Inquirer Editorial: Health-care reform isn't going to die

Posted: November 20, 2011

Judging from opinion polls, millions of Americans must be eager for a showdown at the U.S. Supreme Court over the key, but unpopular, provision of the landmark health-care reform law that calls for a special tax penalty on anyone who doesn't have health insurance.

Yet, this could turn out to be one of those situations where one has to be careful with one's wishes.

The law's critics could come to regret it if the court's decision last week to review the issue leads to its reversal of other provisions of health-care reform that are not only widely popular, but needed.

Reforms already put in place under the Patient Protection and Affordable Care Act have had sweeping impacts: There are one million more graduate-school-age adults with health insurance. Gone is the hated practice of insurers jettisoning people once they become ill. Regular checkups don't come with a co-pay, and 85 cents of each premium dollar has to go toward health care - not executive pay and perks.

But even if the Supreme Court says the federal government cannot require individuals to have health insurance, effective health-care reform can proceed.

Indeed, it's pretty much unstoppable - given the fact that there's really no debate that the nation's $2.5 trillion health-care system faces collapse if not reformed to lower costs, improve quality, and expand patient access.

And what, really, is the mystery about the fact that the so-called individual mandate polls so badly? In part, that's no doubt due to the drumbeat of partisan criticism from an unprecedented coalition of Republican governors and attorneys general in 26 states, including Pennsylvania, that challenged the requirement in the courts.

As for the legal challenge, the GOP onslaught hasn't done all that well. Two appeals courts have upheld the insurance requirement, and only one struck it down. A fourth ruling took the entirely reasonable stance that it's too early to challenge the measure, since no one will pay a penny in penalty until the 2015 tax returns are in.

While the high court's conservative bloc has shown no hesitation in issuing activist rulings that have political ramifications, the court must concede that it's not a novel idea to use tax rules to shape societal behavior. The IRS code already encourages marriage, charitable giving, and retirement and health-care savings. Why not use it to encourage a healthier citizenry?

What's more, if the mandate did not exist, someone would have to invent it - or some similar mechanism. Insuring most people is the only way to share costs and, thus, make coverage more affordable and available to 32 million citizens now going without health insurance, at the risk of serious illness and even premature death.

Given a chance to craft a health-care reform that would confront the crisis of the uninsured, GOP lawmakers offered Band-Aids. Just as the Supreme Court must disregard polls, it should not aid partisan efforts aimed at slowing reforms critical to the health of the nation.

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