It's 5:10 P.M. on Thursday, June 28, 2012, and unless you've completely avoided all forms of electronic communication today, by now you know that the U.S. Supreme Court ruled today that most of the Patient Protection and Affordable Care Act is constitutional. The court's decision marked the end of a legal fight that began literally on the day the president signed the law -- state attorneys general filed lawsuits to block it before the ink was dry.
I heard a commentator say that the court essentially said, "This is no longer a legal question -- it's a political one. Mr. President, Congress -- you work it out." How they work it out is no clearer tonight than it was this morning. Supporters and opponents of the law both feel very passionately about their positions. It would have a been an issue in this fall's elections in any case, but today's events have certainly elevated it. From now until November 6, we will have one long national conversation (or, unfortunately but more likely, a shouting match) over the direction the U.S. health care system should take. There seems to be consensus that the current system is not sustainable in the long run. How it should change is a question that is far from settled.
I started this primer to bring out the facts about the law. It hasn't been easy, and it's really not finished. The law is very complex, and once I finished the insurance changes, my motivation for slogging on declined considerably. Now that the court has given it a grudging seal of constitutional approval, I will wade back into the PPACA waters from time to time. I would like to review the cost-control provisions in the law (beyond the IPAB, which was the subject of three posts a few weeks ago.) Judging from the table of contents, there is much in the law that has little to do with insurance and much to do with attempting to raise the quality of care that patients receive and limit the amount of money that payers have to fork over for it.
No one will ever describe this law as perfect, and I believe that both its supporters and detractors make valid points. However, as of this morning, we can describe it as constitutional, at least in the opinions of five voting justices of the Supreme Court. It's not enough to settle the argument, but it's a start.