An “Inevitable Overhaul”: A Stronger Prescription For What Ails Health Care
In arguments before the Supreme Court this week, the Obama administration might have done just enough to keep the Affordable Care Act from being ruled unconstitutional. Those who believe in limited government had better hope so, at least.
If Obamacare is struck down, the short-term implications are uncertain. Conservatives may be buoyed by an election-year victory; progressives may be energized by a ruling that looks more political than substantive. The long-term consequences, however, are obvious: Sooner or later, a much more far-reaching overhaul of the health-care system will be inevitable.
To say the least, the three days of oral argument before the high court did not unfold the way many experts had expected. Confident predictions that the administration would prevail by a lopsided margin became inoperative as soon as the justices began pummeling Solicitor General Donald Verrilli with pointed questions.
At one point Wednesday, as the barrage was winding down, Chief Justice John Roberts told Verrilli he could have an extra 15 minutes to argue a point. Verrilli replied, “Lucky me.”
In the end, however, Verrilli gave the skeptical justices what they were looking for: a limiting principle that allows them, should they choose, to defer to Congress and uphold the law.
At the heart of the legislation is the requirement that individuals purchase health insurance or pay a fine. It became clear by their questioning that the court’s five conservatives — including Justice Anthony Kennedy, the swing vote who sometimes crosses the ideological divide and votes with the liberals — see this mandate as a significant expansion of the federal government’s reach and authority.
Verrilli argued that the mandate is permissible under the clause of the Constitution giving the government the power to regulate interstate commerce. Justices demanded a limiting principle: Where does this authority end? If the government can compel a citizen to buy health insurance, why can’t it compel the purchase of other things?
Justice Antonin Scalia raised the specter of an all-powerful government that could even “make people buy broccoli” if it wished. Scalia’s mind seemed to be made up, but Kennedy seemed to be genuinely looking for a principle that permitted a health insurance mandate but not a broccoli mandate.
And Verrilli gave him one. The market for health insurance is inseparable from the market for health care, he argued, and every citizen is a consumer of health care. Those who choose not to buy health insurance require health care anyway — often expensive care at hospital emergency rooms — and these costs are borne by the rest of us in the form of higher premiums.
I think Verrilli made his case. The court is supposed to begin with the assumption that laws passed by Congress are constitutional. Justices don’t have to like the Affordable Care Act in order to decide that it should remain in effect. If some members of the court think they could do better, maybe they should quit and run for legislative office.
But it’s going to be a close call. What if they strike down the law?
The immediate impact will be the human toll. More than 30 million uninsured Americans who would have obtained coverage under Obamacare will be bereft. Other provisions of the law, such as forbidding insurance companies to deny coverage based on preexisting conditions and allowing young adults to remain on their parents’ policies, presumably would also be invalidated; if not, they would have to be modified to keep insurance rates from climbing sharply. The United States would remain the only wealthy industrialized country where getting sick can mean going bankrupt.
Eventually, however, our health-care system will be restructured. It has to be. The current fee-for-service paradigm, with doctors and hospitals being paid through for-profit insurance companies, is needlessly inefficient and ruinously expensive.
When people talk about out-of-control government spending, they’re really talking about rising medical costs that far outpace any conceivable rate of economic growth. The conservative solution — shift those costs to the consumer — is no solution at all.
Our only choice is to try to hold the costs down. President Obama tried to make a start with a modest approach that works through the current system. If this doesn’t pass constitutional muster, the obvious alternative is to emulate other industrialized nations that deliver equal or better health-care outcomes for half the cost.
I’m talking about a single-payer health-care system. If the Supreme Court strikes down Obamacare, a single-payer system will go from being politically impossible to being, in the long run, fiscally inevitable.
By: Eugene Robinson, Opinion Writer, The Washington Post, March 29, 20122
“On The Government Dole”: The Supreme Court And The GOP’s Healthcare Hypocrisy
There’s always hypocrisy in Washington but past and present Republican presidential candidates have used the debate on healthcare to take it to heights unimaginable even in the nation’s capital. This week the Supreme Court heard arguments on the Affordable Care Act and the GOP tried again to cripple Medicare, the federal health insurance program for seniors.
What do Rep. Michele Bachmann, former House Speaker Newt Gingrich, former Sen. Rick Santorum, and Rep. Ron Paul have in common? They were or are candidates for the 2012 GOP presidential nomination. They all oppose the Affordable Care Act, and they’re all hypocrites. Michele Bachmann feels so strongly about the law that she has been present in the Supreme Court during the oral arguments this week. Rick Santorum is so hostile to the Affordable Care Act that he took time away from the campaign trail to appear on the steps of the Supreme Court building on the first day of arguments. But Bachmann still enjoys the benefits of the gold plated federal healthcare insurance for members of Congress. Rick Santorum enjoyed the same government health benefits when he was a senator.
All of them say they oppose the Affordable Care Act because they claim it is “government run healthcare.” But don’t panic, because they’re wrong. Since President Obama decided not to fight for a single payer plan or even for the public option, healthcare is still in the deadly clutches of the insurance companies.
Even if the Republicans candidates were right, they have some nerve even making the argument. While they all criticize government run healthcare and Medicare, as members of Congress they took full advantage of the gold plated healthcare insurance provided by the United States government. What the Republicans are really saying is that government run healthcare is fine for them but too good for working families. Since Michele Bachmann and Ron Paul are still members of Congress, they could easily refuse their government run healthcare insurance and go into the private market like everybody else. But don’t hold your breath waiting for them to opt out. Bachmann and Paul are still on the government dole, and so are all the others members of Congress who opposed the Affordable Care Act. Hypocrites all.
Then there’s former governor and former liberal Mitt Romney who also has been very critical of the mandate in the new federal health insurance law. But the healthcare reform bill that he signed into law in Massachusetts has the same government mandate for everyone to have health insurance that is in the Affordable Care Act. After the reform bill became law in the Bay State, Romney said it was a model for the rest of the nation. Well he was right. Romneycare became Obamacare.
It’s not really surprising that Romney supported the insurance mandate in Massachusetts. The mandate was originally a Republican idea. Even Newt Gingrich supported the mandate in the 1990s. Republicans felt that people who didn’t buy health insurance were freeloaders. When people who don’t have health insurance are hurt or get sick, they go to emergency rooms and hospitals bill the taxpayers for the cost of treatment. The idea is that uninsured people should take financial responsibility for their own actions. That sounds pretty conservative to me, but it’s still a good idea.
So why do politicians like Romney and Gingrich oppose the mandate after they supported it. They thought it was a great idea when conservative think tanks developed it, but once a Democratic president used their idea in his bill, it became radioactive.
Rick Santorum is right about one thing. Mitt Romney will have a lot of trouble trying to explain why his mandate was such a good idea and why the president’s mandate is such a bad idea.
By: Brad Bannon, U. S. News and World Report, March 29, 2012
“Don’t Pick Out Hymns For Its Burial”: Still Plenty To Watch For In Health Care Debate
I have a few quick thoughts on this week’s Supreme Court hearings and what it will mean for our coverage of health reform.
Most people in the courtroom (or people who, like me, listened to audio, read transcripts, wrote and edited a ton of copy and couldn’t avoid Jeff Toobin) ended up with the gut feeling that health reform is in deep trouble – that the court is likely to toss the individual mandate, some of the insurance provisions, and maybe a whole lot more. Maybe all of it.
But of course, we don’t really know what the court will do. Tough questions in public certainly let us know that all nine justices are not exactly the law’s biggest boosters. But what they will do, as they mull and debate behind closed doors, is not a sure thing. We can guess, but we don’t know. And we won’t know for about three months. (There’s a chance that it will be sooner – but traditionally big rulings come out at the end of the term. And this is a big, big ruling).
Remember the “Conventional Wisdom” was wrong before – wrong from the beginning. The CW didn’t think Obama was going to push for comprehensive health reform. The CW didn’t think he’d be able to enact health reform – particularly not after Scott Brown’s election. The conventional wisdom didn’t think there would be a fight about the mandate. Or that the mandate would end up in the Supreme Court. Or that it would be in deep, deep, deep trouble once it got there.
So what do we do for the next three months?
First of all, we are going to get spun – and the negativity about the oral arguments is going to help the anti-health law camp of spinners. (The “hey it’s hunky-dory, it’s all fine” advocacy world rings a little hollow at the moment – although they may turn out in June to be right.) Keep an eye out for that “the law is dead so let’s get real” drumbeat because if things are said often enough, in a media or political context, they can start becoming the new conventional wisdom and affecting how we report and write.
We might get pushed by editors to be more forceful about predicting the demise of the law (or the mandate) than we are comfortable with. Push back – you can certainly say there are real questions about the law’s survival. You can’t pick out hymns for its burial.
Watch your state. Are officials slowing down implementation? Not submitting grant applications for exchange planning when they were before, or not putting out bids for exchange IT teams, etc.? Are the implementers slowing down – and are the non-implementers freezing? How much catching up will they have to do if the statute is upheld – and they have to meet some exchange certification deadlines by Jan. 1, 2013.
Is the court situation affecting state politics – local, congressional, presidential. How?
Is anyone talking about state initiatives to fill in if the parts of the federal plan are punctured? For instance, if the federal mandate fails, there’s nothing to stop a state from passing its own mandate; the federal constitutional questions don’t apply. I suspect few states will do this – but I can think of a handful that might. (If this does start to bubble up in your state, please email me your coverage.)
What are the hospitals’ and insurers’ and physician groups’ contingency plans? Are delivery system reforms and innovations on hold – or is the assumption that they can either proceed without the federal law, or that the relevant sections of the law will survive
And does the public know what it wished for? It wanted health reform when it didn’t have it. Then it decided it didn’t like health reform when it got it. Do Americans really want to go back to March 22, 2010 (the day before President Obama signed it)? And do they realize they can’t; that the health system has changed? Do they understand that people who are getting benefits under the first phases of the law’s implementation could lose them? And that costs will rise, the numbers of uninsured (now somewhere around 50 million) will rise, and Congress – so polarized that it has trouble doing much more than renaming post offices these days – is not going to come swooping in with a pain-free bipartisan fix-the-problems-with-no-cost-or-dislocation make-everyone-happy solution.
By: Joanne Kenen, Association of Health Care Journalists, March 29, 2012
“Mitt’s Q-Tip”: Appeal Helps Obama No Matter What The Supreme Court Decides
Irony alert — President Obama gets a boost no matter what the Supreme Court decides on his politically toxic healthcare reform law.
The high court either upholds Obama’s signature domestic accomplishment, imprinting it for history, or it overturns the law, thereby breaking a big stick with which the GOP planned to beat Obama this fall. Should front-runner Mitt Romney become the GOP nominee, what’s left of the stick would more likely resemble a Q-Tip.
Although a final ruling is nearly four months away, oral arguments at the Supreme Court on Tuesday called into question the constitutionality of a mandate to purchase insurance. But recall that four years ago, then-Sen. Barack Obama opposed a mandate for the purchase of healthcare insurance when he was running against Hillary Clinton in the Democratic primary. Four years ago, Romney, on the other hand, admitted his support for mandates.
Obama ultimately changed his mind, and followed the example then-Gov. Romney had set when he signed healthcare reform into law in Massachusetts in 2006. Both men concluded that conservative think tank Heritage Foundation was correct decades ago in deciding there was no way, without a mandate to buy coverage, to control prices or to protect the taxpayer from uninsured free riders who leech off the government every time they go to the emergency room.
While Romney could control the choice to build elevators for his cars at the beach house he is building in California, he could not control the fact that Obama changed his mind on the mandate, that his law evoked a visceral reaction from the GOP base or that Newt Gingrich and every other conservative who had supported the mandate earlier would flip from the concept and run. Romney, who started running for president in 2006 or earlier as the conservative alternative to John McCain, chose to run after them. Romney tried pivoting by claiming he never intended it to become a national model, yet a Google search proves that effectively false.
Fortunately for Romney, it hasn’t been that tough to keep his stride. Republicans seeking to defeat him in the primary campaign failed miserably to use the best weapon against him — he was given a pass on RomneyCare. But no more. Romney can be sure the Obama campaign will possess the discipline Rick Santorum did not and won’t be distracted from healthcare by messages that send female voters running for the hills. Obama the candidate surely won’t display any weakness or kindness to his rival, or whatever it was that caused former Minnesota GOP Gov. Tim Pawlenty to retreat from his planned attack on “ObamneyCare” and basically kill off his own candidacy for good.
Democratic strategist James Carville said on CNN that the prospect of the healthcare law being overturned might be the best political outcome for Democrats and Obama.
“I honestly believe — this is not spin — I think that this will be the best thing to ever happen to the Democratic Party, because healthcare costs will escalate unbelievably … the Republican Party will own the healthcare system for the foreseeable future.”
Unbelievably cynical. But Senate Majority Leader Harry Reid (D-Nev.) made the same point almost immediately.
Should ObamaCare be stricken, congressional Republicans will be free to paint the president and his party as socialists who passed a partisan, unpopular, unprecedented intrusion of government into the private sector and ultimately had to be stopped by the Supreme Court from destroying liberty in the United States for all time.
Romney might not want to, as it will only invite attacks on his ambiguous record of supporting insurance mandates. He will probably want to stick to the economy instead, and to hunt for some other sticks.
By: A. B. Stoddard, Associate Editor, The Hill, March 28, 2012
“At The Heart Of An Ideology”: Republicans Are Causing A Moral Crisis In America
There is moral crisis afoot! So say the Republican candidates for president, their pals in Congress and in state houses. Abortion, gay marriage, contraception— contraception, for Pete’s sake — things that so shock the conscience that it’s a wonder The Washington Post can even print the words!
Here’s something I bet you wouldn’t think I’d say: They’re right. There is a moral crisis in the United States. The only thing is — they’re wrong about what it is and who is causing it.
The real crisis of public morality in the United States doesn’t lie in the private decisions Americans make in their lives or their bedrooms; it lies at the heart of an ideology — and a set of policies — that the right-wing has used to batter and browbeat their fellow Americans.
They dress these policies up sometimes, give them catchy titles like Rep. Paul Ryan’s “Path to Prosperity.” But they never cease to imbue them with the kind of moral decisions that ought to make anyone furious. Ryan’s latest budget really is case in point. It’s a plan that says that increases in defense spending are so essential, that massive tax cuts for the wealthy are so necessary, that we must pay for them by ripping a hole in the social safety net. The poor need Medicaid to pay for medicine and treatment for their families? We care, we really do, but the wealthy need tax cuts more. Food stamps the only thing standing between your children and starvation? Listen, we feel your pain. We get it. But we’ve got more important things to spend money on. Like a new yacht for that guy who only has one yacht.
It’s hard to point to a single priority of the Republican Party these days that isn’t steeped in moral failing while being dressed up in moral righteousness. This week, for example, they are hoping the Supreme Court will be persuaded by radical (and ridiculous) constitutional arguments to throw out some or all of the Affordable Care Act. Sure, you could argue that it’s really nice to make sure 31 million people who didn’t have health care can get it. Sure you could make the case that lifetime limits are a bad thing, that women shouldn’t have to pay more for health insurance just because they’re women, that the United States shouldn’t be a country where you die because you lost your coverage when you lost your job. But then again, liberty. Let’s not forget liberty. Also, freedom.
It is a very strange thing that the people who lecture most fervently about morality are those who are most willing to fight for policies that are so immoral. They watch Wall Street turn itself into the Las Vegas strip, take the economy down and destroy people’s lives and livelihoods. To that they say, “By God we need less regulation. Get me the hose, I have things to water down!” They see a CEO of a bank or a corporation, someone who passed off all of the risk and took on all of the reward, and they say, “Get that man a bigger bonus! In fact, get him two!”
They see corporate interests flood the political system with unfathomably large sums of money, they see lobbyists defining the terms of debate, and they say, “Now this . . . this is what democracy should look like.”
They see an environmental crisis spinning out of control, the effects of climate change being felt already, the possibility of the biggest natural disaster in modern human history. To which they ask, “Anyone know if we can drill this hole any deeper?”
So yes, Rick Santorum. Yes, Mitt Romney. Yes, Paul Ryan and Republican politicians all over this nation. You are right, as right as you’ve ever been. There is a moral crisis in this country. A horrifyingly, back-breaking, bankrupt-the-core-of-this-nation style crisis. But it isn’t women or the poor or the middle class or the gay community or health-care advocates or environmentalists that are causing it.
It’s you.
By: Katrina vanden Heuvel, Opinion Writer, The Washington Post, March 27, 2012
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