My area of expertise is in Medical Sociology, so it was really timely that the Supreme Court ruling on the individual mandate of the health reform bill came out while I was taking the exam so I could comment on that. So you want my take on it as a PhD-level medical sociologist? Well, it's complicated for sure.
It's no surprise that the individual mandate was the part that received so much media attention, because Americans really value their independence, freedom, and personal liberties to do as they please with their hard earned money. Americans like having choices. But the healthcare reform bill (PPACA) puts the squeeze on insurance companies by requiring them to accept everyone regardless of preexisting medical conditions, and to provide unlimited lifetime spending on health care services. So requiring healthy people who otherwise wouldn't rationally pay for health insurance to now purchase it helps to subsidize the more expensive, more sickly people. If there's not some kind of subsidizing or "redistribution," insurance doesn't work.
Insurance companies have historically enjoyed substantial profits from their cut of transactions in health care services, and PPACA limits those, to some extent. So shoveling in more money from coverage of healthy people (under age 26, plus anyone who wouldn't otherwise choose to purchase health insurance) really helps to keep insurance companies profitable (albeit, limited to 20% under the act, with some exemptions).
For a great read on health reform, check out Howard Watizkin's Medicine and Public Health at the End of Empire
. Really the only last chapter is where he digs into PPACA, but the rest of it kind of sets up the argument. What I loved about this book is that despite how much of the book focused on overthrows of capitalism as an evil beast, the final chapter presents a liberal criticism of PPACA. You can get conservative criticisms by the truckload, but it's really unique to see something written from the left that is not supportive of the act. Essentially, he argues that PPACA will continue to serve the interests of the "transnational ruling class" (read - the 1% but on a global scale), and the whole system will implode from continually expanding costs that focus on expensive technology. So that view may be extreme, but it's really interesting to see an analysis of PPACA that doesn't focus on individual liberties.So personally I'm not going to argue that PPACA is good or bad. It's got a mix of good and bad. You've got more people covered (but still not everyone - Waitzkin argues it'll only cover half of the currently uninsured at best), but not much of a cap on escalating costs of high tech medicine that has a poor return on quality of life. I'm also not sure if it's going in the right direction, because that all depends on what the desired outcome is - cost, quality, access, coverage. Pretty much all PPACA addresses is coverage (and to some extent, quality, but that's a whole can of worms in itself). But we'll see where it goes from there.
