The Supreme Court Decision

By now of course, everyone knows that the Supreme Court upheld the Affordable Care Act and specifically the individual mandate as a valid exercise of Congress's ability to levy taxes. For me, this is a huge victory. By guaranteeing that everyone has insurance (or, as opponents may say, forcing everyone to get insurance), it shores up what I find one of the strangest paradoxes in American medicine. It always seemed odd to me that everyone should have access to care, yet not everyone participates in the pool that funds the care. Ethically, ability to pay should not influence how physicians treat a patient. Practically, EMTALA is a law that guarantees evaluation and stabilization of life-threatening injuries if anyone presents to an emergency department. Yet until now, there was no requirement that everyone have health care. Furthermore, prior to this law, personal health insurance had little regulation, leading to difficulty for someone to obtain it, keep it if they got sick, and use it meaningfully. And we have known for a long time that preventing disease and having a regular physician is far cheaper to the system than repeated emergency department visits and hospitalizations.

Like any big change, the Affordable Care Act will have its stumbling blocks. It will have its darker moments, its awkward transitions, and its unforeseen consequences. But it is paving the way for a future in which good health is a right and where we bear the responsibility of paying for that good health.