A Good Day

The Supreme Court upheld the constitutionality of the Health Care Reform Act, specifically the individual mandate upon which the program rests, by a vote of 5 to 4. They issued their decision this morning.  As summarized by Mike Sachs at the Huffington Post: "The controlling opinion, written by Chief Justice John Roberts, upheld the mandate as a tax, although concluded it was not valid as an exercise of Congress' commerce clause power."  Roberts' vote totally surprised me...my money had been on an overturn of the individual mandate and potential gutting of the law.  (At least I called Justice Kennedy's vote correctly in the last post; he voted with the right-wing justices.)

As the President said in his comments today: this is a victory "for people all over this country".  An overturn of this crucial legislation would have been devastating.  We would not have a reasonable chance at extending medical coverage for Americans for another generation.  In her remarks after the ruling, Nancy Pelosi paid tribute to Ted Kennedy who worked tirelessly during his life to bring universal health care to this country - promoting the concept of health care as a right, not a privilege.  Although she didn't mention herself, the smiling former Speaker Pelosi had been instrumental in holding Democrats together and getting the legislation through the House in 2010.

By a 7-2 vote, the Court struck down the provision of the Health Care Reform Act that would have kicked states out of the Medicaid program if they did not subscribe to the extension of Medicaid provided by the law.  States stand to gain enormously from the legislation - the Federal government provides at least 90% of the funding for Medicaid and significant net savings accrue to the states since they will no longer have to cover medical expenses for the currently uninsured.  In fact, the only reason for states to deny the extended Medicaid coverage to the people of their state is simple mean-spirited ideology.  Unlikely and unreasonable as it seems, some states may opt out.  The legislators in these states will be supported by people who really don't understand the economics or the benefits, by miscellaneous business groups who prefer not to spend on health care, by people who would protect tax breaks for the rich at the expense of services for the less well off and, let's face it, by those bigots who don't want a black President to appear powerful and those who still believe in the racist stereotypes of welfare recipients. 

The post-ruling sour grapes and promises to repeal health care reform from Republicans made them seem as ridiculous on health care as they've been on privatization of Social Security and ending Medicare as we know it.  Of course, this Supreme Court decision may be for nought if the Republicans take control of the White House and Senate in the November elections.  In spite of today's good news, the race between Romney and Obama remains tight.  Every vote will count this November.  With Romney pledging to repeal health care reform, you have some idea of what's at stake.

So what made Chief Justice Roberts side with the four moderate and liberal justices on the court?   David Cole's post in The Nation may have gotten it right: "In part, the outcome reflects the fact that the truly radical position in this dispute was that of the challengers. Even very conservative lower court judges...had concluded that the law was valid ....But in addition, I cannot but think that at the back of Roberts’s mind was the Court’s institutional standing. Had the law been struck down on 'party lines,' the Court’s reputation would be seriously undermined....Today’s result, which upholds the actions of the democratically elected branches on a major piece of social welfare legislation that affects us all against a challenge that was always a real long shot, driven more by politics than legal principle, may help repair the Court’s tarnished image."

So that was this morning.  This afternoon, I enjoyed watching Italy defeat Germany in a Eurocup 2012 semi-final.  They move on to the finals which will be played Sunday.  Yes, it was a very good day.

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.