A birthday rant.

Today is my 46th birthday. Today also happens to be the 4th anniversary of the Supreme Court's decision in National Federation of Independent Business v. Sebelius, (NFIB v. Sebelius), otherwise known as the decision which--unlike the King v. Burwell decision, which could have only crippled the law had it gone the other way--saved the Affordable Care Act from oblivion on June 28, 2012:

The Supreme Court, in an opinion written by Chief Justice Roberts, upheld by a vote of 5 to 4 the individual mandate to buy health insurance as a constitutional exercise of Congress's taxing power. A majority of the justices, including Chief Justice Roberts, agreed that the individual mandate was not a proper use of Congress's Commerce Clause or Necessary and Proper Clause powers, though they did not join in a single opinion. A majority of the justices also agreed that another challenged provision of the Act, a significant expansion of Medicaid, was not a valid exercise of Congress's spending power as it would coerce states to either accept the expansion or risk losing existing Medicaid funding.

In short, the SCOTUS made two major decisions:

  • 1. The Shared Responsibility Penalty provision of the ACA (ie, the $695 or 2.5% of household income) that people have to pay if they don't acquire ACA-compliant healthcare coverage or receive an exemption from doing so) is a tax, not a fee...which makes it Constitutional; however...
  • 2. The Medicaid expansion provision of the ACA, in which the states had to agree to expand Medicaid or they'd have all of their Medicaid funding taken away, basically amounted to extortion, so that penalty threat had to be killed off.

The result is that most of the ACA remained intact, with the main exception being that expanding Medicaid was now up to the individual states as opposed to being mandatory nationwide. The rest, of course, is history.

But that's not why I'm posting this. I'm writing this because U.S. Senator Bernie Sanders, who I was considering voting for President as recently as mid-January of this year, and who has still, as fo this writing, refused to concede defeat in his primary campaign and endorse Hillary Clinton for the Democratic nomination, tweeted out the following last night:

They tell us the only thing we can get is incremental change. We tell them: no thanks. We're thinking big and demanding real change.

— Bernie Sanders (@BernieSanders) June 28, 2016

I responded with a brief series of tweets which capture my increasing frustration with not just Sen. Sanders, but his hardcore supporters as well:

Dear @SenSanders: It's crap like this that turned me from considering supporting you to being irritated by you. https://t.co/wttzq4A2d8

— (((Charles Gaba))) (@charles_gaba) June 28, 2016

@SenSanders "incremental" doesn't necessarily mean "breadcrumbs". It simply means something done in stages over a period of time.

— (((Charles Gaba))) (@charles_gaba) June 28, 2016

@SenSanders "incremental" is how social security grew. It's how Medicare grew. It's how Medicaid has grown.

— (((Charles Gaba))) (@charles_gaba) June 28, 2016

@SenSanders "incremental" is how electric cars and solar panels are going mainstream. It's how marriage equality happened.

— (((Charles Gaba))) (@charles_gaba) June 28, 2016

@SenSanders Saying "incremental isn't good enough" is LITERALLY the same as Veruca Salt demanding "I want it NOW!"

— (((Charles Gaba))) (@charles_gaba) June 28, 2016

@SenSanders That doesn't mean we shouldn't TRY for improving things as much as possible as quickly as possible, but that's not the same...

— (((Charles Gaba))) (@charles_gaba) June 28, 2016

@SenSanders ...as threatening to hold your breath until the whole country turns orange if you don't get your way.

— (((Charles Gaba))) (@charles_gaba) June 28, 2016

Anyway, none of this means that we should just let things be. The ACA, like any other large, complicated piece of legislation, does have serious flaws and is in need of significant modifications...but some of those needed changes take time in the best of circumstances, and others only become clear as time passes anyway. We're now 6 years into the law as a whole and 3 years into the major provisions; in a perfect world, both parties would be working together to improve the law's effectiveness. Instead, one party wants to tear it apart and replace it with a mish-mash of failed policies and talking points.

Next year, assuming Hillary Clinton wins the White House, the Democrats retake the Senate, and the House is at least in a position where some amount of reasonable discussions can take place, there's an opportunity for significant improvements to the ACA. I'm 5 months early, but my birthday wish is that this is how things play out this November.