I've never had much worry about access to affordable health care, thanks to steady work, good luck on the chronic-disease front, and my sterling ability to dodge dangerous drivers on the Schuylkill Expressway.
But I've watched others suffer for a lack of it, and I worry about my daughters having to navigate an increasingly tough health-care market. So I was struck last week at the breathtaking lack of common sense among some of our nation's smartest people.
Yes, I'm talking about the U.S. Supreme Court, though I mean no disrespect. People like Chief Justice John G. Roberts Jr., Justice Antonin Scalia and Justice Samuel Alito are razor-sharp, quick on their feet, and often witty. But then they do things like comparing health insurance to broccoli or emergency roadside assistance, or joke that actually having to review details of a 2,700-page law rather than just tossing it out would violate the Eighth Amendment's ban on cruel and unusual punishment. Really?
Since the justices have undoubtedly had Grade A health insurance throughout their high-powered careers, maybe they're just too distant from the real world to understand what's at stake for more than 40 million Americans who lack insurance, or for everybody else who's just one layoff and a bad medical break away from having to forgo crucial care or face a medical bankruptcy. So here are five things I hope the justices keep in mind as they weigh the fate of Obamacare:
The health-care market is a genuine mess. If that's not obvious, it should be. Tens of millions of people - as many as one of every four people in Texas, leader of the pack - lack coverage. For all but the wealthiest, facing a serious injury or illness without insurance means also facing financial catastrophe. For the unluckiest among us, care can cost millions of dollars - that's why it's a big deal that Obamacare will finally bar most annual and lifetime limits.
If the uninsured can't pay, the rest of us pick up the tab. According to Solicitor General Donald B. Verrilli Jr., Congress found that about $43 billion a year of that burden is redistributed through "an unfair patchwork of hidden cost-shifting" that adds about $1,000 a year to every insured family's premium.
The libertarian position is fantasy. You know the everybody-just-take-personal-responsibility argument - the one ventured by U.S. Rep. Ron Paul to a cheering debate crowd when asked what should happen if a young man arrives, uninsured, at a hospital in urgent need of care. "That's what freedom is all about, taking your own risks," he said.
Unlike some libertarians, Paul didn't suggest just turning the man away - as a doctor, he knows that's been against federal law since the 1980s, and wouldn't play well beyond his fans. But here's the bottom line: Unless we want to roll back the clock to a world where patients die outside hospital doors, the only question is who pays.
Paul's stance was echoed last week by Mitt Romney, who responded to a similar question from Jay Leno: "If they're 45 years old and they show up and they say, 'I want insurance because I've got heart disease,' it's like, 'Hey, guys, we can't play the game like that.' You've got to get insurance while you're well, and then if you get ill you're going to be covered."
And if you're not? We're back to the who-pays question. That's why we're discussing the individual mandate, a market-based alternative that both sides of the political spectrum considered an imperfect compromise - that is, before conservatives started disavowing it as an affront to liberty. Personally, I'd prefer Medicare-for-all.
The opponents' Commerce Clause argument doesn't pass the smell test. Health-care accounts for about 17 percent of the national economy, and virtually everyone needs it at some point. Regulating commerce "among the several States" is among the "enumerated powers" that the Constitution gives Congress. I can't say it better than legal scholar Charles Fried, solicitor general under President Ronald Reagan, did last week: "Health care is interstate commerce. Is this a regulation of it? Yes. End of story."
"Congress isn't forcing people into that market to regulate them," Fried told the Washington Post, rejecting as "a canard" that key framing by Obamacare opponents. "I was astonished to hear it coming out of the mouths of the people on that bench."
When he took over the case for Obamacare's opponents, Paul D. Clement, another former solicitor general, wisely ditched the hair-splitting distinction the law's foes first tried to make between regulating activity and inactivity. But the new framing - that Congress is wrongly using the individual mandate "to create commerce" - is only slightly less artificial.
The truth is, we're all "in the health care market," simply because life is fragile and unpredictable. Young and healthy as you are, you can arrive at a hospital unconscious after getting hit by a bus. Which brings us to ...
No, it's not like broccoli, or cellphones, or burial insurance. My not buying a cellphone generally doesn't raise the cost for everybody else. Burials can be pricey, but keeping people alive is what can cost millions. The price of a commodity like broccoli will likely rise if more people buy it, not fall, and people can live without it. Above all, none of those markets is subject to massive cost-shifting.
Death panels. Remember this, the most famous canard of the long debate over Obamacare - the claim that a new, 15-member Medicare board charged with finding ways to save money without harming coverage or care would somehow send the old and disabled to their deaths?
Well, here's the real irony: If a majority of the Supreme Court throws out Obamacare, the high court itself may deserve that title.
For all its faults, Obamacare was Congress' best attempt to provide quality medical insurance to tens of millions of uninsured Americans - a man-made malady that, according to a 2009 Harvard study, raises death risks by 40 percent and kills nearly 45,000 people a year.
Go back to square one, and more people are pretty much guaranteed to die. Is that really what the Supreme Court wants to do?