Some Comments on Recent Affordable Care Act Political Developments

I was a bit taken aback when I read E.J. Dionne's column in The Washington Post last Thursday morning. The normally temperate columnist concluded:

“Here’s a hypothetical for you: First, the Supreme Court issues a ruling that installs a conservative president. Then, he appoints two conservative Supreme Court justices who then join with three of their colleagues to make mincemeat of the greatest achievement of a progressive president elected by a clear majority. If such a thing happened in any other country, would we still call it a democratic republic?”

In the same vein, Linda Greenhouse concluded her article (“Law in the Raw”) written for The New York Times on King v. Burwell on a dispiriting note:

“So this case is rich in almost every possible dimension. Its arrival on the Supreme Court’s docket is also profoundly depressing. In decades of court-watching, I have struggled — sometimes it has seemed against all odds — to maintain the belief that the Supreme Court really is a court and not just a collection of politicians in robes. This past week, I’ve found myself struggling against the impulse to say two words: I surrender.”

Emotions are obviously running high on this subject. Opponents of the ACA are gleeful, thinking that they may have the ACA on the ropes, while supporters of the law are fearful of what might happen if the Supreme Court finds for the plaintiffs. As I have indicated, Republican opponents of the law are probably better off politically if they lose this case. That way they can complain about whichever justice or justices joins the four more liberal members of the Court while still contending that the ACA is a terrible statute and terrible public policy. If they win, Republicans in Congress and many Republican governors will have to deal with real-world consequences, including some very angry voters.

If King v. Burwell was not enough to keep Republican opponents of the ACA’s spirits up, there were some new Jonathan Gruber videos on which to comment while they conveniently ignored that both parties play games in order to get the CBO to score the fiscal impact of legislation in a way that enables it to be passed.

Gruber was, of course, not careful in what he said. Calling voters “stupid” in a public forum is not smart. Congressional committees may now hold hearings on what Gruber said, but this is for show – in fact, it is a sideshow. Rather than getting on their high horse and criticizing Democrats for dishonesty and lack of transparency, serious Republican policy wonks would better spend their time in coming up with ways to reduce U.S. medical costs to levels approaching what other industrial countries pay while providing universal healthcare to their citizens and achieving better public health results. Harping on Gruber is not serious.

As a final point, while the ACA will at some point be amended and, hopefully, improved, the goal of providing universal, or near-universal, affordable healthcare is not going away, no matter how successful the Republicans have been at bad-mouthing “Obamacare.” Republicans need to accept that. They might usefully remember that, while admittedly, the United Kingdom is a very different country than the U.S., Prime Minister Clement Attlee, whose government, among other initiatives, created the National Health Service after World War II, is considered to be among the greatest Prime Ministers of the 20th century.

“The arc of the moral universe is long, but it bends towards justice.” (Theodore Parker, Martin Luther King, and others.)