Map of life expectancy at birth from Global Education Project.

Wednesday, March 28, 2012

Dream on . . .

The shiny silver lining meme that's going around progressive circles these days is that if the Supreme "Court" tosses the Affordable Care Act, congress will have no choice but to go to single payer national health care. This was actually first proposed by Robert Reich in the Puffington Host, but I don't link to purveyors of quackery and pseudo-scientific gibberish.

In fact the "justices" are going to have a hard time twisting themselves into the contortions necessary to hand the far right a victory in this case. Note that I say "far right" advisedly because the basics of the Affordable Care Act were first proposed by the Heritage Foundation. If they toss the whole thing, it's unclear what happens to the money that's already been spent and the structural reforms that have already happened. For example, the Patient Centered Outcomes Research Institute already has its income stream and has started to spend the money. The Center for Medicare and Medicaid Innovation, the Independent Medicare Payment Advisory Board, high risk pools, limits on medical loss ratios, extending eligibility for inclusion in family policies to age 26 -- all of these would seem to have nothing to do with the individual mandate, and the closely linked provisions of guaranteed issue and community rating. (All of which are contrary to the Bible, of course, as well as the Constitution.)

So they could leave all that alone, and just toss the individual mandate along with guaranteed issue and community rating. But if they do that, they will have to admit that health insurance isn't anything like broccoli after all, and that congress did indeed have a perfectly good reason for including the individual mandate in order to accomplish its clearly legitimate and constitutional goals of regulating interstate commerce; and that there is indeed a limiting principle in that a similar problem does not apply to any other good or service.

But if they just toss the mandate and leave the rest alone, the result will be a disaster, which will cause utter chaos and destroy the market for health insurance. The presumption by Reich and others is that at that point, congress will just have to do something, and the only something that's left which is clearly constitutionally legitimate is single payer.

Hah! The very same powerful interests that made single payer impossible in the first place and left the individual mandate as the only option aren't suddenly going to let that happen after all. They'll get congress to clean up the mess by repealing community rating -- and they'll probably get the medical loss ratio requirement repealed in the process. We'll just pretty much end up where we started, only three years further down the road to ruin.

Sorry to be a downer.


robin andrea said...

I have to admit that I would LOVE if single-payer came out of this debacle, but I don't see that happening. I really didn't like this particular Obamacare plan, because it kept intact the things that make health care expensive (like private insurance). I don't like that this case will be seen as a referendum on Obama's first term, especially since the decision will be handed down in an election year.

Cervantes said...

Some referendum. Five conservative ideologues, appointed by past presidents who nobody today even respects, consisting of a patrician father and his idiot son.

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