As much as I sympathize with their
goals, I find that hard to believe that a single payer health care
system will make its way through Congress in the near future, even in
the unlikely event that a re-elected President Obama were to support
it. If he didn't have the votes to support even a public option
in early 2010, when the Jackasses controlled the House and had a
veto-proof majority in the Senate, what are his chances of passing
an all public system in 2013? And how will an overturning of the act by the
Supremes affect Obama's chances of re-election? Are you ready for
the endless barrage of super PAC-financed TV ads reminding
voters that Obama's “signature accomplishment” has been rejected
by the courts?
The public also wants the ACA to be
overturned. According to a New York Times poll, 29% want the Supremes to overturn the individual mandate, which requires all
Americans to purchase health insurance, and another 38% want them to
overturn the entire law. After three days of debate, it looks as
though they will get their wish. This morning's Washington Post reports that the Supremes “may be on the brink of a major
redefinition of the federal government's power.”
Justices on the
right of the deeply divided court appear at least open to declaring
the heart of the overhaul unconstitutional, voiding the rest of the
2,700-page law and even scrapping the underpinnings of Medicaid, a
federal-state partnership that has existed for nearly 50 years.
Of course, you can never predict the Supremes' decision solely on the basis of oral arguments. But if you doubt that they are
seriously considering it, remember that they spent 1.5 hours Wednesday discussing what
should happen to the rest of the ACA if—or is it when?—the
individual mandate is overturned.
This is not a game. With all its
flaws, the ACA extends health insurance to 32 million people not
previously covered. Without that coverage, we return to a status quo
in which 45,000 Americans die every year from lack of health
insurance. The Elephants don't have an alternative plan. Their plan
B is to “let them die.”
I can point you to a serious article
giving at least three constitutional bases for the ACA, but in fact,
it's a no-brainer. John Cassidy has referred to this legal case as a
“bad joke.” Robert Parry refers to the justices as “clowns.”
Who could possibly believe that Congress has no right under the
Commerce Clause to regulate the health care, an industry which
accounts for 17.6% of GDP? In 2005, Justice Scalia wrote a concurring opinion in Gonzales v. Raich, in which argued he that the
Commerce Clause gave government the right to prohibit the sale of
medical marijuana. I don't know what percentage of the nation's
health care dollars are spent on medical marijuana. Let's say it's
about one-tenth of 1%. Are the conservative justices saying that the
sale of medical marijuana is important enough to affect interstate
commerce, but the entire health care industry is not? Seriously?!? It's hard to see this as
anything but a farce.
In my opinion, all the verbal
jousting going on this week is intended to mystify the public and give judicial cover to the five conservative
justices, so they can do what they intended all along:
Help the Elephant Party to ensure that Barack Obama will be a
one-term president whose four years in office are remembered as a
failure. This should not be unexpected. Previous lineups of the
Supremes have already allowed politics to trump both the Constitution
and legal precedent.
This brings us to the Supreme irony of
Obamacare. It appears that the ACA will be destroyed by the
individual mandate—an Elephant proposal that Obama was initially
reluctant to accept, and that he agreed to in order to save our
privatized health care system from the threat of single payer.
During the 2008 campaign, Obama opposed
the individual mandate, which Hilary Clinton supported, because he
knew it would be perceived as a restriction of individual freedom and
there would be a backlash. Why did Obama eventually agree to include
something as unpopular as the individual mandate? Basically, it was
to save the private health insurance companies.
Insurance companies make money by
covering healthy people and denying coverage to those who are sick—or
refusing to pay the medical bills of their clients who get sick.
That means that in this country, if you develop a serious illness,
you are for all practical purposes uninsurable. Americans in this
unfortunate situation either become dependent on some sort of public
program, die sooner than they otherwise would, or both.
To avoid this, you could require the
insurance companies to insure everyone (called guaranteed issue).
But if they are forced to cover sick people, they will charge them
an amount that most of them can't afford. To avoid this, you could
require the insurance companies to charge everyone the same amount
regardless of their prior medical history (called community
rating). But if you have both guaranteed issue and community
rating, there is no logical reason for healthy people to purchase
insurance. They can simply wait until they get sick, confident that
the insurance companies will have to cover them at an affordable
rate. This is known as adverse selection—the tendency for
people who buy health insurance voluntarily to be less healthy than
the general population. This causes insurance company profits to go
down, rates to go up for everyone, and eventually the entire system
descends into chaos. To avoid this, you have to require everyone to
buy insurance—the individual mandate. This ensures that
there are enough healthy people in the system to spread the risk and
make insurance affordable for all.
But there's another way. You could
simply bypass the insurance companies. Collect the money that people
would otherwise pay for insurance premiums up front as taxes and use
it to insure everyone. In other words, you could establish a single
payer system. This is how social security and Medicare are financed.
It would be politically difficult to argue that they are
unconstitutional (although some of the arguments currently being
advanced against the individual mandate imply that they are).
This irony at the heart of Obama's dilemma was not lost on at least one of the Supremes, Justice Ruth Ginsberg, who noted on Tuesday that:
There's something very odd about that, that the government can take over the whole thing and we all say, oh, yes, that's fine, but if the government wants to preserve private insurance, it can't do that.
Of course, single payer would eliminate the health
insurance business. But that's exactly what we should do!
Health insurance consumes about 20% of medical spending and provides
no useful service in return. It's a giant parasite that sucks up our
resources, even as it adds additional misery to the lives of some of
our sickest citizens. Eliminating that 20% surcharge virtually
guarantees that the extra amount people pay in taxes for single payer
will be less than they are currently paying for health insurance.
(That's not the only way single payer
will save money. Single payer will give the government the
bargaining power to negotiate lower prices for prescription drugs and
to rein in the exhorbitant fees paid to doctors and hospitals.
Needless to say, big pharma and the for-profit hospitals oppose it
too.)
So why couldn't Obama propose a single
payer health care system? As the media put it, single payer was “not
politically feasible.” That's media-speak for a proposal that is
favored by the majority of the American people, but opposed by the
“corporate persons” who finance our political campaigns. And in
a political system that's basically just legalized bribery, those
who finance the campaigns are the only ones who really matter. The
richest 1% not only bought and paid for Obama, but most of Congress
as well. Had he proposed single payer, he would have faced
opposition not only from the Elephants but also from the majority of
his fellow Jackasses.
The individual
mandate was a conservative idea that President Barack Obama adopted
to preserve the private market in health insurance rather than move
toward a government-financed single-payer system. What he got back
from conservatives was not gratitude but charges of socialism—for
adopting their own proposal.
No matter how often he kisses their
behinds, the 1% will never accept the legitimacy of Obama's
presidency.
Give some credit to the conservative
propaganda apparatus. They have successfully framed the individual
mandate, the central issue of the debate, as an attack on personal
freedom. “The government is trying to force you to buy health
insurance.” This is reinforced by a series of wildly implausible
slippery slope arguments. “If the government can force you to buy
health insurance, then it can also force you to buy broccoli, or a
cell phone, or gay pornography!” (Naturally, such proposals are
likely to sail through Congress with little dissent.) An American
public that lacks the ability or motivation to think critically appears to be
buying into this fallacy.
I think Slate's
Dahlia Lithwick nailed it when she pointed out that, “This case
isn't so much about freedom from government-mandated broccoli or
gyms. It's about freedom from our obligations to one another. . .
It's about freedom to ignore the injured, walk away from those in
peril. . . It's about the freedom to be left alone.”
During Tuesday's
oral argument, Solicitor General Donald Verilli argued that health
care is different from other markets because we don't just let sick people
die. “(G)etting health care service,” he said, “[is] a result
of the social norms to which we have obligated ourselves so that
people get health care.”
To which Justice
Scalia replied, “Well, don't obligate yourself to that.”
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