Supreme Court affirmation of the Affordable Care Act closes the loop, establishes that Americans are entitled to cradle-to-grave health care.
And no entitlement, once created, has ever done anything but grow.
For day-to-day Mississippians, not much will change – at least in the basics of availability of services and such.
A fourth of state residents (more than 700,000) are already enrolled in Medicaid, the federal- and state-funded program begun 47 years ago, initially to serve the basic health-care needs to the poorest of the poor.
Medicaid was joined by Medicare, completely funded by the feds. Mississippians 65 or older are eligible for Medicare, for which premiums are collected to pay a fraction of the cost.
Just about everybody else has health coverage through an employer-sponsored plan, a private-pay plan or as a veteran.
Mississippians with no coverage are those who make a little too much to qualify for Medicaid, but nowhere near enough to pay for private coverage at today’s rates. It is these “in betweeners” who were the targets of the Affordable Care Act.
Context is important here. This law is not an innovation. It is a continuation. Medicaid began as a compassion-based program for the destitute. But Medicaid outlays in Mississippi in 2010 totaled $4.2 billion. Mississippi’s portion of that total is, today, more than the state pays to support eight comprehensive universities.
The official budget forecast for Medicare was that it would cost the federal treasury $3 billion per year. In 2010, it cost $523 billion nationwide.
And, as a clearly happy President Barack Obama said within hours of the court ruling, the Affordable Care Act will be no different.
His signature program is a hodgepodge written largely by lobbyists. In happy talk, it is a public-private partnership. In effect, it is a confusing mess.
In a single-payer system (socialized medicine), government would employ all providers, everybody’s medical expenses and impose taxes sufficient to pay those costs.
At the other extreme is pure capitalism – a system solely controlled by the private sector, which is what existed before Medicaid and Medicare. (A caveat is that many communities were served by faith-based or local public “charity” medical institutions. That was before the explosion in medical technologies and Wall Street’s discovery of profits to be made.)
To push a plan through Congress, although dominated by his fellow Democrats at the time, Obama had to make promises to businesses on the receiving end of those government billions.
So what consumers of medical services will have to confront, as a result of the concessions, is a cumbersome and incredibly expensive hybrid. Private insurance companies are taken care of in the legislation. So are “big business” hospital corporations and drug-makers that are as profit-centered as a used car salesman.
In a way, this maze reflects our beliefs.
Philosophically, Americans are opposed to socialized medicine. Philosophically, we like private enterprise. But philosophically, Americans don’t like the idea of the sick being left to suffer. We like it when people who are in need get help.
What’s ahead, while there’s every reason to hope for the best, is a combination of elements that will, to put it politely, serve us in the most hamfisted, inefficient way imaginable.
Contrary to popular perception, it won’t be universal. And it certainly won’t be free.
Employers who do pay all or part of the group health premiums for their employees will be enticed to shift their workforce into self-selection of plans through “exchanges.” (Mississippi, although one of the states filing suit seeking to invalidate the law, has made solid progress on establishing a state exchange.)
It remains to be seen whether Mississippi will expand Medicaid from the present income limits to 133 percent of the federal poverty level. But it will be hard to say no, given that initially the feds will pay 100 percent of the cost.
Hospitals and pharmaceutical companies will no longer have incentives to be competititive or try to contain costs. Their efforts will be on how to maximize reimbursements.
Delivery of medical services wasn’t perfect before last week’s Supreme Court decision. And it certainly won’t be perfect when “Obamacare” is in full effect.
What matters most is perception. In terms of perception the decision declares that in this nation that health care is an entitlement.
And there is no turning back.
Charlie Mitchell is a Mississippi journalist. Write to him at Box 1, University, MS 38677, or e-mail firstname.lastname@example.org.