Rebecca Pruveadenti's Letter Published in the Erie Times

 

This Letter was published in the Erie Times on July 15th Single-payer still best system.  It was written by Rebecca Prudevanti of the NW Healthcare for All PA Chapter.

The Affordable Care Act (ObamaCare) was upheld by the Supreme Court and many on the left are unhappy with the ACA and President Obama. This law helps keep an unsustainable, for-profit, health insurance industry in place and calls it health care. It does nothing to control spiraling costs and will spur this country's next financial crisis because it is growing three times faster than the U. S. economy.

The current system is responsible for causing medical bankruptcies -- 50 percent of all U.S. bankruptcies. The health insurance industry acts as a toll booth between you and your health care. When you get sick and begin to use your insurance, you must stop, ask permission, pay to get through. Sound like a privilege or extortion? Single-payer supporters are incensed that a sensible, single-payer solution to heath care in this country is viewed as evil, yet denying health care to a human being is the right thing to do.

Currently, the U.S. has Medicare, a single-payer plan for people over 65; Medicaid, a single payer plan for people under the poverty level; the VA Health System, true "socialized" medicine yet essentially a single-payer plan for veterans and their families; and the for-profit health insurance industry system for whoever can afford it. The most expensive and least effective for "we, the people" is the for-profit model. For-profit means profit at all costs, ignoring all moral imperatives regarding the sanctity of life because it lowers the corporate profit ratio.

The absence of equal access to health care is directly linked to an unhealthy, uneducated populace. A single-payer system where everybody pays in and gets equal access to health care is the sensible solution.

Rebecca Pruveadenti president, HealthCare4All PA, NW Chapter

The Supreme Pennsylvania Medicaid Decision

Little noticed in all of the celebrating over the Supreme Court's decision was the part of it that said that the federal government cannot take away federal funding for states that refuse to implement the Medicaid expansion that is contained in the Affordable Care Act.  States will be reimbursed for the expansion 100% in 2014 with decreasing amounts to 95% in 2017 and 90% in 2020 according to the Pittsburgh Post-Gazette.  Pennsylvania Governor Tom Corbett(R) hasn't said if he will participate the expansion which could cover about an additional 800,000 of the state's estimated 1.4 million uninsured in 2009.  So far the governors of Florida, Louisiana, and South Carolina have said that their states will not participate in the expansion even though about 900,000 and 300,000 would become eligible in each state respectively.

Can past behavior on Medicaid in Pennsylvania be an indication of how Gov. Corbett will act?  In January I did a post on how about 88,000 children were dropped from the Medicaid rolls due to a bureaucratic backlog.  Greg Kaufman in The Nation magazine reports that number to be 89,000 and they still have not been reinstated and were not picked up by the CHIP program. Corbett's decision to end Adult Basic coverage for 45,000 Pennsylvania adults may provide an indication as well.


Right after the Supreme Court announced its decision on Thursday David Cole at The Nation said on Democracy Now! that "we shouldn't let the perfect be the enemy of the good."  I say we shouldn't let the lousy be the enemy of the good either.  A system that mandates care for all is what is needed as Walter Tsou points out in Common Dreams.

 

**Update**

The Facebook page Stop Obamacare in PA (111 likes) is circulating a petition urging Gov. Corbett not to implement any of the Affordable Care Act which can be seen here.  I do not know how many signatures they have and am not going to sign it but this could also be a good test case for how much leverage does the Tea Party have with the Governor. 

**Related Posts**

The Friday Morning Quarterback 

Protecting the Parasites: The Irony of Obamacare

The Pennsylvania Medicaid Budgetary Squeeze

States as Laboratories and Lavatories of Democracy

Healthcare 4 All PA Response: Supreme Court Ruling on PPACA and Implications for the Single Payer Solution

This is the official Healthcare for All PA response from Executive Director Chuck Pennacchio to the Supreme Courts decision on Thursday.

 

Dear Friends of the Proven Single Payer Solution:

The Supreme Court of the United States ruled this morning, by a narrow 5-4 decision, that the Patient Protection and Affordable Care Act (PPACA) is largely constitutional.  Writing for the majority, Chief Justice John Roberts found the insurance purchase mandate permissible, but only if re-conceived of as a "tax" and, therefore, consistent with Congress' regulatory powers under the Commerce Clause.  The remainder of the national health insurance bill was also found to be constitutional, with the notable exception of the law's punishing effects of withholding funds from states that refuse to accept PPACA's new Medicaid eligibility standards.

Now that the Supreme Court is permitting the implementation of PPACA, what does the ruling mean for potential recipients, costs, access, quality, providers, jobs, economy, and sustainability?  And what will it mean for the proven Single Payer Solution that effectively addresses and resolves the aforementioned issues and steers clear of any current of future constitutional challenges?

Given the six-year implementation of the Massachusetts Model, the PPACA-related answers to the above questions are mixed - but, regrettably, mostly negative.  Yes, perhaps 2% percent of Americans - those aged 19 to 26 (2.6 M), those with pre-existing conditions (70 K), those who are indigent and uninsured (3 to 4 M) - will appreciate increased access to healthcare providers and services.  That is PPACA's best news - and one cannot understate or undervalue the importance of expanding healthcare to Americans previously shut out of the system altogether.  On the other hand, a significant chunk of the 2% targeted beneficiaries intended for inclusion in expanded healthcare will not get what they need because of the shrinking pool of primary care physicians, community hospital closures, unaffordable premiums/co-pays/deductibles, across-the-board cuts in healthcare spending, and systemic "gaming" and "cherry-picking" by a profit-centered health insurance industry.

Now for the predictable bad news - based on PPACA's legislative forerunner, the Massachusetts Model.  Initial Massachusetts successes in increasing those with health insurance paperwork and those with actual access to healthcare have given way, in the last four years, to alarming rises in the uninsured, the under-insured, taxes, premiums, co-pays, deductibles, hospital closures, physician flight, and overall healthcare outcomes  (http://tinyurl.com/723stts).  The Massachusetts legislature is now cutting, not increasing, services, as economic and budgetary restraints bring political calls for austerity.  Profit-first, health insurance-centered healthcare is proving to be unsustainable in a state that is disproportionately wealthier and more liberal than most.  If PPACA modeling can't work in Massachusetts, how can we expect it to work in the partisan puzzle palace known as Washington, D.C.?

Now for the good news: advancing the Proven Single Payer Solution. PPACA is simply unsustainable - financially, economically, morally, politically, and logically.  Simply put, PPACA over-promises and under-delivers.  It increases the power and profits of the profit-first, healthcare denying health insurance industry, while leaving patients, providers, taxpayers, municipal governments, businesses, labor unions, and more, at the mercy of the predatory medical-industrial-complex.  Politicians enable, corporate insurance profits, citizens suffer.

Only the Proven Single Payer Solution solves the system.  And, irony of ironies, PPACA provides state-based waivers and instruments to implement state-based single payer!  As healthcare-related costs continue to escalate out of control (to perhaps 25% of GDP in 2025), healthcare access diminishes, medical bankruptcies and preventable medical tragedies increase, and more, the system will collapse on itself.  Who knows where the tipping point is?  But we all know that the evidence and morality point to the American answer: Single Payer, aka, Expanded and Improved Medicare for All.  That is, publicly-funded, privately-delivered, guaranteed, quality, comprehensive, doc-and-nurse-retaining, cost-cutting, job-generating, healthcare for all.  Single Payer.  Centrist.  Sensible. Solution.

Today is a day to build on.  Our struggle continues.  We will win.  Healthcare for all!

Yours in solidarity,

Chuck Pennacchio

Executive Director

Healthcare for All Pennsylvania 
cpennacchio@gmail.com

The Friday Morning Quarterback

So much is being written about yesterday's Supreme Court decision “upholding” the Affordable Care Act (ACA) that it's hard to gain a clear perspective on the consequences of the decision. One week for now, I may regret most of what I've written here.

Here's the Court's decision. For those interested in just the basics, check out The New York Times' annotated summary. However, I recommend that everyone read Justice Ruth Ginsberg's dissent (which starts after p. 59) in its entirety. It's a masterpiece of clarity and common sense.

In reacting to the decision, I think President Obama hit the right note by refusing to discuss its political implications and focusing on the millions of Americans who are or will become seriously ill who will benefit from the decision. Paul Krugman had a similar reaction.

Let's face it. Regardless of Chief Justice John Roberts' motives, we dodged a bullet here. Just look at the decisions—both good and bad—that were announced this week: the reaffirmation of Citizens' United by striking down Montana's campaign finance reform law, the rejection of mandatory life sentences for juveniles, the upholding of Arizona's right to stop and detain people merely because they appeared to be Hispanic. A conservative, activist Supreme Court has inserted itself into the history of the country with consequences that will be difficult or impossible to reverse. The most important issue in November's presidential election may be its implications for future Supreme Court appointments.

Roberts' denial that the ACA constituted the “regulation of interstate commerce,” when health care accounts for 18% of GDP, is not just absurd. The implications of ruling that people who refuse to buy health insurance are not engaged in interstate commerce because they haven't bought it yet are difficult to foresee. In the past, the commerce clause has been used to justify a variety of labor, public health and safety, and civil rights laws that protect people who are not directly engaged in interstate commerce, but who are indirectly affected by its consequences, i.e., people who live downwind from a source of industrial pollution. These reforms now appear endangered by this decision. Does this mean that corporations may refuse to hire or serve minority applicants because, after all, if they are excluded from participation, they are not engaged in interstate commerce? How will this decision impact Congress's ability to implement a national energy strategy by, for example, requiring people to purchase some of their energy from renewable rather than nonrenewable sources?

One important provision of the ACA that the Supremes failed to uphold was the expansion of Medicaid. Under the ACA, Medicaid was expanded to cover all folks under 65 whose incomes are 133% of the federal poverty level or less. This amounts to about half of the 30 million people who are not now insured, but would be under the ACA. Medicaid is administered by the states, but the federal government agreed to provide 100% of the money for the Medicaid expansion in 2014. This was to be gradually reduced to 90% in 2020. The incentive for states to comply was that, if they refused, the federal government would withhold all their Medicaid funds.

Chief Justice Roberts thought this was too coercive, a “gun to the head” of the states. This is the first time in our history that a state spending requirement has been rejected as too coercive. What other federal requirements will states object to? In 1987, the states were told that all federal highway funds would be withheld unless they agreed to raise the drinking age to 21. Presumably the Roberts court would consider this too coercive. Federal funds for public education are contingent on the states' meeting federal standards. Is that too coercive?

Will the states implement the Medicaid expansion even though there is no penalty for refusing to do so? The Democrats are optimistic. How can the states justify withholding benefits from poor people that are paid for entirely by the federal government? That's like turning down free money, right? However, just within the last three years, some states have turned down federal stimulus money and even unemployment benefits for their citizens. The Jackasses may have underestimated the extent of some Americans' hostility toward the poor, especially those Americans who mistakenly think that most Medicaid recipients are African-Americans.

If not all states implement the Medicaid expansion, the states in which this coverage is most likely to be denied are those whose citizens have the greatest need for it—states like Alabama, Mississippi, Louisiana and Texas. Although experts are still working out the detailed implications of yesterday's decision, it appears that, because the ACA assumes that the states will implement the Medicaid expansion, most of the people below 133% of the poverty level in any states that refuse to expand Medicaid will also be ineligible for low income subsidies to help them purchase health insurance. What a mess! Health care is far too important to be left to the states.

Finally, let's remember that the ACA is no substitute for a single payer health care system. Even if it is completely implemented, it still leaves 27 million people living in this country uninsured. As presently written, it does little to control either the cost or the quality of our health care. Needless to say, there is still a lot more work to be done.

Mission Accomplished

It's Wednesday. Here's something to think about while we're waiting for the nine Supreme beings to come down from the mountaintop tomorrow and hand us the tablet that will mean life or death for thousands of Americans.

By now, you probably know the recent history of health care reform. The individual mandate—the requirement that everyone purchase health insurance—originally proposed by the Heritage Foundation, a conservative think tank, was the cornerstone of Republican health care plans for two decades. They preferred it because it encouraged “individual responsibility.” President Obama opposed the individual mandate during the 2008 campaign, but he and the Jackasses eventually conceded in the hope of gaining conservative support. (Flip!) Then, in 2009, in an even more remarkable turnaround, the Elephants in Congress unanimously decided that the individual mandate was unconstitutional. (Flop!)

As Ezra Klein reports, in 2010, when 14 Republican state attorneys general filed their suit challenging the constitutionality of the Affordable Care Act (ACA), “it was hard to find a law professor in the country who took them seriously.” (Here's an analysis of why the ACA is constitutional.)

How did the corporate media report on the constitutionality of the law? First of all, here's what they were reporting on. There were nine court cases related to the constitutionality of the act. Four of these courts overturned the law and five upheld it. There were also several cases in which courts dismissed complaints without ruling on the constitutionality of the law.

Media Matters looked at all the reports devoted to these courts cases on the nightly newscasts of ABC, CBS, CNN, Fox and NBC—a total of 31 segments. Of these 31 segments, 26 (84%) reported decisions that the act was unconstitutional, 3 (10%) reported rulings that it was constitutional, and the remaining 2 (6%) dealt with dismissals. If instead of counting segments, you get out your stopwatch, you find that a remarkable 97% of air time was spent discussing cases that overturned the law.

Unfortunately, the researchers do not report the number of minutes these newscasts devoted to advertisements paid for by pharmaceutical companies, insurance companies and health care providers.

Newspapers were only marginally better. There were 59 articles about these court cases in the Los Angeles Times, New York Times, USA Today, Wall Street Journal and Washington Post. Thirty-five of them (59%) dealt with rulings that the ACA was unconstitutional, 17 (29%) dealt with decisions that it was constitutional, and 8 dealt with dismissals. Rulings of unconstitutionality were far more likely to make the front page.

It's possible that, initially, the greater attention given to rulings that the ACA was unconstitutional was due to the fact that journalists were surprised by these decisions, given the near-unanimity of their legal experts. However, that does not account for the consistency and longevity of these findings.

The bottom line is that this unbalanced coverage appears to have had its intended effect. A Gallup poll released earlier this month found that 72% of Americans think the ACA is unconstitutional. Several polls have found that the majority favor repeal of the law. For example, Rasmussen reported that, as of June 23-24, 54% of likely voters favor repeal and 39% oppose it. Although, as my colleague Paul Ricci reports, a majority of those folks favor starting work on a new health care reform bill, it's hard to imagine that any new health care legislation could get through Congress in the foreseeable future.

Healthcare Polls in Anticipation of SCOTUS Decision

With the political class anxiously awaiting the Supreme Court's (SCOTUS for short) decision on the Affordable Care Act (ACA) as if it were an endless Christmas night (Healthcare 4 All PA has prepared official responses for the possible ways in which it may rule).  There has been a flurry of new polls on the act summarized below from the website Real Clear Politics:

Polling Data

Poll	Date	Sample	For/Favor	Against/Oppose	Spread
RCP Average	4/5 - 6/18	--	38.6	49.4	Against/Oppose +10.8
Associated Press/GfK	6/14 - 6/18	1007 A	33	47	Against/Oppose +14
Rasmussen Reports	6/9 - 6/10	1000 LV	39	53	Against/Oppose +14
Reuters/Ipsos	6/7 - 6/11	1099 A	45	44	For/Favor +1
CBS News/NY Times	5/31 - 6/3	976 A	34	48	Against/Oppose +14
CNN/Opinion Research	5/29 - 5/31	1009 A	43	51	Against/Oppose +8
NBC News/Wall St. Jrnl	4/13 - 4/17	1000 A	36	45	Against/Oppose +9
Quinnipiac	4/11 - 4/17	2577 RV	38	51	Against/Oppose +13
FOX News	4/9 - 4/11	910 RV	40	53	Against/Oppose +13
ABC News/Wash Post	4/5 - 4/8	1003 A	39	53	Against/Oppose +14

The polls generally state public opposition when they are averaged together in the top row of the table above.  Obviously these polls cover a long time frame from April to June, the period of the court's deliberation.  The sample sizes are given in the next column with the letters stating from which population it was taken.  A means general American public, RV means registered voters, and LV (in the Rasmussen poll) means likely voters in the next election, the most biased of the three sample types above.  Among other factors, the way in which the sample of a poll or survey is selected can bias it's results.

With the exception of the Reuters/Ipsos poll, all of the ones above show at least an 8 point spread against the ACA which would be outside the margin of error so we can be confident that that is the way that the US population feels about the law.  Clicking on the link above for each of the polls will take you to the summary report for the poll.  For the Reuters poll there is a 45-44 split which is within the margin of error (+/- 3%).  The poll does ask a further question of those who oppose the law if it goes too far or does not go far enough.  Of those who are asked this question, there is a 22-68% split for those who say it does not go far enough relative to those who say it does.  When that 22% is added to the 45% who support the bill there is a 54-44% split in favor of universal healthcare like the ACA or stronger.  The CNN poll has found a consistent pattern for the last two years.  When combining those who oppose the ACA because it is not liberal enough with those who support it they find a 56-34% split in favor relative to those who oppose it because it is too liberal. Neither poll probes what 'not liberal enough' or 'not far enough' means.

The other polls do not ask similar questions.   The AP poll does ask if SCOTUS overturns the ACA what Congress should do and found that 77% want them to work on a new law.  Of course single payer was not mentioned in any of these polls or surveys but there does seem to be a receptiveness in the public to stronger reforms of the health care system.  The challenge now will be to get the message out.

**Update**

The Nation magazine has produced a graphic which illustrates part of what I wrote above.

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Pearl Korn: With the Affordable Care Act Hanging by a Thread, It's Time for Single-Payer

Healthy Artists Video on Bicyclists Injury

Any day now the Supreme Court of the United States or SCOTUS will announce it's ruling on the Affordable Care Act (ACA) or Obamacare.  Julie Sokolow at Healthy Artists has produced another video clip profiling an artist, Daniel Menges who experienced an injury while riding his bicycle and was aided by the Affordable Care Act.  While we agree that some are helped by the Act who weren't before (because this person could be kept on his mother's insurance until he's 26)   Many cyclists are uninsured making them vulnerable to injury by cars and bad roads and trails.  Cycling has many health and environmental benefits and should be encouraged.  Bike Pittsburgh advocates for safer riding conditions for cyclists.  You can read about their efforts on their blog.

There still are many improvements that need to be made to the ACA as are spelled out in this website.in posts below and in the tabs above.

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STOP Obamacare in Pennsylvania and the Uninsured

 

Racial and Gender Differences in Pennsylvania's Uninsured 

 

Santorum: No One Has Ever Died Because They Didn’t Have Health Care | The New Civil Rights Movement

Protecting the Parasites: The Irony of Obamacare

Earlier this month, the Green Party called on the Supremes to strike down the individual mandate and put an end to the Affordable Care Act (ACA). Their argument is that the ACA is merely a multibillion dollar public subsidy for the insurance, pharmaceutical and medical industries. This is certainly true. But they go on to predict that if the ACA were declared unconstitutional, this would hasten the passage of a single payer, or Medicare for All (as they call it), health care system. (The usually astute economist Robert Reich has made a similar argument.)

As much as I sympathize with their goals, I find that hard to believe that a single payer health care system will make its way through Congress in the near future, even in the unlikely event that a re-elected President Obama were to support it. If he didn't have the votes to support even a public option in early 2010, when the Jackasses controlled the House and had a veto-proof majority in the Senate, what are his chances of passing an all public system in 2013? And how will an overturning of the act by the Supremes affect Obama's chances of re-election? Are you ready for the endless barrage of super PAC-financed TV ads reminding voters that Obama's “signature accomplishment” has been rejected by the courts?

The public also wants the ACA to be overturned. According to a New York Times poll, 29% want the Supremes to overturn the individual mandate, which requires all Americans to purchase health insurance, and another 38% want them to overturn the entire law. After three days of debate, it looks as though they will get their wish. This morning's Washington Post reports that the Supremes “may be on the brink of a major redefinition of the federal government's power.”

Justices on the right of the deeply divided court appear at least open to declaring the heart of the overhaul unconstitutional, voiding the rest of the 2,700-page law and even scrapping the underpinnings of Medicaid, a federal-state partnership that has existed for nearly 50 years.

Of course, you can never predict the Supremes' decision solely on the basis of oral arguments. But if you doubt that they are seriously considering it, remember that they spent 1.5 hours Wednesday discussing what should happen to the rest of the ACA if—or is it when?—the individual mandate is overturned.

This is not a game. With all its flaws, the ACA extends health insurance to 32 million people not previously covered. Without that coverage, we return to a status quo in which 45,000 Americans die every year from lack of health insurance. The Elephants don't have an alternative plan. Their plan B is to “let them die.”

I can point you to a serious article giving at least three constitutional bases for the ACA, but in fact, it's a no-brainer. John Cassidy has referred to this legal case as a “bad joke.” Robert Parry refers to the justices as “clowns.” Who could possibly believe that Congress has no right under the Commerce Clause to regulate the health care, an industry which accounts for 17.6% of GDP? In 2005, Justice Scalia wrote a concurring opinion in Gonzales v. Raich, in which argued he that the Commerce Clause gave government the right to prohibit the sale of medical marijuana. I don't know what percentage of the nation's health care dollars are spent on medical marijuana. Let's say it's about one-tenth of 1%. Are the conservative justices saying that the sale of medical marijuana is important enough to affect interstate commerce, but the entire health care industry is not?  Seriously?!?  It's hard to see this as anything but a farce.

In my opinion, all the verbal jousting going on this week is intended to mystify the public and give judicial cover to the five conservative justices, so they can do what they intended all along: Help the Elephant Party to ensure that Barack Obama will be a one-term president whose four years in office are remembered as a failure. This should not be unexpected. Previous lineups of the Supremes have already allowed politics to trump both the Constitution and legal precedent.

This brings us to the Supreme irony of Obamacare. It appears that the ACA will be destroyed by the individual mandate—an Elephant proposal that Obama was initially reluctant to accept, and that he agreed to in order to save our privatized health care system from the threat of single payer.

During the 2008 campaign, Obama opposed the individual mandate, which Hilary Clinton supported, because he knew it would be perceived as a restriction of individual freedom and there would be a backlash. Why did Obama eventually agree to include something as unpopular as the individual mandate? Basically, it was to save the private health insurance companies.

Insurance companies make money by covering healthy people and denying coverage to those who are sick—or refusing to pay the medical bills of their clients who get sick. That means that in this country, if you develop a serious illness, you are for all practical purposes uninsurable. Americans in this unfortunate situation either become dependent on some sort of public program, die sooner than they otherwise would, or both.

To avoid this, you could require the insurance companies to insure everyone (called guaranteed issue). But if they are forced to cover sick people, they will charge them an amount that most of them can't afford. To avoid this, you could require the insurance companies to charge everyone the same amount regardless of their prior medical history (called community rating). But if you have both guaranteed issue and community rating, there is no logical reason for healthy people to purchase insurance. They can simply wait until they get sick, confident that the insurance companies will have to cover them at an affordable rate. This is known as adverse selection—the tendency for people who buy health insurance voluntarily to be less healthy than the general population. This causes insurance company profits to go down, rates to go up for everyone, and eventually the entire system descends into chaos. To avoid this, you have to require everyone to buy insurance—the individual mandate. This ensures that there are enough healthy people in the system to spread the risk and make insurance affordable for all.

But there's another way. You could simply bypass the insurance companies. Collect the money that people would otherwise pay for insurance premiums up front as taxes and use it to insure everyone. In other words, you could establish a single payer system. This is how social security and Medicare are financed. It would be politically difficult to argue that they are unconstitutional (although some of the arguments currently being advanced against the individual mandate imply that they are).

This irony at the heart of Obama's dilemma was not lost on at least one of the Supremes, Justice Ruth Ginsberg, who noted on Tuesday that:

There's something very odd about that, that the government can take over the whole thing and we all say, oh, yes, that's fine, but if the government wants to preserve private insurance, it can't do that.

Of course, single payer would eliminate the health insurance business. But that's exactly what we should do! Health insurance consumes about 20% of medical spending and provides no useful service in return. It's a giant parasite that sucks up our resources, even as it adds additional misery to the lives of some of our sickest citizens. Eliminating that 20% surcharge virtually guarantees that the extra amount people pay in taxes for single payer will be less than they are currently paying for health insurance.

(That's not the only way single payer will save money. Single payer will give the government the bargaining power to negotiate lower prices for prescription drugs and to rein in the exhorbitant fees paid to doctors and hospitals. Needless to say, big pharma and the for-profit hospitals oppose it too.)

So why couldn't Obama propose a single payer health care system? As the media put it, single payer was “not politically feasible.” That's media-speak for a proposal that is favored by the majority of the American people, but opposed by the “corporate persons” who finance our political campaigns. And in a political system that's basically just legalized bribery, those who finance the campaigns are the only ones who really matter. The richest 1% not only bought and paid for Obama, but most of Congress as well. Had he proposed single payer, he would have faced opposition not only from the Elephants but also from the majority of his fellow Jackasses.

Or as E. J. Dionne put it:

The individual mandate was a conservative idea that President Barack Obama adopted to preserve the private market in health insurance rather than move toward a government-financed single-payer system. What he got back from conservatives was not gratitude but charges of socialism—for adopting their own proposal.

No matter how often he kisses their behinds, the 1% will never accept the legitimacy of Obama's presidency.

Give some credit to the conservative propaganda apparatus. They have successfully framed the individual mandate, the central issue of the debate, as an attack on personal freedom. “The government is trying to force you to buy health insurance.” This is reinforced by a series of wildly implausible slippery slope arguments. “If the government can force you to buy health insurance, then it can also force you to buy broccoli, or a cell phone, or gay pornography!” (Naturally, such proposals are likely to sail through Congress with little dissent.) An American public that lacks the ability or motivation to think critically appears to be buying into this fallacy.

I think Slate's Dahlia Lithwick nailed it when she pointed out that, “This case isn't so much about freedom from government-mandated broccoli or gyms. It's about freedom from our obligations to one another. . . It's about freedom to ignore the injured, walk away from those in peril. . . It's about the freedom to be left alone.”

During Tuesday's oral argument, Solicitor General Donald Verilli argued that health care is different from other markets because we don't just let sick people die. “(G)etting health care service,” he said, “[is] a result of the social norms to which we have obligated ourselves so that people get health care.”

To which Justice Scalia replied, “Well, don't obligate yourself to that.”