Saturday, August 1, 2015

Health reform scare tactics move beyond broccoli

The stakes for health reform keep rising. Remember when opponents warned that it could lead to the mandated purchase of broccoli? Now some say it would let Congress require that everyone buy a car.

Health reform scare tactics move beyond broccoli


The stakes for health reform keep rising.

Remember when opponents warned that it could lead to the mandated purchase of broccoli? Now some say it would let Congress require that everyone buy a car.

That’s the prediction of Paul Clement, the lead attorney for the health reform challengers in the pending Supreme Court case. He issued it in a briefing last week sponsored by SCOTUSblog, an influential website that covers the Court, and Bloomberg Law.

What doomsday scenario will opponents dream up next? Perhaps they fear the government will make us all buy Rolex watches.

It may help to review what the health reform law does and does not actually say.

It does not require that everyone buy health insurance. That may come as a surprise to some, but many parts of the law are widely misunderstood.

What it does require is that everyone have health insurance. That’s very different.

Over 100 million Americans, a third of the population, are covered by the government through programs like Medicare, Medicaid, veterans health care, and military health care. Under health reform, they won’t have to buy anything. And all of us will join their ranks at age 65 when we qualify for Medicare.

And 155 million or so more, about half the population, are covered by an employer, either their own, a spouse’s, or a parent’s. They already comply with the insurance mandate and will see no change under the law.

Most of the remaining Americans, about a sixth of the population, would like to have health insurance. But they can’t get it because a preexisting medical condition either shuts them out of the market entirely or makes coverage unaffordable. Health reform will enable them to obtain a product they have only been able to dream about until now.

And the law offers substantial subsidies to help many of them acquire it.

All told, fewer than 10 percent of Americans will find themselves mandated to buy a product they might otherwise have chosen to go without. And many of them will continue to go without it by deciding to pay a tax penalty instead.

It may also help to review the purpose behind the health reform mandate.

It is to guarantee that everyone can obtain coverage while at the same time saving the insurance market from collapse. Without it, what’s to prevent people from waiting until they become sick before buying insurance? If they did, policies would become unaffordable.

With that in mind, what might the health reform mandate really mean for cars? A reasonable analogy is that, under the same concept, Congress could require every American to maintain access to transportation, either public or private, to keep the transportation system afloat, provided it also offered subsidies to those with low incomes.

That is hardly a doomsday scenario. And it is consistent with the broad congressional powers the Supreme Court has recognized several times in matters involving interstate economic activity. (See my blog post of November 17, 2011.)

Health reform’s insurance mandate may or may not reflect wise public policy. Some supporters of the law believe there are better ways to accomplish the goal of guaranteeing coverage for all.

But it does not represent a radical expansion of government control. And it will not put broccoli in our kitchens, cars in our driveways, or Rolex watches on our wrists against our will.


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Check Up covers regional health news and a wide array of healthcare topics from pharmaceutical happenings to patient safety. Read about some of our bloggers here.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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