Obamacare as an Onion

The onion has many skins. A multitude of skins. Peeled it renews; chopped it brings tears; only during peeling does it speak the truth.

Gunter Grass (born 1927), German novelist,   Peeling the Onion, 2007

Understanding health care reform is similar to unraveling an onion – many layers and many tearful moments.

Sally Pipes,  founder and president, Pacific Research Foundation,  “Post-Court Report: The Future of Health-Reform in America” March 28, 2012

April 3, 2012 -  The Supreme  Court is now  engaged  in peeling the Obamacare  onion.

The onion has many layers – constitutional, political, and emotional.    Each layer has its own constituency.   Each layer benefits somebody.  Each layer harms somebody.  Each layer has its own truths. 

Each layer contains  good things -  coverage for the uninsured and disenfranchised ,  some by choice, some by poverty,  some under parents plans,  some falling into doughnut hole, some with pre-existing illness.

Each layer contains bad things – threats of  exploding  costs,  people losing their current health plans,  employers shedding  health benefits,  extension  of  federal power over the individual,   loss of clinical liberties,   stifling of medical innovation,  doubling even tripling of federal health expenditures.

This peeling process is not easy  and depends  on who is wielding the peeling knife.  

The President insists if the Court turns down Obamacare,  it will prove the Justices are conservative judicial activists,  intent on eviscerating Presidential power.  He will attack the court. He will insist he needs to be re-elected so he can appoint  Supreme  Court Justices more to liberal liking..  

Conservative critics  will say turning down the individual mandate,  even the whole enchilada,  would be a good thing.  It would  reflect the will of the people,  56% of whom oppose the law and 76% of whom are against the individual mandate. It is time, critics will inveigh,  to chuck the whole thing and start all over to restore the balance of power between government and the governed.

As a realist,   I  know  it will be difficult  to toss aside the whole onion, or   to repeel it, if I may use a bad pun.   On the other hand, I find the current  onion  rotten at its core.    Even if Obamacare  survives the Court,  the onion may unravel if: 1) the GOP wins the House and Senate in 2012; 2) an estimated 11 million Americans lose their current health plans; 3) costs continue to escalate as they have over the past 3 years; and 4)  Americans  insist on having a choice between private and government plans.

Tweet:  Over the next 3 months,  the Supreme Court will try to peel  or repeel  the Obamacare health reform onion.