Sunday, August 18, 2013

Sorry, Mr. President, But The Affordable Care Act Did Not Make Insurance a "Right"

In the weekly address President Obama delivered this morning, he focused on the implementation of the Patient Protection and Affordable Care Act (often just "Affordable Care Act"). He concluded with the following line:
So I’m going to keep doing everything in my power to make sure this law works as it’s supposed to.  Because in the United States of America, health insurance isn’t a privilege – it is your right.  And we’re going to keep it that way.
If only that were true. 
First of all, the insurance exchanges and corresponding subsidies have not been fully implemented yet. The individual and employer mandates do not go into effect until 2014 and 2015, respectively. Only 26 states have accepted the Medicaid expansion so far. Some are still debating it. So, no, as of this moment, health insurance is not a right

But, more importantly, even if the ACA were fully implemented, would health insurance then be considered a "right"?  The answer is, unfortunately, no.

In March 2012, the Congressional Budget Office (CBO) estimated that the ACA would bring insurance to 30-33 million people, leaving 26-27 million still uninsured in 2016. Taking into account the effects of the Supreme Court ruling (i.e., the optional status of the Medicaid expansion), a group of health policy wonks in the peer-reviewed journal Health Affairs estimated that at least 29.8 million would be left uninsured.

Almost 10% of the population uninsured?  That doesn't look like a "right" to me.

Had the ACA implemented a Canadian-style single payer system, a British-style NHS, or a model akin to one of the social democratic systems in most of the Continent, then, yes, we could say that health insurance is a "right"--or, at least, that it would be upon implementation.

Were we to see health insurance as a right, we might treat health care similarly to how we treat education. There would be a national health service that would offer a robust package of basic coverage, available to all whether citizen or not. A public option would have at least moved us closer to such a system.  But, alas, that is not the law with which we ended up. Through a complex system of regulations, rebates, subsidies, and program expansions, the ACA (despite its flaws) has expanded coverage and will continue to do so upon implementation. However, it will not be fully universal, it will not make health care into a public good, and it will not treat health care as a basic human right.
You don't buy your rights on the private market.

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