Schultz commentary: However court rules, health system still sick

If the Supreme Court this week kills or mortally wounds the federal health care law, Gov. Scott and Florida Attorney General Pam Bondi will go into a victory dance. Here is what they will be celebrating:

  • A health care system that in 2008, according to the Commonwealth Foundation, spent roughly $7,500 per capita – about 50 percent more than the next highest-spending countries, Norway and Switzerland;
  • A health care system that, for all the money we spend, produces lousy results. In 2000, according to the Atlas of Global Inequality, life spans in Cuba and the United States were roughly equal. Yet we spent 25 times more than the Cubans;
  • A health care system that consumes roughly 18 percent of gross domestic product, and in which costs for employers have increased 113 percent since 2001, according to the Kaiser Family Foundation. Those higher costs have forced companies to drop coverage or charge employees more for less;
  • A health care system in which an estimated 75 percent of the costs go for chronic diseases, which are better managed by lower-paid family physicians than higher-paid specialists;
  • A health care system that, according to a 2010 Commonwealth Fund study of 12 industrialized nations, stood out for insurance problems and income disparity.
  • A health care system that, according to the Gallup Wellbeing survey, left nearly 17 percent of adults uninsured in 2011. The rate in Florida was even worse — 22.6 percent, or fourth highest.

Yet Gov. Scott and Ms. Bondi have joyfully led Florida's fight against the Affordable Care Act, known to critics as "Obamacare." One of the many ironies in this debate is that the law looks little like what Mr. Obama proposed as a candidate. He wanted to start on health care reform by covering children, and favored a public option.

However the court rules this week, news coverage will emphasize the politics. Spinners will work overtime. If the court upholds the law, President Obama and Democrats will proclaim it a great day for progress. If the court rules the other way, Republicans will proclaim it a great day for freedom from government tyranny.

In other words, the reaction will be partisan. Which brings us to another irony: the law is bipartisan.

The much-reviled individual mandate and the exchanges – government-supervised marketplaces in which health insurers compete for business from individuals and small business that don't have the size to bargain? Those are Republicans ideas from the health care debate of two decades ago.

A conservative think tank devised the mandate, for the very sensible reason that a private insurer-based system needs everyone paying into it. One segment of the uninsured is the voluntarily uninsured, who claim the "freedom" to freeload on everyone else. Revenue from the mandate finances popular parts of the law: companies can't deny coverage based on preexisting conditions, and parents can keep children on their policies until age 26.

As for expanding Medicaid to cover many of the involuntarily uninsured, that's a Democratic idea. Medicaid was part of Lyndon Johnson's Great Society program of the 1960s. Under the law, the federal government would provide 90 percent of the cost for Medicaid expansion.

Gov. Scott and Ms. Bondi call the Medicaid expansion an unfunded mandate, even though state participation in Medicaid is voluntary. The catch: If a state doesn't participate, it doesn't get the federal money, and must figure out how to finance health care for the poor. If Gov. Scott and Ms. Bondi lose on that point, will they want Florida to leave the Medicaid program?

However the court rules, what happens at the polls will matter less than what happens in doctors' offices and hospitals. If the law stands, its major provisions don't take effect until 2014, so whoever controls Washington will have to make the law work. If the law falls, whoever controls Washington will have to find an alternative.

Any alternative would have to be bipartisan. With luck, it would not be the bipartisanship that prevailed four months ago in Tallahassee.

Legislators – part-timers all — refused to end their cheap, taxpayer-subsidized health insurance. Republicans looked hypocritical because they call the federal law a "government takeover of health care." Democrats looked hypocritical because they criticize unfairness in the health care system.

Our national health care system resembles Florida's education system: more about tests than results. No celebrating until we find a cure.

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