From the NY Times....
ON the subject of the Affordable Care Act — Obamacare, to reclaim the
name critics have made into a slur — a number of fallacies seem to be
congealing into accepted wisdom. Much of this is the result of
unrelenting Republican propaganda and right-wing punditry, but it has
gone largely unchallenged by gun-shy Democrats. The result is that
voters are confronted with slogans and side issues — “It’s a tax!” “No,
it’s a penalty!” — rather than a reality-based discussion. Let’s unpack a
few of the most persistent myths.
OBAMACARE IS A JOB-KILLER. The House Republican
majority was at it again last week, staging the 33rd theatrical vote to
roll back the Affordable Care Act. And once again the cliché of the day
was “job-killer.” After years of trying out various alarmist falsehoods
the Republicans have found one that seems, judging from the polls, to
have connected with the fears of voters.
Some of the
job-killer
scare stories are based on a deliberate misreading of a Congressional
Budget Office report that estimated the law would “reduce the amount of
labor used in the economy” by about 800,000 jobs. Sounds like a
job-killer, right? Not if you read what the C.B.O. actually wrote. While
some low-wage jobs might be lost, the C.B.O. number mainly refers to
workers who — being no longer so dependent on employers for their
health-care safety net — may choose to retire earlier or work part time.
Those jobs would then be open for others who need them.
Ultimately the Affordable Care Act could be a tonic for the economy. It
aims to slow the raging growth of health care costs by, among other
things, using the government’s Medicare leverage to move doctors away
from exorbitant fee-for-service medicine, with its incentive to pile on
unnecessary procedures. Two veteran health economists, David Cutler of
Harvard and Karen Davis, president of the Commonwealth Fund, have
calculated that over the
first decade of Obamacare total spending on health care, in part by employers, will be half a trillion dollars lower than under the status quo.
OBAMACARE IS A FEDERAL TAKEOVER OF HEALTH INSURANCE. Let’s be blunt. The word for that is “lie.” The main thing the law does is deliver millions of new customers to the private insurance
industry. Indeed, a significant portion of the unhappiness with
Obamacare comes from liberals who believe it is not nearly federal
enough: that the menu of insurance choices should have included a robust
public option, or that Medicare should have been expanded into a form
of universal coverage.
Under the law, to be sure, insurance will be governed by new
regulations, and supported by new subsidies. This is not the law Ayn
Rand would have written. But the share of health care spending that
comes from the federal government is expected to rise only modestly, to
nearly 50 percent in 2021, and much of that is due not to Obamacare but
to baby boomers joining Medicare.
This is a “federal takeover” only in the crazy world where Barack Obama is a “socialist.”
THE UNFETTERED MARKETPLACE IS A BETTER SOLUTION. To
the extent there is a profound difference of principle anywhere in this
debate, it lies here. Conservatives contend that if you give consumers a
voucher or a tax credit and set them loose in the marketplace they will
do a better job than government at finding the services — schools,
retirement portfolios, or in this case health insurance policies — that
fit their needs.
I’m a pretty devout capitalist, and I see that in some cases individual
responsibility helps contain wasteful spending on health care. If you
have to share the cost of that extra M.R.I. or elective surgery, you’ll
think hard about whether you really need it. But I’m deeply suspicious
of the claim that a health care system dominated by powerful vested
interests and mystifying in its complexity can be tamed by consumers who
are strapped for time, often poor, sometimes uneducated, confused and
afraid.
“Ten percent of the population accounts for 60 percent of the health
outlays,” said Davis. “They are the very sick, and they are not really
in a position to make cost-conscious choices.”
LEAVE IT TO THE STATES. THEY’LL FIX IT. The Republican
alternative to Obamacare consists in large part of letting each state
do its own thing. Presumably the best ideas will go viral.
States do have a long history of pioneering new ideas, sometimes
enlightened (Oregon’s vote-by-mail comes to mind) and sometimes less
benign (see Florida’s loopy gun laws). Obamacare actually underwrites
pilot programs to reduce costs, and gives states freedom — some would
argue too much freedom — in designing insurance-buying exchanges. But
the best ideas don’t spread spontaneously. Some states are too poor to
adopt worthwhile reforms. Some are intransigent, or held captive by
lobbies.
You’ve heard a lot about the Massachusetts law. You may not have heard
about the seven other states that passed laws requiring insurers to
offer coverage to all. They were dismal failures because they
failed to mandate that everyone,
including the young and healthy, buy in. Massachusetts — fairly
progressive, relatively affluent, with an abundance of health providers —
included a mandate and became the successful exception. To expand that
program beyond Massachusetts required ... Barack Obama.
OBAMACARE IS A LOSER. RUN AGAINST IT, RUN FROM IT, BUT FOR HEAVEN’S SAKE DON’T RUN ON IT. When
Mitt Romney signed that Massachusetts law in 2006, the coverage kicked
in almost immediately. Robert Blendon, a Harvard expert on health and
public opinion, recalls the profusion of heartwarming stories about
people who had depended on emergency rooms and charity but now, at last,
had a regular relationship with a doctor. Romneycare was instantly
popular in the state, and remains so, though it seems to have been
disowned by its creator.
Unfortunately, the benefits of Obamacare do not go wide until 2014, so
there are not yet testimonials from enthusiastic, family-next-door
beneficiaries. This helps explain why the bill has not won more popular
affection. (It also explains why the Republicans are so desperate to
kill it now, before Americans feel the abundant rewards.)
Blendon believes that because of the delayed benefits and the general
economic anxiety, “It will be very hard for the Democrats to move the
needle” on the issue this election year.
He may be right, but shame on the Democrats if they don’t try. There’s
no reason except cowardice for failing to mount a full-throated defense
of the law. It is not perfect, but it is humane, it is (thanks to the
Supreme Court) fiscally viable, and it comes with some reasonable hopes
of reforming the cockeyed way we pay health care providers.
Even before the law takes full effect, it has a natural constituency,
starting with every cancer victim, every H.I.V. sufferer, everyone with a
condition that now would keep them from getting affordable coverage.
Any family that has passed through the purgatory of cancer — as mine did
this year, with decent insurance — can imagine the hell of doing it
without insurance.
Against this,
Mitt Romney offers
some vague free-market principles and one unambiguous promise: to dash
the hopes of 30 million uninsured, and add a few million to their ranks
by slashing Medicaid.
If the Obama campaign needs a snappy one-liner, it could borrow this one
from David Cutler: “Never before in history has a candidate run for
president with the idea that too many people have insurance coverage.”
This article has been revised to reflect the following correction:
Correction: July 18, 2012
An
earlier version of this column referred incorrectly to one consequence
of the 2010 health care law. While it is estimated to provide coverage
to 30 million Americans who are currently uninsured, the estimate
includes both an expansion of Medicaid and additional enrollment in
private insurance plans, not only the latter.
