Ruling on grounds I don’t think many of us expected, the U.S. Supreme Court upheld a piece of legislation that’s known either as the Affordable Care Act (ACA) or “Obamacare,” depending on whether you color your politics blue or red.   Since all three branches of the federal government have now approved this far-reaching set of programs, taxes and regulations, it’s now the law of the land, right?  Well…not quite.  With Republicans determined to “repeal and replace” ACA, and likely to control both houses of Congress after the November elections, the debate is far from over.

I don’t think any of us believes that our current healthcare system is the best we can imagine. How can anyone argue that a system which consumes nearly 18% of GDP—far more than any other country—while delivering mediocre results by any statistical measure and which will soon collapse under the burden of entitlements and demographics is the best we can do? I don’t think that even the people who drafted the legislation would call it perfect, though admittedly, I haven’t asked them. My particular gripe is that I don’t believe ACA will do anything to lower the cost of healthcare to a level that the economy can sustainably afford.  Our elected representatives, both red and blue, have perfected the art of delivering goodies, but they haven’t figured out how to pull back the goodies—either directly or through taxation—that no longer, or never did, deliver a true public benefit. And, as you’ve heard me say before, none of our hands is completely clean in this regard.

Perhaps the ongoing acrimony over healthcare legislation is part of a healthy process where policy is made, revised, and made again.  Part of the wisdom of the American system is to make policy through incremental steps, and part of ACA’s problem may be that it was an attempt to do something more holistically than our long-established process can accept.  If so, I welcome the upcoming debate and look forward to learning more about how a better set of programs can improve what’s now the law of the land.  

If in fact, however, the debate is not about the merits of individual insurance mandates or whether insurance companies must cover certain individuals or if we should tax tanning salons—all legitimate policy questions, but that debate becomes a zero-sum reflection of our increasingly polarized political scene, then I’m worried.  We have some major, complex, and politically difficult decisions to make in the next year. I hear the “fiscal cliff” may be pushed off to March, but it’s time to get beyond posturing, name calling, and can kicking and start making some meaningful decisions .  Whether you love it, hate it, or consider it a package with both necessary features and bad ideas, ACA has been an attempt to push ahead decisions on a policy issue that can’t be avoided. 

To the extent those decisions hinge on what kind of government we should have, I welcome the debate.  To the extent, that it’s an extension of the, “I wasn’t listening to what you said, but if you said it, I know I don’t like it” mode we’ve recently been in, I’m worried.  I’m worried because our fiscal, infrastructure, education, and entitlement issues won’t wait forever, and we need to move ahead in addressing them.

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