Would it be better if the Supreme Court nullified the Patient Protection and Affordable Health Care Act?
I am sure you have all read/heard or speculated about the many different scenarios that could unfold should the Supreme Court nullify all or part of the Patient Protection and Affordable Care Act, passed as the signature legislative achievement during the first term of President Barack Obama. Whether Obama has a second term might well depend on the outcome of the Supreme Court decision and, if negative, his reaction to it. Many have argued that if the “individual mandate” of the law is declared unconstitutional, many other valuable features of the bill will still remain intact. The “individual mandate,” which forces individuals to purchase insurance if they don’t have it through their place of employment, will be part of a $477 billion government subsidy to the insurance companies and without that critical source of funds, the entire healthcare plan could easily unravel. While this healthcare bill is projected to provide health insurance for 30 million Americans who lack this fundamental component of a civilized society, it will still leave about 20 million Americans without health insurance; it is thus an incomplete solution to our problem. Yet, isn’t it odd how things have been twisted, as the Democrats are now hoping that the Supreme Court will not rule against a bill that just a few years ago was a Republican plan for national healthcare, not a Democratic solution.
I can personally see the rationale for declaring the bill unconstitutional because the individual mandate forces people to buy insurance from a private company, thereby subsidizing their profits and insuring corporate survival by a mechanism different from the “free market.” We have a 5/4 “free market” Supreme Court, but in this case it’s hard to know how the court will react because government support of corporations is a big, non-verbal part of our “free market economy” (consider for example the government-subsidized military industrial complex or our government subsidies to oil companies that make obscene profits). In contrast to the new healthcare legislation, our other social programs, such as Medicare and Social Security, are government-run organizations, paid for through payroll deductions, not through subsidizing private companies. The Patient Protection and Affordable Care Act was conceived by the Heritage Foundation and its 2000 pages were written by corporate lobbyists representing them–it was designed to meet the needs of the for-profit health insurance industry. When the law was first passed, the stock value of the for-profit healthcare organizations went up–it was perceived as a victory for them by their investors.
There is another downside and inefficiency to the new healthcare law: it doesn’t separate us from our employment. The new law will still connect our healthcare to our jobs and if you lose your job, you lose your healthcare and have to replace it with something else, hopefully something less expensive than the nightmare, very costly alternatives we have now: we still don’t know how well that component will work, as it is not yet part of the system in motion. As we expand government subsidies to the private healthcare industry, we will make them more profitable and more effective in lobbying Congress to chip away at the healthcare laws and rules to make these healthcare giants ever more profitable. We have a history that includes the inability to resist that kind lobbying, particularly in the current iteration of our government: indeed that’s how our system works. Money means influence and more money means more influence. Just as we don’t want financial institutions that are too big to fail (even though we have them), we don’t want private healthcare providers to become so rich that they have ample profits to spend money on lobbying against our own healthcare laws. Remember, these companies describe themselves as healthcare organizations and no matter what their ads say, they are determined to get more profit and to do so by minimizing the care they deliver–it’s in their DNA. Buried in those 2000 pages of the new healthcare bill are exceptions and exemptions that companies can use to deny care in the interests of profits. It is simply not possible to have a national healthcare system where one of the main components is trying to maximize its profits and compete against the interests of a population trying to get decent healthcare. It’s not that these companies should be regulated more effectively–they should be eliminated as obstructionists to a decent healthcare system. The mere existence of these for-profit health insurance companies will pose a constant threat to our healthcare system, no matter where the Supreme Court decision on this bill should fall.
Chris Hedges, writing in Truthout, visited the demonstrations held outside the Supreme Court building when the debate was going on. There were those supporting what has become known as Obamacare while the right-wing was entrenched against it and refers to it as socialism (despite its Heritage Foundation origins). But there were also a small number of thoughtful people, with whom Chris identified, including Dr. Margaret Flowers, who is a well known healthcare activist, lobbying for the destruction of Obama’s individual mandate and replacing the entire Obamacare with a single payer system that would gut the for-profit healthcare industry and replace it with “Medicare for all.” They have a single payer website which you can visit, join and help advance the cause for a more rational healthcare system. Margaret Flowers’ point is this (quoted from the Hedges article): “If you are trying to meet the goal of universal health coverage and the only way to meet that goal is to force people to purchase private insurance, then you might consider that it is constitutional,” Flowers said. “Our argument is that the individual mandate does not meet the goal of universality. When you attempt to use the individual mandate and expansion of Medicaid for coverage, only about half of the uninsured gain coverage. This is what we have seen in Massachusetts.” Thus the healthcare system in Massachusetts, which has implemented basically the same healthcare system we plan to put in place under the new law, by experiential history , does not lead to universal coverage, something that should be the goal of any national healthcare system. Many people who support this bill believe it’s a start, that an early beginning can lead to later expansion of the system to cover all Americans. I don’t believe that will happen–I think it’s more likely that we will have a two tier system that won’t change for many years, simply because we are too divided as a country to agree on something as profound as universal healthcare–that has to happen through a surging political mandate. The cost factor of our present system is also problematic and seemingly doesn’t get fixed with the new healthcare law and we already top the charts compared to other countries (see chart): currently, our healthcare system costs twice as much as that of most other countries (as a percentage of our GDP) and one reason is the administrative costs incurred by the for-profit system as well as the many unnecessary medical procedures created from the profit motive. If you paid doctors a salary, like the Mayo Clinic and Cleveland Clinic do, you could reduce the motivation behind unnecessary medical procedures. When you consider that we already have the most expensive medical care system in the world, but still leave 20 million uninsured, you have the ingredients of a very sick system, even if the new law gets full backing from the Supreme Court.
But, suppose the Supreme Court rules against the healthcare system? Then imagine that Obama, faced with the reality of a Supreme Court, whose ideological composition may be in place for many years and motivated by public outrage at the Court’s decision, decides to campaign for a single payer system embodied in “Medicare for All.” Although polls show that the majority of Americans are opposed to the Patient Protection and Affordable Care Act, many of them are opposed to it because it doesn’t go far enough in support of a single payer option. Many of us were very unhappy when Obama didn’t give the single payer option more of an opportunity to resonate with the American people before it got pushed aside as an option that couldn’t be passed. Obama’s failure to give the public option more support served as one of the first disappointments in what turned out to be a long string of triangulating and seemingly cowardly attempts to placate the right at a time when everyone but the White House knew that they would not compromise. Not a single Republican voted for the Patient Protection and Affordable Care Act. Obama has faced this problem for his entire Presidency. But, the polls show that when the polling questions are formulated properly, the majority of Americans favor a single payer system. The bill that was proposed in favor of such a system was written on a single page, containing a few sentences describing who would be included in Medicare–all those between birth and death. What could be simpler; Medicare already works and has been serving people for more than fifty years. There is enough money to support this system, but part of it must be removed from the expensive, absurd costs of supporting for-profit healthcare and the excessive costs of drugs for seniors passed by a Republican congress and signed into law by GW Bush. And we should not forget, that by making the for-profit healthcare companies even wealthier, we will be setting the stage for the lobbyist erosion of the best parts of the Affordable Care Act, because those parts will mean less profit to the healthcare corporations and serve as the first targets of their lobbying efforts. These efforts are already underway–these companies will forever be sending lobbyists to Washington to chip away at our healthcare system in order to enhance their profitability. When Bush announced his perception of candidates for the “axis of evil,” he forgot to include medicine for profit in the mix. I for one would be energized if the Supreme Court declared “Obamacare” unconstitutional.What about you?
RFMPrint This Post