme Court. The controversy over the individual mandate of the Patient Protection and Affordable Care Act extends well beyond the healthcare and demonstrates a growing shift in Americans view of their country.
Since 2007 there has been a rise of two groups with some similarities but also great differences. The fiscal conservative movement has become represented under the moniker of The Tea Party while the Occupy movement is representing the view that the top 1% of money holders owes support to the other 99% of Americans. This split in American’s view is not new but the legislation demonstrated in the Patient Protection and Affordable Care Act demonstrates the extent that the progressive (Nash et. al., 2011) movement has been able to influence American legislation.
Ultimately the Patient Protection and Affordable Care Act on its own is not the able to change America but it is the first time that a law has been passed that tells Americans what they must purchase because they are American. If the mandate is allowed to stand it sets the precedent that America’s government can tell Americans what they must purchase and where they must purchase said product. This power in the hands of the government will ensure that business will have to spend more time assessing future government legislative moves than they have in the past.
While legislation and taxation have influenced American business for generations a government that can dictate the features and marketplace for a product is a game changer for American business. In the past business has used various methods to determine the products the American public will buy and the sales channels needed to sell the product. The individual mandate in the Patient Protection and Affordable Care Act dictates the design of acceptable product specifications and creates a government maintained sales channel for the distribution/sale of the product. This precedent will allow the government to become the product designer and seller of any product they desire if it is ruled constitutional.
This governmental reach into the purchasing habits of every American has a twofold effect. It creates a precedent for government to mandate purchases by its citizens and makes the government the ultimate decider of product design undermining free market principles of supply and demand. This precedent has the potential to change both the business and government climate in America by allowing the government to dictate to the American consumer what products they will purchase and from where they will purchase said product. It also has the potential to further the system in which those with more resources are forced to provide for those with fewer resources.
In Overtreated Shannon Brownlee lays out the current American system and how over utilization and lack of coordinated care contributes to the growing cost of American Healthcare and uninsured populations (Brownlee, 2007). The question facing the American people is who is responsible to manage utilization and to coordinate care. The insurance concept of managed care was designed to place the insurance company and a primary care physician in this position but full managed care limited the consumer’s choice of specialists and hospitals and led to a backlash by the consumer (Walker, 2009 & AHIP, 2007). From personal experience I have learned that when the consumer manages care effectively both the care and the willingness of insurance to cover costs are raised. However, the complexities of the healthcare system and the lack of expertise of the American consumer has led to a lack of personal accountability of the American consumer (Brownlee, 2007).
While the American healthcare system needs improved the Patient Protection and Affordable Care Act is not the solution to the problem. The act does not address the actual problems of the system (JAMA, 2011, AHIP, 2011, Overtreated, 2007) and allowing the government to mandate the purchasing actions of individuals is too high a cost for America to pay to resolve the issue.
Recommendations
As stated in Overtreated (Brownlee, 2007) the actual issues of American healthcare are not inherent to health insurance but disconnects within the healthcare system itself. There is a multiple level approach that needs to be taken to address the healthcare breakdown in America.
First and foremost American healthcare consumers need to become empowered to be their own advocates and healthcare coordinators. This can be accomplished by the consumer’s willingness to participate in their own healthcare and in healthcare providers being willing and trained to treat consumers as partners. In addition both patients and healthcare providers (doctors, hospitals, specialists, pharmaceutical providers, etc.) need to become partners with the insurance agencies and vice versa.
The patients and providers need to view the costs spent on healthcare in the same manner they would view the same services if they were paying cash for the service. This awareness of cost would help keep doctors from over utilizing tests and specialists when they know full well that the likelihood of the test providing for the care of the patient is minimal.
In addition doctors need to maintain a relationship with the patient and all specialists the patient is referred to in order to assure no over utilization of the system or overmedication of the patient. In the current system doctors do not have the time or incentive to practice this level of patient management. Due to the existing payment structure of Medicare, Medicaid, and private insurance the doctor must move patients through the exam room every 15 minutes for a general visit and 30 minutes for a chronic condition visit. This economic need for quantity over quality motivates doctors and doctor administrative offices to encourage fast “diagnoses” or to move the patient off to a specialist.
Additionally the legal system needs reformed to discourage lawsuits against healthcare professionals where there is no intentional negligence or neglect on the part of the provider. Currently providers will over utilize services in an effort to assure they have left out no test in case someone sues them in the future. This is not based on the need of the patient but on the need of the doctor’s malpractice insurance company.
For the American healthcare system to not be a drain on American purse strings and for all Americans to be insured all parties involved in healthcare will have to change their habits and the consumer will have to take ultimate responsibility for their actions. More legislation will not resolve the American healthcare crisis but will continue to add to the reluctance of doctors to only recommend and utilize needed services. The American consumer has to be on the front line of the reform issue by changing their view of healthcare and utilization practices and demanding their healthcare providers coordinate care appropriately. It is also important for the consumer to seek out doctors that will participate in a doctor patient partnership.
While this sounds overwhelming and impossible to many people my husband and I are proof that a disabled person with a chronic condition can receive adequate care and help the insurance companies control costs when the patient and the patient’s family are willing to put a reasonable amount of time and effort into managing their own care and understanding their health insurance plan.
References
- American Founding Fathers (2005) The Constitution of the United States Pocket Edition (2nd Edition). Malta, ID: National Center for Constitutional Studies
- America’s Health Insurance Plans – AHIP. (2011) Retrieved from http://www.ahip.org/
- Carman, D. (2011, October 26) Cardiologist works to change ‘unfair’ health care system, Solutions. Retrieved from: http://www.healthpolicysolutions.org/2011/10/26/cardiologist-works-to-change-unfair-health-care-system/
- Brownlee, S. (2007) Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. New York, NY. Bloomsbury USA.
- Congress (2009-2010) H.R. 3590 Patient Protection and Affordable Care Act, The Library of Congress Retrieved from: http://thomas.loc.gov/cgi-bin/query/F?c111:5:./temp/~c111tMBhuq:e406299:
- Lanham (2001, October 28) This Week in Washington: Respect for Rights of Conscience Act, Congressional Documents and Publications Retrieved from: http://ezproxy.ccu.edu:2087/pqdweb?index=21&did=2498779281&SrchMode=1&sid=2&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1320511109&clientId=5146
- Nash, G.B., et at, (2011), The American People: Creating a Nation and a Society, Volume 2 Since 1865, (Concise 7th ed.). Upper Saddle River, New Jersey: Pearson Education, Inc.
- Skousen, W. C., (1981) The 5000 Year Leap. United States of America: National Center for Constitutional Studies.
- The Journal of the American Medical Association – JAMA. (2011) Retrieved from http://jama.ama-assn.org/
- Walker, D. M. (2009) Comeback America: Turning the Country Around and Restoring Fiscal Responsibility. New York, NY: Random House, Inc.
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