The Supreme Court, Health Care and the Current Political
By Nick Unger
Published by portside
March 30, 2012
Did you see the article on the Internet that the Supreme
Court could decide to throw out the ACA and instead
impose single-payer? It said it was "Supreme Jury
Nullification." Somebody else wrote they heard that if
the Court declares the ACA unconstitutional then
Congress gets to have an up or down vote on Medicare For
All. Then there were all the comments saying this was
all a fantasy and absolutely not true.
I made this up, but something rather like it really is
going on. Many are seeing the Supreme Court hearings as
Single Payer v. ACA. A more appropriate name for it is
1% v. USA or perhaps Radical Right v. American
Democracy. These at least place the case in its
political context rather than treating it mainly as a
health policy debate.
There is no need at this moment for another movement-
wide policy debate between single payer and the ACA. The
health care justice movement has long called for quality
affordable care for ALL. The ACA does not go that far,
and so it is appropriate to point that out. Just as the
benefits are real the shortcomings are real. It would be
a shame if defense of the ACA against right wing assault
and being proud of the steps forward for women, for
young adults, for those hurt by pre-existing condition
loopholes and many more were accompanied by leaving out
what every part of the movement has always believed in:
health care justice for everybody and we won't stop
until we get there.
Those who say it might even be better for universal
health care if the ACA was thrown out, or say that the
decision will not change the fact that we will still
have to continue to fight appear to me to fundamentally
be talking politics more than health care. A respectful
discussion, not a debate, over different assessments of
the current political landscape is therefore
appropriate, even more so if it can be conducted with
building unity in mind rather than scoring points. What
follows hopefully follows that path.
Supreme Court case is part of bigger battle for future
I find it helpful to see the court case as part of a
fierce and vital battle over what kind of country we are
going to be. There is a powerful, organized, well-
financed assault on the modern (post 1929) state and on
the advancements in democracy over the past century.
Destruction of the structures for the social
distribution of a portion of society's wealth developed
in the Depression, and then even more after World War
II, has long been a goal of corporate leaders, and their
political organizations have never been quiet about it.
Prop 13 in California was 35 years ago. It was an
outlier then, but not any more. Grover Norquist talked
about shrinking government to the point where he could
drown it in a bathtub years ago. The once hidden
centers like the Koch Brothers and ALEC are now open for
all to see.
The 1% don't want any wealth distributed socially, and
they don't want any government obstacles standing in
their way of taking it all. They have a head of steam
and are not deterred by occasional setbacks or stumbles.
· The shocking attempts to restrict the right to
vote are part of it. For those my age this is
unthinkable. It took 100 years from 1865 to 1965 to
create a semblance of universal suffrage. That very
structure is being battered. Voter ID is the 21st
century Poll Tax.
· The Citizens United declaration that
corporations are people and can directly spend money on
elections is part of this. The ruling says unions can
do the same. Alas, corporations can spend all they
want, while unions can spend all they have. This means
it is easier for corporations and harder for real people
to be engaged politically.
· The nationwide bi-partisan campaign against
public education and public libraries, key components of
modern democracy, it part of this full court press
against modern democracy.
· The direct legislative attacks on public sector
unions are part of it, as well as the coordinated right-
to-work drives in the Northeast and Midwest.
· The court ordered end of gun control laws is
part of this. Even more, their replacement with Stand
Your Ground (License to Kill at Will) Laws.
· The attempts to remove all government regulatory
agencies through legislation, court challenges or
defunding, and often all of them, are part of this.
The list could go on, and others are urged to help
socially construct a fuller description of what is
It is useful to see that the Supreme Court battle over
the ACA is part of this attempt to delegitimize the
modern state much more than a discussion over the best
way to carry out health care reform. Ten or fifteen
years ago it would have been unthinkable. Every element
of the ACA would have been seen as a good or bad
political decision, not a constitutional challenge. The
mandate was one way among many to do things that all
knew had to be done. No Medicaid expansion has ever
been challenged in this manner. But that was all before
the corporate - right wing felt they had to power for a
full-scale attack on all fronts. That the nature of the
Medicaid, as defective as it is, is facing its biggest
test of legitimacy since 1965 is a sad marker of how far
they have come and how much ground has we have lost in a
relatively short time. The court case provides another
opportunity to shut down the public, social activities
of society in the name of freedom.
In this context, overturning part or all of the ACA can
best be seen as a political victory for the opponents of
universal health care, independent of any analysis of
the ACA. It will be bad news. The struggle will
continue, but under worse conditions.
Union organizers always say that the boss is the best
organizer. And we all say that where there is
repression there is resistance. I think there is more
than enough repression around right now, so much that we
don't need any more to come together in resistance.
Nick Unger is a veteran labor and health care activist
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