Obamacare revisited

Suppose the Supreme Court strikes down the individual mandate this week. The mandate requires that all people not currently covered by other insurance, usually provided by their employers, buy insurance on the private market. It’s the most controversial component of Obamacare, and by my rough guess, there’s better than a fifty-percent chance the court will rule that it’s unconstitutional. If that happens, Obamacare collapses. Without the individual mandate, and with the guarantee that preexisting conditions are always covered (a very popular component of the plan), there’s nothing to prevent people from going without insurance until they get sick, then opting into a policy. Young people especially believe they will never get sick or injured, or at least not anytime near future. But without paying into the system as they go, there’s no money to pay back to them if they need it. This is how insurance works, whether it’s a private insurance company or a national system. So, what to do if the Supreme Court rules as I suspect it will? Actually, the answer is simple and should satisfy even the most hardened opponents of Obamacare. We allow, let’s say, a one-year period for people to shop around and decide either to buy in to the system or to risk it on their own. Those who choose not to purchase insurance then lose the protection for preexisting conditions. This is the epitome of individual freedom and free-market economics that conservatives most revere. Once you’ve made the choice to opt out of available coverage, you lose the right to opt back in anytime you actually need it. Choices have consequences. Now we have what might best be called optional universal coverage. The system is financially sustainable and health insurance is available and affordable for anyone who wants it. The sad part is that we’ll still be seeing posters around town or posts to Facebook announcing pancake breakfasts to raise money to treat somebody’s nine-year-old girl who has brain cancer. This is the tragedy and the travesty of our current system, but now it happens to people who never had a choice. Under free-will Obamacare, it will only happen to people who made a bad choice. Or to the children of people who made a bad choice. It’s an ugly and cruel alternative, but it might be the only alternative we have. It’s the consequence of trying to design a universal health care system that is still based on free-market principles instead of the single-payer alternative that never had a chance in a Republican-controlled congress. And we can always hope that after a few more years, or decades, of pancake breakfasts, we might have a congress ready to support true universal coverage. In the meantime, I love pancakes.