Health Care: A Beginner's Guide to the (Non)-Sense of the US System

For us Brits who are used to debates and votes in both Houses of Parliament, followed by a Bill signed into law by a Royal Assent, the passage of the American Healthcare Reform Act was tortuous and confusing. We expect all the politicking to come before the event.

So could we assume that Obama signing the Bill into law on 22 March was the conclusion? Evidently not --- the Bill was required to go back to the Senate to reconcile it with the provisions passed by the House of Representatives, and even then it had to return to the House for a second vote to cover the minor technical differences. I think the process is now concluded, but the reporting in Britain of the Congressional procedures has been so poor that it is difficult to follow exactly what has happened.


Let us assume that the Bill has finally passed. Cutting through the confusion of what has been retained from the original proposals and what has been removed, the immediate changes for the American public are: 1) insurers can no longer deny coverage to insured persons because of pre-existing medical conditions; 2) the elderly will receive a $250 rebate to help them buy prescription drugs; 3) small businesses will receive a tax credit to insure employees; and 4) young people will be permitted to stay on their parents’ policies.

In 2014, the big changes arrive. A majority of Americans currently without insurance will be required to buy cover or pay a fine. Insurers will not be permitted to refuse policies because of pre-existing conditions which, in theory, should ensure that those Americans will be able to acquire cover. Most of the arrangements, under the bill's provisions, will occur in an "exchange" where insurers bid to provide the policies for groups of the newly-insured.

In 2018, a new tax will be imposed on high-cost insurance plans, as part of the effort to limit expenses, and the government expects that by 2019, 94% of Americans will have health insurance cover. The struggle between the executive and legislative branches on the legislation now ends, at least for the time being.

That, in theory, should be the process, but there could be a further complication if the Supreme Court enters the arena. There could be strong grounds to defeat the legislation, based on the 10th and 14th Amendments of the US Constitution. The former entitles the individual US states to object to federal legislation on issues that properly belong to the states.

The Federal Government can point to Medicare and Medicaid, both federally-based programs, to support its right to pass the legislation. However, the States can point to the requirement on individuals to buy insurance, a provision thought to be a matter for the States alone as there is nothing implicit in Article I of the Constitution to the contrary.

The 14th Amendment argument arises because Americans are entitled to equal protection under the law but, even after the legislation takes effect in 2014, there will be 15 million American who will not be entitled to the benefits of the legislation, as they will not be covered by the dealings of the insurance "exchange". Legally, the new law could fail as a result.

The Supreme Court is a political as well as a legal body, and eventually, possibly as early as 2011, cases will come before the Court. No doubt, the messages passed to Republican-appointed Justices by the party's rank and file, not to mention leading politicians, will be clear: “Hear the several appeals that will come before you. Strike the healthcare laws down.”

Does all of this still make little sense, given the fundamental that at least 35 million Americans are uninsured and many more "under-insured", vulnerable to a combination of illness, disease, or accidents and the economic circumstances that leave them unable to protect their health?

Well, if that is the case, it is because the debate in America over healthcare seems to have lost all sense of reality at the same time it has been mired in politics. Under George W. Bush, more than half the expenditure in his last three budgets was covering the cost of federal healthcare and Social Security, yet vast numbers of still Americans were unable to afford to pay medical bills. If “freedom” and “liberty” are basics of the American system, isn’t the right to proper medical treatment at an affordable price just as important?

Comments

[rezvan]

Would be interested to. hear comments of self righteus. and arrogant advocates of their type of 'democracy' being foisted on the Iranian people, if the nuts who have to date pulled every trick in the US political book to derail Obama's effort. Obama probably succeeded where others have failed by also abandoning the consensus approach and using the personal touch with many congress reps and the not so 'democratic' process of coercion & a little used political tool to get the bill through. Republicans have been talking about civil war and the day frredom died! Perhaps the Tehran govt needs to take up their cause in international forums againstt the current US administration for infringing US citizens civil and personal rights and acting as a dictator! To boot there is talk by Republicans to use their over representation amongst the Supreme Court judges to stop this law from ever being implemented. So much for US style 'democracy'.!

[Observer]

Thank you for this commentary. The US Health Care debacle is a big one, but certainly not the only one that has occurred during this administration's first year. Whichever side one takes, several instances of walking all over the US Constitution, using varied methods, are primary. Readers of the past year's news have observed the phenomena and its results elsewhere. :0(

[Josh Mull]

"There could be strong grounds to defeat the legislation, based on the 10th and 14th Amendments of the US Constitution."

Doubtful. So far there haven't been any credible cases made on those grounds. You'll notice that the Internal Revenue Service is the agency responsible for the health insurance mandate, and they've already got plenty of court-approved jurisdiction to enforce the law across state lines.

"The Supreme Court is a political as well as a legal body, and eventually, possibly as early as 2011, cases will come before the Court. No doubt, the messages passed to Republican-appointed Justices by the party’s rank and file, not to mention leading politicians, will be clear: “Hear the several appeals that will come before you. Strike the healthcare laws down.”

That's a very serious allegation to make with the only evidence being you having "no doubt." Of course the Justices aren't apolitical robots, but to suggest that they are taking cases and making decisions based on the command of the "party's rank and file," which presumably means the congressional leadership of Boehner et al? Certainly you don't mean Republican National Committee staff, headed by hapless fuckup Michael Steele?

Either way, it's a pretty far fetched conspiracy theory. I'll give the benefit of the doubt to the constitutional argument (I'm no expert), but even as hyper-partisan as this country has become I don't believe anyone credible would suggest that the SCOTUS is some kind of subservient tool of the Republican Party.

[WitteKr]

When we discussed the New York Times article on the 'nuclear threat' from Iran yesterday, some people pointed out that the NYT has a reputation of being hawkish when writing about defense, and liberal when writing on domestic issues. I was tempted to post this link then, just as an example of this editorial 'policy'. I didn't, because I thought the Health Care debate would distract us from Iran... But now I think it is appropriate.
And this blog is about Enduring America, anyway :-)

(In the meantime this Op-Ed has risen to the top 1 of most emailed articles (it was on rank 5 yesterday).

The Rage Is Not About Health Care
By Frank Rich

Bottom line: "If Obama’s first legislative priority had been immigration or financial reform or climate change, we would have seen the same trajectory. The conjunction of a black president and a female speaker of the House — topped off by a wise Latina on the Supreme Court and a powerful gay Congressional committee chairman — would sow fears of disenfranchisement among a dwindling and threatened minority in the country no matter what policies were in play."

http://www.nytimes.com/2010/03/28/opinion/28rich.html?src=me&ref=homepage

606 comments, so far... http://community.nytimes.com/comments/www.nytimes.com/2010/03/28/opinion/28rich.html?sort=recommended

[maliheh]

tea party are just using this health care debate as an excuse to be racist and some right-wing media likes to spin the bottle

[maliheh]

Secrets of the Tea Party, troubling history of Tea Party leader Dick Armey http://bit.ly/9GesSa <--reason i dont like the tea party and this is also "iran related"

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