Watch Democracy Now! Special: Supreme Court Upholds Healthcare Overhaul, Individual Mandate
A one-hour Democracy Now! special broadcast hosted by Amy Goodman, covering the U.S. Supreme Court’s landmark decision on the Patient Protection and Affordable Care Act. Chief Justice John Roberts was the swing vote in upholding the Act, joining Ruth Bader Ginsburg, Sonia Sotomayor, Elena Kagan and Stephen Breyer. From outside the Supreme Court in Washington, D.C., to New York and around the country, we get reaction from filmmaker Michael Moore, health insurance industry whistleblower Wendell Potter, Georgetown University law professor David Cole, Elisabeth Benjamin of the Community Service Society of New York, Rep. Keith Ellison (D-MN), Dr. Margaret Flowers of Physicians for a National Health Program, Hilary Shelton of the NAACP, Russell Mokhiber of SinglePayerAction.org, and Karen Higgins of National Nurses United.
Tune in on Friday for more analysis on the historic ruling.
AMY GOODMAN: From Pacifica, this is a Democracy Now! special. Live from the Supreme Court in Washington, D.C., from New York and around the country, we are moments away from learning whether the court will overturn President Obama’s landmark healthcare law in part, in full or not at all. We’ll speak with filmmaker Michael Moore, with attorney David Cole, with insurance industry whistleblower Wendell Potter, Dr. Margaret Flowers of Physicians for a National Health Program, Elisabeth Benjamin of the Community Service Society of New York, and others. All that and more, coming up. Welcome to Democracy Now!, democracynow.org, this Supreme Court special. I’m Amy Goodman.
Yes, the Supreme Court is moments away from issuing its decision on the constitutionality of the Affordable Care Act, the landmark healthcare reform bill signed by President Obama two years ago. The case heavily focuses on the so-called "individual mandate," which requires most people buy health insurance by 2014 or pay a tax penalty. The court will decide whether to strike down the mandate and determine whether the rest of the law can stand.
Coming on the last of the Supreme Court’s term, the ruling will have major implications not just for the nation’s healthcare system but also the 2012 election race and beyond. Republican presidential candidate Mitt Romney has called for the law’s repeal despite its similarities to the mandate-based healthcare measure he oversaw as Massachusetts governor.
Progressive legislators are launching a campaign today to push for single-payer legislation if the court strikes down the law. Seventy-five members of the Congressional Progressive Caucus have signed onto a bill by Congressmember John Conyers to create a single-payer, publicly financed, privately delivered universal healthcare program. Single-payer activists are gathering on the steps of the Capitol, as well, calling for Medicare for all.
In a moment, we are going to the Supreme Court. We’re joined by Georgetown Law Professor David Cole, legal correspondent for The Nation, in Vermont. But I just want to get a sense of the scene of outside the Supreme Court. Let’s turn right now to Democracy Now!’s Renée Feltz.
Renée, can you describe what you’re seeing around you outside the Supreme Court?
RENÉE FELTZ: I certainly can, Amy. We are, as you said, minutes away, really—seconds, possibly—but really minutes away, and the nation is waiting with bated breath to see what the Supreme Court justices are going to decide about Obama’s keynote legislation of his administration: his healthcare reform bill.
Outside the Supreme Court on the steps, it’s quite a crazy scene. We are seeing hundreds and hundreds of protesters. They’re all kind of gaggled together. But what we do see when you start to parse the mix are you see students who are here, who have said that they’ve come all the way from places like Louisiana, afraid of losing their healthcare under their parents’ health insurance.
I’ve seen many nurses with the organization National Nurses United. And as you know, they’re health practitioners, and they say that one of the reasons they’re here and that they hope that the Supreme Court upholds this—parts of this bill is because they see patients coming into their emergency rooms who have waited 'til the last minute to get treatment, because they don't have healthcare.
I also met an artist here who tried to profile people who had different problems with their health insurance and lack of healthcare and was, in that process, moved to become an activist. And she’s out here today protesting.
Many of the organizations you speak with are not really taking a stand one way or the other on what some would call "Obamacare." They’re sort of parsing out some things they like about it, some things they don’t, so you get some mixed messages on that.
I should note that there is also a sizable contingent of pro-life protesters here, as they call themselves, who are wrapping into this whole discussion the issue of abortion. So it’s a highly politicized debate here at the nation’s capital—surprise, surprise. And it’s taking place on the steps of the Supreme Court.
Amy, when we come back, we’ll have Dr. Margaret Flowers of Physicians for a National Health [Program] joining us. But that’s the scene here at the Supreme Court.
AMY GOODMAN: Renée, thanks so much.
I want to go up to Vermont, which has progressive healthcare legislation in the state. David Cole is there. He’s law professor at Georgetown University Law Center and legal affairs correspondent for The Nation magazine. He’s in Charlotte, Vermont.
David, thanks so much for being with us. Why don’t you lay out what’s at stake today? Talk about the Affordable Care Act, the Patient Protection and Affordable Care Act, that the Supreme Court is minutes away from issuing a ruling on.
DAVID COLE: It’s a piece of legislation that seeks to ensure that everybody can get healthcare in the United States, and it does so by guaranteeing that people can buy healthcare and can’t be discriminated against based on pre-existing conditions. But then it also says that those people who can afford to buy healthcare insurance must buy healthcare insurance or pay a tax if they choose not to. The reason for that is that if you ensure that people can get healthcare without discrimination based on pre-existing conditions, there’s an incentive for people to become freeloaders or free riders and wait until they get sick and only then buy insurance. So the scheme says, we’re going to make sure everybody can get healthcare, but then we’re going to also make sure that people can’t be free riders by waiting until they get sick to purchase the healthcare.
And the principal question before the court is whether that requirement, that people who can afford to buy healthcare must—health insurance must buy health insurance, is constitutional under the Commerce Clause, which gives Congress the power to regulate interstate commerce, or the Necessary and Proper Clause, which gives Congress the power to enact laws that are necessary and proper related to their affirmative powers to regulate commerce.
AMY GOODMAN: We’re going also to the Supreme Court, just outside, where Margaret Flowers is standing by, among many single-payer activists. She’s a pediatrician. She’s president of Physicians for a National Health Program. She was arrested in a very raucous Baucus caucus. What I mean by that is it was Senator Max Baucus of Montana who, as the legislation was being considered, when the panels were being held and no single-payer representative was there, she stood up in that hearing room, and she was taken out by security.
Dr. Margaret Flowers, you’re on the steps of the Supreme Court today. As David Cole describes what the legislation is and as the decision is just about to be handed down, where do you come down?
DR. MARGARET FLOWERS: Well, it’s so interesting to hear David Cole using these progressive talking points defending the law, because too much of what’s going on here is about politics and not about health policy. I was with a group of physicians and lawyers who filed an amicus brief to the Supreme Court, asking them to find the individual mandate unconstitutional. We do not believe that it’s right to force people to purchase a private product, especially when that product is defective. When people have private insurance, they still can’t afford to get healthcare, and they still go bankrupt when they have a serious accident or illness. Private insurance is the problem. We don’t want to further privatize our healthcare. The simplest way to address our healthcare crisis is through Medicare for all.
AMY GOODMAN: And what about the decision? If they strike down, for example, the individual mandate, do you consider that a victory, or do you consider that a problem for healthcare in this country?
DR. MARGARET FLOWERS: We would like—yeah, we would like to see the individual mandate struck down. It’s not constitutional. We’re spending $447 billion of our taxpayer dollars to give them directly to a private industry. It’s a corporate welfare on steroids. This bill does help people, and we don’t oppose expanding Medicaid. We don’t oppose trying to regulate insurance. We don’t think that’s going to work. We know that those are not solutions. We believe that every person in this country should have healthcare. Why are we debating these little tiny things—who gets a little bit more, who doesn’t get a little bit more? The conversation we should be having is about what works and what doesn’t work. We’re already spending twice as much as the other industrialized nations per person per year on healthcare. We are paying for lifelong, high-quality comprehensive healthcare; we’re not getting it, and we’re not going to get it until we go to a Medicare for all. That’s the simplest solution.
AMY GOODMAN: We are just getting word from the SCOTUSblog—that’s the Supreme Court blog—that the individual mandate has survived as a tax. The individual mandate has survived as a tax.
Elisabeth Benjamin is vice president of the Community Service Society in New York, one of the leading healthcare advocates in this country, awarded the Families USA Consumer Health Advocate of the Year award. What about this news? What does it mean?
ELISABETH BENJAMIN: It’s in—I mean, it’s incredible. It means that, you know, 30 million Americans will gain coverage come 2014. You know, sorry, it’s something I’ve been fighting for all my life, so it’s quite something.
AMY GOODMAN: Now I should say that CNN, as opposed to SCOTUSblog, is saying exactly the opposite.
ELISABETH BENJAMIN: Oh, no.
AMY GOODMAN: So we’re going to—we’re going to just keep on reporting to you—
ELISABETH BENJAMIN: That’s a little—
AMY GOODMAN: —what others are reporting until we actually get the news.
ELISABETH BENJAMIN: OK. So, if the law were upheld, which we don’t really seem to know yet one way or the other, it will mean that 30 million people that have no health insurance right now will get coverage. But as importantly, for those of us who do have health insurance—and, honestly, I defy anyone right now to go out and say, "Oh, I don’t want health insurance. I’m going to hope that we get Medicare for all." I mean, in the meantime, we have to actually deal with the system and the reality we have. You know, as much as we may not prefer that reality, that’s the reality many of us have.
We get—right now in America, hundreds of—you know, hundreds of millions of people get health insurance through their jobs. So, those of us who have health insurance through our jobs will now benefit from incredible—are right now already benefiting from incredible protections. We have the right to appeal. We didn’t used to have the right to appeal. We have free preventive care. We didn’t used to have the right to free preventive care. The insurance industry used to be able to say you have a lifetime cap on your insurance coverage, so if you had—needed a transplant, you wouldn’t be able to get it, because you had hit your lifetime cap or your annual benefit cap. So all of those things mean a lot to, you know, everyday Americans. And—
AMY GOODMAN: I want to just report, as your speaking, Elisabeth Benjamin, again SCOTUSblog is saying the mandate is constitutional. Chief Justice Roberts joins the left of the court. This is what’s coming from SCOTUSblog as we speak. But, Elisabeth Benjamin, isn’t it true that tens of millions still are not covered?
ELISABETH BENJAMIN: Well, in 20—well, right now, yes, it’s true, because the health reform hasn’t actually been implemented yet. And at some point I think we should talk about what’s it all mean and how it works, because I think there’s still a lot of confusion about it. But even after the Affordable Care Act is—
AMY GOODMAN: I’m going to interrupt one more time.
ELISABETH BENJAMIN: Sure, sure.
AMY GOODMAN: SCOTUSblog will be continuing to update people as the court—the information trickles out of the court. The Medicaid provision is limited but not invalidated. Elisabeth?
ELISABETH BENJAMIN: Medicaid or mandate?
AMY GOODMAN: It says the Medicaid provision is limited.
ELISABETH BENJAMIN: No, I mean which should I talk about? Medicaid.
AMY GOODMAN: Talk about the mandate.
ELISABETH BENJAMIN: That is really tricky. I think that was—it was a big surprise for most legal observers that the court took the Medicaid provision. What the Medicaid provision does is expand Medicaid. In New York—some progressive states had already done so. Quite a few, actually, had already expanded public coverage for many of their families. And many states had not. So, many states had Medicaid only up to 25 percent of the poverty line, which is something like $3,000, $5,000 a year. That was almost impossible for most people to get onto coverage in many, many states.
Now, what this means is that there will be a federal baseline for Medicaid coverage, 138 percent of poverty, which is around $15,000 a year, is not a lot of money. But people who are very poor would have some guaranteed level of coverage. That means coverage for 16 million Americans come 2014. What was before the court was whether the federal government had the power to essentially say, "Look, we’ll underwrite this. We’ll pay for 90 percent of the cost of expanding Medicaid in your states, but you have to come up with 10 percent." And that’s what many states objected to. They perceived that as being bribery. But we do not, because we know it means for life—what it means to the real lives of real people.
AMY GOODMAN: David Cole, Dr. Margaret Flowers was saying you’re using progressive language to talk about legislation, that looks like, at least at this part, SCOTUSblog is saying, the bottom line, the entire ACA, the entire Affordable Care Act, is upheld, with the exception that the federal government’s power to terminate state’s Medicaid funds is narrowly read. David Cole, put that in English and then respond to Margaret Flowers’ criticism.
DAVID COLE: Well, in English, it means that the bulk of this law will be in effect. And we have the best we could get from the Congress that we had when we were seeking to get universal healthcare coverage. And Ms. Flowers is correct. It’s not a single-payer system. And a single-payer system, many people think, would be better. But, of course, that was politically unrealistic. And what the Obama administration was able to get was this scheme, which uses the market but also uses regulation to ensure that everybody can get on, to expand coverage for the poor, and to require those who can afford health insurance to either buy that health insurance and not be a free rider or pay a tax. And it sounds like, from the reports from SCOTUSblog, that the Supreme Court upheld that provision, that individual mandate provision, on the ground that it is a tax. Essentially, it is saying to people, you either do something, buy health insurance, or you pay a tax. And that was one of the arguments that was put forward by the Obama administration in the court as to why the law was constitutional. Congressman—
AMY GOODMAN: It’s so interesting. SCOTUSblog is saying that, largely, the bottom line is the entire Affordable Care Act is upheld, and CNN is still reporting what seems the opposite: justices ruling overturns requirements that Americans must buy health insurance. We’re joined from right outside the Supreme Court right now by Karen Higgins from National Nurses. But Barbara Flowers is still there, as well.
DR. MARGARET FLOWERS: Yeah, sorry, I couldn’t hear.
AMY GOODMAN: Margaret Flowers—
DR. MARGARET FLOWERS: Yes.
AMY GOODMAN: —the news that we are bringing you, it is contradictory. But SCOTUSblog is insisting that the ACA has been upheld, even as CNN says that the mandate has been struck down.
DR. MARGARET FLOWERS: Right. You know, this is not surprising. We called this—
AMY GOODMAN: Now CNN is reversing what they’re saying.
DR. MARGARET FLOWERS: We called this earlier in the week, that if the Supreme Court justices sided with the corporations, as they have been doing, they would find the entire law constitutional, because this law is a corporate bailout for the private industries that are profiting off of our current situation.
And the talking points that you’re hearing are coming from people that are supporting—they’re partisan supporters of this law. Health Care for America Now is the group that Elisabeth’s group belongs to. They’re a front group for the Democratic Party. We’ve got to stop making this political. We’ve got to start talking about the truth. Maybe you’re expanding some coverage to more people. What kind of coverage are they getting? They’re getting Medicaid. That’s very poor coverage. They’re getting private insurance that’s skimpy, that will still leave them bankrupt when they have a serious illness. When we accept working within the framework that is handed to us, we will not get to where we need to be. We must demand that Congress and the White House drop two words from the current Medicare Act, expand Medicare to every person in this country and then improve that. Until we do that, we’re not going to have a universal, high-quality healthcare system in this country. This has got to be about policy and not politics.
AMY GOODMAN: Dr. Margaret Flowers, we—
DR. MARGARET FLOWERS: And I’m so disappointed to hear them.
AMY GOODMAN: Dr. Margaret Flowers, when you say drop two words, those two words: "over 65"?
DR. MARGARET FLOWERS: Right, yeah, drop them. Expand Medicare to every person in this country immediately. Then we will have a universal healthcare system that’s publicly financed, that’s about health. Right now, what we’ve done is we’ve further privatized our healthcare system. We’ve gone in the wrong direction. And if this was passed by Romney, you would have had the same people sitting there opposing it. This is the Romney bill passed by Obama. We’ve got to stop making this about politics. It’s got to be about what’s best for the American people. We have to demand healthcare for every person in this country—
AMY GOODMAN: And, Dr. Margaret Flowers—
DR. MARGARET FLOWERS: —not just a few more.
AMY GOODMAN: Dr. Flowers, just before you go, what is your plan right now? You have Justice Roberts voting to save the ACA. He joins the more progressive elements of the church—of the Supreme Court, and they have upheld this. So what is Physicians for a National Health Program going to do right now?
DR. MARGARET FLOWERS: We’re going to do what we do every single day: we’re going to continue to educate and push for a national Medicare for all. We’re going to continue to advocate on behalf of every person and demand what we—what every other industrialized nation has: a universal healthcare system. We won’t stop until we achieve that.
AMY GOODMAN: Elisabeth Benjamin of Community Service Society, Margaret Flowers is saying your group is part of a coalition that’s just there to support the Democratic Party.
ELISABETH BENJAMIN: Well, we’re a nonpartisan institution. The Community Service Society clearly doesn’t—is not supportive of the Democratic Party, so I—you know, I don’t want to make this personal. It’s not personal. What is—it’s personal to the lives of everyday Americans. The Community Service Society runs a consumer assistance program. We’ve helped 73,000 New Yorkers under the Affordable Care Act in the last 18 months. Those people need health coverage. They don’t want to wait for the day that we can get Medicare for all, although we would all love to have Medicare for all, I’m sure. Right now we have the reality we’re dealt with, and that’s that, you know, real people need health coverage. Real people need to be able to deal with their medical bills. Sixty-three percent of all Americans who are in bankruptcy have—are there because of medical costs.
AMY GOODMAN: Let me go to David Cole for a moment, as SCOTUSblog says—you know, this is the blog on the Supreme Court—calls the money quote: Chief justice’s vote saving the ACA, saying, "Our precedent demonstrates [that] Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it." What that means?
DAVID COLE: Well, the law on the taxing power has long been that Congress can enact a tax for any purpose that it deems to further the general welfare. So, unlike its regulatory powers—Congress’s powers to order the people do X, Y and Z, on pain of going to prison or the like—there Congress has to point to a specifically granted power in the Constitution. And so, many people were saying, well, the power to regulate insurance purchase is a commerce power. But this argument, which the court accepted, is different. It says, because the only consequence of not purchasing healthcare insurance is you pay a tax, then this is actually an exercise of the taxing power, and the taxing power is unlimited in terms of substance. As long as it comes in the form of a tax, as long as the penalty for not doing something the federal government tells you to do is to pay a tax, there’s no restriction on what Congress can do. And so, the court upholds the mandate as an exercise of the taxing power.
AMY GOODMAN: Karen Higgins is standing outside the Supreme Court right now. She’s a nurse and co-president of National Nurses United. Overall, it looks like the Supreme Court, with the support of Chief Justice Roberts, has decided to uphold the Patient Protection and Affordable Care Act, President Obama’s law. Your response, Karen Higgins?
KAREN HIGGINS: Well, I think that—what I think this hopefully does is open the debate once again about, clearly, where are we going with healthcare. This bill is not healthcare. This bill is basically health insurance. It does not cover everybody in this country. There are millions of people that still do not have health insurance. It isn’t, to us, going to make a difference. Some people, you can mandate them to be insured, but if they can’t afford it, if the discussion is, if I need to feed my children and put a roof over my head, you know what? I’m not going to have insurance, if those are going to be my priorities in an economy right now that is just devastating.
So, what we hope is that this will open the door for us to really talk about, as we—you know, a true Medicare-for-all system. We do this for our elderly. We take care of them when they’re over 65. We’ve had this program for over 40 years. It’s very cost-containing. It actually runs well. We think this needs to be expanded out for everyone in this country.
The only ones that are making out, unfortunately, on this bill are insurance companies and drug companies. We still are going to see more and more people that I see coming into the ERs, that end up in ICUs, where I work, because why? They couldn’t afford medications. They couldn’t go to a doctor, because they couldn’t afford it. And these are people that have healthcare. You know, when you look at it with—between co-pays, deductibles, these are a large chunk of change to some people who are struggling every day to make ends meet. So, an opt of not going to a doctor because you can’t afford those costs, you end up in an ICU. This is not acceptable in this country.
So, you know what? This happened, but what we really hope will come out of this is that we will now truthfully have a very strong debate on what is really healthcare in this country and what is health insurance, and what is the best thing for people in this country. And that would be true healthcare.
AMY GOODMAN: Elisabeth Benjamin?
ELISABETH BENJAMIN: Well, I was just going to say that one of the interesting things under the law is that states can experiment, and so those states, like Vermont, that want to move forward with a single-payer system will be able to do so. And we completely support the states’ rights to move forward in single payer, and we expect many will.
But in the meantime, many millions of Americans and consumer health advocates are trying to work with the system that we have. Most Americans get job-based coverage. That’s what they’re comfortable with. And that’s what the court has upheld. And we’re going to move forward and make that system better.
I think the most important thing, though, is for low-income Americans. Thirty million low-income Americans will be able to get free quality health coverage, and we’re really excited about that. And, of course, moderate-income Americans will be able to get tax subsidies that will defray the costs of having coverage.
AMY GOODMAN: What are the other special programs? For example, kids on their parents’ health insurance.
ELISABETH BENJAMIN: OK, yes. One of the things that’s been most popular is three million young adults that have come home—we have a real boomerang generation happening right now. There aren’t a lot of jobs for young people that have good, high-quality healthcare benefits. And a lot of those kids have come back to their parents’ homes, or just come back and started working jobs that don’t have benefits. They’ve been able to be added—three million of these folks have been able to be added to their parents’ coverage, and that has really made a difference in everyday life.
We helped one woman named Megan Schley, who lives in Circleville, New York, and she came home from college last year. She was feeling really sick. She was, of course, uninsured as she started getting a job. She went home. She was feeling very sick. Her parents got tested—her tested. They thought she had cancer. They racked up $10,000 in bills. Turns out she had Crohn’s disease. We were able to get her on this pre-existing health insurance plan, which is a plan that’s been set up that’s a sort of a bridge to 2014 in every single state. Along with 70 other thousand other Americans, she was able to get into this healthcare plan. It covered all the costs of her new Crohn’s medication. And then, on top of that, she was able to, in January, go on her parents’ coverage for free. And that’s made, you know, a profound difference for Megan’s life.
And that’s what is happening over and over again. We see it in our Community Health Advocates program, where we help individual New Yorkers. We have people come to us with cancer. You know, they go to a place like Memorial Sloan-Kettering. They’re told that they have to pay $65,000 up front, or they can’t go in the door. We can get them coverage. Suddenly they can get care. That’s—it means a lot to real people, and it’s just—it’s an extraordinary moment for us all.
AMY GOODMAN: But the idea that this will set back the move for Medicare for all?
ELISABETH BENJAMIN: Well, it hasn’t set it back in Vermont at all. And so, I think the point is, is that in those states where the people of those states are ready to go forward, we can get Medicare for all. And I think the problem is, is that in many places people aren’t quite ready for Medicare for all. Though I personally may be, I think, not every American is. And, you know, we live in a democratic society. This is what we could get with our Congress and with our current president, and it’s an incredible leap forward.
You know, just think of it. Thirty million Americans will be able to access quality affordable coverage come 2014 through these health insurance exchanges, which I like to think are kind of like these Costcos in the sky, where people can get—take advantage of bulk purchasing. Prices will go down in New York state as much as 66 percent. For small businesses, they will finally have an easy way to get health coverage. They’ll be able to do apples-to-apples comparison and buy health insurance at an affordable rate and get incredible tax subsidies to do so.
AMY GOODMAN: This is a key comment on salvaging the Medicaid expansion. This is from Chief Justice Roberts. He says, "Nothing in our opinion precludes Congress from offering funds under the ACA" — that’s the Affordable Care Act — "to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding." That critical detail, you can’t take away the existing Medicaid funds.
We’re joined on the phone right now by Wendell Potter, a well-known insurance industry whistleblower, senior analyst on healthcare at the Center for Public Integrity, former executive at CIGNA and Humana, author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.
Wendell Potter, you, too, are in Vermont right now, which is a state that is pushing for Medicare for all. What about the Supreme Court decision, Justice Roberts siding with the four more progressive members of the court to largely uphold the ACA?
WENDELL POTTER: I think it’s a very good thing, and certainly it will indeed have a profound effect on many, many Americans, almost every one of us, and already has for many, many people, and even for Vermonters. I will be speaking to healthcare reform advocates here, those who are working for single payer in Vermont. The Affordable Care Act actually provides funding that will enable the state to go forward. Vermont’s a small state. To be able to do this without any support from the federal government would be a challenge. Now, the state has to wait until 2017 without waivers to fully implement single payer, but I think this is a victory all around for consumers, including those here in Vermont.
AMY GOODMAN: Joining us in Washington, D.C., right outside the Supreme Court, is Hilary Shelton with the NAACP in Washington, D.C.
Hilary Shelton, your response to the court largely upholding the Affordable Care Act? There are a number of single-payer advocates there who are deeply concerned that this means the continuation of private insurance for some and no insurance for many.
HILARY SHELTON: Well, it continues to expand what we knew we needed to address when we passed the Affordable Care Act in the first place. And that is, we knew at that time we had about 47 million Americans without healthcare insurance or healthcare coverage. Because of that, individuals, families and even the hospitals themselves were negatively affected by that particular predicament. This bill, if fully implemented, will add 32 million more Americans to the healthcare rolls. Now, we agree that we haven’t completed the issue of covering all Americans, but it’s a major step forward. We have to make sure we can do everything in our power to make sure it’s fully implemented, so those 32 million, over 30 percent of which are African American, actually have healthcare insurance coverage.
AMY GOODMAN: And, Hilary Shelton, where does the NAACP go from here in terms of advocacy? Progressive legislators talking about launching a single-payer initiative. Of course, many activists are saying this, that the legislation is there—just drop the words "over 65" from Medicare for all.
HILARY SHELTON: We very much support the need to cover the rest of Americans that are not yet covered, even by this law. This law has to be fully implemented, which means appropriations and other issues have to fall in line. But as we look at those Americans that are still yet to be covered by healthcare insurance, we must continue to push in that direction. And yes, certainly, single payer must be on the table as we have these discussions, to cover all Americans and provide healthcare insurance for all.
AMY GOODMAN: David Cole, still on the line with us from Vermont, I’m looking at SCOTUSblog, which is giving us so much of the accurate information that’s coming out of the court right now. Justice Ginsburg would uphold Medicaid just as Congress wrote it. That, too, is not controlling. Going on to say, in opening his statement in dissent, Anthony Kennedy says, "In our view, the entire Act before us is invalid in its entirety." David Cole?
DAVID COLE: Well, that’s quite remarkable. I mean, I think two things are remarkable here. One is that everybody thought that Kennedy was the decisive vote here, that the—that if he went with the liberals, it would be upheld; if he went with the conservatives, it would be struck down. And in fact, he went with the conservatives, and Chief Justice Roberts turned out to be the one who broke from the conservatives and went with the court on—with the liberals to uphold the law.
The second thing that’s remarkable, at least from that opening line of Justice Kennedy’s, is that the conservative justices, joined by Kennedy in this instance, would have not only invalidated the individual mandate, they would have struck down the entire statute because one particular provision, they concluded, was unconstitutional. That’s a really remarkable position and would have, you know, really put us back, way back, beyond square one in terms of starting over.
AMY GOODMAN: And the idea that this continues private insurance, it sort of will stop the momentum for saying clearly the whole system is broken.
DAVID COLE: Well, yes. I mean, but you can’t let the perfect be the enemy of the good. I mean, this is a law, as Hilary Shelton underscored, that is going to have the effect of expanding healthcare insurance to millions and millions of Americans who did not have it before. It’s also a law that ensures that people with pre-existing conditions can’t be denied coverage, can’t be discriminated against, can’t be charged higher rates. It does a lot of good. And, yes, it’s not as—it’s not the perfect law, it’s not the best law. But, of course, that wasn’t the question before the court.
The question before the court was, does Congress have the power to step in and deal with a problem of national breadth by enacting a broad-based law that regulates the insurance industry and requires people who can afford to do so to buy into the system rather than be free riders? And thanks to Chief Justice Roberts and the four moderate to liberal justices, we will be able to live with that law. Now, if it doesn’t work as best as it should, then of course there’s—there will be room for reform in the future. But I think those who think that, you know, it would have been good if it were struck down because somehow that would get us to single payer are just living in some alternative universe.
AMY GOODMAN: Wendell Potter, you worked for the insurance industry. We’ve got all sorts of reports. You know, they’ve been pretty quiet, because they’re doing very well. With a mandate, they make a lot of money. But we did hear, even with that, behind the scenes they were working to subvert this legislation. You were a top exec with two major insurance companies, spokesperson for Aetna and Humana. They come out pretty well here, don’t they?
WENDELL POTTER: Pretty well. They don’t like the mandate’s penalty. In other words, they think that it’s a—that the law doesn’t penalize people enough for not buying coverage. And so there’s a—they’re not of one mind within the industry. Now, they were concerned that the mandate would be struck and the other parts of the law go forward. That was their worst nightmare.
But I want to point out and reiterate what some of the others have been saying, too. This is not a setback for the single-payer movement, either. And I think the insurance industry realizes that they’re going to be under the gun to make sure that they are better able to provide coverage to Americans, or the single-payer movement will indeed get much stronger, and I think it will. The other thing is that not all single-payer people or advocates are believing this is a setback, by any means. I travel and talk to a lot of healthcare advocates, including single-payer advocates, and I know that many of them see this, as I do, as the end of the beginning of reform, something that we can build on and must build on. This brings millions of people into coverage that we need to do. And I think single-payer people really support that notion that we need to do all we can to bring more people into coverage because it saves lives.
AMY GOODMAN: Elisabeth Benjamin, in terms of the issue of saving lives, overall, Medicare for all, if you could explain it, what it would mean, and the difference between that and what we have preserved right now?
ELISABETH BENJAMIN: Sure. The Medicare system is a system where the government reimburses providers, essentially, directly, although some people use Medicare through managed care plans. The vast majority of Americans who are seniors or have disabilities, long-term disabilities, use the Medicare system to pay for their care. That is very—you know, that is just a direct government-to-provider payment, essentially. What this does is it puts insurance companies in the middle, and it’s building off the current system of employer-sponsored insurance coverage or job-based insurance coverage. And what it does is it says that people who don’t have Medicare would go to the—in their local states, if they didn’t get job-based coverage, and your employer will now have to automatically—if you’re in a large employer, they would have to automatically enroll you in health insurance. If you’re in a small employer, they have no requirement to offer you coverage, but they get up to 50 percent tax subsidies if they do so, so there’s an incredible incentive for small businesses to now offer you health insurance coverage. And, in fact, to facilitate small businesses to offer their employees coverage, they will be setting up these little Costcos, these health insurance exchanges or marketplaces, where the small businesses can go do an apples-apples comparison and quickly buy and efficiently buy health insurance coverage.
The other thing it does is that it also offers these exchanges or marketplaces for individuals who don’t have coverage with tax subsidies or incredible subsidies, a kind of ladder of subsidies as you go up the income scale, to buy health insurance, because insurance is so expensive.
Finally, the third leg of the stool is that it expands Medicaid, a program that’s different from Medicare. Medicare is for seniors and people with disabilities. Medicaid is the program for folks who are very low-income. And that’s essentially free coverage for very low-income people. So what this law does is build off the existing system, trying to make it a little better. It also will generate, I think, $143 billion in deficit savings over 10 years.
And it—and what it does—and then the final—I guess another sort of component of it—and there are many, many elements. It’s a pretty complicated law. But another element of it is that it really starts to regulate the insurance industry. I think many of your prior speakers have put up a lot of, you know, legitimate concerns that the current private industry isn’t as regulated as it should be. And I think the Obama administration has taken those concerns very much to heart, and I know the state insurance commissioners, many have also taken those concerns to heart. And the Obama administration is starting to order insurance rebates of about a billion dollars to 12 million Americans, starting this year. And we will see more and more insurance regulation to really correct the bad actors in the market.
AMY GOODMAN: I want to talk about racial disparities in healthcare, but I just want to read a summary from Amy Howe at SCOTUSblog, who says, "The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding." Again, that from Amy Howe of SCOTUSblog.
Hilary Shelton is still with us in Washington, D.C., outside of the Supreme Court. He is the NAACP Washington bureau director and senior vice president for advocacy. Hilary, can you talk—actually, I’ve just been told that it’s Russell Mokhiber that is now with us, editor of Washington, D.C.-based Corporate Crime Reporter, also founder of SinglePayerAction.org.
Your thoughts today on the Supreme Court, the chief justice, Roberts, siding with four other members of the court saying that the Affordable Care Act is constitutional, including the individual mandate?
RUSSELL MOKHIBER: Good morning, Amy.
Well, you know, Single Payer Action, It’s Our Economy and 50 medical doctors filed an amicus brief with the court asking them to strike down the Obama mandate. We thought that it was unconstitutional to force people like myself to buy lousy health insurance from major corporations. Instead, we want to get rid of the insurance corporations—and this is constitutional—get rid of the insurance corporations and then place them all with one single payer, like Taiwan, like Canada, like the UK. This would—you know, no longer would we have 120 Americans dying every day from lack of health insurance. We would control costs. We would have a system that most major Western industrialized countries have. But instead, the Supreme Court decided to side with the corporations and with the corporate parties, the corporate Democrats and the corporate Republicans.
We are—we reject Obama. We reject Obamacare. We reject Romney. We reject Romneycare. And we’re with the American people, for single payer, for Medicare for all. And we’re—we haven’t figured out—I don’t think anyone has really figured out how to bust up this two-party corporate duopoly. But it’s not going—Obama might be celebrating today. The Democrats might be celebrating. And we got into fights with the corporate Democrats in front of the Supreme Court today. They accused us of taking money from the Republicans and all this, because we’re calling for the mandate to be struck down as protect—you know, because the mandate protects the insurance industry.
But this was a bold, courageous move, 50 medical doctors calling on the court to strike down the Obama mandate and then let us all move to get rid of the insurance companies. So, but this fundamentally, Amy, is not a legal issue; this is a political issue. And what the court is telling us today is we have to figure out how to organize to move this Congress to do the right thing, to do what the American people want, to do what all the majority of doctors and nurses want, and that’s get rid of the insurance companies and have one single Medicare-for-All payer.
AMY GOODMAN: Russell, what about this point that David Cole made about the perfect being the enemy of the good, the idea—I mean, he’s speaking to us from Vermont, where they have passed healthcare for all—the idea that you work toward that, but still cover tens of millions of people more, Russell Mokhiber?
RUSSELL MOKHIBER: Well, Vermont is not single payer. And what—and, in fact, what’s happening under—or what would happen under Obama wouldn’t cover 23 million people, even though—even when it was fully implemented. And people are going to suffer for probably five to 10 more years, until the suffering becomes unbearable. And then we’re going to have to come to the conclusion that the rest of the industrialized world has come to. And that is, get rid of the insurance companies, have one single payer.
These—Obama is not the—I don’t know if you heard, Amy, about the Harvard law professor who taught Obama two courses on law, Roberto Unger, saying that Obama must be defeated. And the reason he said that was because he was—because Obama pretends to be a progressive, and he’s not, that he puts out the idea that this is a progressive law, and it’s not. It just protects his corporate funders. And so, the Supreme Court today protected Obama’s corporate funders also.
AMY GOODMAN: Russell Mokhiber, standing right next to you is a Congress member from Minneapolis, in Congressmember Keith Ellison, one of the members of the largest caucus in the House, I believe, and that is the Progressive Caucus. And one of the issues that has been raised over the last few days is that the members of the Progressive Caucus will launch a single-payer initiative. Congressmember Ellison also happens to be the first Muslim member of Congress.
Congressman Ellison, welcome to the Democracy Now! special broadcast. As you speak outside the Supreme Court and hear that Chief Justice Roberts joined with four other members of the court to uphold the Affordable Care Act, what is your response?
REP. KEITH ELLISON: Well, my response is that I think it’s better that it was upheld than it was struck down. But I also long for the day when we got Medicare for all. But the fact is, is that change doesn’t happen in one fell swoop. It usually happens in gradations. And I think that the Affordable Care Act, as much as I think it can fairly be questioned, was a giant leap over what we had before. Thirty-two million more people are going to get healthcare. And there are a number of other provisions that are going to benefit people. But the progressive movement—I think I just lost something. I hear a dial tone.
AMY GOODMAN: We hear you fine, Congressmember Ellison.
REP. KEITH ELLISON: I hear a dial tone.
AMY GOODMAN: We hear you fine.
REP. KEITH ELLISON: No, I hear like a phone just hung up.
AMY GOODMAN: You are fine, Congressman Ellison. We hear you. We hear you.
REP. KEITH ELLISON: Call back. Call back.
AMY GOODMAN: We hear you. Keep talking. If the cameraperson, if our producers can tell Congressmember Ellison to just keep on talking, that would be great. By the way, in a moment, we’re going to be going to Michael Moore responding to—responding to this. David Cole in Vermont, the point that Vermont doesn’t have—does not have universal healthcare?
DAVID COLE: Well, I’m not an—I’m vacationing in Vermont. I’m not an expert on Vermont, you know. But again, I just think we should be—we should keep our eye on the ball here, right? The question was: should the Supreme Court of the United States overturn what the Congress and the president had enacted in attempting to extend to a large number of people, who are not covered, healthcare insurance. And the real quid pro quo for doing that was to say to people who can afford it — again, this only applies to people who can afford to buy healthcare insurance— "Look, you’ve got to buy into the system or pay a tax, because if you don’t buy into the system, then you’re part of the problem, you’re a free rider. And everybody has to be responsible to act together to ensure that we can provide as broad healthcare insurance as is possible." And the question was whether Congress has the authority to do that. And I think we should be celebrating the fact that the Supreme Court upheld that power. We don’t—that doesn’t mean that this is the best law that could ever have been enacted, doesn’t mean we still shouldn’t be pressing for better healthcare insurance for all. But this is far better than the alternative. The alternative would have been denying healthcare insurance to the many, many millions of people that this law extended it to and going back to where we were before this massive effort to try to expand healthcare insurance was undertaken.
AMY GOODMAN: We have—David, we have Minneapolis Congressmember Keith Ellison back in Washington, D.C., part of the Progressive Caucus, co-head of the Progressive Caucus. Congressmember Ellison, what about the issue of a public option, of a single-payer healthcare, what the Progressive Caucus plans to do, even as you support the upholding of the Affordable Care Act?
REP. KEITH ELLISON: Well, it’s—America needs it. It’s what’s needed. It is the next logical step. It’s what we all have to fight for and agitate for. Now that the—we know that the Congress has the authority to regulate in this area, why should we stop now? I think we need a public option. We need Medicare for all. And this is going to be a key feature of what we will continue to stand for.
We also need to understand that this should put wind in our sails. You know, we should be more invigorated. If there’s anything to worry about now, the big worry is to make sure that insurance companies don’t try to gouge with their premiums. But the other worry is to make sure that the progressive movement doesn’t think, "OK, we won that one." No, we saw the law upheld, which is good, but now it’s time to organize in the grassroots much more so. I’d like to see some amendments that would allow states to pursue a single-payer system, public-option system, that would allow states to conglomerate and not just have exchanges in their own state, but actually on a wider basis, and really have some real accountability at these insurance companies, which is something that is sorely needed and has been for generations. So I think there’s a lot more work to be done. And now we should get at it, knowing that at least this round, this step forward, was protected.
AMY GOODMAN: Elisabeth Benjamin of Community Service Society?
ELISABETH BENJAMIN: I was just going to say, to the congressman’s point about we need to work to prevent insurance companies from gouging us, that there is a lot in the Affordable Care Act that does go to that end. Basically, the medical—the Affordable Care Act says insurance companies must spend at least 15 percent of every premium dollar—so 85 percent of every premium dollar on healthcare costs. Only 15 percent, which is still too much in my opinion, can be spent on administration, profits and a bunch of other stuff. But right now, there are many, many insurance products out there where the insurance companies are only spending 75 cents or 60 cents of every dollar on healthcare costs. So this is a huge step. It’s a beginning of a longer conversation about the role of insurance carriers, of course, but there is a lot of sort of aggressive regulation that’s built in to protect us and consumer protections that are built in to protect us, who have health insurance, in the law. And it’s an exciting day, because those provisions have been upheld.
REP. KEITH ELLISON: Yeah, let me agree.
AMY GOODMAN: Congressmember Ellison?
REP. KEITH ELLISON: Let me agree. That is absolutely right. But we’ve got to make sure these provisions are fully utilized and enforced. In fact, there’s an additional provision which allows for states to be able to actually take legal action, if they feel that they’re being gouged and having premiums rising at a—you know, at an extraordinary rate beyond any sort of rationality. And so, there are a few ways to try to hold insurance companies more and more accountable.
So there are—so, I mean, the big effort now will be to fully implement the law. There’s a number of states that have been resisting the implementation of the exchanges. I think, you know, right now, HHS has to make sure that every state has one, that it’s functioning as people intend it—as intended, and that we really let the Affordable Care Act soak in, so that it becomes just like Medicare is, that people see it the way they see Medicare, they see it the way they see Social Security. Nobody ever said we couldn’t improve Medicare and Social Security. And we will, and we have. We’ve got to improve this, too.
AMY GOODMAN: Congressmember Keith Ellison, I want to thank you for being with us, a member of the Progressive Caucus.
REP. KEITH ELLISON: Thank you.
AMY GOODMAN: And Elisabeth Benjamin, as well, of the Community Service Society. As we turn now to Michael Moore in Los Angeles, Michael Moore, the Academy Award-winning filmmaker who made, among many of his films, the 2007 documentary Sicko, which examined the American healthcare system.
Michael, your response to the Supreme Court, led by Chief Justice Roberts, upholding the Affordable Care Act?
MICHAEL MOORE: I think—let me state the positive first. This is—this really is a huge victory for our side, in spite of all of my concerns with this law. It didn’t go far enough. It doesn’t cover all Americans. This is not true universal healthcare. Nonetheless, the right wing has been handed a serious defeat today. This is a real—a real smackdown of their—the way that they believe our country should be structured. And on that alone, everybody should feel really good right now. I know we’re not used to euphoria over anything. It rarely happens. But in this case, I think that everybody should pause today and celebrate this victory.
And then, tomorrow, we have to keep moving the ball down the field. We have to work toward Medicare for all, so that everyone’s covered, a single-payer system, all these things. It would have been a lot harder to move that ball had the decision gone the other way today. That’s why the best thing about this is, is that it moves history forward on the right path, toward what we will eventually have, just as every other civilized country has it. So, I’m—on that level, I feel really good.
And tomorrow, or maybe even later today, we’ll start—we’ll start talking about how this law was also structured to create huge, huge profits for insurance companies. And in the end, we can’t allow private insurance—people making a profit off of people getting sick. Private insurance is not the way to go. And that’s—we have to keep moving toward.
AMY GOODMAN: I wanted to remind people about the documentary you did, which goes very much to the point you just made, Michael Moore. This is the trailer of Sicko.
PRESIDENT GEORGE W. BUSH: We got an issue in America: too many good docs are getting out of business; too many OB/GYNs aren’t able to practice their—their love with women all across this country.
NARRATOR: When Michael Moore decided to make a movie on the healthcare industry, top-level executives were on the defensive. What were they hiding?
SECURITY: That’s not on, right?
MICHAEL MOORE: No.
LEE EINER: The intent is to maximize profits.
MICHAEL MOORE: You denied more people healthcare, you got a bonus?
UNIDENTIFIED WOMAN: When you don’t spend money on somebody, it’s a savings to the company.
PRESIDENT RICHARD NIXON: I want America to have the finest healthcare in the world.
MICHAEL MOORE: Four healthcare lobbyists for every member of Congress. Here’s what it costs to buy these men and this woman, this guy, and this guy. And the United States slipped to 37 in healthcare around the world—just slightly ahead of Slovenia.
LINDA PEENO: I denied a man a necessary operation and thus caused his death. This secured my reputation, and it ensured my continued advancement in the healthcare field.
NARRATOR: In the world’s richest country…
MARY MORNIN: I work three jobs.
PRESIDENT GEORGE W. BUSH: You work three jobs?
MARY MORNIN: Yes.
PRESIDENT GEORGE W. BUSH: Uniquely American, isn’t it? I mean, that is fantastic.
NARRATOR: Laughter isn’t the best medicine.
LAURA BURNHAM: I get a bill from my insurance company telling me that the ambulance ride wasn’t pre-approved. I don’t know when I was supposed to pre-approve it. After I gained consciousness in the car? Before I got in the ambulance?
NARRATOR: It’s the only medicine.
MICHAEL MOORE: There was actually one place on American soil that had free universal healthcare.
Which way to Guantánamo Bay?
GOVT. OFFICIAL: Detainees representing a threat to our national security are given access to top-notch medical facilities.
MICHAEL MOORE: Permission to enter. I have three 9/11 rescue workers. They just want some medical attention–the same kind that the evildoers are getting. Hello?
AMY GOODMAN: There you have it, Michael Moore, the Academy Award-winning filmmaker. It’s the fifth anniversary of his documentary Sicko. He’s on the Democracy Now! video stream with us from Los Angeles, responding to the Supreme Court upholding the Affordable Care Act. And those that sided with the chief justice, who was the swing vote in the decision, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan.
Michael, we’ve spoken to a lot of single-payer advocates who say it’s not a surprise Roberts sided with them, because this is siding with the insurance industry, certainly an industry that you have taken on and that has targeted you. So your thoughts, when you say tomorrow we begin the fight for Medicare for all, on what direction that should go?
MICHAEL MOORE: Toward exactly what you just said: Medicare for all. We just need to expand Medicare for all the citizens of this country. Now, of course, this is something that the insurance companies don’t want to happen, because, ultimately, Medicare for all won’t work if the people aren’t in charge of it. Right now, and continuing even with this victory today, the insurance companies are going to call the shots. They’re going to be restricted more than they were in the past. For instance, one of the great things about today is that the provision that they cannot deny people because of pre-existing conditions, that apparently now stands. The fact that parents can keep their children, up to the age of 26, on their health insurance, that stands.
So there’s all these smaller provisions that are in that—you know, they keep talking about the mandate being the centerpiece of this law. Well, there’s other pieces of the law that are, I think, just as important, if not more important. And the mandate is—I mean, it’s—I’ve never supported it, because it mandates people to give money to these profit-making insurance companies. If it was different, if it was something that the government ran, that you and I were in charge of, then, yes, everybody has to be part of the system. And we’re all in this together. We all have to share the burden. We all ought to take care of each other.
So, that’s the fight that needs to continue. The National Nurses Union is going to lead the way on this. We should get behind their efforts. And, look, I am very optimistic. I know we have a hard road ahead of us. But if you just take the long view of this, every step of the way goes in our direction, not the backwards direction. So—
AMY GOODMAN: Michael Moore, I want to thank you so much for being with us. Michael Moore, who is the Academy Award-winning filmmaker who did Sicko, among many other films.
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