• by Michael Dukakis and Wendy Parmet
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Photo on the left: A portion of approximately 33,500 signed "Defund ObamaCare Petitions," are displayed on Capitol Hill, Thursday, June 28, 2012. (Cliff Owen/AP) Photo on the right: Holding a sign saying "We Love ObamaCare" a supporter of health care reform rallies in front of the Supreme Court, Tuesday, March 27, 2012. (Charles Dharapak/AP)


The Affordable Care Act (ACA) is either the most significant accomplishment or the most disastrous mistake in U.S. domestic policy over the past four years. President Barack Obama has embraced the (originally derisive) nickname “Obamacare” to describe the law, saying he now “kind of likes it.” Gov. Mitt Romney has promised to “repeal and replace” the law on his first day in office.

Michael Dukakis and Wendy Parmet offer their thoughts on how the next president — and Congress, and the Supreme Court — should deal with Obamacare, and how those decisions could affect the way “We the People” understand our relationship with the federal government.

Michael Dukakis is distinguished professor of political science at Northeastern University, a three-term governor of the Commonwealth of Massachusetts, and the Democratic Party’s presidential nominee in 1988.

The United States is the only industrialized nation that doesn’t guarantee access to health care for all its citizens. And 90 percent of those without access to decent, affordable health care are working Americans and their families. We cover the elderly through Medicare and the poor through Medicaid, but we still have 50 million fellow citizens without health insurance. That’s what Obamacare is designed to fix. The law also seeks to rein in runaway costs and the evidence is beginning to reveal that it is working.

It expands our liberty and improves the quality of life for all our citizens.

That’s why the next president – whether it is Barack Obama or Mitt Romney — should defend Obamacare and make sure it’s fully implemented. Despite what he’s said on the campaign trail, Gov. Romney knows this is the responsible thing to do because of what has happened in Massachusetts since the passage of “Romneycare.” Because of the 2006 law Governor Romney signed, virtually every citizen in the Commonwealth has access to affordable health care. Not only is Romneycare good policy; it’s good politics. It remains the most popular achievement of Romney’s tenure as governor of Massachusetts.

Access to affordable health insurance for working Americans and their families is the biggest part of Obamacare, but it’s not the only part. The ACA also provides for doubling the number of community health centers. The next Congress should fully fund that effort (community health centers have traditionally enjoyed bipartisan support for their low-cost, high-quality, community-based approach to health care), and the next president should make sure it happens.

The ACA is full of great solutions — many pioneered here in Massachusetts — to America’s health care problems. Once it’s fully implemented the rest of America will know what we in Massachusetts already know from our experience with Romneycare over the past six years. It doesn’t threaten our liberty; it expands our liberty and improves the quality of life for all our citizens.

Wendy Parmet, a leading expert on health, disability and public health law, is associate dean of the Northeastern University School of Law.

What power does the federal government have to take actions to improve the health of its citizens?

That is the big question thrown open by the Supreme Court in its closely divided and confusing NFIB v. Sebelius decision upholding the constitutionality of the individual mandate portion of the Affordable Care Act. While upholding the mandate as a constitutionally-appropriate tax, the Court, for the first time ever, found that Congress had unconstitutionally coerced the states by placing a condition (expanding Medicaid) on states’ receipt of federal funds (for the entire Medicaid program).The Court’s conservative justices also appear to read the Commerce Clause — which gives Congress the power to regulate interstate commerce — as a limit on federal power, not a grant of federal power as the founders clearly intended.

What’s at stake is not only the future of the Affordable Care Act, but the extent to which the federal government has power to regulate.

Given the degree of constitutional uncertainty created by the decision, the Supreme Court is likely to decide several additional important cases regarding the federal government’s role in health protection in the next few years. What’s more — we also can expect that the next president will likely have the opportunity to appoint one or two new justices to the Court.

This means the future of Obamacare and more broadly the future of our health care system rests, to a large extent, on the Supreme Court and the nominations the next president makes to fill the expected vacancies on the Court. What’s at stake is not only the future of the Affordable Care Act, but the extent to which the federal government has power to regulate tobacco, set workplace safety standards, undertake public health campaigns (like vaccinations) or initiate any of a thousand other actions to promote the and protect the health of its citizens.

Related content:

  • WATCH video of these lectures — plus a Q & A with Michael Dukakis and Wendy Parmet — here.

Tags: #advice2012, Barack Obama, Election 2012, Law, Mitt Romney

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  • Morningstar

    I understand that under Obamacare the premium for Medicare will gradually rise to $240 in 2014. Amongst other facts isn’t that enough reason not to vote for him, It doesn’t take a brain surgeon to understand he will put America under the bus being the spendthrift that he is. We’re loosing our country and we need to take it back. Those who support him are on the receiving end, make no doubt about that!

    • mikberg

      Obamacare will undoubtedly save many American lives by allowing early diagnosis and treatment of diabetes, hypertesion, cholesterol and cancer in millions of Americans who currently have no insurance. Are you not willing
      to pay a little more to save those lives?

  • Johannes van der Spek

    In less than 2 years – 2010 to today – the CBO has revised the cost of the taxpayer subsidy upward by 25% – and it is not even in place and formalized yet

    Also, in less than 2 years, CBO and Industry trade groups have increased the estimated numbers of employers who will drop coverage, to 10% MORE per year.

    Current employer dropping of employee coverage is at 10% per year.

    At this rate, the CBO estimates for ACA are going to be even less accurate than it’s projections for Medicare from 1965

    • mikberg

      The ACA will undoubtedly save many American lives by allowing early diagnosis and treatment of diabetes, hypertension, cholesterol and cancer in people who previously had no insurance.
      Are you not willing to spend some money to save lives?

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  • Steven

    Most American’s agree that all Americans deserve health insurance and access to health care, even the socially conservative republicans the the socially liberal democrats love to hate so much, agree. The issues are how do we pay for it, and is our federal government, which has proven itself time and again to be inept and corrupt the right organization to manage it. As the current administration has demonized the free market system and the corporations that have thrived in it, providing jobs for our citizens since our founding fathers formed it, the real question is, who can we trust to define and manage it? My vote is with the FREE market, while it is still free ….

    • mikberg

      Romney care works in Massachusetts. Why should someone in Alabama die with diabetes because they live in the wrong state? We are all Americans.
      Are you willing to let people die just to save some money?

  • ANNA

    This is an evolving ‘work in progress’, and one of the major impediments is the demonizing of everything socialist, as if we don’t already have many of our services delivered that way. Public education, police and fire protection,
    transportation, social security benefits and much more are already
    socialized services. Medicare for those over 65 is another example of a
    socialized service we’ve had since 1965 that most seniors love. Many
    liberals still lament that Medicare for All was there for the taking during
    the 2009 health care reform discussions. If it were that easy, the
    President would have acted on it. But it wasn’t that easy. Why? The
    health insurance goons axed it.They aren’t going to allow their cash cow
    of 31 cents on every premium dollar to be slaughtered without a
    multimillion dollar fight. How EVER would their stockholders continue to
    gamble on Wall St without our premium dollars? How EVER would their
    CEO’s continue to rake in such exorbitant salaries and stock options? If
    we had Medicare for All they’d be ‘history’! So…. they’ll keep up this
    ruse for as long as they can get away with it….’til the American
    people finally see they’re being ripped off and demand single-payer, not
    for profit Medicare for All. Alternatively, now that the ACA has been
    enacted, Medicare for All could ‘evolve’ into being. When the health
    insurance cartels can’t make enough off of us anymore due to the ACA’s
    ‘new rules’, perhaps they’ll finally get out of the health insurance
    business. It won’t happen overnight. But either way, it WILL
    happen…and you can help it along by supporting Medicare for All. Oh,
    and it’ll save us $400 billion a year while covering everyone. Don’t you
    think it’s about time? I do.

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  • Sinclair2

    Why aren’t the Republicans, or at least the conservatives, calling our federal, state and locally funded public school systems “socialism” just like they’re calling the Affordable Care Act “socialism”.
    Is it because public education is an immediate need for everyone and individual illness is perhaps someday but not now? Illness, like death, taxes and education is for everyone.

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