In some ways, politically, this may have been what the president and Congress wanted, but couldn’t get. They feared making the mandate a tax back when they were passing health care reform. That was because “tax” is a four-letter word in American discourse. So instead, they made it a penalty. But the court decided it was a tax anyway, meaning that Democrats got their desired outcome without having to make an undesirable argument.
Since the mandate is constitutional under taxing power, the other arguments related to it went away. The court did not have to rule on the regulations, and that means the other parts of the ACA that deal with insurance and the exchanges were left untouched. The “doughnut hole” remains, the cost-control measures remain, and so does everything else.
Healthcare Reform is Far From Over. Regardless of your political persuasion, there are many reasons not to celebrate. The truth of the matter is that our health care system is still a mess. At last count, there were about 50 million Americans who lacked insurance for all of last year. More than 7 million of them are children. Millions more lacked insurance for part of the year. Millions more are underinsured, meaning that illness could still ruin them financially, if they can afford treatment at all. Yes, the ACA will reduce that number, but not to zero. More than 20 million Americans will likely remain uninsured.
Even if you have insurance, access is still terrible. Almost 20% of people in the United States report having to wait six days or more if they are sick. Fewer people in the United States think that their doctor spends enough time with than any comparable country. Fewer people think their doctor knows important information about them as well.
Our information systems are abysmal. As of last year, only one-third of physicians reported that they have a functioning electronic medical record system that met the criteria for a “basic” system.
The United States still has the highest infant mortality of any nation we’d want to compare ourselves to. If you think infant mortality is rigged, then you still have to acknowledge that we have the highest maternal mortality. That’s right — more mothers die in childbirth every year in the United States than any other comparable country. The mortality rates for a host of diseases are shockingly high.
We have fewer doctors per population than any other comparable country. We have fewer hospital beds per population than any other comparable country.