It may be constitutional, but it’s still a bad law

June 28, 2012

So the Supreme Court has upheld most of the Affordable Care Act as constitutional. As someone who supports universal healthcare, who has lived most of his life in the UK, which has an admirable national health service, and who believes affordable healthcare for all is the mark of a civilized nation, I say it’s too bad. It is a wretched piece of legislation: complex, expensive, incomprehensible – do you know anyone, even a health expert, who can tell you what it means in a single sentence – easy for the unscrupulous to manipulate, unpopular, and politically catastrophic for the president.

All credit to Barack Obama for at least getting universal healthcare on the statutes, something that has eluded presidents of both stripes for a century. It is a shaming fact that 50 million Americans have to either burden themselves with debt or throw themselves on the mercy of emergency rooms when they get sick. Some may be libertarians, others so rich they don’t have to worry about paying out a fortune when they fall ill. But they are in a minority.

Most are ordinary folks, those who don’t enjoy the canopy of care provided through employers, oblivious young people who imagine they’re immortal, or those without work or who simply can’t afford exorbitant premiums. These are the mothers with blubbing young children you meet in any emergency room at any time of day or night, throwing themselves and their offspring on the mercy of hospital staff. They are not making some principled stand about keeping government at bay. They are the sort of people – poor people, or people on modest incomes — you might imagine a Democratic president would strain to serve.

At first it seemed Obama would do the right thing. Long an advocate of a public option, he said in 2003: “I happen to be a proponent of a single-payer health care program. I see no reason why … the wealthiest country in the history of the world … cannot provide basic health insurance to everybody … a single-payer health care plan, a universal health care plan. And that’s what I would like to see.”

In the primary debates in 2008 he dissed Hillary Clinton for proposing a mandate that would drive everyone into the arms of insurance companies. Back then he thought such a plan unconscionable. “The insurance companies don’t mind making sure that everybody has to purchase their product,” he scoffed. Yet that is what his Affordable Care Act entails, a mandate the Supreme Court has now approved.

Leave aside Obama’s broken promise that negotiations with healthcare companies would be televised and the careless way he assumed the Act was within the Constitution. Despite having both Houses in his grasp, Obama didn’t use the ample goodwill toward him and his vast political capital to deliver an equitable healthcare system. Instead he adopted a conservative plan concocted by the Heritage Foundation that became the blueprint for Mitt Romney in Massachusetts. The motive for the conservatives’ belated ingenuity was not a good-hearted desire to see every American well taken care of but a mean-spirited device to ensure there were no free riders. The result is a poll tax ensuring everyone, rich or poor, pays the same high price unless they plead for a federal handout.

Obama now has the opportunity to make healthcare a moral issue. Does Romney want 50 million Americans to suffer from ill health or enjoy the best medicine in the world?

How come, as Obama once asked, “the wealthiest country in the history of the world cannot provide basic health insurance to everybody?” If universal healthcare is socialist, how come Margaret Thatcher ruled Britain for 13 years and repeated at every election: “The National Health Service is safe in our hands”? Is Romney suggesting Thatcher was a socialist? Teddy Roosevelt and Richard Nixon wanted universal healthcare. Were they socialists, too? Asking such awkward questions is far more likely to win Obama re-election than having to defend a flawed and feeble program.

Nicholas Wapshott is the author of Keynes Hayek: The Clash That Defined Modern Economics. Read extracts here.

PHOTO: A group of doctors protest against the individual mandate in President Obama’s healthcare reform in front of the U.S. Supreme Court in Washington, June 25, 2012. REUTERS/Yuri Gripas


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It might not be all that it could be, but it is a start. I am sure he had to compromise quite a bit to even get here.

In 10+ years, it will have settled and morphed into something that is close to universal health care.

Even now, many of the Insurance companies are seeing the good in the law and were agreeing to keep some of the provisions if the law was struck down.

Do you even for a second believe Obama *deliberately* did not stick to his promise or did not try hard enough to get it right?

If he wins a second term, it will be because people believe he is a genuine person. And seeing him so far, I am not sure he will make it a ‘moral issue’ like you suggest. He has more class than that.

Romney on the other hand… s/2012/06/27/12444941-romney-calls-obama care-moral-failure-on-eve-of-supreme-cou rt-ruling?chromedomain=usnews


Posted by bertie_w | Report as abusive

This piecer raises a number of issues. The UK system is admirable? Hardly. Like Canada, the UK has a slow, old-hat medicine, selective system. The U.S. does have the best health care system in the world, but what happens to the quality of medicine under a universal system when the profit motive is removed? Was Thatcher a socialist? Perhaps not, but the UK medical care system is.

Posted by BuckeyeNick | Report as abusive

@ Sanmati

Unfortunately, the Obama administration deliberately killed the public option: lescu/ny-times-reporter-confirm_b_500999 .html

Obama has always been corporate president whether it be the health care system or wall street regulation. You could make a valid argument that Romney would be an even more extreme version, but let’s not try to paint Obama as the people’s president.

Posted by tsukiyomii100 | Report as abusive

Poor Mr. Wapshott, It would seem he has spent so much time writing for magazine publications and talking on network programs, he’s had little time to read the real costs and coverages available to all and listen to the infinite amount times the highlights have been listed in those same programs of which he speaks. I suppose however, there’s always London!

Posted by mlcopines | Report as abusive

If it’s a bad bill it’s because the GOP did everything they could to wreck it, and they are just getting started. All any Americans want is the same health insurance coverage that the members of this do-nothing House of Representative have. Is that such a crime?

Posted by gangof4 | Report as abusive

I never heard of Canadians coming to the U.S. for operations. I have heard of busloads of senior citizens going to Canada for affordable medications however.

Posted by gangof4 | Report as abusive


I like others was bummed to see no public option being offered.

But, that was a key compromise. The industry was against it for obvious reasons, and many in Congress did not believe that Government could run that effectively, and refused to sign the bill if it had the public option.

But, it also does not mean it cannot be introduced in the future.

Like is said, this is a start…

Posted by bertie_w | Report as abusive

Mr. Wapshott,

How on earth can you know this? Conclusions should never be drawn until action has been taken and history has unfolded. We won’t know if this is a bad law until it has had a chance to work (or not work). Give it time, collect your data, and then judge. You must be a youngster and have not had the lessons that only age can bring. Be patient, my son.

Posted by explorer08 | Report as abusive

Give me foodstamps, public housing, social security, healthcare, internet, and phone service, or give me death!!!

Posted by jeromyd2000 | Report as abusive

America does *not* have the best medical care system. We have the most expensive, particularly as a % of GDP at 17% which is 5% higher than the next highest at 12%, and given that we have the largest GDP in the world, that makes our healthcare system very expensive indeed. Yet, if you look at the *quality* of care received compared to other countries as measured by favorable outcomes, we rank 30th, behind Slovenia for crying out loud.

Posted by RT10 | Report as abusive