Friday, June 29, 2012

Obamacare Upheld: Why This Bill is Better than You Think

On Thursday, the Supreme Court handed down one of its most important decisions in recent memory. In a stunning 5-4 vote, they elected to uphold the Affordable Care Act, which has been arguably the biggest piece of legislation that President Barack Obama has helped shepherd through Congress.

The bill, controversial thanks to many provisions including the requirement that all individuals buy health insurance or suffer fines, was saved by a vote from Chief Justice John Roberts, a conservative appointed by President George W. Bush who stunned observers by changing his vote at the last minute.

I have quite a few reactions to this bill, but we’ll start with the fact that Roberts ended up siding with the four liberal judges on the Court in upholding the law. Many conservatives today are crying “BETRAYAL” at the fact that Justice Roberts ended up siding with the left side of the Court, and although I do not share their anger, I do share their utter surprise.

Roberts came into the Court as a noted conservative jurist with some serious views on freedom that definitely caused me to think of his vote as safely on the side of overturning the individual mandate. The revelation that he cast the deciding vote has been argued in many different ways, but from my perspective, there is a simple reason that he ended up supporting the bill: to protect his Court from being lumped in with the other “activist” courts like the Warren Court and Burger Courts of the 1960’s and 70’s.

Conservatives frequently rail against those type of judicial bodies, saying that they are taking steps beyond the Constitution to invent freedoms out of thin air. Cases like Miranda vs. Arizona and Roe vs. Wade were hallmark decisions passed by those Courts, but as the Court has shifted to the right, there has been a bit of hesitation to do anything quite that Earth-moving.

In this case, Roberts was likely convinced to uphold the measure despite his probable objection to the individual mandate because he did not feel it was the Court’s responsibility to overturn an act of Congress unless there was clear Constitutional grounds to do so. He deftly avoided politics as a reasoning behind his decision, saying essentially that the Court is not responsible for subverting the will of those representatives that the American people elect, and while this deflection of responsibility was probably met with chagrin on the right side of the aisle, as an avowed left-winger I fully embrace his views on the subject.

The truth of the matter is that I have not agreed with every decision that the Court has passed down while Roberts has been the Chief Justice. Biggest among those cases I oppose is the decision reached in the Citizens’ United case, which found that corporations should have the same right to free speech as individuals, and therefore can donate any sum of money that they choose to whatever cause they deem necessary. This has given rise to super-PAC’s founded by the likes of the Koch Brothers and others who have pumped more dark money into our democracy than even the Justices could have anticipated, and with examples like Scott Walker outraising his opponent in the Wisconsin recall election by a 10 to 1 margin, we have already seen just how much impact money can have on elections in these quantities.

With that being said, I am also a firm believe r in the notion of respecting the Court’s decisions whether I agree with them or not. I believe that firm dissent is the right of every American citizen, but there also needs to be an appropriate level of respect levied towards the Supreme Court. The fact that people like Senator Rand Paul of Kentucky have made comments disparaging the Court and suggesting that their power to judicial review is some kind of farce are absolutely ludicrous. His insinuation that just because the Justices found the law Constitutional doesn’t mean that it actually is sounds like a bunch of sour grapes from an elected official who should have more class and decency than that, and it begs the question of just how critical he would be of the Court’s powers of review gleaned from the Marbury vs. Madison decision if Roberts had struck down the entire health care law.

Speaking of folks who are opposed to the bill, presidential candidate Mitt Romney reiterated his opposition to the law on Thursday, saying that the only way that America is going to move forward on healthcare is to “repeal and replace” Obamacare. While this looks great on a bumper sticker (alliterative and easy to remember is pretty much a win-win), the reality is that as Americans tune back in to the Presidential race after the summer ends, he is going to quietly move away from this topic, but the President’s re-election campaign would be well advised not to let him.

There is no outrunning the truth that Mr. Romney’s law in Massachusetts was the inspiration to the current health care law, right down to the individual mandate. If the American voting public has taught us anything in these last few elections, it’s this: there are two things that they cannot tolerate, which is a potential leader who is out of touch with their concerns, and one that flip-flops on issues.

John Kerry in 2004 was felled by his waffling on issues like the war in Iraq, and in 2008, John McCain was felled largely because of foolish comments like “the fundamentals  of our economy are strong” and his failure to remember how many houses he owns. If there was a candidate that the Democrats could have drawn up that better embodies both of these characteristics, it would most closely resemble Governor Romney.

This notion that he was for the individual mandate before he was against it has got to be something that the Obama campaign hammers home. Just because his party swung to the right does not mean that Romney should be given a free pass to do so, especially if he is going to be so overtly critical of the President’s policies on health care. No matter how hard he tries to run away, the Obama campaign has to keep whacking him with this mallet.

In addition to keeping him accountable for coming up with this whole idea in the first place, Romney also needs to be questioned harder about his repeal and replace stance on the law. The repealing part of it is pretty easy to see happening if Republicans gain the White House and majorities in both the Senate and House, but the replacing part of it is another matter altogether. In my eyes, there are three main options that the Romney administration would have:

-A return to the status quo as of now, where insurers can reject people based on pre-existing conditions and place lifetime caps on insurance claims, in addition to getting rid of the mandate so people can continue to live without insurance.

-Adding a public option to the proceedings to make the mandate more palatable, which would turn off a lot of conservatives and some liberals because of how far to the left that idea is on the political spectrum.

-Gutting Medicare and Medicaid and privatizing everything, which would infuriate not only Democratic official but would spell complete and total doom for the Republicans among the AARP-generation, which still holds a huge amount of sway in the proceedings.

None of those three options is anything better than sheer political poison, so Romney would have to come up with something more creative than that if we were to take him seriously on his promise to replace the ACA. Perhaps the most likely creative alternative would be to keep the laws in place that prevent insurance companies from issuing coverage caps and compel them to insure even folks with pre-existing conditions, but to get rid of the individual mandate.

This idea seems like a good idea on its surface, but it glosses over what the entire purpose of the individual mandate is, which is to help keep costs from continuing to spiral out of control. In theory, the way it would do so would be to cause more people to carry health insurance, and therefore to stop rushing to the ER every time they have a cold, and then skipping out on their hospital bill, thus driving up the price on the rest of us who actually are covered by insurance. By getting more people to buy into the system, the insurance companies can keep premiums at a steady pace or even lower them, and it was that type of deal that led the companies to sign off on the healthcare law in the first place.

The individual mandate is not a perfect idea. In fact, in the interests of intellectual honesty, most liberals have been opposed to that idea since the 1940’s when health care for all started to become something that politicians were pushing for. It was originally a Republican idea, and one that was argued for emphatically by those on the right during times like the 1994 debate on health care reform, all the way up to Romneycare being instituted in Massachusetts during his administration as governor. Democrats were usually opposed to this idea because of the impact it would have on families who could barely afford to keep roofs over their heads, much less afford a monthly insurance premium on top of it, and even President Obama was opposed to the idea when he ran for office in 2008.

The thing that really changed liberal’s tune on this subject was the fact that it was the only way to get insurance companies to change their policies to be more inclusive of everyone. Seeing that opening made their dreams of health reform a reality, and they jumped at the deal. Modern Republicans, obsessed with courting the Tea Party movement amid their calls for fewer taxes, immediately seized on the idea as a tax, and were opposed to it in line with their further right sentiments.

The reality of this situation is that the individual mandate is needed so long as our country relies on private insurance to help take care of us. We have to be able to take steps like this that have the potential to lower costs for everyone, and the idea of a shared burden is about as American as you can get, despite calls of “communism” that seem to rain down at every inference of such a spirit of cooperation. The President and the Democrats who crafted the bill made sure that there was an expansion of Medicaid (a government program similar to Medicare that helps cover families at or below the poverty line), as well as creating subsidies that would help families who didn’t qualify for Medicaid to afford their insurance premiums. In many cases, these subsidies would cover all of their premiums, but there would still be some folks who will suffer because of this mandate.

Even though they will be forced to pay some out of pocket for this new insurance coverage, those folks who are going to be hit by this need to remember one key thing. If they or a loved one were to contract a disease like cancer, their entire financial life would be completely destroyed if they didn’t have health insurance. They would likely go bankrupt in the process, and all of their worries about not having enough money because of that monthly premium would be for naught.

In addition, if they were fortunate enough to have insurance before the ACA was passed, there would be a lifetime cap that they could feasibly hit before their treatment was completed, and they would either have to pay out of pocket or watch as they, or a loved one, succumbed to the disease because of a lack of funds.
Both of these scenarios are prevented by the ACA, and with the subsidies involved in helping obtain insurance, as well as the requirement for businesses of more than 50 employees to carry a health insurance plan, this is a lot more doable than some on the right side of the aisle would have you believe. This isn’t a bill just designed to eat up your tax dollars. It is a bill to encourage people to live healthier lives by getting screenings to detect disease before they turn into dollar-eating monsters, and most importantly, it should help lower the cost for all of us without turning our doctors into lower-paid serfs with no incentive to do a good job.

That, perhaps more than anything else during the debate over health care reform, is the biggest issue supporters of the law have faced. There are STILL people who have the ridiculous notion stuck in their heads that there is a death panel somewhere out there who will tell them that their elderly grandmother will not be able to get a life saving operation because the cost benefit is too low. That could not be further from the truth, as the bill specifically forbids rationing of health care, or prevents spending money on someone because of their age.

There are also folks who view this as a first step toward socialized medicine, but the reality is that the socialized medicine this country does have is actually quite popular. Medicare is something that senior citizens have been zealously trying to protect ever since it came out, and Medicaid is the same way. Private insurance companies will never sign off on becoming wards of the state in a socialized medicine form of health care, so all of this posturing by right wingers that this is an insidious plot is patently absurd and should be ignored.

Perhaps most importantly of all, we need to make sure that we aren’t jumping the gun and drawing conclusions about what exactly this bill is going to do before it even takes effect. Most of the provisions of the bill do not take effect until 2014, and the ones that have become law have met some very solid support. Letting kids stay on their parents’ insurance plans until they are 26 years old and in school has been a resounding success, and has resulted in some very good reviews for that part of the law.
Insurance companies are also adopting particular parts of the bill concerning eliminating caps and preexisting conditions, as well as encouraging people to get preventative screenings for diabetes and other diseases even before those things are mandated by law.

This all plays back into the notion that when the bill is looked at in its individual components, they are all quite popular, with the exception of the individual mandate. Looked at as a whole, there is still a great deal of skepticism, largely because of the right’s aggressive campaign against the bill.

As the provisions start becoming active, we will have a clearer picture of the impact it is having on the American people, positive or negative. If things work out and the bill lowers costs like it was designed to do, then it will mark an important milestone in the mission of this country to improve its care for its citizens. If it doesn’t, then we can always go back to the drawing board, because that is the best thing about our democracy: we have the power to change whatever we want whenever we want.

All that matters in situations like this is that people display a little bit of patience, and a little bit of a desire to take the terrible things that they hear with a grain of salt. This bill isn’t the end all be all of the American people, and I encourage all of you to take a deep breath before writing your next missive about how this tax will be the death of us all. 

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