Finally digging my reaction to the Supreme Court's decision on King v. Burwell out of the notebooks.
June 25, 2015.
How soon before House Republicans vote to repeal it again?
Over at the New York Times:
WASHINGTON — The Supreme Court ruled on Thursday that President Obama’s health care law allows the federal government to provide nationwide tax subsidies to help poor and middle-class people buy health insurance, a sweeping vindication that endorsed the larger purpose of Mr. Obama’s signature legislative achievement.
The 6-to-3 ruling means that it is all but certain that the Affordable Care Act will survive after Mr. Obama leaves office in 2017. For the second time in three years, the law survived an encounter with theSupreme Court. But the court’s tone was different this time. The first decision, in 2012, was fractured and grudging, while Thursday’s ruling was more assertive.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Chief Justice John G. Roberts Jr. wrote for a united six-justice majority.
I'm choked up over this. I know what it means for people. We're ok now, but last year the ACA saved our family.
I probably won't be here to see it, but I predict that in twenty or thirty years, if there's still a Republican Party, Republicans will be claiming the ACA as their own because of Romneycare and Kennedy and Roberts. They'll also be trying to claim President Obama, the way they try to claim JFK and MLK.
But the Republicans could have had a piece of this now. All it would have taken was for McConnell and Boehner to have released a handful of their members to vote for it. Well, that and the current Republicans being actual conservatives with the interests of the country at heart and not a pack of spiteful ideologues hellbent on increasing their power by exploiting the anger and fear of the Right Wing yahoos who have become the GOP base.
The ACA is, after all, a conservative law.
It's also a very liberal one, but I'll get back to that.
Defenders of the ACA, trying to bring around red state and red district voters, the few intelligent and well-intentioned Republican governors considering setting up exchanges and accepting the Medicaid money, and the political press corps locked into their narrative that both parties have been captured by their extremists and the only solution is for Democrats and the President to compromise more, have frequently resorted to calling the ACA a Republican plan.
Actually, so have liberal critics, but of course being critics they've meant it as a criticism.
This is making too much of its having among its models the Heritage Foundation's plan and Romneycare. Republicans weren't fooled. Romneycare is the law of the land in the People's Republic of Massachusetts. It was passed by the overwhelming Democratic majorities in both houses of the state legislature of that bluest of the blue states. Mitt Romney signed it but that was one of the things Republican voters had against him. Putting his name on it was like signing a surrender document.
They recognized Romneycare and Obamacare as essentially liberal because they knew it would do what they most hate liberalism for doing: helping poor people obtain what they can't afford on their own.
They didn't recognize either's essentially conservative aspects because although the call themselves conservative they aren't conservative and don't know what it means to be conservative.
Of course the most obviously conservative aspect of the ACA is that it preserves the private health insurance industry and even increases its profitability. This is probably what lefty critics hate most about it. But to me that isn't what makes it conservative. I'm a liberal Democrat not a leftist and I don't mind if private businesses make money off a government project as long as the public good is being well and honestly served. In fact, I think its often for the best since it cuts down on the number of bureaucrats putting their oars in.
I think many on the left forget that most of their ideal solutions to the nation's ills require massive expansions of government bureaucracies. I don't like or trust bureaucrats no matter which party hires them.
As far as I'm concerned then, there's nothing particularly not liberal about the fact that private insurance companies get to go about their business (as long as the government's watching them like hawks). At the time it was passed, during the darkest days of the Great Recession, it was even in an important way more liberal than the preferred liberal alternatives, immediate implementation of single payer and Medicare for all, because besides not requiring an even larger expansion of the federal bureaucracy, it didn't take away thousands and thousands of people's jobs all at once and destroy the economies of several cities.
But, to me, what's essentially conservative about the ACA is what I don't see as essentially not liberal. It doesn't solve the problem---problems---with the American health care system by tearing everything down and rebuilding it from scratch.
It's an attempt to fix things by tinkering.
Which gets at one of the things I was saying the other day. Conservatives used to be great tinkerers.
Thing is, they used to be other things as well, one of which was capable of admitting there are some problems needing to be fixed that the government not only has the responsibility to fix but whose fixing the government is in the best position to direct and manage.
Once upon a time, conservatives preferred to leave things up to private individuals but they didn't operate from a religious faith that all government involvement was the devil at work.
It gets more basic than this. Once upon a time conservatives could admit that there were problems that needed fixing even when those weren't immediately problems for themselves. They cared that other people were struggling.
They were charitable.
They were also pragmatic.
They understood that problems for others, if left to get worse, will, in one way or another, become problems for all of us.
There were serious problems with our health care system. Still are. One of them Republicans not only admit but have harped on. Ever and steeply rising costs.
The preferred conservative solution, let the market correct itself, was part of the problem. The market was correcting in the way it most often does---by sucking up all the money available and emptying it into the wallets those with their hands on the vacuum hose. Conservatives should be able to see this isn't just unfortunate for individuals. It's ultimately destructive of free enterprise. Less apocalyptically, it is expensive and increasingly inefficient as those who have it all grow increasingly adverse to risk and innovation because things are working to their advantage just fine.
Of course the bigger problem was that millions of people could not afford to see a doctor.
Conservatives should have been able to see that fixing that problem was not simply a matter of charity. It was costing them and the whole country in social capital as well as in dollars. Even if your gold-plated insurance covered your kids completely, it didn't insure them against having to sit in classrooms with other people's sneezing and coughing kids. Conservatives should have been able to see that it's a benefit to society to have all its children healthy and energetic enough to pay attention in school and learn.
Conservatives should also have been able to see that it's a benefit to businesses to have a healthy and happy and contented workforce who see themselves as having a real stake in the success of the businesses they work for. It's better to have employees who are working energetically for something rather than just working out of the fear they will lose everything.
Conservatives should have been able to see that the ACA tackled those problems in a way conservatives should approve of, through leaving most of the insurance industry alone to continue to make gobs and gobs of money, by minimizing the expansion of the federal bureaucracy, by giving lots of freedom to the states to design their own exchanges and set up needed new bureaucratic offices, and encouraging individuals to take an active responsibility for their own health care and requiring everyone to have "skin in the game."
Most important and conservative of all---and also most liberal---it left medical decisions to be made by patients and their doctors to the same degree those decisions were left between them before. While issuing dark warnings about the government intruding between patients and doctors, Republicans have refused to deal with the fact that as things were,there were always invisible third parties in the examination rooms. Representatives from private insurers had a say over whether or not patients would have certain tests, be prescribed certain medicines, undergo an operation, or receive any treatment at all. Sarah Palin's death panels were already at work in that there were people whose Christmas bonuses depended on their denying coverage for procedures to people who thought being able to have those procedures was why they paid for insurance. That hasn't exactly changed, but it's still the case that government bureaucrats aren't entering into medical decisions with any more intrusiveness than the representatives of the private insurers. But there is something else that comes along with this that conservatives should approve of. Stricter cost controls figuring in the decisions.
Conservatives should have been able to see all that, and many probably did. Trouble is there aren't all that many conservatives left and the ones there are have had no say in the Republican reaction to the ACA because the Republican Party is not a conservative party. It is, I say again, a party of Right Wing reactionary ideologues who do not have the national interest at heart, let alone anything like a concern the common good.
Today's Supreme Court decision was a victory for the President, of course. But that's almost beside the point. As many have pointed out, it's a victory for millions of sick Americans who could have lost their insurance. It's also a victory for millions of healthy Americans who now don't have to worry that if they get sick, they'll go broke too.
But, on top of everything, it's a victory for the ideals that we're all in this together, that no one gets left behind, and, as Dr Vonnegut says, that we're here to help each other through this thing, whatever it is.
Once upon a time, it was ok for conservatives to hold those ideals too. They didn't like to admit they did. They could be grumpy about it. Skeptical. Stubborn and slow to act. And often resentful. But they could admit it and be moved to do something about it.
Read Adam Liptak’s whole story, Supreme Court Allows Nationwide Health Care Subsidies, at the New York Times.
Also: Max Ehrenfreund’s analysis, Chief Justice Roberts quietly burns Scalia in the Obamacare decision, at the Washington Post’s Wonkblog.