The U.S. Supreme Court’s decision on the health care law passed by Congress in 2010 likely will be the most important one in the lifetimes of the people it will affect, which is everyone. Americans should hope that at least a majority of the justices will reject judicial activism and allow the law to stand. Here’s why:
• Health care is almost one-fifth of the gross national product, a huge chunk of the economy.
• Changing the dynamics of one-fifth of the economy will take decades, but without reform our deficit problems can never be reduced.
• The problem of rising costs cannot be resolved on a small scale, and giant-scale change is uncomfortable, even scary. Many things about the existing system will have to change, because the present system is not sustainable.
• Dealing with the cost crisis is virtually impossible without a mandate that everyone must have insurance. Absent it, all of us will continue to fork over more than $100 billion a year for those who cannot or will not shoulder their share of a national problem.
• All sides of the debate can project frightening numbers by cherry-picking the data. It’s important to remember that adjustments can always be made as realities change. But if we don’t make a start, the numbers become even more frightening.
Against that factual backdrop, it’s useful to consider some of the more hysterical and fearmongering claims about the law’s effect and potential.
• Claim: Since Obamacare passed in 2010, premiums have gone up 16.8 percent. (Only a few parts of the law are in effect; most don’t start until 2014, so the new law could hardly have driven that increase. Premiums have increased every year since 2000 by an average of about 9 percent. Against that, consider the 2.3 percent rise this year in Massachusetts, where a version of the national act has been in effect for six years.)
• Claim: Medicare and Medicaid benefits will be cut by $500 million. (We can hope the drop will be even larger, because those “cuts” are actually the reductions in costs through more efficient delivery of care.)
• Claim: 4 million employees will lose coverage in 2016. (It probably will be more than that, because of the long-term trend of companies dropping health insurance in response to the burgeoning costs the law is designed to reduce.)
• Claim: Reform is better left to individual states. (This is a national problem. Imagine the struggles of insurance companies, medical practitioners, regulators and patients trying to wade through 50 differing “solutions ” and sets of rules.)
That the court will hear six hours of arguments over three days rather than the usual one hour demonstrates the justices’ appreciation of what’s at stake. But the composition of this Supreme Court reflects the deep ideological divisions in the country. In cooler decades, the left and the right could not count on the court to salvage their political defeats, because those less-politicized courts paid more deference to the separation of powers and thus were reluctant to strike down acts of Congress.
Because of this court’s sharp divisions, however, it’s certain there will be a 5-4 decision, or at best 6-3, either way. That’s an outcome that cannot unite the nation but will extend its ideological fissure.