So, less than 24 hours before the momentous decision of the conservative leaning U.S. Supreme Court on the constitutionality of the Patient Protection and Affordability Care Act (ACA), I am hearing almost no public discussion or reading any popular media addressing moral issues.
Instead, we are hearing legal scholars discuss what time of the morning the justices come into the chamber, or whether the so-called individual mandate, which would compel every American to buy health insurance in the private market, is permissible under the Commerce Clause doctrine. We are getting detailed accounts of the ways the court might go on key issues, such as Medicaid’s expansion to have the federal government expand coverage to persons 133% above the federal poverty level and if the lawsuit by 26 states attorney Generals is valid before the law can be implemented. And so on and so forth, go very learned people trying to make sense of a complicated case.
What we are not hearing enough of are discussions about how many millions of Americans remain uninsured, and the costs associated with doing nothing to address that crisis. (The U.S. Census Bureau pegs the number at 50 million.) We are hearing next to nothing about the historic efforts that have prevented this nation from adopting a national health care system like other modern, capitalist democracies such as Canada, Taiwan, Japan, and France (see this comparison of how the United States system is different than and similar to other national systems, but still less efficient and more expensive). I suppose we are not getting this rehash because our nation already had that spasm of coverage during the debate before the passage of the ACA in Congress along strictly party lines in March 2010.
So in this vortex of news distortion without perspective, I would recommend that anyone who wants to get a grasp of the “bigger story” about the essential inequity and deficiencies in the U.S. health system read T.R. Reid’s clearly written tome called The Healing of America, the book I read before I began my studies in public health in 2010. In his 2009 analysis of health care systems in France, Germany, Japan, the UK, Canada, India, Switzerland, and Taiwan, Reid finds we are doing far worse in the United States, paying more money, and living less healthy lives, despite the false propaganda that we have the “best health care system in the world.” You can see a summary of the other national models here. I am not the first person to point out that learned persons, such as the 12 justices who will rule on June 28, 2012, should read this book.
Reid notes, in an article that draws from what he outlines in his book: “The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.”
Reid points out the immorality that is our patchwork system of universal care (the Department of Veterans Affairs for military personnel), subsidized care for the poor and elderly (Medicare and Medicaid), and privatized care, if you have an employer in most cases. It is immoral because it still leaves out millions of Americans, which the very imperfect ACA, after intense lobbying to pre-empt a single payer system and scuttle any discussion of a national health plan, tried to address by using market mechanisms (the individual mandate). According to Reid, “Every developed country except the United States has designed a health care system that covers every resident. … Covering everybody in a unified system creates a powerful political dynamic for managing the cost of health care … Universal coverage also enhances health care results by improving the overall health of a nation.”
So again we are failing to discuss the main issue here, which is a moral one. Health care, argue many medical and religious leaders, is not purely a political issue, but a moral right. I will leave this post with a very clearly stated summary from the group called Physicians for a National Health Program, an 18,000-member organization dedicated to the creation of a national single-payer health program. The organization states: “The U.S. spends twice as much as other industrialized nations on health care, $8,160 per capita. Yet our system performs poorly in comparison and still leaves 50 million without health coverage and millions more inadequately covered. This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.” I could not have said it better myself.
As for me, I was contemplating a bit of street theater downtown on June 28, but perhaps in my laziness I did not execute the costume and plan. Maybe later, when we learn about the implications of the Supreme Court’s decision, I will dress up as a public health wizard, like Harry Potter and his pals at Hogwarts. Then, I will recite magic phrases and wave my wand and cast spells to cure people and pay their medical bills, without of course actually doing something to fix what is ailing our political and health care systems that continue to leave our nation dragging behind other countries by all measures. That may actually be a job in demand, because if the ACA is struck down, a lot of public health interventions will no longer be funded, and our nation’s health will be worse because of it.
The court, in the first public reading of its decision, largely upheld the law. Justice Ruth Bader Ginsburg’s dissenting opinion from Chief Justice’s Robert’s opinion re the application of the Commerce Clause doctrine, largely highlights the issue listed above, that the compelling matter is the crisis of tens of millions of uninsured Americans and the inability of current system to solve that problem, requiring federal intervention. Wrote Ginsburg, in concurrence with Justices Sotomayor, Bryer, and Kagan: “In sum, Congress passed the minimum coverage provision as a key component of the ACA to address an economic and social problem that has plagued the Nation for decades: the large number of U. S. residents who are unable or unwilling to obtain health insurance. Whatever one thinks of the policy decision Congress made, it was Congress’ prerogative to make it. Reviewed with appropriate deference, the minimum coverage provision, allied to the guaranteed-issue and community-rating prescriptions, should survive measurement under the Commerce and Necessary and Proper Clauses.” Go here for the opinion: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf.