As far as I can see, the Supreme Court Decision on the “Affordable Care Act” (ACA) made no improvements to that flawed law, but it provided distractions from the ugliness of ACA.   

First, the Court decision changed the name of the penalty for non-participation from a “fine” to a “tax” – the kind of trivial labeling change that can boost politicians’ egos.   On the other hand, consumers will fixate on how ACA changes their experience of health care and its hit on their pocketbook.   For unwilling participants, any distinctions between “tax” and “fine” are irrelevant.  The Court decision left the coverage premium unaffected and it will be stratospheric except for those whose votes are bought through huge subsidies.

Second, the Court blocked the federal government’s plan to vindictively withhold all Medicaid funds from states that refuse to expand coverage to 16 million low-income non-elderly people.  The federal subsidy is incomplete and unreliable for the out-years, so 17 states say they may not comply with the expansion

ACA remains fatally flawed.  Instead of first containing costs and then expanding coverage, ACA just expands coverage and commandeers “someone else’s money.”  The keys to containing costs within the system are obvious; require use of electronic health records, let doctors advertise and require them to post prices, use more paraprofessionals, set deductibles that make all consumers more price sensitive , rein in malpractice lawsuits, and tie patent protections to fair drug prices in the U.S.  

The U.S. health system already stands at 18% of GDP.  Fed Spending is near 23% (one quarter for healthcare).  So, ACA places a total of 35% of GDP under federal control – a doubling of federal pocketbook power and more intrusion than most want from government.   The 35% does not include state and municipal spending on health care – which is sometimes behind their bankruptcy (e.g. Stockton, CA) and deep budget deficits.

The take home lesson for consumers is: ignore the nattering “experts” on Supreme Court decisions.  Instead, focus on healthcare quality, cost containment and who bears the cost (i.e. the names of real people who’ll pay – “government” is a delusional answer). 

Alan Daley is a retired businessman living in Colorado and who focuses on public policy from a consumer’s perspective.