I’ll leave the detailed legal analysis to other commentators that you’ll no doubt find elsewhere.
Although some may not feel this way, this is an outcome everybody should be happy with.
Most important, patients should be happy. As I wrote in the New York Times Room for Debaterecently, the ACA has already provided benefits not to only the uninsured, but one of the most vulnerable segments of the population — seniors:
One of the unsung benefits of the Affordable Care Act is Medicare’s Annual Well Visit exam, which has been offered since 2011. Thanks to these visits, which I perform everyday in my primary care clinic, I have the opportunity to evaluate seniors for their risk of falling, screen for depression and ensure preventive services like vaccines and cancer screening are adhered to.
Furthermore, health reform has already helped seniors save money. In 2011 alone, nearly 3.6 million Medicare beneficiaries saved $2.1 billion in prescription drug costs.
Primary care doctors should be happy as well. As the ACP’s Bob Doherty has written, they had much to lose, including billions of dollars in higher Medicare and Medicaid reimbursements.
Of course, progressives will be happy with the outcome. The President’s signature accomplishment is allowed to stand. 32 million previously uninsured Americans will have access to affordable health insurance in 2014, which will certainly help the scores of millions who live everyday without that safety net. Those with pre-existing conditions will have access to insurance at reasonable prices. And although not optimal, various cost control initiatives, like bundling care and the formation of Accountable Care Orgnaizations, will proceed.
Conventional wisdom dictates that it would be those on the political right who would be most disappointed with this outcome. Although they may be stinging now, here’s why they should be happy as well. It will prevent, or significantly delay, the prospect of a single payer system.
The Affordable Care Act entrenches the current system of private insurers. In fact, they should expect tens of millions of new patients because of Obamacare. And concerning the individual mandate, remember it’s actually a conservative idea born from the Heritage Foundation, and implemented by Republican presidential candidate Mitt Romney in Massachusetts.
Had the ACA been struck down, we would have been back to the drawing board. No one would touch health care again for years, while costs continue to spiral out of control, and the number of uninsured continue to rise. Progressives would have introduced a Constitutionally compliant way to expand coverage that could be passed via budget reconciliation, bypassing the need for a Senate supermajority. That solution would have been a gradual expansion of Medicare: effectively, steps to a single payer system.
In fact, had the Supreme Court ruled the other way, some states couldn’t wait to go the single payer route.
And that is a true government takeover of health care.
Now, I’m aware that scenario may happen whether the ACA was held up or not. If the ACA’s cost control measures fail, for instance. But at least this gives the private insurance system a chance to fix our system before resorting to a draconian single payer route.
Obamacare is far from perfect. It doesn’t do anything to fix our broken medical malpractice system, its most glaring flaw. It doesn’t provide enough incentive for medical students to choose primary care. It doesn’t address the crushing burden of medical school education.
But it’s a start.
The Supreme Court’s ruling is an obvious victory for primary care doctors, patients, and progressives. Considering what the alternative could have been, those on the political right should take comfort in the decision as well.