Assessing the Supreme Court Health Care Ruling

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Here’s a roundup of perspectives and analysis of yesterday’s Supreme Court Affordable Care Act decision.

A Defining Decision for Chief Justice Roberts
“Chief Justice John G. Roberts Jr. has a favorite quotation from one of the giants who preceded him on the Supreme Court. Assessing the constitutionality of a law passed by Congress, Justice Oliver Wendell Holmes Jr. once wrote, ‘is the gravest and most delicate duty that this court is called on to perform.’ In finding a way to uphold President Obama’s health care overhaul law on Thursday, Chief Justice Roberts performed the task with exquisite delicacy. That he did was a surprise from a judge whose rulings and background, including legal work in the administrations of President Ronald Reagan and the first President George Bush, suggested a conventionally conservative worldview… The legacy of the Roberts court came into focus on Thursday.” Adam Liptak, The New York Times

The Fate of the Uninsured Remains Embattled
“Tens of millions of Americans don’t have access to basic care for prevention and treatment of illness. For decades, there’s been wide support for universal health care. Finally, with the passage of Obamacare, two years ago, we did something about it. The law would provide coverage to people like those my friends told me about, either through its expansion of Medicaid eligibility or through subsidized private insurance. Yet the country has remained convulsed by battles over whether we should implement this plan — or any particular plan. Now that the Supreme Court has largely upheld Obamacare, it’s tempting to imagine that the battles will subside. There’s reason to think that they won’t.” Atul Gawande, The New Yorker

Pre-Decision Speculation and Post-Political Fallout
“To the extent there are marginal effects of the court’s decision, they would seem to be positive for Mr. Obama. The framework of the bill has now been endorsed by the court, including by John G. Roberts Jr., the relatively conservative and relatively well-respected Chief Justice who wrote the majority opinion… It is what passes for conventional wisdom that may have been the clearest loser with the court’s decision. Sentiment in prediction markets and among pundits had been that the law was more likely than not to be overturned… Statistical methods to predict the court’s decision, which have been more reliable than expert judgment in the past, had pointed to a case that was too close to call.” Nate Silver, The New York Times

Did Scalia’s Intransigence Move Roberts?
“Having already written half a dozen posts about the Supreme Court’s decision in the Obamacare case, over lunch I decided to dive into the dissent, authored by Antonin Scalia. It’s fairly remarkable…This is a very far-reaching dissent, and goes to show just how far four members of the court are willing to go. They didn’t choose the most restrained option, overruling only what they absolutely had to. They gleefully took a meat axe to everything, concluding that the only possible resolution was to completely invalidate the major provisions of the law, and then to invalidate the entire law… In fact, it’s possible that Roberts was initially willing to join the four conservatives, but then flipped sides when they implacably insisted on gutting the entire measure. If that’s the case — and there’s some evidence that it is — liberals were saved not by the force of their arguments, but purely by the intransigence of the court’s conservatives.” Kevin Drum, Mother Jones

Where the Uninsured Live
“Legal scholars are still parsing today’s complicated ruling, which upheld the mandate as a tax and precluded the federal government from withholding Medicaid funds from states that choose not to participate in the law’s Medicaid expansion. In that sense, there remains some uncertainty as to how the landscape of the uninsured might vary state-by-state once the law is fully implemented in 2014. Still, regardless of any potential variation in Medicaid expansion, one thing at last seems certain: This map of uninsured Americans will soon look very, very different.” Sommer Mathis, Atlantic Cities Blog

Map of the U.S. uninsured; Credit: Gallup Healthways

What’s In it For Me?
“The court’s decision to uphold all but one component of the health-care law means new rules for insurers that have already taken effect will remain in place. Beginning in 2014, virtually all Americans will have to obtain health insurance or pay a penalty. There also will be new opportunities to get coverage, including state-based marketplaces known as exchanges* (through which individuals will be able to purchase private plans that meet strict benchmarks for quality) and federal subsidies to help low-income people buy plans on the exchanges. The law will also expand the eligibility rules for Medicaid, but the Court found that states can not be penalized if they decline to comply with the expansion, raising questions as to how effectively the federal government will be able to implement it.” The Washington Post

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  • Anonymous

    Who’s to say that Congress won’t do to this legislation what it is doing to Dodd-Frank — namely, destroying it before it even gets a chance to be implemented?

    It’s a nightmare of a plan, so I guess it’s importance is in the fact of its existence: in theory, it could just as easily be improved as destroyed.  In theory.

  • JonThomas

     I hope for “improved.” Like, improved right over to single payer. lol

  • Celie Cairney

    It was stated from the very beginning that the Affordable Care Act wasn’t perfect, that it needed tweaking.  Now that the Court has ruled on it why can’t the congress get to work on making it a better law, one that improves the lives of the greater majority instead of this continued childish  bickering.  

  • Anonymous

    Well, well, well,  for the life of me, I do not comprehend our friends ” just up north” and “across the pond” having one payor insurance for everyone and not being called “socialist” – whatever that means to some people – isn’t there something about “LIFE, LIBERTY, ETC….” – life itself is required first I believe – and given some time progression in medicine since those words were written…seems so obvious       VOTE

  • Lance C

     They are not called socialist because they are not.  And pointing only to Britain and Canada as the only examples of universal health care is misleading and, let alone that these models work well and produce better outcomes than ours does and at lower cost.  It also ignores alternative universal health care models

    There are several other models that are quite different than the British/Canadian model.  Germany, France and Japan are good examples.  They are not single-payor, but they also work very well.  Whether in the British or other systems, everyone has good health care.

    These universal health care systems produce far better health outcomes than ours and at much lower cost.  One key and common thread in all of them is a single fee structure that determines what all service providers charge.  Every doctor, hospital, etc. charges the same fee for the same service.  Is this socialism?  Not really.  It simply is developing policy that
    enhances freedom and liberty for everyone.

    The real problem here in the US is that, unlike in every other industrialized nation, we have yet to agree that heath care is a right and not a privilege.  The other nations concluded that all citizens have a right to good quality health care, and then, they built systems to provide it.  Their people and societies are no less free and democratic than we are.  They just take a different approach that puts greater emphasis on collective responsibility for the good and freedom of all than we do, and to their credit, I’d say.  It is absurd that we have 30 million people without health insurance and access to good health care!

  • Lance C

     Congress is not the problem.  We, the people, are the problem.  We say we like universal health care, but then, we reject any change in our current system.  We cannot have it both ways. 

    We, the people, have to make a clear decision that health care is a right and not just a privilege for those who can afford it.  then we must vote based on this decision and demand that politicians develop a system that is fair and just for everyone.  Once we do,  the politicians will follow.

  • Lance C

     Nothing can stop Congress from repealing or gutting the law, except we, the people.  If we agree that universal health care is a must – as every other industrialized democracy has done and implement – then Congress will follow. 

  • Lance C

    Single payor is hot necessarily the best solution.  This is the model most familiar to us in America because it is the British/Canadian model.  There are other models that are equally effective and also produce better outcomes than our American system and at much lower cost.  Germany, France and Japan are good examples.  See “Healing of America” by T.R Reid for details about the range of models out there, how they work, etc.

    To me, what matters is that we, as a nation, finally make a clear decision that health care is a right and not just a privilege, and demand universal health care for all Americans.  Which specific model we use can be determined after further research, analysis, debate, etc.

  • Lennart

     I suppose Solidarity is not part of ETC….

  • Hillside

    It’s the little things that matter in something this large.  Such as reducing the rate of uncompensated care in hospitals – it’s not just that this has to be covered, but it has to be provided for.  Take that off the table and rates can go down.  Improving efficiency and effectiveness in hospital operations – bringing them into the digital age – paid for by the Federal Government so that costs can come down.  And a wide range of nips and tucks with the goal, in 2014, of rates that most honest cititzens will be able to say, “Yes, I can live with that.”

  • profpeter

     Lance C,

    I agree wholeheartedly with the points you put forward, especially that health care is a human right. It was precisely that argument that brought Canada’s system into being — by a vote of a majority of the citizens — in 1982.

    Another multi-payor system that works quite well (and is, relatively recent in its making) is the system of universal health care in Switzerland. This is another upon which T.R. Reid has reported.

  • Clb

    Question: Where does the government get rights? I was listening to the “Stolen Valor” arguments on C-span and Scalia referred to the government right to determine the truth in criminal investigations. But I thought the government got its rights from the people, that the authority of the laws is based on a delegation of the inalienable right of self defense. And there is a legal principle that no one can assign rights they don’t have. Yet Supreme Court decisions both defend the right of government to lie to the people and the right of the government to demand truth from the people.  If rights don’t come from the consent of the governed, what’s left? Might makes right?

  • Bluegrassbloke

     Just for clarification, were you implying Canada & UK’s systems are the same? The only similarity is in its universality.

  • Bluegrassbloke

     A vote in ’82? What vote was that? I must have missed something. I live in BC saw it implemented here in ’70. Tommy Douglas premier of Saskatchewan is the father of Canadian universal healthcare.

  • Dirk Faegre

    And it bears adding …. when asked, in those other countries to which you refer, if they would want to change places with us … they blanche in horror (0r alternatively burst out laughing).  They may find problems with their own systems but nothing, not even close, to the shortcomings of ours.  This applies to every single other developed (and even some undeveloped) countries.  We are blind as to how bad our systems are and, at a minimum, twice as expensive — and to a few we are three times as expensive.  We have met the fools and we are them (apologies to Pogo).

  • JonThomas

    There was a comment from someone named “Concerned2337,” which was posted last night about 12:30 am.

    Is there a reason it isn’t here anymore?

  • moderator

    It was flagged, now it is back up. Thanks!

    Sean @ Moyers

  • JonThomas

     Thank you Sean.

    The comment was well detailed and seemed to have well documented points.

    It also seemed to be very politely written. Thank you for putting it back up.

    If what is written  in a comment is untruthful, people are free to point out where it is untrue.

    I guess someone found it upsetting that it exposed some of the things which no one is talking about.

    Interesting how both the left and the right get upset if they don’t like what is said, then instead of refuting the points, they resort to forms of censorship with tactics like, in this case, flagging a comment.

    Thank you again for giving us a chance to judge the comment on it’s merits.

  • Miss Jan

    The legislation is entitled and affirmed the “Affordable Care Act.” I live in Oregon. Oregon has a web page on the State website for its version of the “Health Insurance Exchange”. That web page has a calculator for the individual mandated to buy health insurance to determine what they will be paying per month. I ran the calculator today. It not only says I will expect to pay more than I currently pay per month for rent, utilities and car insurance. Of course, it promises that there will be a “tax credit” to “offset” a large percentage of that leaving the cost at only what I pay for utilities and car insurance. I am concerned as I understand from years of experience as a taxpayer that a “tax credit” only happens when you file your taxes the following April 15. Does that not actually mean, then, that a “cash flow analysis” draws the conclusion that the FULL amount will have to be paid monthly to the insurance company with the (hope) “credit” for the government’s share not given until well into the FOLLOWING year? Further, Oregon’s calculator also tells me I should expect to pay thousands of dollars in addition to the monthly premium for co-pays and deductibles!

    If that is indeed the case, cash flow being what it actually is for me, there is simply no possible way for me to pay this.

    I do not believe that most people forego health insurance because their goal is to stick it to medical providers by using the ER as their primary health care institution; I believe it is because people simply cannot afford it. Currently (before 2014 that is) I would have to pay approximately twenty percent more than my entire take-home pay to buy health insurance. It does NOT appear to change appreciably in 2014.

    Mr. Moyers, perhaps your team would address the REAL monthly financial challenge for individuals who do not have health insurance through an employer. And, as well, experts to discuss the fine points of the ruling which still require larger employers to offer health insurance to their employees. The operative term here would be “offer.” It doesn’t say “pay for.”

  • mbrecker

    All Congresspeople and the Supreme Court Justices have govt. health care. Can you name one Congressperson that publically said they would go on private health care like the rest of us who still have it until single payer was in place? Dennis Kucinich. I’ve never heard literally anyone else from Obama on down do the same thing.

    The reasons? The millions they get in campaign money. Two, not all but many actually believe that they’re “entitled” to it. Just because of who they are. An ironic choice of words. But true.

  • Matthew Crockett

    I for one haven’t been able to follow is that right up to the point before President Obama took office the mandate was a Republican idea. It was discussed as far back as Nixon and one reason why Mitt Romney has been limited in his ability to attack the President is the fact that, as a governor,  he implemented that very idea as part of his own state-level bill. 

    Once our current president signed the bill, every prominent Republican has cited the mandate as the primary reason why the bill specifically Has to be repealed In Its Entirety rather than simply revise it.

  • Anonymous

     Lennart, I am confused – what are you referring to? – the Polish Movement of quite a while ago?????

  • Anonymous

    well, you certainly appear to have done your homework and I certainly haven’t done mine as well as you and will now start a better effort. Thanks for your bibliography – sincerely

  • Anonymous

    Reply to Jon Thomas
    Don’t understand how “flag thing” is supposed to work, but doesn’t appear to as by my replying to you – you got a flag????? & what I am saying is thank you for calling attention to “Concerned2337″ & getting it up because I am trying to keep up with this and had missed it. Will have to read to see if I agree or disagree, but shamed me in my incomplete study. Thank you

  • JonThomas

     You’re welcome.

    The flag icon, found under comments, seen when you hover the cursor over a comment, to the right of the time stamp, is a link that sends the site moderators a warning.  It is a tool given to users so they can let moderators know that a comment may contain offensive, false, or libelous/slanderous content.

    Basically, when used properly, it is simply an alert that a comment may contain objectionable (usually to the point of being abusive) material.

    I saw the email for that comment and scanned it quickly before bedtime. I was looking forward to reading it closely, but was disappointed to see it removed.

    Since I didn’t notice anything abusive in the comment, I thought it good to ask about it’s status.

    I guess it’s possible someone flagged it by accident, and I shouldn’t jump to conclusions, but some people do abuse the system to try to get items they disagree with removed.

    Usually the flag icon does not remove a comment from a forum (I don’t speak from knowledge of the workings of this site, all are set up differently.) But, that comment did come in late on a Sunday night. Maybe the mods have it set up to err on the safe side, especially on a weekend…that is; to simply let the flag remove the comment until a moderator can review it closely.