Fixing Healthcare Good

Avedon Carol,  "Games People Play"


Ian Welsh, "To point out the obvious on today’s Supreme Court Decisionon the ACA"


 Darshak Sanghavi, Slate "Don’t Celebrate Yet: The Supreme Court’s decision will make it much harder to extend healthinsurance to America’s poor. "



New York Times, "Roberts Shows Deft Hand as Swing Vote on Health Care"


CNN, Emotions high after Supreme Court upholds health care law


Wikipedia, National Federation of Independent Business v. Sebelius



 



A universal requirement to buy insurance isn't really the same as universal health care, and you'd think that the boosters of the Affordable Care Act must know this. That's why it's difficult to decide what looks more ridiculous, democrats and others praising the pro-mandate Supreme Court decision, or Romney supporters cavilling about how the governor's healthcare bill for Massachusetts was different.

One of the generally unstated premises of  so-called healthcare reform, at least as practiced in this country, has been, "how do we protect regular, respectable people from the needs of the poor" as if the need for healthcare is different  for different  segments of the population, and they are  intrinsically in competition with one another for the same (artificially) scarce resources. Obama himself  has repeatedly offered as a  selling point of the 2010  Affordable Care  Act that "people who liked their insurance could keep it"  as if he were really  saying  that he was protecting the middle class from the uncertainty that something scary like a federal single-payer plan might entail.  Simultaneously progressives argued, without evidence, that ACA would bring us closer to single-payer, someday, but then again nobody listened to them.

A lot of people seem to buy the premise that the needs of the poor are the big problem with the American healthcare system, as opposed to, say, the needs of private insurance companies, or the huge debt that doctors have to assume to get educated, etc.

 (I detect the poor vs everybody else assumption in  this short piece by Matthew Yglesias, who at least recognizes that Roberts and the rest of the court pushed the door closer to fully shut for real socialized healthcare in the US, rather than opened it wider.)
 
A 'death by a thousand cuts' is likely to be in the offing, in which legislators gradually reduce the coverage requirements for the "minimum liability" policies people will need,  resulting in junky insurance policies that don't really cover anything but keep you legal becoming the norm for many, and simultaneously allow pols to point to dubious statistics about increased overall coverage. Likewise a reduction in the 'burden' of the fine businesses must pay if they don't want to cover their employees, resulting in more businesses that have to cover their employees not doing so, cue to an expert who expresses surprise at this turn of events on the evening news. Next, there will be  reduced access and funding for medicaid, justified by the afore-mentioned dubious stats about increased coverage, so that politicians can demonstrate how ACA saves money, shifting the costs from employers and governments to individuals along the way.

You may object that if you vote for the democrats this will prevent these things from happening. But just as Obama insisted on a deficit commission, remember that ACA was designed from the start to be vulnerable to such funding cuts and loosening of  regulation. A universal plan, some kind of single payer or national health plan wouldn't have created a wary fence between the haves and have nots, and  would eventually  become as popular as medicare or social security.

ACA wasn't random;  it serves both the democrats and the republicans(and the insurance companies).  So the dems can frighten you about coverage being on the chopping block, while republicans frighten you about spiralling out of control costs. Win-win.