Court May Force Open Health Care Debate

The US Supreme Court has a chance to move the United States closer to a single-payer health-care system – but only if it does the unthinkable and invalidate President Barack Obama’s reform law. The court agreed to review the law, with arguments expected to take place in March and a decision likely by June. That means health care is going to be a central issue in the 2012 presidential election.

The generally accepted wisdom is that, should the court rule against the president and the Affordable Care Act, it would be a devastating political blow to the president and the prospects for extending coverage to more Americans.

But it’s not clear that a court ruling against the health-reform law would leave us in worse shape than we are now. As Robert Scheer, editor of put it recently on the Left Right and Center radio show, the Affordable Care Act “amounts to a transfer of wealth from American healthcare consumers to the big insurance companies.”

Scheer’s point is pretty simple: The health care reforms leave the health insurance industry in place, allowing it to continue raking in massive profits, while forcing Americans without insurance to sign on to the broken system. These new premium payments will go to the insurers – a nice, added stream of profit. So while the law has a requirement that a minimum amount of money must go toward care, the health insurance industry offered only modest opposition.

The question we need to ask is this: What happens if the Affordable Care Act and its requirement that everyone buy insurance are declared unconstitutional?

The answer is not an easy one, but I think it is clear to everyone that the status quo is not sustainable. The US spends about twice per capita on medical care and related services than nearly every other industrialized country in the world. Our health outcomes are below most others and about one in six Americans is forced to go without coverage at some time during a given year.

As the New England Journal of Medicine pointed out last year, international rankings show that “in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.” In a country that claims to be the wealthiest and most enlightened in the world, that is just not acceptable. The Affordable Care Act was supposed to provide insurance to about three-quarters of the nation’s uninsured, but would still leave about 15 million people without health insurance and, therefore, without access to healthcare.

If a federal mandate is taken off the table by the courts, the debate would then have to shift away from the intricacies of policy to the broader question of whether we should trust the market to provide health care.

Republicans are likely to focus their reforms around minor subsidies and possibly an information clearinghouse, leaving the insurance industry in place and leaving it to health-care consumers to navigate the choppy waters of an overly technical and complicated marketplace.

The alternative has to be to remove health care from the marketplace, to create a single-payer system expands Medicare coverage to all Americans and pay for it through taxes. Doctors would be paid the same way they are now, and there would be room for other reforms – paying doctors based on a continuum of care rather than on an itemized basis, lowering drug prices through negotiations with the drug companies, etc.

Open Secrets, in a 2009 report, showed that Democrats were the big winners in the health industry sweepstakes: “the sector gave $90.7 million, or 54 percent of the total, to Democratic candidates and party committees, compared to $76.6 million to Republicans.” The gap grew during the first quarter of 2009, the report says, “when Democrats collected 60 percent of the total $5.4 million in contributions.” And this does not include the massive amounts spent on lobbyists.

It is up to us, therefore, to make sure that health care – like campaign finance and income inequality – is at the center of the debate.

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From The Progressive Populist, January 1-15, 2012

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