There is a lot to get into with this subject so I have decided to split things into more and smaller segments so that they are readable. So this first post will just focus on the Commerce Clause. I have noticed in my discussions on this subject that my fears of right wing legal challenge to single payer are most often dismissed by a simple evocation of the Commerce Clause. Unfortunately there is reason to believe that single payer’s constitutionality under the Commerce Clause is not so straightforward given recent decisions and the direction of the courts.
The Beginning of the Debate of What Commerce Means
Kevin Drum made a rather bold claim recently in an article for centrist malcontents Mother Jones: the Affordable Care Act is untouchable despite the imminent Republican control of all three branches of federal government. The basic idea is that (1) Republicans cannot repeal the pre-existing conditions protection; (2) insurance companies need a substantial federal healthcare infrastructure in order to afford taking on clients with pre-existing conditions; therefore (3) Republicans cannot substantially repeal the Affordable Care Act because it would cause the individual insurance market to collapse.
Aetna has joined many other major insurers in pulling out from most of the markets created by the Affordable Care Act. The right wing mainstream media is predictably depicting this withdrawal as a sign that the Affordable Care Act was too ambitious. Aetna for its part blames the Affordable Care Act’s risk-adjustment system. The truth is much more simple. Universal healthcare and the free market are incompatible ideologies: trying to create a hybrid of the two was as likely to succeed as pairing ice cream with industrial waste. The removal of profit motive is the only means of ensuring healthcare coverage for all people.
Though we tend to forget since liberals united behind it during the repeated attacks by the Tea Party and others, the Affordable Care Act was such a deplorable compromise that even Left-liberals like Dan Savage called it “Less evil. But still evil.” And Savage easily identifies the main flaw: it is as dependent as the Republican’s suggested alternative on people “not getting sick.” This is indefensibly shameful when the corporations behind these plutocrats have had free reign and government subsidizing to brainwash people into drinking, eating, and otherwise consuming poison. 98% of the 4000 food ads children view every year are products high in fat, sugar, and sodium. But that’s just half of why the “don’t get sick” model is so patently offensive. Aetna and even the U.S. government wants you to believe that the problem has been that an unexpected number of people got sick and, according to Aetna, the ACA did not have the risk-adjustment tools necessary to deal with that. It is a lie.