Black robes, healthcare, seat belts and politics

The U.S. Supreme Court--whose justices habitually attire themselves in black robes--has heard the arguments for and against the Patient Protection and Affordable Care Act of 2010, and they plan to meet on Friday to vote on their decision about its constitutionality.  It might be another three months before we learn of the Court's decision.

Or maybe not; who knows?

A friend of the right-wing persuasion--yes, I have quite a few friends like that--has commented that based on the news reports of the proceedings before the Court, I am sounding less confident about the outcome.  Not so.  One always wishes for the best fortune possible, and this time is no exception, but there's no decline in my confidence.

The Affordable Care Act--known as ACA and as Obamacare--has changed the nation's conversation about healthcare.  There's no going back to the past when the conversation has changed.  This is politics; conversation, discussion and lots of talking are the lifeblood of politics.  It is because of that fundamental change that my confidence in accomplishing the goals of the ACA is still high.

Since you are wondering about this, here are some of the goals of the ACA that have already been accomplished:  there is no longer denial of medical coverage for pre-existing conditions; coverage for pre-existing conditions cannot be subject to higher insurance premiums or other discrimination against the individual needing the coverage; there are no longer any life-time caps on a beneficiary's insurance payouts; insurers must continue to provide coverage for policyholders' adult children up to the age of 26; health insurance plans must spend at least 80% or 85%--depending on the nature of the plan--of their premium revenue on medical and related services.

Do you remember that it wasn't all that long ago that a pre-existing condition would make a person an insurable pariah?  When was that?  Oh, yes, it was in the pre-Obamacare Dark Ages!  Even most of my right-wing friends agree that was an egregious abuse of power.  Well, they can't do that any more.

Numerous changes to improve quality and control costs have been implemented by insurers and medical service providers as required by ACA.   These things, and more, are significant, but either you will just have to take my word for it or go look it up yourself because they are too numerous and detailed to write about here.

But the conversation got hijacked.  It was hijacked by the Republican Party and the so-called Tea Party so that they could holler about the unfairness and unconstitutionality of the ACA requiring that everybody be financially-responsible for their own healthcare needs by having health insurance.

Gee, what a concept!  People should be prudent and financially-prepared for the future and the unexpected things in life.  What a wholesome, red-white-and-blue American, mom-and-apple-pie sort of thing.  Finally, those spend-thrift, left-wingy Democrats are getting behind a plan for individual responsibility.

Well, that turned out to be a problem, because it took away something for the Republicans to complain about.

Besides, people don't like being forced to do anything; that's natural.  So the insurance mandate is political low-hanging fruit.

This is sophistry of the worst sort.  Here's why:  the individual insurance mandate that is at the heart of the constitutional challenge is a right-wing idea from its beginning.  It was dreamed up by the Heritage Foundation in the early 1980s, and was pushed by the Republican establishment as an economically-sound way of funding the operations of the health insurance companies.

Or, at least, economically-advantageous for the insurance companies.

Let's take a little trip in the Healthcare Way-Back Machine.  What's the fundamental problem that we were trying to solve with this individual mandate?  Remember?  Of course you do.  The health insurers were blaming increasing insurance premiums on the willingness of the uninsured part of the population to seek healthcare in the most expensive setting possible -- the hospital emergency room.  The right-wing solution to this problem, which is what became imbedded in the ACA, was to enhance the corporate revenue streams of the insurers through compliance with an individual insurance mandate.

And now the Supremes have allowed themselves to be drawn into. . .well, what is this, anyway?  Is it an issue of basic legal human rights? 

(Probably not if you want to believe what Republican presidential candidate Rick Santorum said the other day on the steps of the Supreme Court, when he declared that human rights come from God and not from laws.  What's up with him, anyway?  Is he running for Pope or for President?  Has he forgotten about that American legal paper-work known as the Bill of Rights?) 

(And while we're on the topic of Republican presidential candidates, isn't there an essential contradiction in the logic of Mitt Romney, the "inevitable Republican nominee," championing the constitutional failings of the ACA individual mandate, when his signature governing achievement was an individual insurance mandate for the State of Massachusetts?  I know, he says it's OK for states to do this, but not for the Federal government. . .how does that make any sense?  Think about it long enough, and it'll be enough to make your head explode.)

Is it just a big political confrontation?  Is this all about money and debt and government expenditures and taxes?  Is it a big mess?  Probably, it's a combination of all of the above.

All of this reminds me of a similar confrontation of social welfare, economics, governmental authority and visceral arguments that happened a half-century ago.  Here we go in the Way-Back Machine again. 

Fortunately--or perhaps unfortunately, depending on the point of view--my age is such as to provide me with first-hand memories of the "Great Seat Belt Controversy" of the mid-20th Century.  In a debate that had remarkable similarities to this age's debate over healthcare, we had to put up with dire warnings that mandatory seat belts in automobiles would cause end-of-times government overreach and economic disaster.  None of that happened.  Instead, we ended up with safer cars, and eventually with air bags which provided a quantum leap in safety.  Same things were said by industry and their political allies about air bags during the 1980s, but we got past that experience in the same way.  For anybody who has been under a rock since the early '80's:  there's been no economic disaster from seat belts and air bags in cars, and we have not been troubled by the end-of-times because of horrendous government overreach in regulating the safety of something that people use all the time. 

People use cars all the time, or at the very least, they are passengers in cars that they don't drive, so everybody is affected in some way by safety characteristics of cars.  There's simply no way to convincingly assert that any appreciable portion of the American population does not benefit from the safety features of auto seat belts and air bags.

Likewise, people use healthcare services, some more than others, but there is no way to convincingly assert that any appreciable part of the population will not at some point use or benefit from healthcare services.  If somebody doesn't use healthcare services right now, they probably will at some time in the future.  At the very least, everybody is affected by the health of everybody else around them.  Think of:  flu, pneumonia, AIDS, flesh-eating bacteria. . .the list is long.

The value of the precaution of having and using seat belts and air bags in cars is well-established and accepted.  It's all about safety, prudence, health and well-being.  Sort of sounds like healthcare, doesn't it?  So, it would seem that the precautionary value of being a participating part of the healthcare system would also be easily accepted.  But that has not been the case.  Why?  Because of politics.

And so now we wait on the deliberations of the black-robed ones.

If the ACA is deemed by them to be constitutional, then we continue on an established path for an improved national healthcare system.  It's not a perfect one, and future course corrections are inevitable, but it will yield benefits; some as described earlier in this writing.  The politics surrounding it will, of course, continue.

If the ACA is deemed to be unconstitutional, then what happens?  It's hard to say.  More politics, at a minimum.  Probably improved odds of an Obama reelection as the realities of diminished insurance benefits or higher insurance premiums, or both, sink in.  If the whole thing is ruled unconstitutional, then maybe we end up back in the Dark Ages with regard to pre-existing conditions and some of the other popular results of the ACA.  That's a reality that would stir people up.  If only the insurance mandate is ruled unconstitutional, then underpinnings of the political compromise for the economics of the whole thing probably fall away.  That might lead to significantly higher insurance premium payments, or it might not.  The great gnashing of teeth over the additional cost of adding seat belts and air bags to cars eventually ended up as a tempest in a tea pot.

Which make me wonder if the Supremes drink tea or coffee or both?  And do they go for the de-caffeinated varieties?  I hope they avoid the caffeine; they have plenty of things already to keep them up at night.