Social Security as a Model for the Affordable Care Act’s Future

Check Back in a Generation to See if the Health Law Withstands Challenge” suggests the New York Times in an insightful piece that ran earlier this week, which suggests Social Security as a useful comparison. Social Security was enacted in 1935 but benefits didn’t start until 1941. During that long lag conservatives tried hard to get rid of Social Security and it took 10 years or so before it was firmly entrenched. Now of course conservatives love Social Security and other big entitlement programs they previously railed against, with Medicare being Exhibit A.

Democrats and Republicans realize the Patient Protection and Affordable Care Act (PPACA) is most vulnerable over the next few years before it is fully in effect, which is why Democrats designed it to have at least some elements kick in soon and why Republicans are mounting such a furious attack on it now.

It seems to me that history is likely to be on the side of the Democrats. Repeal isn’t going to happen with Obama in office, and if Republicans are somehow successful in having the Supreme Court declare the individual mandate unconstitutional and shave off some of the Act’s edges, what exactly are they going to do then? Health plans are going to scream bloody murder if they don’t get a bunch of healthy new customers –which the mandate is designed to deliver– and I can’t believe Republicans are going to bring back medical underwriting, i.e., exclusion from coverage based on pre-existing conditions.

If Republicans are successful in breaking the back of PPACA, they’ll have handed themselves a poisoned chalice. They have no viable alternative to PPACA, and a collapse is likely to lead to nationalized health care within a few years as employers find health insurance unaffordable and health care costs continue to bankrupt the country.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. MBA (Harvard), BA (Wesleyan)

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7 replies »

  1. “which suggests Social Security as a useful comparison. Social Security was enacted in 1935 but benefits didn’t start until 1941.”
    The funniest thing about liberals is they are so compltly stupid they don’t know how stupid they are. If youre going to hold up SS as an example could you maybe get the basic facts right? NYT can’t even do basic research, what a joke.
    “The first reported Social Security payment was to Ernest Ackerman, who retired only one day after Social Security began. Five cents were withheld from his pay during that period, and he received a lump-sum payout of seventeen cents from Social Security.”
    If not a benefit then what was paid to Ernest?
    History will judge Democrats the clowns they have always been.

    Uh .. Social Security is technically bankrupt — too many political promises made for amount of $$$ coming in.
    Why, in God’s name, would anyone want to repeat that mistake?
    Another inconvenient fact: Social Security was debated in Congress for EIGHT (8) years. A lot of “bugs” were worked out, during that time.
    Unlike OWEbama-care, rammed through by fools without high school math skills. Where a new gross-error is discovered weekly.
    Repeal, and start over. Put adults in charge, this time.

  3. Even with a collapse of the PPACA, I don’t believe there would ever be a situation in which there could be a nationalized health plan. At some point, the state governments would refuse to support that plan, as it would divest a significant amount of influence/power/authority from the states. You would then have a number of enforcement issues with which to contend. The worst-case scenario (and it is only worse case for a subset of the total population) would be furtherance of the status quo. Most likely, the states would adopt their own healthcare restrictions for providers and insurers alike, and you would see an exodus of both to states that are friendly to their views.We should NOT be encouraging the creation of a “nanny state” or other, similar, socio-political constructs through the advancement of overly paternalistic legislation. A populace that is divorced from the consequences of their actions, is a populace that loses the ability to be responsible for those actions. The U.S. government is oppressive enough, it doesn’t need encouragement to subsume any more “rights/powers/authorities” from the states and their citizens.

  4. Social Security and Medicare/Medicaid are, frighteningly, good analogies. This analysis and the NY Times article present tidily narrow arguments. If you ignore costs and unintended consequences, you can make any program sound good in journalistic prose. What scares me is the extreme rhetoric coming from both sides. If they can leave extreme ideologies behind, Republicans and Democrats can make sensible and affordable changes. As it stands, the Patient Protection and Affordable Care Act is poorly named.

  5. I agree with the statement, but not with the time frame. If PPACA’s back is broken, it will take decades, not a few years, for a practical alternative to emerge.

  6. You voiced exactly what I’ve been thinking – exactly what do the Repubs plan to do if they succeed? Going back to what we had is a non-starter. Expanding HSA’s will be like the proposal to privatize Social Security – with the added knowledge of what the Great Recession would have done to that idea. The analogy of a poisoned chalice is a great one – but I highly doubt they have thought that far ahead, being the Party of No.

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