Of Stars and Proper Alignment: Scanning the Heavens for the Future of Health care Reform

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On
March 23, 2010, the United States took a giant step toward achieving
universal health care, an elusive goal it has pursued for almost a century.
The legislative fight was bitter and divisive, pitting Republicans against
Democrats. It revealed, as effectively as any issue in recent years
has, how difficult it is to achieve bipartisan cooperation when tackling
America’s biggest problems. Nonetheless, the product of that
contest, the Patient Protection and Affordable Care Act—referred
to herein as the Affordable Care Act, the Act, or, as its detractors
call it, “Obamacare”—fed the hopes of many Americans that we could
finally come to recognize an adequate level of health care as a right
of all our citizens and thus shake the dubious distinction the United
States has long held of being the only major, industrialized nation
on earth that has not committed to this noble goal.

But
as this is written, in March 2011, the Affordable Care Act’s future,
and the future of health care reform more broadly, is far from certain.
Two federal district courts have ruled that what many regard as the
Act’s keystone provision, the individual mandate to purchase health
insurance, The first
court concluded that the offending provision can be excised from the
law and the remainder left intact; the second
held that the provision is so integral to the overall legislative scheme
that the entire law must fail. Since three other district
courts have already rejected challenges to the Act’s constitutionality,

it is virtually certain that the Supreme Court will ultimately review
the Act. If the case takes the traditional route through the courts
of appeals, then it should reach the Supreme Court around the time of
the national elections in November 2012. On a parallel
track, the newly installed 112th Congress has begun to consider a repeal
of the law. Despite the formidable
obstacles that a repeal attempt would have to overcome—unlikely passage
in the Senate and a likely presidential
veto—the winds of opposition are blowing so strongly that a repeal
is at least within the realm of possibility. Setting aside these
challenges and assuming the Affordable Care Act survives, it is an open
question whether the Act can deliver on its very ambitious promise to
secure basic health care coverage for almost our entire population
without bankrupting the nation’s health care financing system or reducing
the quality of care those who are now covered enjoy. Clearly the
road to universal health care is a difficult one for the United States.
Like previous trips, this one may again prove to be a road to nowhere.

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