If not Obamacare, what’s next?

Opponents to Obamacare have yet to propose an alternative should the Court strike it down.


The arguments before the U.S. Supreme Court on Obamacare are now over, and all bets are off. Observers who tried to assess the mood of the Justices seemed to be more perplexed at the end of the hearings. One thing is certain: it will be a close call.

The Court is essentially divided along ideological lines with conservatives (including Chief Justice John Roberts, Justices Antonin Scalia, Clarence Thomas, and Samuel Alito) fairly consistent with the right of center viewpoint.

Progressives include Justices Ruth Ginsburg, Stephen Breyer, Sonja Sotomayor, and Elena Kagan who also seem in tune with their ideological bias. Justice Arthur Kennedy, a George H.W. Bush appointee and a conservative, has occasionally crossed the ideological divide.

At issue: is Obamacare constitutional?

Much is made about the political implications of the eventual ruling, expected in early summer of this year. Little, however, is discussed about the possibility that Obamacare be ruled unconstitutional and what that would mean.

Let us recall that Obamacare is the most far-reaching healthcare reform since Medicare and Medicaid, passed during the 60’s under the Lyndon B. Johnson Administration. The U.S. system is a hybrid model with a mix of public and private monies. The U.S. spends more public money per capita than any nation in the world.

Yet, many of its citizens are covered by private insurance companies. Currently, it is estimated that close to 1/6 of the U.S. population are uninsured (50 million).

Obamacare tried to address that problem by bringing forward an idea from conservative think tanks, and once supported by Mitt Romney and Newt Gingrich – the healthcare mandate.

The mandate would require by 2014-15 that the uninsured buy insurance or suffer a penalty. Using the commerce clause in the U.S. constitution, the Obama Administration believed that their approach was constitutional since all citizens are at one point consumers of healthcare.

It is important to recall that even the uninsured get full services should they go to the emergency wards. But someone has to pay at the end of the day.

Currently, healthcare represents about 18% of GDP in the U.S. compared to approximately 10% in other OECD countries. Costs are escalating and the U.S. remains the one country in the Western World where getting sick can bankrupt you.

Like it or not, Obamacare was meant to address the problem. Obama chose the mandate approach as opposed to the single payer approach that we in Canada have since the late 1960’s and early 1970’s. He was encouraged back then in 2009 by former Governor Mitt Romney to adopt this approach which had become the norm in Massachusetts under the said Governor’s Administration.

Obamacare has since become a lightening rod for the Republican Party and the conservative establishment. What is disconcerting and confusing to many is that no one has an alternative in the event Obamacare is struck down.

Obamacare currently eliminates pre-existing conditions as a factor for private insurance companies to refuse coverage. It also allows young people under 26 years old to stay on their parents’ plan.

In addition, it provides seniors as they begin retirement with financial help with their medication costs.

If the law is judged unconstitutional, do all provisions fall, or just the infamous mandate provision? The fact is the mandate provision provides private insurance companies with the risk pool to provide for the more popular aspects of the law and possibly bring costs down.

Whatever happens and whatever the merits, it is sad that opponents to Obamacare have yet to propose an alternative should the Court strike it down.

Maybe the only alternative left is the single payer system which we know conservatives and the GOP abhor and consider socialism.

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If not Obamacare, what’s next?

  1. I believe the author meant “lightning rod” not “lightEning rod”.


    • I dunno, I find the response to it does indeed shed some light on various parties involved.

  2. Comprehensive and Universal healthcare from the “cradle to the grave: under a single payer plan. Those who want to porchase additinal insurance, are certainly free to do so.

  3. As someone who works with the uninsured at a Free Clinic in Sonoma County it is obvious that something has to be done.  Every clinic we see very sick people who have ignored their hypertension, diabetes,  and other chronic and acute medical problems because of a lack of insurance or other access to health care.  Some of these people are very sick or in constant discomfort.  If Obamacare does not happen for any reason, what do the Republicans have to provide regular medical care for those people-and they are people like you and me-who lack access to affordable medical care?  I’m old enough to remember the early votes on MediCare when evvery Republican voted against it until there was an uproar against them in this cournrty.  They don’t seem to learn from history.

    • What is the evidence that people who generally neglect themselves suddenly become responsible when their needs are “free”?  There is an alternate hypothesis: people inclined to neglect their health will neglect their health, whether they have access to preventive care or not.

      • It’s not that they’re neglecting their needs, it’s that they can’t afford to fulfill them — until it gets serious and they’re covered by the “emergency” part of medicare.  Of course, by then it’s a hell of a lot more expensive for the tax-funded system to deal with.  

        The problem is that the body can, and often does, heal illness on its own.  Thus trying to pay for early treatment when there’s still a chance your body would heal itself would seem counter-productive — especially if you’d have trouble affording the treatment.

        On the other hand, if you’re insured, then you’re much more free to get the problems checked out early, even if your body might heal itself.

        • Plenty of perfectly well-off people neglect their needs – men in general are (in)famous for not paying much attention to recommended preventive health monitoring measures and care.  People with dependency issues are also not noteworthy for being able to afford health care (well, they might afford it, with different spending priorities) or for taking great care of themselves or their environments.  The “can’t afford” excuse is overused.

          • So you’re willing to condemn (and pay the requisite costs in taxes) for those who really can’t afford it because you’ve got a hate on for those who can but don’t?

            Heard about cutting off your nose to spite your face?

          • I think the fraction of people who really can’t afford basic annual checkups and care is approximately the same fraction of people who are generally incompetent to manage any of their affairs well, and amount to about 2% of the general population.  I think the right thing to do is subsidize and guide (assist, not direct) their entire existence, because the alternative is to allow them to starve in misery.  Likewise, I think the only alternative to single-payer catastrophic coverage is to allow people to die in misery, so my preference for individualism takes a back seat to the collective solution we have.  But the remaining 98% of people I expect to look after their own routine needs; if they don’t see to their health, I consider that a choice in which it is not my business or duty to intervene.

          • That’s nice. Some people think martians are real too.

  4. If it doesn”t have Obama name attached to it, it will be ok. It’s not health care it’s Obama. Tells you what really going on in America. I hope if the plan is shot down the marjority will push in a single payer system. Serve the tp and right of Kanas right.lol

    • Call it racism or whatever but those Republicans are NUTS !

  5. It is sad that proponents of Obamacare also have yet to propose an alternative should the Court strike it down.  It might be left to states to decide individually how to deal with the problem; they have some constitutional powers that the federal government does not.  Proponents of a federal solution can pass a clean single-payer system instead of a back-handed devious incomprehensible lie of a bill artificially structured to game the CBO’s estimates, next time they control Congress and the presidency.

  6. I hope that the Obamacare will be accepted.Nathalie L.

  7. “Maybe the only alternative left is the single payer system which we know conservatives and the GOP abhor and consider socialism.”

    There are plenty of alternative models that would be acceptable to the right – indeed, many primary candidates are campaigning on just that. Two I’ve seen people talk about are:
    -block granting public healthcare dollars to the states
    -medical savings accounts

    The problem with US healthcare is more one of implementation than public vs. private, meaning that there are many possible directions that would be better than the status quo. Why does the US model have problems?

    1. Employer-based healthcare: employers, not consumers, pay the insurance premiums for most Americans. As a result, you have less labour market flexibiltiy (people take lousy jobs to maintain insurance eligibility), and a market that is not responsive to consumer needs. Moreover, the tendency has been growth in co-pays and deductibles, instead of premiums. 

    2. the political economy of Medicare: old people vote. This is precisely why devising social programs that discriminate on age is a bad idea – any such programs are going to be over-funded (if they benefit old people), and virtually impossible to reform. That is especially bad in the case of medicare, because dollar-for-dollar, it would make more sense to put public health dollars toward preventive care, rather than emergency care for people who are going to die soon. 

    • block grants to States is a single payer alternative and health savings does not cover very many . If you force it , it becomes a mandate . If not , it does not do the job to build the risk pool . Republicans controlled Congress from 1994 to 2006 and what did they do ? Zero ,except the drug prescription program that was unfunded . Bad news if Courts rules as expected against Obama.

  8. Whatever happens and whatever the merits, it is sad that opponents to Obamacare have yet to propose an alternative should the Court strike it down.

    If legislation is unconstitutional, it’s not the job of the challenger to provide a constitutional alternative. What a ridiculous little man you are.

    • Not sure you understand the stakes. So I will explain slowly . If ….. Obamacare….. is…… struck ….down   ,what …..replaces …..it…..?Was this slow enough for you to grasp the stakes ?Nothing ,so we are back to square one . Never mind .

      • If PPACA or part of it is struck down, it is because the court finds it unconstitutional.  Whether there is anything to replace it is irrelevant – the drafters of the legislation should have legislated something different and treated the constitutionality questions seriously (Are you serious? Are you serious?).  The mistake is theirs to correct.  For PPACA’s supporters to say “we fucked up, but it’s your job to fix it” is kind of funny, really.  Is that how everything is supposed to work, in a “heads we win (legislation stands), tails you lose (legislation falls, so you other guys have to create a constitutionally acceptable solution)” kind of way?  Nice try.

      •  Also, everyone seems to have lost sight of the fact that the Republicans have at various points tabled several ideas for reform.  The fact that Democrats don’t agree to support them doesn’t mean no alternatives were ever proposed.

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