Supreme Court case plaintiffs may benefit from Obamacare

As Obamacare wends its way through the judicial labyrinth, let’s glance at the plaintiffs. Not the state attorneys general. Not the small-business federations. But the all-American Joes and Janes named in the suits. They don’t want Uncle Sam to force them to buy health insurance.
One plaintiff, Mary Brown, considered insurance a burden she didn’t need, didn’t want.
A lot has happened since Floridian Brown signed on as a plaintiff. Her auto-repair business failed. In September she filed for bankruptcy. Among her bills: $4,700 for medical expenses. Admittedly, those bills – $4,700 is minuscule by medical-bill standards – did not drive her into bankruptcy, though medical bills do propel many Americans down that route.
But hospitals, physicians and the rest of us must absorb those bills. Mary Brown, moreover, was fortunate: a cardiac operation, an appendectomy, a year of chemotherapy would have sunk her into a fiscal abyss.
Meet Charles Edward Lee. His take: God, not Uncle Sam, will provide. By “provide” he includes not just spiritual well-being, but physical and financial too. Unfortunately, God didn’t oversee Charles Lee’s finances, or maybe bankruptcy was part of the divine plan.
His Texas-based lawn and tree service failed. In September 2009 he too filed for bankruptcy. If catastrophe befalls him – he slips on a banana peel, a drunken driver rams into his car, the stomach ache turns out to be a tumor – Charles Edward Lee will accept the consequences. According to his lawyer, he wants only prayer, not treatment. But if he were to change his mind, hospitals and clinics would treat him, leaving the rest of us to pay those bills. Attorney John Ceci also signed on to the cause. Although he could have afforded the premium, he opted out. In an affidavit, he declared, “I would prefer to purchase a new car rather than pay a monthly health care premium.”
The economy derailed Ceci’s business: like Charles Edward Lee and Mary Brown, John Ceci filed for bankruptcy. Unlike Mr. Lee, Mr. Ceci has not vowed to forswear treatment if he needs it.
Among the 44 million people under age 65 who don’t have health insurance, the law’s challengers have found a few people – all healthy – who could have bought insurance, but didn’t.
The nine Supremes will be deciding the nature of markets: must people be forced to buy anything, no matter how beneficial? Broccoli? Insurance?
But the consequences of poor nutritional choices fall on the consumer. Risks after all are not certainties. People who dine solely on cheeseburgers can live to be centenarians; vegetarians can die at age 50.
Health care, though, is not a classic market. Hospitals and clinics must treat people without insurance. The person who spurns broccoli accepts the risk; the person who spurns health insurance passes that risk on. To make health care a classic consumer market, clinicians would reject anybody who couldn’t pay – and, given the costliness of much life-saving therapies – that would mean anybody without insurance.
But in that classic market, I suspect these plaintiffs, if ill, would plead for, not against, Obamacare. •


Joan Retsinas is the managing editor of Medicine & Health/Rhode Island, a monthly journal of the Rhode Island Medical Society.

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