The Supreme Court and the ACA: The Ultimate Death Panel?

I started Extreme Thinkover in the fall of 2008.  The presidential race was in full swing.  Universal health care was one of the major topics that the candidates, media, and the public were debating.  One of my primary motivations for creating the blog was to have a forum in which to express my ideas about the health care debate.

I’ve worked in the health care industry for nearly 16 years and have daily contact with patients and families in the hospital.  I hear their stories, good and bad, about what these hospitalizations are doing to their lives.  Yes, what the hospitalization is doing to their lives.

Here in America, going to the hospital is not just about getting medical treatment; it’s also about entering a very broken and extremely expensive system. It nevertheless tries to limp along: In all fairness to the medical professionals who work very hard on behalf of their patients, in most cases, if you find yourself hospitalized, you get reasonably good medical care.

However, in the middle of this is an ongoing battle with the major health care players (hospital systems, health insurance, pharmaceuticals, medical equipment providers, etc.) all wanting to maximize their profits in an economic power race that too often is at the expense of the quality of care delivered to the patients who pay for their services, as well as forcing ever-increasing demands on their care givers to do more with less.  Admittedly, it doesn’t happen everywhere, but it is far too pervasive in Rube Goldberg “system” that passes for health care in America.

I wrote in fall 2008:

Here’s the question: What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?

That perhaps is not the question you expected to hear. The national conversation has focused on how much will it cost to provide all Americans with health insurance, how will the spiraling costs of health care be brought under control, will taxes have to be raised to pay for it, what will the roles of the health insurance industry, and the medical industries, and most of all the federal government be? Tough questions all around.

That question, “What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?” remains the key to a successful national health care program.  It also remains almost totally ignored by politicians, lobbyists, and, sadly the American public, none of whom have yet realized that without answering this question first, in my opinion, the debate about the cost cannot be resolved.  I contend this is why the health care law polls low for national support.

The current law, the Patient Protection and Affordable Care Act, passed in 2010, nibbles at the edges of what I think is essential, but it, also, is far too focused on trying to control medical costs.  And in case you are wondering, yes, I’ve read the law cover to cover.

Beginning Monday, March 26, the Supreme Court of the United States is going to hear arguments for and against the PPACA.  The primary question before the Court is whether Congress overstepped its authority regarding the interstate commerce clause of the U.S. Constitution by mandating all Americans (sort of) be required to purchase health insurance.  The debate is guaranteed to be rancorous, even in the sedate and forcibly polite setting of the Supreme Court.  The debate, though, once again is all about the money.  A healthy America will likely never even come up. The pundits will have a field day with this, without question, but I doubt any will see the fundamental flaw in all the arguments, based on my point of view.

Will the justices see past the smoke screen of political ideology, special interest group pressure, and inflammatory rhetoric that is fueling these proceedings?  If they do, and declare the law constitutional, there is hope that the ACA can continue to be refined, actually moving toward being a mechanism to support a healthier America.  If they don’t, by striking down all or parts of it, the Supreme Court will, for all intents and purposes, become the Ultimate Death Panel, condemning tens of millions of Americans to poor health, premature, and in some cases, an agonizing death because they will have been denied the right to even the most basic level of health care.  And that, tragically, just months before a law already on the books would have given them the care snatched away by the Supreme Court Death Panel.

Now we wait to see how this court rules on the fate of Americans’ health for generations to come.

The Thinkover:  When Patrick Henry uttered those iconic words, “Give me liberty or give me death!”  he wasn’t suggesting that death was preferred outcome of that stand for patriotism.  So far, the opponents of the ACA have been clueless to this obvious distinction in demanding “liberty” from the ACA mandate.

3 thoughts on “The Supreme Court and the ACA: The Ultimate Death Panel?

  1. Patients who show up at the ER legally get emergency medical care irrespective of ability to pay, pre-ACA or post-ACA.

    We could extend this “right vs. privilege” argument to food, clothing, and shelter. Is society obligated to pay for these?

    Few things irritated me more when I had a Medicaid pt (reimbursement 50% of the break-even level) complain about a $2 co-pay, have an “attitude,” and be noted to have an expensive manicure and new SUV.

  2. The question underlying your question is this: is healthcare a right or a privilege? For those who believe the latter, emasculating the Affordable Healthcare Act is the right thing to do. I suggest this: those who oppose the ACA be required to stand at an emergency room entrance and personally turn away those who show up injured or ill but who haven’t “earned the privilege” of humane care. Ron Paul should take the first shift.

  3. Everyone already has a right to medical care. The issue is who pays for it.
    The mandate is an enforcement mechanism to make more people have “skin in the game.” But alas, the penalty is set too low, and people who skirt the law will get free care anyway once they sign up for ins after they get sick.

    Another issue is to whom do the members of the appointed IPAB have accountability.

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