Sunday, March 21, 2010

Democrats usher in new era of freedom and security (at the expense of constitutionality?)

Note: As you read this, you may be tempted to call me partisan or left-leaning.  However I respectfully ask you to withhold the urge to slot me into a simple political perspective as you read through this.  This analysis is my best attempt to look at the health care reform bill on the merits and demerits, with my personal bias towards proactive problem solving, as well as my bias for effective leadership.

While certainly full of problems that come with any large initiative or legislation that enables substantial change, the expansion of access to health care for Americans will, indeed, spread freedom and security throughout the land.  Here's how:
  • By outlawing pre-existing conditions, Americans will have more freedom to leave insurers, change insurers, and select insurers. 
  • Americans will be free to tell the truth about their pre-existing conditions (instead of lying about not having any so that they can have insurance). 
  • Americans will be free to leave or change employers, and choose from a larger swath of employers (esp. small businesses).  Thanks to serious tax-payer subsidies, more people will be able to afford insurance without needing it to be an employer-based benefit.
  • Just like our military uses our tax dollars to ensure our security and safety, so will this legislation.  The military is all about keeping us alive and free.  So will this health insurance reform legislation.  As a country, we've time and time again decided that our tax dollars are well worth our safety, security and freedom.  This is no exception.
  • Americans just got a new "benefit" just for being an American.  Just like any good employer provides good benefits to its workforce, a good country delivers good benefits for its citizenry.  
However, it's not all butterflies and roses.  Unlike prior "social justice" measures that progressives have led throughout history, there is a serious liberty loophole in the legislation as I see it:  The individual mandate, which forces Americans to buy insurance or else get fined by the government, may be unconstitutional.  At a minimum, it's unprecedented:

Never before has a federal law forced a citizen to buy a product from a private company.* 

(*as far as I know -- if you know of precedent for this, please add to the comments below)

Democratic defenders will typically respond to this critique with the question: "How is that any different from being forced to buy car insurance?"  Well, in two ways, but only one is important:  No American is forced to buy a car.  The secondary reason is that car insurance mandates are regulated at the state-level, not federal.  Ironically, if the so-called "public option" were part of this legislation, I don't think there would be a constitutional issue at hand.  After all, there is a lot of precedent of the government forcing Americans to buy things from the government.  So, with a public option, an American would merely be forced to buy something from the government -- which is far closer to a tax than anything else.  But this compromise that forces Americans to buy something from a private company really seems constitutionally troubling, and is philosophically at odds with a mainstream view of the reach of government.  

But is this the right legislation?  Well, we can look at almost anything and pick it apart.  Give me an hour, and I'll give you two hours of critiques of any organization out there, their products, their services, etc.  Everyone's a critic.   Regarding this bill specifically, outlawing pre-existing conditions is tricky business for an insurance company from an actuarial perspective.  And mandating that all businesses with 15 or more employees offer health insurance will have a heaping spoonful of unintended consequences in the shape of the rise of temporary workforces.   And the fact that it doesn't substantially affect the cost or delivery of health care seems like a pretty big miss. 

Of course there are better ways to solve this problem than this bill prescribes.  But there are better ways to do just about anything.  And if you have ever worked with or in a large organization, you'll know from your own experience that large organizations require large compromises to get anything of substance done.  Large projects never launch on time, and never include all the things that should be in there.  There are often too many competing priorities, limiting the 'perfection' of almost anything, and instead focusing on the important bits that keep you just competitive enough to compete another day.  So, while this legislation is far from great in terms of its elegance and ability to reform health care cost and delivery, it certainly accomplishes meaningful progress in the tactical-yet-important-to-many-people spheres of access and affordability (via subsidies). 

In short, this legislation is not a "government takeover of health care" as the Republicans have so effectively mis-portrayed the plan over the past year.  Rather, it's a real expanded role of government -- an expansion that adds new responsibilities to the federal government for ensuring that its citizens have access to the care needed to keep themselves alive. 

You may or may not think this is the proper role of government.  You may think this will help or hurt our economy.  You may think that socially funding access is bad for the economy.  You may even be with me in thinking that its specific implementation could prove to be unconstitutional.  In one way or another, these are all debates that we've had over the past year.  But what is not debatable is that this legislation will enable new levels of freedom of employer choice, new levels of insurance provider choice, and new levels of health security for Americans.