Health Care Act on Trial

I was not happy about the Affordable Care Act when it was finally passed in 2010, after nearly two years of wrangling in Congress.

I thought President Obama had sold out, that he should have at least urged a discussion of single-payer or a public option. In the end I felt like the insurance companies had won a great victory, and I still think that. Since then I’ve tried to soothe my outrage by looking at the good points of the finished legislation: Insurance companies can’t refuse coverage because of preexisting conditions or drop you when you get sick; the “lifetime limit” on coverage is banned; kids can stay on the family health plan until age 26; seniors get help paying for their prescriptions. I told myself that, after a hundred years of inaction it was a start, and it could be improved over time.

I should have known better.

I still don’t know why there was a popular outcry against the bill. I assume it was uninformed cranks or people who just hated Obama. Why would you not want affordable health care for everybody? But then the state attorneys general got into the act, and now the Supreme Court is deliberating. Once the court challenges began I knew it would end up with the Supremes, and I was sure they would uphold it. I still think they will, but I’m no longer certain, and neither are most court watchers.

Here are two reasons why I think the law will be substantially upheld:

  • There are four right-wing extremists on the court, plus Justice Kennedy, who is pretty conservative. Their questioning during the arguments this week indicates that they are viewing this case through the most partisan of lenses. They seem to have made up their minds, and are looking for a way to strike down the law. But… like most extreme right wing politicians, they are controlled by rich people and corporate interests. They know their job: Make life better for Exxon, Halliburton and United Heath Care. Right now, this bill feeds 40 million new customers to the U.S. insurance industry. Strike down this bill and the industry would have to spend untold millions of dollars over several decades to gain that much new business, and it’s possible that they never would. I don’t think the corporatists on the court will let that happen.
  • The right wingers on the court are worried about the requirement in the bill that everyone must purchase insurance. They think it’s too much government intrusion. Fair enough, but if they invalidate the health care bill and put the nation right back where it was — near the bottom among developed nations in medical outcomes and near the top in medical spending — there will still be a health care crisis and a desperate need for reform. And version 2.0 of that reform will very likely be a single-payer system administered by the government and paid for with taxes. This would be unarguably constitutional, but a nightmare scenario for the right. I believe that someone will mention this to the conservatives on the court in the next few weeks, and that it will make them stop short of striking down the bill.

That’s what I think, anyway. But lately the right wing has become sort of unhinged. They do things based on a perceived ideological mandate rather than practical considerations of moving the nation forward. We can’t always predict what they will do. So they might shoot this down.

In the chaos that will ensue, I hope none of them sprains a wrist high-fiving each other, because there will be a long wait to get treatment at the emergency room.

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