I have some thoughts on the politics of this — mainly because the politics is what I have some expertise to speak about. But that will be my next post. Before I do that I wanted to state very clearly that the politics of the decision pales before its substance, a fact that I suspect will get little attention today. This decision will have a massive effect on the lives of literally millions of people. Mitt Romney may have joked yesterday that the White House was “not sleeping real well” last night. But a lot of people tonight and in the future will sleep a lot better for this result. Young people, people with pre-existing conditions and mainly people who through the chaos of the health care market simply find themselves with no coverage.That’s the big deal.
What also matters is this: we may learn that President Obama sacrificed his presidency to push through this piece of legislation — the Dems already lost Congress over it. But presidencies are for doing important things not just for getting elected to second terms in office. And I strongly suspect that even if Mitt Romney wins and gets a Republican Congress, they still won’t be able to get rid of this law.
That counts. That matters.
This is an imperfect law. But what’s most important is that it provides a structure under which the country can make a start not only on universal coverage — as an ethical imperative — but on doing away with the waste and inefficiencies created by the chronic market failure of the US health insurance system. Again, that matters. And I suspect there’s no going back.