Two hundred forty-one years ago this weekend, colonial delegates were shut in a hot and steamy room debating the idea of independence from Great Britain. They ultimately came up with an answer. And they pledged their lives, their fortunes, and their sacred honor to see it through.
That debate was dramatized in the musical 1776. And, while some artistic liberties were taken, the play did follow the historical record. For example, we may not know what caused the colony of Georgia to vote “yea” to independence. Yet the story offered an explanation based in historical fact, an inspirational quote from an Irish statesman: Edmund Burke.
Mr. Burke, seeking a seat in British Parliament for Bristol, gave a speech to the electors of that city in November 1774. The quote that allegedly gave rise to Georgia’s decision to seek independence?
You can see its application to the debates of today. For all the cries about “the will of the people!” those elected and paid to serve on behalf of the public are expected to exercise wise and learned judgment.
We can only hope that is happening in Washington.
As our modern Congress breaks for its Fourth of July recess thanks to the founders, they have plenty of unfinished business. Foremost is whatever the Affordable Care Act-repeal or -replacement is now called. That’s probably a good thing.
Many of the changes in the replacement bills deal with our tax code, not health care. Indeed, the entire ACA — Obamacare — was built on myriad tax changes. Some of those, like the fine for not having insurance, were explicitly defined by advocates as “not a tax” as part of their political posturing. However, when Chief Justice John Roberts and a majority of the Supreme Court declared that the only constitutional grounds for the imposition of the “fine” was Congress’ taxing power, it magically became a tax.
They added just under 1 percent in new Medicare taxes. Which are assessed on income. But are not income taxes. They added 3.8 percent on investment income, which is an income tax, but not part of the income tax rates. Or the “individual shared responsibility” tax. Which isn’t an income tax, or an excise tax, or clearly defined under Congress’ limited constitutional taxing power. But it’s definitely some kind of tax. Because the Supreme Court said it was.
Clear as mud?
That’s the challenge with ACA reform. Neither the Affordable Care Act nor its replacements really deal with costs of care. Since around 1983, health care prices have increased at double the rate of inflation. Some of that is great news. Our technology has advanced to a point where individuals — extremely premature babies, HIV patients — have a shot at full, productive lives, where in decades past their prognosis would have been much more grim.
Yet technological advancement costs money, so we struggle with how to pay for it all. Should it be consumer-, insurance carrier-, or government-driven? Should medical coverage be insurance for when things go bad, or should it be a service plan for routine checks? Should employers pay chunks of the bill? Or individuals? Or government?
These questions are big. And for some Americans, they are life or death.
So a little more time in the oven might be good for these proposals. It could be worthwhile to look at the tax code writ large, since a tax dollar is a tax dollar, no matter how you define it. It is worth understanding how the changes will impact the cost increases in health care, stemming the tide in their continual rise. And it could focus less on the campaign promise of mere repeal, and instead close in on, in their judgment, a policy that delivers the best outcomes, for the most Americans, at the lowest cost.
To get there, maybe we should cancel Congress’ recess and take a page from the opening number of 1776. Lock our representatives in a hot, sweltering room. As they shout for someone to open up a window, we can agree to do so.
But first, they will need to get something done.