Dear Editor:
In all of the uproar about the politics of the Affordable Care Act, we seem to have lost focus on who the law was written to protect.
As a cardiologist, each month several previously young and healthy individuals present to our emergency department with heart attacks as their initial sign of disease. Many of these people have avoided preventive care because they lack health insurance, and now may be crippled for life by damaged hearts.
For those unlucky individuals without insurance who come to a New Jersey hospital with an acute heart attack, there will always be premier health care from my colleagues and the hospital staff. However, as cardiologists, we must decide whether to place the state-of-the-art “drug- eluting” coronary artery stents (which require long-term treatment with more expensive medications), versus the older “bare metal stents” which are often less protective over time but don’t require the same long term medications that uninsured patients often won’t be unable to afford.
This said, it’s unfortunate the Supreme Court was forced to make its decision regarding the Affordable Care Act based on whether the federal government can impose what is essentially an economic mandate on citizens. To lump together the issue of broccoli and health care reduces the argument to a grade school debate. This is not a mandate about eating certain foods, nor should it involve any particular social, political or business activity.
Does the Federal government actually have the ability to mandate expenditures for the good of individual citizens? One need only look back to the Federal Guidelines for Motor Vehicles, imposed in 1967, which mandated that automobile manufacturers install seat belts with the purpose of “preventing injury and death due to auto accidents.” It’s a reality that the Federal government had already governed using economic mandates to insure the health of individuals.
The dissenting justices did bring up the issue that not all young people will use health care, and I suppose they would make the same spurious argument that no one is forced to buy an automobile and pay the added expense of seat belts. But at some point, just about everyone travels in an automobile, and the added expense of seat belts is in some manner added into the cost passed along to drivers or passengers, whether they’re in a taxi or a family vehicle.
And unlike seat belt laws, the ACA only imposes an economic sanction on individuals who chose not to have health insurance, unlike the penalties imposed (granted by the states, which regarding the ACA will also be legislating how to care for their uninsured) for not wearing seatbelts.
Austin Kutscher, M.D
Flemington, New Jersey
Governor, New Jersey Chapter
American College of Cardiology