With all of the silly signs outside the Supreme Court and philosophizing inside, it can be easy to miss how catastrophic it would be for the country if the justices strike down the Affordable Care Act. While still a work-in-progress, the new health law is almost certainly the last best hope we have for attacking the fatal flaws in the American health care system. Take away the law, and we are stuck for a generation or more with the reality of a health care system that each year will cost more, deliver less and exclude more people.
Here are six things that every sane person should know about the healthcare debate.
1. The legislation is not as big and complicated as we've been made to think. Think of the law as a triangle that does three basic things: First, it tightens the screws on insurance companies so that none of us is at risk of being cutoff or denied coverage when we or our loved ones get sick and need it most. Second, it brings almost everyone into the system by providing individuals with subsidies to buy coverage and expanding the Medicaid program to cover all people at or just above the poverty level. And third, it promotes a set of promising local and state innovations designed to improve the delivery of care in order to reduce the cost and improve quality.
Rather than see the Affordable Care Act as a big federal take-over of healthcare, as it has been politically attacked, it is more accurate to understand the law as a framework for states, local communities, health care providers, businesses and ordinary citizens to tackle the urgent task of fixing the American healthcare system. We should not be fighting about the framework, which represents a set of compromises between conservatives and progressives, but about how to implement the law.
2. The Affordable Care Act is already helping tens of millions of people get better health. In 2011 more than 86 million Americans received free preventive care such as mammograms and colonoscopies. More than three and a half million Medicare beneficiaries have saved more than $2.1 billion on prescription drugs. Small businesses are better able to provide coverage to their employees, and parents of children with pre-existing conditions no longer have to worry their children will be denied coverage. More young adults (2.5 million) are able to stay healthy by remaining on their parents' health insurance plans. In the coming years millions more Americans will gain the physical and financial security of having health coverage.
3. There is no real alternative. With all of the talk about repeal, there is no viable alternative on either the right or the left that would plausibly result in a healthcare system that provides coverage to all Americans and slows the growth in healthcare spending. If the Roberts' Court strikes the mandate, it will probably also eliminate popular rules that prohibit insurance companies from denying people coverage for pre-existing conditions. This would take the heart out of the law. The Roberts' Court could still leave in place the expansion of Medicaid, which extends health coverage to as many as 16 million low-income uninsured people. That would still be an important step forward for the country that shouldn't be sneezed at.
Regardless of whether the Roberts' Court takes a scalpel or a sledge hammer to the law, it will be extraordinarily difficult to find any common ground in Congress to pass new health care legislation. And federal politicians will go back to avoiding the issue like the plague, as they did after the Clinton effort failed. After all of the political capital invested by President Obama, who would try again anytime soon?
4. People will die. I found it sickening to read of Justices Scalia and Alito's concern about the financial health of insurance companies and the amount of reading their clerks might have to do in contrast to their seemingly heartless disregard for human life and the pressures on families who cannot afford health insurance. Each year about 40,000 people die prematurely because they lack health coverage. Many hundreds of thousands of people delay needed care and live with unnecessary pain and stress. The justices (who sit in the warm embrace of government-provided healthcare) are happy to philosophize over broccoli. They need to be reminded that their decisions on this case will have life or death consequences of people in the United States.
5. Costs will go through the roof. The Affordable Care Act does not do enough to limit the long-term growth in health spending in the United States. But it does put the country on the right path by changing how health care is paid for to reward medical providers for getting and keeping people healthy rather than for more tests and procedures. It also enables states to create health care exchanges that will bring transparency to the health care market and be a boon for people who purchase coverage on their own. More will need to be done, but almost all of the policies that control health care costs build on what is already in the new health law.
6. If it looks like judicial activism and smells like judicial activism, it is. Seventy-five years ago the U.S. Supreme Court relented on its stubborn opposition to regulations designed to protect children and families from the vicissitudes of an increasingly complex national economy. Since then, the Court has allowed Congress and the President to regulate the national economy without judicial meddling. If the Roberts' Court decides to strike down the health care mandate or the entire health care law, it will not be because it faces a novel question, but because Justice Roberts and his conservative colleagues have made a decision to use their powers to remake the country along their personal preferences. And they know that.
The Roberts' Court's Citizens United jurisprudence on money in politics has already fundamentally eroded American democracy. In June we'll know if the Court has done the same thing to our social safety net.
Let's pray for Justice Kennedy -- the court's swing vote -- to find the wisdom and compassion to understand the real world, human consequences of his legal analysis. If he fails, our nation will not only miss out on an opportunity to save tens of thousands of Americans from shorter and more painful lives, it will move one step further in losing the Supreme Court as an instrument of justice, fairness and social progress.
Follow Gordon Whitman on Twitter: www.twitter.com/piconetwork
The Rand study and several others have shown that more comprehensive insurance leads to higher medical spending and does not contribute to better health outcomes, despite all the hype about preventative medicine and early detection.
In order to drive down health care costs health care consumers need to be making spending choices with their own money.
Thing the government could do
-Allow people to purchase high deductable insurance without all the add ins required by states
-Allow people to buy insurance across state lines
-Non-doctors to do more medicine. (nurse to diagnose and recomend treatment or referral)
-Eliminate the tax deduction that encourages employer insurance, shift the benefits to individuals and apply to basic high deductable plans.
-Reduce the length of drug patents -but pay for some of the very expensive trial using tax payer money
-force greater disclosure from insurance firms on Rescission and other practices so that consumers can compare.
-offer cronic care insurance riders. If a cronic condition exceeds your deductable for 3 years. The government supported rider will pay "X" percent of your deductable for the next "X" years
Much that could be done that would lead to lower healthcare costs, keep the system focused on the healthcare consumer and result over time in better more accessible health care. If the Clintons had supported this the last time health costs would already be dropping.
The answer is not more government, the answer is a competitive health care services and insurance market where people are vested in making decisions about the insurance and care they receive and are free to purchase the coverage they want from anyone they want.
Coverage should not be provided through your employer as it is now so you are not constrained to buy what they provide or by the limits they set.
When will the 99 % demand the same level of medical care as the Chief Justice? Why are they so brainwashed?
Gordon Whiteman is right. 40,000 people die prematurely because of inadequate health care. But let's look into the GOP future. Once in power, the GOP will eliminate SCHIPS, Medicaid, and the EPA. That will enable industries and power plants to fill the air and ground water with all sorts of toxic chemicals. Millions of children will become sick. Their parents will be unable to buy insurance for any price. The GOP will abolish the Emergency Treatment and Active Labor Law, signed by President Reagan in 1985, and thousands of children suffering from ashtma attacks will be left to die on guerneys outside of emergency wards throughout this country.
This is the future that the Robert Court wishes up on the US, and think! We're supposed to be a Christian country.
I myself refuse this future. I want Medicare for all. I also want to impech the conservatives on the Roberts Court.
Let's put the blame where it belongs.
P.S. Ben Nelson, the Blue Dog Democrats and the GOP all get generous campaign contributions from the health insurance industry, financed by your premiums.
if the supreme court invalidates ACA, can they roll back the parts that have already been implemented? That is, if folks have taken advantage of the parts of the law (like the 20-somethings that are now back on their parents plan where they had been booted off before due to age). Would the SCOTUS decision against ACA immediately nullify what they have?
And I sincerely hope it is!
Why should we get less than anybody on this globe while we waste trillions of dollars not approved by us. People are also against the minimum wage increase and shooting themselves in the foot and you know why, because the media is bought and paid for and people buy their explanation hook, line and sinker. That why the dumbing down of Americans is so important for the 1%ers, and it works!
Now where I work they want $ 700 from my measly paycheck before taxes of $ 2000.
Were you wearing blinders from 2001-2008?
All the provisions of the ACA won't kick in until 2014 so the insurance companies are sticking it to policy holders while they still can. They will sell you a policy but if you are on a medication or have any preexisting conditions at all, the rates are so high you can't afford it unless you are a member of the 1% class. The system is broke and everyone knows it.
I agree with others on these boards that believe providing an individual's health care for profit is wrong. We marginalize treatment or discourage/deny coverage so shareholders and investors can profit. Of course if you have $$ that doesn't concern you. The I got mine, the hell with you attitude is what some think America is all about. The good old USA is supposed to be the leader of the world and in this area we are a distant 16th according to studies published about healthcare services/cost/effectiveness in industrialized nations. Our military is second to none but our ability to take care of our citizens health sucks unless you are again, wealthy.
Thomas Jefferson in our Declaration of Independence told the world that all men are created equal. Throughout the history of our country some men have been more equal than others. Money talks and the trend continues....
What every sane person should know, whether they agree with this gentleman or not, it that if it smells like a framed argument to appear like only "rational" and "reasonable" people wouldn't agree with the legislation, it is most likely a framed argument to appear like only "rational" and "reasonable" people wouldn't agree with the legislation. More fodder for the garbage pile.
Costs have not gone down.
To prevent increases in Premiums insurers have made more less expensive plans available with Higher Deductables and bigger Co Pays.
Despite accepting lower coverage plans ($2,000 deductables, $50 Co Pays etc.) our premiums have risen from $11,000 a year for a family to over $15,000.
Prior to the plan 5% of Mass residents didn;t have coverage, today 50% of that group still don't.
Health Care costs in Massachusetts are now the second highest in the nation .