PLANK JUNE 25, 2012
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Do you care how the Supreme Court rules on health care reform this week? I don’t mean in the political sense. I mean in the personal sense—because the law’s fate is a very personal matter for many millions of Americans.
They’re the Americans who have diabetes and Crohn’s disease, cancer and hay fever. They’re the Americans who don’t have access to health benefits and the Americans who have access to health benefits but can’t afford to pay for them. There are a lot of these people, more perhaps than you realize—at least tens of millions and perhaps more than a hundred million, depending on how you want to define the categories. If by now you’re thinking, gee, maybe I could end up becoming one of those people, you’re right. Death and taxes aren’t the only certain things in life. Accident, illness, and injury are too. They’ve plunged the lives of plenty of Americans, even those who thought they had good insurance, into financial and physical chaos.
The Affordable Care Act won’t help all of these people. But it will help an awful lot of them. In fact, it's already starting to make a difference. On Thursday, the Obama Administration announced that 12 million Americans would be getting rebates from their insurance companies. The reason for the rebates was a regulation in the Affordable Care Act. Under the law, insurance companies must spend at least 80 percent of their premiums on actual patient care. (For some insurers, it's 85 percent.) Insurers that fail to meet that standard have to give some premium money back to their subscribers, in the form of rebate checks.
The rebates were not huge: The average was $151, although some consumers got rebates approaching $1000. But it’s yet another reminder that, by and large, the Affordable Care Act seems to be working. More than 5 million seniors have saved hundreds of dollars on their prescription drugs. As many as 6 million young adults now have comprehensive insurance coverage because, under the law, Americans under the age of 26 without access to coverage can enroll in their parents’ plans.
Not everything in the law has gone so well. Special, bare-bones insurance plans for people with pre-existing conditions—a temporary measure, until the full reforms kick in—haven’t attracted as many people as projected, although those who have the coverage are grateful for it. But nor have any of the awful predictions of critics come to pass. Opponents of the law frequently warned that the health industry would struggle to cope with changes in the way Medicare pays for services. Instead, the industry seems to be adapting, in ways that will actually make the health care system more efficient. In Massachusetts, the one state that’s tried a version of these reforms, the results are even more encouraging.
Will the Supreme Court stop this progress? Will it declare the Affordable Care Act unconstitutional, in part or or in whole? I know as much as you do, which is to say that I know nothing at all. The Court could deliver its ruling on Monday morning. Or it could deliver its ruling later in the week, by adding a special day to announce more decisions. As for the verdict itself, anything from a total validation to a total invalidation is possible. (Here's a rundown of the most likely possibilities.)
It's important to recognize the distinctions between great and good and bad and awful. But a decision to strike down even part of the law would have grave consequences—for the court’s legitimacy and, perhaps, the norms that make our constitutional system function. (I’ve written about the former many times. On the latter, see this excellent James Fallows piece.) It'd also have grave consequences for the people whose employment, financial, or medical status renders them vulnerable—a group that may someday include you, if it doesn't already.
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16 comments
All I can say, is thank the Lord I live in Massachusetts. Preventable care, good doctors, great coordination, low premiums; and I feel healthier than ever. And I don't have to worry about losing care. Thank Goodness I don't have to worry about losing care. Thank you Mitt Romney for you shining executive moment signing that health care bill, you equivocating scoundrel, you.
- RedState
June 25, 2012 at 6:39am
The Fallows piece is excellent. This all reminds me of a speech I heard by Ray Bradbury who claimed he discovered that no matter what the change was: air flight, automobiles, a polio vaccine (or social security, medicare, medicaid, and health care reform); somebody would always be against it.
- Nusholtz
June 25, 2012 at 7:48am
Thank the Lord for people like Cohn! Providing insurance coverage for millions of working Americans is a tremendous accomplish, for which Cohn and others deserve much of the credit. But there's one subject on which Cohn and I disagree: pre-existing, mostly chronic conditions. Yes, ACA will improve the lives of those who suffer from them, but ACA will not prevent their downward economic spiral: loss of job, loss of life savings, loss of dignity. Expansion of Medicaid to the nearly poor will help, but not until those who suffer from chronic conditions deplete their savings to the point they qualify. Private insurance, which is preserved under ACA, is incompatible with chronic conditions. How do I know? Long ago we as a nation concluded that the chronic condition suffered by the most was incompatible with private insurance and adopted a form of public insurance for them, so they wouldn't be forced to deplete their life savings in order to receive health care. Last week I re-read the very moving article written by Noah's late wife, Marjorie Williams, for Vanity Fair (and linked in Slate). Like Ms. Williams, my sister was struck by a fatal cancer at a relatively young age, and her journey was similar to Ms. Williams', in particular the role of her husband (never giving up for a cure) and the concerns she expressed for her children who would grow up without her. But their journeys diverged in one major way: Ms. Williams' employer maintained group insurance on which she was able to rely throughout her illness (to her comfort as expressed by her in the article), whereas my sister did not have the security of quality group insurance so every doctor visit, every procedure, every therapy, every hope for a cure was a battle with the private insurance company and a further depletion of her will along with her life savings. If, as I have predicted, C.J. Roberts joins the majority in upholding the mandate and ACA, it will be a big step forward for health care reform. But for many if not most with chronic conditions, their struggle won't be over.
- rayward
June 25, 2012 at 7:50am
Jon Chait has an excellent commentary companion to Jon Cohn's column: http://nymag.com/daily/intel/2012/06/health-care-as-privilege-what-gop-wont-admit.html Why don't Democrats speak in moral terms anymore, like the Jons?
- tmmats
June 25, 2012 at 10:30am
The Fallows piece is awesome, maybe even more so his excerpt from it since it clarifies his argument that our country is undergoing a severe challenge. I agree the Dems should speak in moral terms. Indeed the Left has a morality yet never seems to articulate it whereas the Right claims the mantle of Jesus, distorted or otherwise.
- Sophia
June 25, 2012 at 1:10pm
JC, it's come to this? An emotional appeal? Of all the previous stuff you've written, the graphs, the charts, the detailed analysis. In the end, you fall to your knees and begging for sympathy for someone with hayfever? Lets see, there's Denial, Anger, Bargaining, Depression and Acceptance. I think this article is a breakthrough. When you work WITH the other side, you find out what they want, you know what you want, and you work out a plan to captures both elements. There isn't a republican alive that likes the idea of anyone (especially themselves) getting denied because they suddenly got cancer. Check mark: Common ground #1 Nor does anyone like the idea of rates going through the roof becuase you suddenly got cancer. Check mark: Common ground #2 And so on... That is how congress should work. Find the common ground, build the framework. What happened with ACA was not that. it was the nastiest example we've ever seen of ramming something through. Even the dems had to be paid off to deliver the needed votes in the end, with the cornhusker kicksbacks and various backroom deals. Just nasty. And you are left with a public that overwhelmingly despises the law. No surprise. Shame on the dems for wasting this much time on this. Shame on the dems for not finding a way to make this work based on the common ground Assuming, of course, scotus overturns. If they don't, then never mind. PS. SCOTUS UPHOLDS request for states to demand immigration papers 8-0! Go figure!
- seattleeng
June 25, 2012 at 1:11pm
PS rayward's absolutely correct, alas. The cost of treating chronic illnesses can be absolutely devastating. And, it's unclear to me how driving people into bankruptcy is a correct path, indeed if one is trying to treat an ill person that's the last thing they need.
- Sophia
June 25, 2012 at 1:19pm
A guest on C-Span's Washington Journal this weekend mentioned that the ACA has 216 elements, large and small, in it that were Republican proposals, at the federal and state (Romneycare) levels. These, of course, include universal coverage and the individual mandate. And, of course, many people who vote Republican and who hate "Obamacare" are already taking advantage of some of the benefits of ACA, such as rebates from the insurance companies. Does this expose as much as anything the weasel element in human nature?
- magboy47.
June 25, 2012 at 1:23pm
now we have to wait until thursday? all I can say is thank God I am in and have pretty much always been in good health, living in Mexico I never once begrudged my taxes going to support those less fortunate than I. Now I am moving back to the states and am dreading it. It is not that I am so afraid for my own health situation, but I really don't want to live in the same country with so many Republican assholes.
- blackton
June 25, 2012 at 1:39pm
seattle, ACA didn't get a single vote from a Republican at any stage of its evolution through Congress. This despite the fact that almost everything in the bill was proposed and/or supported by Republicans in the past (see my comment above). I see you still haven't come back from La-La Land.
- magboy47.
June 25, 2012 at 2:32pm
P.S., seattle, Republicans don't want a health care bill of any kind passed while a Democrat is in the White House. That's why they fought like tigers against Obama and the American people. And if Romney is elected, he can't sponsor and/or support a health care bill either (Romneycare! Romneycare!). So millions more Americans will go bankrupt when they catch "hay fever," which you so coldly compared to catastrophic diseases. Your Ayn Rand is shining through, seattle. She loved it when mortally ill people went bankrupt. Survival of the fittest, you know.
- magboy47.
June 25, 2012 at 2:51pm
"PS. SCOTUS UPHOLDS request for states to demand immigration papers 8-0! Go figure!" Seattle, calm down, you're scaring the horses! --- the Court upheld the provision that says that law enforcement can check the immigration/citizenship status of anyone who has been arrested. It is, however, possible that the provision will come back to the court in later years as the number of angry citizens who have been subject to status checks on the basis of their appearance or last names increases.
- ironyroad
June 25, 2012 at 3:07pm
Most people --other than tea partiers--know that the ACA has certain desirable elements--but all the spin in the world does not hide the fatal flaw in the legislation. It was designed by the private insurers, and designed to maintain their profit stream. I know that you keep trying to justify it-- but it can't be justified. With or without the mandate, subsidizing the profits of the private insurance industry with money needed for care, and with our tax dollars is just plain wrong! Even at full implementation, the legislation will leave over 23 million uninsured. Age rating is retained. I have just consulted a premium calculator on the Kaiser Foundation site. One can get a rough prediction of how much it will cost to buy an individual (non-employer) plan in the private insurance exchange. Enter your age, income and family size. http://healthreform.kff.org/SubsidyCalculator.aspx#incomeAgeTables Happily, those eligible for Medicaid will be helped, but we didn't need an insurer bailout and a proliferation of MCOs to accomplish that. As employers cut back on coverage, everyone will see a rise in rates and/or cutbacks in benefits. Imagine the bureaucracy that will be needed to oversee all the machinations of the insurers, given their penchant for dekaying and denying, dodging requirements, holding to the MLR ratio etc. No matter what SCOTUS decides, we need a single payer system. Enact the Expanded & Improved Medicare for All ACT. Our economy needs it, our people need it--and it's constitutional.
- hmseil01
June 25, 2012 at 3:16pm
Consolidation in the industry is occurring throughout the country, as large hospitals put together networks of physicians. Such integrated delivery systems (the integration being between the physicians and hospitals), as they are called, have many potential consequences, some of them not so good. But one potential consequence makes me smile: taking private insurers out of the mix. With an IDS, there is no point in including an insurer and its roughly 20% take off the top, as individuals can simply sign up with an IDS in their area. Will the insurer be missed? No, because the insurer offers nothing of value for its 20% take. Sort of like organized crime.
- rayward
June 25, 2012 at 4:13pm
Magboy writes: "Republicans don't want a health care bill of any kind passed while a Democrat is in the White House." Goes both way, Magboy. If ACA falls to pieces and republicans pick up the fight and pull in the more popular aspects of ACA and then some, you can bet dems will fight it tooth and nail. Obama has lectured us that we need real immigration reform for the how long? And yet the dems hammered down Bush's two real efforts there. it's called politics. The difficulty we have in getting things done is by design. It is how our founding fathers intended it.
- seattleeng
June 26, 2012 at 1:27pm
hmseil writes: "With or without the mandate, subsidizing the profits of the private insurance industry with money needed for care," That you believe the profits of private insurers are what drives this shows your ignorance. Insurer profits are about the same as the premiums paid by doctors for malpractice insurance. Adn both are fairly small: a few % of our total health care spend each year. The reason our health care costs so much is the same reason a Big Mac in Aspen, Colorado costs more than a Big Mac in Jasper, Kentucky. figure that out, and it all becomes clear.
- seattleeng
June 26, 2012 at 1:32pm