Thursday, June 28, 2012

Health Care and Supreme Court

So, the Supreme Court upheld what some refer to as "Obamacare."  It certainly will be Obama's biggest legacy in his first term.  Many people thought it went way too far, and many thought it didn't go far enough.  It takes the U.S. one step closer to being more like the rest of the first world.

Initially, the law was assumed to be constitutional.  The experts agreed on that point.  But over time, conservatives started attacking the individual mandate--the portion of the law that penalized people for not having health insurance.  A conservative Supreme Court, and recent decisions by that Supreme Court that seem overly partisan in nature (as well as recent political attacks coming from Justices like Scalia, who usually have the good sense to stay out of partisan politics) have cast doubt on the "constitutionality" of the law.  (For the record, the Supreme Court determines whether something is constitutional or not, regardless of what the Founders may or may not have intended).

As I expected, the four liberal Justices all favored the law, and Thomas and Scalia, the far-right-wing Justices, opposed it.  Kennedy is the moderate conservative, and is usually the deciding vote in cases like this (making him a contender for the most powerful man in the U.S.).  Alito (another conservative) and Kennedy both opposed the law.  I actually expected Kennedy to support it, but I wouldn't have been surprised either way.

What is surprising is that Roberts--who is firmly in the conservative camp--voted to uphold the law, including the individual mandate.  His rationale for upholding the law had to do with classifying the penalty as a tax--a rationale I agree with (even if it may not be popular to call it a tax).  Because Roberts saw it as a tax, he saw the law as being constitutional.

The Supreme Court has started to lose credibility in the past twelve years or so.  Many have started to see them as being purely political--ruling based on their political preferences rather on the constitution and previous case law.  Roberts' move here brings the court a bit more credibility, as it was clearly not politically partisan.

So what can we expect now?  As of January 1, 2014, all Americans will be required to have health insurance, or they will have to pay a (rather small) penalty.  The upside is that a family of four making under $88,000 a year will be able to receive some help on insurance payments (and on an intelligent sliding scale, meaning families making $40,000 will receive a lot more help than families making $80,000). 

It also means that families of four who make less than $30,000 will be placed on Medicaid (right now, many children in these families have Medicaid, but, at least in Idaho, their parents can't get it unless the parents are making basically nothing--I think the cutoff is $200/month, or something ridiculous like that, and there is no sliding pay scale).

Next step--how to reduce costs to match the rest of the first world (in other words, cut them in half).  End-of-life care equals 1/3 of all healthcare costs in the U.S., and often the people receiving the care didn't actually want it, but aren't in a mental position to say no when the time comes.  Hopefully Congress can now get started on fixing that without people like Palin crying out "DEATH PANELS" every chance they get.  We need to start cutting the costs, now.

1 comment:

Tim said...

Actually reading the decision (instead of just relying on news reports) indicates that the increase of Medicaid (to families of four making $30k or less) may be in question. That will probably differ from state to state, and may not actually become law in your state.