A stronger prescription for what ails health care
In
arguments before the Supreme Court this week, the Obama administration might have done just enough to keep the Affordable Care Act from being ruled unconstitutional. Those who believe in limited government had better hope so, at least.
If Obamacare is struck down, the short-term implications are uncertain. Conservatives may be buoyed by an election-year victory; progressives may be energized by a ruling that looks more political than substantive. The long-term consequences, however, are obvious: Sooner or later, a much more far-reaching overhaul of the health-care system will be inevitable.
To say the least, the three days of oral argument before the high court did not unfold the way many experts had expected. Confident predictions that the administration would prevail by a lopsided margin became inoperative as soon as the justices began pummeling Solicitor General Donald Verrilli with pointed questions.
At one point Wednesday, as the barrage was winding down, Chief Justice John Roberts told Verrilli he could have an extra 15 minutes to argue a point. Verrilli replied, “Lucky me.”
March 30, 2012
In Health Case, Appeals to a Justice’s Idea of Liberty
WASHINGTON — The way to frame a Supreme Court argument meant to persuade Justice Anthony M. Kennedy is to talk about liberty. It is his touchstone and guiding principle, and his conception of liberty is likely to determine the future of President Obama’s health care law. If the administration is to prevail in the case, it must capture at least one vote beyond those of the court’s four more liberal justices, who are thought virtually certain to vote to uphold the law. The administration’s best hope is Justice Kennedy.
The point was not lost on Solicitor General Donald B. Verrilli Jr., who concluded his defense of the law at the court this week with remarks aimed squarely at Justice Kennedy. Mr. Verrilli said there was “a profound connection” between health care and liberty. “There will be millions of people with chronic conditions like diabetes and heart disease,” he said, “and as a result of the health care that they will get, they will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty.”
Paul D. Clement, representing 26 states challenging the law, had a comeback. “I would re
March 29, 2012
Broccoli and Bad Faith
Nobody knows what the Supreme Court will decide with regard to the Affordable Care Act. But, after this week’s hearings, it seems quite possible that the court will strike down the “mandate” — the requirement that individuals purchase health insurance — and maybe the whole law. Removing the mandate would make the law much less workable, while striking down the whole thing would mean denying health coverage to 30 million or more Americans. Given the stakes, one might have expected all the court’s members to be very careful in speaking about both health care realities and legal precedents. In reality, however, the second day of hearings suggested that the justices most hostile to the law don’t understand, or choose not to understand, how insurance works. And the third day was, in a way, even worse, as antireform justices appeared to embrace any argument, no matter how flimsy, that they could use to kill reform.
Let’s start with the already famous exchange in which Justice Antonin Scalia compared the purchase of health insurance to the purchase of broccoli, with the implication that if the government can compel you to do the former, it can also compel you to do the latter. That comparison horrified health care experts all across America because health insurance is nothing like broccoli. Why? When people choose not to buy broccoli, they don’t make broccoli unavailable to those who want it. But when people don’t buy health insurance until they get sick — which is what happens in the absence of a mandate — the resulting worsening of the risk pool makes insurance more expensive, and often unaffordable, for those who remain. As a result, unregulated health insurance basically doesn’t work, and never has.
MARCH 29, 2012, 9:00 PM
Nature-Deficit Disorder
By TIMOTHY EGANTimothy Egan on American politics and life, as seen from the West. Rick Scibelli, Jr. for The New York TimesMount Lemmon in the Santa Catalina Mountains.
TUCSON — Your day breaks, your mind aches for something stimulating to match the stirrings of the season. The gate at the urban edge is open, here to the Santa Catalina Mountains, and yet you turn inward, to pixels and particle-board vistas.
Something’s amiss. A third of all American adults — check, it just went up to 35.7 percent — are obese. The French don’t even have a word for fat, Paul Rudnick mused in a mock-Parisian tone in The New Yorker last week. “If a woman is obese,” he wrote, “we simply call her American.”
And, of course, our national branding comes with a host of deadly side effects: heart disease, stroke, Type 2 diabetes, certain kinds of cancer. Medical costs associated with obesity and inactivity are nearly $150 billion a year.
By Callum Borchers
| GLOBE CORRESPONDENT
MARCH 30, 2012
A Supreme Court ruling against President Obama’s landmark health care law could prompt challenges to the Massachusetts law that inspired it, according to legal specialists and activists following the case.
The legal case against the federal Affordable Care Act pivots on the constitutionality of its requirement that nearly every American obtain health insurance. Massachusetts was the first state to introduce such an individual mandate when lawmakers passed Governor Mitt Romney’s health care plan in 2006.
| GLOBE COLUMNIST
MARCH 30, 2012
IF THE US Supreme Court strikes down Obamacare, there will be one big loser. No, not Barack Obama. Nor Congress. It will be the high court itself.
This was a case many thought the government would win relatively easily, based both on a landmark 1942 precedent and on a 2005 case whose six-vote majority included Antonin Scalia and Anthony Kennedy.
| GLOBE COLUMNIST
MARCH 30, 2012
The most interesting social experiments start with one basic question: What does it take to make people change the way they do something important?
Health insurance companies doing business in Massachusetts are wrestling with that question right now. They are rolling out all kinds of new medical insurance products, trying to figure out what kinds of limits and restrictions people are willing to accept in order to save money on their premiums.
For the past decade, the blunt tool insurers used to limit premium increases was a system of high - often very high - deductibles and copays. That strategy is approaching its limits.
The Supreme Court will decide on the health-care law soon. It will tell you later.
If the usual process occurs, the justices of the Supreme Court will gather around a large rectangular table Friday morning and, one by one, cast their votes on the constitutionality of President Obama’s health-care law.
They will let the rest of us know the outcome in due time.
http://www.washingtonpost.com/politics/the-supreme-court-will-decide-on-the-health-care-law-soon-it-will-tell-you-later/2012/03/29/gIQAB0TujS_print.html
On health care, are Republicans ready for victory?
By Dan Balz, Published: March 29
Three days of oral arguments at the
Supreme Court have given Republicans reason for optimism that President Obama’s health-care law could be heading for a legal defeat in a few months. But would such a victory for the GOP this summer mean political success for the party in November and beyond?
No one can say with any certainty what the justices will decide. But the individual mandate — the symbol of all that conservatives loathe about the new health-care law — appears to be in trouble, based on the give and take at the high court. And Justice Antonin Scalia argued that if the mandate is ruled unconstitutional, the entire law should fall with it.
Such a ruling would be a major win for opponents of the federal statute. But it could come with complications. First, a party that has built its health-care message on the phrase “repeal and replace” would immediately come under pressure to reach consensus on how to reform the health-care system. Second, Republicans, who benefited from a sizable enthusiasm gap in the 2010 midterm elections, could face a Democratic opposition deeply angered and newly motivated by its setback in the high court.
http://www.washingtonpost.com/politics/on-health-care-is-the-gop-ready-for-victory/2012/03/29/gIQANTm3iS_print.html
Supporters of Obama's health care reform are "keeping a stiff upper lip"
reports The Hill as reaction to three tough days of oral argument and questioning on aspects of President Obama's
Affordable Care Act (ACA).
The entire health reform effort seems to hang in balance, dangerously. It looks like a very real possibility that Americans who do and will need health care, and who do or will have health conditions -- i.e., pretty much everyone -- will again be excluded from coverage for pre-existing conditions and others priced out of coverage at alarming rates if the unusually conservative and ideological Supreme Court backs the GOP.
It didn't have to be this way. We had the power to make things different. In fact, we still have the power to make things different.
The Supreme Court is so full of it. The entire institution, as well as its sanctimonious judges themselves, reeks of a time-honored hypocrisy steeped in the arrogance that justice is served by unaccountable elitism.
My problem is not with the Republicans who dominate the court questioning the obviously flawed individual mandate for the purchasing of private-sector health insurance but rather with their zeal to limit federal power only when it threatens to help the most vulnerable. The laughter noted in the court transcription that greeted the prospect of millions of the uninsured suddenly being deprived of already extended protection under the now threatened law was unconscionable. The Republican justices seem determined to strike down not only the mandate but also the entire package of accompanying health care rights because of the likelihood that, without an individual mandate, tax revenue will be needed to extend insurance coverage to those who cannot afford it.
Marcia Angell: Happy birthday, ObamaCare
By Marcia Angell, M.D.
USA Today, March 27, 2012
The Patient Protection and Affordable Care Act, otherwise known as ObamaCare, turned 2 years old Friday, just in time for this week's Supreme Court hearings on its constitutionality. The major provisions of the law, meant to increase the number of insured Americans while controlling costs, will be implemented in 2014, but a few are already in effect. What are its prospects, and will it survive intact to its next birthday? The outlook, I'm afraid, is not good.
http://www.pnhp.org/print/news/2012/march/marcia-angell-happy-birthday-obamacare
Health Care Jujitsu
By Robert Reich
The Huffington Post, March 26, 2012
Not surprisingly, today’s debut Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.
Behind this judicial foreplay is the brute political fact that if the Court decides the individual mandate is an unconstitutional extension of federal authority, the entire law starts unraveling.
But with a bit of political jujitsu, the President could turn any such defeat into a victory for a single-payer health care system – Medicare for all.
Here’s how.
The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs including marketing and advertising. Yet the only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance – including young and healthier people who are unlikely to rack up large health care costs.
This dilemma is the product of political compromise. You’ll remember the Administration couldn’t get the votes for a single-payer system such as Medicare for all. It hardly tried. Not a single Republican would even agree to a bill giving Americans the option of buying into it. But don’t expect the Supreme Court to address this dilemma. It lies buried under an avalanche of constitutional argument.
