I don’t normally get up early to hear Supreme Court decisions.  All their decisions are legally important, but many of them don’t directly affect my profession and the people I provide service to.  This ruling about the constitutionality of the Affordable Care Act affects all citizens.  Americans pay more for health care and get less return for their money than any other country.  They pay not only for doctors, nurses and techs, but also an equally vast army of insurance industry workers.

The insurers have a coequal balance of power with the health care providers, much like the way the three branches of government exist in a system of checks and balances.  We at the clinic get to recommend what procedures are needed for a patient.  The insurers get to determine who must pay for it and at what cost.  The Act is our first tentative attempt to fix that, because profit-driven corporations should not be the last word in who gets or doesn’t get affordable care.  Health care is a right, not just a product subject to market forces.

I’m not a lawyer.  I don’t understand all the subtleties of why the Supreme Court has decided to uphold the PPACA.  Basically, the Chief Justice was the deciding vote in a 5-4 decision in favor of the act’s constitutionality.  They ruled that Congress does have the power to penalize citizens who choose not to buy mandated insurance, not under the commerce clause (as the states objecting were arguing against), but under the power to tax given to the Legislative branch.  This is similar to the reasoning used by other countries to require universal health care coverage.  It’s a mandate that promotes the general welfare of all, so all should both be a part of the system, and help pay for it if they are able to.  It’s a baby step toward adopting a single-payer system, which is what we really deserve.

I was pretty scared they would strike the law down.  I didn’t see this line of reasoning coming.  I know there will still be a huge political fight over it, but at least the question of whether the act is LEGAL is settled.  I can put on my scrubs for work with a little extra spring in my step.


Filed under Ethics and Morality

18 responses to “UPHELD !!!

  1. Pie

    There are many things about our NHS, we complain about, but when it works, it works beautifully. And I’m contributing to this. Well done for your victory. There is no way on this earth that I would ever want to live under your health regime, though our current coalition government is certainly going to give it a good go.

    • Now that constitutionality is settled, the fight is shaping up to be between those who don’t want to pay any kind of tax, which is what the IRS penalty for not having health insurance will be, and those who must frame the argument that all citizens deserve care. People who are focused single-mindedly on the “no taxes” argument ignore the fact that most already have insurance via their employer (which they and the company contribute to), and therefore won’t be subject to the penalty.

      The tax is upon “free riders”, healthy, young earners who voluntarily choose not to be insured. They currently contribute nothing to the system, then when they get sick or injured, they go to the ED and the rest of us get to pay their bill – the most inefficient, expensive business model possible.

      Those who oppose this law say it restricts freedom of choice. It does. The current exorbitant cost of care restricts freedom as much or more, especially for those who get sick and go bankrupt as a result.

      Thanks for dropping by, Pie. It’s a complex problem for any nation to try and solve.

      • It’s interesting, isn’t it, that everyone pays taxes into Medicare, and virtually no one objects to it. This ACA “tax,” or assessment as it were, will start at $95. Yes, that’s a lot of money to some people, but these will be people who could actually afford health insurance, as I understand it. Those who can’t afford it will qualify for subsidies and tax credits to help them. So, $95 a year for the privilege of not buying health insurance? And you’ll get ER care anyway? Seems like some kind of deal to me. But, of course, as Buckminster Fuller said, what’s going on is not really what’s happening.

        • Well put. It certainly isn’t anything like the “biggest tax increase ever” lie offered by those opposed to the law. Hopefully having a small tax penalty in place, combined with expanded availability of Medicaid for those at the bottom, will help incentivise more to join. Thanks for weighing in!

      • Sean Reilly

        Do you honestly believe the “tax” is only going to be on the “free riders?” Please tell me you’re not that naive.

        • If you have insurance through your employer, have a religious objection to medical care, are incarcerated, in the military, or buy insurance through exchanges set up either by the states, or by the feds in states which don’t set them up, you don’t pay the tax. Finally, if the cost of buying healthcare will cost more than 8% of your income, you are exempt. There’s no one left except “free riders”! I’m naive about many things. I admitted to not being a lawyer. However the part of the law that says who has to pay the penalty is clear enough for even me to understand.

      • Sean Reilly

        Biggest Tax Increase ever “lie?” No sir! The biggest lie was told by Mr. President himself — multiple times — “no tax increase.” He was adamant about it (well not really, but he sure “worked it” with the American people). So… the foundation of the program is built on a lie, but now you’re willing to trust him to move forward with a skyscraper? Good luck with that.

        • The per person penalty is $95 in the first years, and caps out at $695 for a family when fully implemented. If you eliminate all those exempted, that’s peanuts for the (primarily) young, healthy workers who just don’t want to buy insurance, for whatever reason. The intent of the law is to make insurance available to more who do not have it now, and to bring down the cost of care for all by managing the entire population of patients under a more unified, simpler system. By increasing regulation and requirements for all insurers to cover equally at a similar cost, it also reduces inequities in the current situation. As others here have pointed out, it’s only a first step. The best end result would be single-payer, i.e. “Medicare for All”.

          This out-of-control cost situation has been building through the administrations of at least the past six presidents. This type of health care reform was first proposed (by Republicans) in the 1980s, and of course the current law is closely modeled after the law operating in Massachusets signed by then Governor Romney, the presumptive GOP nominee. Access to affordable health care for all should not be a partisan issue, unless you think members of only one or the other side will be getting sick or injured. (I don’t ask how people vote when I’m assigned to perform examinations.)

          I am glad to have your input, Sean, even if I disagree. If you leave a back-link to your own blog or website (if you have one) I’ll be happy to give your place a plug. I call them “gift baskets”, and first-time commenters get them FREE! (no IRS penalty)

  2. Well said, Mikey! I couldn’t agree with you more!

    • Thanks, Myra. It’s going to be confusing and difficult to get where we need to go, but everyone who isn’t making obscene profits from the way things are now should be able to see that what we have now is financially unsustainable as well as unjust.

  3. You’re right it’s a baby step but the first step is the most important one to take.

  4. So glad you had a little spring to your step, just wanted to let you know I’m cheering you on over here in Blighty! 🙂

  5. Like you, I’m relieved the legality of the law was upheld. In the broader view, my concern is that the law itself does not go far enough to address the problems you identified. A single payer system with universal coverage makes so much sense, but only if we devote more attention to wellness and prevention. Until then, the current law is a step in the right direction.

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