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SCOTUS v. Obamacare: The Hidden Ironies

SCOTUS v. Obamacare: The Hidden Ironies

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With the Supreme Court poised to issue its ruling on “Obamacare” any day now, many of us find ourselves wondering whether our nation’s highest court will interpret our Constitution in such a way as to actually make it MORE difficult for this country to achieve what virtually every other industrialized nation already guarantees as a fundamental human right: universal access to quality affordable health care.  This is a huge irony. Whereas other nations’ highest courts serve as the bulwark against their government’s attempts to deny or injure fundamental human rights, the debate in America is the obverse.  In the name of divining the elusive limits of a somewhat obscure constitutional doctrine (the Commerce Clause), our Supreme Court may actually operate to prevent our federal government from finally achieving the goal of bringing America fully into the family of civilized nations.  American Exceptionalism indeed.

Fundamental Drivers of Poor Health

A second enormous irony is that even if the Supreme Court upholds the core provisions of Obamacare and the program proceeds towards full implementation, the health of Americans will likely continue to deteriorate, particularly that of low income Americans, because the fundamental drivers of poor American health are only indirectly addressed by Obamacare. The so-called social determinants of health (poverty, racism, education, employment, segregation, etc.) are the central factors contributing to the chronic stress load of poor Americans. They ultimately cause the chronic disease epidemic that is bankrupting us.

Even the best health care cannot remediate the ravages of a lifetime of poverty and social exclusion. You can’t treat social ills with pills. Nevertheless, this has been our approach. So many aspirations of progressives are tied up in the fate of this imperfect vehicle called Obamacare.  At its core, though, Obamacare further entrenches our sclerotic “sick care” system, which has been designed and presided over by insurance companies, pharmaceutical conglomerates, medical device manufacturers, and hospital corporations. This is not the system that we would have constructed were we to start from scratch. Instead, this is a hobbled compromise built by polarized ideological politics and moneyed interests. It will ultimately topple under the weight of its inefficiencies and spiraling costs. The only question is when.

A Social Compact on Healthcare

However, apart from these two monstrous ironies, and assuming the Supreme Court does not, in a fit of extreme petulance, strike down and eradicate every conceivable vestige of the Affordable Care Act, there is some very good news that will slowly become apparent soon after the Thursday’s ruling.  Obamacare will irrevocably change our country because it represents, for the first time in American history, a comprehensive social compact on healthcare for virtually all Americans.  This is a real game-changer. 

To recognize the impact, one has to understand a body of research that has examined the health consequences of social exclusion and isolation. To be uninsured in America is to be socially excluded. In human beings, social exclusion causes a profound psychological burden that produces measurable adverse health consequences. The lack of security that is fostered by being excluded from the system of health insurance can harm a person's subjective sense of well-being, as well as his or her intellectual achievement and immune function. 

The opposite of social exclusion is social connectedness or belonging.  A growing body of research indicates that a sense of belonging can have profound positive health effects. Obamacare, by dramatically altering the American social compact on health care, will create a sense of inclusion and belonging among a class of Americans who for too long have felt excluded and vulnerable by virtue of being uninsured.  Believe it or not, that will have measurable health effects on up to 50 million Americans. No matter what happens this Thursday, America will be changed irrevocably. The only bit of unfinished business, in this regard, is extending that social compact to new immigrants who are still excluded in the Affordable Care Act.


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Thanks for your informed analysis of the SCOTUS action on ACA. More people need to understand the value of true social integration and inclusion, so that we can build a stronger society. There are numerous health benefits for the individual, and by being more expansive in provision of care to all, we help prevent a great number of stressors that contribute to interpersonal violence and other crime. We also can take advantage of the fulfillment of human potential, and have more creative, productive systems and economies. A healthier society eventually becomes a more peaceful and fruitful society - I hope!


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