RANCHO SANTA FE, Calif., October 14, 2013 — Obamacare has become the cornerstone of two largely unrelated problems: the budget crisis that has led to a government shutdown; and the debt ceiling crisis that purportedly threatens to put the government in default.
As the healthcare industry in the United States represents approximately one-sixth of our nation’s economy, tampering with it raises risks and rewards that can affect the lives of every American citizen. Let’s examine the good, the bad, and the ugly elements of the controversial law’s journey.
Healthcare costs have been rising disproportionately relative to inflation for several decades. This inevitably translates into less affordable and less accessible healthcare for a growing segment of society. Most people would agree that addressing the issues of cost and accessibility would be a good thing to do. Obamacare attempts to do that.
Meanwhile, there is a debate over the quality of healthcare in the United States. Has it remained the best in the world or has it deteriorated over time?
According to the World Health Organization, our country now ranks 33rd in life expectancy and 38th in overall healthcare effectiveness. Some argue that these rankings are skewed. They do not adjust life expectancy for non-healthcare-related causes of death such as homicides and automobile accidents. If those adjustments were made, they would embarrassingly improve our ratings. However, rather than celebrating our propensity for murder and reckless driving, trying to improve the quality of healthcare in the United States would seem to be a good path to follow. Obamacare attempts to do that.
In effect, Obamacare’s ostensible purpose complies with its more formal name: The Patient Protection and Affordable Care Act. It attempts to maintain and improve the quality of healthcare (“Patient Protection”) while expanding accessibility and lowering the cost of healthcare (“Affordable Care”).
Obamacare theoretically provides a variety of positive outcomes:
- Tens of millions of uninsured citizens will gain access to free or affordable quality health insurance through the new marketplace.
- Medicare will be improved to expand free services, manage costs, and eliminate the “donut hole.”
- Medicaid will be expanded to cover approximately 16 million men, women and children who are living at or below 138 percent of the poverty level.
- The Children’s Health Improvement Program (CHIP) will be expanded to cover nearly 10 million additional children.
- Pre-existing conditions will no longer preclude coverage, you can’t be dropped from coverage because you get sick, and lifetime coverage limits will be eliminated.
- All insurance coverage will provide preventative services and essential health benefits.
- Young adults will be able to remain under their parents’ plans until the age 26.
- You can’t be dropped from coverage when you get sick or make an honest mistake on your application. You also can’t be denied coverage or treatment for being sick or charged more for being sick. You can’t be charged more for being a woman, either.
Most people would agree that meeting these objectives would improve the current state of healthcare in the United States, if it could be done in an efficient and effective manner. Therein lies challenge.
There are serious structural issues related to Obamacare that are difficult to ignore. Some are associated with the political way in which it has been driven; others reside within its practical application.
The Obama Administration succeeded where the Roosevelt, Truman, Nixon, Ford, Carter and Clinton Administrations failed. It used brute force political maneuvering to secure passage of the legislation.
Presidents Roosevelt and Truman backed away from executing the universal healthcare component of the New Deal because they recognized that the strong opposition to the program was being driven by a representative element of government. The Obama Administration simply chose to vilify similar opposition to overcome it.
Presidents Nixon, Ford, and Carter all pushed for variations of universal healthcare only to fail because of the same roadblock: Senator Edward Kennedy. While homage was paid to Sen. Kennedy (who had recently passed away) when Obamacare was written into law, it was the Senator himself who blocked it from passing during the 1970s. His public commitment to healthcare reform was exceeded only by his inveterate demand to make it conform exactly to his requirements. His efforts against Nixon and Ford were further fueled by a partisan need to prevent such reform from being attributed to a Republican administration.
The Clinton Administration failed as well. One week after his 1993 inauguration, President Clinton announced the formation of the President’s Task Force on National Health Care Reform and appointed his wife, Hillary Clinton, as its chairperson. We were told that the Task Force would deliver a proposal to Congress within 100 days. While the direction and composition of the Task Force was well-thought, the time frame and other salient elements were not.
As a side note, every one of these prior Administrations shared one thing in common with the Obama Administration: It had a Democrat-controlled House and Senate.
Another presidential reference parallels the complexity of healthcare reform and offers interesting contrasts to the current Administration’s approach.
On May 52, 1961, President Kennedy said, “I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the Earth.” On January 25, 2007, then-Senator Obama made a declaration of similar magnitude: “The time has come for universal healthcare in America.”
President Kennedy went on to say, “I believe we should go to the moon. But I think every citizen of this country as well as the Members of the Congress should consider the matter carefully in making their judgment … because it is a heavy burden, and there is no sense in agreeing or desiring that the United States take an affirmative position in outer space, unless we are prepared to do the work and bear the burdens to make it successful.”
Similar to President Kennedy’s statement, Senator Obama repeatedly made promises during his 2008 Presidential campaign that echoed a similar awareness of the importance of Congressional support and the participation of the American people.
With respect to Congress, he vowed to “turn the page on the ugly partisanship in Washington” and to create “the most transparent Presidential Administration ever.”
With respect to the American people, he promised that “These (healthcare) negotiations will be on C-SPAN, and so the public will be part of the conversation and will see the choices that are being made … We will work on this process publicly. It’ll be on C-SPAN. It’ll be streaming on the Internet.” His campaign website even boasted: “As president, Obama will not sign any nonemergency bill without giving the American public an opportunity to review and comment on the White House Web site for five days.”
President Kennedy honored his words. You may reach your own conclusion with regard to President Obama.
Another point of differentiation lies within whom the two presidents tasked with crafting a solution.
President Kennedy (and Johnson after him) sought Congressional approval and appropriations for the development of the Mercury and Apollo projects. However, NASA and its rocket scientists were charged with the responsibility to actually design and execute the projects.
Under President Obama’s leadership, Congress was chosen to reform our healthcare system. Try to imagine the level of success the Space Program would have achieved had President Kennedy appointed Congress as its architect.
In fairness, Congress delegated the responsibility. Senator Baucus, Democratic Chairman of the Senate Finance Committee, announced that his Chief Health Policy Counsel, Elizabeth Fowler, was the actual architect of the bill.
Before serving in this capacity, Ms. Fowler worked for WellPoint (our nation’s largest insurance provider) and informally lobbied on its behalf. After drafting Obamacare, she was rewarded for her efforts with a White House appointment to implement the law. However, she quickly left that role to work in a senior government affairs position to lobby on behalf of Johnson & Johnson.
Coincidently, Fowler’s pre- and post-Obamacare positions are tied to the two industries that are considered to be the big “winners” in healthcare reform: insurance and pharmaceuticals.
Beyond the methodology that was used to draft Obamacare, the process by which it passed into law also merits discussion.
The final bill was not particularly well-vetted. As then-Speaker Pelosi famously said, “We have to pass the bill so you can find out what is in it.”
It was voted upon by a House comprised of 253 Democrats and only 178 Republicans (with 218 votes being required to pass). Yet, it only passed by a vote of 219-212 (with 34 Democrats and all 178 Republicans voting against it). Similarly, the Senate voted upon straight Party lines (60-40).
This marked the first time in history that landmark legislation passed without being able to attract a single crossover vote in its favor. Does this reflect the recalcitrance of the Republican Party, the inability or disinterest of the Democratic Party to reach a true consensus, or both? Think about that when you evaluate who’s at fault for the current budget and debt crises the Parties have been able to create.
From a pragmatic basis, it is difficult to conceive how a 2,700 page bill that created 159 new boards and committees, which have since added over 20,000 new pages of regulations, can reduce costs.
- The infrastructure associated with 159 new boards and committees creates a cost;
- The entire healthcare system needs to assimilate major change to comply with the evolving regulations, and such change inherently adds cost; and
- The private sector has to absorb the costs of determining the impact of the new regulations and conforming to them.
“Affordability” may be more of an issue than the administration anticipated.
Even “Patient Protection” may be at risk since there isn’t a provision to address the supply-and-demand healthcare provider issue that inherently will arise with a surge of 30 million new “patients.” The preventative services and essential health benefits elements of Obamacare create new income streams for the insurance and pharmaceutical industries, but they only serve to strain the already thin network of healthcare providers. Obamacare doesn’t provide any direction with respect to what can be done to bridge this gap.
The Parties have drawn lines in the sand to battle over “all things Obama,” so the colloquial name of the law only raises the ugliest aspects of partisan politics.
Republicans claim that Obamacare will destroy our economy and our country unless it is totally repealed or defunded. Democrats accuse Republicans of hating women and the poor and wanting to deny them healthcare. Both positions are absurd. They are intentional misrepresentations used to build fear among the Parties’ respective bases for the purpose of raising money and locking in votes for the 2014 mid-term election.
Think about it.
Have you ever received a white paper from either of the Parties that clearly articulated its position without claiming that the Earth is about to be thrown off its axis and life as we know it will cease to exist? More importantly: Have you ever received a communication from either Party that did not solicit a donation?
Here’s the discussion we need to have.
With Respect To the Republican Party:
You introduced legislation to repeal or defund Obamacare 42 times since March 21, 2010. In case you haven’t noticed, Majority Leader Reid is prone to block such bills from ever reaching the Senate floor; you don’t have the votes in the Senate; and the President is on record as having said he would block any such bill if it were to reach his desk.
Before even your most zealous supporters recognize that you are either “slow” or inept, why don’t you change tack?
You have had ample time to dissect the law and offer amendments that would remove or improve poorly constructed elements of the law without eliminating the positive elements that it contains. Try that for a change. If Reid chooses to block such bills from reaching the Senate floor, you could position his abuse of power in a manner that may allow to you to reclaim the Senate in 2014.
If you are truly as concerned about the President’s policies as you suggest, retaining a majority in the House and claiming a majority in the Senate should be your highest priority. Instead, you have attached your latest attempt to deal with Obamacare to the only two issues that currently occupy the minds of the American people who are paying even modest attention, i.e., the budget and debt, and the course you have chosen has burdened, or at least annoyed, the general public.
When will you recognize that Obamacare is so structurally flawed that portions will collapse under their own weight if you can muster the intelligence to get out of the way?
With Respect To the Democratic Party:
Stop embarrassing yourself. Republicans don’t wake up in the morning hating woman and the poor. They wake up hating themselves for their inability to successfully articulate their message.
You are absolutely correct when you smugly state that Obamacare is “the law of the land” and that Republicans should respect it. However, keep in mind how you acquired the necessary votes to pass the legislation.
You had to secure the necessary votes in the House, which you controlled, by ladening the bill with “pork” like the “Louisiana Purchase” and the “Cornhusker Kickback.” That raises two questions: Were the best interests of the People served by the political gimmickry; and would Obamacare have passed without the political favors?
The latter question is particularly interesting given the rhetoric of “extortion” and “blackmail” that has been woven into your criticism of the Republicans use of the budget and debt ceiling issues as a fulcrum to address their opposition to Obamacare. Were it not for political “extortion” and “blackmail,” the bill may never have passed.
It is also somewhat entertaining when you place great weight on the fact that Obamacare has been held to be constitutional by the Supreme Court. So was Citizens United.
Correspondingly, SCOTUS had to ignore Congressional intent to save the law for you. You swore that the fines included in the legislation were penalties rather than taxes. If Chief Justice Roberts had thought you were telling the truth, Obamacare would have been held to be unconstitutional.
You also would be well-served to stop pretending that Obamacare is a well-structured law that can be implemented in a clean manner. It already has required a significant number of waivers, and about half the States have opted out of the Federally-run exchanges.
Perhaps most embarrassingly: Having had a disproportionately large budget and three-and-a-half years to prepare for the October 1, 2013, launch of the Obamacare website, it suffered from what you call “glitches.” Is this akin to the “bumps in the road” that the deaths in Benghazi represented? Please spare the excuses and fix the problem.
Obamacare was sold to the American people base upon false promises. Once it is fully implemented, there will be no place to hide.
It will touch every citizen in the United States in some way. Some Americans will benefit from the law, some will be inconvenienced, and others will be devastated. Why not join with Republicans to proactively address the known defects. In a rare turnabout, honesty may be the only way you can retain the Senate for the president’s final two years.
What would you do to bridge the divide between the Parties?
As Speaker Boehner recently said, “This isn’t a … game.” We are tampering with one-sixth of the United States economy (about $2.7 trillion per year) in a way that will affect the lives of every American.
Article I provides bicameral chambers for debate. Article II provides a singular position to preserve unity. Maybe if the President were to focus on the latter element and serve as a mediator rather than a partisan, we could begin to make progress.
Within the Legislative Branch, both sides need to find common ground. One suggestion would be to recommit to their Oath of Office, which commands them to “support and defend the Constitution.” That document clearly places the best interests of the People ahead of the best interests of the Parties.
Why not work together toward common goals that comply with that premise?
- Agree to allow adequate time for the positive provisions of Obamacare to take effect;
- Try to resolve the law’s glaring deficiencies;
- If additional problems become apparent, address them; and
- Constantly try to improve our healthcare system in a way that inures to the best interest of the People.
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