The Battle for Healthcare Has Just Begun

By the Editors
The Nation, July 11, 2012

If you thought the battle over healthcare reform came to an end when the Supreme Court declared the Affordable Care Act’s individual mandate constitutional, think again. The fight is just beginning. On one side the Republican Party and its big money allies aspire to defeat President Obama, take control of Congress and repeal the largest piece of domestic legislation in forty-five years. Mitt Romney’s plan is even more regressive. He’d not only eliminate insurance for the 30 million Americans covered by the ACA; he would change the way the industry is taxed and regulated, turn Medicare into a voucher program and transform Medicaid into a block grant, which together would strip access to healthcare from as many as 28 million Americans who are currently insured.

On the other side are people-powered progressives determined to implement the law and strengthen its less than ideal aspects to achieve universal coverage (see Wendell Potter, page 4). Under the ACA, for example, states will be empowered to create state-based single-payer systems. Vermont has already passed such legislation, and advocates in California are pushing a similar plan, passed by the legislature twice, only to be vetoed both times by then–Governor Schwarzenegger.

But if the fast and furious attack from the right is any indication, we have our work cut out for us. As many as eight Republican governors—led by Tea Party ideologues like Florida’s Rick Scott, Wisconsin’s Scott Walker, South Carolina’s Nikki Haley, Texas’ Rick Perry and Louisiana’s Bobby Jindal—have refused to implement the law’s expansion of Medicaid to cover some of America’s poorest. In Florida, that would affect some 1.3 million people who make less than 133 percent of the federal poverty level (about $31,000 a year for a family of four). In Texas, where 25 percent of residents are uninsured—the highest rate in the nation—Perry’s intransigence would leave 1.8 million out in the cold.

This cruel, cynical agenda has been enabled by a cabal of groups bankrolled by the 1 percent, such as the Chamber of Commerce and Karl Rove’s Crossroads GPS. Even before the Supreme Court decision came down, these organizations had spent some $235 million on attack ads vilifying “Obamacare,” and they are on track to spend much more by November. Already the Koch-backed Americans for Prosperity has launched a $9 million campaign against the ACA and the Democrats who voted for it. Concerned Women for America has pledged another $6 million.

These ads and the rhetoric emanating from the Tea Party guvs are nothing but open fearmongering and baldfaced lies. They insinuate that the ACA would ration healthcare (in fact, the ACA rations it no more or less than the current system). Governor Scott justified his refusal to expand Medicaid by claiming it would add $1.9 billion to Florida’s budget (though the federal government funds 100 percent of Medicaid expansion in the first three years, and Florida’s own healthcare agency estimates it would cost the state far less). Not to be outdone, Rush Limbaugh hysterically called the ACA the “biggest tax increase in the history of the world” (when, in fact, it contains tax breaks for middle-class Americans).

These lies have done a great deal of damage. Many people are confused about what the act does and does not do, creating a debate that seems to take place in an alternate reality. The stakes in this fight, then, are profound: the health of millions of Americans, of our shared social safety net and—not least—of our democracy itself.

Originally posted as a reader comment:

It is disappointing to see that the editorial position of The Nation has framed the current status of the health care debate as, on the left, a determination to “implement” and “strengthen” the Affordable Care Act, and, on the right, an effort to “repeal” ACA.

The objection is not with the characterization of the right, but with the implication that the left has settled on a right-center approach designed by conservatives. Token mention is made of the Vermont and California efforts to enact single payer, but, in fact, states do not have the option of diverting federal funds from programs such as Medicare and Medicaid into a state-based single payer program, nor can they bypass federal requirements such as the ERISA restrictions, usurping funds from employer-sponsored self-insured plans.

All the tweaking in the world cannot repair the highly-flawed, fragmented, and egregiously administratively wasteful model of ACA. It needs to be replaced with a bona fide model of social insurance – the most appropriate for the United States being a single payer, improved and expanded Medicare that covers everyone.

Also, it is a mistake to be hung up on a left-right linear polarity when the issue of health care justice should be much more inclusive. In an article this week in the Des Moines Register, retired health executive Jack Bernard stated, “If we Republicans took the Medicare-for-all approach, it would thrust us into the vanguard of reform. Instead of the Democrats stealing our ideas, we could steal theirs.”

The Democrats did steal the Heritage model which was originally introduced by Republicans as a conservative response to the Clinton proposal. Democrats have now succeeded in enacting it, but what a terrible model. It will leave tens of millions uninsured while creating a new standard of underinsurance, imposing financial hardship on those with health care needs.

Everyone should read Jack Bernard’s article, and then we should see if we can get past the simplistic polarization to bring us together to improve our health as individuals and to improve the health of the nation.

Jack Bernard, “Head-in-the-sand ‘solution’ is killing GOP”:

The Nation editorial: