U.S. Supreme Court decision on health care reform bill: A Pyrrhic victory

We have nothing to celebrate with the U.S. Supreme Court’s decision to uphold the Affordable Care Act. The ACA is pain management and palliative care for a terminally ill health system. The U.S. health system needs a truly revolutionary transformation, and the ACA seeks to shore it up by pumping billions of taxpayer dollars into it. What we really need to do it s to pull the plug on a fee-for-service, capitalist market-driven system, substituting universal health care provided by a single-payer, national health care system.

The ACA is actually a boondoggle for the insurance industry. More than $400 billion in taxpayer funds will be channeled to private insurers through government subsidies of private premiums. The federal government will pump billions more into the U.S. health system through expanding Medicaid to some 16 million poor people currently uninsured.

Meanwhile, insurers will exploit loopholes to dodge the law’s restrictions on their misbehaviors. For instance, the limit on administrative overheads predictably will elicit accounting gimmickry. For example by relabeling some insurance personnel as “clinical care managers.” While insurers are prohibited from “cherry picking” — selectively enrolling healthy, profitable patients — they’ve circumvented similar prohibitions in the Medicare health maintenance organizations (HMOs).(2) The ban on revoking policies after an individual falls ill similarly replicates existing but ineffective state bans.

The so-called individual mandate, requiring uninsured people to buy insurers’ defective health insurance policies is a boon to the insurance companies. Nothing in the ACA contains any more teeth than existing state regulations on the insurance industry. Therefore, we can expect that the insurers will continue to find loopholes and other ways around restrictions on the denial of the human rights of their policyholders. We can expect the insurers to find ways to “cherry pick” those they cover – selectively enrolling only the most healthy and profitable patients. They will continue to find ways around restrictions against revoking policies after an individual falls ill. The restrictions on this practice in the ACA are no different than those that exist in many states in which the private insurers have found a way to avoid circumvent them.

It’s infuriating that the ACA is touted as a mechanism for universal health coverage. Under this act, some 23 million people will remain uninsured in 2019. Millions of undocumented workers will be denied health coverage under the law. These working people will be denied adequate health care coverage by the ACA, and the so-called safety-net hospitals upon which they rely for their care will lose $36 billion in funding because the law mandates an end to federal government funding for indigent care.

Meanwhile, employers are forcing workers onto high-deductible health insurance plans; in effect, shifting health care costs onto working people themselves. Many people, as a result, are unable to pay their medical bills, with a serious illness sending many into bankruptcy. At present, illness and medical bills account for 62% of all bankruptcies – and three-quarters of those bankruptcies occur in people who have insurance.(1)

A similar health care “reform” was instituted in Massachusetts in 2006, and it was clearly a model for the ACA. What have been the results? In the first 2 years after the Massachusetts health reform was instituted, the state’s health care costs increased 15% — twice the national rate.(2) The physician workforce was woefully inadequate to meet the increased demand for primary-care and other services, and the state began cutting back on services.

Let’s face it: the ACA, drafted in close collaboration with the pharmaceutical and insurance industries, funnels billions of taxpayers’ dollars into the coffers of big business. To win support for this conservative legislation, Obama and the Democratic Party threw in a few sobs – expansion of Medicaid, $1 billion a year for community health centers, no denial of coverage for pre-existing conditions, and coverage of dependents until age 26. We shouldn’t buy into a plan designed to enrich the insurance and pharmaceutical industries in exchange for these modest reforms. Let’s really transform health care in the United States. We need a non-profit, single-payer, national health insurance program that covers everyone in the country. Anything short of that is putting a Band-Aid on a festering wound.


1.  Himmelstein DU, Wright A, Woolhandler S. Hospital computing and the costs and quality of care: a national study. Am J Med 2010;123:40-6.

2.  Kowlaczyk L. Call to cap medical payments is likely. Boston Globe 17 Mar 2010.


Thursday, June 28th, 2012 at 09:37