Health Care Reform
Well that was a shock.
Although, perhaps, not as much of a shock that some people are suggesting. After all during the oral arguments in court Chief Justice Roberts did gently float that tax wheeze he relied upon to support the liberal justices in upholding the law. So we had a hint this might be the result. But that hint became lost, as so much is nowadays, in the welter of extremist rhetoric subsequent to the court arguments.
What now?
Some folk on the left have already – in typical fashion – sought to find reasons for being pessimistic. One line making the rounds is that Roberts pulled a neat trick. By arguing the way he did he handed Obama a temporary victory, but he also toughened the interpretation so-called commerce clause of constitution thus making future grand government plans more difficult to pass muster. I don’t buy this. Health care reform is a major piece of legislation. It will gradually settle into becoming a centerpiece of our social fabric. In contrast, the commerce clause has been invoked in opposition to relatively minor or incidental legislation. So toughening that clause versus allowing massive legislation to stand is hardly a great trade-off, and certainly not a great strategic win.
The Affordable Care Act, to give Obamacare its proper name, is deeply flawed. It is a kluge. Its roots are in the Republican Party’s efforts to prevent the most obvious and effective way to legislate cheaper health care. A simple extension of Medicare to everyone is the best solution to our spiraling health care cost crisis, but that prospect so scared and infuriated the right that they spent years coming up with alternatives. The ACA is based on the Romney legislation in Massachusetts, and Romney’s legislation was based on one of those Republican alternatives to universal Medicare. So the ACA is, essentially, a Republican plan. This, of course, is something the Tea Party and its extreme confreres want us not to realize.
My preference is still single payer insurance. Something along the lines of universal Medicare would do just fine.
But ACA it is.
The voting public has, in poll after poll, given a very negative verdict on the ACA. I suspect this is more a function of the effectiveness of Republican criticism and the ineffectiveness of Obama’s defense of it. One of the great and continuing criticisms of Obama that I have repeated here often enough – perhaps too often – is that he seems incapable of explaining what he’s doing. His message is inevitably swamped by a subsequent title wave of vitriolic and often inconsistent propaganda. He has failed repeatedly to use his position to get his point of view across. Indeed on more than one occasion he appears to have caved into the vitriol before even attempting to promote legislation. The stimulus of 2009 is a good example of such weakness.
Nonetheless he has now won a major battle on the ACA, and will now be forced to explain himself for the next four months as the Republicans, as they are now bound to do, make health care reform a central issue of the election.
So, is the upholding of the ACA actually a benefit for the Republicans? After all, as I just mentioned, it polls very badly whenever put to the public. No. I don’t think so.
The Republicans are now faced with a significant dilemma. If, as they have already started to do, they move the ACA onto center stage for the election they run the risk of downplaying or marginalizing the economy. And the economy is a much larger immediate threat to Obama than health care reform. The public is saturated, and probably fed up with, health care debate. But it is now settled law. By putting it back on the agenda so forcibly the Republicans could appear to be fixated about the past rather than being forward looking. It would leave the Democrats to make all the positive moves with regard to the economy and would simply highlight the constant negativism that has pervaded the Republicans during the Obama administration and which is voters have grown tired of. Don’t forget that despite the apparent unpopularity of the ACA, Congress generally is even more in the voter’s bad books.
As for the ACA itself. With the central plank of Republican opposition undermined, by a conservative justice no less, it will survive. There ins no chance it will be tossed out by a Romney administration, despite all the brave promises now being made. The Democrats may lose control of the Senate this year, but they will not disappear sufficiently that they cannot block repeal. More likely is that a number of revisions will make their way into law and I would argue that the cumulative effect of such revisions will improve rather than debilitate the law. This is because, over time, voters will see more benefit from the reform and will start to vote to support it. This is the trajectory followed by Social Security and Medicare. I see the ACA going the same route.
So, while Republicans will continue to hate – perhaps that’s an understatement – the ACA, they will become increasingly powerless to get rid of it. Opposition to it will become, along with Social Security and Medicare, an iconic measure of right wing ideological rectitude, but little more.
This does not mean that the next few months and years will be any more quiet than the last few. Indeed the election will now be even more hate filled and extreme. But health care reform stands.
Which means that a whole lot of average Americans won something very important. And that maybe, just maybe, we have a chance to get our health care system back from its current low status and accomplishment.
It would be nice if our health care system were about health and not simply profit. We have a shot at that now.
