|John Roberts has a happy...|
My pessimistic side had assumed we were doomed. We may yet be, but not today. Today we rejoice and enjoy watching the Republicans and Mitt Romney twist themselves into pretzels. As Paul Krugman says, today is "double scotch time." Make mine wine, but I will toast come happy hour.
|...Antonin Scalia has a sad.|
All those referring to Obama's saying that it was not a tax, are referring to that ABC interview. In it, Obama declares that the ACA is not a tax increase. Now, I get that part of his argument is that regardless of whether or not you elect to buy insurance or pay a penalty -- collected by the IRS -- the overall impact of the ACA is that your costs for health care will go down, while coverage for the American citizenry is broadened. And I essentially agree with him.
There's a simple way to dismiss this tax argument: no responsible adult needs to pay the penalty; all they need to do is obtain healthcare coverage. End of story. And the 85% of Americans already covered by health insurance don't even enter into the uninsured penalty zone anyway.
But to argue sensibly with the conservatives is a waste of time, unless you enjoy pretzel watching.
|James Inhofe, the Senate's in-house science denier, literally had a pretzel.|
I prefer to move on to what the SCOTUS decision made me consider. Now that the law will come into effect by 2014, how can savvy state politicians take advantage of the situation for their home states by preparing early for the law?
The answer hit me like a brick, and I hope that it stands up upon closer examination. Here's what I recommend to, say, Jerry Brown, my California governor:
- As required by the ACA, each state in the nation needs to set up health insurance exchanges, which are to be the marketplace where the uninsured, as of 2014, can acquire affordable health insurance.
- A smart way to make a state's health insurance exchange truly affordable is for it to be based on an already functioning and affordable system. Most states already have such an exchange available to its public sector employees, where they can choose from a variety of healthcare packages. (I participate in such an exchange. I did, first, as a public-school teacher, and do so now, as a retired teacher who isn't yet of Medicare age. I'm 63.)
- So, as soon as is practicable, Jerry Brown -- in my example -- should find a way, either through legislation or state agency policy, to declare that all state employees are now de facto participants in the health insurance exchanges.
- All local government agencies, whether towns, cities, or counties, should be invited to join in the state exchange, in order to create an even larger negotiating pool, placing participants at a better competitive advantage with the health insurance providers.
- Next, all private-sector businesses should be invited to join.
- Lastly, all uninsured private citizens should also be allowed a mechanism for participation.
I would further recommend that the state require a small fee, say $10, to participate in the exchange, with a $20 reinstatement fee if someone leaves the pool or allows his participation to expire (to discourage flightiness). This fee would have little impact on individuals but would easily finance the bureaucracy needed to run the exchange.
Everything I know about economics says that the sooner a state or public entity participates in such an exchange, the sooner the state's healthcare costs go down. This allows states, municipalities, counties, businesses, and even individuals to make their healthcare costs affordable. Seems to me states could radically reduce their budget shortfalls.
What am I missing here? Seems like a no-brainer.
|Mitt Romney, reacting to the SCOTUS decision, literally has a no-brainer.|
Update. Somehow in this post I failed to mention an important point, though I had intended to: Roberts, who wrote the majority opinion, didn't uphold the individual mandate because it was a tax. He upheld it because, by the most generous interpretation of language (demanded by precedent), the penalty could be inferred to be a tax -- because it was collected by the IRS -- thus allowing Congress to pass a law with an individual mandate using its taxing power. Congress did not have to rely, then, on its power to regulate commerce, which was precluded by Roberts' opinion.
Update 2. You've just got to see this, courtesy Andrew Sullivan's blog post of "reader reax."Here's one such reader's email:
Just imagine if Romney had originally stood by his Massachusetts health care mandate when he began his run for 2012 president. Today's SCOTUS decision could have been Romney's big win - the triumph of a health care plan conceived by conservative leaders that Romney himself successfully implemented in Massachusetts. He could have proclaimed himself as a national visionary of conservative health care, while painting Obama as a pale Romney-imitator. But such are the perils of pandering to today's conservative base: Forswear your prior political successes instead of building upon them, then let your opponent reap the rewards of favorable SCOTUS decisions that you could have claimed.Live by the pander, die by the pander.