In a 5 - 4 ruling today, the Supreme Court upheld most of the Affordable Care Act—often called “Obamacare”—with Chief Justice John Roberts casting the deciding vote. The ruling puts an end, at least for now, to a fight that has largely defined President Obama’s first term. Here are three things we’ve learned from the battle so far:
1. Conservatism is truly out of its collective mind.
It can’t be emphasized enough that the reforms implemented by the Affordable Care Act were originally Republican ideas, and that few Constitutional scholars—even right-leaning scholars—take the arguments against the ACA seriously. Ezra Klein sums up the context in this excellent piece.
Also, when we finally achieve something close to universal healthcare coverage in 2014, the U.S. will become the last country in the industrialized world to do so. As this chart shows, Norway got there fully a century ago. Japan had it in 1938. Germany, whose economy is among the strongest in the world right now, has had universal coverage since 1931.
But if you take right-wing rhetoric seriously, the ACA amounts to a Communist revolution. Sarah Palin tweeted out: “Obama lies; freedom dies” this morning. A staffer at the conservative American Spectator wrote, “I am fairly stunned by this outcome and can’t help but feel that the soul of our nation has just been lost.” On his radio show, Rush Limbaugh bellowed that “what we now have is the biggest tax increase in the history of the world … We have been betrayed and deceived by Congress. We have been betrayed and deceived by the Supreme Court.”
This hyperventilating is about modest healthcare reform that originated with Republicans.
2. A single-payer system would have been easier to defend.
Of course, President Obama and the Democrats chose to adopt Republican ideas precisely because they hoped that the Affordable Care Act would attract bipartisan support. They didn’t imagine that the GOP would cast it as a “soul-destroying” revolution.
One problem with the ACA’s piecemeal approach to reform is that the public doesn’t have any idea what it will do. And at this point Americans don’t much care. A blog post by Nate Silver yesterday contained this startling fact: “[A] fair number of Americans do not seem to think that the health care bill exists any longer. About a quarter of Americans think the bill has already been repealed, while another quarter aren’t sure if it has been.”
A more fundamental problem with the Democrats’ approach is that the ACA will tweak a system that everyone knows is broken. So Democrats have been forced to explain how the reform legislation will improve on our basic healthcare model, but they haven’t been motivated to tell the plain truth about that model, which is that it’s shockingly inefficient and does a poor job of providing health care, measured by the standards of other industrialized nations.
Supporting a single-payer system from the outset would have allowed them to tell those truths. It also has the benefit of simplicity. And it wouldn’t have been subject to a Constitutional challenge. Yes, the GOP would have assaulted it as a socialist takeover. But they’ve done that anyway.
3. Single-payer reform might still have a chance—or not.
In the past few weeks and months, when the media consensus settled on the idea that the ACA would be struck down by the Court, the single-payer idea seemed to be gaining some momentum. In March, a writer for Forbes argued that if the Court strikes down the ACA, “single payer instantly becomes the number one organizing cause for liberals in America. This Congress won’t pass a single payer insurance law, but you can bet Democrats would the next time they control both the legislative and executive branches.” This week, Ben Nelson, the conservative Democratic senator from Nebraska, made essentially the same argument.
But what now? Is the ACA the first step toward more fundamental reform? Or will lawmakers be satisfied with having passed something that addresses the system’s worst failings, and decide they’ve done enough?
We won’t know the answer for several years, maybe decades. The battle over the ACA offers reasons for both skepticism and hope. On the one hand, even a modest set of reforms couldn’t gain the support of Republicans in Congress, and conservatives still don’t grant any legitimacy to the ACA, even after its validation by the Supreme Court.
On the other hand, our health-care system has received scrutiny and been the subject of serious debate for the first time in two decades. If Democrats can refine and sharpen their critique of its shortcomings, and are pushed by the party’s base to advocate for deeper and more serious reforms, there’s no telling where the momentum from today’s ruling might lead.
Those are big “ifs,” yes. But they’re not entirely implausible.
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Theo Anderson is an In These Times contributing writer. He has a Ph.D. in modern U.S. history from Yale and writes on the intellectual and religious history of conservatism and progressivism in the United States. Follow him on Twitter @Theoanderson7.
