The Affordable Care Act in two essential points

With all the bazillions of words spewed on the Affordable Care Act (ACA), the Supreme Court decision to uphold it, and the asinine teeth-gnashing offered up by politicians and pundits on all sides -- do we really need more?

Yes. But not very much more. I'll try to be brief...

The thing is, if you're distracted by Congressman Mike Pence, running for governor of Indiana and likening the SCOTUS ruling on the ACA to the 9/11 terrorist attacks; or Breitbart.com editor-at-large Ben Shapiro tweeting that the decision is the end of America as we know it; or Rush Limbaugh calling the Supreme Court a "death panel"; or any other silly, irrational, socially-corrosive hysteric -- you could well be missing two essential points.

(1) LaLaLaLa I can't hear you!

The Kaiser Family Foundation released a poll on Tuesday. Based on a survey taken on the day of and two days following the Supreme Court decision upholding the Affordable Care Act, KFF found that 41% of Americans didn't know the ruling had been announced, or knew there had been a ruling but didn't know what decision SCOTUS had come to.

The Pew Research Center released a similar poll on the same date. Results from Pew are ... worse:

Despite extensive public interest in the court’s ruling, just 55% of the public knows that the Supreme Court upheld most of the health care law’s provisions; 45% say either that the court rejected most provisions (15%) or do not know what the court did (30%).

If what people don't know won't hurt them, 45% of Americans might never need a doctor. Wheeee!

Essential point #1, then, is that for all the yammering about a question that impacts just about everybody (because everybody who doesn't die suddenly and unexpectedly will need health care sometime, whether or not they're able to afford it), a shockingly large fraction of citizens in our ostensibly democratic polity aren't paying attention.

(2) ACA is a stake in the ground

Is the Affordable Care Act -- pioneered by Mitt Romney, realized by Barack Obama, upheld by Supreme Court Chief Justice John Roberts -- all good?

No! Of course not! It's riddled with Byzantine concessions to a rapacious health care "industry" concerned with maximizing profit irrespective of benefit to public health. (I'm talking about insurance companies, in case anybody's wondering.)

That is to say, the ACA is faulty because it's not single-payer. So say I, anyhow.

But if you disregard the pols and pundits currently telling any pandering, hyperbolic lie that they imagine will give 'their side' an edge in the November elections, and recall that every major policy initiative in the history of the United States evolved over time after its initial passage, what you're left with is a very simple conclusion.

What we have now in the ACA is an opportunity -- a compelling opportunity -- to fix deeply broken, staggeringly wasteful, and poorly focused health care policy and infrastructure.

Eugene Robinson said this very nicely in the Washington Post the day after the SCOTUS ruling:

Rather than seek a radical reshaping of the health-care system, Obama pushed through a set of relatively modest reforms that will expand insurance coverage to a large number of the uninsured — about 30 million — but still not all. He also tried to use free-market forces to “bend the curve” of rising costs, slowing but not halting their rise.

The result — the Patient Protection and Affordable Care Act — is a huge, complicated, unwieldy piece of legislation. I would have loved to see the president try for something simpler and more elegant, perhaps a “Medicare for everyone,” single-payer system. Maybe that’s where we’ll end up someday.

But despite all the rhetoric we’ll hear from Romney and the GOP until Election Day, health-care reform is here to stay. Provisions such as guaranteeing insurance coverage to those with preexisting conditions are too consumer-friendly to be taken away, and once these measures take effect, which happens in 2014, insurance rates would rise sharply — and unacceptably — without the individual mandate.

And medical costs will continue to soar, despite the law’s efforts to contain them. Inevitably, if only because of deficits and the national debt, Congress will have to revisit the health-care issue with an eye toward more radical changes.

When that next big push takes place, it will be with the underlying assumption that health care should be available to all who need it regardless of their ability to pay — that it is not a privilege but a right. Progressive presidents since Theodore Roosevelt have tried to enshrine this principle. Barack Obama did it.

Essential point #2, then, is that the ACA is not only not "the end of America as we know it," it's not even the end of health care reform.


Whether you're paying attention or not, the real work has just begun.


Related posts on One Finger Typing:
Acting like citizens about health care
Socialized medicine: an inside scoop
G.O.P proposes a death panel plan for health care


Thanks to the White House for the Reality Check image; and to The Alliance for Democracy for catching Dan Wasserman's on-point 2008 cartoon in the Boston Globe.