Can the Health-Care Debate Finally Evolve?

The Affordable Care Act (ACA), otherwise known as “Obamacare,” cleared its latest judicial attack today, with the Supreme Court ruling 6–3 against the challengers who claimed the federal government wasn’t in a position to give subsidies to exchanges run by individual states. The whole lawsuit was a pretty obvious political move. The argument was that because the actual wording of the ACA said subsidies were available to people getting insurance on “an exchange established by the state” (in one passage, on something like page 341 out of thousands), this had to literally mean the state (i.e. “Wyoming”) was the only entity entitled to give subsidies, rather than “the State” (i.e. the federal government, as referred to in the title of “Secretary of State,” which does not refer to an individual state — do I see another lawsuit coming?).

Whether you agree or disagree with Obamacare, it was pretty hard to suggest that the actual content of this lawsuit (the whole State vs. state thing) was meaningful in any way. It was the result of special interest groups poring over the documentation and finding literally anything that they could turn into a lawsuit so that they could take another run at repealing a law they don’t like.


Here’s the thing: I’m just so #@%##@!! tired of seeing our national health-care debate lowered to the level of a playground fight with nothing but petty attacks based on nothing of substance. From what I can tell (and I’ll warn you here — I’m about to get a little partisan), the Republican base has no intention of doing anything constructive on this issue. The only thing I hear is “repeal, repeal, repeal,” and often under utterly ridiculous circus acts like this most recent lawsuit.

It’s fine if you don’t like Obamacare — a lot of people don’t. But you simply cannot say that our health-care system was in great shape eight years ago. Eight years ago former Republican voters were speaking at massive rallies imploring Congress to “do something about the health-care crisis.” People were sick of HMOs turning them down for coverage that should have been provided. They were sick of insurance companies employing entire divisions of the company to find said loopholes to deny coverage to their most “costly” (read: sick) clients. The U.S. now has added over 16 million people to the insurance rolls, largely thanks to Obamacare. And even so, we STILL have some of the worst outcomes, highest costs, and lowest access among all the industrialized nations. But it was even worse eight years ago.

What we need, and what is so challenging in our toxic, generally vindictive, and petty current political environment, is some kind of compromise. But that can’t happen when one of the groups in question will accept nothing but absolute repeal. My only hope is that with this latest ruling, and the fact that repeal at this point would mean literally millions of Americans losing health insurance, we might be forced into a more reasonable conversation. Perhaps the political reality will finally set in that all-out repeal is not only unattainable on a practical level, but that the political fallout from such a massive cutting of services to so many Americans is so great that it is simply too politically dangerous to keep pushing down that road.

Because if we can move past this all-or-nothing standoff we’re locked into, maybe, just maybe, we can actually start to address some of the shortcomings of the law! And there are shortcomings. This is the first attempt at a massive overhaul of a system that was heading toward disaster eight years ago. So no, it’s not perfect. I know a number of people who now have health insurance for the first time in years, who absolutely love the fact that the ACA is here. And I’ve heard from people who lost good coverage, and were forced into the exchanges when the law went into effect and understandably hate the ACA.

First attempts are messy — we seldom get everything right from the beginning. But the only way to address what’s wrong is to find a way to drop the posturing, the political games, the petty attacks, and the special-interest-driven campaigns and actually meet somewhere in the middle. I sincerely hope that we might finally be able to do a little of that now. The ACA is here, and it’s not going away. Even if you don’t like the current ACA, as someone with a chronic condition, that’s good news. It’s good news because it might mean that we can finally figure out a way forward that works for all of us.

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