In a 5 to 4 vote, the United States Supreme Court ruled that the controversial provision requiring Americans to purchase health insurance was not unconstitutional, as its opponents had hoped, but amounted to a levy which Congress can issue based on its constitutional right to collect taxes. In a surprise move, Chief Justice John G. Roberts, long seen as a staunch conservative, backed the ruling and delivered the verdict.
German healthcare experts have long had difficulty understanding the debate in the United States because mandatory healthcare insurance has been required for decades in Germany, just as it is in many other European countries. People living in Germany cannot be excluded from health insurance because of previous conditions and, for those who are covered under the public-private national healthcare scheme, their premiums are based on how much income they earn.
Opponents in the US argued that requiring Americans to buy insurance is an intolerable intrusion into an individual's right to purchase what he or she feels is necessary and amounts to a move to Socialism, which they reject.
But the court argued that the constitutionality of the law is not based on Congress' right to regulate commerce, as liberals on the court had argued, but on its power to tax citizens.
Proponents argued that health insurance only works if everyone -- sick as well as healthy individuals -- are part of the system. Large health insurers backed this, fearing they would experience big financial losses if required coverage were removed but a mandate requiring them to insure people regardless of their pre-conditions was kept.
On Friday, German commentators examine the significance the Supreme Court decision could have on the Obama presidency, his chances for re-election and the likelihood that the United States will no longer be the only industrialized nation that allows millions and millions of its citizens to go without healthcare.
The center-left Süddeutsche Zeitung writes:
"It is a scandal that the biggest industrial nation in the world allows 50 million of its citizens -- nearly one-sixth of the population -- to go without health insurance. For economic reasons alone, this makes no sense. The costs of treating the acutely ill uninsured are transferred to taxpayers, who support hospitals with public subsidies, and to those who are insured, who end up paying higher premiums."
"Above all, this lack of insurance is indefensible for humanitarian reasons, because it means that the uninsured can only get help in an absolute emergency. This is the way that mild illnesses turn into chronic diseases that can become deadly. This antiquated healthcare system is a symbol of America's moral destitution."
"In terms of domestic policy, Obama sacrificed far too much for his healthcare plan. He had to give up climate protection because he ran out of strength after the epic battle for healthcare. Desperately needed new rules on immigration haven't moved a step forward. And although he did reform the financial market, that reform remains far behind expectations. If it weren't for the fact that Obama is the first black man in the White House, his term in office wouldn't be all that historically significant. Now he at least has healthcare to show, but it's something his own people didn't even want."
"(If elected, however), Mitt Romney would turn the dividing lines in America's political and social policies into deep canyons. The rich would become even richer and the middle class and the poor, who have already lost ground since the Bush years, would continue to lose. On the foreign policy front Romney's cookie-cutter sayings don't bode well. You have to hope that the American people will show Obama some mercy and give him the benefit of the doubt, as the Supreme Court has done."
The Financial Times Deutschland writes:
"The Supreme Court decision in Washington is a big victory for Obama ... more than that, though, the decision is a victory for Americans. The state of the healthcare system is shameful for a superpower like the USA. It is by far the most expensive system in the world -- two and a half times more expensive than the OECD average -- and offers some of the worst care among industrialized countries. It doesn't cover 50 million citizens. And treatment costs bring many people and companies to the brink of financial ruin."
"Obama's historic healthcare reform -- called Obamacare by its opponents -- is far from resolving these injusticies. But after five decades without reforms, it is the first successful attempt to fundamentally restructure the system. It is a long overdue project -- both economically and socially -- that all of Obama's predecessors failed to push through."
The conservative Die Welt writes:
"Obama was victorious. A lot of things during his presidency didn't work out as he had planned after he lost the majority in Congress two years ago. This health reform package that even Bill Clinton once failed at obtaining, will go down in the history books as a historical achievement -- even though it's unclear how Americans, who already have the most expensive healthcare system in the world -- will pay for the extra costs."
"Obama's Republican challenger Romney wants to base his campaign on getting Americans to give him a political mandate to get rid of (Obama's requirement of) mandatory health insurance. But even if he wins the race and also secures a majority in both houses of Congress, that wouldn't necessarily mean the end of 'Obamacare'. Europe has a lot of experience with this: Once the state has begun providing social benefits, few politicians dare to then take them away from the people, even if there is no way of paying for them. With this reform America has without a doubt become more European. Whether or not that is good for the country remains to be seen."
The center-right Frankfurter Allgemeine Zeitung writes:
"It is a surprising and striking victory for President Obama and his Democratic Party and a bitter defeat for their opponents. Obama has every reason to be relieved because healthcare reform is not just any social policy initiative. It's a trademark of his presidency. It's something he's invested enormous amounts of political capital and energy into and also something that has symbolized and exacerbated the polarization of the country and its politics: Not a single Republican voted for the plan."
"On the one hand Obama is now going into the presidential election with an unambiguous victory; but he hasn't won yet. On the other hand, his Republican challenger Mitt Romney will pull out all the stops. There's nothing that mobilizes your own side more than a clear picture of the enemy. This enemy is a social state that has been expanded by Obama that (the Republicans) claim robs the people financially and overextends its boundaries. Romney will move into the election battle with arguments that if he is president and has a majority in Congress to back him, he'll overturn 'Obamacare'. What has been legally clarified now becomes ammunition for the campaign."