Train Wreck?

A legal reporter from one of the cable news stations (I believe he was from CNN) described yesterday's hearings on the Patient Protection and Affordable Health Care Act as a "train wreck" for the Obama Administration.  Intense questioning from the five conservative members (actually four since Clarence Thomas appartently never asks any questions) made it clear that the law was in danger of being struck down. 

Today, the last day of hearings, the court expanded on the theme of invalidation of the law.  Specifically, if the personal mandate were to be declared unconstitutional, would the entire law need to be declared invalid?  Or could separability be invoked as it often is in commercial contracts?  (A separability clause ensures that if one section of the contract is declared invalid, the remaining sections still remain in effect.)  Further, would the law be viable without the individual mandate?  That is, could the system of health benefit exchanges function and could the affordability of health care coverage be ensured without the individual mandate? 

What's at stake?  A good summary of the health care reform act can be found at the senate.gov health reform bill webpage.  Among its immediate effects (2010), the law eliminated lifetime and unreasonable annual limits on benefits,  prohibited the voiding of health insurance policies, provided assistance for those who are uninsured because of a pre-existing condition, prohibited pre-existing condition exclusions for children, required coverage of preventive services and immunizations, and extended dependent coverage up to age 26.  Other elements of the law are aimed at simplifying the purchase of health insurance, making it more affordable and assisting those who cannot afford it. The act would add between 30 and 40 million people to the ranks of the insured. 

So there is a lot at stake.  (Or in the memorable words of Joe Biden "This is a big f***ing deal".)   Make no mistake about it - mortality is affected adversely by poverty and other social factors The inability to get health care costs lives.  Researchers at Columbia University's Mailman School of Public Health analyzed 47 studies published between 1980 and 2007.  These studies provided estimates of the relationship between social factors and adult all-cause mortality.  The researchers' meta-analysis produced some stunning results: "The investigators found that approximately 245,000 deaths in the United States in the year 2000 were attributable to low levels of education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality, and 39,000 to area-level poverty. 
Overall, 4.5% of U.S. deaths were found to be attributable to poverty..."

There is probably no other action more immediately helpful to the lives of those living in poverty than to provide them with adequate health care.  This makes the poll results reported today on Yahoo's Daily Ticker, disturbing:  "A new poll by CNN/ORC International finds that the majority of Americans do not want the high court to completely overturn the current law. Nearly 25% of Americans want the Supreme Court to leave the bill untouched; 43% of respondents believe some parts should be overturned and 30% want the bill completely overturned."  (Emphasis added,)

Who are these 30% that would deny people the ability to access adequate medical care?  Are they ignorant of the effects of poor medical care?  Are they driven by a free-market ideology that clearly has failed in the delivery of health care to those living in poverty?  Whoever they are, let's hope that SCOTUS ignores them and does what is right for the American people - uphold the law as passed by Congress.  If the Patient Protection and Affordable Health Care Act is struck down or if it is made inviable, it will be another generation before we will have the opportunity to address this most important issue again.