In the 1990s, under Bill Clinton, the Democratic Ruler, healthcare policy and concerns surrounding Medicare were raised. The reform was guided by Hilary Clinton, the new Secretary of State, but encountered such stringent resistance and became so controversial that it was abandoned without much progress being achieved. Often controversial was the first Medicare issue in 1965. Overall, any moment it has come to the surface, health care and health benefits has been a controversial topic in American politics for fifty years.
Today, the cause of health care reform has been taken up by President Barack Obama. It was a central plank of his democratic campaign and he signed the Patient Safety and Affordable Care Act on March 23, 2010 (PPACA). In the House and the Senate in 2010, critics of the programme proceeded to fight aggressively against the Act. Furthermore, the matter is now before the judiciary and will finally be resolved by the Supreme Court. The current controversy is often animated by the presence of ‘Teapartiers’ with a fresh, nationwide audience, such as Senator Rand Paul, Republican of Kentucky, and other far-right opponents of health care reform.
The subsequent discourse would concentrate on the resistance to the restructuring of health care, especially as articulated in Congress, but even, to a lesser degree, as it progresses in the courts. As a consequence, the discussion will commence with an outline of the planned amendments, named PPACA. This would include a forum for the main proposals of critics of health care legislation to be established. In the body of the report, their critiques of the suggested amendments would be enumerated. Finally, in the final portion, the present condition and possible course of the discussion would be speculated about.
Health Care Reform
Not surprisingly, the White House lauds the reforms as all things to all people: “Health reform will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy.” (The White House, 2010) These ‘Mom, Pop and apple pie’ ideas of affordability, accountability and sustainability are shared throughout Congress on both sides of the aisle.
The conflicts and confrontations are in the details of the practical programs that will achieve these shared goals. The PPACA is predicated on an individual mandate: Every American is required to have health insurance unless they qualify for a specific exemption: “financial hardship, religious objections, American Indians … for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold.” (KFF, 2010)
Additionally, financial inducements are included to persuade employers of more than 50 persons to introduce company health insurance programs. Individuals not covered by employers or purchasing private insurance would have access to “state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and costsharing credits available to individuals/families with income between 133-400% of the federal poverty level … [and] separate Exchanges through which small businesses can purchase coverage.” (KFF, 2010)
Overall, therefore, the PPACA fundamentally alters the landscape of the American health insurance industry. The marketplace widens with employers, large and small, encouraged to introduce company programs and state exchanges offering, ideally, similar group savings to individuals who remain uninsured.
As such it vastly increases the role of government in the health insurance marketplace. The federal government will be taxing and incentivizing business to encourage company health programs and the state governments will be operating health insurance exchanges.
It also, arguably, increases the role of the government in the life of the individual because it “requires most U.S. citizens and legal residents to have health insurance.” (KFF, 2010) This is the ‘individual mandate’. Critics suggest it is also a violation of Congress’s mandate.
Liberal-journalist and political commentator James Fallows argues that requiring health insurance is no more unusual than requiring that vehicle operators have insurance. “On the highway, everyone understands that it’s irresponsible and anti-social, along with illegal, for people to drive without insurance,” and so it should be with health care he argues. So it is with health care in much of the developed world (Australia, Canada, Great Britain, the E.U.) he notes. “I bet that a generation from now Americans will have the same ‘of course everyone needs it!’ attitude about health insurance that we now have about car insurance and Medicare”, he concludes optimistically. (Fallows, 2010)
For advocates of the health care reform process the change is, in a global context, not shocking or extreme, as various types of public health insurance predominate in the developed world. Even in terms of domestic policy it is seen to be as sensible, and as constitutional, as automobile insurance. In terms of intervention in the marketplace advocates of reform argue that it compels the marketplace to open wider and increases the range of choices available to individuals and businesses of all sizes. The White House concludes that it will open the marketplace to 32 million Americans and increase coverage to 95% of the nation. (The White House, 2010)
Charles Lane, an opinion columnist for The Washington Post is one of the most articulate opponents of the current reforms. Lane (2011) agrees that Mom, apple pie and health care reform are all noble goals: “But if, in the name of that noble goal, you construe Congress’s power to regulate interstate commerce so broadly as to encompass individual choices that have never previously been thought of as commercial, much less interstate, there would be nothing left of the commerce clause’s restraints on Congress’s power.”
Lane also quotes approvingly Judge Vinson who illustrated his opposition to the legislation with a tale of the humble broccoli, “Congress could require that people buy and consume broccoli at regular intervals, not only because the required purchases will positively impact interstate commerce, but also because people who eat healthier tend to be healthier, and are thus more productive and put less of a strain on the health care system.” (Lane, 2011) By analogy Vinson and Lane argue that if you can be compelled to purchase health insurance by the government than you can (conceivably) be compelled to buy anything and everything.
Lane also suggests that a single (government) provider system like the public system in Great Britain where the National Health Service is the sole provider would be more constitutional under the government’s right to tax to provide services for the general welfare of the nation. (Lane, 2010)
Senator Rand Paul, Republican of Kentucky, and an unofficial Tea Party spokesperson has voiced strong objections to the PPACA: “If you can regulate inactivity, basically the non-act of not buying insurance, then there is no aspect to our life that would be kept free from oversight and interference by the government…. From my perspective as a physician, I saw that we already had too much government involvement in health care.” (Herszenhorn, 2011) To the Tea Party and the most extreme opponents of the PPACA it is a further extension of government influence into a field that is already over-regulated.
On February 2, 2011, The New York Times reported, “Senate Democrats on Wednesday defeated a bid by Republicans to repeal last year’s sweeping health care overhaul.” (Herszenhorn, 2011) The entire drama in Congress was largely a tempest in a teapot as the entire House process occurred with widespread knowledge that the Senate would defeat any repeal legislation. It served to create a stage for both positions and both parties to publicize their policies.
The real debate now has moved to the courts and appears to be on its way to the Supreme Court. On February 4, 2011 Bloomberg reported that a Supreme Court hearing was “inevitable” over the issue of health care reform. (Stohr and Blum, 2011) They note that four trial judges have split 2 – 2 on the issue. Not surprisingly the split also fell along party lines with Republican appointees ruling that the PPACA was unconstitutional and Democratic appointees ruling that it was constitutional. The cases are now moving to the appeals courts level and will eventually reach the Supreme Court.
In The New Republic Jonathan Cohn argues that opponents to the individual mandate are taking their case to the courts as one of states right’s to disguise its true nature, “It’s founded instead on an individualistic, libertarian objection to a governmental program that imposes a collective solution to a social problem.” (Cohn, 2011) He concludes the constitutional argument is a smoke-screen for libertarian urges not satisfied by the Constitution. Without mentioning Paul, Cohn delivers a cogent response to his hysterical claims that, ‘there is no aspect to our life that would be left free from government regulation and intrusion.’
These questions remain at the core of the debate and will as the issue passes through the court process. Is the PPACA a legitimate and constitutional ‘collective solution to a social problem’ or is it even more ‘government regulation and intrusion’? Is it within Congress’s mandate to raise revenue for the public good (expanded health insurance) or is it an infringement of the states’ rights to unhindered intra-state commerce and the individual’s rights basic liberty?
- Cohn, Jonathan. “This is Not Judicial Restraint”. (7 February 2011). The New Republic. http://www.tnr.com/blog/jonathan-cohn/82961/health-reform-mandate-judicial-restraint-constitutional.
- Interesting. Right-wing criticism of the opponents of the health care reforms. He argues that the issue has nothing to do with state’s rights and even less to do with constitutional impositions on individual rights. He concludes the constitutional argument is a smoke-screen for libertarian urges not satisfied by the Constitution.
- Fallows, James. “Health Reform Notes from All Over”. (21 March 2010). The Atlantic. http://www.theatlantic.com/politics/archive/2010/03/health-reform-notes-from-all-over/37784/.
- The veteran journalist briefly remarks on the predominance of public health insurance in the developed world. He then draws an analogy to vehicle insurance, and suggests health insurance is no more radical and no less necessary than vehicle insurance.
- The Henry J. Kaiser Family Foundation (KFF). “Summary of New Health Reform Law”. (2010). http://www.kff.org/healthreform/upload/8061.pdf.
- This non-profit, charitable organization provides information for the public and policy makers. It’s summary of the PPACA is lucid concise and reasonably objective.
- Herszenhorn, David M. “Senate Rejects Repeal of Health Care Law”. The New York Times. (2 February 2011). http://www.nytimes.com/2011/02/03/health/policy/03congress.html?ref=healthcarereform.
- The New York Times is one of the most widely respected media sources in America. This is a news reporting item about the Senate vote on the Republican bid to repeal health care reform. It notes that the Republican initiative was defeated but opposition to the reforms will continue.
- Lane, Charles. “Give Me Liberty or Give Me Health Care”. (3 February 2011). The Washington Post. http://voices.washingtonpost.com/postpartisan/2011/02/give_me_liberty_or_give_me_hea.html.
- Articulate and lively criticism of the PPACA and health care reform. The author quotes the trial judges in the cases declaring the PPACA unconstitutional while logically and incisively outlining the various shads of the conservative position on health care reform.
- Stohr, Greg and Justin Blum. “Obama’s Slow Legal Approach on Health Law May Build Support”. (4 February 2011). http://www.bloomberg.com/news/2011-02-04/obama-s-go-slow-approach-at-supreme-court-on-health-law-may-build-support.html.
- These columnists opine that time is a key element in the administration’s strategy for health care reform. They argue that the government will stretch the various court cases out as long as possible to build public support and comfort/familiarity with the PPACA (it is already closing in on one-year since its enactment).
- The White House. “Putting Americans in Control of Their Health Care”. (2010). http://www.whitehouse.gov/health-care-meeting/proposal.
- This is the White House’s official ‘spin’ on health care reform. It is upbeat, laudatory and short on details. It provides the administration’s ‘official’ view, but it cannot be considered an objective source of information.