Affordable Care Act--DOA (dead on appeal)? Does it matter?

As pundits jockey for position in anticipation of the US Supreme Court's decision on the Affordable Care Act, the outcome of the court's call matters little because the parameters of healthcare debate will continue to overlook what exactly drives costs up.

The topic remains so unspeakable--even suppressed--as if to illustrate its taboo status. However, without integrating it into the conversation about healthcare's (un)affordability, all ideas on how to control costs are, at best, acts of pantomime.

Healthcare's prevailing assumption reads something like this: medicine's success in curing humanity's ills depends on its profitability as an industry; its delivery, as a product or service, must be structured, without limit, for profit.

John Ehrlichman, special counsel to President Nixon, put it in much simpler terms. "All the incentives are toward less medical care," the aide confided to the president in a February 17, 1971 conversation about Kaiser Permanente's for-profit health maintenance organization, "because the less care they give them [patients], the more money they [healthcare providers] make."

President Nixon signaled his approval of such an arrangement and went on to make it public by signing into law the Health Maintenance Law of 1973. It brunted an effort by Sen. Ted Kennedy, who sought to legislate universal health coverage with his proposed "Health Security Act". Eventually, Kennedy came around to support Nixon's HMO bill--a decision the Massachussetts senator later regretted.

Such details help define this nation's healthcare legacy, orienting the debate away from the privileged place profit making has enjoyed for decades; moving the conversation toward the civic or humane values that our national character depends upon.

Is money allowed to cry 'fire' in a crowded theatre?

The US Supreme Court's recent call to let their Citizens United decision ride reinforces  a kind of Animal Farm persuasion that taints elections in this country: simply put, that all votes are equal but some are more equal than others. Take heart--billionaires will remain unfettered in their efforts to buy elections.

Those who defend Citizens United blinklessly assert that corporations are people, too, my friend--an argument so specious as to be worthy of drunks and defiant children. Who has yet to address the twisted irony about today's corporation--whose purpose is to manage personal liability (meaning, avoid personal culpability) for its members; and now they cling to the Bill of Rights? Not only do elite, moneyed interests want to have their cake--they want to inhale it as well.

If you have any doubt that corporations enable the abandonment of personal responsibility, you should read about the Wachovia money laundering scandal that no one remembers anymore--that not one official from the bank was even arrested doesn't improve anyone's chances of recollection.

Need a more recent reminder? Not one member of any financial institution that misled investors and spread toxic mortgage assets--leading to the 2008 economic meltdown--has been arrested.

Fast forward to 2010: the British Petroleum oil spill--no arrests. Oh, wait, the feds did recently file some fey obstruction of justice charge against a low ranking engineer for deleting text messages. It's an arrest certain to strike fear in the hearts of would-be polluters all over the world.

What to do? Many progressives are spreading the message about a constitutional amendment that would reverse Citizens United. It's a great idea, however, said amendment would have to pass through the congressional and statehouse machinery that is largely already owned by elite, moneyed interests.

The solution will require a de facto effort on the part of those who care for the common good. The challenge appears almost impossible: ignorance and apathy have joined forces to comprise the 40% of eligible voters who fail to show up at the polls come election time. We are failing to teach the 40% a civics-minded media literacy, the kind of knowledge informing each voter about his or her choices--that there is no obligation to support candidates for public office who trade their decision making for large, bundled campaign contributions. Ultimately they must learn (and it may come to the hard way) what is at stake for his or her quality of life and well being.

It's a goal comparable to Thomas Jefferson’s hope for an educated citizen--someone prepared for the tasks of self-government and encouraged “to judge for himself what would secure or endanger his freedom.”