That tweet from CNN legal analyst Jeffrey Toobin pretty much sums up the general feeling about the Obama Administration’s defense of its centerpiece legislation, the Patient Protection and Affordable Care Act (A.K.A. Obamacare or PPACA). It appears that a stipulation that every American buy health insurance - commonly referred to as the “Mandate” - is the most likely piece of the legislation to be declared unconstitutional, but it’s also possible that the entire law could be scrapped.
The possibility of the whole law being thrown out by the Supreme Court makes me so angry I could throw a garbage can through a window ala Mookie in Do The Right Thing. I campaigned to get some sort of health insurance reform, by collecting signatures at local farmers’ markets, during the summer of 2009 when the national debate was heating up. Then, unexpectedly, I moved abroad for a year where I experienced the much maligned and misrepresented (in this country) British National Health Service. My experience with the UK’s universal healthcare was extremely positive. That year in Scotland strengthened my belief that our healthcare system is not only broken, but barbaric and Americans don’t know what they’re missing.
For one thing, we need to start thinking of ourselves as ‘patients,’ as opposed to ‘consumers’ - as if health care is akin to shopping for electronics. After all, we aren’t profit centers we’re human beings. Health isn’t a commodity, it’s a public good and vital to our strength as a nation. Sadly, when it comes to health care the U.S is not ‘Number One.’ If we are doing so much better than all the ‘socialist’ countries with their ‘socialist’ health care - as many conservatives argue - then why, for example, is our life expectancy 38th in the world? Oh, and do you know who is 37th? Cuba.
Every other wealthy nation - EVERY ONE - has some form of universal health care. Don’t like the way Canada or Britain does it? Fine. How about taking what does work from those countries or learning from the systems in other places like Germany, Japan, Switzerland or France?
I don’t love the bill that was finally passed in the Spring of 2010. Obamacare was simply a patch. It was a way of extending the private health care system already in place to more American citizens. The PPACA, with its requirement that we all buy private insurance, seems like a big handout to insurance companies. The law (which is supposed to take effect in 2014) requires uninsured Americans to buy insurance or pay a penalty as a means of bringing overall costs down. The basic economic reasoning is that the more healthy people that are in an insurance pool, the lower the costs for everyone. Also, if an uninsured person ends up in the emergency room, that cost is passed on to people with insurance. There are also measures for helping low-income people afford insurance. This plan was originally a Republican proposal floated by Bob Dole and other leading Republicans as a counter to more liberal proposals. It was supposed to be a free market solution. It is also - more or less - the plan implemented by Mitt Romney in Massachusetts. The Administration, and many Democrats, wanted something a little to the left of this plan, but the relatively conservative bill was passed because it was what seemed politically possible at the time.
If the “Mandate” is carved out of the law by the Supreme Court it will affect the cost-cutting measures, which would be a shame. Since I wanted to see something more robust - such as a Medicare buy-in or a Public Option - I can’t say that I’m particularly sad about seeing the mandate disappear. I understand the resistance to the mandate. Like many Americans, I don’t really like being told that I have to buy something.
What really makes my blood boil, however, is the idea that key components of the law (which are already in effect and already helping people ) could disappear. Here are a few examples of the people who will truly suffer if the entire law is declared unconstitutional and we go back to square one.
- People with Pre-Existing Conditions: The Huffington Post recently featured a story about a mom with Multiple Sclerosis in California named Kelly. Her husband has his own business, which means that they purchase insurance on the open market rather than through a large group insurance plan. Until Obamacare passed, it was perfectly legal for private insurance companies to refuse to insure someone like Kelly. People will pre-existing conditions do not make money for insurance companies. They are seen as bad bets, so they can’t get coverage. When someone is buying insurance privately - rather than as part of a large group - they do not have others in the pool to offset the cost, therefore, someone with a serious illness hurts the insurance company’s bottom line. If they do get coverage, it’s at a cost that is nearly impossible for middle class Americans to afford. This is one of the many reasons a serious illness can cause financial ruin for a family - something unheard of in other wealthy nations.
- Kids with Cancer: Before the PPACA went into effect, many people (not just kids) with very serious illnesses discovered that their insurance had a lifetime limit. Once they reached that spending cap, the insurance company would no longer pay for their care. That’s right - until the PPACA, people WITH insurance were told, “Nope, sorry, we’re not spending any more money on you. You’re on your own with that Leukemia.” Death panels aren’t real, but this is. If you’re not a profitable investment for for an insurance company, they’ll find a way to get you off the rolls.
- Small Business Owners and their Employees: The PPACA has a provision for tax credits for small business owners who provide insurance to their employees. When the entire law takes effect in 2014, small businesses will be able to shop for insurance in special exchanges which will allow them to provide better insurance similar to what larger companies provide.
- Adult Children under the age of 26: This is generally a healthy portion of the population, but accidents and illnesses do happen and many young people don’t have health coverage. This provision allows for parents to have young adult children on their insurance policies until they are 26 years old. I didn’t have health insurance in my first few years out of college and this would have really helped me. I even looked for private, high deductible insurance only to find that the cheapest insurance available to New York City residents at the time cost about $300 per month. By the time I had three health emergencies in a row, at the age of 28, I was in grad school and back on my dad’s family insurance plan. This was an unusual arrangement only possible because he had premium, large group insurance through his state government job. If my health problems had happened when I was uninsured, the appendicitis might have bankrupted me and the other two problems - which were caught during regular check-ups - might have gone undetected until I developed cancer.
Overall, the changes in Obamacare are modest and most Americans won’t even see much of a change in their health care. Some are complaining that Obamacare is causing the rise in health insurance premiums and according to a 2011 study by the Kaiser Family Foundation it may have contributed to a small percentage of the increased costs. However, if we look at the larger picture, that may be due to the fact that the cost cutting measures (e.g. the mandate) haven’t kicked in yet.
Kaiser Family Foundation CEO, Drew Altman said it best, "Critics of the national health reform law passed in 2010 like to blame everything but the weather on 'Obamacare,' but regardless of how you feel about the Affordable Care Act, its effect on premiums this year is modest. Most of the law’s provisions don’t go into effect until 2014. The two biggest changes this year allow young adults up to age 26 to stay on their parents’ insurance policies and require some insurance plans to cover preventive services at no cost to patients. These are popular provisions that provide real benefits, and combined they account for about one to two percentage points of this year's premium increase."
To read my blog from 2010 about going to the doctor in Scotland click here.