RACHEL MADDOW
Political commentator and host of MSNBC’s “The Rachel Maddow Show”
The policy upheld in Thursday’s Supreme Court ruling is a rough approximation of the Republican Party’s 1993 federal proposal for insurance reform and of then-Gov. Mitt Romney’s bipartisan insurance reforms in Massachusetts five years ago. It’s fun to denounce it as socialism or the “end of America” or whatever, but in reality the Affordable Care Act is a small-c conservative reform that preserves the private insurance system. Without reform, that system has produced outcomes that no one should have been satisfied with — compared with other well-off industrialized countries, we’ve been getting lousy outcomes, for twice the price, with tens of millions of Americans left out of the system altogether. Scuttling Medicare isn’t going to fix that system, nor is doing nothing. But these reforms might. Beyond the bloodthirsty partisanship that is so desperate to deny this president anything that looks like a victory, I think history will view this ruling, and this policy, as simple affirmations that the country can and ought to use policy to try to come up with practical solutions to even our big, complicated problems.
HOWARD DEAN
Former chairman of the Democratic National Committee; former governor of Vermont
The Supreme Court’s decision will have three long-term consequences. First, barring a Romney win in November and repeal of the Affordable Care Act, the debate about the private sector’s role in health care has been settled. With the exception of the roughly 100 million Americans who get their care through Medicare, Medicaid and the Veterans Administration, universal health care in this country will be based on a regulated private-sector model.
Washington is abuzz, tallying the political winners and losers of the ruling. More important is what this means for people. The president, Congress and now the courts have expanded access to health care, mostly using the framework already in place. That means our American system of health care will continue to evolve along the federal-state partnership model that exists in the Medicaid system and in the private sector.
Second, the Affordable Care Act’s heavy emphasis on electronic medical records and accountable care organizations will lead to a restructuring in the private sector on how we pay for health care. This will mean insurance companies and hospitals are likely to merge in preparation for the change in the reimbursement system from per procedure to per patient. This is happening in Massachusetts, where this kind of health-care reform was essentially piloted by Mitt Romney six years ago.
Third, more Americans will now buy their health insurance in the individual market, much like the approach John McCain suggested in his 2008 campaign. Small businesses, followed gradually by larger ones, will stop providing a health insurance benefit beginning in 2014, thus breaking the link of health insurance to employment. This will help the competitive position of American businesses while creating new jobs among smaller businesses. In their criticism, Republicans continuously neglect to point out that businesses, particularly small businesses, will pay a lot less for health care and that what they pay will be far more predictable.
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