Health care decision a vital first step

On June 29, the Supreme Court of the United States released its long-awaited decision in the several cases aggregated as Florida, et al v. Department of Health and Human Services, et al. In a 5-4 decision, the majority, led by Chief Justice John Roberts, upheld almost all of the Patient Protection and Affordable Care Act of 2010 — pejoratively referred to by opponents as “Obamacare” — including the controversial “individual mandate.”

The court disagreed that the individual mandate was constitutional under the commerce clause of the U.S. Constitution — the argument advanced by the Obama administration — but did find it an allowable exercise of the taxing authority of Congress. The only part of the law that actually was struck down was the portion related to the Medicaid expansion requiring states to comply or lose all federal Medicaid funds.

The constitutional processes of our government — executive, legislative and judicial — all functioned as they should in this matter, just as the Founding Fathers envisioned. The expectation at the birth of our nation was that the verdict of the Supreme Court would be the final word on such a matter. And so it is. Except, of course, for those who have a minuscule grasp of how our government was intended to work, or are unrepentant sore losers … or both.

Like it or not, the PPACA is now the law of the land. Americans can stop fretting that a grave illness will “max out” their insurance, because such arbitrary limits are forbidden. Americans now can stop fretting that a pre-existing health condition will preclude them from obtaining insurance, because such exclusions are forbidden. And the almost 40 million Americans who are not covered by any form of health insurance — and thus essentially are denied proper access to the full capabilities of our health care system — will begin gaining coverage under the expansions the act provides.

A tangible and proactive, if imperfect, first step in providing all Americans access to affordable health care has been taken. The nature of its imperfections will be hotly debated in coming months, but the one that ultimately will gain the most favor with the American people is … the PPACA does not do enough.

From the outset, the intention of the Obama administration and the Democratic majority in Congress was to move toward a single-payer form of universal coverage — essentially an expansion of Medicare to cover all citizens, not just those over age 65. But the president’s desire for a bipartisan bill that could be supported by both parties gradually whittled away at the legislation until all that remained was a replication of the plan instigated by Mitt Romney when he was the Republican governor of Massachusetts.

Now that the PPACA is set for implementation, the people will become more and more cognizant of its shortcomings — especially the requirement that they must further enrich health insurance companies — and the inherent simplicity of providing universal coverage for all Americans under a single-payer plan.

Critics of a single-payer plan maintain that it will bankrupt the nation — that health care costs not only will continue to rise, but will rise faster than the participants’ contributions sustaining the system. It is true that costs likely will continue to rise, but not because of the plan itself. Rather, costs will continue to rise because of the unchecked greed and corruption of corporations involved in the delivery of health care.

In the 1990s, before he became governor of Florida, Rick Scott was CEO of health care giant Columbia/HCA. At the conclusion of a massive probe of that company’s billing practices by the FBI, Columbia/HCA pleaded guilty to 14 felonies and paid a record fine of $1.7 billion to settle the criminal and civil charges levied against it and its executive corps. No individual executive — including the CEO, who had by then taken the millions of dollars offered in severance and left the company — had to face criminal charges. The government, it seems, was content to recover most of the money defrauded from taxpayers, rather than also send rich corporate types to prison.

Columbia/HCA was charged with a host of corrupt practices, including “upcoding” (claiming patients were sicker than they were and filing for more expensive treatments) and bribing physicians and other health care providers to provide unnecessary referrals. The practices went back to the very first hospitals Rick Scott bought in Texas in the 1980s.

For years, the fine stood as the largest ever paid for health care fraud … until this week. GlaxoSmithKline, the British pharmaceutical giant, just agreed to a new record fine of $3 billion in settlement of criminal and civil charges brought by the U.S. Justice Department for advertising drugs for uses not approved by the Food and Drug Administration, and for bribing doctors to prescribe its drugs.

Only two companies — a conglomerate that operates more than 250 hospitals and surgery centers, and a pharmaceutical monolith with $45 billion in worldwide sales — now account for almost $5 billion in criminal and civil fines paid to the U.S. government. One rightly could imagine that these two companies represent only the tip of the proverbial iceberg. If so, then any single-payer system operated by the federal government — including the current Medicare system — is unnecessarily burdened by billions of dollars in fraudulent claims and charges. Eliminate the crooks — and their crooked spoils — and you eliminate most, if not all, of the upward pressure on health care costs.

Coupled with the efficiencies expected to be achieved from a single-payer system, health care costs actually should start to decline. But only if the malefactors among the health care providers are forced to conduct business honorably and fairly — or weeded out.

There are many who, awash in jingoistic pride, love to extol the United States as the greatest country in the world. But the greatest country in the world does not allow 50,000 of its citizens to die each year because they lack access to proper health care. Nor does it allow millions of its citizens to face economic ruin because of the costs of paying exorbitant health insurance premiums.

If America truly aspires to be the greatest country in the world, then it must start by ensuring that every American has affordable access to quality medical care.