July 13 ,2012
Obama Wins Big on Health Care
The Supreme Court narrowly upheld President Obama’s signature achievement, the Affordable Care Act, which will finally bring health insurance coverage to almost the entire US population. America for decades has been the only industrialized society that did not have some kind of universal health care, and the number of uninsured has reached over 50 million people. For decades, Democrats have wanted to expand the safety net to cover the whole population, but Republicans blocked every attempt, most recently President Clinton back in 1993.
Obama was able to get his ideas through because the Democrats finally got to 60 senators, enough to overcome a Republican filibuster and finally pass legislation. While the law was signed in 2010, its major provisions to expand coverage will not take effect until 2014. In the meantime, Republicans had one last shot at blocking health care for the 50 million without insurance. They cleverly declared the individual mandate, the concept that government could require everyone to buy insurance, to be unconstitutional, and ran to the Supreme Court, where they hoped the 5 conservative justices would side with them and throw out Obama’s law. Never mind that the individual mandate was an idea created by a Republican think tank in the 1990’s, that it was the centerpiece of several Republican proposals for healthcare reform, that Mitt Romney, the Republican nominee for President, actually instituted this idea in Massachusetts in 2006 and called it a model for the nation, and that even Newt Gingrich supported it just a few years ago. Suddenly, it had become an obvious act of government tyranny. I think every one who holds that view, if they are intellectually honest, must also declare EMTALA, the 1986 law mandating that doctors and hospitals provide free emergency care for anyone who needs it to also be unconstitutional. Let’s have a society where uninsured people die in the streets in misery and pain because they were too irresponsible or unlucky to have health insurance, or too caught up in their own notions of personal freedom to buy insurance.
Regardless, though most legal scholars felt the law was clearly permissible under the constitution, conventional wisdom was pretty certain that Obama was going to lose. It came as a great surprise that Chief Justice John Roberts, a solid conservative appointed by George W. Bush, sided with the four liberals on the court and upheld the law. To conservatives this was a disastrous outcome. For Romney, it puts him in an odd position of having to disavow his main achievement as governor of Massachusetts six years ago, and proclaim to everyone that the very same plan he created is a disaster for the country and should be repealed.
Can Obamacare be turned back at this point? If the Republicans take back the Senate and Romney wins the White House, then there is a chance that significant parts of the law can be reversed, but with the Democrats holding enough Senate seats to uphold a filibuster, it will be difficult for the Republicans to fully repeal it.
The key provisions, expansion of Medi-Cal to cover the working poor, allowing young adults to be covered by their parents’ policies, and preventing insurance companies from denying insurance on the basis of pre-existing conditions, will be hard to get rid because they will enjoy significant public support. If the Democrats hold onto either the Senate or the White House, then this law will take full effect.
Once America sees Obamacare in full action in 2014 and 2015, public opinion will swing behind it. Right now many are afraid of the unknown, and Republicans have stoked fears about what it will do. But within a few years it will become part of the fabric of American life. In the longer run, the ACA is not the last word on health care in the US. The other big question still to be addressed is bending the cost curve and keeping health care from swallowing up the economy. I believe the logical evolution will be that large US companies will realize Medicare is the lowest cost option and will want the right to buy into it for their workers. When that happens we will begin the move toward a true single-payer Medicare for all solution, which is where we are ultimately headed.
