BTW, We STILL Don't Have Universal Healthcare

I am more relieved this morning that I realized I would be when I read the announcement that the US Supreme Court upheld the constitutionality of health care insurance reform passed in 2009 (commonly called "Obamacare"). I had mentally prepared for a negative decision, which I believe would have been wrong and would have set a precedent that would have had effects far greater than the measure under consideration.

The core question of whether the federal government has the right to require people to purchase something was a silly question, IMHO. The government provides tax incentives to control our behavior all the time. In fact, the tax code is so confusing because it is built around such mandates and incentives rather than any logical monetary policy. Calling the provision in Obamacare a "mandate" to do commerce was a political construction. What the law does is no different than "mandating" that homeowners upgrade their energy efficiency or that people keep their retirement money tucked away in their IRA until they are 59-1/2 years old. (The first has a reward incentive, the second a penalty.) I'm happy to see the court didn't go for the convoluted reasoning that led to that assertion.

But even though I'm relieved, I'm not celebrating. The measure passed in 2009 is no where near what we need in this country. All that really has happened is baby steps. Monumental and historical baby steps, but baby steps nonetheless.

I'm being given the "choice" to give profit to corporations that have made their billions through the deaths of individuals who could have lived full and productive lives or pay a penalty to a government in the form of taxes. This "choice" is no choice at all. I do not and will not pay premiums to a private insurance company. Ever.

If we had to compromise, I would have liked to have seen a government option for those of us who would rather pay into a government plan than to a private insurance company. I would have to preferred that these companies be put out of their misery and we go to a single-payer system.

Today's decision means that it will be an ongoing political struggle not a court decision and for that I'm grateful. A negative vote today would have set back any efforts at real reform. But let's not over-exaggerate the contribution Obamacare has made. It is impressive because it moved inches forward in a system that is pushing hard against it, but it is not really progress.

I have two basic arguments regarded universal healthcare that Obamacare did not address:

1. For-profit medical care is unsustainable economically. If you are a capitalist, you should oppose for-profit medical care on principle. A free market can only be free when sellers are in competition with each other and buyers can freely pick among them. Healthcare cannot work this way. When a patient (buyer) is ill, they do not have the freedom to shop around. In addition, a patient (buyer) cannot obtain the information needed to make a shopping decision. The sellers (doctors, hospitals, pharmaceutical companies, etc.) will always have an unfair advantage over buyers. Thus, medical care cannot never be a free market. Medical care is definitively a natural monopoly and thus should be regulated and administered for the group by the group. In our current sociopolitical world that means through government (though alternatives to this exist beyond the usually reductionist dichotomy of either government or private industry, but that is another topic for another day).

2. Healthcare is a human right and should be respected as such. Article 25 of the Universal Declaration of Human Rights states:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The current system, even under Obamacare, does not recognize this right or respect it. We got a little closer with the abolition of "pre-existing conditions" but medical care that is mostly for-profit is medical care that is classist. We do not have adequate care and in a for-profit system we cannot have universal adequate care because profit always seeks profit above all else.

I'm not really a fan of big government, but I'm even less of a fan of big business. The pharmaceutical-medical industrial complex is big business and Obamacare gave them a big gift: 30 million more customers. It wasn't unconstitutional to do so, but it still hasn't got it right.

In 2014, I will most likely be penalized for not participating in Obamacare by paying the thieves their due. I wonder if I might become a medical refugee, heading to a country with real universal healthcare. I hope that before then a viable government option, an expansion of Medicare, would emerge. In the current political climate, I'm not holding my breath, but today's decision makes it a possibility and that is better than the alternative.