The Supreme Court's health care ruling is merely the latest turn in the sad spectacle of American health care reform. In its 5-4 decision, the court on Thursday declared that the Affordable Care Act (ACA) is constitutional. Upon its announcement, liberal celebratory outcry ensued and a storm of media commentary was unleashed. This ruling will remain the focus point of blogs, newspapers and all major news outlets for weeks to come.
The irony - and the spectacle - lies in the utter insignificance of the reform. Designed to decrease health care costs and to insure the 50 million uninsured Americans, the ACA does neither; even after the law's full implementation, tens of millions will remain uninsured and costs will continue to rise. Nor does insurance guarantee economic security: high co-pays and deductibles will continue to burden even those now covered.(1)
Regardless of such failings, liberal writers and columnists on Thursday unanimously declared the ruling "momentous" and a "historic win." Pulitzer Prize-winning journalist Eugene Robinson claimed that Obama "enshrined" the belief that "health care should be available to all who need it regardless of their ability to pay - that it is not a privilege but a right." Such statements disgrace the roughly twenty-five million Americans whom this legislation has neglected to insure. And they fail to acknowledge the still-rising costs of health care for all Americans.
Democratic hyperbole has turned a mild reform into a monumental achievement for all Americans. Back when the Congressional battle for ACA's passage was waging, Democrats and commentators quickly dropped all aspirations for a (truly progressive) single-payer option, deciding instead to throw all their propagandistic might behind something more politically unchallenging. As "single payer" lost whatever currency it initially had, the entire political discourse shifted rightward. According to this modified discourse, a small expansion in insurance coverage is declared "historic." This shift in discourse has also enabled Republicans to convince millions of citizens that the ACA constitutes a government takeover of health care, that it is a radical, unconstitutional impingement on personal liberty. On either side (and there are only two), health care debate has thus become a bloated and spectacular exaggeration of what is, in policy terms, a question of minor reform. Yet, much of the country has taken the bait. If the language we use determines how we think, then it's easy to see how the sensationalist political and mediatic portrayal of this debate has rendered us incapable of noticing its insignificance.
Obviously, health care reform was needed. And, yet, the ACA only increases the profits of the very private insurance industry responsible for skyrocketing costs and the neglected care of the poor and the sick. Here's how the legislation works: to lower average health care costs (for all), it imposes a mandate that requires every US citizen to buy insurance. Consequently, the healthy and previously uninsured will now enter large private insurance pools, thus bringing down overall costs for others in the pools. With the added revenues from these newly insured, the law requires companies to provide insurance for the sick, those whom they've previously rejected. And, yet, the insurance industry's support for the legislation is telling: by increasing the numbers of the insured (paying customers), these companies only stand to benefit.
According to a statement issued on Thursday by Physicians for a National Health Program (PNHP), "the ACA perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers' bottom line; and it obstructs any serious effort to control costs." This legislation further empowers the very interests at the heart of the diseased American health care system. There is nothing "momentous" about it.
The spectacle of health care reform is testament to the poverty of our political discourse. Unable to distinguish between real and illusory reform, we dumbly paste hyperbole unto the most mild of legislation and pour our energies into the most insignificant of policy battles. The ACA deserves not even a fraction of the attention we have given it.