Obamacare is working! Thanks ... Republicans??

by Duane N. Burghard
©2015

In case you haven't heard (and let's face it, if you've been paying attention to conservative media, you absolutely have NOT heard), early results are in and, so far, it appears pretty clear that the Affordable Care Act (aka Obamacare) is working. Back in June of 2015, The Atlantic magazine reported that, officially, some 16.4 MILLION additional Americans are now covered by some kind of healthcare. That number represents a drop in the uninsured of over 35 percent, which is the best improvement in over 40 years. And what groups are the biggest winners? Well, again, according to the official numbers, minorities and young people posted the biggest and best gains.

And yet it would be something of a massive understatement to say that the Affordable Care Act is a rousing success with the public. As of a year ago (the last spot I could find poll results that I thought were truly non-partisan), only 37% of those polled said they completely approved of the law (although, perhaps more interestingly, the same poll revealed that a staggering 75% of those who were newly insured did). And then of course, there's our "do nothing" House of Representatives which, despite its staggering inability to address basically ANY problem facing our Republic today, has found the time to vote to repeal the ACA over fifty times now.

And this brings me neatly around to my point today, which I suppose you could describe as a PROW (Political Rant Of the Week, for those who don't regularly read this blog), but I don't see it as a rant as much as a ... well, a point of confusion on my part. In a sentence, I truly do NOT understand the ridiculous, vitriolic, completely over the top and most importantly irrational hatred that most Republicans express when it comes to the ACA. After all, IT WAS THEIR PLAN!

Yes, that's right. I'm sorry to shock some of my more conservative friends who don't know this, but the Affordable Care Act was, in actual point of fact, originally, a REPUBLICAN based and sponsored health care plan. The "birth" of the ACA actually took place at a Conservative Think Tank organization called the Cato Institute back in the late 1980s (you may also find articles listing another Conservative organization, the Heritage Foundation, as another "founder" if you will of the basic outline of the ACA, although that was in the early 1990s). In fact, at one point (1993), a bill that looks a LOT like the Affordable Care Act (and the similarities are anything but accidental) was introduced in the Senate by a Republican and had the support of a majority of Republicans in that body. Now, it may be hard for some of my readers to understand how such a thing could start from such a Republican based, but also frankly bipartisan beginning, and yet end up with the name "Obamacare" and then be labeled things like "socialism" and "the root of all evil in the universe." Believe me when I tell you that it's a pretty big mystery for the rest of us too (although the label of "socialism" is the one that drives me particularly crazy as the use of that term to describe the ACA is probably the most ridiculous misnomer in the history of American politics (and THAT is saying something!) and only serves to demonstrate the pure and unadulterated idiocy and ignorance of the person so describing it. But that said, once President Obama chose it as the "compromise of least resistance" and the idea most likely to get the votes to pass, well, evil it became and evil it was to everyone whose lives are so sadly laser focused on opposing everything the President does (usually if not always for no reason at all, other than the sake of opposing him).

But again, here we are, in late 2015, and every day there is more and more evidence that the ACA is doing what it's supposed to do ... AND it's saving us money (collectively, though not always individually) ... IF you compare it to the costs of the same level of care for the same number of people if we didn't have the ACA. If you think about it, this should make sense since the focus of the program was to add millions to the pool of insured persons which, by definition, allows insurance companies to develop ever better and more accurate premium models (which does, in fact, drive total, aggregate costs downward ... it is what the insurance industry calls the "law of large numbers" in action).

Overall, of course, the total costs have gone up, but that's exclusively because the number of people covered and the aggregate coverage provided have both gone up substantially, however, the two curves are absolutely not congruent.

At this point you'd be forgiven for thinking that I'm a big fan of the ACA, but if you think that, you'd actually be wrong. While there's no question that decreasing the number of uninsured persons in our society is a good thing (and it does in fact have a positive effect on controlling some costs within our health care system, and it also brings us closer to what other western democracies have done, though they are still doing it far better and more efficiently than we are), the ACA fundamentally fails to address the elephant in the room: the exploding costs of healthcare and drugs in America. Of course, the ACA was never intended to do that.

The ACA was intended, again, by its originally Republican authors, to allow for insurance and drug companies to continue to make radically higher profits (hence the creation of an insurance exchange with private insurance companies ... a major reason why the description of the ACA as socialism is just one of the dumbest things I've ever heard). The lack of ability to control costs is actually the source of the greatest amount of Democratic Party frustration with the ACA. Most Democrats would have preferred (and most still would prefer) something a lot closer to a "single payer" solution which would allow for the costs to be far more controlled. Essentially, what Obama has accomplished (and frankly, I should more accurately say, once again what Obama has accomplished) is more of what the Republicans wanted than the Democrats ... and for this they crucify him daily.

So, despite their success (and their refusal to even acknowledge their success), the Republicans continue to lambast the ACA daily. This constant and ongoing opposition is very confusing to me because, as time goes on, the empirical successes of the program (and the number of people positively affected by it) will continue to increase. A FAR better strategy, in my opinion, would be for the Republicans to (correctly) remind everyone that the ACA was in fact THEIR idea in the first place. If they're concerned about the need for some political cover in making such an about face, they could pass some meaningless amendment to it and declare it "fixed now" (though I seriously doubt this is necessary ... they've cultivated followers who are so extreme and obedient that, within 24 hours of the change of position, I would expect Fox News et al to be extolling the virtues of the great Republican success that is the Affordable Care Act and how Obama almost ruined what is clearly a great American success story etc.). In any case, it would seem to make much more sense to me to simply declare victory and move on.

But regardless of what happens with the Republicans and their position on the ACA as we move forward, the elephant in the room (or the other elephant I suppose), the costs issue, will remain, and there appears to be precisely ZERO political will to deal with that problem right now. Interestingly enough, Secretary Clinton spoke out this week specifically about controlling drug costs. Unfortunately, I view almost all promises and proposals made by Presidential candidates rather cynically (I find them largely ridiculous because they often involve things that the President has basically NO control over ... which makes the campaign promise meaningless beyond the grandstanding points earned with followers and potential followers who lack the basic civics education needed to know that). It seems more likely that Clinton was making her point to capitalize on the anger and frustration regarding the young billionaire who bought an AIDS drug and jacked the price from $13.50/dose to over $750/dose (which is, no question, outrageous ... but the young man has since spent the week becoming one of the most hated people in America, has promised to lower the price substantially, and is now under Federal investigation for fraud and lots of other fun charges ... karma, it seems, was actually awake and paying attention this week). Still, I applaud ANY efforts to control these costs because the ACA isn't going away any time soon ... and my point is that, whether you like it or not, if you're looking for the party to credit or blame for that fact ... well, it's probably NOT the party you thought it was.