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The Affordable Care Act: an Allegorical Perspective


Let’s imagine ourselves as belonging to a remote valley population that survives on water supplied by groundwater reserves.  As a society we have collectively decided to send the best and brightest to use their ingenuity to find the reserves and dig efficient wells that can sustain the population.  They consider it a proud public service.  As a result of population growth and technological advancement, more wells are dug farther and farther from the valley.  The society subsequently grants a charter to a group of businessmen to incorporate and manufacture electric cars to transport people to and from the wells.  Again, this is considered to be for the good of the population: people need access to water.  These businessmen are allowed to behave according to classical market principles whereby profits incentivize efficiency.  Higher efficiency means better access water which is essential for survival.

As time passes, the population continues to grow and technology continues to advance.  It becomes increasingly clear that the most efficient way to facilitate water access to the population is to a construct a high speed train that the entire population can use.  Since it’s a train, it would eliminate the need for each person to purchase an electric car.  When you need water, all you would need to do is hop on the Aquatrak.  People would rather concern themselves with creative endeavors and personal relationships than how they’re going to afford an electric car.  Water is essential to human life, so implementing the Aquatrak is pretty obvious, right?

Wrong, because we forgot about the owners of Megawatt Motors.  We let them incorporate and accumulate profit which became an addiction.  They became wealthy enough to bribe our leaders and chief decision-makers.  They couldn’t let Aquatrak develop or they would lose all their business.  It doesn’t matter if all of their employees stand to benefit greatly from the better access to water.  The profit distribution at the top would inexorably decline.

Eventually people get unruly and uncooperative as their collective sympathy kicks in upon witnessing the poor go without electric cars and the thirsty go without water.  To check the unrest, Megawatt Motors allows for the construction of Aquatrak.  They refuse to fund it, but they demand that only the poor and the old can use it.  This, too, starts to unsettle the savage population so they stipulate that you can get on the train if you’re about to die from thirst, but those wonderful people we sent to dig the wells are going to have to pay for it which makes them jaded and cynical.  Everyone else needs to buy a car if they want water.

Some discover that you don’t need to buy a car.  If they really need water, they figure they’ll just walk the distance to the closest groundwater well.  If, along the way, they realize that they were too brash and can’t make it the whole way, they have three options: 1) die 2) rent a car or 3) board the emergency train.  Each option is a problem.  Our society doesn’t like dying which leaves the latter two.  Option 2 is bad because Megawatt Motors needs to cover its costs.  So when less people buy their cars, they increase the unit price which is only rational.  Increasing the unit price is bad for everyone else because they have no choice but to pay the extra cost: they need the car because they needwater.  Option 3 is bad because, again, those bright groundwater seekers have to pay for it.  But they’re jaded and cynical now so they bill at a higher rate for their labor.

So now both electric cars AND water are ridiculously expensive which burdens the society.  The motor of public unrest begins to turn again.  People are angry that access to water has become so expensive.  It did not used to be this expensive.  They can no longer focus on their passions because they are always worried about water.  Disdain forms between those who can afford electric cars and those who cannot afford electric cars.  The entire population becomes bitter and suspicious.  They don’t understand why they are paying for an Aquatrak that they’re not allowed to use.  They become angry at those using the Aquatrak.  Blinded by consumerism, xenophobia, and nationalism, they cannot understand what is happening.

Megawatt Motors eventually sees a grand opportunity.  They see this opportunity because they are clever which they have to be in order to feed their addiction.  They allow a single idea to penetrate the hazy confusion and reveal its head above the cloud.  Society begins to entertain the idea of forcing its constituents to buy electric cars.  It seems like a great idea because the cost of water and water labor will decrease.  It appears to be an answer to the big problem, a solution in the midst of turbulence.

If everyone buys an electric car, everyone gets water and both become cheaper.   To many, it’s a no-brainer.  But the rest can’t let go of their suspicion and bitterness.  They detest the idea of being forced to buy an electric car. They feel that it is unfair, oppressive, and hostile to their liberty.  Megawatt Motors waits silently as the two sides argue bitterly against each other.  The legal obligation to purchase an electric car would be great for business and profits would soar.  That’s why they let the idea grow, develop, and reach public consciousness.

In the chaos, the general population forgets about the power of Aquatrak, the simplest solution of all.  One train versus an electric car for each person.  The train is not fueled by the addiction to profit, but rather by the need for water.  Everyone is allowed on the train, so no one is suspicious of each other.  Everyone takes the train, so our innocent water collectors can go back to digging new wells instead of running tabs.  Collective sympathy is restored.  We remember that water isn’t a commodity, but an element of societal survival.

Aquatrak represents a single-payer universal healthcare system that cuts out the insurance middlemen represented by Megawatt Motors.  During Tuesday’s Supreme Court session, attorney Paul Clement argued with Justice Kagan about the difference between electric cars and health insurance as market entities: “My unwillingness to buy an electric car is forcing up the price of an electric car…If only more people demanded an electric car, there would be economies of scale, and the price would go down” (1).  Clement argued that that sort of inaction does not indicate active engagement in commerce and likewise with failure to buy health insurance.  Kagan disagreed with the analogy and argued that healthcare is by nature different in that even if you do not buy health insurance, you are still entitled to healthcare.  It would be like refusing to buy an electric car, but reaping the benefits of automated travel.

This forced intimacy between two “markets” is the absurdity that we all overlook.  to buy or not to buy health insurance is NOT the question.  It doesn’t have to be.  Congress does not have to impose commerce.  Article 1, Section 8 of the Constitution: The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.  There’s no reason to force the people to do business with Megawatt Motors when Aquatrak can be financed via taxes.

These Supreme Court proceedings cloud the importance of health not as a commodity but as elemental to human civilization.  Every human depends on it and, as such, it unites us in solidarity.  We care about each other’s access to it.  How can we stay silent as Americans when we’re the only modern industrialized nation where loss of employment means loss of health, loss of life?  Why is corporate profit so intimately connected with popular sustenance?   If healthcare distribution by wealth weren’t so viscerally immoral, why did we find it necessary to forbid emergency rooms to turn people away?  Is that really the limit to our moral imagination?

We can’t see the 47 million uninsured, but we know they are there.  How is this okay?  Mandated coverage under Obamacare will not come near closing that deficit, but we’ve allowed the debate to be framed in such a way that there is no other option.  Not only does it not go far enough, it’s going in the wrong direction.  Channeling billions right back to private MCOs and pharmaceutical giants is not a band-aid on a papercut.  It’s cauterizing a stab wound to the neck.  It might stop the bleeding, but it will become infected.

Ravi Katari works for a health law firm  in Washington D.C.  He graduated from the University of Virginia with a degree in Biomedical Engineering. 


(1)    http://www.supremecourt.gov/oral_arguments/argument_transcripts/11-398-Tuesday.pdf

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