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Guest commentary / Health care law

We can't afford not to insure all

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By Larry Donohue, M.D.
The Supreme Court has spoken affirming the constitutionality of most of the Affordable Care Act, aka "Obamacare."
But this will not be the last word. Additional provisions will activate in 2014 and can be challenged for legality. In addition, Congress can vote to rescind part or all of the Affordable Care Act.
The people have not been engaged in discerning where we, as a society, should go. I fault the proponents of ACA for not adequately explaining the problems of our health care system and how the ACA can be the remedy.
The Congressional Budget Office, December 2008, estimated that 45 million citizens, roughly 17 percent, of the non-elderly population would be uninsured at a point of time in 2009.
The economic turndown has undoubtedly made the actual statistic higher.
The poor have a higher incidence of being under insured. The poor must often choose between food and housing versus preventive health care. When an accident or illness does befall them, an emergency room is their haven of last resort. Emergency rooms are mandated to evaluate all who present themselves regardless of their ability to pay. The uncompensated care is paid for by cost shifting to those who can pay. It is estimated that such cost shifting adds more than a $1,000 per year to a family's health insurance premiums.
Critics say that we cannot afford to provide basic health care for all. But I submit that we cannot afford to not provide such care.
Support for universal basic health care can be based on our disposition to help our neighbor in need or it can be based on our own self interest.
The Preamble to our Constitution states "... promote the general welfare ..."
At least 21 religions have an ethic of reciprocity, or Golden Rule. "Do unto others as you would have others do unto you." Many secular humanists, including the late Christophen Hitchens, agree with this thought.
But, if that doesn't convince you, know that our society and our economy are damaged by poor health and diminished life spans of the uninsureds.
The Institute of Medicine in 2002 estimated the costs at $65-130 billion for each year of health insurance forgone. The New America Foundation, in 2006, upped that estimate to $102-204 billion.
Having employer-based insurance makes our companies less competitive in global markets, e.g. Boeing pays the health care costs of their employees whereas Airbus, because of their government provided health care, does not have that overhead. Employer-based insurance disappears if you lose your job or move out of the area.
Can we justify private health insurance system with its approximately 20 percent overhead?
Most of the rest of the developed world has figured this out.
When so many of our fellow citizens have limited access to adequate health care, we need to abandon salvos of ideologic sound bites and come together to discern the best way to remedy this. It really is that important to get involved!

Dr. Larry Donohue is a retired physician from Seattle

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