Thursday, June 28, 2012

Affordable Healthcare Act

“We do not consider whether the act embodied sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenge provisions.”
Chief Justice John Roberts, Affordable Care Act decision

When polled on the individual provisions of the ACA, a majority of Americans have consistently approved of them. But when polled on "Obamacare," the results have been different.

The ACA is pretty  much a reform Americans can & should accept. The idea for this kind of reform came from Republicans, with some Democratic support, in the 1990's as an alternative to the Hillary Clinton plan, & as a counter to the single payer plans adopted by nations with universal health coverage. Mitt Romney used this plan as the foundation for the Massachusetts plan.  The goal of a national (or state) plan is to get everyone covered. Poor people & people on fixed incomes mostly have health insurance now, through Medicare, Medicaid, & the private HMOs contracted by those programs. So there are two groups to get insured: working  & unemployed people who can't afford health insurance & healthy people who can afford it but  gamble &  deliberately opt out. The latter are a big  reason for the mandated coverage. So the latter are made to pay, as Justice John Roberts reasoned, a "tax" for their decision. The minority on court  denied this payment constituted a "tax."

On the face of it, I doubt if most Americans with health coverage care much that people who can afford but  refuse health insurance are treated as scofflaws. What Americans do resist are "mandates," being ordered by the government to do something. Americans are already mandated to do all sorts of important things: pay taxes, provide public education for children, have car insurance, on & on it goes. Traditionally, we tend to prefer these mandates, where possible, be decided on the state level.  Other nations have reasoned this through to providing health care for all, which can't be done state-by-state.  When "conservative" governments are elected in other democracies, they may act to "reform" their national health care systems, but they don't dare suggest dismantling those systems.

The Supreme Court decision is very bad for Republicans, who wanted the Court to do their dirty work for them. Even if President Obama is reelected, Repugs will hold the House of Representatives & probably take slim control of the Senate. As they attempt to repeal "Obamacare" they will have to argue it provision-by-provision: young adults staying on parents' coverage after college; rules against arbitrary hikes in  rates; prohibitions against denying   insurance  due to pre-existing conditions; expanded drug benefits;  "But we want those," Americans will say. Which brings up the problem of how to pay for them; the very reason mandated insurance is necessary. People who can afford to purchase insurance but do not cannot be allowed to be a drain on the system, driving up everyone else's premiums.  This is the same reasoning  as applies to other mandated forms of insurance, be it business liability or auto insurance or  insurance on mortgaged property.

ACA is not the health care reform I've always wanted. I don't believe it will control health care costs. I believe only a national, single payer system can do that. But ACA will ease the health insurance burden on millions of Americans & guarantee insurance for millions more.  I have not heard of any other feasible options  to the individual mandate that would satisfy the conservative ideologues who only a decade ago thought the individual mandate through private insurers was a pretty good idea.The Repugs got nothing. Go ahead, ask them what you're supposed to do when you can't afford health insurance for your family. 

I visited a  website that may or may not have been created  as a joke: Americans who want to move to Canada because of Obamacare. Some of the comments aren't  jokes. Anyone seriously considering it hasn't heard of the Canada Health Care Act or doesn't understand the word "irony." There are no other  western democratic nations without a national health care system.

The thing with the ACA is that the more Americans know about it the more they like it. This act may be the last useful thing the US federal government ever accomplishes. The problem is that most aspects of it don't kick in until 2014 and the Republicans will fight 24 hours a day until then to kill it. I know it sounds like hyperbole, but this election coming up is the biggest election in our lifetimes.
Also, Blogger is the worst. I'm often tempted to comment here, but Blogger forces you to create a Blogger profile just to comment. (My WordPress blog is self-hosted; I don't participate in any of those other choices.) I finally did that, but it's ridiculous. If I wanted a blog outside my lonely Harry Ramble universe, I'd create one. Also, finally, the level of narrative quality here is terrific.
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