That decision will have profound policy implications regarding the reach and scope of federal government and at the same time have little impact on our daily lives in terms of health care.
The time to consider this paradox is before the decision is announced. Afterward, all anyone will talk about or even think about is political and financial effects, winners and losers. Any thoughts about how the ACA will affect you, me and our health care needs will be ignored in the scorekeeping, especially effects on the general election in November.
While we can do so, let’s consider how the ACA will impact Mr. and Mrs. Everyperson and family.
Suppose the court strikes down the individual mandate that forces people to buy insurance and penalizes them if they do not. This takes away a large revenue stream from Washington. Otherwise, it changes nothing.
Will striking down the individual mandate change the availability of health care service? Since the number of insured people will not change from what it is now, the answer is no. Since ACA cuts in Medicare reimbursements are unaffected (unless they go up), there will be the same shortage of providers able to care for Medicare patients.
Will striking down the individual mandate change the expansion of the bureaucracy? Will it stop the creation of the Independent Payment Advisory Board and five other whole new federal agencies? No.
Will striking down the individual mandate stop the development of accountable care organizations, which are “accountable” to everyone except the patients? No.
Will striking down the individual mandate halt the creation of health exchanges, which impose further federal control of health care on the states and suppress competition? No.
Will striking down the individual mandate expand the number of jobs? Yes and no. It will massively increase the number of administrative, legislative and regulatory oversight positions, but not one new doctor or nurse. Quite the contrary, as the Medicare reimbursement cuts take effect. The job expansion will do nothing to improve access to health care. It will in fact reduce care as money is taken from care providers and given to managers and overseers.
ACA does of course spend money, huge sums of it. Estimates range between $1 trillion and $2.7 trillion.
What do We the Patients get for all those expenditures? Answer: no more, or better, or safer, or quicker health care. Just more regulations and more bureaucrats.
If your teenager goes to the store and spends cash, she cannot spend more than is in her wallet. If she uses your credit card, the sky’s the limit. The same is true for the federal government. The loss of the revenue from a struck-down individual mandate will not slow down the general spending spree because it can do one thing that you and I and the 50 states cannot: print money. So whether the Supreme Court upholds or strikes down, nothing of substance will change except the size of the bill we are passing on to our children.
We need to realize that the justices, whatever they decide, will not save us from the harmful effects of the ACA. Only repeal can do that. And of course repeal alone still leaves us with a critically ill, dying in fact, health care system. Stopping the bad medicine – ACA – only reduces the rate of decline for health care. We need to start practicing good medicine on health care, something we have never done before.
Keep all this in mind when the hysterical reactions to the Supreme Court decision – whatever it is – take over the airways. Everyone will be talking about politicians, justices and bureaucrats. No one will be paying any real attention to We the Patients.
Dr. Deane Waldman is a professor at the University of New Mexico as well as the author of “Uproot U.S. Healthcare” and “Not Right!”