Posted on July 16, 2012
This entry was posted in Anatomy.
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The Health Care Tax/Penalty Panacea
By Eric Postal, MD | July 13, 2012
Just in case you’ve been blissfully (or willfully) ignorant of the latest developments on the national health care front, the Supreme Court recently ruled that a centerpiece of ACA/Obamacare — the individual mandate that all citizens buy health insurance — is constitutional.
This aspect of the law was (and is) troubling to a lot of people, as it threatens to establish a new legal precedent that the government can tell you what goods and services you must buy. Proponents argue that such forced purchases already exist (they most frequently cite auto insurance), but this rings hollow as one can choose not to drive, and thus not legally need auto coverage.
The justification of the Supreme Court in allowing the mandate to stand was that it was actually a tax, which government has the power to levy. Buy insurance, or you pay the IRS. This seemed somewhat odd, as the politicos who wrote and passed ACA stood on their heads to make sure everybody knew that they were not calling it a tax, but a “penalty.” The theory was that citizens might get angry at DC-ites who raised their taxes, and vote them out of office, but such citizens would be completely fooled if you didn’t use the word “tax,” and no backlash would occur.
Naysayers will surely now be sounding the alarm that this is an even more ominous legal precedent: Now that it has been established that laws which otherwise might not be constitutional can be permitted by attaching a penalty/tax for non-adherent citizens, is there any individual liberty that cannot be ransomed?
Rather than crying over spilt milk, I say we go with it. ACA, everyone agrees, is deeply flawed and needs adjustment to live up to such goals as lowering the cost and raising the efficacy of our health care system. The Supreme Court has now given us the means to strong-arm the citizenry into having better, cheaper care — whether they want it or not.
It’s been firmly established that lack of preventive care and noncompliance are huge contributors to expensive diseases and poor outcomes. Until now, the only way the health care system had to fix this was to educate, plead, and nag patients into visiting their primary care docs and following recommendations such as for return visits, referrals to specialists, and taking various medications. If a patient chose not to follow up or decided he didn’t like taking his meds, we generally could do nothing about it — just document our efforts and be there to pick up the pieces when the patient’s condition worsened. Such was the liberty of the American Way; people were masters of their own destinies, and you couldn’t force them to do anything against their will.
Now, however, we have been shown a better way. I propose new laws in this regard:
An individual mandate that patients visit their primary care docs at least once per year, and more if needed. To make it constitutional, failure to comply will carry a 1 percent tax/penalty. Let’s have another 1 percent for those who don’t take their meds. Maybe another 1 percent for obese patients who fail to exercise or diet their way to better habitus.
Let’s also make unhealthy food and drink illegal, with a “sin” style tax/penalty for those choosing to buy their beloved pork rinds anyway. Thanks to the Supreme Court, the path is clear for us to modify any behavior we want, as long as we carefully attach a tax to the law, theoretically allowing citizens a way to preserve their freedoms if they’re willing to pay for ‘em.
Of course, all of the extra tax money would stay in the government’s health care coffers, defraying the runaway costs that ACA is on track to create in spite of the cockeyed CBO analysis which originally pretended that the bill would reduce costs. Yes, our government would never raid one segment of the treasury to fund another. The Social Security Trust Fund is a sterling example of our financial restraint in this regard.
There is, however, a potential flaw in all of this. These tax-based solutions only generate funds and adherence in segments of the population which stand to lose something by not complying with new health care edicts. The poorest segment of the population tends to have the worst outcomes, and wouldn’t be too motivated by an extra 1 percent tax when they’re paying little or no tax anyway. They, at least, would continue to see worse outcomes and elevated costs of care. To offset this, the taxpaying members of society would probably need to have their tax penalties hiked. Call it their “fair share.”
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