Obamacare Shows the Limits of Coerced "Solutions"

Don't expect the argument over the burdensome, costly policy to end anytime soon

When it was enacted in 2010, Obamacare was supposed to be the final culmination of 60 years of effort by Democrats to realize the dream of universal health insurance. It was a complicated scheme, designed in such a way as to bridge the gap among Americans of different ideologies on how to address an alleged evil.

But dreams are rarely easy to bring into reality, especially when one person's dream is another's nightmare. Legislation that appeared to show the possibilities of compromise has ended up proving its limits.

Compromise is possible when two contending groups share a goal while differing on the means to achieve it. The problem in the realm of health care is that Democrats and Republicans don't agree on either one—or even, really, on whether a serious problem exists. Legislation passed with the bare minimum of popular support is inherently vulnerable.

It should be no surprise that neither side is particularly enamored of the program, since it reflected neither of their preferences. Democrats mostly preferred a Medicare-for-all system, with the federal government directly providing health care coverage. Barack Obama was one of them, though he eventually concluded it was politically impossible.

Instead he offered a public-private hybrid that preserved the existing private health insurance system while imposing new regulations, furnishing help to many to pay for it, and expanding Medicaid coverage.

He probably started out thinking this middle way would attract some Republican support. After all, its basic structure mirrored a 1989 proposal from the conservative Heritage Foundation. It was modeled on an overhaul adopted in Massachusetts at the behest of Mitt Romney.

It didn't attract Republican support but near-unanimous Republican opposition. The president's mistake—one of them, anyway—was failing to see that he had borrowed ideas Republicans were eager to get rid of. By the time he arrived in office, they had lost interest in making citizens buy insurance, even to minimize public burdens.

Or maybe the GOP had simply lost interest in addressing the problem that motivated Democrats: the lack of health coverage for some 40 million Americans. It was not merely their problem, since almost all hospitals are required—under a 1986 federal law signed by Ronald Reagan—to provide emergency care to patients regardless of their ability to pay.

But the individual mandate, conceived as a way to force potential freeloaders to take responsibility for themselves, was a bridge too far for conservatives. They saw it as a huge federal violation of personal autonomy, as well as an unprecedented and unconstitutional assumption of power.

Arguing the latter point, they came within a whisker of getting the Supreme Court to invalidate the law. Republicans also predicted the plan would be impossible to administer, a forecast that has gained enormous credence thanks to Kathleen Sebelius.

They have the advantage of opposing the expected evils of Obamacare, which have eclipsed the defects of what went before. One way to make a program popular is to make the benefits visible and the costs inconspicuous. But the individual mandate and the signup snafus reversed the formula. Lots of people are leery of being shafted or coerced, while those who will gain appear to be mostly unaware or ungrateful.

Not that a different approach would have been more successful. In early 2010, pollster Douglas Rivers of YouGov/Polimetrix reported that when asked what would happen if Obamacare passed, most people said they would get "worse care at a higher cost." And if it didn't pass? They would get "worse care at a higher cost."

Republicans have succeeded in changing the subject. Instead of discounting the disease, they can focus scrutiny on the president's defective remedy. They can also divert attention from their failure to do much of anything about the supposed ailment when they held power.

They oppose Obama's plan as a burdensome, costly federal solution, only 10 years after they approved George W. Bush's burdensome, costly federal solution to another supposed failure of American health care: the obligation of retirees to pay for prescription medicines.

That program is now accepted and protected by politicians. Had Obamacare been equally popular, it might also become an unchallenged part of the landscape. But it became law without ever generating a durable national consensus.

Lacking that consensus, enactment was not the end of the fight. It was just the opening round in a fight that will not be over soon.

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  • Ted S.||

    Every imposition they want to put on doctors ought to be tried on lawyers first.

  • db||

    They do that to a point, and look at the quality of legal representation supplied by public defenders.

    Ask Obamacare supporters if they want their health care to be provided by the medical equivalent.

  • Ted S.||

    Sinle-payer legal care is the logical response.

  • sarcasmic||

    Single-payer legal care. Isn't that where the defense works for the prosecution? What could possibly go wrong?

  • larry hammond||

    They do now if you can't afford your own representation. Public defenders are paid for by the same Government bringing the charges.

  • Fist of Etiquette||

    It was a complicated scheme, designed in such a way as to bridge the gap among Americans of different ideologies on how to address an alleged evil.

    Designed in such a way to buy 60 Senate votes and however many House votes. And it failed on the former.

  • sarcasmic||

    Government is force. Everything it does is based upon a threat of violence. So whenever someone wants something to be done by government, it should be asked if that something deserves violence.
    Protecting the borders from violence? I think so.
    Providing a means to resolve disputes without resorting to violence? That's fair.
    Forcing everyone to pay for the health care of everyone else? Hmmm. I don't think that's going to work out as intended.

  • wareagle||

    those first three words are so self-evident and, at the same time, so ignored. Unless it's the other Team looking to impose force. Then, it's a problem.

    The NYT is trying to claim that Obama "miss spoke." Because TelePrompters are noted for doing that.

  • Heroic Mulatto||

    Speaking of "misspoke", Harry Belafonte said the mentality of the Koch Bros. is that of a Klansman. He also called them "White supremacists".

    Now I realize he is senile, but I really wish that "daylight come" and "he go home" (aka die) already.

  • wareagle||

    I doubt he'll claim having misspoken. He's echoing what Alan Grayson said and what is now an article of faith of among liberals.

    They are simply unable to debate anything rationally, unable to use substance to persuade others, and mostly unable to accept the legitimacy of views other than their own.

  • sarcasmic||

    They are simply unable to debate anything rationally, unable to use substance to persuade others

    Of course they can't. All they've got is emotion. Any rationale is reverse engineered. They come to a conclusion based upon emotion, they work backwards to explain it.

    and mostly unable to accept the legitimacy of views other than their own.

    What kind of emotion would someone have to come up with alternate views? Hatred? Greed? Racism? Only a bad person could disagree. A person motivated by bad emotion.

    This whole idea of starting with premises and applying logic just doesn't make sense. Only an unfeeling monster would do that.

    So if you disagree you're an unfeeling monster, or a monster motivated by bad emotion. Either way, you're a monster and it doesn't matter what you say because you're a monster.

  • Swiss Servator, Burn a Böögg||

    I dunno - he is useful as an illustration of the mindset.

  • db||

    Government only needs to use force because backward refuseniks imply the threat of force to resist it.

    /leftist

  • Rich||

    whenever someone wants something to be done by government, it should be asked if that something deserves violence.

    Excellent.

  • Scarecrow Repair||

    Or, as I found it somewhere, "Government's only purpose is to prohibit or compel; coercion is its core competency."

  • Agammamon||

    "By the time he arrived in office, they had lost interest in making citizens buy insurance, even to minimize public burdens."

    And so had the Democrats

    Or maybe the GOP had simply lost interest in addressing the problem that motivated Democrats: the lack of health coverage for some 40 million Americans.

    Oh, so now it *40* million, when this monster was first mooted it was only 30 million. Also, how much of a problem is not having health *insurance* really? I mean half the reason we have this Obamacare crap is because people without insurance were getting treatment at the emergency room - and having health *insurance* is no indicator of the availability of health *care*.

    Hey, hey! Maybe there's something to this HTML jazz after all.

  • wareagle||

    along with ER's, people also managed to find care at a variety of free clinics and doc-in-a-box type places that take direct fee for service payment. It's never been about health care or health insurance. The object is control, but you know that.

  • blcartwright||

    the guy last week who said to Jay Carney "a few years ago I had a heart attack and I didn't have insurance". Apparently he got the care he needed, as he was still breathing well enough to attend the press briefing and ask the question.

  • Agammamon||

    "they had lost interest in making citizens buy insurance, even to minimize public burdens.

    Or, or, maybe they simply realized that forcing everyone to buy insurance *wouldn't* minimize public burdens.

  • SugarFree||

    This isn't what the progs really wanted; it's a compromise forced on them by that nasty GOP. This is Republicancare! That's why none of them voted for it! Proof!

  • Swiss Servator, Burn a Böögg||

    ROMNEYCARE!!! HERITAGE STUDY!!!!

    /derp

  • Vincent Milburn||

    Interesting point: I thought Romneycare initially allowed people to get bare minimum catastrophic coverage. That is a huge difference.

  • Agammamon||

    "But the individual mandate, conceived as a way to force potential freeloaders to take responsibility for themselves"

    Are you serious? The individual mandate has its origin in quelling the fears of the insurance companies that the law would break them. Its there more to funnel money to insurance companies now that 'must issue' is legal policy for insurance. If it was intended to stop 'freeloaders' (who mostly paid for their healthcare out-of-pocket - not checking into the ER under a false name) then the penaltax wouldn't be $100 or 1% of your income (whichever is higher). Not to mention that maybe, *maybe* the GOP was smart enough to realize that with the penalty set so low (to garner votes and silence opposition) that the individual mandate is going to be what undoes *any* good the law might achieve and finally breaks this country financially.

  • blcartwright||

    exactly.

    Requiring coverage for pre-existing conditions coupled with prohibiting charging premiums based on risk ensured a crap load more payments by the insurance companies that would have to be offset by more premiums coming in from the healthy. Couple the higher premiums with higher deductibles means the light users of are paying in more for less coverage.

  • Agammamon||

    "Republicans also predicted the plan would be impossible to administer, a forecast that has gained enormous credence thanks to Kathleen Sebelius."

    Is this 'Top Man' syndrome rearing its ugly head? Its not *Sebelius* that is incapable of managing this program - the damn program is simply unmanageable, by *anyone*.

  • wareagle||

    but scapegoating Sebelius lets Chapman avoid looking at the Bullshit Artist in Chief.

  • Swiss Servator, Burn a Böögg||

    Maybe the Lightworker will get really angry and have to roll up his sleeves, find out whose ass he has to kick and fix it himself.

  • Shirley Knott||

    Well, apparently he brags that he's 'really good at killing people'. Maybe he should focus that attention on his own appointees and staff members.

  • Dweebston||

    This month I forewent opting into the company's healthcare plan. I'd be on the hook for ~$120 a month, which given what I've read isn't altogether bad, but my share of the penaltax comes to $180. For the year.

    If my characteristic is anything like other "young invincibles," I'm expecting massive subsidies to insurers before Obama leaves office. Also, the sun will rise in the east and the next Pine/Quinto Star Trek will be a steaming pile of Bantha fodder.

  • sarcasmic||

    Uh, the phrase "Bantha fodder" comes from Star Wars, not Star Trek.

  • Agammamon||

    What difference, at this point, does it make?

  • Dweebston||

    Ba-dum tish.

  • TheZeitgeist||

    The Lightworker speaks of a Jedi nerve-pinch, so the context here is apt.

  • KarrenMahoney||

    my co-worker's sister-in-law makes hourly on the laptop. She has been out of work for 5 months but last month her payment was just working on the laptop for a few hours. pop over to this web-site........

    works23.com

  • Gary T||

    Well she will be even more SOL, independent proprietors will be the worst hit hard by Obamacare, as will anyone who goes to that website for work.

    (Yes I know it is spam :-))

  • blcartwright||

    The prescription coverage was a Dem idea that they were relentlessly hammering Bush and Team Red with until it turned into a no win situation. Oppose it and you were heartlessly wanting Grandma to eat dog food. At least they got a compromise (I'll give something I don't really like if you give back something you don't really like) in that it also including an expansion of medical savings accounts which I hoped would be the start of a transition away from employer based to individually purchased health care. Unfortunately, like welfare reform passed under Clinton, Obama quietly wiped them away in his first term.

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