James Anderson writes from Washington: The most relieved person in this town is President Barack Obama. The US Supreme Court has just ruled that his Patient Protection and Affordable Care Act –dubbed Obamacare – is constitutional. But only just: by five to four.
Chief Justice John Roberts then caused surprise by calling the bill a tax, contradicting the President who has been insisting all along that it was not a tax. Going through the Senate and the House of Representatives it was never dubbed a tax. The significance of this is that since it is a tax, the citizens of America can decide to vote for or against it. It is no longer up to the Supreme Court to rule on it. By implication, the way to kill Obamacare is to oust the President from the White House. It was no surprise that $3.2 million poured into Mitt Romney’s war chest immediately the judgement was made known. Mr Romney, so that you know, promised to ban the legislation if he wins.
The four dissenting US Supreme Court judges were ferocious in their condemnation of Obamacare. They found the ‘entire Act before us invalid in its entirety’. Congress has no business forcing Americans to buy health insurance. It is up to the individual to choose. As a result, the arguments in favour are ‘feeble’. Despite this, Congress can tax Americans if they do not. The Inland Revenue Service (IRS) will penalise them if they do not. So the 30 million Americans without medical insurance will now be obliged to acquire some.
Medical care already consumes 16 per cent of US Gross Domestic Product. This is over double what the National Health Service costs the UK taxpayer. Even Democrats accept that Obamacare will increase the cost of health care for patients, employers and the government. An insurer cannot cancel insurance if a patient becomes seriously or terminally ill. This will put up the cost of insurance.
Obamacare will become a federal law. This means that once enacted, it will be very difficult to remove it. Congress and all fifty state legislatures would have to repeal it. Hence it is highly unlikely that conservatives would be able to remove it from the statute book.
America is enacting universal medical care at a time when European governments are realising that they cannot afford present welfare budgets. Spain is showing the way. Prescriptions now have to be paid for in, for example, Catalunya. However, those who cannot pay are exempt. The austerity being forced on many EU governments will lead to a cutting back of welfare, including health budgets. So America is bucking the trend. At a time when its budget deficit is soaring, it is planning to increase it. The poor and unemployed in the US cannot afford to pay for medical treatment. Where is the money to come from to pay for medical insurance? The answer is quite simple. The better off will have to pay. President Obama has made much of his pledge not to increase taxes for those earning up to $250,000 a year. He has just broken that pledge. The only way for the middle classes to stop their taxes increasing is to eject Obama from the White House in November. Will they decide it is their moral duty to pay for the less fortunate or will they rely on self-interest? Only time will tell.