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
In my last post, I gave a straightforward but ambitious directive: “The Left needs to shake its discomfort with wielding power and build the intellectual and political synthesis to gain power.” While I did not mention it in the post (which focused instead on net neutrality), I was inspired by a hopeful shift being enacted by the Democratic Socialists of America’s (DSA) Medicare for All campaign. Those who worked on the Affordable Care Act may remember how power rarely if ever entered into the conversation. The power of health insurance corporations and powerlessness of the people were assumed, and instead the discourse focused on how to navigate these dynamics rather than disrupt or eliminate them.
While there are some who want to return to these paltry discussions, Medicare for All could be a crucial first step for the Left towards taking power. That is why I and many others have poured so much time into it, from door-to-door canvassing to work with medical debt. There’s a great groundswell of volunteers. But that is just part one of my aforementioned directive. Medicare for All will not be won solely by the Left deciding that it should take power. We also need to create the intellectual and political synthesis to make it happen. To be clear, this is not needed to fulfill the mandates of Medicare for All’s critics. They have already shown they have no qualms criticizing strawmen rather than any policy put forth by the campaign. Rather, it is needed to make sure that when we pass Medicare for All that it is an unencumbered single payer system, that it withstands constitutional challenge, and that it does not foreclose the path towards fully socialized medicine.
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.