What's fair?

The U.S. Supreme Court is hearing arguments on the constitutionality of the Affordable Care Act (also known as "Obamacare"). 

In a sense, the case has already been heard in the court of public opinion. In the three years since the law was first proposed, public opinion has consistently opposed it, as described in this Washington Post article. 

Political scientist Daniel Hopkins has studied surveys asking people why they support or oppose the act. He's narrowed the results down to six clusters of words like "cost," 'taxes," "affordable," "government," "socialism," and "insurance."

Based on his analysis of these clusters, he believes the 41% who support the act do so principally because of dissatisfaction with insurance company policies, such as the exclusion for pre-existing conditions.

Similarly, he believes the 52% who oppose the act do so pricipally because of its presumed cost and the government's increased role in healthcare.

In Hopkin's view, this isn't particularly surprising. "The federal government’s role in the health-care system has been a recurring political issue for generations," he writes. And indeed, one can find such arguments as far back as when Medicare was was first discussed and passed.

But one shouldn't take comfort from this long view.

The Obama administration built support for the act by attacking insurance industry practices such as exclusions for pre-existing conditions. That won support in many quarters and put complex reform in terms the average person could understand.

But like all legislation the act is ultimately evaluated on the most basic concepts of fairness. And on that score the act's supporters have presented  an overly narrow case.

The act's supporters believe it's unfair for health insurance to be beyond the reach of some people. Opponents believe it's unfair to increase people's taxes to expand health insurance coverage, which they see as the act's ultimate result.

Arguments over the nature of "fairness" are futile. Both sides have logical arguments. And trying to convince people they are "unfair" is an unrealistic and self-defeating goal.

A better approach is to broaden the application of fairness to all those people who don't buy health insurance but expect the rest of us to pay for their care when they get sick.

That's the ultimate unfairness of our current system. According to a 2011 study, the cost of treating the uninsured was $49 billion in hospital bills that had to be picked up by the rest of us.

One study estimates that the cost of providing healthcare to the uninsured adds $1,100 a year to the average family's health insurance premiuns.   

Fair? I don't think so.