Affordable Care Act--DOA (dead on appeal)? Does it matter?
Thursday, June 28, 2012 at 12:00AM 
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.