Health reform, President Obama said during the lead-up to the dramatic series of Congressional votes on the Affordable Care Act, was a debate about the character of the country. He pointed to the century-long effort to establish affordable health coverage for all Americans, and noted that the recent national debate raised even larger questions than how to reform a system that comprises 17 percent of the nation's economy. He argued that moving forward or not on health reform legislation would indicate whether our nation could still meet great national challenges.
Two days after the President delivered these remarks, the House of Representatives narrowly enacted the Affordable Care Act, and a few days later the Senate approved a series of modifications that give the new law its final structure. With this conclusion to the legislative debate, the United States clearly met the character test President Obama laid out in his remarks at George Mason University. But in another sense, the new law provides another opportunity to strengthen the national character through the creation of new roles and responsibilities for every individual. More specifically, in addition to reforming the health insurance market, establishing new help with health insurance premium costs, and controlling the growth of health care costs, this new law represents an important evolution in America's social compact.
As far back as Plymouth Plantation, Americans have pledged to subsume their individual desires and interests to strengthen their community. The 41 men who signed the Mayflower Compact bound themselves to each other and to the principle of self-government, agreeing to abide by the rules and regulations of the community in exchange for greater physical, political and economic security. In the modern era, we have used the strength, taxing capacity and reach of the Federal government to establish social safety nets that protect elders, the young, the poor and the sick.
Now, with this legislation, the nation will move beyond specific programs designed to protect those who are defined as vulnerable. Through new rules and responsibilities, we will assume greater shared ownership of the randomness of DNA, the influence of the external environment and the twists of fate that make everyone vulnerable to high-cost illness. For example, we have agreed that insurance companies must offer coverage to everyone, including those with a history of disease, or a genetic predisposition to a particular illness, and that insurers cannot use discriminatory pricing to discourage these individuals from purchasing coverage. These steps are likely to mean higher premiums for people who are young and healthy, but they also offer significant protection to all of us who expect that we cannot remain young and healthy all of our lives.
Under the new law, everyone must hold health insurance - whether through an employer, a public program, or an individual policy purchased on a new health insurance exchange. This "individual mandate" represents a new obligation each person assumes for themselves. In policy terms, this obligation is necessary to ensure that the much-vaunted insurance market reforms will work. Without this requirement, many people who are healthy could decline to buy insurance, knowing that they could purchase it when they get sick - ultimately driving up prices for everyone. But in other terms, we have sacrificed some degree of individual autonomy for our broader well-being. We give up the right to be uninsured - if, indeed, running the risk of incurring catastrophic health care costs and pushing these costs onto others is a right to be treasured -- and we enable the government to direct us to purchase a particular type of product. But by ceding these rights, we expand access to health insurance coverage for other Americans - relieving them of the financial anxiety and limited access to health care characteristic of being uninsured in this country.
While we cede some rights, we also assume new responsibilities. First, we assume the responsibility to obtain and maintain coverage for ourselves, and acknowledge that we cannot wait to purchase health insurance until we are sick. We also take on greater responsibility for others, particularly by helping individuals and families purchase coverage if they cannot afford to do so on their own.
Does it strengthen our national character to assume these responsibilities? Financing health coverage for others is not a new obligation. We already provide direct coverage through the Medicare and Medicaid programs, and we indirectly subsidize employer-sponsored coverage through the tax code. But the individual mandate represents a new kind of obligation - the obligation to take care of ourselves so that the nation as a whole is strengthened. To my mind, shouldering responsibility for ourselves in order to meet the needs of the nation is the essence of character.
Karen Davenport is Director of Health Policy at the Center for American Progress. She is former Washington Director for the Medicare Rights Center and also served as a senior program officer at the Robert Wood Johnson Foundation where she developed and managed such programs as Covering Kids and Families and Covering America: Real Remedies for the Uninsured.
Health reform, President Obama said during the lead-up to the dramatic series of Congressional votes on the Affordable Care Act, was a debate about the character of the country. He pointed to the century-long effort to establish affordable health coverage for all Americans, and noted that the recent national debate raised even larger questions than how to reform a system that comprises 17 percent of the nation's economy. He argued that moving forward or not on health reform legislation would indicate whether our nation could still meet great national challenges.
Two days after the President delivered these remarks, the House of Representatives narrowly enacted the Affordable Care Act, and a few days later the Senate approved a series of modifications that give the new law its final structure. With this conclusion to the legislative debate, the United States clearly met the character test President Obama laid out in his remarks at George Mason University. But in another sense, the new law provides another opportunity to strengthen the national character through the creation of new roles and responsibilities for every individual. More specifically, in addition to reforming the health insurance market, establishing new help with health insurance premium costs, and controlling the growth of health care costs, this new law represents an important evolution in America's social compact.
As far back as Plymouth Plantation, Americans have pledged to subsume their individual desires and interests to strengthen their community. The 41 men who signed the Mayflower Compact bound themselves to each other and to the principle of self-government, agreeing to abide by the rules and regulations of the community in exchange for greater physical, political and economic security. In the modern era, we have used the strength, taxing capacity and reach of the Federal government to establish social safety nets that protect elders, the young, the poor and the sick.
Now, with this legislation, the nation will move beyond specific programs designed to protect those who are defined as vulnerable. Through new rules and responsibilities, we will assume greater shared ownership of the randomness of DNA, the influence of the external environment and the twists of fate that make everyone vulnerable to high-cost illness. For example, we have agreed that insurance companies must offer coverage to everyone, including those with a history of disease, or a genetic predisposition to a particular illness, and that insurers cannot use discriminatory pricing to discourage these individuals from purchasing coverage. These steps are likely to mean higher premiums for people who are young and healthy, but they also offer significant protection to all of us who expect that we cannot remain young and healthy all of our lives.
Under the new law, everyone must hold health insurance - whether through an employer, a public program, or an individual policy purchased on a new health insurance exchange. This "individual mandate" represents a new obligation each person assumes for themselves. In policy terms, this obligation is necessary to ensure that the much-vaunted insurance market reforms will work. Without this requirement, many people who are healthy could decline to buy insurance, knowing that they could purchase it when they get sick - ultimately driving up prices for everyone. But in other terms, we have sacrificed some degree of individual autonomy for our broader well-being. We give up the right to be uninsured - if, indeed, running the risk of incurring catastrophic health care costs and pushing these costs onto others is a right to be treasured -- and we enable the government to direct us to purchase a particular type of product. But by ceding these rights, we expand access to health insurance coverage for other Americans - relieving them of the financial anxiety and limited access to health care characteristic of being uninsured in this country.
While we cede some rights, we also assume new responsibilities. First, we assume the responsibility to obtain and maintain coverage for ourselves, and acknowledge that we cannot wait to purchase health insurance until we are sick. We also take on greater responsibility for others, particularly by helping individuals and families purchase coverage if they cannot afford to do so on their own.
Does it strengthen our national character to assume these responsibilities? Financing health coverage for others is not a new obligation. We already provide direct coverage through the Medicare and Medicaid programs, and we indirectly subsidize employer-sponsored coverage through the tax code. But the individual mandate represents a new kind of obligation - the obligation to take care of ourselves so that the nation as a whole is strengthened. To my mind, shouldering responsibility for ourselves in order to meet the needs of the nation is the essence of character.
Karen Davenport is Director of Health Policy at the Center for American Progress. She is former Washington Director for the Medicare Rights Center and also served as a senior program officer at the Robert Wood Johnson Foundation where she developed and managed such programs as Covering Kids and Families and Covering America: Real Remedies for the Uninsured.
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