Frankly, we were better off when the Supremes were two soul singers backing up Diana Ross.

The current Supremes, the nine lawyers in black robes, do us harm in unexpected ways. Over the years some trends appear.

Unsurprisingly the five conservative justices vote in ways that please the Republican Party, from Bush v. Gore to Citizens United v. Federal Election Commission. They generally favor the federal government over states rights (Bush v. Gore and the recent Arizona decision.) They favor free speech even when the effects are harmful. Citizens United allowed unlimited and unaudited use of corporate funds to influence elections. This has had the perhaps unintended effect of drowning out the speech of those not funded by the Koch brothers. And a less publicized recent decision stripped the FCC of power to prohibit bad language and nudity on TV broadcasts. Hide the remote from the kids.

Sometime today the Supreme Court justices will unveil their decision on the Affordable Health Care Act. If they rule against the individual mandate, originally a Republican idea first promoted by the Heritage Foundation, the financing for the other provisions will collapse and premiums will skyrocket. We already spend twice as much per capita for health care than any other major nation, with very uneven results.

If, as is likely, President Barack Obama is re-elected and the House of Representatives remains in Republican hands, the health-care situation will be at best murky. Both before and after the passage of the Affordable Care Act (Obamacare if you prefer) we have clung to the quaint but ruinous concept of health care being the province of private industry both on the provider side and the payer side.

For decades the AMA has preached against "socialized medicine" and has defended its stance to the last Cadillac and Mercedes Benz. But they also preached against the corporate practice of medicine, and that stance is largely forgotten today. A combination of high equipment costs and high malpractice insurance costs have driven doctors and other providers into corporations, which like local banks are taken over and merged into ever larger corporations. We know how well that worked on Wall Street.

The nations with more cost-effective health-care systems abandoned all or most of the private profit model for health care with varying results. But they all do better on the cost side than we do. And many do better than we do in the overall provision of health care. Today a practitioner is rewarded by the number of visits made and the number of services provided. That makes no sense. A practitioner should be rewarded for keeping clients healthy. But this change requires a massive overhaul of our entire health-care system.

The major flaw of the Affordable Health Care Act was the earnest protection of the private profit model. On the payer side the single (government) payer model had already been proven as the most successful model, even in this country. From 1798 to date, public programs from the Marine Hospitals to Medicare Parts A and B have provided excellent care at reasonable costs. But the anti-government ideologues don't let facts get in their way.

The Affordable Health Care Act would have been much more cost-effective from the start if a public option had been offered. But Obama, ever the placater, banned its consideration.

Today's decision will be made with the vote of Clarence Thomas. He has refused to recuse himself, even though his wife is a leader in the anti-Obamacare movement. The odds are good that the decision will leave America's health care system in much worse shape than before.

Actions have consequences, a principle that the black robed Supreme Court justices seem never to grasp.

Advertisement
Advertisement
Advertisement