Supreme Court, healthcare and American exceptionalism
The U.S. Supreme Court has completed three days of hearing oral arguments as part of the judicial process of determining the constitutionality of the Affordable Care Act. The proceedings have focused on the questions of penalty or tax, individual mandate to purchase health insurance, severability and the federal abrogation of state rights. With all of the controversy and media frenzy it might benefit all of us to step back and put this entire issue in some sort of perspective.
I would submit that the passage of the Affordable Care Act and what has followed represents an attempt to fashion a solution to a problem that has never been clearly acknowledged by the American electorate. The term American exceptionalism has been introduced into popular use by those who maintain that this inherent characteristic of the American experience places us in a superior position with respect to other countries throughout the world.
If we focus on the healthcare system in the U.S., our exceptionalism has resulted in fundamental inequalities in access to health and medical care with the number of Americans without health insurance coverage numbering in the tens of millions. This is in marked contrast to every other major nation in the world that has provided the assurance of universal health insurance coverage to its citizens.
Those who oppose universal healthcare coverage in this country point to the other countries as having fostered socialistic systems, even though there is a great diversity in what has been adopted. While Great Britain has a national single payor system, Germany has an employer mandate with insurance companies from which the insured select coverage. In 1994, Switzerland’s citizens voted to move from a healthcare system quite similar to ours to one modeled on those of Germany and France.
In his book The Healing of America, T.R. Reid observed that in studying how healthcare is provided and financed in a number of countries throughout the world, the word solidarity was a value embraced by each. Solidarity is defined as the belief that there is a right or obligation to provide universal coverage to every citizen. There has never been a national discussion of this principle in the U.S. and a vote by our citizens on its adoption.
T. R. Reid suggests that we as Americans must decide our basic values. Do we believe every American has a right to healthcare when needed? After this question is resolved, we can move on to the task of designing a healthcare system that works for all Americans.
Our country has a fundamental ethical and moral question that needs to be resolved. Until this happens, politics will prevail over fundamental values.
Mike Stephens blogs regularly at Action for Better Healthcare.
