June 3, 2012
The time to consider this paradox is before the decision is announced. Afterward, all anyone will talk about or even think about is political and financial effects, winners and losers, gamesmanship. Any thoughts about how the ACA will affect you, me, and our health care needs will be ignored in the score-keeping, especially various predictions about effects on the general election in November.
While we can do so, let's consider how the SCOTUS decision on the ACA will impact Mr. and Mrs. Everyperson and their family in day-to-day activities.
Suppose SCOTUS strikes down the individual mandate*, that forces people to buy insurance and penalizes them if they do not. This takes away a large revenue stream from Washington. Otherwise, it changes nothing.
Striking down the individual mandate is the most likely course that SCOTUS might take on the grounds that the Federal government cannot force people to engage in commerce nor penalize them if they choose not engage in such commerce. (Please also note that buying health insurance is not an "interstate" activity. Indeed, competition by insurance companies across state lines is illegal.)
There were arguments both for and against "severability," meaning that SCOTUS had to either uphold or strike down the entire Act. The Judges made clear that they were not limited in their choices. They could decide to do whatever they thought was in keeping with Constitutionality. That was their sole purview.
So what might their decision do to us?
Will striking down the individual mandate change the availability of health care service for the average person? Since the number of insured persons will not change from what it is now, the answer is no. Since ACA cuts in Medicare reimbursements are unaffected (unless they go UP), there will be the same shortage of providers able to care for Medicare patients.
Will striking down the individual mandate change the expansion of the bureaucracy in any way? Will it stop the creation of IPAB (Independent Payment Advisory Board) and five other whole new Federal agencies? No.
Will striking down the individual mandate stop the development of ACOs (accountable care organizations), which are "accountable" to everyone except the patients? No.
Will striking down the individual mandate halt the creation of Health Exchanges, which impose further Federal control of health care on the States and suppress competition? No.
Will striking down the individual mandate or upholding it for that matter solve the problem of health care for illegal residents and the unfunded mandates for care? No way!
Will striking down the individual mandate expand the number of jobs? Yes and no. It will massively increase the number of administrative, legislative, and regulatory oversight positions, but not one new doctor or nurse. Quite the contrary as the Medicare reimbursement cuts take effect. The job expansion will do nothing to improve access to health care. It will in fact reduce care as money is taken from care providers and given to managers and overseers.
ACA does of course spend money, huge sums of it. Estimates range between $1 trillion and $2.7 trillion. That is more than has been spent on the wars in both Iraq and Afghanistan.
What do We The Patients get for all those expenditures? Answer: no more, or better, or safer, or quicker health care. Just more regulations and more bureaucrats.
If your teenager goes to the store and spends cash, she cannot spend more than is in her wallet. If she uses your credit card, the sky's the limit. The same is true for the Federal government. The loss of the revenue from a struck-down individual mandate will not slow down the Federal spending spree because it can do one thing that you and I, and the fifty States cannot: print money. So whether SCOTUS upholds or strikes down, nothing of substance will change except the size of the bill we are passing on to our children.
We must accept that SCOTUS, whatever they decide, will not save us from the harmful effects of the ACA. Only repeal can do that. And of course, repeal alone still leaves us with a critically ill, dying in fact, healthcare system. Stopping the bad medicine - ACA - only reduces the rate of decline for patient Healthcare. We need to start practicing good medicine on this patient Healthcare, something we have never done before.
Keep all this in mind when the hysterical reactions to the SCOTUS decision take over the airways. Everyone will be talking about Obama, Romney, Pelosi, Boehner, Justice Roberts, Sebelius, etc. No one will be paying any real attention to We The Patients.