Much of the debate over the US Supreme Courts ruling that the Affordable Care Act i.e., Obamacare is constitutional has surrounded the politics.
Did Chief Justice John Roberts bow to political considerations when he voted to uphold it? Will the decision help President Barack Obama win re-election? And how can Mitt Romney respond, given that the reforms essentially are carbon copies of the Massachusetts plan put in place when he was governor of the Bay State?
The bigger question, however, is whether Obamas health-care reform will actually alter the health-care landscape and ensure that the one in six Americans who now goes without insurance for long stretches can get coverage and quality care.
The answer to this question is a decided maybe.
The Affordable Care Act is likely to expand coverage to between 15 and 30 million uninsured Americans by presenting a choice to the uninsured: Get insured or pay a penalty (defined as a tax by Roberts). There are subsidies in the plan and a proposed expansion of Medicaid to 133% of the poverty level, among other changes to existing health-care law.
But the ACA is a flawed reform that will expand the power of the health insurance companies, does little to address costs or improve health outcomes and still leaves an estimated 20 million uncovered. It is, at best, incremental reform and, at worst, a con job, a massive tinkering around the edges.
The rationale behind so-called Obamacare is relatively simple, as described by Robert Scheer in Truthdig (in a column critical of the contortions being performed by Republican presidential hopeful Mitt Romney):
The issue faced by the court was the same on the federal level as it was on the state level; if the public, through its government, must ultimately bear the cost of caring for the uninsured as would be so in any society possessed of even a modicum of shared social responsibility then it can vote to levy taxes to finance that effort.
In accepting this argument, the court majority added balance to a badly imbalanced equation. The mandate expands the insurance pool, and shifts the cost of coverage to health-care users, rather than having the larger taxpaying public pick up the cost.
Sounds logical. But it remains unclear how the ACA is going to curb the outrageous costs plaguing our system. We currently spend twice the median per capita spending for other industrialized country studied by the Commonwealth Fund, with outcomes that rank us below near the bottom on measures. According to a July 2011 report:
The US had a comparatively low number of hospital beds and physicians per capita, and patients in the US had fewer hospital and physician visits than in most other countries. However, hospital spending per visit was highest in the US. Prescription drug utilization, prices, and spending all appeared highest in the US, as did the supply, utilization, and price of diagnostic imaging. With regard to quality, US performance on a limited set of measures was variable. Five-year survival rates for patients with three types of cancer were relatively high; the US ranked near the middle on in-hospital, case-specific mortality for three conditions within 30 days of admission. The US also had among the highest rates of hospital admissions for five chronic conditions and the greatest number of lower-extremity amputations due to diabetes.
The American health system is not delivering superior results despite being more expensive.
This brings us to the only real reform: Expansion of Medicare, either with a full single-payer or, at the very least an expanded system that can serve as a public option under a system of choice.
Let me humbly suggest that as an alternative to a mandatory system rejected by the majority, we return to the idea of covering most people by attracting them to quality public and private programs through consumer choice, and that one of those choices be a version of the public option we now offer seniors, Scheer said in an earlier column. Its called Medicare and it works splendidly.
US Sen. Bernie Sanders agrees. He praised the courts decision, but made it clear that it should be viewed only as a first small step toward real change. He told John Nichols in The Nation that the Affordable Care Act is an important step in the right direction, but that the nation need(s) to do better.
If we are serious about providing high-quality, affordable healthcare as a right, not a privilege, the real solution to Americas health care crisis is a Medicare-for-all, single-payer system, he said. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.
Obamacare is not going to get us there, but Medicare-for-All will. Liberals and progressives who have been going to the mats to defend the president and his health-care plan can feel good about the courts ruling, but they need to be reminded that more needs to be to fix a still broken health-system.
Hank Kalet is a poet and freelance writer in New Jersey. Email firstname.lastname@example.org; blog, kaletblog.com; Twitter, @newspoet41
From The Progressive Populist, August 1, 2012
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