Don’t know about you but most every Democrat I know was absolutely thrilled at Thursday morning’s announcement that the Supreme Court of the United States upheld the Patient Protection and Affordable Care Act (commonly known as Obamacare). And even more astounded that Chief Justice Roberts was the swing vote.
There’s lots to talk about … most importantly that all of us who care about this sort of thing need to push hard over the next several months, and not be defensive or apologetic about this. It is a big deal. (You want the t-shirt? Here is a link!)
Judge Ruth Bader Ginsgurg wrote one of the majority SCOTUS opinions regarding Obamacare. In fact, her opinion about the Commerce Clause fairly shreds Chief Justice Roberts’ claim that the individual mandate is, for all intents and purposes, a tax (more on that in another post).
Pres. Obama shoulda hired her to sell this. Her rationale is for the Act is lucid, easy to understand and very difficult to rebut.
Her written opinion runs to 60-plus pages so I’ve excerpted some of her more salient comments. You can find the entire opinion (including the venomous dissenting opinions of Scalia, et al) here. Look for Docket # 11-393 National Federation of Independent Business v. Sebelius. Justice Ginsburg’s opinion begins on page 66 of the PDF.
Unlike the market for almost any other product or service, the market for medical care is one in which all individuals inevitably participate. Virtually every person residing in the United States, sooner or later, will visit a doctor or other health-care professional.
When individuals make those visits, they face another reality of the current market for medical care: its high cost. In 2010, on average, an individual in the United States incurred over $7,000 in health-care expenses.
When a person requires non-routine care, the cost will generally exceed what he or she can afford to pay. A single hospital stay, for instance, typically costs upwards of $10,000 … in 1998, the cost of treating a heart attack for the first 90 days exceeded $20,000, while the annual cost of treating certain cancers was more than $50,000.
Although every U. S. [household] will incur significant medical expenses during his or her lifetime, the time when care will be needed is often unpredictable. An accident, a heart attack, or a cancer diagnosis commonly occurs without warning. Inescapably, we are all at peril of needing medical care without a moment’s notice.
To manage the risks associated with medical care— its high cost, its unpredictability, and its inevitability—most people in the United States obtain health insurance. Many (approximately 170 million in 2009) are insured by private insurance companies. Others, including those over 65 and certain poor and disabled persons, rely on government-funded insurance programs, notably Medicare and Medicaid. Combined, private health insurers and State and Federal Governments finance almost 85% of the medical care administered to U. S. residents.
Not all U. S. residents, however, have health insurance. In 2009, approximately 50 million people were uninsured,either by choice or, more likely, because they could not afford private insurance and did not qualify for government aid.
As a group, uninsured individuals annually consume more than $100 billion in health care services, nearly 5% of the Nation’s total. Over 60% of those without insurance visit a doctor’s office or emergency room in a given year.
As just noted, the cost of emergency care or treatment for a serious illness generally exceeds what an individual can afford to pay on her own. Unlike markets for most products, however, the inability to pay for care does not mean that an uninsured individual will receive no care. Federal and state law, as well as professional obligations and embedded social norms, require hospitals and physicians to provide care when it is most needed, regardless of the patient’s ability to pay.
As a consequence, medical-care providers deliver significant amounts of care to the uninsured for which the providers receive no payment. In 2008, for example, hospitals, physicians, and other health-care professionals received no compensation for $43 billion worth of the $116 billion in care they administered to those without insurance.
Health-care providers do not absorb these bad debts.Instead, they raise their prices, passing along the cost of uncompensated care to those who do pay reliably: the government and private insurance companies. In response, private insurers increase their premiums, shifting the cost of the elevated bills from providers onto those who carry insurance. The net result: Those with health insurance subsidize the medical care of those without it. As economists would describe what happens, the uninsured “free ride” on those who pay for health insurance.
The size of this subsidy is considerable. Congress found that the cost-shifting just described “increases family[insurance] premiums by on average over $1,000 a year.” Higher premiums, in turn, render health insurance less affordable, forcing more people to go without insurance and leading to further cost-shifting.
Because those without insurance generally lack access to preventative care, they do not receive treatment for conditions—like hypertension and diabetes—that can be successfully and affordably treated if diagnosed early on.
When sickness finally drives the uninsured to seek care, once treatable conditions have escalated into grave health problems, requiring more costly and extensive intervention. The extra time and resources providers spend serving the uninsured lessens the providers’ ability to care for those who do have insurance.