published Wednesday, November 16th, 2011

Health reform goes to court

The Supreme Court's decision Monday to review the constitutionality of the 2010 health care reform act, and its linchpin mandate requiring most Americans to purchase health insurance, puts in motion a trial of one of the nation's most heavily freighted political controversies in decades, and will do so amid a heated presidential election. Whether that's fair or good for the nation remains to be seen. Yet regardless of the court's ruling, it has already become clear that the need for reform is too huge, too critical and too compelling to be stifled by inaction. If the court's controlling conservative judges are at all attuned to justice for the nation's needs, they will rise above political currents and affirm the federal government's role in devising and marshaling systemic health care reform.

The court has promised to hear selected appeals on the constitutionality of the Affordable Care Act next March, and to deliver an opinion by June. That will place its ruling in the middle of a super-heated presidential campaign which may turn on the court's decision in this historic case.

Ironically, it's impossible to predict the impact of the court's decision, whatever it decides. At first glance, it would seem that the Obama administration would benefit from a decision affirming the constitutionality of the act, and its central provision requiring Americans to purchase health insurance (largely with the broad federal wage-indexed subsidies for most families).

Yet affirmation of the reform act might energize opponents to elect a presidential candidate and representatives who promise to repeal the reform act. Similarly, a court decision to overturn the act might rally its supporters around the administration to advance the hope of passing a bona fide public plan as a voluntary option for Americans to private insurance. Such a plan, say, an expansion of Medicare for all who elect to pay a fair, flat-rate premium to join a full-benefit plan with no pre-existing conditions, would benefit most families. It certainly would be cheaper and far superior to private insurance companies that cherry-pick the healthy, deny people with pre-existing conditions, and spend outrageous shares of premium revenue on executives' breath-taking salaries and stock options.

It is these insurance industry tactics that create the nation's unaffordably high rates of uninsured and of under-insured Americans. More than 50 million Americans are uninsured. An equal number are under-insured who, like the uninsured, are also vulnerable to bankruptcies due to outrageous medical costs -- now the largest segment of the nation's bankruptcies.

These are national problems that argue for the Affordable Care Act's provisions that ban pre-existing conditions and annual and lifetime limits on coverage, and that fix flat community rates and guarantee enrollment for all purchasers. The Obama administration rightly argues that the purchase-mandate is just one of several "absolutely intertwined" reform mechanisms that are needed to assure a stable health insurance system for the nation.

The administration correctly views the insurance purchase-mandate and its wage-indexed subsidies as a constitutionally permissible mechanism, under the commerce clause, to ensure an orderly interstate insurance market responsive to public needs. In that sense, the mandate operates much like a stabilizing federal minimum wage, which places a federal floor on wages paid by private employers, and yet allows states to require, as many do, a higher minimum wage.

Without the purchase mandate, for example, insurance companies would not receive the enrollment volume they need to make the Act's flat-rates and scope of coverage affordable. And congressionally required care for uninsured free-riders would continue to require hospitals, doctors and insurers to shift the costs of treating the uninsured to the premiums and bills of paying patients, distorting the health care market and aggravating the costs to payers and care-givers.

That dilemma has spurred the unregulated chaos and costs of the health care industry, and propelled America's health care costs to nearly double the per-capita cost of health care in other western countries. In another couple of years, those costs will account for an unsustainable 20 percent of the nation's GDP. If the Supreme Court rules in these circumstances that the commerce clause doesn't permit federal intervention for the good of the nation, it will sink the economy -- and the hope for affordable health care.



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conservative said...

"If the court's controlling conservative judges are at all attuned to justice for the nation's needs, they will rise above political currents and affirm the federal government's role in devising and marshaling systemic health care reform." Here you have the mind of a flaming liberal and Socialist! Supreme Court members were put there to rule on matters of the Constitution. This writer wants the conservative ( as in conserve our Constitution ) judges to be "attuned" to the "nations needs" and rule for a government mandate to buy health insurance. What contempt for our Constitution!

November 16, 2011 at 8:39 a.m.
Livn4life said...

"...and affirm the federal government's role in devising and marshalling systemic health care reform." Wow, I have recently read the US Constitution and found nowhere any hint or glimpse of the federal government having any role in either devising or marshalling systemic health care reform. So, let's look at what the federal government has devised, the US Postal Service, no let's don't. Let's look at...no, let's not! It is disastrous! That this has ended up before the US Supreme Court shows what a great job of buffoonery occurred with the obvious party putting this in motion. But it is what and it is where it is. We who sit on the sidelines are wondering from Congress, the White House, and the Supreme Court, who has courage enough to do the right thing for the COUNTRY instead of their own political aspirations? I will wait, watch, and listen....Do not see anyone anywhere just now I have any confidence in.

November 16, 2011 at 11:09 a.m.
conservative said...

Astonishing! The writer recognizes a principle of insurance that a certain enrollment volume is needed to make insurance affordable. The writer wants this purchase mandate for Obaminationcare, but criticizes private insurance when they practice the same by denying people with pre-existing conditions coverage. How could a private insurance company stay in business if they were forced to cover someone who was just diagnosed with cancer who then comes knocking at the door wanting coverage? How dumb would that be? Why doesn't the writer be consistent and demand that one not have to buy auto insurance untill he gets in a wreck?

November 16, 2011 at 11:41 a.m.
fairmon said...

It is not and should not be a federal issue, it belongs to states. The most abused and misused words ever uttered were "for the greater good" which some can stretch to mean anything they like and want. What is the next item Americans will be required to buy "for the greater good"?

The governments negotiated rates and forced defensive medicine has distorted and driven health care cost up like everything else the federal government gets involved in. Their insistence on no down payment loans without confirmation of income and ability to pay brought about the housing bubble and collapse. Education has become more expensive and less effective since the dept of education was established. The list goes on and on.

November 17, 2011 at 1:01 a.m.
charivara said...

Conserve “as in conserve our Constitution”? What does that even mean? Should we abolish the Air Force because the Constitution doesn’t mention airplanes? The Constitution means whatever the Supreme Court says it does. The question is wether we want to interpret the Constitution to describe a government that represents the interests of all of the people or only 1% of them. That 1% wants to conserve all the power and wealth they have appropriated, they don’t want to return any of it and certainly not to any of the foolish among the 99% who blindly support their pillaging of our democracy.

November 17, 2011 at 10:14 a.m.
charivara said...

harp3339: What a sweeping indictment of an overbearing and ineffective federal government! Could you give us some data that indicates that government negotiated rates and government forced defensive medicine have driven health care cost up? (Nothing else has?) How about an example or two of “everything else the government gets involved in.” Could you give us some data to show that the establishment of the Dept. of Education caused the alleged increase in costs and decrease in effectiveness of education? Part of the list that goes on and on would be nice, too. Actually, do you have any facts at all to support anything at all you say in your comment?

November 17, 2011 at 10:44 a.m.
conservative said...

To be concise, the framers of our Constitution wanted a federal government with LIMITED powers. I want to conserve that intent. This is the opposite of the wish of lieberals who are Socialists, even though they may be reluctant to admit it. They have gotten judges on the Supreme Court who are of like mind to rule one has the Constitutional right to kill their baby, practice sodomy, adultery, but ruled as unconstitutional the reading of the Bible in schools when the first amendment clearly permits such. Yes, for the five corrupt lieberals on the court the Constitution is what they say it is. Think about the absurdity of that. They could just as well rule that a 45mph speed limit in the state of Tennessee is 10, or 20, or 90, or 100. Heritage.org is agreat website for info on the Constitution.

November 17, 2011 at 12:44 p.m.
JustOneWoman said...

That was a laugh! The Heritage Foundation says Hannity and Rush are experts! The site is just full of lies, and is trying to convice people that poor people just don't have it so bad. According to them, if you own a car or truck, vcr, air conditioning,etc you must not be poor. The Heritage Foundation is also the originator of the insurance mandate, dating back to 1989. They have since changed their position, wasn't convenient for them.

Not surprisingly, Heritage Foundation is a Koch Brothers foundation. Con, can you tell us more about the Koch Brothers, where they are from, who their father is? Do you know why they would want more power plants, or the need to hold down minimum wage? Do you know why they have the stance on EPA as they do? And last of all, can you tell us more about why the Heritage Foundation took the stance of an insurance mandate, but now doesn't?

I will be awaiting your answers with baited breath.

November 17, 2011 at 2:18 p.m.
JustOneWoman said...

I have heard time and again from conservative leaning folks that we have the most liberal supreme court in history. I am astounded every time I hear this. It is a fact that it is indeed the most conservative in decades. That is backed up by fact, by voting records, by stance, etc. But for the longest, I couldn't figure out why the lie. It makes sense now. These five Con refers to must be the ones Koch Brothers are not able to buy off. I am curious Con, what are the names of the judges you consider liberal?

November 17, 2011 at 2:58 p.m.
conservative said...

Lieberals, socialists and atheists hate the truth. Since it is impossible to refute the truth they resort to personal attacks, outright lies, or change the subject.

November 17, 2011 at 3:36 p.m.
JustOneWoman said...

You brought up the heritage Foundation and acuse me of changing the subject! Then proceed to call me names. How rude! Just like a con. No answers? aye?

November 17, 2011 at 3:50 p.m.
JustOneWoman said...

Con, again, here are the questions.
Con, can you tell us more about the Koch Brothers, where they are from, who their father is? Do you know why they would want more power plants, or the need to hold down minimum wage? Do you know why they have the stance on EPA as they do? And last of all, can you tell us more about why the Heritage Foundation took the stance of an insurance mandate, but now doesn't?

November 17, 2011 at 3:52 p.m.

JOW, I can answer your quesitons. 1). I have no idea who they are.

2). Mr. Koch

3). To satisfy increasing demands for power would be my guess.

4). When minimum wages go up, the price for all goods and services across the board go up which hurts everyone, especially those on a fixed income (retired seniors) and those who earn minimum wage.

5). The EPA is a corrupt, unconstitutional monstrosity that does the same thing raising the minimum wage does without providing the offset of increased wages.

6). No idea. I am not privvy to that information since I don't think I have ever visited that site.

November 17, 2011 at 5:04 p.m.
conservative said...

The writer states," The administration correctly views the insurance purchase-mandate and its wage-indexed subsidies as a constitutionally permissible mechanism, under the commerce clause, to ensure an orderly interstate insurance market responsive to public needs." Hidden in this verbose statement is the silly notion that forcing Americans to buy insurance is Constitutional under the commerce clause when they are not engaged in commerce! He wants you to believe you are engaged in commerce when you are not engaged in commerce!

November 17, 2011 at 5:07 p.m.
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