A Healthy Dose of Reality

Suddenly, the press, fresh from a near-consensus that the Supremes would find Obamacare constitutional, is abuzz with the news that Justice Kennedy frowned, or something. As Jeffrey Toobin writes, "All of the predictions including mine that the justices would not have a problem with this law were wrong."

So be it. Having read a big chunk of the 2,000-plus pages of this law, I won't be able to muster much grief at its demise.

Besides, there is an obvious solution for the President, should he wish to avail himself of it. A couple of simple rules would suffice.

First, reduce Medicare support for hospitals providing charity care. Cover only palliative care --the relief of pain and the mitigation of damage that would prevent discharge of a patient: fix broken legs, provide antibiotics. No heart operations, no cancer treatment, no dialysis.

Second, allow insurers to impose a two-year waiting period on anyone applying for new coverage.

Both these rules would probably require nothing more than executive orders. And I can promise that the free market that everyone loves so much --the big insurance companies-- would be only too happy to abide by the two-year rule, given the requirement that they accept all comers.

Assuming the Supreme Court leaves the law intact, except for the hated individual mandate (not necessarily a safe assumption, given the ideological underpinnings and political motivations of this Court), the government could still provide subsidies for the low-income newly-insured.

Cutting the hospital subsidies for charity care would remove a major incentive for tax-exempt hospitals to retain their tax exemptions, with all those odious anti-inurement rules; so there may even be an upside to states and municipalities who could begin putting these huge organizations with their enormous physical plants onto the real estate tax rolls.

Now, many people, seeing the impossibility of enrolling later if they did not enroll now, would probably sign up for insurance; even healthy twenty-somethings who are sensible would do that. But inevitably lots of people would remain without coverage. It would take a few years of horror stories for the message to get across: no, we won't let you die in the street. You can die at home, with morphine, but not with Avastin, or dialysis, or a bypass operation that you cannot pay for yourself. So you might want to think about getting coverage before you need it --because by the time you need it, you won't be able to get it. And no more Emergency Room admission when you're feelin' poorly.

Sorry. It's a tough world. But it's the one you voted for.

Of course, an awful lot of people might flock to Massachusetts.
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