Healthcare Reform Debate at Supreme Court (UPDATED)

My consumer lobbying and healthcare interests explain my attention to this week’s Supreme Court case and the many articles I’ve commented on and tweeted about. Comments generally go something like this:

Without the mandate, we need another way to pay for the Affordable Care Act (opponents call it ObamaCare) or an entirely new alternative to our existing healthcare system. The “affordable” alternative is a Single-Payer system — i.e. Medicare for all — like Thailand adopted, funded by tax revenue and available for all regardless of income. Thailand has exceptional care outcomes and the lowest healthcare costs in the world with a government-run program. Maybe we should adopt their model, since ours is obviously broken.

I admit to being a political hack and consumer advocate. Prior to launching Modern Health Talk, I co-founded Homeowners of Texas (HOT), a nonprofit advocacy group that gave homeowners a voice in the legislature to balance the power of special interests. With no outside funding we crafted a grass-roots effort that engaged hundreds of homeowners to ultimately defeat powerful lobbyists from the $35 Billion Texas Home Building industry. We convinced lawmakers to abolish an abusive agency that the builders created, the Texas Residential Construction Commission (TRCC or “trick”), and worked with the Texas Society of Professional Engineers to pass new consumer protections requiring engineered foundations for homes built on expansive soil. This 3-min HOT celebration video highlights powerful arguments presented in this immense David v. Goliath legislative win.

The Real Death Panel

The image below contrasts Doctors in white coats who take the Hippocratic oath, are licensed, and can be sued for malpractice, with the nine politically appointed Supreme Court justices in black gowns who take Judicial and Constitutional oaths but have lifetime terms with no accountability.

Does this court truly understand the magnitude of their decision? If the ACA is killed, some sort of healthcare reform must still be enacted, like Medicare for all. But a bigger impact may be the damage to the US political system and citizen trust in Congress, the Presidency, and Supreme Court where a few politically appointed justices with life terms and no accountability make decisions critical to our society and economy and with huge influence from wealthy special interests.

What might happen to senior care if the Court concludes the mandate is unconstitutional?

From Forbes:

• Medicaid benefits for long-term care services–already facing major cuts–would be at even greater risk.
• Several new home and community-based care programs would die with the law.
• The “donut hole” for seniors participating in the Medicare Part D drug benefit program would remain, and the ACA’s prescription assistance would go away.
• The small increase in payroll taxes aimed at increasing revenues for Medicare would not occur, placing even greater financial pressure on that popular program.
• Important incentives to encourage hospitals, nursing homes, doctors, and other providers to work together to improve care for people with chronic disease would disappear.

If the Court strikes down the entire law, all of these provisions would die. And given the ugly partisan fight over the health reform, don’t think Congress act quickly to rewrite the law. It may be years before lawmakers are ready to tackle these issues again, so in many respects senior health would be left much worse off than it is now.

Health Care Reform is clearly a polarizing issue, but most people agree that our current system costs too much. I shared my own views of a Single-Payer system funded by tax dollars but invite you to add yours in the comment section below.

Related articles in the media

1. The One Thing Health Care Protestors On Both Sides Agree On — Despite stark opposition on the issue of healthcare reform, demonstrators outside the Supreme Court shared a common view on one thing: health care in America costs too much.
2. Supreme Court Might Decide Their Second Election — “It was a similar crew of conservative justices on the Supreme Court that decided that their long held beliefs on states’ rights were irrelevant and made George W. Bush our next president in 2000. Now, they’re back — and they might decide yet another presidential election.”
3. What Health Care is Like: Seeking Supreme Analogies — “Health care is nothing like cell phones, or any of the other things that ‘might’ come in handy during some future emergency: a bulletproof vest, a car, a ladder, a fire extinguisher, a helicopter, a Hazmat suit, a gas mask, a tank, etc. Truly, about the worst analogies I’ve ever heard.”
4. The Economic Question at the Core of the Individual Mandate — “If the Supreme Court rejects the mandate, millions of people will go without health coverage, thousands of them will continue to die prematurely each year because they lack coverage, and tens of thousands will continue to suffer from crippling medical debt.”
5. Health Care Is Not Broccoli — “To listen to our Supreme Court justices Tuesday, you’d think they were shopping for produce rather than reviewing the law. It seemed so because the arguments devolved to how is broccoli different from health care.”
6. Health Care Reform May Come Too Late For Kenneth McNelly — “The court will weigh seemingly obscure questions about constitutional law, but for people like the McNellys who desperately need affordable health care, the court’s decisions are a matter of life and death.”
7. Could the Whole Thing Go? — “The Supreme Court is signaling it could throw out some other key parts of President Barack Obama’s health care law if it first finds the individual insurance requirement unconstitutional. On the third and last day of arguments, the justices appeared to accept the administration’s argument that at least two important insurance reforms are so closely tied to the insurance requirement that they could not survive without it.”
8. Is the Health Care Mandate on Life Support? — “The centerpiece of the new federal health care law looked to be doomed after the first hour of the Supreme Court’s hearing on it Tuesday. But it seemed to rally in the second hour, and, while not exactly assured of being upheld, had conspicuous signs of new life.”
9. No Surprise: The Supreme Court Is Hostile to Health Care — “A Court that could decide a disputed presidential election in Bush v. Gore; unleash Citizens United on our electoral process; and repeatedly wade into presidential war powers can be expected to have no hesitancy deciding the fate of the Affordable Care Act.”
10. In Health Care Case, The Roberts Court Comes Of Age — “After appearing united on Monday in brushing off a legal technicality they could have used to punt away the politically charged challenge for a few years, the justices split hard on Tuesday over the individual mandate’s constitutionality.” As expected, the attacks came from Chief Justice John Roberts and the other conservatives.
11. Health Reform Cases Reach Final Day In Supreme Court — “Having tackled, and perhaps terminated, the individual mandate on Tuesday, the Supreme Court will spend its third and final day of the health care reform cases testing the Affordable Care Act’s broader fate. The justices will consider how much of the sweeping health care reform law must fall, should they strike down the mandate.”
12. Is the Roberts Court Really a Court? — “In a Court of logic and precedent, the challenge to Obamacare would be a total non-starter. But here we are again, waiting to see whether the Court will follow the path of justice or the path of power.”
13. Mitch McConnell: We Won’t Do Much If Health Care Reform Is Overturned — “Prominent Republicans have made no secret about their disdain for President Obama’s health care law. Senate minority leader Mitch McConnell is among the opponents, but appears to be offering little course of alternative action for uninsured Americans.”
14. Supreme Court Justices Come Down Hard On Individual Mandate — “From the very start, things did not go well for the government’s argument that the requirement under the Affordable Care Act that virtually all Americans have health insurance or pay a penalty is constitutional. U.S. Solicitor General Donald Verrilli began his argument not with his usual calm and clear delivery, but rather with a case of coughs that seemed to take him off his game.”
15. Nightmare Awaits If Court Rejects Individual Mandate — Without the Patient Protection and Affordable Care Act, “health insurance companies and the White House are worried the health care market could blow up come 2014. ‘If the mandate goes, people can literally buy coverage on the way to the hospital and then drop it the next day.'”
16. Affordable Care Act: A Garden of Lies and Distortions — “The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.” So why the many misrepresentations?
17. Supreme Court Health Care Reform Protest Highlights Opposition’s Terrifying Vision Of Future — “Hundreds gathered in a park across from the Capitol Tuesday to hear Tea Party and conservative leaders describe a dystopian future that awaits if President Barack Obama’s health care reform law is left in place.”
18. 10 Countries Spending The Most On Health Care — “This week, the Supreme Court considered President Obama’s health care reform law. The Patient Protection and Affordable Care Act expands health coverage to millions of uninsured Americans. If the law is overturned, health care costs covered by the federal government would drop substantially.” (I disagree.)
19. Citizens United, the Supreme Court, and Our Independent Judiciary — “I’m perplexed these days as I consider how justices of our Supreme Court — lawyers at the pinnacle of that system — have opened the door to an unprecedented assault on judicial independence.”
20. Judicial Activists In The Supreme Court — “Conservative justices are prepared to act as an alternative legislature, diving deeply into policy details as if they were members of the Senate Health, Education, Labor and Pensions Committee.”
21. Wall Street thinks the high court won’t blow up Health Care Reform — “Wall Street seems pretty optimistic about the Supreme Court’s decision on health care reform. Share prices for big publicly traded health insurance companies like UnitedHealth Group and WellPoint jumped on Thursday.”
22. This Wouldn’t Be Our First Health Care Mandate — “There’s a Medicare payroll tax on workers and employers, for example, and a requirement that hospitals provide free emergency services to indigents. Health care is full of government dictates, some arguably more intrusive than President Barack Obama’s overhaul law.”
23. Some democrat leaders suggests Obama could go campaign-negative against Supreme Court & Congress — “We have seen presidents run against Congress and we have seen presidents run against the Supreme Court. Franklin Roosevelt did it to the Supreme Court; Truman did it to the Congress.”
24. Congress Gets Roughed Up By Justices — “The Supreme Court left little doubt during last week’s marathon arguments over President Barack Obama’s health care overhaul that it has scant faith in Congress’ ability to get anything done.”
25. When Healthcare Titans Compete, Patients Lose — “What happens if the Court throws out the mandate as well as the insurance reforms? The insurance industry would get the benefit of many more customers because the subsidies would still be in place. But they would be healthy because the insurance underwriting and pre-existing condition provisions would remain.” While the insurance industry would do well, the providers and patients would suffer.
26. The Real Health Care Train Wreck — It was happening across the street, in the halls of Congress, where a party line vote in the House passed a 2013 GOP budget that “would control health care costs by essentially ending the guarantee to cover all seniors through Medicare and the guarantee to cover qualified low-income Americans — including low-income children — through Medicaid.
27. The Supreme Court on Trial — “Before this week, the well-being of tens of millions of Americans was at stake in the lawsuits challenging the Affordable Care Act. Now something else is at stake, too: The legitimacy of the Supreme Court.”
28. Individual Mandate versus Do Not Treat — If people can’t be made to buy insurance, even with subsidies, what else might make them act responsibly? The cold-blooded answer is to let them die. They could hypothetically sign waivers and wear black “do not treat” wristbands alerting medics not to treat them.
29. Sense of Peril for Health Law Gives Insurers Pause — “Many of us did not get the bill we wanted, but I think having to start over is worse than having to fix this.” Popular provisions, like insuring adult children up to age 26 through their parents’ policies, might survive in the market, but extending Medicaid and requiring insurers to cover preexisting conditions would be nearly impossible to salvage.
30. Both Parties Brace for Fallout in Court’s Ruling on Health Care — “There will be substantial political fallout no matter how the court rules. But both sides acknowledge that they must wait until the court rules, most likely at the end of June, to grasp fully the way forward.”
31. One-Sided Passion Over Health Care Case — “Losing Health and Human Services v. Florida would be a defeat for the Obama administration, but it does not have to be a devastating one.”
32. Supreme Court Health Care Repeal Would Drive Up Hospital Costs — According to Moody’s, Hospitals and health insurance companies both face a sticky situation as they await word from the Supreme Court. A full or partial repeal of Obamacare could create chaos in the market for individuals and small business in 2014 and beyond.
33. What Obama Should Have Said About the Supreme Court and the Affordable Care Act — A Court decision to overturn the individual mandate would be “inconsistent with precedent dating all the way back to 1824, and would represent an effort by Justices to inject themselves into the political & policy debates surrounding our health care problems.”
34. Why the Supreme Court Wants to Kill Universal Health Care — My comment: “How gullible is America? Are we Lemmings or Lions? Big money will buy big ads and repeat the same lies until lemmings believe them and follow the herd off the cliff. Lions, on the other hand, are critical thinkers, and we know it’s much harder to herd a bunch of cats.”
35. Terribly Disrespectful? — Comment: “The danger and source of criticism seems to be that the Supreme Court is applying its Legal & Constitutional perspective without understanding the Medical & Economic perspective from years of public debate. At least one judge said he had no interest in gaining those perspectives by actually reading the bill.”