Nabeela Rehman, Ph.D
On Monday, March 26 2012, the United State Supreme court began hearings to determine the constitutionality of the Affordable Care Act, and while the court jurists will examine the legality of the behemoth law, the rest of us may find ourselves not in a policy debate, but rather returning to a deeper, moral conversation: what kind of people are we? What kind of country do we want? Who do we care for?
The Supreme Court hearings ended on March 28, 2012, covering three different aspects of the Affordable Care Act, and their decision will probably arrive in the early summer. A variety of developed nations have adopted different strategies for distribution of health care services, and in 2009 the USA adopted legislation which would allow individuals to purchase affordable health insurance coverage through an insurance marketplace. The health insurance industry reluctantly agreed to massive reforms, such as abolition of lifetime caps, no increased rates for people with pre-existing conditions, free preventive health screening, etc, on the condition that every American be required to purchase health insurance. Health insurers claim they need a pool of healthy people to invest in the system before their companies will be able to manage the financial risks of reform. Seven states which had previously enacted pre-existing condition laws without mandating coverage saw insurers dropping out of the market, no new individual policies, and/or massively increased premiums. At the heart of the Supreme Court hearings will be the question of whether the individual mandate, sometimes called the individual responsibility, to purchase health insurance is constitutional. If the individual mandate or personal responsibility clause is struck down by Supreme Court, the next question is what will happen to the rest of the Affordable Care Act. The other case which will be heard by the Supreme Court is that a number of states have rejected the expansion of Medicaid to +133% of the poverty level under the Affordable Care Act.
The conservative push-back to the Affordable Care Act, funded in a large part by the Koch brothers, has been substantial. The argument by conservatives runs along the lines “the government is forcing me to buy something”, they are “infringing on my liberty”, and “next they will force me to buy carrots”.
The government’s rationale is that you must pay your fair share of health insurance because when you do not pay you infringe on the liberty of everyone else in the community. When you cannot pay your hospital bill, the hospital takes an economic hit which it then passes onto the insurance companies, which then pass the cost onto all consumers in the form of increased premiums. Mandating the intake of carrots or broccoli is not the same as mandating healthcare coverage. These are very different markets. No one comes into the grocery store and claims they will drop down dead on the spot if they are not given $20,000 worth of broccoli. If they did, we probably would see some kind of reform in the produce department.
At the core of this conservative argument is the premise, “I am most fully an American when I stand alone. Americais about personal freedom. A mandate for the common good makes me less of an American.” And this is the crux of our moral conversation. What is our personal responsibility for the common good? The individual mandate requires individuals to purchase insurance, particularly young, healthy people, but despite the hysteria, it will not affect most Americans. Americans are being asked to financially contribute to a system they may not use in order to pay for the health care of the poor, elderly, extremely sick, and handicapped. In order for the Affordable Care Act to function, we must make financial sacrifices and have faith that the government will act with justice. If you feel that our government cannot act with justice, then we need to have that conversation. If you firmly believe “society can’t say nuthin’ to nobody” because it impinges on personal freedom, then we need to talk about what kind of a society you do envision.
If Muslims are taught hadith such as “A Muslim wishes for her neighbor what she wants for herself” or are reminded of scripture “You will never come to piety unless you spend of things you love; and whatever you spend is known to God”(Qur’an 3:92), then where do these ethics lead us? At what cost are we willing to fulfill these precepts of our faith?
The values that I bring to this debate are based on the stories that people have told me. I have heard parents of handicapped children working two or three jobs to cover their child’s medical expenses, a neighbor who hasn’t had a preventive Pap smear test in ten years because it isn’t covered by her medical insurance, a woman who was diagnosed with a complicated pregnancy and flew back to Palestine for medical treatment, a man with tears in his eyes telling me he and his wife are just praying she can make it to age 65 when her brain cancer can be treated through Medicare- in the meantime she is having seizures and his company insurance won’t cover her treatment, a girls’ basketball team from a very poor inner-city neighborhood unable to compete at the state championships because not all the girls were vaccinated, and the list goes on. But the story which initially motivated me is by far the most personal: my own uninsured mother fighting metastatic breast cancer as my father’s lifetime of financial gain collapsed into an overwhelming debt of medical bills.
The funny thing about stories is that they can be interpreted different ways. Watching my parents’ experience catapulted me into a realm of grassroots activism, while my mother’s death had a completely different effect on my father. He continues to vote Republican, subscribes to the ideas of Ayn Rand, and believes that we should all fend for ourselves.
Nabeela Rehman, PhD is a freelance writer in Willowbrook, Illinois. Her work has appeared in the Islamic Monthly, Chicago Parent, Chautauqua and Darien-Illinois Patch. She has also volunteered for the Illinois Campaign for Better Health Care to promote health care justice. Email: firstname.lastname@example.org