As the Supreme Court decides which parts of the Affordable Care Act will be upheld or struck down this week, I wonder how this will effect the inevitable path the Unites States is taking toward a universal health care system. The fact remains skyrocketing cost is the biggest problem for our system and the only proven way in human history to bring those costs down and cover everyone is through a system with heavy government intervention. Everyone paying attention to this issue has seen the charts comparing the U.S. to other industrialized nations and has seen the inflated amount of money spent in America on health care with lesser results. We are going to get a universal system at some point regardless of the opposition to it. But how will this Supreme Court decision effect the timing of the change?
The biggest issue in the case will be the, at first conservative-championed and now conservative-loathed, individual mandate that states everyone must posses health insurance when the law goes into full effect two years from now. The reason for the individual mandate is to bring down premiums for everyone by getting healthy citizens who think they do not need insurance to buy into a health insurance plan. This premium money is then used to pay for the higher cost folks whose health is low or deteriorating. Without the mandate, premiums for people wanting health insurance will be even higher and our problem gets worse.
If the Supreme Court upholds the mandate, it will likely prolong the march to the changes we really need. Once the law goes into effect the infusion of money into the coffers of the insurance companies will slow the continuing rise in premium costs and keep the system from reaching catastrophic debt levels for a period of time. Guessing when this happens is impossible since we have no idea where the economy and factors such as the unemployment rate will be in the years to come but we know it’s coming.
If the mandate is struck down, disaster hits much sooner. Insurance companies will be mandated to carry the sick (the ones that can actually afford the care that is) and not benefit from carrying the healthy. Typical premiums for everyone will increase to levels only the highest of incomes will be able to pay and eventually the system collapses. Either way, major changes will come.
What will the health care system look like at that point? Germany? Japan? The United Kingdom? Who really knows? There are lots of choices in how the government can help control the costs of the system contrary to most believing it’s either the U.S. way or the Canadian way. The most likely path is a “Medicare for all”-type system since that is partially in place as we speak and would be the easiest transition. Whatever happens then, one thing is clear now. The system we are currently under is unsustainable in the long term and ACA doesn’t do enough to address costs, regardless of what the Supreme Court decides. Change is inevitable.