In my first post in this health care series, I described my first experiences with our health care system as an adult on my own. In this post, I want to shed some light on my conservative, libertarian perspective on health care at the time as well as go over the events that led up to the passage of the infamous Affordable Care Act. I hope it’ll help you understand where I’ve come from on this topic and just how drastically I’ve shifted my views. I also want to be clear about how I was no supporter of the push for Obamacare but adamantly opposed it at the time.
Shortly after entering office—and keeping us from a complete global financial collapse—Obama took up health care as his signature legislative push. During the election, I hadn’t looked too closely at either of the major candidates' proposals as I basically wrote them both off as big government intrusions with different flavors. Now with the health care debate in full swing and my own foray into the weeds of our messed up health care model, my libertarian view on the matter was emboldened. The government shouldn’t be messing things up and the free market should be responsible for bringing costs down and increasing efficiency.
I thought my experience was a perfect example—I paid cash for an MRI that should have been more expensive than a much simpler ultrasound and yet it was way more affordable. It was the free market at work! If we just had more price transparency and didn’t have to carry these bloated insurance plans that covered everything from a runny nose to brain surgery, the cost of basic care would plummet. After all, you don’t carry car insurance to cover your oil changes!
I don’t think this diverged too much from general conservative thought at the time. One of the main calls for action from the right was to allow insurance companies to sell plans across state lines. The argument goes that this would expand the market, increase competition, and thus reduce prices by improving efficiencies.
Another idea was that health care consumers should be able to pick and choose what their plans cover. They know their health the best and what their needs are so they shouldn’t be forced with an all-you-can-eat buffet when they just need the a la carte menu. Give patients, with the help of their doctors, power over their own health care!
Going even further, individuals should have the freedom to make the choice whether or not they even need coverage. Why should a healthy 23-year old be forced to take on insurance that they don’t need? The idea of government imposing such force was an affront to a core conservative principle of individual liberty.
Finally, what I think was (is?) a defining difference between conservatives and liberals on this issue was the idea of health care being a right. Generally speaking, the conservative thought is that health care is not a right and liberals would say that it absolutely is a right.
At this point in my life, I vehemently argued that health care was not a right. A right is something that one possesses without any outside influences. As Thomas Paine put it, “Rights are inherently in all the inhabitants”. So, how could health care be a right? With no outside forces, one does not simply have a right to health care like one has a right to life, liberty or property. Rights are not given, you possess them for no other reason than being alive. But, in order to receive health care, you require someone else’s services. If you are on a solo hiking trip and you fall and break your leg, is your right to health care being infringed because there are no physicians nearby to help you?
The idea of health care as a “natural right” just doesn’t mesh with the classic idea of rights as they were established during the Enlightenment period. When discussing this argument with liberals, they would get extremely frustrated as they adamantly argued that health care was a basic human right that every person should be afforded and secured by government. It seemed like a philosophical divide that just could not be bridged. In the years to come, I came to the conclusion that this was an irrelevant argument. It doesn't matter if we call it a "right" or not. But this type of divide was what framed the political landscape before and since the passage of the ACA.
I’ve debated about whether or not to talk about the entire process surrounding the Affordable Care Act. It’s easy to get into a blame game and I don’t want that to be the direction we go down (at least for now). However, I believe there have been some severe mistruths about the process pushed by the right. On the other hand, I think it’s fair to say there’s been some whitewashing by the left. Because of that, I want to attempt a fair representation of what transpired in 2009 and 2010 to get Obamacare passed so that we can get some context on how the stage was set for years to come.
Early on in the process, health care reform actually got off on a pretty good foot. Senate Finance Committee Chair, Max Baucus (D), worked with ranking member Chuck Grassley (R) in a bipartisan manner to publicly release some policy options after holding a few health care roundtables in April and May of 2009. In June, three Democratic committee members and three Republican committee members, the Gang of Six, held the first of over 30 bipartisan meetings to discuss a reform bill.
Let’s pause for a moment to just relish in that fact. About a decade ago, members of the senate from different parties were actively working together on a massive piece of legislation as sweeping as health care reform. That seems almost unfathomable right now. During this time, the Democrats made significant concessions to try to secure bipartisan support. Some of those concessions included dropping the public option, adopting a plan based on the conservative Heritage Foundation (the individual mandate), and cuts to Medicare and Medicaid reimbursement schedules. So, what happened?
A full on fear mongering campaign was launched. In August, during a town hall in front of his Iowa supporters, Senator Grassley said he wouldn’t support a plan that “determines when you’re going to pull the plug on Grandma.” He continued with making the oft repeated false claim that it would be a government takeover of our health care system. The idea that care would be rationed for the sick and elderly and their lives would be decided by a “death panel” was pushed by Sarah Palin. But, at the core of the opposition was Mitch McConnell, the Senate Minority Leader at the time. McConnell explicitly said that it was his goal to not allow a single GOP vote on the bill lest it even give the appearance of bipartisanship to the public. So, despite the Democratic concessions and the inclusion of over 200 Republican amendments to the bill, McConnell made it his prime directive to not lend any Republican support to the bill in terms of votes. It was purely a political strategy that helped lay the foundation for the congressional GOP resurgence in the upcoming elections.
Looking back, it's easy to see that the cries of "government takeover" were ridiculous—at least in terms of the insurance industry. The Affordable Care Act was the best thing that could have happened to health insurance companies. While Republicans were crying "Socialism!", companies like UnitedHealthcare, Anthem, Aetna and their shareholders were laughing all the way to the bank. Annualized returns since the passage of the ACA for those three companies have been 24.9%, 17.2%, and 23.1% respectively.
On the other side, President Obama made the claim that if you liked your doctor or plan, you could keep them. This was a claim that was repeated many times. Whether is was naivete or deceit, it was simply false in the end. In fact, Politico called it the lie of the year in 2013. With the new rules imposed by Obamacare, it was simply ridiculous to assert that insurance plans that did not abide by those rules would remain. Also, the idea that people would certainly keep their doctor was a ridiculous promise as well. With or without the ACA, insurance networks change through negotiations or mergers and acquisitions. I know, because we had to go through the terrible experience of losing our pediatrician because our employee-sponsored health insurance (i.e. not an "Obamacare plan") no longer included their office in network after they joined a larger hospital system.
Another claim that was made by Obama was that premiums would be lowered by $2,500. This particular promise, which was repeated a number of times, was made during the campaign. It wasn't based on any extensive research—it basically assessed some areas of cost savings that amounted to $200 billion and then divided that number by the population and multiplied it using an average family size of four. They then rounded it to $2,500. The first issue with this is that figure pertains to the entirety of health care expenditures, not just premiums. That number wouldn't translate directly to lower premiums. The second problem with this is that it's a ridiculous campaign promise that has no basis in actual policy. It's literally napkin math. This particular claim is a perfect example of a vacuous campaign promise that comes back to bite a politician when reality comes crashing in hard. And the reality was that in 2009, we just weren't in a political climate that allowed for the significant systemic overhaul that our health care industry needed.
Let me be clear. I’m not a huge fan of the ACA. I definitely wasn’t supportive of it when I held conservative views and I’m quite disappointed with it from a liberal or progressive perspective as well. I think there are some good pieces to it: Medicaid expansion that has helped many struggling working-class families and those with children who have disabilities; removing lifetime caps that cut people off from life saving treatment; reasonable out-of-pocket maximums that reduce the chances of bankruptcy; protecting people with pre-existing conditions, etc. However, in the grand scheme of things, these are just bandages on a festering wound that is our health care system.
While I am not satisfied with where we’re at, I want to make it better. The Democrats handed us this lackluster legislation that has significant shortfalls, but the unfortunate truth is that Republicans have worked extremely hard to undermine Obama’s signature piece of legislation every chance they have got. At the same time, they have refused to offer up a viable alternative that gets us closer to achieving the three goals we mentioned. It was one of the main motivators of the Tea Party in 2010 and politicians like Ted Cruz rode that wave in 2012. It has been one of his major stances for his entire term and he and the GOP have been successful at picking away at the band-aid while completely blaming the pain on the Democrats and the ACA. The reality is the Republicans are directly responsible for several shortcomings in the ACA by intentionally setting up roadblocks and undermining core components of the legislation. In my next post, I’ll go through these attempts of sabotaging the ACA in detail.