The Supreme Court Has Spoken

Michael Moore

The Supreme Court of the United States has spoken in the matter of President Obama’s Affordable Care Act (ACA). The vote to uphold the constitutionality of the legislation reflected what might be considered, at first glance, strange bedfellows. Chief Justice John Roberts joined the more liberal members of the Court to uphold the ACA. Some chalk up Roberts’ ‘defection’  as wanting to salvage the reputation of the Roberts Court against charges that decisions are made repeatedly along ideological lines. While we can’t get into the Chief Justice’s head, we can speculate about what else could explain the ruling.

Keep in mind that the blueprint for ACA comes from the conservative Heritage Foundation and was embraced by Gov. Mitt Romney in Massachusetts. In addition, the ACA puts in place a system of corporate welfare for health insurance companies. So it really should come as no surprise that a conservative Justice would vote to uphold it.

In writing his masterful opinion, Roberts exhibited a stroke of genius. Two particular aspects of the ruling have political implications. Roberts dubbed the penalty for non-compliance a “tax”, saddling President Obama with the title of ‘taxer-in-chief’. In fact, a Quinnipiac University poll found that 55% of respondents believed that the ACA amounts to a tax increase, while 36% believe it does not.

Another part of the Chief Justice’s opinion says that the federal government can’t force states to expand Medicaid or penalize them for refusing to do so. This is a particularly sharp blow to ACA since Medicaid expansion was supposed to take care of a hefty percentage of those to be covered under the law. It remains to be seen how the ACA will play out in the coming years.

The Supreme Court ruling notwithstanding, the ACA in no way writes the final chapter on health care in the United States. We cannot continue to rely on what a New York Times editorial called “the disjointed, costly American health care system.”

Response from HealthCare4AllPA

It is clear that the single-payer movement in states across the country is going forward. HealthCare4AllPA’s leaders have written in response to the ACA decision.

President Dave Steil wrote shortly after the ruling: “In March of 2010 the United States Congress passed the Patient Protection and Affordable Care Act (PPACA). This landmark legislation addressed some health care issues but also left many questions and legal challenges. In the past few days the United States Supreme Court has upheld the constitutionality of the Act which means that the various provisions will continue to be implemented, mostly by 2014 but also continuing through the end of the decade. One of those provisions is that States may propose their own innovations in health care provided that those innovations do not fall below the requirements of the PPACA. As the law is written this cannot occur until 2017.

“Here in Pennsylvania a number of citizens from all walks of life have banded together in an organization known as Health Care 4 All PA. We believe that resolution of the health care issue begins with allowing the states to adopt health care programs tailored to the needs of their residents. Moreover, we believe that a single payer system is the most cost effective and economical method of delivering that health care. Research data and economic analysis support that conclusion. Huge costs of the present health care system are eliminated through reducing or eliminating extensive administrative, marketing and management costs.

“Single payer means, simply, that every Pennsylvania citizen would be provided health care with the expectation that every citizen and every business would contribute to its cost. It is clear that those costs would be significantly less in total than the costs of the current system which leaves many Pennsylvanians without health care protection.

“Our organization is committed to moving forward with a single payer model and to be prepared to join other states including Vermont, Hawaii, Montana and Washington by 2017 with the implementation of the proposal.”

Executive director Chuck Pennacchio wrote: “Given the six-year implementation of the Massachusetts Model, the PPACA-related answers to…questions are mixed – but, regrettably, mostly negative. Yes, perhaps 2% of Americans – those aged 19 to 26 (2.6M), those with pre-existing conditions (70K), those who are indigent and uninsured (3 to 4 M) – will appreciate increased access to healthcare providers and services. That is PPACA’s best news - and one cannot understate or undervalue the importance of expanding healthcare to Americans previously shut out of the system altogether. On the other hand, a significant chunk of the 2% targeted beneficiaries intended for inclusion in expanded healthcare will not get what they need because of the shrinking pool of primary care physicians, community hospital closures, unaffordable premiums/co-pays/deductibles, across-the-board cuts in healthcare spending, and systemic “gaming” and cherry-picking” by a profit-centered health insurance industry.

“Now for the predictable bad news – based on PPACA’s legislative forerunner, the Massachusetts Model. Initial Massachusetts successes in increasing those with health insurance paperwork and those with actual access to healthcare have given way, in the last four years, to alarming rises in the uninsured, the under-insured, taxes, premiums, co-pays, deductibles, hospital closures, physician flight, and overall healthcare outcomes. The Massachusetts legislature is now cutting, not increasing, services, as economic and budgetary restraints bring political calls for austerity. Profit-first, health insurance-centered healthcare is proving to be unsustainable in a state that is disproportionately wealthier and more liberal than most. If PPACA modeling can’t work in Massachusetts, how can we expect it to work in the partisan puzzle palace known as Washington, D.C.?

“Now for the good news: advancing the Proven Single Payer Solution. PPACA is simply unsustainable – financially, economically, morally, politically, and logically. Simply put, PPACA over-promises and under-delivers. It increases the power and profits of the profit-first, healthcare denying health insurance industry, while leaving patients, providers, taxpayers, municipal governments, businesses, labor unions, and more at the mercy of the predatory medical-industrial-complex. Politicians enable, corporate insurance profits, citizens suffer.

“Only the Proven Single Payer Solution solves the system. And, irony of ironies, PPACA provides state-based waivers and instruments to implement state-based single payer! As healthcare-related costs continue to escalate out of control (to perhaps 25% of GDP in 2025), healthcare access diminishes, medical bankruptcies and preventable medical tragedies increase, and more, the system will collapse on itself. Who knows where the tipping point is? But we all know that the evidence and morality point to the American answer: Single Payer, aka, Expanded and Improved Medicare for All. That is, publicly-funded, privately-delivered, guaranteed, quality, comprehensive, doc-and-nurse-retaining, cost-cutting, job-generating healthcare for all…”

HealthCare4AllPA’s Dr. Walter Tsou posted the following at Common Dreams.org: “The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

“Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

“Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

“The answer – single-payer national health insurance, also known as an improved Medicare for all – would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

“Outrageously, the simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed ‘politically impossible.’…

“So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth…

“Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today…”

Others React

There was certainly no shortage of commentary following the Supreme Court’s decision. Here’s a sampling:

Richard Cohen, a syndicated columnist for the Washington Post Writers Group, wrote, “As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialistic but because it is not socialistic enough. A government-run health care system such as the ones used in virtually all the industrialized world – the so-called single payer systems – would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American way.”

In a letter posted to the Wall Street Journal, J. David Gaines, M.D. wrote, “Although the Supreme Court has upheld the Affordable Care Act, the unfortunate reality is that the law, despite its modest benefits, is not a remedy for our health care crisis. It will not achieve universal coverage, as it leaves at least 26 million individuals uninsured. 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 it will not control costs.”

Jack Bernard, a retired health care executive who formerly worked with Kansas hospitals on planning and cost containment issues and who currently serves as a Republican county commissioner in Monticello, GA, wrote in the Kansas City Star, “We did end up with a health care reform law. But, strangely enough, it was stolen from Romneycare and the Republican side of the aisle simply because of  the political cost to Democrats of inaction. It is a horse put together by a committee – ineffective, complex, and political. If Romneycare is any indication, it will clearly not control costs to the taxpayer, the top health care concern of most Americans…Plus, this administration squandered the chance for real reform, a simple expansion of Medicare. The ‘government takeover’ catch phrase scared them off. Universal Medicare is a concept that makes sense technically and fiscally. The U.S. currently has per capita health expenditure costs double that of other developed nations on single-payer systems…Taking the long view, universal Medicare will eventually be implemented in the U.S., because of increasing premium costs and cost shifting if nothing else. But in 15 or 20 years, our health care cost and quality problems will be even worse because of congressional inaction.”

Rube Goldberg on Steroids

Is there anyone on the planet who knows all the details and ramifications of the multi-thousand page ACA? It’s an almost impossible feat due to the overly complex nature of the law. Add to that the fact that the chameleon law’s provisions seem to change as time goes on.

The health care team at FireDogLake.com has put together a fact sheet attempting to separate myth from truth. Some samples:

Myth: This is a universal health care bill.  Truth: This bill is neither universal health care nor universal insurance. (They suggest that at least 24 million will remain uncovered.)

Myth: Insurance companies hate this bill.  Truth: This bill is almost identical to the plan written by AHIP, the insurance company trade association, in 2009. (They note that since Congress released the first of its health care bills in October, 2009, health care stocks have risen 28.35%.)

Myth: The bill will make health care affordable for middle class Americans.  Truth: The bill will impose a financial hardship on middle class Americans who will be forced to buy a product they can’t afford to use.

Myth: This plan is similar to the Massachusetts plan which makes  health care affordable.  Truth: Many Massachusetts residents forgo health care because they can’t afford it.

Myth: The bill will require big companies like WalMart to provide insurance for their employees.  Truth: The bill was written so that most WalMart employees will qualify for subsidies, and taxpayers will pick up a large portion of the cost of their coverage.

Myth: The bill prohibits dropping people in individual plans from coverage when they get sick.  Truth: The bill does not empower a regulatory body to keep sick people from being dropped when they’re sick. (They note that without an enforcement mechanism, there is little to hold the insurance companies in check.)

FireDogLake.com touches on many other aspects of the ACA, but you get the picture.

Still SiCKO After All These Years

Two days after the Supreme Court rendered its decision, the One Payer States (state-based Medicare for all advocates from across the country) held a rally in Philadelphia on June 30. The event, titled Still SiCKO After All These Years, featured Michael Moore and seven cast members of his documentary, SiCKO, marking the five year anniversary of the film’s release. Cast members brought the audience up to date on their struggles with health care in the years since their experiences were chronicled in the film. Former health insurance industry executive turned whistleblower, Wendell Potter, also spoke at the event.

We’ve seen SiCKO so many times that listening to the cast members tell their stories was almost like catching up with old friends. Their tales were haunting examples of our immoral health care system. Particularly moving was the case of Adrian Campbell Montgomery. The 30 year-old three time cancer survivor displayed a combination 0f vulnerability, steely determination and strength. “Health care,” she stated, “should be barrier free.”

Former insurance company employee Lee Einer nailed it when he said, “We have a corporate hegemony problem.” Lee is now a community organizer working for systemic change.

Julie Pierce, widow of Tracy Pierce, Sr. (who died because his insurance company refused to cover a needed bone marrow transplant) was emphatic. “Someone in a cubicle should not decide whether we live or die.”

Whistleblower Wendell Potter acknowledged that SiCKO started a “crisis of conscience” which began his journey toward the realization that he could no longer work in the health insurance industry. He is working very hard to atone for his sins.

Donna Smith eloquently pointed out that the SiCKO U.S. health care system victims would encounter the same health care issues under the ACA as they did five years ago. Pushing for single-payer reform, she concluded, “We won’t stop til the job is done, and we’re not done yet.” Donna asked Michael Moore and Wendell Potter to stay on board until the end and they vowed that they would.

Michael Moore’s remarks were sharp, witty, and at times hysterically funny. But regarding health care reform moving forward, the filmmaker was quite serious. He compared the ACA to putting clove oil on a toothache. It feels better for a while, but it won’t cure what’s wrong. To raucous applause he proclaimed, “The single-payer train has left the station, and it’s not turning back!”