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ROBINSON: The bigger picture

Eugene Robinson

Eugene Robinson

WASHINGTON -- The political impact of Thursday's stunning Supreme Court decision on health care reform is clear -- good for President Obama and the Democrats, bad for Mitt Romney and the Republicans -- but fleeting, and thus secondary. Much more important is what the ruling means in the long term for the physical and moral health of the nation.

All but lost in the commentary about the court's 5-4 ruling, with Chief Justice John Roberts Jr. unexpectedly joining the majority, is that the Affordable Care Act was intended as just a beginning. We have far to go, but at least we're on our way.

Obama's great achievement is not any one element of the health care reform law -- not even the now-upheld individual mandate compelling individuals to have health insurance or pay a fine. The important thing is the law's underlying assumption that every American, rich or poor, should have access to adequate health care.

In the rest of the industrialized world, this simple idea is taken for granted. When Obama took office, however, about 50 million Americans lacked health insurance. Many low-income families, especially the "working poor" who make too much money to qualify for Medicaid, were faced with impossible decisions: Take a sick child to the doctor or pay the rent? Buy medicine or buy groceries?

Those who cannot afford health insurance do ultimately receive care, of course -- but often in hospital emergency rooms, where treatment is much more expensive than in a doctor's office. Our system is thus both callous and extravagant, costing much more than it should while delivering substandard results.

The World Health Organization gives the U.S. health system an overall ranking of 37th in the world, far below other Western democracies. The CIA World Factbook -- hardly the work of a bunch of left-leaning one-worlders -- reports that life expectancy in the United States is not just lower than in other industrialized countries but also lower than in Jordan and Bosnia. Infant mortality in this country, according to the CIA, exceeds that of Slovenia and Cuba. It is possible to quibble with these figures but not to ignore them. We should be ashamed of ourselves.

Most working-age Americans who have health insurance obtained it through their employers. But this is a haphazard and inefficient delivery route that puts U.S. businesses at a disadvantage against foreign competitors, most of which shoulder no such burden. Tying health insurance to the workplace also distorts the labor market and discourages entrepreneurship by forcing some employees to stay where they are -- even in dead-end jobs -- rather than give up health insurance.

For healthy individuals, it is crushingly expensive to buy insurance on the free market. For those with pre-existing medical conditions, it is essentially impossible -- but not for long, thanks to the Supreme Court's landmark ruling.

Rather than seek a radical reshaping of the health care system, Obama pushed through a set of relatively modest reforms that will expand insurance coverage to a large number of the uninsured -- about 30 million -- but still not all. He also tried to use free-market forces to "bend the curve" of rising costs, slowing but not halting their rise.

The result -- the Patient Protection and Affordable Care Act -- is a huge, complicated, unwieldy piece of legislation. I would have loved to see the president try for something simpler and more elegant, perhaps a "Medicare for everyone" single-payer system. Maybe that's where we'll end up someday.

But despite all the rhetoric we'll hear from Romney and the GOP until Election Day, health care reform is here to stay. Provisions such as guaranteeing insurance coverage to those with pre-existing conditions are too consumer-friendly to be taken away; and once these new measures take effect, which happens in 2014, insurance rates would rise sharply -- and unacceptably -- without the individual mandate.

And medical costs will continue to soar, despite the law's efforts to contain them. Inevitably, if only because of deficits and the national debt, Congress will have to revisit the health care issue with an eye toward more radical changes.

When that next big push takes place, it will be with the underlying assumption that health care should be available to all who need it regardless of their ability to pay -- that it is not a privilege but a right. Progressive presidents since Theodore Roosevelt have tried to enshrine this principle. Barack Obama did it.

Eugene Robinson is an associate editor and columnist for The Washington Post. Email him at eugenerobinson@washpost.com. For archived columns, go to www.gwinnettdailypost.com/eugenerobinson.

Comments

JV 1 year, 9 months ago

Two key things to take with you from Robinson’s opinion. You can see where we are going in the future.

“I would have loved to see the president try for something simpler and more elegant, perhaps a "Medicare for everyone" single-payer system. Maybe that's where we'll end up someday.”

“And medical costs will continue to soar, despite the law's efforts to contain them. Inevitably, if only because of deficits and the national debt, Congress will have to revisit the health care issue with an eye toward more radical changes.”

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dmoore 1 year, 9 months ago

Roberts has handed the election to Romney if he and his staff are smart enough to exploit it. He has categorized the penalty for not having healthcare as a "tax". The GOP needs to push hard the fact that the Obama administration has now placed the largest tax increase in the history of humanity on the middle class of America! We only need to look at the hideously incompetent healthcare systems in Europe and Canada to see where we are headed. It's time to wake up America! Socialism or Free-Market?

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kevin 1 year, 9 months ago

Well, here we are, back on the cartoon section again! 1) Robinson is lost for words in describing Robert's decision. He wants to make sure he doesn't bode him well since he still is "conservative." 2)"not even the now-upheld individual mandate compelling individuals to have health insurance or pay a fine" Call a spade a spade. This is a TAX idiot 3)"health care reform is here to stay." Until Jan 2013 4)"it will be with the underlying assumption that health care should be available to all who need it regardless of their ability to pay -- that it is not a privilege but a right." This is simply your humbly opinion. The rest of the nation says medical insurance is NOT a RIGHT. That is NOT in the Constitution that you and Obama swore to live by. You Liberals are nothing but hypocrits. 5)"Congress will have to revisit the health care issue with an eye toward more radical changes." I guess Obama care is NOT here to stay. Make up your mind what you want to say. It will be repealed and made completely over, not a 2,500 pg fiasco of a bill with Czars. 6)."Those who cannot afford health insurance do ultimately receive care, of course -- but often in hospital emergency rooms, where treatment is much more expensive than in a doctor's office. Our system is thus both callous and extravagant, costing much more than it should while delivering substandard results." Yes, this new law will be more expensive than no insurance. For those that can't buy insurance, or who can sidestep the"tax," the taxpayers will be paying for their free health care insurance, along with welfare, food stamps, flat screen TV's, cell phones, and soon retirement funds! This also includes paying the benefits for illegals also.

There is NO incentive to ever work again folks. We should all get with the programs. Then the President, Congress, and all the rest of the ones that decide to work, will be paying everything for us that don't want to work. And there you have "socialism" in its purest form. See what happens to a country when 50% or less of the population has to support the other 50%+ folks. Is that really what you all think when you vote for Obama and any Democrat?

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Jan 1 year, 9 months ago

dmore & kevin: You should really examine facts and not allow the republican rhetoric to instill unwarranted emotions. Fact: The health care bill is not socialist. Insurance is still through private companies. We did not even get a public option to improve competition. Medicare, including the costly drug plan of the Bush administration are socialist - didn't hear the yells of "SOCIALISM" when his plan was written to the advantage of drug companies at tax payer expense. We have socialism with the insurance that firemen will be available should our houses catch fire. Before the health care plan was passed, we did not have much choice in insurance since it is usually a perk from our employer, who chooses the plan. While Medicare remains, it is the most efficient and least restrictive when compared to any private insurance policy. Why is it so wrong to allow others the same health care benefits that I get on Medicare? A single payer system would greatly reduce overhead costs for health care providers and help control the expanding health care costs. What is your argument against single payer other than "Socialized medicine scares me, I don't want others to get proper medical attention so I can get more attention". Greed and fear so often interferes with logical thinking.

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kevin 1 year, 9 months ago

the definition of socialist is when a government FORCES you to do something. My how Liberals have been brain-washed by their own kind. It also would NOT be socialism if Obama allowed health insurance between state lines, like home owners policies are written. That is why we have more choices to save money. I can see who you voted for and I hope you are unemployed for it. as for your choice, you did have a choice. Take the "private" company policy or not or resign and look elsewhere. You are so narrow-minded.

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Jan 1 year, 9 months ago

What a stretch! So, in your opinion, our government is socialist because it forces us to drive on the right side of the road? And I am brainwashed? Let me be clear. I am retired, on medicare but your "choice" to resign gainful employment in the hopes of finding an equally good job with a policy that you like better you think is a viable option for those that need their pay check to buy food. Certainly glad that you are not my representative. I do not believe that even Representative Woodall and his illogical way of thinking would support such an idea.

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JV 1 year, 9 months ago

And how about another one of our great socialist.

"I know we're slow learners sometimes. But geez, come on now, we've got this piece of it. Now let's move forward and get the next piece and the next piece. There's no going back, though. We're on the path leading toward this universal health care. We're not on the path back on the past to Oliver Twist. Those days are gone," Michael Moore said on Thursday's broadcast MSNBC's "Last Word."

"And Republicans and conservatives who are sitting around thinking tonight, 'Year, we're going to turn this thing around.' I'm telling you friends, this is a huge locomotive. And as the American public experiences the parts of the bill that are really great, they're not going to want to turn that train around. You better get on the train or watch your party implode. That's my words of advice to the Republican party," Moore added.

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notblind 1 year, 9 months ago

Did Moore mention anything about printing lots more money ? That must be the liberals' and progressives' solution to the mountain of money this boondoggle is going to cost.

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