By  J. Samuel Glasscock

A good health care system should provide reasonable access to quality care at a reasonable cost. While everyone may not have a right to the most complete care possible, any nation as wealthy as ours should have a system in which everyone has at least a basic level of high-quality care. Also, reasonable cost is important if we are to survive as a nation in a highly competitive global economy.

Let us look at some of the characteristics of our present system:

• Some of the best, most sophisticated health care in the world is available in the United States.
• Approximately 50 million people (one-sixth of our population) are uninsured. Some are too poor to purchase insurance, and some just refuse to do so. Both groups get treatment when they are sick or injured. Most of us don’t mind paying for those truly unable to help themselves, but we object to the free-riders.
• The cost of health care in the United States per person is about twice the cost of that care in other industrialized countries and accounts for about one-sixth of our economy, making it very difficult for us to compete in the global economy.
• Despite the sophistication and high cost of our health care system, life expectancy, infant mortality and many other health outcomes are not as good here as in many other countries.
• Our health care payment system has some perverse incentives. For example, it pays for procedures and services rendered, not for good health results, thereby encouraging some unnecessary treatment.
• The system has allowed insurance companies to deny coverage to those with pre-existing medical conditions. This has not eliminated the cost of treatment, but directed those patients to a more expensive setting, shifting the cost to the rest of us.
• Our tort liability system improves medical care, but it has increased costs by increasing medical provider insurance and encouraging more care than sometimes is necessary.
• End-of-life medical care accounts for a significant part of our costs, and much of that extra cost results from our failure to have a public dialogue and private discussions about what sort of dignity we want in our last days.

Efforts to make sense of our health care system sometimes get sidetracked by the work of special interests primarily concerned about their own financial health. Many in Congress are influenced by campaign contributions from those special interests. We citizens are also part of the problem, as we are often only interested in maintaining the present system, even though some changes could improve it.

The Affordable Care Act is an imperfect, but bold, attempt to address some of the problems.

The act calls for coverage of many uninsured people in our country. We already are paying for much of their care, but not cost-effectively. The act also eliminates pre-existing condition restrictions and reduces the number of free riders. Unfortunately, it does not do enough to reduce costs.

The most controversial feature of the act is the mandate for individuals to carry health insurance or be subject to a tax. Americans by nature resent being required to do anything. However, in order to achieve reasonable access, many people believe we must have either a government-sponsored single-payer system or the individual mandate.

Some years ago, conservatives objected to the single-payer system and proposed the individual mandate, a system presently used in Massachusetts. Now the conservatives object to both options.

The Supreme Court has upheld the Affordable Care Act. Chief Justice Roberts was correct in joining with the other court conservatives to rule the act could not be upheld under the Commerce Clause of the U.S. Constitution. Requiring a citizen to purchase something would expand the federal government’s power too greatly.

Chief Justice Roberts also was correct in voting with the Court’s liberal wing that the act and the individual mandate should be upheld under the taxing authority of Congress.

While the act is imperfect and certainly needs some changes, it represents the best effort so far to get a coherent health care system.

Repeal of the act in the present partisan political climate would be insane. We don’t need to move back to a system we know is broken. We need to move forward with further improvements. The future of our country demands it.

J. Samuel Glasscock is a former state delegate. He represented Suffolk in the General Assembly for 22 years, until 1991. Contact him at 539-9200.