The Supreme Court is finally reviewing the constitutionality of The Affordable Care Act. Finally. And I too have been reading about it, watching and listening. But I can't add much new or insightful--except one overriding thought that kept suggesting itself through the days of arguments and all that has been said and written about them. And that is, this is what you get when you have to force delivery of a public good--and healthcare is surely that--through market constructs poorly conceived, inappropriate and inadequate to deliver any service equally and dependably to all citizens.
Markets by their nature discriminate by ability to pay--and the more finely tuned their functions become, the more clearly and effectively they discriminate. Trying to jury rig a complex and labyrinthian set of rules, contingencies and incentives to move market processes to clumsily approximate the same result appears very much a fools errand. And now a poorly prepared and politically distracted group of nine old people in robes will likely try to restructure it so that the result makes some sense, but only in that it will touch a few disputed principles and guideposts in the process of juridical review of the legislative process and the legislation produced.
Public goods, like education, social service programs and healthcare, are the natural province of the public sector, and a national health service, or at least a single-payer (government) insurance function, are the only logical and truly workable answers. Upon reading my sentiments expressed in an earlier e-mail, a friend responded that it was like trying to fit a square peg in a round hole. So true. The best we can now hope for is a result that sets the occasion for future movement in the right direction. But I have no idea what the Supreme Court will do--and it appears they do not either, struggling as they are to understand the implications of their charge, and the array of poor results and degrees of damage which are their only choices, other than an unqualified finding of constitutionality.
Markets by their nature discriminate by ability to pay--and the more finely tuned their functions become, the more clearly and effectively they discriminate. Trying to jury rig a complex and labyrinthian set of rules, contingencies and incentives to move market processes to clumsily approximate the same result appears very much a fools errand. And now a poorly prepared and politically distracted group of nine old people in robes will likely try to restructure it so that the result makes some sense, but only in that it will touch a few disputed principles and guideposts in the process of juridical review of the legislative process and the legislation produced.
Public goods, like education, social service programs and healthcare, are the natural province of the public sector, and a national health service, or at least a single-payer (government) insurance function, are the only logical and truly workable answers. Upon reading my sentiments expressed in an earlier e-mail, a friend responded that it was like trying to fit a square peg in a round hole. So true. The best we can now hope for is a result that sets the occasion for future movement in the right direction. But I have no idea what the Supreme Court will do--and it appears they do not either, struggling as they are to understand the implications of their charge, and the array of poor results and degrees of damage which are their only choices, other than an unqualified finding of constitutionality.
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