Health Care’s Big Victory

Posted on behalf of Peter Galuszka, who is out of town today. — JAB

The U.S. Supreme Court’s surprising and wise decision backing the vast majority of the Affordable Care Act is a major victory for ordinary Virginians, tens of thousands of whom up to now don’t have or can’t afford health insurance.

The victory could be as big as Social Security or Medicare in terms of overall impact. It restores faith in at least one branch of government and helps the country move beyond the horrible partisanship that marked last summer’s debate over raising debt ceilings. It could set Barack Obama’s legacy after a fairly stumbling presidency and is a major boost for him in the upcoming election.

Virginia Republicans, led by Gov. Robert F. McDonnell, were predictably negative and sullen. McDonnell said he was “very disappointed.” The Richmond Times-Dispatch curiously trotted out the irrelevant Lt. Gov. Bill Bolling, its choice for the next governor, as the spokesman for the state’s Establishment against the decision. That might be expected, but what wasn’t was wild card Kenneth Cuccinelli’s rethinking of the ruling saying that maybe it isn’t so bad. This seems especially odd given that he made Obamacare on of the flashpoints in his politically charged legal activities as Attorney General

Now the ruling GOP elite has to, ahem, actually get on with the task of starting those health care exchanges to sell policies to people who have trouble getting them due to pre-existing conditions or lack of funds. They can stop whining about the “commerce clause” which SCOTUS neatly sidestepped by saying that ObamaCare is a tax and guess what, Congress CAN tax. Too bad, Libertarians and Tea Party types!

The big winners, besides the average man and woman, are hospitals and some doctors’ practices. Losers are Big Insurance and managed care, in other words, the very people who put lots of campaign bucks into the coffer of Rep. Eric Cantor so he can protect their rackets that hurt millions.

Unfortunately, the law doesn’t do much to bring transparency to health care pricing, which is based on two things (1) what Medicare says it is and (2) whatever deal hospitals and doctors negotiate with Managed Care.

You will probably hear a lot of whining from other bloggers about how this will bring Boomergeddon and disaster. It will be more expensive. But without clear pricing and choices, all this talk of the free market is a lot of hot air. So is the idea of “boutiques” in which the rich pay doctors to take care of them individually. But these 1 percenters already have insurance. The Average American is left out. Or was, at least, until Thursday.

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  1. How many companies will drop their coverage for employees? retirees? Politically, this is a win for the right. Had the ACA been dumped by the Supreme Court, Obama would have had his bully pulpit to argue that unelected judges dumped his law. But he won, but on the ground that the penalty was a tax. We know have the biggest tax increase in U.S. history. And it hits the middle class too. This is different from Social Security and Medicare. Those programs instituted taxes for new benefits for everyone. Obamacare institutes new taxes, but a sizable segment of the economy gets nothing new. In fact, a large number of them that have company-provided insurance and will probably lose it.
    Democrats don’t do anything for the Middle Class.

    1. Richard Avatar

      So the elephants are trying to spin this as a tax? Good luck with that. It’s no tax to anyone who has insurance. It’s a tax only if you are a free rider, and it’s still quite a deal if you pay it and can beg some free health care when you really need it. If that’s a tax, it’s quite a good one.

      There may be some who get nothing new – but most people get a lot: lower overall costs because care for the uninsured isn’t shuttled through the emergency room and everyone has access to preventive care; no pre-existing conditions; coverage if you lose your job; these are benefits for everyone, including those who are fortunate enough now to have insurance.

      1. “So the elephants are trying to spin this as a tax?”

        It’s either a tax or a mandate. Take your pick. If it’s a mandate, then it’s unconstitutional. I don’t think you want that. Therefore, it is a tax — a conclusion supported, by the way, by a Supreme Court majority.

        Therefore, I don’t think it’s fair to accuse the Elephants of “spinning” it as a tax.

  2. larryg Avatar

    well.. I’ve got news about the retirees part. Most companies force their retirees onto Medicare when they turn 65 .

    I think no matter how the decision turned out – the right has yet to put forth any real alternatives other than pretend they’d support govt laws to require insurance companies to accept folks with pre-conditions and not dump those that get sick.

    How can we say this is the biggest tax increase in history without quantifying a number? Isn’t that just more right wing rhetoric being repeated?

    What about the current EMTALA “tax” that we all pay for those who don’t have insurance? Why do we never quantify that “tax” also?

    I obviously disagree with TMT. What this law does for the middle class:

    1. – allows their kids to have insurance at least until age 26
    2.- assures that the middle class will not have a family member turned down due to a pre-existing condtion
    3. – assures that a middle-class family does not go bankrupt and lose all of their assets including their home just because one of their kids came down with lukemia
    4. – Mom and Dad can switch jobs to better their economic circumstances without having to worry about losing their health care coverage.

    I can go on but this is a dunderhead debate that has been WON by the right wing propagandists…. they have thoroughly cleaned Obamas’ clock because of their ability to convince the gullible that ObamaCare will hurt them instead of help them.

    Bacon and his fellow GOPers have suggested that their REFORM will be to get rid of employer-provided health insurance.

    Think about that – for the average middle class family with a member who has health problems.

    How much sense would it make for Mom to get a job at Fairfax Schools if they did not offer family health insurance and there was no restrictions against insurance companies and pre-existing condition and other coverage.

    The bottom line is that the anti-Obama folks have nothing.

    they supported the individual mandate under Clinton but quickly forgot that idea when HillaryCare was defeated.

    The GOP has no answers other than “kill” ObamaCare and the hell of it is that they’ve convinced even those who would end up with no insurance under the GOP plan – to support it.

  3. larryg Avatar

    Here’s something that might be worth reading – that sums up my perspective:

    Health Care: Solidarity vs. Rugged Individualism

    ” Let us set up two distinct systems for health care within our nation. Call one the Social Solidarity system and the other the Libertarian system. Ask young people — at age 25 or so — to choose one or the other.”

  4. I have many friends who work in or used to work in the telecom industry. Most of them have access to company-related health care insurance – some on a primary basis and some on a secondary basis, after Medicare. They have a good deal. My issue is, how many of them will lose this insurance, over time, due to Obamacare? I suspect many will. And what they then will have will not be as good as what they have today. These friends tend to believe that they have lost something.
    Second, there are all sorts of additional taxes on interest, dividends, sales of stock, sales of house, etc. that do not have anything to do with health care except that it costs so damn much Congress had to take money from unrelated sources. Don’t even more people lose?

  5. larryg Avatar

    the “theory” is that the employers will find it cheaper to pay the penalty rather than provide the insurance but that’s yet another false premise emanating from the right wing propaganda machine – and with good effect. But the truth is that employers do not have to provide health insurance right now – and they still choose to in part to offer a competitive benefits package. ObamaCare does not change that dynamic at all.

    The only way the premise “works” is if health care costs keep going up and the companies bail from providing benefits as a result but again – that has nothing to do with ObamaCare but don’t let facts get in the way here.

    In fact, what usually happens as health care costs keep going up is the premiums cost more and the coverage reduces and employees end up devoting whatever raises they might get – to increased premiums – again that happens already.

    This happens regardless of ObamaCare but don’t let that stop the folks who want to blame ObamaCare … because the end.. it’s about opposition regardless of the facts.

    That’s the most bizarre thing about the health care debate. It’s not on the actual merits. It’s based on political philosophy and those who oppose don’t really care about facts, anything that will “stick” is good enough.

    So as a country, we are no longer about finding compromises and solutions to problems. It’s all about what are political views are and “no compromise”.

    In terms of “losing insurance due to ObamaCare” – think about this. Where would they go? Well, they’d go to one of the private providers that are in the exchange and buy a replacement.

    And quess what? from that point on, they don’t care if an employer offers insurance or not. They don’t have to worry about a lapse in coverage if they change jobs or one of their family members not eligible for new employer insurance.

    From that point on, the customer has guaranteed family coverage regardless of their employer or employer health insurance policies.

    That’s a “bad” thing?

    As I said, this is no longer about the merits of the changes. It’s opposition to change that derives from political opposition in general.

  6. Hydra Avatar

    As Krugman pointed out, the big winners are the people who think they have insurance, until they lose their job. And many others who are OK now but take a sudden setback. In that category tere are many more people than the few million who will be able to get insurance because of this.

  7. larryg Avatar

    re: it’s a tax.

    yes. The Solicitor General himself made that as one of his arguments.

    what difference does that make?

    Congress has the power to tax. If you wait to sign up for Medicare, but do it late, guess what, you have to pay a tax penalty.

    We’re talking about a tax on less than 1% of citizens and only those who CAN afford to have health insurance but choose to not buy it.

    These are the freeloaders who we all pay for with higher premiums on our own health care to pay for the care that freeloaders evade paying for.

    We don’t call our increased premiums to pay for freeloaders a “tax” but it’s every bit like a tax that all of us have to pay because of scofflaws. These are the very same people who would not buy auto insurance if the law did not require them to and would not buy homeowners insurance unless the mortgage company forced them to.

    Yes.. we are taking away their “liberty” by forcing them to buy auto and homeowners insurance.

    Never seen that go to SCOTUS….

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