Let’s begin with what ought to be obvious: Nobody has a “right” to medical care.
The first 10 amendments to the Constitution, codifying the heart of the Declaration of Independence, make clear the nature of rights. They’re Creator-given and government-guaranteed, but otherwise do not require the labor or property of others to be fulfilled.
The same cannot be said for laying claim to a trip to the family doctor, or even that we have a right for that trip to be affordable. Remember, antebellum plantation owners thought they had a right to affordable field hands.
But just because something isn’t a right doesn’t mean a great nation founded on the supremacy of the individual shouldn’t aspire to medical care that is world-class, affordable and, indeed, universal. After all, we built the interstate system and went to the moon, two pretty good government projects that fell outside the Bill of Rights.
The problem is, no matter what its namesake claims, Obamacare — the Patient Protection and Affordable Care Act — is so lousy at its ambitions, it would have to improve just to rise to Apollo 13’s “successful failure” standard.
On this morning after the end of the ACA’s second open-enrollment period, we are well past President Obama’s repeated “if you like your plan” fib and deep into the nightmare of finding out, as then-House Speaker Nancy Pelosi promised, what’s in the law.
The down and dirty is this: In virtually every area that Obamacare was supposed to help, it’s been disastrous.
Universality? Not so much. According to the Congressional Budget Office, when the ACA is fully implemented in 2017, the number of Americans without insurance will have shrunk by only half.
Cost savings? Premiums for employer-sponsored policies continue to surge unabated, as do those from the exchanges; meanwhile, deductible and co-payments are on the rise. Small wonder Staples — and not just Staples — is keenly watching its part-timers’ hours rather than get socked for employee coverage.
Still, aren’t there subsidies for lower-income Americans?
Yes. Alas, somebody has to bridge the gap, and that brings us to taxes Obama vowed wouldn’t hit any but the well-to-do. Instead, the CBO says new taxes on health-related corporations are passing down the consumer food chain. Moreover, based on Tax Policy Center figures, the revenue gap not paid by the better off and stealth-taxing corporations (about $330 billion) leaves the rest of us on the hook.
As for Obamacare being deficit-neutral, does anyone still believe that? Certainly not a former CBO director, who puts the shortfall at $500 billion over 10 years, a Medicare public trustee ($340 billion to $530 billion) or the General Accounting Office ($6.2 trillion over 75 years).
That’s the ACA for you: An unbroken skein of shattered promises.
Meanwhile, the Supreme Court soon will hear King v. Burwell’s argument over the plain language of the act — only clients of state-based exchanges are subsidy-eligible — and will be reminded of ACA architect Jonathan Gruber’s explanation of why that arrangement fit the drafters’ intent.
Because the justices pay attention to the possible impact of their decisions, congressional Republicans (belatedly, but that’s another column) are beginning to coalesce around a replacement, premium-support plan that stresses portability, flexibility, freedom and market forces, and has been judged by some experts to get at universality more effectively, and without Medicaid expansion, than Obamacare.
Good. Medical care doesn’t have to be a right before a great nation does the right thing the right way.