As anyone with access to the internet, cable TV or radio knows, the Supreme Court announced this morning that it is upholding Obamacare. As I write this, the opinions themselves have yet to made public. When they are, it is my hope that Burt and Mark will weigh in on their thoughts on both the language used and what that language might mean for future cases.
Now that Obamacare is, indeed, the Law of the Land, I’d like to zoom out of the mandate-related minutia and comment briefly on what I’d wish our country’s focus and takeaways might be post-SCOTUS:
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1. We Still Need the Rest of the Plan. Lost in the shuffle of the partisan bickering these past two years is the simple but undeniable fact that Obamacare, as it stands, is but a temporary reprieve from disaster. True, it will provide health insurance for those that could no longer afford it – and that’s a good thing. Further, it fixes a broken mechanism inherent in our system – we financially reward those that are young and healthy when they wait until they are neither to pitch into a system they themselves need – by requiring everyone to be insured. However, it ignores the underlying problem that lead to the crisis in the first place: exponentially increasing healthcare costs.
Having a mandate will mean substantially more people will be in the system, which should reduce premium per individual substantially. I suspect that the first year or two this benefit will be diluted as those who have been financially unable to seek healthcare “catch up” with various treatments; but after that there should be a substantial reduction. However, since the new system still does not address the exponentially growing costs we’ll be back to square one soon enough. We haven’t avoided driving into the wall we were about to hit – we’ve put the car in reverse and backed up a few miles before we put our foot on the gas and race toward that wall again.
Now that the questions of the law’s legitimacy have been put to rest, we need to start having a very real conversation about what healthcare in this country should and shouldn’t be. The current mindset we cling to – that we should be allowed any and every kind of care regardless of cost, efficiency, or effectiveness, without being subjected to rising premiums – needs to be discarded. This means its time to stop with the “Death Panels!” hysteria. It’s time, in other words, for us to start acting like grownups about our own healthcare system. If we don’t, the new system will necessarily be made by fiat behind closed doors, without our input or knowledge.
2. This Has to be Bad News for Romney. Not being especially charismatic (even his base is pretty “meh…” on the guy) Romney needs Obama to fail pretty profoundly in order to win the November election. For all intents and purposes, the right has already shot its messaging wad here with independents and moderates. Three years of constantly shrieking incoherently that the President is a [insert your over-the-top charge in all-caps here] has become a dull white noise that no one who isn’t already drinking the Kool-Aid takes seriously anymore. The Republicans therefore have had two real chances to unseat Obama: The first is that the country would continue to slide into economic despair. Instead, it might well be in the worst place it could be for GOP messaging: the very well off have fully recovered and are making money hand over fist, and this has not translated into the working/middle classes feeling more secure. This combination will make it very difficult for a “Give Our Job Creator’s A Break!” message to resonate.
The other hope has been that their candidate might ride anti-Obamacare sentiment into the Oval Office. Unfortunately, however, Mitt Romney may be the single GOP pol that can’t use this strategy to his advantage. It will be difficult for him to loudly decry Obamacare as Evil and Socialist without drawing the obvious (and embarrassing) comparisons to Romneycare. He might be able to argue that the basic idea is a great one but that it’s better to have your governor do it than your president, and he may even be right about that. But that’s hardly the message that will make the villagers grab the torches and pitchforks and storm the castle. The obvious way for Romney to have his “Socialist!” cake and eat it too would have been for the Supreme Court to strike down the federal program with language that allowed Romney’s state program to stand unchallenged. Now that Obamacare is officially constitutional, Romney’s ability to take aim at the president on this front is severely diminished.
Barring a further economic collapse, Mitt may now have to rely on his charm – in which case he’s cooked.
3. To Conservatives: Shouting Something’s “Unconstitutional” Loudly Enough Doesn’t Actually Make It So. The Republican strategy surrounding Obamacare to date has been to shout loudly and long enough that it would never, ever survive a court ruling, provided conservative appointed judges were part of that court. If Republicans could just convince enough people that this was the case, they seem to have reasoned, they would surely win their day in court. Except they didn’t; a conservative court has upheld Obamacare.
Think of what conservatives have squandered with this failed strategy.
They might have spent the past two years focusing on some of the policy problems with Obamacare (hint: it doesn’t control costs!). They might have put together a comprehensive competing vision to Obamacare, or they might have come up with legislation that allowed Obamacare’s popular mechanisms to survive while making it more efficient, effective or fiscally restrained. They might have, in other words, done their jobs. We have a tendency to forget this in our bloggy, talk radio, 24-hour news radio world, but the job description of a legislator isn’t actually getting their team elected over and over – it’s getting shit done. The Republicans, in the case of Obamacare, have taken an actual existing crisis of our healthcare system and used it (along with, I’m guessing, billions of dollars) to create what is now a failed public relations campaign. My hope is that now we’ll see the House and Senate GOP members focus on the problems on the table, and not on which spin will get them more time on FOX.
(I am not holding my breath.)
4. To Liberals: Show Some Freaking Backbone. My son is a huge New England Patriots fan. When they’re playing a big game he’s worried they may not win, he’ll sometimes bet a friend $5 against New England. His reasoning is simple: If the Pats win, he doesn’t mind losing the bet. If they lose, hey, at least he gets $5 to help console him in his wretched grief. This is the exact strategy I have seen with liberals over the past few weeks as they anticipated the SCOTUS ruling. Faced with what seemed to them to be the very real possibility that the mandate might be overturned (and the Democrats embarrassed), they went into preemptive scorched-Earth mode:
The Supreme Court is absolutely, positively ruling against us! Because the system’s broken! And corrupt beyond repair! And Evil! We should begin dismantling our entire democratic system of checks and balances right now!
The strategy seems to have been convincing the faithful that, because they were going to lose this one thing in court, the coming decision and the SCOTUS itself was somehow invalid. I wonder how they’re feeling about that same system this morning. Seriously, liberals, you need to stop panicking about anything and everything at the drop of a hat. I’ve felt like Louis CK all week as I’ve been reading liberal blogs: “Give it a second, would ya? Could ya give it a second?”
It’s stuff like this pre-SCOTUS abandon-ship panic that, despite my antipathy for the right, still makes me hesitate before penciling in the bubble by Democratic candidates on my ballots.
The path to good, affordable health care is now pretty clear.
Get coverage in another country. Take care of routine and emergency needs in the US, and spend a few hundred dollars in airfaire when needing expensive planned procedures.Report
… bullshit. you want artificial reconstructive surgery, you want a new gallbladder? you is coming here. You think we don’t get plenty of folks from the Middle East and plenty of other places???
You haven’t had the conversation: “He’s from egypt. is he african, asian, caucasian”
“the government doesn’t care. they only care about American minorities”Report
Kimmi, You’ve never heard of medical tourism? There’s a hospital in, iirc, Bangkok that was western-built and only hires western trained doctors. Costs are so low that it’s cheaper to fly there and pay out of pocket for many procedures than to have it done in the U.S.Report
We’d looked at medical tourism as a possibility for fertility treatment, if it was required.Report
Fertility treatments being, amusingly, one of the things 99% of insurance plans don’t cover.Report
Yeah, if it was covered, we’d just let the insurance company pay for it!
(Of course, if pregnancy-related bills are any indication, we might not tell them about it and just sneak off to India for the treatment. Our insurance company is using my wife’s pregnancy to modify the terms of routine claims that were covered before. Now it’s all considered pregnancy-related and thus applies to the deductible.)Report
Now that it’s Constitutional, can we call it “Obamacare” again (without being yelled at, I mean)?Report
I believe the administration is now directing you to call it Wondercare.Report
I just call it “care.”Report
A note to future lawmakers: if you don’t want to call it Obamacare, Hillarycare, Bushstimulus, Stop With the Alphabet Soup!
If I don’t even remember the abbreviation, I’m just going to use Obamacare, because at least that’s recognizable.Report
I dunno, I think PPACA is pretty straightforward (“Packah our even Puhpackah work for me. I think the defensiveness surrounding “Obamacare” was out of proportion, but it was an easy enough request to honor.Report
I don’t see PPACA and think health care. I just… don’t.
It aggravates me.
If we can call them Pell grants, why not obamacare?Report
There’s no reason we can’t call it Obamacare, except that I was told it was a slur. But there’s no reason not to call it PPACA for the same reason we call EMTALA and HIPAA by their acronyms.Report
Actually, I take that back, we shouldn’t call it Obamacare because it wasn’t his baby half as much as it was Pelosi’s. So, if anything, it should be Pelosicare.
(Pelosi was truly an amazingly impressive Speaker.)Report
Successful legislation has a thousand fathers. PPACA was a loaf kneaded by a hundred hands, not least of which was Karen Ignagni, who single-handedly struck the Single Payer provisions from the bill with a naked threat to Obama, in the Oval Office.Report
Successful legislation has a thousand fathers. PPACA was a loaf kneaded by a hundred hands,
So what were the other 900 fathers doing?Report
950. Two hands per person.Report
Damn it! I was just about to write that!Report
What were the other 900 fathers doing? Read the story of the Little Red Hen to see what they were up to: waiting for the loaf to be baked.Report
In all fairness, it *was* coined as a slur. I think of it as being similar to back in ’08, when people would take care to emphasize the “Hussein” and then ask innocently, “What? What? Isn’t it his name?”
That the name Obama care hasn’t taken on the level of shame it was meant to doesn’t make the original intent any less true.Report
See, I don’t remember it that way at all. I remember lots of people using the term, and not just fans of Fox News. Obama’s attempts lacked a widely-used name, and Obamacare filled that void. Then suddenly it wasn’t acceptable anymore. Hit me like a ton of bricks because I’d been using it in a non-slurry way the whole time.Report
I googled it, and came up with this:
http://wiki.answers.com/Q/Who_coined_the_phrase_ObamaCare
It was a slur, but it was coined by the Clinton campaign in the primary.Report
Interesting. Especially given that I very much do remember Hillarycare as a slur. With Obamacare, I genuinely remember it being in rather wide circulation until it wasn’t. Maybe I’m nuts.Report
I confess, I forget until things like this remind me just how bitter and vitriolic that primary got before it was over.Report
i don’t recall it being in heavy use… people just used “health care reform”. but it is Obama’s signature issue…
hillarycare was coined around when people started weighing the law…Report
The funny thing is that for much of the race, most Republicans I knew preferred HRC.Report
I mean preferred Obama over HRC.Report
Obama has recently embraced the name “Obamacare” and I think that will be even more the case after the SCOTUS decision today.
Imagine 30 years from now “Obamacare” being used the same way “Medicare” is used now. I’d think that would warm the heart of ol’ Obama sitting in the Ex-Presidents Retirement Village.Report
If that’s true, it makes the tut-tutting over conservatives calling that particularly obnoxious.Report
yeah, if obama has started to call it that, we ought to slap people a fishie if they still bitch about its use.Report
The current mindset we cling to – that we should be allowed any and every kind of care regardless of cost, efficiency, or effectiveness, without being subjected to rising premiums – needs to be discarded. This means its time to stop with the “Death Panels!” hysteria. It’s time, in other words, for us to start acting like grownups about our own healthcare system.
Yes. This.Report
Agreed. Something has to give, especially as the population. Perhaps it should be the notion that we should be kept alive at any cost because it’s technically possible to do so.Report
Which is why it will never happen, because the majority of Americans are not, mentally speaking, grownups.Report
Now that the questions of the law’s legitimacy have been put to rest, we need to start having a very real conversation about what healthcare in this country should and shouldn’t be.
While I agree with most of what you’ve said in this piece, I don’t think that a 5-4 Supreme Court decision is going to put questions about the law’s legitimacy to rest. Conservatives are just going to move the fight to Congress. Romney’s already doubled down on his call to repeal it.
We do need to have a real discussion about health care policy; just as we need to take an honest look at entitlements such as social security and Medicare. But neither of our political parties has indicated that they’re serious about addressing these issues beyond using them as political talking points. Particularly the Republicans.Report
I’m not entirely sure I agree with this being a bad thing.
One of the things I noticed over these past few weeks, when conservatives were so sure that they were going to be victorious this morning, was how much they’ve been pushing the need to keep certain parts of the HCR bill alive. Scott Walker, Boehner, even Rubio in the interview the other night stressed hard that they were going to Do Something.
I think it’s one thing to say “Unconstitutional!” in front of a microphone. I think it’s another thing to start telling people that you’re going to take away things like pre-existing condition laws. Most polls that I have seen suggest that voters, Rs included, do not favor Obamacare as a fuzzy concept, but by and large support much of what the bill does. I don’t think we’ll see a straight repeal at this point without a counter-proposal of some sort, which is what should have happened two years ago – so better late than never.
If I’m wrong, and the GOP thinks they can just repeal without having to answer to voters why they eliminated the things voters wanted to keep, then their goose will be cooked for a long time coming.Report
I think a lot will hinge on the outcome of November’s election, both presidential and congressional. If Obama survives, then Obamacare stays and becomes increasingly difficult to repeal. But if Romney and enough Tea Party types get elected, I think the whole thing is at risk, even the stuff people like. Some Republicans might want to “do something” but, aside from the Ryan Plan to privatize Medicare, I’ve yet to see many specifics.Report
Its pretty unlikely Rs will get the trifecta required to repeal Obamacare, though. Provided Ds retain either the Senate or the White House, there’s no actual repeal. So the worst you get is attempts to de-fund or otherwise prevent implementation of the bill. But precisely how does that go – I’m having trouble thinking of an avenue that doesn’t either create a awesome “Republicans killed your grandmother” talking point, or give someone standing to sue.Report
80:20 Obama wins. and growing higher as we speak, and romney’s campaign bus does circles around obama rallies.Report
If I’m wrong, and the GOP thinks they can just repeal without having to answer to voters why they eliminated the things voters wanted to keep, then their goose will be cooked for a long time coming.
I see all the crap that the GOP has done over the years and, as long as they have the media in their pocket, I doubt anything will cook their goose.Report