Harvard University professor Theda Skocpol, a proponent of the Affordable Care Act, says she finds Americans in general remain concerned about health care reform but find the Affordable Care Act "huge, complex and mysterious." ("People like health reform when they learn what it does," Contexts, January 2011; contexts.org.)
In part, confusion can be blamed on media, but 21st-century media assure confusion since the World Wide Web alongside broadcast, cable and print media amount to an informational Tower of Babel loaded with emotional, tendentious rhetoric.
New York Times business writer David Leonhardt offers an overview, saying the sharp political division on the health care law "stems from the tension between two competing traditions in the American economy.
"One is the laissez-faire tradition the celebrates individuality and risk taking. The other is the progressive tradition that says people have a right to a minimum standard of living." ("Opposition to health law is steeped in tradition," Dec. 14, 2010, www.nytimes.com.)
But Skocpol, co-author of "Health Care Reform and American Politics: What Everybody Needs to Know," said she found that "when people learn more about the specifics, they feel better, becoming more interested in how to carry through the law's implementation effectively."
In her Contexts essay, she said people were able to grasp the "individual mandate" - requiring everyone to purchase health care insurance - when she likened it to requiring vehicle owners have insurance.
"This rule, I explained, is like car insurance, preventing people from shifting the cost of their illnesses to others," she said.
Leonhardt makes a similar point. Requiring everyone to have insurance is "spreading the costs of care among the sick and the healthy.
. . . Without it, some healthy people will wait to buy coverage until they get sick - which of course is not an insurance system at all. It's free-riding."
The issue is the center of legal challenges to the Affordable Care Act by several states, although the individual mandate appears to be not very different from the federal mandates for working people to contribute to Social Security and Medicare. Not all workers will collect on what they pay in.
There is also no difference to the 2007 Massachusetts law requiring all residents to acquire health insurance "to strengthen and stabilize the functioning of health insurance risk pools by making sure they include healthy people (who, if not offered employer-sponsored and -paid insurance, are more likely to take the risk of not having insurance) as well as people who know they need regular health care services." (Health Care Access and Affordability Conference Committee report, Massachusetts State House, 2007.)
In that regard, the Affordable Care Act is like auto insurance law. Both the healthy and the not-healthy pay into the pool that funds payments to health care providers just as both good drivers and bad drivers pay into a pool to cover costs of accidents. There are differences. Auto insurance providers can adjust rates on driving records and even reject bad drivers, preventing them from owning a vehicle - but NOT preventing them from driving, which raises risk and cost to the insured.
With Affordable Care, insurers are barred from rejecting individuals who are already ill. But the healthy will pay for the not-healthy under any circumstances since an uninsured patient cannot be refused necessary health care under the Emergency Medical Treatment and Active Labor Act.
If not in direct costs of health care insurance, the healthy pay taxes or higher rates to subsidize hospitals that must care for the uninsured. As Leonhardt notes, there are conflicting traditions in America: A belief people should not die of treatable medical conditions and a belief people have rights as individuals to take risks on whether they can pay - until they can't.
* Edwin Tanji is a former city editor of The Maui News. He can be reached at firstname.lastname@example.org. "Haku Mo'olelo," "writing stories," is about stories that are being written or have been written. It appears every Friday.