Conservative Chief Justice John Roberts surprised many by siding with the court's liberal members, providing a majority opinion that will allow the health care reform legislation to be implemented as planned by 2014. However, in writing the court's opinion, Roberts explained that he upheld the legislation's individual mandate as a tax, not as a valid exercise of Congress' commerce clause power.
The court's decision trimmed back the power of the federal government to impose the Affordable Care Act's goal of expanding Medicaid eligibility in the states. By a 7 to 2 vote, the justices prohibited Washington from withdrawing all Medicaid funds to states that refuse to participate in the expansion.
Despite the court's ruling, public opinion polls find that the nation remains largely split on their support or opposition to the health care reform law. However, the reasons many oppose the bill vary widely. Advocates for a single-payer universal health care system that exists in most other industrialized nations of the world, are critical of the Affordable Care Act for its severe limitations. They point out that once fully implemented, some 26 million Americans will not be covered under the law, and that the measure won't do much to effectively contain sharply rising health care costs. Between The Lines' Scott Harris spoke with Dr. Steffie Woolhandler, professor of public health at the City University of New York and co-founder of the group Physicians for a National Health Program. Here, she assesses the Supreme Court ruling on the Affordable Care Act, and the way forward for advocates of a single-payer healthcare system.
DR. STEFFIE WOOLHANDLER: You know it's a good thing that the Supreme Court decided to obey the Constitution rather than play politics. I think them playing politics and overturning the law on really bogus grounds would've been a very bad thing. The law has some modest benefits, but they are modest indeed, and there are also some very big downsides to the Obamacare law.
One of the biggest downsides is that when it's fully implemented, the law will leave 26 million Americans completely uninsured. We know from some prior work we've done that when you have 26 million Americans you can expect to have about 26,000 deaths annually caused by lack of health insurance. So, 26 million uninsured Americans is simply unacceptable to me as a physician. And it means that we need to be moving forward to that single-payer, expanded, improved Medicare for all that you were talking about earlier.
BETWEEN THE LINES: Dr. Woolhandler, from your perspective of being an advocate of single-payer, is having the Affordable Care Act in place after the Supreme Court ruling a better place, a better starting point for universal coverage than if the law was struck down by the Supreme Court or repealed in the near future?
DR. STEFFIE WOOLHANDLER: Well, it's hard to say. At this point, the Obamacare is the law of the land. I doubt it's going repealed, so I think that's the base we're starting from. So, the slogan we're using is "Forward to Single-payer." Whether you think Obamacare was a slight step forward, a step backward, a step to the side, is somewhat irrelevant now because this is what we have, and it's clear that it's not a solution. That we're still going to have 26 million uninsured people, that we're still going to have tens of millions more middle-class people who buy health insurance in good faith only to find that when they get serious illness and their insurance fails them. There's too many gaps like co-payments, deductibles and uncovered services so that despite having health insurance, they still can't afford the care. And the health care costs are still going to go through the roof. And, all of those things are going to push us to a new round of reform.
I don't expect to hear much about that until 2014, when the law goes into effect and people get a chance to look at what it is and say, "Wow, this is in effect? It's fully implemented and there's nothing here for my family and there's nothing for me. My health care's still too (un)affordable and I can't get the health care I need and deserve. So we do expect the debate to re-open after full implementation in 2014. Until then, I think a lot of folks will continue to be very confused about what's in the bill and what isn't. Some of that confusion is by this crazy talk that the Republicans have been doing. But some of the confusion actually is done by people who support President Obama and feel that they can say a word that's bad about anything he's doing. I certainly hope Obama beats Romney in the next election, but I don't think it's reasonable for people to keep their mouths shut and not tell the truth about the problems in some of these laws that Obama passed.
BETWEEN THE LINES: The political reality in the estimation of many observers is that the giant insurance and pharmaceutical companies call the shots in Washington. The question really is, "How can their power and money be defeated and allow a single-payer or Medicare-for-all system to go forward? What's the focus of your work going to be in the coming months and years?
DR. STEFFIE WOOLHANDLER: We think we need to build a movement. The way we got civil rights in this country was not a bunch of politicians talking about it, but building a movement to win civil rights. The way we ended the Vietnam War in this country wasn't persuading politicians; it was a political movement. And the American people are really suffering under the current health care system. They may like the doctors in hospitals, but they're tormented by the payments, knowing that when they get sick they could be bankrupted, that if they somehow manage to get care, they're ruining their grandkids' future by spending all the family assets. So people really suffer under the current health care system and I think it's really not possible, but probable that we'll be able to build a movement of the American people to demand a single-payer movement. I'm very unhappy with corporate power in Washington, but we're not giving up on democracy. We still think we can make democracy work if people get involved.