The Affordable Care Act (a.k.a. “Obamacare”) was upheld by SCOTUS this morning.  The Court’s decision has led to celebration for some, and ire from others.  To me, it’s just another step on a path that’s leading this country to deeper division.  I went back to the Declaration of Independence, the Constitution and quotes from the Founding Fathers to figure out where I stand.

First, though, I should lay out from where my opinions come.  I’ve probably seen more sides of the health care debate than most.  As a cancer survivor, I’ve spent time as a beneficiary of Supplemental Security Income (SSI) – which I eventually wrote to the government to stop once I was well.  I worked for a Medicare contractor for 8 years, as part of the mechanism which distributes federal health care dollars.  Now, I work as an RN in a regional ER, providing health care (largely to the population who stands to benefit the most from increasing federal entitlement programs of any stripe.)

The second paragraph of the Declaration of Independence uses some phrases which seem to frame our modern differences.  We’re all familiar with the phrase regarding our rights, “… that among these are life, liberty, and the pursuit of happiness.”  We seem to be at a point where ideas and opinions of what constitutes “liberty” and/or “the pursuit of happiness” clash.  Supporters of Obamacare, I suspect, would argue that ensuring health care is an embodiment of the State’s obligation to ensure the citizen’s “pursuit of happiness”.    The Declaration goes on to mention, “… government, laying its foundation on such principles, and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness.” The people on the political “left” seem to focus more on this particular role of government – that of a provider of that which makes us safe and happy.

The Preamble to the Constitution makes a similar reference:  “… promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity…”  Supporters of Obamacare, and I gather of entitlement programs in general, would focus on “promoting the general Welfare”.  At what point, though, does that idea start to impinge on “the Blessings of Liberty”?

In essence, the question seems to be one of how far the Government should go to address these things.  Thomas Jefferson said, “A wise and frugal Government, which shall restrain men from injuring one another, which shall leave them otherwise free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor the bread it has earned. This is the sum of good government, and this is necessary to close the circlue of our felicities.”  Obamacare was upheld by SCOTUS under the premise of being supported by a tax.  How is that tax to be seen, given Jefferson’s views? 

The focus on health care as a “right” is relentless;  however, there is deafening silence when it comes to our responsibilities in that regard as Citizens.   Since health care is now, in essence, a guarantee, the issue will become the extent to which the Government will assert control over our behavior in order to guarantee this “right”.  In other words, we’re moving to a place where we’ve lost focus on our responsibility to do what is right in favor of Government seeing to it that those things are done by fiat.

My time as an ER nurse has given me a particular perspective.  Since the uninsured disproportionately utilize ERs for their primary care, I get to see how health care as a “right” looks.  By and large, the American health care system is already (i.e. pre-Obamacare) being crushed under its own weight.  As healthcare providers, we’re tasked with providing care, but we’re discouraged – or prohibited – from encouraging (much less advocating for) responsibilities on the part of health care recipients.  For example, I’m responsible for keeping an acknowledged drug addict alive after he/she ODs, but I would be reprimanded if I acknowledged the fact that the patient is draining the healthcare system of time and resources because of a behavioral issue.  The same goes for non-compliant diabetics and hypertensive patients who will not comply with their prescribed treatment regimen.  The health care system is burdened with the responsibility of providing the care, while the patient is free of any responsibility at all.  This scenario repeats itself over and over, in multiple scenarios:  cigarette smokers, the obese – all of these patients do – and will continue to – drain the health care system of resources, without any corresponding expectation of responsibility on their part.

The health care system will prove to be totally unsustainable given this disproportionate focus on rights over responsibilities.  What we will inevitably see – in the name of preserving health care resources – will be quiet, subtle rationing of care.  This was initially debated under the unfortunate guise of “death panels”, but the basic principle will hold;  that is, legislation will dictate who receives care, for how long, to what degree, and under what circumstances.  Ironically, the model will closely resemble that of the old HMOs, which were so demonized for their efforts to control health care costs.

Now we are left to see how this all plays out.  My prediction is that we will increasingly see care rationing spun as “unnecessary spending”.  It has already begun – how may news reports have we already heard about scaling back mammograms and questioning the utility of PSA tests?  Make no mistake – this is the future:  health care with all the effectiveness, utility and efficiency of the DMV.  That will be the inevitable endpoint for a society more interested in its rights than its responsibilities.

Health care for all.  Enjoy your wait.

“They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.”  --  Benjamin Franklin

“If ye love wealth better than liberty, the tranquility of servitude better than the animating contest of freedom, go home from us in peace. We ask not your counsels or your arms. Crouch down and lick the hands which feed you. May your chains set lightly upon you, and may posterity forget that you were our countrymen.”  -- Samuel Adams