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.