AMERICAN REASON
ON THE MORALS OF HEALTH CARE Is an ounce of prevention worth a pound of legislation? BY VIKRAM PATEL AND MATT SOWADA
Ten Things You Should Know About the Affordable Care Act (ACA) 1. Learn about health insurance and get to know some key vocabulary: premiums, deductibles, out-of-pocket maximums, copayments and coinsurance. 2. Go to healthcare.gov or idph.state. ia.us/HBE to learn about your insurance options. Open enrollment in the health care exchange lasts from Oct. 1 - March 31, 2014.
Photo by Rachel Jessen
O
n the first of this month, health care exchanges facilitated by the Affordable Care Act (ACA) were brought online. How might changes from ACA, a.k.a. Obamacare, affect the way we view the health of our fellow citizens? We
know that regularly eating fast food
or microwave dinners is unhealthy, so why not tax them?
MATT SOWADA: I predict the ACA is here to stay and we will find ourselves more involved in each other’s health decisions. We already have a moral obligation to strive towards health, because our community might justly call upon us to provide bodily service (sandbagging in a flood for example) and it is our duty to be prepared. Obamacare will deepen that moral obligation due to the financial effects our actions will have on health costs for the rest of society. Vik, do you feel we have a moral obligation to strive for health and will the ACA affect it? VIKRAM PATEL: Yes, we have a moral responsibility to try to be healthy, but the real question is: Should the moral aspects of health also carry legal weight? An apt analogy comes from how our society handles lying. Lying 4 | Oct 16 - Nov 5, 2013 | LITTLEVILLAGEMAG.COM/LV142
always has a moral dimension, but rarely does it carry legal consequences. When it does, the legal consequences fall into two categories: significant harm to another individual (e.g. fraud) and harm to the public (e.g. perjury). I can’t see the harm done to another individual by our health decisions rising to a level necessitating legal intervention (even with the ACA). However, I can envision new legislation intended to incentivise better health decisions justified by the financial burden that poor health decisions can place upon society. These inducements to avoid poor behavior would correspondingly take a financial form—taxes and subsidies. I think this is reasonable, within limits. MATT: Well, I think that this is a tricky sort of problem: a real, serious concern with (evergrowing) externalities that does not avail itself of a just and effective governmental response. Whether it’s the negative incentives that taxes offer or the positive incentives of subsidies, I don’t see what more the federal government can really do. When, exactly, should the government use its power to part me from my money? One approach would be to encourage people to make wise daily decisions. The problem here is that there are a million different healthy lifestyles. Just looking around my kitchen I can see that most of the food that I consume falls into the category of “part of a healthy diet, in moderation.” A couple of glasses of red wine per night is good for the body and
3. No current coverage? The individual mandate makes it your personal responsibility to enroll or else be subject to tax penalty. If you opt out, the penalty will occur when you file your 2014 taxes. 4. Consider the healthcare marketplace like the Amazon.com for health insurance. 5. Prices for individuals will vary on four criteria: age, tobacco use, location, family size. 6. Undocumented individuals will not be eligible for coverage--only lawfully present, permanent or U.S. Citizens can receive insurance. 7. No insurance company can deny coverage or raise premiums based on any pre-existing conditions. 8. The amount of government subsidy you receive will depend on MAGI (modified adjusted gross income) in relation to FPL (federal poverty level) guidelines. 9. For 2014, six insurance companies will offer coverage in Iowa through the ACA health care exchange. Only two will offer coverage to all 99 counties: Coventry HealthCare and CoOportunity Health. 10. In Iowa, there are three “navigators” with trained professionals able to guide individuals and small businesses through the process of obtaining health care: Planned Parenthood, Visiting Nurses Association and Genesis Health System. —Natalia Espina