A Sigh of Relief is Appropriate, but a Victory Lap is Premature

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I will admit that I am breathing a sigh of relief that the Supreme Court upheld Affordable Care Act (ACA) as constitutional. Readers of this site know that I was not optimistic about that outcome. Perhaps, as David Corn observed, the Supreme Court is not immune to public outrage. Perhaps the decision was a masterful political move on the part of Justice Roberts. Then again, Roberts could be simply upholding his status as the most corporate friendly justice in memory by maintaining what is, in essence, a multi-billion dollar boondoggle to the insurance industry. Regardless, health reform has survived three branches of government and the twisted process of checks and balances that are the result of contemporary, schizophrenic politics. Overall, that is a good thing, and something to be relieved about.

Our relief, however, should not blind us to the realities that the ACA is, at best, a second rate reform. Many of the elements of reform are no more than minor tweaks for equalizing an inherently unbalanced system. These tweaks are popular, but with our current system, they are sustainable only with the implementation of a grossly unpopular individual mandate. Thus, the ACA upholds and even reinforces the current system, which most Americans feel is inadequate. Despite the benefits of not having to worry about being dropped from your plan once you are sick, or denied coverage because of a pre-existing condition, will the ACA improve the quality of care in the United States, and make health care access more affordable? The jury is still out. The best we can say is that Massachusetts, the model for the individual mandate, indicates that there could be some benefits.

We should not lose sight of the fact that though the ACA may be the best we can do at this point, it simply isn’t good enough in the long run. The Journal of a Mad Sociologist has always advocated for the development of robust public option, leading ultimately to Medicare for all. We were almost there. The fight for an affordable public option should not be punctuated by the political maneuverings of Joseph Lieberman. Nor should our relief over the ACA decision cap the goals of health care reform. Obama became president, in part, because of his commitment to this next stage of health care reform. A public option remains popular.

The Affordable Care Act may be a step in the right direction, but it is only a step. There’s a lot of work that needs to be done. It’s time to reject a commodity paradigm and recognize access to healthcare as a universal right. Obamacare, regardless of its benefits, does not address this.