So the Supreme Court did the \u201cunexpected\u201d (expected by constitutional scholars and those in the know, but unexpected by the media, so therefore unexpected) and upheld the bulk of Obamacare, specifically the mandate. Medicaid expansion was tweaked, and there are some arguments that the limits on the Commerce Clause is the real far-reaching story of the day, but all the same, this is something to be thankful for.<\/p>\n
<\/p>\n
It\u2019s hard to believe that more than four years after Obama started running for President, and more than two years after it was passed into law (an event that I am not ashamed to admit drove me to tears of joy), it all came down to this test before nine people, which it survived despite popular wisdom. And of course this issue isn\u2019t even close to being done. It\u2019s not the beginning of the end for Obamacare, but it is the end of the beginning.<\/p>\n
I have lots of random thoughts about the decision. First, about whether it is a tax or not. Sure, it\u2019s a tax. The fact that it is a tax is the reason it was upheld, because the most convincing argument all along has been along these lines:<\/p>\n
Economically, plans #1 and #2 are identical. Since #1 is clearly constitutional under the Congress\u2019s power to levy taxes, the equivalent outcome #2 should also be constitutional. This is the logic that John Roberts ultimately bought in upholding the mandate.<\/p>\n
Although he upheld the mandate under the ability to tax, I disagree with his statement that it can\u2019t be upheld under the Commerce Clause. Judge Ginsburg is right: there is no way you can opt out of the health care market, and therefore every decision you make affects commerce. Don\u2019t buy insurance and get hit by a bus? Somebody has to pay for your ER care, and that somebody is either existing policy holders, or property tax payers, or income tax payers, or somebody other than you. You can no more opt out of the health care market than you can opt out of police or fire or military protection.<\/p>\n
As for the dissenters, only Kennedy bears comment. Of course Scalia, Alito, and Thomas would vote against anything. They voted to put kids away for life without parole, fer chrissakes. But Kennedy? To join the rest of that crew in saying that the entire ACA is unconstitutional on its face? I can\u2019t believe that he would go that far in his legal reasoning. I think that\u2019s really going to reflect poorly on him going forward.<\/p>\n
Now, what about the politics? Lots of people are arguing that this is really going to energize the Tea Party base and lead to a Republican sweep. Maybe it will, but in politics, as in life, success begets success. Obama just had a huge win, and that\u2019s got to give him some momentum. And while the Tea Party may use this to rally the troops, as they are promising, if the Democrats are smart (and that\u2019s a big \u201cif\u201d), then expect to start seeing these ads on a TV near you:<\/p>\n
Etc. etc. As poll after poll shows, the individual aspects of Obamacare (aside from the mandate) are all popular. If you start gutting them with your \u201cone page repeal bill on day one\u201d, you are going to have to deal with lots of constituents who wonder why you hate kids with cancer so much.<\/p>\n
And let\u2019s bring this specifically to Mitt Romney. Obamacare is Romneycare<\/a>, pure and simple. One is modeled upon the other. Obamacare is a conservative, not liberal, solution to our health insurance crisis (which is why Newt Gingrich also supported<\/a> mandates). Again, if Obama is smart, he is going to say this in one of the debates:<\/p>\n \u201cMitt, Obamacare is modeled on Romneycare, mandate and all. You argued that Obamacare was different because it was unconstutional, That is no longer true. So if your plan is wrong for the country, why did you pass it in Massachusetts? And what would you replace it with if you were elected?\u201d<\/p><\/blockquote>\n Much hemming and hawing would commence, I believe. Because what can Mitt say that makes sense?<\/p>\n I end with a couple of observations. David Frum is one of the few conservatives that I read because he argues from facts and not made-up nonsense, and while I don\u2019t always agree with him, his arguments are solid. He puts forward<\/a> a rather conservative approach to improving health care. Again, frankly, it\u2019s one that I hard a hard time quibbling with. It\u2019s one that most Democrats would eagerly agree to. Once upon a time, it\u2019s one that Republicans would embrace too, before their party became nothing more than a vehicle for blocking any and all Democratic initiatives.<\/p>\n Second, I\u2019ve read a lot of stories in the past week leading up to this decision about people who would be positively impacted by Obamacare when it is fully implemented: those with pre-existing conditions, those who can\u2019t afford insurance, and so forth. What I\u2019ve been struck by is the fact that a lot of these people don\u2019t<\/em> like Obamacare, saying it doesn\u2019t feel right or it infringes upon their freedom. Freedom to get sick and not get treatment, I guess. But still, this shows that most people just don\u2019t get the full scope of the plan yet. Frankly, I don\u2019t think they ever will, and that\u2019s something that policymakers need to understand.<\/p>\n In the end, I don\u2019t much care for Obamacare: it isn\u2019t remotely like what I think our health insurance system should look like. Like I\u2019ve said a million times before, insurance should be severed from employment (as David Frum admits), and something that has a public option. My favorite analogy is a regulated cell phone market: there are many regulated plans to choose from, with varying benefits that meet a minimum standard, at various cost levels. Obamacare isn\u2019t close to that. However, this decision means that maybe, possibly, for the first time the fact that millions of people don\u2019t have insurance will no longer be acceptable, and even more important, will no longer exist. Again, this decision is just the start. From here on out, I hope that both Democrats and Republicans can work together to come up with a system that covers everybody and provides quality care at a lower cost than currently.<\/p>\n I can dream, can\u2019t I?<\/p>\n","protected":false},"excerpt":{"rendered":" So the Supreme Court did the \u201cunexpected\u201d (expected by constitutional scholars and those in the know, but unexpected by the media, so therefore unexpected) and upheld the bulk of Obamacare, specifically the mandate. Medicaid expansion was tweaked, and there are some arguments that the limits on the Commerce Clause is the real far-reaching story of… Continue reading Health Care, The Future, and All The Fish<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[77,186,220,88],"class_list":["post-748","post","type-post","status-publish","format-standard","hentry","category-politics","tag-health-care","tag-obama","tag-romney","tag-supreme-court","entry"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t