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Joshua Shulman Headshot

How We Pay For Health Care Now

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While we all wait to see whether the Supreme Court will overturn decades of established precedent by gutting Congress's power under the Commerce Clause so that it can overturn the Affordable Health Care Act, it's worth taking a moment to remember how health care is paid for now.

The controversial part of the Affordable Care Act (call it "Obamacare" if you want, but just remember that before it was Obamacare it was "Romneycare") is the individual mandate. That's the part of the law that charges an additional tax to anyone who does not have insurance. You get a choice: buy insurance, or pay a tax. For people who can't afford insurance, enough subsidies will be given so that they can afford it. But middle class people who don't want to buy health insurance will be penalized by paying this tax. It's true; and it's certainly understandable why it's controversial.

But what happens right now to middle-class people who don't want to buy health insurance? Most of them get away with it, because they're healthy. But every year some percentage of them get a serious illness, or get hit by a car, or fall off a ladder. Remarkably, these people -- your friends and neighbors -- don't stay at home and die, wishing all the while they had bought health insurance. Instead, they go to their local emergency room. There, they get treated, and are sent home with a $100,000 or $300,000 or $1,000,000 invoice. They declare bankruptcy, bilk their creditors, and stiff the hospital.

Who pays for that? You do. You pay for it in higher taxes to pay for hospital bailouts, higher insurance premiums, and higher hospital charges.

Don't like it? Here are your options: (1) Stick with our current system in which $56 billion in medical care was provided to the uninsured in 2008, resulting in higher taxes, insurance bills, and hospital charges. (2) Obama(Romney)care. (3) Have emergency rooms stop treating the uninsured. This would mean repealing the Emergency Medical Treatment and Active Labor Act (EMTALA), which has required emergency rooms to treat all comers since 1986, when it was passed with great bipartisan support. Such a repeal would leave uninsured people to bleed to death, curable diseases to go undiagnosed, and babies to die in their mothers' wombs for want of medical care. The L.A. Times recently ran an interesting article detailing this colorful history of of EMTALA.

Obama(Romney)care is starting to look pretty good to me. We'll find out soon if the Roberts Court agrees.