The Affordable Care Act (what Republicans contemptuously refer to as “Obamacare”) goes before our brilliant Supreme Court this week. Given that the law does yeoman service to preserving the private health insurance industry in America and is therefore a friend to the almighty Corporation, one might expect them to turn back the constitutional challenges on that basis alone. There are, of course, stronger constitutional arguments in favor of the plan – David Cole runs through them in The Nation much more fluently than I could ever attempt to do. I think, though, that we have to see these challenges for what they are, not for an effort to secure something called “economic freedom” which G.O.P. presidential candidates regularly invoke but fail to define.

The challenges are, of course, a cynical delaying tactic and an effort to procure through other means what the Republicans failed to achieve through the legislative process. They have attempted to put a log in the spokes of this effort from the very beginning, despite the fact that the legislation we ended up with is precisely the kind of health reform their party has been advocating for decades. Aside from a slight expansion of those covered by Medicaid, under this legislation health insurance remains in the private sector. Outside of Medicare, Medicaid, and the VA, no one will have government health insurance unless they’re covered by a state plan. So the Republicans’ charge of a “government takeover of health care” is a transparent lie.

I don’t think the AFA is the best solution. I think we should have Medicare for all, expanded sufficiently to eliminate the need for so-called “Medigap” coverage. It would work better, be more efficient, bring better outcomes, and likely cost a great deal less than what we have now. Nevertheless, the AFA has some virtues; it has helped some people keep their coverage. Perhaps most importantly, it establishes the principle of national health insurance – one that we can hopefully build upon in the years to come.

The attack on the personal mandate is laughable, frankly. I’m starting to think that Americans – even though we live in the land of a billion insurance policies – simply do not understand the basic concept of insurance. “I don’t see why I should pay the medical bills of some drunk who sits around watching T.V. all day,” a neighbor of mine once griped. (He’s on Medicare.) Thing is, we already do pay for that guy. If he has no coverage and ends up in the hospital – as pretty much all of us eventually do – ultimately the bill goes to us. It’s a question of how we cover these costs.

People bridle at the notion of government forcing us to purchase something. But (like it or not), government has the right to tax us, correct? The health mandate says, buy a policy; if you can’t afford it, we’ll subsidize you. If you can afford it and refuse, you pay a tax. The fact is, the government is basically taxing everyone to provide universal coverage. Buy a policy and you get out of paying the tax. That’s not forcing you to do anything: you don’t have to buy insurance. But if you want the tax break, that’s what you’ve got to do. What’s unconstitutional about that?

Republicans say they have an alternative, and indeed they do: absolutely nothing. If there’s one thing you can say unequivocally about the AFA, it’s that it is better than nothing.

luv u,

jp