Consider today’s ruling by the U.S. Supreme Court to be a half-full glass. In upholding President Barack Obama’s signature legislative success, the Affordable Care Act, it allowed the expansion of health coverage to about 15 million more Americans than had been covered in the past.
But in doing so, it allowed to stand a flawed reform that will expand the power of the health insurance companies, does little to address costs or improve health outcomes and still leaves an estimated 20 million uncovered.
The rationale behind so-called Obamacare is relatively simple, as described by Robert Scheer in Truthdig (in a column critical of the contortions being performed by Republican presidential hopeful Mitt Romney):
The issue faced by the court was the same on the federal level as it was on the state level; if the public, through its government, must ultimately bear the cost of caring for the uninsured—as would be so in any society possessed of even a modicum of shared social responsibility—then it can vote to levy taxes to finance that effort.
In accepting this argument, the court majority — which included conservative Chief Justice John Roberts — added balance to a badly imbalanced equation. The mandate expands the insurance pool, and shifts the cost of coverage to health-care users, rather than having the larger taxpaying public pick up the cost. Scheer, to be clear, has been critical of the Obama healthcare plan. Obama, he wrote last week,
limited his ambition to what Big Pharma and the insurance giants would accept as “reform” in a system that they had so successfully exploited. Obamacare is a faux reform born of opportunism, as was Romney’s original version: Play ball with those who have profited most from the run-up of medical costs and expect them to make it more affordable.
Two dynamics doomed the experiment. First, the new Democratic president wanted to launch a bold progressive program, but rather than channel the spirit of Franklin Delano Roosevelt to address the economic crisis that he inherited, he continued the bailouts begun under George W. Bush and fixed on health care reform instead of the financial pain being suffered by average Americans.
The second dynamic that undercut the health care bill was an overeagerness on the part of the new White House operatives to collaborate with the profiteers in the very industry targeted by reform.
Real reform, Scheer points out, would build upon Medicare, which has been remarkably successful even given the built-in cost issues it faces because its insurance pool is limited to older Americans, who require a greater amount of care.
Let me humbly suggest that as an alternative to a mandatory system rejected by the majority, we return to the idea of covering most people by attracting them to quality public and private programs through consumer choice, and that one of those choices be a version of the public option we now offer seniors. It’s called Medicare and it works splendidly.
U.S. Sen. Bernie Sanders agrees, praising today’s decision but making it clear that it should be viewed only as a first small step toward real change, as he told John Nichols in The Nation.
“In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better,” the independent senator says. “If we are serious about providing high-quality, affordable healthcare as a right, not a privilege, the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.”
Obamacare is not going to get us there, but Medicare-for-All will. Progressives should take a day or two to rejoice over today’s ruling, but then get back to work fixing our broken health-system.
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