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I have studiously avoided the bobble-head punditry and columns since the Supreme Court ruled on Thursday that the Affordable Care Act is constitutional.
I was somewhat exposed to the end-of-the-world coverage on Fox News, the Republican/Tea Party propaganda outlet, while waiting in a doctor’s office, but I tried to pay scant attention to the bloviating.
Ahead of the SUPCO ruling, I found only one prominent pundit who correctly predicted that the law would be upheld and it was former Clinton administration Secretary of Labor Robert Reich writing in the Christian Science Monitor.
Those who have followed my musings on health care for the past 10 years would be surprised to know I have mixed feelings. In the main, I am glad the court upheld the law, but thought overturning the measure might give the Obama administration a chance to do a better job with the legislation.
The measure as passed is flawed on several counts. First, in putting the law together in 2010, the Obama administration caved to the pressures from the insurance and pharmaceutical industries. Add the medical device and equipment and the hospital lobbies, and the legislation wasn’t as consumer-friendly as it should have been. Further, concessions to these entities will not lower costs enough for the plans to be viable.
Then, the Obama administration failed on the opportunity to rein in some of the worst practices in the health care industry — competition and duplication of services. Back in the day, as they say, the industry benefited from comprehensive health planning and certificate-of-need programs. In short, large capital expenditures and certain services had to pass muster at the local level. The organization that wanted the service had to demonstrate community need and the request couldn’t duplicate another service unless the demand in the community justified it. These programs accepted the truth about health care economics: Health care is not “free market” and competition does not improve health care. Those who continue to push the free market model are either corporatist liars who perniciously try to undercut the right way to deliver care or are too stupid to understand the issues. I specifically include Rep. Mac Thornberry and some other Republicans and the editorial board of the Amarillo Globe-News in one or both of those categories.
Such a program would have prevented the proliferation of CAT scanners and MRIs; it would have seriously questioned and possibly prevented Baptist St. Anthony's Health System from duplicating the neonatal intensive care services at Northwest Texas Healthcare System.
The upside of the ACA is pretty clear. Denying coverage for pre-existing conditions and terminating coverage for an illness were the most scandalous, atrocious and indecent practices of insurance firms. The “individual mandate” that was so key to the SUPCO ruling was a political issue because the Obama administration failed to properly explain the denials of coverage were known as medical underwriting.
How heinous was medical underwriting?
It was, in come cases, tantamount to murder and if state legislatures and the United States Congress had any shred of decency, the chief executives and responsible managers whose decision led to the loss of life pursuant to canceled coverage should be charged with accessory to manslaughter. They should go to jail.
For community rating to work, as many lives needed to be covered as possible. That is known as community rating and, ironically, the first successful instance of that in the United States was in Waco with the birth of Blue Cross. Had the administration properly conveyed this to the public, the entire “freedom” garbage from the tea party types would have been undercut and understood by the majority of those objecting to the provision.
The provision that let children stay on their parents’ policies until age 26 was a good provision. It aided in the continuity of family care and, for those who wanted a choice between the college health services and their own doctors, this was helpful.
The most distressing result of the ruling is that the right-wing propaganda machine is hard at work spreading disinformation. Perhaps that’s being too nice. They are lying about the law. The IRS won’t have SWAT teams and the idea that people will go to jail over this law is slim, at best. But, never underestimate the power of propaganda and “The Big Lie.”
One interesting political implication of the ruling paints the right into a little corner. The friends of the Koch Brothers and the Citizens United ruling who are also the enemies of the ACA have told the left to “get over it.” Corporations are people. The Supreme Court said so. How will they handle accepting a court ruling now?
But, the most politically interesting part of the ruling was corporatist Chief Justice Roberts’ and the court’s ruling that the individual mandate is a tax. President Obama had argued that the law would impose no new taxes, but now, in a shrewdly Machiavellian move, Roberts has changed the rhetoric. Obama will have to defend this in an election year. How I would have liked to be a fly on the wall for all the SUPCO discussions. I have little doubt that this most political and least ethical of Supreme Courts would have discussed the political implications.
One thing’s for sure. This fight isn’t over.