Community panelists:
[Note: Please select the hyperlink to read each panelists' statement]
Invited panelists:
Preston Hammock, President and COO of Alamance Regional Medical Center
Resa Walch, Senior Lecturer of Health and Human Performances, Elon University
Susan Osborne, Director of Alamance County Department of Social Services


Ginette Archinal

      My name is Ginette Archinal. I am a board certified Family Practice doctor working for Alamance Regional Medical Center at Elon University Student Health center. I have lived in Burlington for two years, and prior to moving here, owned a private medical practice in Cary NC.
     I attended medical school in Sydney Australia, where I grew up. In Australia I worked in hospitals. When I moved to Britain I worked in hospitals, private practice, and community health centers in London – all part of government operated National Health Service. In the US, I have worked in the hospitals, private practice, and at hospital-owned practices.
Having provided and received health care services in three countries of the Western World, the one thing I know for certain about the provision of health care is that there is no one perfect system. There are positives and negatives to all three, and in the time I spent in each they were all modified, a reflection of the fact that not one of these systems provided what society required at a price that society was prepared to pay.
     My personal point of view is that we in the US have a moral responsibility to provide affordable basic health care to every member of our society. I also believe that from a purely economic standpoint we need to provide affordable accessible basic health care to everyone. There is little argument that we should provide affordable basic education to everyone (although the delivery of that education is, of course, a constant point of discussion). I believe that we are tackling the reform of health care without acknowledging why it needs to be reformed. I regard health care as a right and not a privilege.
     The US is unique in the western world in the way that health care is tied to employment. Historically, the provision of health care changed during and after WW2. In the UK, it was acknowledged that access to affordable health for all was in the best interests of a nation emerging from depression and deprivation. For Britain to become functional again, it needed a healthy work force, and the only way to proved that was by “nationalizing” the delivery of health care. This did not mean the destruction or abandonment of “private” health care. The two entities have existed side by side – with many of the “private’ physicians also providing care within the National Health Service at NHS rates.
In Australia, private health care was the responsibility of the individual, with a safety network similar to Medicaid in this country. It existed against a background of existing social welfare in the form of protection for seniors, the unemployed, and the destitute which was set in place prior to WW2. In the 1970s, the system changed to adopt the mixed private/public model best exemplified at that time by Canada.
     In the US, since wages were frozen during WW2, Unions negotiated health care coverage as a way of increasing workers’ income. What started as a way to protect people has become a trap for some workers – afraid to leave a job due to the loss of the health insurance, bankrupted by health care costs when a job is lost, unable to retire because in retirement, some workers are unable to afford health care costs. The other unintended consequence of this, is that most people whose health care is through their employer, have no idea of the actual cost of that health care. The employee aged 50 who may pay $100 a month towards health care is often blissfully unaware that the true cost may be closer to $1000 per month.  Employees who have not had a pay raise for two years may be unaware that in fact they have had a raise since the cost of health care premiums to the employer could easily have gone up by 10% to 12 % per year with little or no increase in employee contribution. (The numbers are real, as a small business owner I started by providing free health care for my employees. The rates went up so much each year my partner and I had to cap what we paid at $500 per employee per month)
      Imagine the outcry if we tied the education of our children to employment of their parent/s. Imagine if people who worked for themselves, or for very small businesses had to pay the full cost of their children’s education, while the children of their next door neighbor went to school for free because he or she worked for a big corporation. We recognize that an educated populace is essential for the economic health of the nation. I maintain that there is no point in having an educated work force suffering from untreated or undertreated diabetes, hypertension, heart disease, renal disease, obesity, depression, asthma. A sick work force cannot be productive, any more than an uneducated one can be.
I do not have the answer to the issue of delivery of affordable accessible health care – I do not believe anyone has it, mostly because there is no one answer – but I do believe that we need to make some fundamental changes to the system as it has been, because it is not working for anyone – providers or recipients.

Connie Bishop

     HP 2020 is the national initiative by the Department of Health and Human Services.  It is a voluntary effort at improving our nation’s health.  Our community health clinics, Charles Drew and Scott use these to assist us in meeting national healthcare outcomes. 
     There is a HP 2020 goal that impacts our county  and was listed as an Alamance 2011 Community Health Assessment as a priority issue– obesity.
     HP 2020 has a method to conduct a community assessment based on the goals and map out a strategic plan to accomplish those goals.  It would be a wonderful project for some local college students.   Start on something small and achievable – childhood obesity would be a great start.  I’d recommend the university partner with our Sylvan school-based clinic,  with ABSS  as our community partner, Our Charles Drew clinic, has this as one of our quality improvement initiatives would also welcome university collaboration.
     Charles Drew and Scott clinics are part of the national effort to improve the health and well-being of our communities with high quality, affordable and comprehensive primary health care.
     Alamance citizens were concerned about four key healthcare issues: access, obesity, mental health, and substance abuse.  
Healthcare access – 78% have access to Primary care (Second highest penetration category)
Obesity – 48% of adults meeting physical activity recommendations
Mental Health/ Substance Abuse – included in Mental Health statistics – 10% age adjusted suicide rate (Lowest rate category)
Our Charles Drew clinic is in a pilot project to decrease childhood obesity. Our other 6 clinics focus on these health issues and additional preventative care measures as part of our on-going quality initiatives. 

Elderly/Alzheimer’s disease/other dementias – November is Alzheimer’s month
     One third of families in our county will be touched by this disease.  Older adults are the fastest growing segment in NC with 65+ to increase by 45% by 2030.  One in 5 citizens over the age of 65 has been victimized.
     A new initiative by the Alamance County District Attorney’s Office has a new Elder Protection Initiative.  In our county for 2011-2012, there were 312 reports of abuse, neglect or exploitation.  Our state requires mandatory reporting to the County Department of Social Services.
Every 60 seconds a person is diagnosed with this disease.  It is the 6th leading cause of death in the U.S. 
     Alamance has a wealth of resources – Eldercare, ALA-MAP, Dementia specialist located at Hospice and several Memory care centers.  Our PACE program is one way we are keeping the elderly in their own home; while providing primary care services, OT/PT and pharmacy services. 
     We have an Alamance County Chamber of Commerce Health Advocacy group.  I’d recommend this group partner with one or two memory centers to  be a trailblazer in implementing Patient Centered Dementia Care.  Again, starting small – establish and train the concepts of behavioral expression, not behavioral problem.  Start with the one or two memory centers, develop curriculum in partnership with ARMC, the Chamber group and Elon and provide this curriculum for law enforcement.  The goal is to achieve a consistent community approach.
     “The patient-centered medical home—one of modern health care’s most important innovations—is a model of care that emphasizes care coordination and communication to transform primary care into “what patients want it to be.”
Clinicians, insurers, purchasers, consumer groups and others know the patient-centered medical home is a proven alternative to the nation’s costly, fragmented delivery system. Research confirms that medical homes can lead to higher quality and lower costs, and can improve patient and provider experiences of care.”
Our Charles Drew and Prospect Hill clinics are participating in a national pilot program to achieve PCMH recognized status.  Providing medication review and reconciliation are key elements of quality.

Community Health Centers (CHCs) 
• Health center uninsured and Medicaid patients are more likely to have a usual source of care than privately insured
• Health centers reduce disparities in access to mammograms, colorectal screening, and have lower rates of low birth weight than US average
• Health centers save $1,263 per patient per year
• A large, urban health center generates a total economic impact of $21 million for the local community and a small, rural center generates $4 million
• $18 billion could save preventable ED visits
• Health center costs of care have grown slower than national health expenditures 200-2011
• Expand Medicaid – 75% of our patients could benefit.  Since CHC’s contribute directly to the communities economic bottom-line  and decrease ED visits, there is a very real economic impact.
Action items for the community
• Expand Medicaid
• In partnership with ABSS and the university, target Childhood obesity, a HP 2020 goal and an Alamance county priority health issue.
• Leverage existing community resources, the Chamber of Commerce Health Advocacy group, to pilot one aspect of Patient Centered Dementia Care. Include local law enforcement in these efforts.

Suellyn Dalton

     I am interested in NC health issues from all perspectives, but most currently, from the perspective of the thousands of NC residents with developmental disabilities and mental illness who have been cut off from services and assistance by the state of NC.  First the mental health system was dismantled, then critical positions such as Case Managers were deleted, then, more recently, those who do not have the Medicaid waivers had their assistance hours cut drastically.  The loss of these things means many will actually die!!!  These are people who, before now, were able to live on their own in the community.  Now they are faced with possible institutionalization or worse.  There is no help with medication, transportation, personal care, etc.  There is no continuity of service.  There is no one tracking those dropped out of the current mix of service providers whose motives are not always other than profit.  Therefore, what do we expect will happen????  There are no longer independent Case Managers to assist individuals and families with travel through the minefield that is the current mental health maze.  Agencies such as ARC are now providers in this mix, and therefore, are hesitant to be advocates or question the current travesties.
     I am a community advocate and am currently assisting two persons who have been left hanging by the cuts and depletions to the NC systems.
     I cannot get any traction with any agency to help with this.  I have tried Cardinal Innovations, The ARC, and the agency that handles advocacy and has lawyers - Disability Rights, NC.  It is a merry-go-round of phone calls to persons who cannot help with the things that need fixing!  I am personally assisting these two persons who have this lack of service. My family and I spend at least 10 to 15 hours per week either providing or getting needed medical, mental health, or pharmacological assistance.  I cannot even imagine what is happening to others with similar needs who have no advocate or whose families have no idea what to do or who have no transport to look into services.  Their mental health needs are certainly not being met, so one can assume that their health needs are not being met.  I have no idea what will happen to them in the current health care changes.  They have no one to help them sign up for anything.
     Can we please shine a light on the terrible things happening to helpless citizens due to these state changes and cuts?

Kendall Crouther

     My name is Kendall Crouther and I am a senior here at Elon. Since my first year, I have discovered my passion for education and gained experience working with K-12 classrooms, particularly those with English Language Learners, students from low socioeconomic status backgrounds, and in majority minority schools. Throughout my practicums I have noticed a common theme: proper healthcare is critical to student performance in the classroom.
     Just think about it: As a student in the classroom, attentiveness is of utmost importance; however, if finances are a burden to students’ families, physical and mental health coverage options are severely limited and can even seem unreachable. Similarly, if healthcare providers see mental health coverage in particular as unnecessary, additional, or optional for families, providers further the stigmatizations society already perpetuates about mental health being less important or taboo. Just this year in June, the Huffington Post reported research that said Black and Hispanic children, my students, are half as likely as the majority to be diagnosed with the specific learning difference Attention-Deficit/Hyperactivity Disorder – half as likely. Though it is estimated that 11% of all school-age children have ADHD, just 3% of Black students and 4% of Hispanic students are properly diagnosed. That is a 7-8% difference. Even more, these same 3-4% of students who are finally diagnosed are then also less likely than the majority to be prescribed proper medications. Keep in mind that untreated ADHD is specifically connected with poor self-esteem, acting out in class, substance abuse, anxiety, and depression. As you can see, improper healthcare provision begins a cycle of problems – and these are just facts about ADHD alone. As a future educator, I am unable to differentiate my lessons to students based on their needs if their needs are not properly diagnosed and provided for. I am unable to engage all of my students in their lessons if their basic pediatric healthcare needs in general are not covered.
     As a future educator, I am deeply concerned when students cannot learn in school due to a lack of access of quality healthcare, because each and every moment in class is critical. I teach brilliant individuals who will become our next doctors, farmers, factory workers, teachers, lawyers, authors, and presidents for our United States. Let’s ensure that all students can learn and that our nation can compete in our 21st century world. Let’s reform healthcare.

Miles Grunvald

     My name is Miles Grunvald I am a senior at Elon University and will be a first year medical student at the University of Vermont next fall. I was born and raised in Vermont, a state that consistently ranks as one of the healthiest in the nation. Much of my view that I will present today has been constructed by my experiences  in Vermont and the conditions  that allow for a healthy population.
     I believe that we have a moral duty to provide healthcare to all citizens of the US. If we as a nation of individuals share the common value of a right to life, then it would go against our beliefs to have a system in which citizens have to choose between medication or buying groceries, bringing a child to the hospital or heating their house.
Single payer, healthcare exchanges and vouchers, all potentially solve the teleology of healthcare. If a patient needs a procedure, they can use one of these healthcare systems to receive their treatment. If they need medication then there is a chance it will be covered by their provider or the government. These healthcare systems, however, do not do enough, or anything at all to pursue the etiology of many health problems. Diabetes, obesity and heart disease all arise from individuals’ lifestyle choices and have major implications for our healthcare system.
     A 2001 study suggested that 50 to 70 percent of all healthcare costs could be attributed to lifestyle choices: weight management, smoking, poor nutrition, non-compliance to diabetes and hypercholesterolemia treatments etc. Any comprehensive healthcare system must address the fact that Americans are living in ways that are unhealthy and unsustainable. These lifestyles are impacting and will continue to impact our society as a whole. Making health a national priority and refocusing discussions on how we can raise healthier kids should be considered of the highest importance.
Putting caloric or nutritional limits on restaurant food and making it easier for an individual to purchase and prepare food that is more nutritious, are ways we can combat conditions that cost our healthcare system so much. Burlington, Vermont and Montpelier, Vermont have banned McDonalds within the city limits, as they believe it replaced their McDonalds with other restaurants, deciding that both decided that McDonalds is not a good choice for to offer their citizens and no longer have those fast food restaurants. Local, state and federal governments making decisions to increase the restriction of goods that are blatantly harmful for the consumer should not be viewed as an affront to liberty, but a step towards the longevity of their community members.
      Subsidies should be given (or shifted) to Subsidies for corn should be shifted to subsidize smaller more diverse regional farmers and farmers growing crops of direct nutritional value to US citizens. Any comprehensive healthcare system will realize the root of these issues and will include incentives for making healthier choices easier. Vermont is an example of such a system. Farmed food is often available at very low prices and there is a large emphasis on buying local and supporting local farmers. Heuristic evaluations suggests to me that the availability of quality food, and an emphasis on community and agriculture, help to keep low obesity rates low (although they continue to rise).
     Lastly, a holistic healthcare system will encourage activity. Vermont has a fosters an environment where the culture emphasizes physical activity. of its citizens being physicallySpecificallyIn general, residents active and takingtake advantage of hiking, skiing and biking trails. Also, mMany health insurance providers in Vermont offer coverage that includes discounts for gym memberships. Providing and environment where it is easy and affordable for people to stay active is crucial to the health of the citizens and reducesd costs to the healthcare system.
     When reforming health care, Americans should focus on the root of our problems and the preventative aspects of health. There will still always be cancer, chronic disease and palliative care that will be costly to our country but by encouraging preventative measures we can offset the costs and alleviate some the fiscal burden that comes with the task of trying to secure a healthiery America. When reforming health care Americans should focus on the root of our problems and the preventative aspects of health.

Marissa Rurka

     Hi! My name is Marissa Rurka, and I am a Sociology major with minors in Business Administration and Spanish. I would like to discuss the commodification of health care and the implications that this has for society and possible health care reform.
     A lot of people who criticize the commodification of health care are upset about the idea that not just healthcare, but health itself has become a commodity. They believe that it is a shame that good health is not granted to those who can afford it. Believe me, I think that this is awful, and I oftentimes feel guilty that every year I can afford to go to the dentist and the dermatologist while some people cannot even afford basic health services.
However, I believe that the perspective of health as a commodity is not something that will go away any time soon, even under a reformed health care system. I believe that the real question is not whether everyone has a right to basic health care, but what constitutes basic health care. Does everyone have a right to receive life-saving operations? I think a lot of people would say, yes. But does everyone have a right to go see a dermatologist? This is a question that I think people would have a more difficult time answering.  And to go along with what some of the other speakers have discussed, how does mental health factor into this? Does that fall under the category of basic health care?
     Why is the debate over what constitutes basic health care such an important question? Because it is simply not realistic from a financial standpoint to assume everyone can have access to all of the health care benefits available to the average middle-class American.  Although current politics seem to suggest that there is no limit to the amount of debt that we as a nation can accumulate, I believe that there is a limit to the amount that the government can spend on health care. Although the government may be able to provide health care to everyone, the extent and quality of the health care they would be able to provide is limited.
     One argument that is often raised when individuals discuss the viability of universal health care is that it is a shame that education is considered a basic right within the US but that health care is not. My problem with this argument is that I believe that education for all intensive purposes is still very much a commodity. Just because everyone has access to education does not mean that everyone has access to quality education. A quality education is still, for the most part, something that is granted to those who can afford it.
     Whether we like it or not, US health care system is functioning within a capitalist system. If we really have a problem with the way that health care is set up, then ultimately I believe that we have a problem with the capitalist nature of our society. This speaks to the complex nature of the health care issue.

Maria Restuccio

     My name is Maria Restuccio, I am a junior economics major with a strong interest in the ethical and economic facets of the US and international healthcare systems.
     I believe that in our country we cannot support a fully privatized healthcare system. I spoke with Dr. Barbour about the theory of privatized medical care and after analyzing this conversation I believe that we will never allow a healthcare system that denies services to citizens who cannot pay. To say that a healthcare system is truly privatized we must be okay with citizens being denied healthcare because of their inability to pay, even if this means death. I believe that as a nation we will not elect officials who will pass reforms that would let patients die because of lack of insurance to cover emergency treatments.
     This being said the next big question is how do we provide a socialized system of healthcare? Is it fair that I as a hardworking, healthy tax payer have to front the bill for someone who cannot afford their own healthcare? Also, what is the overall benefit to society of providing universal healthcare—is the healthy workforce worth the extra cost? These are economic questions that seem very difficult to both quantify and answer.
     According to the Center for Disease Control (National Healthcare Expenditure Projections 2011-2012) in 2010 the US spent 17.9% of GDP on healthcare, the most in the world, with the majority of health expenditure being spent on hospital care. However, there are still thousands of Americans, insured and uninsured who go bankrupt each year in order to pay for health services according to the Institute of Medicine (Care Without Coverage: Too Little, Too Late 2002.) For me it seems as if healthcare in the United States is treated as an economic good, and a very expensive economic good at that.
If healthcare is seen as a good, how do we address problems of demand among healthy citizens and overall healthcare pricing? If healthcare is mainly needed by the sick, who cost insurance companies money instead of adding revenue, how do we avoid increasing prices and making healthcare attractive for the healthy, yet make coverage affordable for the sick?
     I see three problems in the set-up of our current healthcare model:
     First, insurance companies operate with the goal of satisfying investors. This gives insurance companies incentive to reject patient care on the grounds of economic benefit to satisfy profit margins instead of measuring success on the healthiness of its participants. I think it is unethical that businesses and economist alike can price the lives of the sick and injured, and then chose who to treat and who should be offered insurance?
     Second, I don’t think that we have a strong system in place to offer health insurance to our citizens. Government programs leave gaps in coverage among citizens and there seems to be a disparity between the responsibilities of the federal and state governments when it comes to paying for the uninsured. Additionally, on the topic of providing health insurance I don’t think it is the responsibility of employers to provide health insurance to their employees. This mandates an extra cost to companies who have to make up this cost through either decreased revenues or cuts in employee pay. It also creates an uncertainty about permanence of healthcare for families. If the head of household loses their job, the family loses health coverage and either must face paying privately for insurance, which is extremely costly, or risk not having health insurance and potentially paying huge out of pocket expenses for medical care.
     Third, I think improvements need to be made in how we finance research and development. Research and development is extremely expensive and is paid for by corporation’s profits. How do we encourage this research and development without taking funds away from direct patient care? For example, in the pharmaceutical industry large companies spend billions of dollars developing medications to stay competitive in the market. However, because of these high cost they are forced to charge unaffordable prices for prescriptions. Then, after patent expiration, generic companies offer the same medication at affordable levels, increasing access to treatment for sick patients. However, in this situation large firms lose profit that they could have reinvested in finding cures or treatments for other diseases and illnesses. In regards to the Medical Loss Ratio of Obamacare, where 80-85% of medical premiums must be spent on activities and services that directly improve healthcare quality, how can insurance companies balance the benefits of patient care with the benefits of improved administration? It is important that money be spent on actively treating and preventing sicknesses, but is it not also equally important to invest in new technology, research and resources like top management that could improve healthcare in the future?
     There is no perfect healthcare system, as I am sure we could all agree. But if we were to re-align the goals of maximization of profit and shareholder value to a goal of maximization of patient health, I think that the state of our country’s healthcare system would be much better off. What if we encouraged hospitals and pharmaceutical companies to keep in competition through either offering or cutting off government funding? What if we could find a way to reward insurance companies, either private or government run, based on the health of their patients instead of allowing them to profit off of denying claims? I think that it would do wonders for personal health if we were to operate our healthcare system based on social impact, preventative care, and treatment for the sick. I want to see universal coverage in the US that focuses on patient health first, keeps hospitals, pharmaceutical companies, and researchers competitive through government funding, and shifts insurance from a profit seeking industry to a social improvement seeking industry.

Kaitlin Stober

     My name is Kaitlin Stober, and I am an Art and Sociology major at Elon University. Within the field of Sociology, I have developed a particular passion for mental health and wellbeing. I exercise this interest regularly through my position as a group leader for the mental wellbeing facet of SPARKS peer education.
     I would like to begin my statement by articulating that I am far from an expert on healthcare, let alone healthcare reform. However, I do believe this conversation will benefit from my opinions and concern for the topic.
Discussions surrounding health, healthcare, and healthcare reform often exclude specifics on mental health. This lack of conversation is paralleled, and arguably perpetuated, by a lack of educational resources, as well as services for individuals with mental illnesses.
     The absence of mental health in conversation is unacceptable. According to the National Alliance on Mental Illness (2013), 1 in 4 adults, and 1 in 5 people between the ages of 13 and 18 will experience a mental health disorder at some point over the course of the year.  Of these adults affected, 60 percent will not receive the care they need.  In fact, about 11 million of the 45.6 million individuals with a mental illness in the United States have no form of healthcare at all (NAMI, 2013).
     I recognize that millions of people without mental illness lack health insurance as well; however, there is a significant disparity (greater than 10 percent) between those uninsured with mental illness and those without mental illness. The fact that one in four individuals between the ages of 19 and 25 do not have health insurance is especially problematic due to the likelihood of mental illness developing at this time (NAMI, 2013). 
The adverse consequences that stem from a lack of health insurance transcend the individual, such that the larger structure of society is harmed. According to the U.S Department of Justice (2006) 56 percent of State prisoners, 45 percent of Federal prisoners, and 64 percent of jail inmates have a mental health disorder. These numbers can be put in perspective by comparing them to the number people with mental illness in the hospital. The National Institute of Corrections (2010) does just this, reporting there are 3 times more prison inmates than hospital patients with mental illness.
     The Patient Protection and Affordable Care Act establishes new regulations for health insurance companies. As a result, more citizens of the United States will ideally be able to receive dependable coverage, largely due to the expansion of Medicaid. Currently, Medicaid only impacts few subpopulations including pregnant women and people with disabilities. Therefore, the expansion of the program seems to offer hope for deserving individuals unable to receive coverage at this time. The Patient Protection and Affordable Care Act offers a variety of benefits, on paper, to individuals with mental illnesses as well. For instance, health insurance exchange plans will be required to cover metal health and substance treatment as one of ten core services (NAMI, 2013). Despite the promises made on paper, it is clear this health insurance overhaul is not going especially smooth. Recent news reports have noted the significant amount of people being dropped by current healthcare providers every day as a result of the changes being implemented on January 1, 2014.
I have yet to determine my personal stance on healthcare reform in the United States, but I have determined my investment in the matter.  As a result I look forward to furthering my own understanding, and hopefully assisting in the development of others’ understanding, via the upcoming conversation.


NAMI. 2013. “Policy Topics: Health Care Reform.” NAMI: National Alliance on Mental Illness. Webpage. Accessed October 29, 2013.

Fuller, Torrey & Kennard, Aaron D. 2010. “More Mentally Ill Persons Are in Jails and Prisons Than Hospitals.” National Institute of Corrections. 

James, Doris J. & Glaze, Lauren E. 2006. “Mental Health Problems of Prison and Jail Inmates.” Bureau of Justice Statistics.

Jeremy Troxler

     As a concerned citizen of these United States who has also been afforded the great blessing of knowing the privilege and responsibility in providing for the livelihood of other citizens through gainful employment in this great nation, the issue of health care affects me on both a personal and vocational level.  Although discussions can be fruitful relative to the procedural aspects and potential entailments of the health care law, since implementation is still weeks away and enrollments in the new exchange has been troublesome it is not possible to address the empirical realities of the resulting effects of the law and new related tax impositions.  It is possible, however, for concerned citizens and businesses to address the fundamental principles of the law and register some serious questions for our government.
     At the founding of our nation, in the very declaration of our independence, the rights of life, liberty and the pursuit of happiness were enumerated as unalienable among all humankind.  The Constitution of the United States was written, in part, to “secure the Blessing of Liberty to ourselves and our posterity”.  When seeking to form a more perfect union within the realm of governance, these fundamental principles must remain in the forefront as the Blessing of individual liberty was endowed by the Creator to those whom He created equal.  Establishment of the source of individual liberty, and by extension individuals in commerce as employers and employees, is critical when considering the extraordinary freedoms we enjoy in this country.  Our freedoms exist within a form, not within chaos – there simply are certain truths upon which these freedoms are based.
      As created beings, invested with intrinsic dignity and worth by a personal Creator, caring for personal health and concern for the welfare of others is universally accepted as a societal good.  Furthermore, the existential struggles experienced in providing care through a multitude of circumstances from life in the womb to the elderly resonate clearly in the hearts and minds of all American citizens.  How then should a caring community address such poignant themes in contemporary culture?
     According to section 1501 of the Patient Protection and Affordable Care Act (ACA), health care is commercial and economic in nature.  Subsection (a)(2) states that the mandate for individuals to obtain insurance coverage that meets standards for minimum essential coverage will have certain effects.  These effects are clearly stated as: (A) regulating economic and financial decisions of the individual about how and when health care is paid for and when health insurance is purchased; (B) health care flows through interstate commerce and is therefore able to be federally regulated; (C) will add millions of new insured individuals that will increase both the supply and demand of health services; (D) builds a private employer-based health insurance system; (E) will provide financial security for families; (F) will provide for the Federal government regulation of health insurance; (G) will make healthy people carry health insurance thereby increasing the pool of the insured to reduce premiums for all; and (H) will significantly reduce administrative costs and lower health insurance premiums.
     According to employers of over fifty (50) full-time employees are required to provide each employee with a qualified health plan that provides affordable minimum essential coverage or be levied a per-employee, per-month fee (termed “Employer Shared Responsibility Payment”) due on employer federal tax returns starting in 2015.
     Looking briefly at these two mandates within the overall ACA we can at least compare its fundamental undergirding principles over against those foundational principles of our nation and ask some pertinent questions.  Is it possible to regulate the decisions of the individual American citizens and still maintain the blessing of liberty?  Can caring for the health of unique human persons really be reduced to a commercial and economic affair?  Do we really believe it to be true that health insurance premiums are reduced for all when those who are healthy and choose not to purchase health insurance are forced via the taxing authority of the federal government to make that purchase?  Can businesses over a certain size really engage in a free marketplace when forced to an increased overhead with no possibility for restitution via increase in product price point under the threat of the taxing authority of the federal government?  Are the ends of making health insurance a product owned nearly universally really worth the means of molesting the unalienable right of individual liberty?  Perhaps we can address these most basic and fundamental concerns for the individual and the business owner, even as we discuss the particular nuances of portions of the enacted law.
     As the “Father of the Constitution” so aptly wrote, “In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed; and in the next place oblige it to control itself.”  While certainly responsible for regulating interstate commerce through its enumerated and limited powers, the federal government is not the issuer of rights to life, liberty and the pursuit of happiness.  Thomas Jefferson wrote, “Well aware that Almighty God hath created the mind free…that to compel a man to furnish contributions of money for the propagation of opinions which he disbelieves, is sinful and tyrannical…”  As our founders recognized to be self-evidently true, the personal Creator God endowed those rights to His creation.  As the Almighty said, “Then render to Caesar the things that are Caesar’s, and to God the things that are God’s” (Luke 20:25).  Perhaps we should continually consider how to effectively promote an environment of legitimate care for the well-being of one another as is our civic and moral responsibility while at the same time preserving the dignity of individual liberty.  Perhaps we should fix our gaze on the Creator as we do our best to care for the created.