Many liberals are describing the Supreme Court’s decision to uphold “Obamacare” as a resounding victory for the president and likely to contribute to his chances for re-election. I don’t see it that way.
Supporters of the Affordable Care Act rally outside the Supreme Court following the ruling to uphold "Obamacare" on June 28, 2012. Credit: Mackie Lopez/SEIU.
Though I am happy about this development and feel we should celebrate these small steps in the right direction, I see this victory as severely limited by a deep flaw within the health reform plan: it requires people to buy health insurance but has no effective way to keep the insurance companies from endless increases in what they charge the public (and then blaming those charges on the fact that they have to cover people who are sick).
For those of you who have not heard the details yet, the Supreme Court ruled today that most of the “Obamacare” plan was constitutional in a 5-4 vote. The majority opinion – penned by ultra-conservative Chief Justice John Roberts – presents a rationale for why the “individual mandate” (the part of the Patient Protection and Affordable Care Act that requires everyone to buy health care and imposes a penalty payment on those who do not, so that they too can contribute to the well-being of everyone who does need health care) is consistent with Roberts’s interpretation of the Constitution. The court also ruled that some states can opt out of parts of the plan.
I’m glad that parts of the plan that were pressingly needed – including its elimination of the right of insurance companies to deny coverage on the basis that the applicant has a “pre-existing condition” and its part allowing coverage in a family plan of children up to the age of twenty-six – have been validated, though they are unlikely to be implemented before 2014. But a truly resounding health care victory would be one that ensures health care for all, without handing more power to private insurance companies.
We at Tikkun have consistently supported a universal health care plan that would be paid for out of the general tax system, though we also support having that tax system reformed so that rich people and corporations pay their fair share. We have called for a health care system that essentially extends Medicare to everyone! Medicare works. It’s available to everyone over sixty-five, so why not for younger people as well? The arguments for this and the details of what a rational plan might look like have been worked out by a group with which we work – the Physicians for a National Health Plan. These physicians’ reactions, quite similar to ours at Tikkun, can be found below.
Our full vision for health care transformation, however, goes beyond making sure that everyone has adequate coverage to asking what a spiritually coherent health care system would look like if it were based on the Network of Spiritual Progressive’s New Bottom Line of love, kindness, generosity, and really putting the “care” back into the health care system. I’ve worked out some preliminary ideas on that which can be found in my book The Left Hand of God: Taking Back our Country From the Religious Right, and in a very abbreviated form in our Network of Spiritual Progressives’ Spiritual Covenant with America.
Still, it’s important for us to acknowledge and celebrate small steps in the right direction. The Supreme Court decision today will make it easier for many people to get care that they would not have otherwise gotten. For example, here’s a list of ten health care gains that we likely get to keep since Obamacare was upheld.
One outstanding question, though, is whether the Republicans will be able to build up enough resentment of the individual mandate (and its unfair aspect described above) to get a Republican president and Congress elected this fall, and with that mandate repeal the Patient Protection and Affordable Care Act before it fully goes into effect in 2014).
Nevertheless, let’s celebrate a little in the next few days and feel blessed that we are not living under a political dictatorship, and that every once in a while something in the direction of a more humane society appears to get wide-scale popular approval.
And then, let’s return to the struggle for a New Bottom Line of love and generosity and caring for each other and for the planet.
The following statement was released today by leaders of Physicians for a National Health Program (www.pnhp.org):
Although the Supreme Court has upheld the Affordable Care Act (ACA), the unfortunate reality is that the law, despite its modest benefits, is not a remedy to our health care crisis: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs.
Why is this so? Because the ACA perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.
In contrast, a single-payer, improved-Medicare-for-all system would provide truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.
Research shows the savings in administrative costs alone under a single-payer plan would amount to $400 billion annually, enough to provide quality coverage to everyone with no overall increase in U.S. health spending.
The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable plans have worked in Massachusetts and other states. Those “reforms” have invariably failed our patients, foundering on the shoals of skyrocketing costs, even as the private insurers have continued to amass vast fortunes.
Our patients, our people and our national economy cannot wait any longer for an effective remedy to our health care woes. The stakes are too high.
Contrary to the claims of those who say we are “unrealistic,” a single-payer system is within practical reach. The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program and expand it to cover people of all ages. There is legislation before Congress, notably H.R. 676, the “Expanded and Improved Medicare for All Act,” which would do precisely that.
What is truly unrealistic is believing that we can provide universal and affordable health care in a system dominated by private insurers and Big Pharma.
The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access. Polls have repeatedly shown an improved Medicare for all, which meets these criteria, is the remedy preferred by two-thirds of the population. A solid majority of the medical profession now favors such an approach, as well.
We pledge to step up our work for the only equitable, financially responsible and humane cure for our health care ills: single-payer national health insurance, an expanded and improved Medicare for all.
Garrett Adams, M.D.
President
Andrew Coates, M.D.
President-elect
Oliver Fein, M.D.
Past President
Claudia Fegan, M.D.
Past President
David Himmelstein, M.D.
Co-founder
Steffie Woolhandler, M.D.
Co-founder
Quentin Young, M.D.
National Coordinator
Don McCanne, M.D.
Senior Health Policy Fellow
Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who advocate for single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.
I totally agree. We need to celebrate. The ACA is step in the right direction in that it codifies into law the entitlement of universal health care. Even though it is insurance coverage and insurance company based, it puts us in a better place than we were in before passage of the ACA.
I wish you would have refrained from using the pejorative “Obama Care” . Its been used as a slur to denigrate the president and the law. I would have posted on my Facebook page “here’s what Obama Care does” by Peter Koechley, but it to uses the pejorative,which detracts from the 10 things the ACA does.
I am in agreement with Reb Michael on this. However, we should not lose sight of two important dynamics: The first is that this was described by the Right as the “Fight for truth” and “The Fight against Governmental Tyranny”, i.e. a states rights issue. The Religious Right is taking the position that the State is not the correct vehicle for healthcare in any way and that we have no obligation as people for the well being of one another. None. This is a libertarian issue. This decision challenges that. The second is exactly the issue that Reb Michael describes, i.e., we need a single player plan for this country. It will control costs and put an end to the greed of the insurance companies, a greed apparently which knows no end. For those of us who wish to see Obama argue persuasively that the State is a correct vehicle of action and compassion for one another, this is a small beginning.
Excelent diagnostics,
It took 60 years to het this far. Seeing as the system is so entrenched into the US economy, I can;’t see it getting any closer to a single payer system. Juts a mate of fact, not all countries with universal health use a single payer system
I have to politely disagree with a few of the points made by Rabbi Lerner.The ACA is not a small step. It is a huge step, and once fully implemented will do a great deal to end disparities in care now suffered primarily by women and minorities. I’d love to see Single Payer in the US. This act takes us in that direction.
Rabbi Lerner’s statement that the ACA mandates coverage without creating caps is incorrect. The ACA prevents insurers from jacking up rates for pre-existing conditions, eliminates the practice of declaring femaleness as a “pre-existing condition,” places limits on what insurance companies can charge if they participate in the exchanges (which is where they’ll be finding their customers), and creates state or federal review processes for any rate hike over 10%. In addition, the ACA limits what an insurance company can charge for non-medical costs, so there’s no good reason to raise rates because after a certain point, they can’t go to CEO salaries, lobbying, ads or shareholders’ dividends.
I work in the health care field in one of the most uninsured counties in one of the most uninsured states. I serve those least likely to access care. I thank God this bill passed and was upheld. If it were knocked down, my community would have to wait generations for relief.
There are some very interesting access maps put out by the commonwealth fund that show the impact of the ACA on health care access. In the current environment, a wide swath of states throughout the Deep South and the Southwest are severely limited in access to health care. Once the ACA is implemented, the Deep South and Southwest look like the rest of America.
I believe that the ACA is the most important piece of women’s Civil Rights legislation passed since 1920, and the most important Civil Rights legislation passed since the Voting Rights Act.
We shouldn’t sell our huge victories short. They might not be perfect, but they are huge all the same!