Friday, June 29, 2012

Obamacare prevails in Supreme Court
(and Kushibo was never worried a bit)

"Sweet!" and sourpuss
So I was still in Honolulu when the announcement came that the Supreme Court had ruled mostly in favor of the Affordable Care Act (aka Obamacare), although now I'm on a Hawaiian Airlines plane bound for Fukuoka. [NOTE: I actually posted this using the free wi-fi at Fukuoka Airport.]

Not only am I pleased Obamacare was upheld, but I am also pleased by the logic behind the ruling. Unlike the opponents of Obamacare who oppose it basically because it's Obama's, I don't see any reason why the Federal government — which already runs a mandatory national program like Medicare — shouldn't be constitutionally permitted to regulate the health care market (which not only crosses state lines but eventually includes virtually everyone, which undermines the "compelling commerce" argument).

But I was sympathetic to those who feared encroachment by the Feds: maybe it is a scary thing if the government can compel you to buy something you might not have bought otherwise (even if you should). There are two things about that, however. First, no one was actually compelled to buy anything: you could in fact opt out and simply pay a fee/fine/tax/whatever-you-want-to-call-it to cover your share of the aggregate cost incurred by those who cannot or will not insure themselves.

Second, and more important to Obamacare's critics who worried about a slippery slope of Federal power, SCOTUS's majority decision did not in fact rule that way: this decision does not provide precedence for the government compelling you to buy something. Not even for a "special" case like health care.

Instead, they did something that I had thought they should: they decided that the fee was a tax (which Congress has the power to levy) even though the tax (on those who refuse to get health insurance) was not called a "tax" for political reasons ("the health plan won't raise your taxes!"). It's the Supreme Court philosophy of "if it quacks like a duck" recorded in Acme International versus Scrooge McDuck (1959), and some other ruling about a company town functioning as a real town whose name now escapes me.

[UPDATE: The ruling I was thinking of was Marsh v Alabama, where the Supreme Court ruled ruled that a state trespassing statute (dealing with private property) could not be used to prevent the distribution of religious materials on the sidewalks of the privately owned company town of Chickasaw because the privately owned town essentially had all the trappings and functions of a typical town, where they would be considered public space. In other words, the Court determined that although it was not defined as "public" it essentially acted as "public" and therefore, as far as Constitutional rights and principles were concerned, it should be considered "public." In the current National Federation of Independent Business v Sebelius that saw Obamacare pass Constitutional muster, I see the Court having done the same thing: determining that the "penalty" had all the trappings and functions of a tax even though it was not called a "tax" and therefore, as far as Constitutional rights and principles were concerned, should be considered a "tax."]

Constitutionally this is a win for those who were genuinely concerned about expansion of Federal power into your pocketbook. For those who were opposed to the ACA just because they don't like the commie Muslin "knee grow," well screw them with a garden hoe anyway.

Moreover, the one part of the ACA they should possibly have struck down was in fact overturned, the part about forcing the States to participate in Obamacare by threatening to withhold all Medicaid funds. I call this the "cojones-in-a-vice-grip ruling" because I didn't go to law school and I don't know the actual name.

Now, if you're still bummed out about having to buy insurance, you still have two options. Number one: Don't buy insurance. Just pay the fine that will help cover costs when you end up in the ER or you inadvertently become a vector who makes others sick (the movie Contagion still gives me chills).

Number two: Get your State to come up with a plan that covers as many or more people than Obamacare. You see, the critics didn't like to mention that any State can opt out (Hawaiei does).

As someone in the public health field, I'm excited. Not only does Obamacare target rising costs by addressing market failure quirks of the health care field, it also incentivizes preventive care. Ounces of prevention are generally cheaper than pounds of cure, to the tune of tens of billions of dollars.

Obamacare is not perfect. I think we need a public option to keep insurance providers in line and I think it is utterly foolish to not allow illegal residents to even buy into the insurance plans on their own. As things move along, it will require tweaks and fixes, and it would be best if Republicans and Democrats could come together, leave ideology at the door, and hammer out effective solutions. The core of the ACA, after all, was a conservative plan set forth by the Heritage Foundation. Like it or not, the GOP has a stake in its success.

I am now optimistic about the future. The United States has joined the ranks of the rest of the advanced world, including South Korea and Japan. "M," a public health student from Kansai, says this decision restored her faith in America. I think we will start to see a lot of health indicators change for the better.

In fact, I will make a bold prediction: a few decades from now, we will see members of the 2040s equivalent of the Tea Party holding up picket signs that read, "Keep the government's hands off my Obamacare!"



  1. Your posting was pretty good until you quoted "M" as saying "this decision restored her faith in America."

    For this one shortcoming (that only involves only U.S. indentured, that's a pretty bold statement. Really, after all the U.S. has done, and continues to do, for Japan and nations too numerous to mention. Maybe it is time for the U.S. to move aside and give China and Russia free rein to all of Asia and the rest of the world while we focus on getting our "own" problems at home remedied. I bet we could save tons of money by eliminating defense spending and just relying on that "missile shield" while mothballing the rest of the armed services and all their equipment and not worrying one iota about the rest of the planet. I wonder what "M" would think of the U.S. then.

    1. John from Daejeon derailing a thread with a cynical but ultimately irrelevant rant? How incharacteristic! ;)

  2. "The United States has joined the ranks of the rest of the advanced world, including South Korea and Japan."

    Really? I don't think this is quite the single payer system most of the advanced world uses. I can understand your elation at this, uhm, tepid but important step in the right direction. But wouldn't it have made more sense just to extend Medicare to all US citizens? I mean even the Tea Baggers like Medicare.


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