Healthcare and The Supreme Court

Today, the Supreme Court ruled that the Affordable Care Act was Constitutional – though as a tax rather than a commerce provision – surprising many who expected at least the individual mandate requirement to be struck down.  The Supreme Court has five conservative and four liberal judges, with the expectation that on the biggest issues they will vote along party lines, rather than according to the evidence with which they are presented. This goes against the notion of separation of powers.

The Founding Fathers, in their wisdom, designed the government of the United States with checks and balances, granting some authority to the President, more to Congress, and the task of ruling on the legality of the actions of both to the Judicial Branch.  If the rulings of the highest court in the land are liable to change based on the right or left leanings of the Justices who are on the bench at the time, then interpretation of the law becomes a lottery based on who is in the White House to nominate a new judge when a space becomes available.  This is not how laws should be upheld or struck down, else there is a risk of tyranny of the majority.

“Facts are stubborn things and whatever may be our inclinations, or the dictums of our passions, they cannot alter the state of facts or evidence”

John Adams

This quote from the second President of the United States was part of his argument in defense of the British Soldiers in the Boston Massacre trial.  Despite a risk to his law practice and the well-being of his family, Adams believed that everyone was entitled to a fair trial and took on the case.  Through the passage of time, as politics has become more partisan and the two parties are as divided as any time since the Civil War, this notion of justice and impartiality has been all but vanquished.

Take “Citizens United” – the decision by the Supreme Court in 2010 that ruled corporations are allowed to fund electioneering communications, overturning a previous ban.  Although they are still not allowed to provide funding directly to candidates in federal elections –  SuperPACs have essentially made that ban irrelevant – the ruling effectively stated that companies should be protected under the First Amendment as if they themselves were citizens.  Mitt Romney at the Iowa State Fair last year stated that “corporations are people” – the message that the Supreme Court gave with their Citizens United decision. Common sense tells us that this is not the case.  In the recent recall election of Governor Walker in Wisconsin, the incumbent was able to outspend his opponent 7 to 1 because Citizens United allowed him to receive donations from companies.

If elections were not decided on spending alone, this may not be such a big issue, but nowadays, the more a candidate spends on attack ads and marketing, the greater their chances of winning.  So what could this mean?  Republicans tend to be favoured by the richest people and the biggest businesses in this country, as they advocate lower taxes on the higher earners and a decrease in Corporate Tax rates, thus they are likely to gain the most money in campaign funding.  This increases the likelihood of GOP candidates getting elected, both to Congress and to the White House, giving them the opportunity to nominate and affirm Justices to the Supreme Court.

It is vital, therefore, for the judicial branch to remain independent, no matter who they were appointed by and regardless of their own political viewpoints.  Today’s decision goes some way to restore the notion that the Justices would be able to pass judgement on cases without bias or prejudice of their own allegiances.  Indeed, in his opinion on the ruling, Chief Justice Roberts echoed John Adams’ sentiments noted above:

Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.

Chief Justice Roberts Opinion, National Federation of Independent Business vs Sebelius 2012

It is perhaps the hardest thing to accept – that something you do not agree with should still be allowed to be implemented, but that is the nature of a plutocracy.  I may not agree with much of what they say on Fox News, but I still believe that the First Amendment gives them the right of free speech and they are entitled to broadcast their message.

Health Care

I was not a proponent of the individual mandate provision in the Affordable Care Act, despite being a fan of the President.  It is not because I believe that it would result in a government takeover of the healthcare system, rather due to the fact such a compulsion to buy coverage would only mainly benefit the insurance companies.  While other provisions of the bill made good progress on improving healthcare – such as the removal of pre-existing conditions as reason to deny coverage, or the raising of the age under which people can get insurance under their parents’ plan – the mandate did nothing to help those who previously had no access to healthcare outside of the emergency room.  The long-term plan is to subsidise the premiums for those who cannot afford it, but the execution of that plan will depend on how the law was enforced by future administrations.  If a Single Payer option had been pursued – which President Obama advocated initially but quickly dropped for fear of Republican in the Senate filibustering – then this mandate would never have been in the equation.

What is needed is a complete overhaul of the healthcare system in the United States – with universal coverage provided by the government and private insurance available for those who can afford it.  This system, which has been present in almost all Western Democracies for a long time, ensures that people are not denied care because they cannot afford it, do not go bankrupt if they are sick, and do not lack health coverage if they should lose their job.  Universal Healthcare would also help small businesses, as they could hire more employees, or pay better wages and thus attract better workers, if they are not compelled to provide a costly benefit such as health insurance to their staff.

I could make a protracted argument on the ethics and morality of providing healthcare for all, regardless of their means, but in the spirit of President Adams’ quote above – let me focus on the facts.  This chart provides a comparison of countries with universal healthcare and the United States; the percentage of GDP that they spend on healthcare; their Infant Mortality Rates and the Life Expectancy of the total population at birth:

Country Expenditure on Healthcare as % of GDP Infant Mortality Rate – death per 1000 live births Life Expectancy, Total Population at Birth
Australia 9.1 4.3 81.6
Austria 11.2 3.8 80.4
Belgium 10.7 3.4 80
Chile 8.4 7.9 78.8
Czech Republic 8 2.9 77.3
Denmark 11.5 3.1 79
Estonia 7 3.6 75
Finland 9.2 2.6 80
France 11.7 3.9 81.1
Germany 11.7 3.5 80.3
Greece 10.6 3.1 80.3
Hungary 7.7 5.1 74
Iceland 9.6 1.8 81.5
Ireland 9.9 3.2 80
Israel 7.9 3.8 81.5
Italy 9.3 3.9 82
Japan 9.5 2.4 83
Korea 6.9 3.2 80.4
Luxembourg 7.9 2.5 80.7
Mexico 6.4 14.7 75.3
Netherlands 11.9 3.8 80.6
New Zealand 10 5.2 80.8
Norway 9.8 3.1 81
Poland 7.2 5.6 75.8
Portugal 10.8 3.6 79.5
Slovak Republic 9.2 5.7 75
Slovenia 9.3 2.4 79
Spain 9.6 3.2 81.8
Sweden 9.9 2.5 81.4
Switzerland 11.4 4.3 82.3
United Kingdom 9.8 4.6 80.4
United States 17.7 6.4 78.5

Figures from 2009 statistics – taken from OECD report

What this shows is that, despite spending the highest percentage of its GDP on healthcare, of these 32 nations the USA ranks 26th in life expectancy and 30th in Infant Mortality Rate – with only Mexico and Chile having more deaths per 1000 live births.

Without doubt, the United States has some of the best healthcare facilities in the world, as well as some of the best doctors.  However, it is access to this care that is the issue – these figures show that while those lucky enough to afford insurance premiums may arguably be able to get fantastic service, nationally the system is not performing at the same level as other countries who spend comparatively less on healthcare.  The individual mandate may eventually help those in need gain coverage, but it has to be used to put pressure on insurance companies, not harshly penalise individuals or families who already have low wages and mounting bills with which to contend.

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