May 27, 2018
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The fiscal necessity for laws on some health care issues

By Benjamin Schaefer, Special to the BDN

In a way, the recent push by Sen. Ronald Collins for softening Maine’s seat belt law is reminiscent of the health care debate. Although Collins presents himself as an advocate for seat belts, he thinks wearing one should be the choice of the individual.

Let’s overlook the obvious question why anyone would not want to wear a seat belt. One problem is that it affects not only the person that gets his or her body crushed. It affects all of us. Wearing a seat belt not only saves lives, it saves health care dollars that neither we, nor the state, need to be spending carelessly.

It seems clear to me that making the failure to buckle up a primary offense has led to a decreasing number of offenses, and it should be a no-brainer. Yes, the law may restrict your right to be ignorant, but clearly does much more good than harm.

I can see a few parallels to the national debate on health care, which in large part now seems to hinge on the individual mandate that, interestingly, conservatives have supported until 2009, when it was vilified because part of “ObamaCare.” If constitutional scholars like Harvard professor Laurence Tribe are to be trusted, arguing the constitutionality of the health care law is moot (as was the “death panel” debate, but we know how that went). It is safe to assume that if the government cannot require its citizens to buy health insurance, many will not see the need and will go bare.

So why not let them? Here is why:

First, most people living in the United States today will need health care, some more than others, some sooner than later. Absent a crystal ball, it may be you and it may be tomorrow. Many believe, like I do, that health care is not a privilege but a right. However, such rights come with responsibilities we need to share.

Second, not having insurance leads to worse health, but you won’t be able to pay for your medical care if you become seriously ill. (In reference to seat belts, the lifetime cost for a critically injured survivor of a car crash averages $1.1 million.)

Many defer costs by not seeking care when needed, but later visit the emergency room, where they have to be treated. Who pays for it? All the others, through taxes that support Medicare, Medicaid and subsidies; through inflated health care premiums that insurers use to recoup the reimbursement to providers and institutions, which in turn use the money to pay for the free care they provide.

Furthermore, almost as a paradox, we already pay to have universal coverage after age 65 — eagerly defended by those who opposed a much fairer single payer system for all.

Third, in order to cover people with pre-existing conditions, provide unlimited medical coverage and get rid of the practice of weeding out the sick from health plans, there have to be a large number of healthy people that share that risk in order to keep the cost reasonable. Just deregulating the industry, selling policies across state lines, and trusting that everyone would be able to afford coverage will not do the trick. We have not had a “free market economy” in health care for a long time, and the idea that it would work in this age of technology and $100,000 drugs seems ludicrous.

The “pre-ObamaCare,” which Republicans are so eager to restore without a viable alternative, barely functioned in the past and will not work in the future. We have a need for everyone to be covered, but we only mandated it for the elderly, the poor and in emergencies. That may have worked in the 1960s, but it fails us in the 21st century.

The Affordable Health Care Act is not the end-all, but it has brought us much closer to where we need to be.

Over the years, the 10th Amendment, which limits federal authority, has been implemented to defend practices that involved racial discrimination, child labor and denying minimum wage — all things we abhor now. Should it prevent us from providing health care to all Americans? The answer I think has to be a resounding “No.”

Benjamin Schaefer is a cardiologist in Bangor. He is on the board of directors of the National Physicians Alliance, a multispecialty association advocating for better patient care.

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