Obamacare Before SCOTUS

So the Affordable Care Act got hauled up before the SCOTUS last week. From the way the questions were framed it looks like the individual mandate portion might be struck down, though it is too soon to tell.

I have mixed feelings about the Affordable Care Act. On the one hand I can see why affordable health for all must be a priority. I know people who use the ER room as their sole point if contact with the healthcare system, and sadly some of them have paid the price with their lives. There’s also a selfish reason behind my reasoning. Each time someone uninsured turns up at the ER, and gets top notch care, it is MY tax dollars that fund the treatment. Surely there are better ways to use tax dollars.

And yet a mandate makes me queasy. If the government mandates health insurance today, will it start mandating annual exams and flu shots a few years down the road. I think the most succint response on this topic was summarized thus by a Twitterer: “The problem with the mandate is the insurance is private. Make the insurance public and call it a tax. Problem solved.”

I can hear Americans collectively go This isn’t Canada at this point. But think about it: directly or indirectly, we are paying for the uninsured with our tax dollars. Public health insurance might take away some of the worries we have around bouts of non-insurance resulting from unemployment or old age.

About the author


Priya Ramachandran

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.


  • I heard the same thing as you as far as the line of questioning leaning towards the law being struck down. No doubt it’s going to be interesting to see what result they come out with in their ruling.

    I think you’re description of wanting to help people and save tax dollars in the ER going against the idea of a mandate being a big problem that creates a mixed basket of feelings.

    “Make the insurance public and call it a tax. Problem solved.”
    If you did this, then it would have never passed. Obama could never stand for an extra tax on middle america which as you describe is what this healthcare act will do. Maybe that’s something the Republicans will use against Obama in the upcoming election.

    We’ll see how it plays out. It’s a pretty politically charged issue.

  • Not had a chance to post on any of your discussions although one of the first things that I do is read your blog everyday.
    Interesting topic Priya and John; one way or the other, there is an expense – either through ER or by the way of TAX; its purely syntax at this point.
    Yes its politically charged; its 12 of one and a dozen of another. Unfortunately some people who make the difference do not want to get it.
    Healthcare for all should be a given at this point.

  • Just a thought – aren’t we all required by law to carry auto liability insurance? Which is delivered by private insurance companies. That way, everyone takes their own responsibility.

    How is requiring everyone to carry health insurance different in principal?

  • John, Anthony Subbiah, thanks for the comments. I agree a tax is even more of an uphill battle than Obamacare in its present form. Just playing devil’s advocate here.

    Dan Hughes – I’ve wondered about that myself. I don’t know the history of the auto insurance requirement but did Repubs cry themselves hoarse at that time? If they didn’t, why not?

    And yet… on mandates, if we have someone on McDonald’s hourly wages with a bunch of kids (like the single mom of 7 who supposedly “won” the Mega Millions in MD), how is healthcare affordable even with a mandate? Will the government go out and prosecute such people if they’re found not to have the mandated health coverage in ObamaCare? I.e. are they going to be treated like criminals in addition to not having health coverage?

    I think the motives behind mandated coverage are lofty, but the idea is very low on implementation specifics.

  • The fundamental problem is the lack of responsibility the ER patients take on to pay for the health services they received. Until this changes, more an more people will simply show up for free care. Healthcare is not free and must not be provided for free. Instead we all must be Liable to repay the hospital for our ER visit. This liability could be managed like Bail Bonds are for incarceration. Upon discharge to a responsible person, you have some time to arrange your repayment program. If you skip out, the Hospital get’s the full BOND, and you go to jail or are deported and your possessions are confiscated… We must make it HURT more to skip out on your medical bills than to settle your debt.

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