Health reform: The supremes decide

By Max J. Castro
majcastro@gmail.com

“The law, in its majestic equality, forbids the rich and the poor alike to sleep under bridges, to beg in the streets, and to steal bread,” wrote the French writer Anatole France (1844-1924).

Sometime this summer, the U.S. Supreme Court will decide a case that will affect the lives of about 30 million Americans, the vast majority of whom are too poor to buy health insurance, or too sick for the insurance companies to want their business, or unlucky or unskilled enough to work for an employer that doesn’t provide health care coverage.

The case, brought by 26 states (led by my very own home state of Florida) against the Patient Protection and Affordable Care Act (the formal name for the health reform signed into law by President Barack Obama almost exactly two years ago), ranks with Brown (1954), in which the Court outlawed racial segregation, and Roe (1973), which legalized abortion, as one of the most momentous and contentious Constitutional and social policy questions heard by the high court in decades.

The specific challenge is to the constitutionality of that aspect of the law that compels everyone to have health insurance or pay a penalty, a provision that has come to be known as the “individual mandate.” Under the law, the government would provide subsidies to persons or families of lower income so that they may be able to afford the pricey policies offered in a profit-driven private insurance market. The insurance companies, in turn, would be forbidden form denying coverage to persons with “pre-existing conditions,” such as diabetes or heart disease, or dropping coverage for people who contract a serious illness, such as cancer or AIDS.

Viewed from a comparative, global perspective, or simply from a rational calculus of what would be best for the most people and for the American economy, “Obamacare,” as its many vociferous right-wing opponents label it, falls far short of the mark. How come? And why are right-wing zealots and the health-care industrial complex up in arms over a health-care plan that is market-based to a fault and which would deliver tens of millions of new customers to the health insurance companies?

The beneficiaries of the mercenary model of medicine that is practiced in the United States – the insurance companies, the pharmacological industry, the for-profit hospitals, the American Medical Association, and a whole host of other smaller players – reap enormous profit from the system as it is. They make out like bandits under the status quo, and so they have opposed virtually all proposed changes in the system, including Medicare and “Obamacare.

Shrewdly, they also invest a portion of their financial bonanza on an army of able lobbyists armed with tons of cash and hell-bent on currying favor with key members of what humorist Will Rogers once called “the best Congress money can buy.” And the industry contributes heavily to presidential campaigns. They showed their raw power during the Clinton administration in the 1990s when they pulverized the health care reform plan pushed on behalf of the president by First Lady Hillary Clinton.

So on health care reform Barack Obama had the deck stacked against him from the start. Many progressives, including myself, think he could have played his cards a little better. But there is no way he would have been able to get what we all wanted – a single-payer (government) health care system like Canada’s and that of virtually all other developed countries. In the United States, under the system as it existed before the Obama reform, around 45,000 people died each year simply because they lacked health insurance. A much larger number endured unnecessary pain and suffering – or lost everything and went bankrupt. At least under the Obama health care reform, the scale of this tragedy should be significantly scaled down. That is not an insignificant advance. Perhaps this was the best result the administration was able to extract in the face of all the vested interests arrayed against change.

But even this extremely modest reform was far too much for the likes of Florida Governor Rick Scott, a former health care executive who reaped a huge fortune from managing mercenary medicine, and countless others of his ilk, including Mitt Romney, who as Governor of Massachusetts instituted a program that was the blueprint for Obama’s, but now cynically attacks the administration for scaling up his brainchild to the national level.

Now the battle is joined in the highest court in the land. Most legal scholars believe precedent favors a majority vote to affirm the law. But the right has spent decades injecting its ideology into the judiciary – and many other institutions as well, most notably the media – and scored huge successes, including in the Supreme Court. In its infamous Citizens United decision and other cases, the Roberts court has shown its willingness to ignore a century of precedents and its proclivity for interpreting the law in ways that favor the rich and powerful at the expense of the vulnerable.

Shooting down “Obamacare” would be in keeping with the track record of this court. In addition, in an election year, a decision to overturn a measure that represents the signal accomplishment of the Obama administration would deal a hard blow to the president’s chances for reelection. That would be the second time in a dozen years that a right-leaning Supreme Court has played a major role in deciding who gets to sit in the White House. Somewhere, Anatole France is laughing in his grave.