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Defending the Indefensible: Getting Beyond Insurance and Obamacare

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I am a proponent of universal public health care. I have experienced universal public health overseas and it is remarkable. For that reason I opposed President Obama's health care "reform" bill, because it began life already a slave to the insurance company-spawned ideology of health care as a market commodity and not a basic human right. Though cautioned against pursuing this strategy -- he was more than once urged to propose a single-payer model or at least to offer a public option -- the president never once deviated from this religion. Now his holy fealty is coming back to haunt him

Obamacare, as the new law has now been popularly retitled, is not about guaranteeing every American quality healthcare. What it guarantees is every American's right to buy health insurance. This week, I listened to the arguments made before the Supreme Court, among the attorneys and the Justices for and against Obama's healthcare reform law. The more I listened, the more I found myself agreeing with the plaintiffs, the attorneys general who brought suit to invalidate the so-called "personal mandate" requiring every American to purchase health care. The Solicitor General was blown away, not because he wasn't a competent litigator, but because his real client in this case -- the health insurance industry -- is indefensible.

They're right: the government has no such right. It cannot force citizens to purchase this or that thing -- or for that matter, not to purchase it -- unless there is a compelling public purpose. As anyone who currently pays for health insurance knows, there is no compelling purpose for it. Health insurance is a relatively recent invention, conceived (so the fable goes) to constrain needless medical expense. Of course, it has done no such thing. For many years, as a self-employed consultant, I paid enormous insurance company premiums -- as much as $7,500 a year. Even so, each year, between co-pays and the procedures not covered by insurance, I accumulated more than $1,000 in bills I had to pay. The health care company paid a third of that. I finally decided, after decades in the system, to reduce my premiums and pay out-of-pocket.

I understand that others are not so lucky, those who suffer dreadful accidents or have chronic disease. I do not argue as do those on the right that these less fortunate should be forced to fend for themselves. We all are responsible for the well-being of others. This is not the argument that was made when Congress acted on Obama's initiative, nor did it come up even once in the arguments before the Supreme Court -- precisely because the case before the Supreme Court is not about well-being of others. It is about well-being of insurance companies that argued during the passage of the law that they could not deal with these responsibilities unless everyone chipped in and paid insurance premiums. Thus was born the individual mandate, the requirement to sign up with the new private universal health care system that is being argued about in the Supreme Court, with the government picking up the bill for low-income and indigent citizens.

I suspect that the insurance companies made their ingenuous proposal never expecting the president to take them up on it. They rather hoped it would kill the bill. Or maybe they were thinking ahead and proposed the individual mandate as a time bomb that would go off during the 2010 election -- which it did -- and a poison pill that could kill Obamacare if allies at the state level brought suit before the Supreme Court -- which they did. And the poison is working. The individual mandate is indefensible. Despite the good face put on the Supreme Court proceedings by pro-Obama observers, the Supreme Court seems set to produce a 5-4 opinion invalidating the public mandate. That doesn't kill Obamacare, but it makes it politically vulnerable to repeal. Which will be bad on two counts.

First, the repeal of the law will eliminate its better provisions, including those that ban insurance companies from discriminating against prospective customers based on pre-existing conditions. Second, it will set the stage for attacks on Social Security and Medicare based on the same argument, that government should not come between sellers and buyers of what are essentially discretionary products. (Never mind that government has no such inhibition regarding marijuana, which also has a place in health care -- but that's another story.) During interviews broadcast on C-SPAN, liberal Senators Schumer and Leahy purposely conflated Obamacare with Social Security and Medicare, as if raising the boogeyman will scare the right wing-leaning Roberts Supreme Court from striking down the former for fear of harming the latter -- a situation that the Republican/Tea Party would relish.

(When asked by a reporter if they had a strategy in case the Supreme Court voted against Obamacare, the senators could only reply, "Oh, but of course the Supreme Court has to uphold the individual mandate." Oh, but of course it needn't and likely, it won't. No one asked the same question of reactionary Senators McConnell, Corner or Rubio; everyone knows they're going after Social Security and Medicare. Someone should have thought about that in 2009 as Obamacare with an individual mandate was making its way through the then-Democratic Congress.)

Frankly, I welcome the defeat of the individual mandate. It's a kludge intended to kill universal private health care, and it will. One way or another, it will bring down or diminish universally available health care. In Massachusetts, where Mitt Romney created Romneycare, the progenitor of Obamacare, health care costs are escalating, because unless one eliminates insurance companies in the mix, there is no way to contain them. Insurance companies' profits are directly related to the price of health care, it is in their self-interest that prices continue to skyrocket. That's why I want to throw a tomato every time a Democrat cites Massachusetts as the poster state for health care reform and therefore a suitable prototype for America. It's not. It's a disaster. Romneycare is about to be trimmed -- and with it, any value it has as a model for universal health care in America.

Let's take a different tack. Let's go back to the single-payer model. If government provides a service, de facto it is properly and constitutionally available to all citizens. Take the trillions collected by the insurance companies and invest them in quality health care, "Medicare for all." Then people can pay via their taxes, reasonable premiums when they're younger -- and when they're older, too. No one would be turned away, everyone would be secure, people could spend their money in better ways.

As Robert Reich recently observed in the Christian Science Monitor, a loss before the Supreme Court, even if a short-term negative for the president (perhaps), would open the door for him to promote universal public health care -- the single-payer model, a long-term positive for the president and every other Democrat at every level of government. Consider the financial benefit to the economy: insurance companies' overhead (including stupendous salaries for executives and dividends for shareholders) is typically 30 to 40 percent. For Medicare, a government program, it's 3 percent -- a much better societal bargain. Even Medicare fraud, a subject of constant opprobrium on the right, is considerably less costly than fraud in the private medical sector, much of it never identified as fraud because of sweetheart deals and customs among health care providers, medical technology and big pharma companies, researchers, policymakers and of course, insurance companies whose largess -- our premiums -- ties them all together.

Universal public health care would not be subject to Supreme Court review. It would not for long even be a subject on which the right-wing could dwell. Once societies provide universal public health care, it sticks. It doesn't become a talking point or a soundbite. Sure, people can debate the quality of the service, and should; with public health service comes a new realism regarding how people can live healthier and what the government, the private sector and citizens themselves can do to to make it so. Ironically, the Roberts Supreme Court can make possible the biggest advance in civilizing American society by voting 5-4 against the individual mandate. Give Obama something solid to run on: universal public health care. The President and the Democrats should consider this a gift.