There's an interesting, and I would argue, horrifying article on the front page of the New York Times today, about the historic upcoming arguments before the SCOTUS on the Affordable care Act. It's aptly entitled, Health Care Act Offers Roberts a Signature Case. Indeed. If I had written this, I would have called it, "Death Panel Identified, Angel of Death Outted".
We're being told that John Roberts takes his job seriously. He is a man concerned about his legacy, that an issue as consequential as the ACA comes along once in a century, and that Mr. Roberts will not cast the fifth vote to uphold the Affordable care Act, unless one of his conservative colleagues agrees to hold his hand and they do it together. This is not a joke.
The consensus among scholars and Supreme Court practitioners is that Chief Justice Roberts is unlikely to add the fifth vote to those of the four justices in the court’s liberal wing to uphold the law. But he is said to be quite likely to provide a sixth vote should one of the other more conservative justices decide to join the court’s four more liberal members.As you might imagine, the article is engendering many comments, they are instructive. Many commentors believe, as I do, that the three days of argument being allotted to the ACA, is nothing but more political theater--the fix is in, the die has been cast. The mandate is going down. This outcome is expected--the Supreme Court in its post Bush v. Gore, Citizens United iteration, has lost all legitimacy in the eyes of millions of Americans.
If the mandate falls, perhaps the balance of the law will remain intact, that's quite the quandary, the worst possible outcome, for the for-profit insurance industry. Imagine this murderous industry being required to insure all comers, and only the sick avail themselves. Rates will skyrocket to unimaginable levels, we will truly be rationing care, and only the rich need apply. This is some mess we're in, we Americans are looking down the barrel of a nasty gun.
But the shameful reality remains that every year, 44,000 of us die needlessly, because as a nation, we accept that healthcare is a privilege not a right.
Healthcare in the United States is a privilege by two very clear metrics. One, it's only available to those of us who have jobs which still provide some semblance of employer health benefits. For those of us who are self-employed, or work for an employer who does not provide benefits, we must fend for ourselves in the merciless individual market. In all but six states, if you are not perfectly healthy, you can and will be denied coverage or the rates are so exorbitant, that you are priced out. The Affordable care Act is attempting to remedy this grievous injustice.
The second metric of who lives and who dies in this glorious country, is can you pay for health insurance? This is called healthcare rationing by ability to pay. The Affordable Care Act is offering some very modest subsidies, so more Americans can afford these private, for-profit junk products. Indeed, the ACA is better than nothing, and let's be frank among friends, it is a Heritage Foundation bill given to us by the Democratic Party. That said, it will mean the difference between life and death for millions of Americans.
The New York Times piece is dispassionate as all good journalism should be, and fails to note entirely the life and death nature of what is to transpire. Make no mistake, what we're about to witness is the judicial branch of the government of the United States about to decide whether a huge number of Americans will live or die.
Most of us who have worked tirelessly for many years on healthcare reform, recognize the huge problems with this legislation. That said, if the Court rules the mandate unconstitutional, as a nation, we have condemned millions to unspeakable brutality. The brutality of becoming sick and not having the right to healthcare. The brutality of living in what we're told is a First World nation, which regards the delivery of basic healthcare as a commodity which for-profit corporations can legally price at levels that makes it unavailable for all but the wealthy.
My dear friend Wendell Potter believes that the outcome most desired by the insurance corporations is that the mandate stands, and then the insurers go about weakening at every bend in the road any and all regulation. The worst possible outcome for the American people, naturally, is that we are all required to buy private, for-profit junk insurance with little or no meaningful regulations.
Here’s the reality. The provision of Obamacare at the heart of the constitutional challenge — the requirement that all Americans will have to buy health insurance if they’re not eligible for a public plan like Medicare or Medicaid — is a “must have” for the nation’s health insurance industry.The Commonwealth Fund has a new report about how the ACA will restore some fairness to the US healthcare system. And finally if the mandate falls but the rest of the law remains viable,here are some possible ways that Congress might patch together a viable alternative to the much maligned mandate.. . .Even if their employers continue to offer coverage, more and more workers are taking a pass because they can’t afford their share of the premiums. This, plus the fact that insurers have refused to sell coverage to people with preexisting conditions, explains why the number of Americans without coverage now exceeds 50 million.
Insurers have continued to be profitable, but those profits will soon start to decline sharply because of another penny-wise but pound-foolish practice — shifting more and more of the cost of care from them to us by moving us into high-deductible policies. Absent a mandate requiring that we purchase coverage, more and more of us will come to realize that these policies are not worth the premiums we have to pay for them.
. . .So while the justices farthest to the right undoubtedly will vote to strike down the law for ideological reasons, the more pragmatic Justice Kennedy will recognize that the future of the free-market health insurance system rests completely on his shoulders. I believe he’ll also realize that by declaring the mandate (and the entire law) constitutional, he not only will be saving the Republicans from themselves, he will be giving them a terrific gift. They’ll be able to campaign with renewed (but insincere) vigor against Obamacare, arguing that it must be repealed. I say insincere because conservative candidates will want to keep their benefactors in the insurance industry happy after the 2012 elections. They’re not serious about repealing the entire law — just the parts insurers don’t like. And with Kennedy’s affirmative vote, the insurers will have what they need — billions in federal subsidies to help Americans pay for the coverage the government says they must buy.
The bottom line remains. As a nation we are turning ourselves inside out, to prop up an unsustainable for-profit system. The reason for this is quite simple.It's because the insurance industry funnels huge amounts of money to politicians of both political parties. When the insurers tell the politicians taking all their money to 'jump', the politicians ask, 'how high?' And this is why you get legislation like the Affordable Care Act which codifies the primacy of the for-profit insurance industry into the heart f our 'reformed' healthcare system.
Shhh, don't tell Mr. Roberts this, but for-profit healthcare is unsustainable. Americans pay way, way more than any other country and our outcomes are way worse. Oh and did I mention that we have 55 million uninsured.