Prepare Yourself for an Onslaught of Health Reform Rhetoric...

Prepare Yourself for an Onslaught of Health Reform Rhetoric...


This Friday marks the two year anniversary of President Barack Obama signing the controversial Patient Protection and Affordable Care Act into law. Those on the Left felt it was a good step in the right direction but aren't exactly passionate about it. Many on the Right feel it's a dangerous Bill that strips away fundamental rights guaranteed to us by the Constitution and does a frightfully lousy job of improving how we handle health care delivery in the United States. Some on the Left feel it didn't go far enough, therefore it and those who are responsible for it are failures. Likewise some on the Right feel it goes too far, especially the individual mandate that forces people to purchase a product, and therefore it and those who are responsible for it are also failures.

The funny thing is of course, if you strip the various components out of the Bill and ask people, from all political persuasions if they like the specific items, they are generally supportive of each. However, bundle it all under one name and we have problems.

The loyal opposition is quite aware of the upcoming anniversary. The uptick in op-eds, speeches on the floors of Congress, mailings and special interest media buys not to mention the numerous lawsuits brought by over two dozen various states are all examples of the contempt the PPACA has generated. Over a dozen states have already established State laws that prevent various aspects of the Federal Bill to be enacted. (Which is mostly for show as Federal law trumps State law in most cases.) Voices from the Right have been saying since before the Bill was signed into law that it wouldn't stand up to judicial review.

We'll find out soon who was right.

Next Monday, perhaps the most significant Supreme Court case since the Bush/Gore Election results of a few years back will begin three days of hearings. Is the individual mandate legal? Will the mandate be stripped out from the law but leave everything else intact? Will the entire law be tossed? Will the entire ACA including the mandate be determined as fully Constitutional? No one knows. Anyone who says they do, is a little ahead of themselves.

Both sides, pro and con, have a lot to gain and a lot to lose depending on this court case.

No political figure stands to lose as much as President Obama does if the SCOTUS tosses the whole law, even if they just vote down the individual mandate part. He needs this to emerge whole and intact. If the Court decides its Constitutional, Obama gets a nice lift heading into the serious campaign season. It would be an affirmation of sorts that he used reasonable judgement in directing the PPACA in the direction he did. He will be able to use this decision as proof positive that he's the adult in the room and that the Republicans are behaving desperately.

The Republican party and the eventual GOP nominee can try to make the case that the Court got it wrong, but beyond party loyalists, I'm not sure how convincing they would be. If the nominee is Mitt Romney, healthcare becomes an asset, not a liability to campaign on for President Obama.

On the other hand, if the Court strikes down the mandate, it won't be good for Mr. Obama. Not at all. The centerpiece of his first term will be on life support. Without the mandate, adverse selection comes into play as the youngest/healthiest to insure are no longer required to purchase insurance, and therefor, many won't. That effects the health insurance companies ability to cover the rest of the population, pre-existing conditions and all. There will likely be a ripple effect which will leave the Affordable Care Act in tatters. Some components may survive, but the damage will be done. It will have been de-fanged and politically, President Obama will be held responsible. It will, as someone said a few years ago, become his Waterloo.

For the GOP, the glee and celebrations will be just the beginning of it. There will be, on all major media outlets, a steady stream, 24/7 style, of stories droning on endlessly about Obamacare being found to be unconstitutional. They will discuss how it was an example of wild government over-reach and unbridled ambition from Mr. Obama. They will talk about the waste of time, the confusion that now needs to be sorted out. It will be Barack Obama's fault. They will talk about how a failure of this magnitude, probably unrivaled by any recent President, leaves Obama politically neutered and not worthy of re-electing. He will be radioactive to the point that even some Democrats will avoid him like the plague. It will be Barack Obama's fault. Make no mistake, his chances of re-election take a huge hit.

And finally, let us not forget the other big loser in this drama. The American people.

Some will say the Democrats should fight for the ACA in a piece of revised legislation. Some will say we should go a different route, like Single-payer or the updated Ryan Plan. Given the unlikely outcome this November that any one party controls all three branches AND holds a filibuster proof majority, I suspect not much of anything will actually get done. The Democrats will prevent the Republicans from passing anything and vice versa. Bipartisanship isn't exactly a strong suit of Congress these days and I don't think an adverse finding by the SCOTUS will breed goodwill, fellowship and teamwork.

What I do forsee should the Court rule against the ACA partly or completely, is too many Americans not being able to afford health insurance. Too many Americans not having access to preventative medicine. Too many senior citizens stretching their monthly meds out because they're stuck in the donut hole and can't afford to buy them. Health care costs will continue to grow, with no enhanced mechanism to slow them down. It will revert back to how it was before the 2008 Election. If you're able to afford health insurance and your employer offers it, you'll be ok. However if you can't afford it, or your employer doesn't offer it, good luck finding someone who will insure you and your family. More and more people will resort to using the local Emergency Rooms for non-critical care which will add to the cost problem.

Access, Quality and Cost are considered the three pillars of a health care delivery system. The ACA best addresses access for the uninsured. There are components that address quality and cost issues but not to the same degree that access is improved. We need to improve all three areas to find the health care system that befits the richest nation on Earth. Clearly the Affordable Care Act isn't a magic bullet. Its just a step. One good sized step in the right direction to improve things. If its left intact, there will still be a ton of work to do to make things better. If its voted down, there will still be a ton of work to do to make things better.