Health Care System in Limbo

If the U.S. Supreme Court finds the federal health care reform act unconstitutional later this year, experts say it could unravel more of the nation's health care system than anticipated, including Medicare.

Judy Feder, a former Clinton administration official, tells NPR's Julie Rovner that the push toward more integrated and coordinated health care delivery would be disrupted.

Gail Wilensky, who ran Medicare and Medicaid programs for President H.W. Bush, says voiding federal health care reform would erase the most recent benchmarks for doctor and hospital payment rates. 

"Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid," Wilensky says. "Changes in coverage that have begun to take effect for the elderly, such as closing the donut hole, might not happen." The effects, she adds, would undoubtedly spill over to everyone in the health care system.

Sara Rosenbaum, a professor of health law, likens it a train wreck. "We could find ourselves at a grand stopping point for the entire health care system." One problem she cites is the possibility of thousands of Medicare policies being suddenly null and void.

Jeremy Lazarus, president-elect of the American Medical Association, says, "With countless hours of work already done to implement the law, it is hard to imagine the full impact of it disappearing."

Dan Mendelson, a health care consultant with Clinton administration ties, says the high court's decision could put most of health care in America in a legally murky place. Lazarus calls it "political never-never land."

Repeal or partial repeal of what Republicans like to call Obamacare would make a pretty big policy crater in Congress, which already is staring at big holes in long-term funding for Medicare and Social Security. Trustees for those entitlement programs released reports showing Medicare hits the financial wall in 2024 and Social Security's Waterloo has inched closer by three years to 2033.

More than 56 million American retirees or disabled workers and their spouses and children receive Social Security payments, which average $1,232 per month. It doesn't take a calculator to realize that is a lot of money rippling through the economy because Social Security recipients spend what they receive on food, rent, transportation, utilities and medical bills.

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The Digital Divide

Digital freedom and privacy are surging onto political platforms, legislative agendas and court dockets, with sometimes overlapping impacts.

In the wake of a massive online protest against the Stop Online Piracy Act (SOPA) and the Protect IP Act (PIPA) last week, U.S. congressional leaders shoved the "online piracy" legislation favored by traditional media interests into a broom closet. Protecting the intellectual property of movie makers and book publishers was trumped by cries for Internet freedom.

Meanwhile, many of the same online giants who backed last week's Internet blackout protest may be looking at tougher online user privacy legislation in the European Union. The New York Times reports the EU will introduce a measure requiring Amazon, Facebook, Google and others to obtain explicit approval from their users before sharing personal data with advertisers. They must also scrub personal data permanently from their databases at a user request or face heavy fines in what one EU official called a move toward "online transparency."

The U.S. Supreme Court weighed in with a narrow ruling, with vast implications, indicating law enforcement officers must obtain a warrant before placing a GPS device on a suspect's vehicle. Justices hinted it may be time for Congress to act to clarify just how much privacy citizens can expect in an age when banks, retailers and social media sites routinely mine online data. The court's ruling pumped new life into legislation Oregon Senator Ron Wyden introduced last summer to clarify privacy protection involving police use of electronic surveillance equipment.

The specter of Big Brother tracking your whereabouts by tapping into your smartphone signal is scary. But it is in some ways just a police app for FourSquare, which allows a user to note where they are so friends can find them. Yes, the intent is different, but not a 180-degree difference.

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