Now that the Supremes have affirmed that reforming health care in the United States (at least in the manner that the sausage produced by our dyfunctional legislative process suggests) is Constitutional, it’s time to move on to actually implementing the Affordable Health Care Act and see what the result is. With his balancing on the head of a pin act, this is essentially what Chief Justice John Roberts said:  it’s a political process; the Courts ought not undo what the voters (through their elected representatives) did. The fact that the Right is disappointed and have cried about “activist judges” does not change this fact. (Interesting how suddenly not doing something is suddenly “activisism” when it’s not the result they desire.)

The cry from the right is that this “taking away our freedom.” Presumably, this means the freedom to die in the streets if you’re sick and can’t afford the costs of treatment. They opine that “decisions should be between the patient and his or her doctor.” Really. These people have obvioulsy not had much experience dealing with our broken healthcare system. I have. Recently. Very Recently. It was not pretty.

I wound up in the Emergency room of my local hospital, early on a Sunday morning, after a night of extreme pain. Now, I have good health insurance (like most Americans, through my employer), But most everyone knows never to get sick on the weekend, because it’s impossible to actually get your doctors on the phone, let alone get to see them. (Curiously, if this had happened while I was vacationing in Paris, a doctor would probably have come to my hotel room to see me — even though I’m not a French citizen. Then again, the French have what is considered the best health care in the world — no, it’s not us — and live longer and healthier lives than we do).

My local hospital happens to be a really good medical center which operates as a “charity hospital.” That is, it’s one of the places that private, for-profit hospitals send their non-critical cases when the person is uninsured and unable to pay. Many (maybe most) of the patients that morning in the ER were non-paying cases:  the working poor, the homeless, the uninsured or uninsurable. I gathered that a “paying guest” was somewhat of an oddity overall. One of the first things that happened — shortly after someone came around with a rolling computer cart to take my information — was someone informing me that my insurance had $100 co-pay for an emergency room visit, and would I be able to pay that immediately (credit cards accepted). Mind you, this was a request for payment before any medical professional had even examined me.

Later that day, I was admitted for observation, with the possibility that my condition might require surgery. Fortunately, I did not, and I was released from the hospital late in the evening of the next day. A couple of days later, my health insurance company sent me a copy of their “approval” for my admittance to the hospital. In other words, at a point where where I was facing surgery, the decision to admit me was not really up to me and the surgeon with whom I was talking — it was determined by whether some “faceless bureaucrat” back at the insurance company decided that this was (a) covered under my policy and (b) medically necessary. The approval was only for a single hospital day; additional days would require additional approval by the insurance company — not by the decisions of me and my doctor.

All this talk about decisions being “between you and your doctor” is just crap. We have a system where those decisions are made by faceless bureaucrats at the insurance company. These are, of course, bureaucrats who are not at all responsible to any of us (unlike those infamous “government bureaucrats,” which are subject to the political pressures of the electorate and elected officials). Ironically, if I had been uninsured and unable to pay, the decisions would be much more on a doctor-patient basis.

This is not my first run-in with medical insurance interfering in the doctor-patient relationship. The Affordable Health Care Act goes part of the way in addressing these issues. No more kicking people off for “using too much healthcare” — that is, being too sick. No more denyiing coverage for “pre-existing conditions.” And who knew that being a woman — even a healthy one — was a “pre-existing condition” mandating higher premium rates.

If you think that “repeat and replace” is a good idea, think again, in part because the “replace” part is “go back to the way things have been for the last 60 years.” It’s interesting when the news media interview people who have “reservations” about “Obamacare.” You always hear people talk about being worried that they can’t afford health insurance (something the ACA addresses). You never hear anyone say, “Gee, I really don’t want health insurance.” Hell, even the very wealthy have health insurance, and it’s frequently “Cadillac Plans” that have benerous coverage and benefits. And they can afford to write a check every time they get sick — but they see the benefits. (Let’s not forget that our members of Congress have generous “governement” health insurance, that new of them turn down). It’s going to take a while before we realize Ted Kennedy’s dream of everyone being secure, knowing they will have good health care when they need it, without running the risk of bankruptcy. Or dying in the street.