Saturday, November 15, 2014
Of course the law is complicated, and few people, even members of Congress, bothered to become familiar with every detail. But if they did, they would have understand such features as the tax on "Cadillac" health care plans, or the medical device tax, or the individual mandate, or the many other features that, taken in isolation or out of context, were made to sound threatening.
So why are people so stirred up by the comments of some MIT professor, who thinks that some of the features of the law were downplayed or obfuscated in order to gain the support of the American people? To be cynical for a moment, which I think is appropriate, it's an opportunity for the president's opponents to feed into an assortment of conspiracy theories about this law in particular and the Obama administration in general. What's ironic is that the people peddling these conspiracy theories are the same people who had no problem with misleading the American public about the reasons for going to war in Iraq, or the giveaways to the pharmaceutical industry in Bush's Medicare prescription drug benefit, or about the effects of tax cuts on the deficit, etc., etc. Not to mention all the distortions they promoted about the health care act itself ("death panels," "government takeover," etc.) These are major perpetrators of misleading information in the service of conservative causes.
So the proponents of the Affordable Care Act might have wanted to present that bill in a way that people would support. This is news? Those trying to make it news know or should know that it was up to the bill's opponents, and they were legion, to point out any distortions, and they had ample opportunity to do so.
I think the central distortion was always this: The Affordable Care Act was sold, in large part, as a means of solving the enormous problem of the tens of millions of uninsured in this country: those who are not provided insurance by their employer, those who are unemployed, those who were turned down because of pre-existing conditions, those who simply couldn't afford health insurance. This law was touted as a way to help those millions of uninsured get insured. And it does that. That's why liberals supported it. That's why conservatives, who are suspicious of that kind of government help, opposed it.
In fact, however, although the Act does contain a lot of subsidies to help people afford health insurance, it does that by forcing a lot of free riders on our health care system--those who can afford to pay but don't or won't get insurance because they can always rely on the "free" services of emergency rooms or hospitals in case of catastrophe--to pay their fair share into the system. To gain the support of conservatives, maybe the bill should have been called the Personal Responsibility for Healthcare Act, or the Hospital Reimbursement Act, or something like that. The political problem was that even though Obamacare always had some great moderate and conservative bona fides (it was based on Governor Romney's health care plan in Massachusetts for crying out loud), conservatives were never going to support the president's bill anyway. So it had to be sold to liberals as a way of helping the uninsured. (Which it does. And it also makes the uninsured pay what they can for their coverage.) Was that misleading? Only if you don't take the trouble to understand the law in the first place.
It's ironic that conservative heads are exploding now at revelations that the White House might have strategized about downplaying features of the health care law that had a more conservative bent. Are they suggesting that they might have supported the law if they had only better understood these aspects? Seems doubtful. But then, it's also ironic that John Boehner wants to sue the president (if he can only find a law firm to take the case) for delaying the implementation of a law that the House voted 50 times to repeal. Politics!