President Barack Obama planning to fail!
Vanam Jwala Narasimha Rao
After the recent finding of US economy under fire a fortnight ago, pushing it to a near bottom place in the list of economically strong nations, the latest setback was the decision of an Appeals Court striking down as unconstitutional the national health care law mandate that nearly every American buy insurance or face tax penalties. Two out of the three Judges made clear that lawmakers cannot force residents to “enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”
For Obama the Health Care Law was not only prestigious but also one of the significant legislative achievements. Until the US Supreme Court which opens its next term in October takes up the issue, the have-not American may relax. The Appeals Court’s ruling differed with the federal appeals court in Cincinnati that upheld the individual mandate about a month ago. In fact several lower court judges have also issued differing opinions on the debate. More than two dozen legal challenges were filed against the law since Obama signed the measure in March 2010.
President Barak Obama was able to muster just 218 votes (out of 435 ) needed to pass the controversial Health Care Legislation in the House of Representatives in 2009. At that time some of the House Democrats openly declared that they would oppose the bill along with Republicans and vote against. Obama threw all his official and personal weight against the lobbying effort to defeat it. The division on the so called historic reform was a total vertical and horizontal with all the Obama like minded democrats on one side and the rest-majority of whom are the Republicans-on the diagonally opposite side.
The Democrats were able to introduce the legislation in the Senate and could overcome its first major obstacle. The normal American precedence of Senate conducting its business through unanimous consent was absent in this case which was evident with the 60-39 (out of 100) procedural vote. After 24 days of debate and months of bitter political wrangling, Senate voted the most significant American social legislation. When the Senate approved it boosted Barack Obama on the 2010 New Year eve.
After the vote Obama said that ever since Roosevelt first called for reform in 1912, seven Democrat and Republican Presidents took up the cause and all such efforts were blocked by special interest lobbyists for the insurance industry. He concluded that "with passage of reform bill, we are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people."
The health care law subjected to frequent criticisms by Republican presidential candidates and members of Congress, is intended to insure 32 million Americans, bring in subsidizing policies for the poor and requiring insurers to accept people with pre-existing health problems. On hearing the Court’s decision of striking down it as unconstitutional, the White House and the Department of Justice said they were confident that the law was constitutional.
I was on a visit to the Unites States when the Health Care Reform process was initiated by President Barack Obama, was extensively debated and passed. The extensive coverage in news papers and campaigns by power groups, self professed opinion makers was unparalleled. I noticed that, as the debate moved to the floor of House of Representatives, later to the senate, most of the “forward-looking” initial proposals were either diluted or were missing in the final draft bill gone to both the houses. Lobbying by Doctors, Hospitals, Insurance Houses and other Health Care Providers, with typical pressure tactics changed the not only the content but also the prospects of progressive such a proposal.
The Medicare measure of Obama was undoubtedly laudable. When implemented it would take care of millions of uninsured including the senior citizens. The bill was introduced as ‘‘Affordable Health Care for America Act’’ in the House of Representatives and as “Patient Protection and Affordable care Act” in Senate. It was always emphasizing “Affordability” rather than “Availability, Accessibility and Acceptability”. It aimed at providing more security and stability to those who have health insurance, insisting on insurance to those who do not, and lowering the cost of health care for US families-businesses-government. The emphasis everywhere was on “affordability, costs, insurance and business”. Despite insurance except for emergencies for the rest of health problems, even now, it becomes a herculean task to attain “Availability and Accessibility”. Hence Acceptability is missing. Health Care facility of patient’s choice which is important is absent now and even when the reform takes off after three years if Supreme Court upholds the legislation.
The most significant feature of US Health Care is that, regardless of insurance status, everyone in need of urgent medical assistance is legally guaranteed to receive it. The US Emergency Medical Treatment and Active Labor Act (EMTALA) require hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. Patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.
How the US Supreme Court would decide is a wide open question. It might strike down the entire law, or just few provisions. The individual insurance mandate may be agreed or rejected. The current court judgment in a way suggests any ruling against the law would only touch the part of every American buying Health Insurance.
More and more such unpleasant decisions against Obama mean that it is entirely he and he alone who is to be made responsible for planning his own failures.
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