I Oppose Obamacare. I Support the Affordable Care Act.

Today, more than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly warm feelings toward President Obama. I think his foreign policy is a mess. The trillions in debt that the U.S. has run up over the past 5 years will hurt my generation and future generations, and if Republicans can be faulted for their fantasy that the federal budget can be balanced exclusively through spending cuts, Obama has sustained the Democratic fairy tale that raising taxes on “millionaires and billionaires” is all that is necessary to pay the skyrocketing bills.

On multiple occasions during my time in government, the President had no qualms about squashing science and scientists for political convenience. He is a perpetual campaigner, preferring theatrical gestures to the backstage grunt work of governing. And for all of his rhetorical gifts when preaching to the choir, he’s been one of the least effective persuaders-in-chief to have held the office.

And so, naturally, I oppose Obamacare. I oppose a government takeover of health care that includes morally repugnant death panels staffed by faceless bureaucrats who will decide whose grandparents live or die and make it impossible for clinicians to provide compassionate end-of-life care. I oppose the provision in Obamacare that says that in order for some of the 50 million uninsured Americans to obtain health insurance, an equal or greater number must forfeit their existing plans or be laid off from their jobs.

I oppose the discarding of personal responsibility for one’s health in Obamacare. I oppose Obamacare’s expansion of the nanny-state that will regulate the most private aspects of people’s lives.

It’s a good thing that Obamacare, constructed on a foundation of health reform scare stories, doesn’t exist and never will.

Instead, the Affordable Care Act (which I support) is based on a similar law in Massachusetts that was signed by a Republican governor and openly supported by the administration of George W. Bush. It achieves the bulk of health insurance expansion by leveling the playing field for self-employed persons and employees of small businesses who, until now, didn’t have a fraction of the premium negotiating power of large corporations that pool risk and provide benefits regardless of health status.

The ACA discourages irresponsible health care “free riders” and provides support for people of modest means to purchase private health insurance in regulated open marketplaces. It tells insurers that in exchange for new customers, they can no longer discriminate against the old and sick and make their profits off the young and healthy. Finally, the ACA rewards physicians and hospitals for care quality and good outcomes, rather than paying for pricey tests and procedures that may or may not improve health.

The ACA has flaws. Since it doesn’t do much to narrow the income discrepancy between different types of physicians, it may overwhelm the capacity of primary care as millions of uninsured patients look for family doctors for the first time. The ACA’s provisions to discourage overuse of unnecessary medical services are limited and probably inadequate to the scope of the problem. But it’s worth noting that these problems all predated the law. We don’t have enough family physicians and other primary care clinicians, specialists make too much money in comparison, and overdiagnosis and overtreatment are already rampant today. That the ACA takes on these issues at all is a small victory of sorts.

It’s interesting to consider the counterfactual exercise of what might have happened if Mitt Romney had captured the 2008 Republican Presidential nomination and then narrowly defeated Hillary Clinton, who was the odds-on favorite for the Democratic nomination in that year. No doubt affordable health care would have been an important focus of that hypothetical contest, with Romney successfully linking Clinton to her husband’s failed 1994 reform plan that makes right-wing objections to the ACA look insignificant by comparison. Once elected, a President Romney would have felt compelled to advance national health reform, and would have naturally modeled his proposals on his Massachusetts plan. We might have ended up with a conservative law that looked much like the Affordable Care Act, only this time criticized by the left for being too administratively complex and not generous enough in providing coverage for all.

A farfetched scenario, you say? Perhaps. But it underlines the need for people of all political persuasions to set aside the overheated rhetoric about Obama and Obamacare and focus on making the ACA work, starting today.

Kenny Lin is a family physician practicing in Washington, DC. He is an associate editor of the American Family Physician journal and teaches family and preventive medicine at Georgetown University School of Medicine. You can follow him on his blog Common Sense Family Doctor, where this post first appeared.

21 replies »

  1. Uh, I admire the passion but Obamacare and AFordable Care Act is the same thing. They toss a few crumbs to the peons while your gov’t enjoys great cadillac coverage – because it doesn’t apply to them. And, the personal quesitons should be enjoyable to all.

  2. Sighing a little here…

    I think Kenny gets that. He’s making a point about the connotations associated with each “name.”

  3. Obamacare IS the Affordable Care Act ! They are one in the same. How can you be a MD but not know that it was Nicknamed Obamacare by the masses. They even did an on the street on jimmy kimmel and like you 9 out of 10 people said the same thing that they liked the affordable over the obamacare act BUT they are one in the same.

  4. As a small business owner, there are some actual facts I now have in hand. I just received the premium costs after the plan is “upgraded” to comply with Obamacare. Our company is small but growing, about a dozen people.

    Our insurance premiums are going up 42.5%, this is an absolute fact as I have the quote from one of the largest carriers in the country (Anthem). This is a high deductible plan, where the employee or employer pays the first $5,000 to $10,000 in costs directly each year (meaning most employees will never use the insurance to pay for anything).

    I worked it out, with the new premiums, we will be spending about the cost of 2 employees on healthcare per year — that is 2 fewer people that we could use to grow as a company. Since we are under 50 employees, we may be forced to drop healthcare altogether.

    I actually am supportive of our employees and want to provide decent coverage for them, but now it appears to me that this is just a way for the insurance companies to bilk us for even more. Now if we are forced to drop healthcare coverage, our employees will be forced to purchase their own plans.

    And how do the really big companies that employ service people deal with this? By limiting minimum wage employees to 30 hour part time positions, so they can skirt the rules.

    The upshot is that this is expensive, it will take it’s toll on small business in a big way. And small business is the best economic engine this country has.

    So much for more affordable healthcare under the new rules…

  5. I’m not a Republican or Democrat

    ObamaCare was made Law, but not one Republican in the House voted for it. And if I’m correct only the House can access taxes. Obamacare was unconditional per the Interstate Commence laws, but made a tax after it was passed into law. Interesting interruption…

    Some claim the majority wants Obamacare, but than again the majority of the house is against it, and the Republicans (in the house) were voted in by the same pool of “citizens” that voted in the majority of Senators, so maybe we the people, like checks and balances.

    Pelosi said “we have to pass Obamacare to find out what is in it”, put aside all that can be said regarding such a remark, but doesn’t that statement imply. lets see what’s in it(Obamacare) and make changes?

    Obama was dead set against raising the debit ceiling when Bush was President, but now, he has changed his mind, and that’s OK. And if it is OK, than so can everyone else.right?

    The employer mandate was postponed a year, could that have been a political tactic to have employers drop providing health insurance and thus a way to get everyone to buy via the exchange? Is this why Obama refuses to give the same postponement to the individual? It seems fair to make the same postponement in light of all the issues already encountered.

    And why shouldn’t Congress and all their staff be required to buy into Obamacare, and why should the taxpayers supplement their existing premiums to the tune of 75%?

    Why is there a tax on medical devices, isn’t that just going to raise the cost of health care (yes, I know it is also looked at as a source of revenue) ? Are people that need medical devices being penalized. Shouldn’t individual choices also than be penalized, like people who smoke, drug users, etc…?

    Just some thoughts from Tax payer who now seems to have no choice.
    I don’t know the source of this quote. but
    “Why is one person’s liberty take away because of another guilty conscience?”.

    Health care for all sounds like a noble goal, but is this the right way?

  6. Under Obamacare, we will be offered with insurance exchanges which will be divided under 4 categories, bronze, silver, gold and platinum. Each of these tiers will limit out-of-pocket expenses for individuals to $6,350, and to $12,700 for a family of two or more. At the same time, insurers will have the freedom to choose their “in-network” number of doctors and hospitals. Bronze plans will have the lowest premiums, but will cover only 60% of out-of-pocket costs. Platinum plans, on the other hand, will charge the highest premiums, but will cover 90% of out-of pocket costs. With similar plans competing against each other in the same tier, customers will benefit from lower premiums.

    I got this insight from this well-written article: http://goo.gl/Ucw56W

    I hope that everyone is provided with exact and accurate information so that they can make the correct decision, while going for suitable package.

    Cheers 🙂

  7. Mr. Lin, You raise interesting points. I should admit my causal manner in tossing around the words “social medicine” was inappropriate. As a rationalization, however, I will point out the irrational, knee-jerk, reactions most folks have to seeing or hearing the accurate term or terms many times shuts down the minds of emotionally driven readers and listeners. Socialized medicine would involve government owning the means of production, which, by my definition, at least for now, is not an accurate description, yet. So let me rephrase my comment to “you extolling the virtues of communistic medicine and are well on the way to embracing fascist medicine.” When you argue for equalizing wages of doctors of significantly different skill levels that have significantly different value to the end users in the open market, then you are arguing the virtues of communal medicine.


    It is clear to me that this administration was and is not courageous enough to put their ultimate socialized medicine plan into effect initially, since they are unwilling to take responsibility for the negative consequences and outcomes and believe that they can redirect the blame for their failing fascist based medical delivery scheme onto the insurers, providers, and the end users, many of which are apparently anarchists, terrorists, hostage takers, and worse yet, capitalists. Thank you for your open mindedness.

  8. 2- “quite far”…which way:

    Normal —– IQ 85-115
    Deficient —- IQ 71-84
    Moron —— IQ 51-70
    Imbecile —- IQ 26-50
    Idiot ——– IQ 0-25

    Just kidding.

  9. Dear Kenny,

    I am aware that reducing cost of healthcare is not a simple task and as rightly pointed out many countries have tried with mixed (at best) success. And I do not know a single magic solution to this challenge. But I would bring the attention to several points:
    1.There are three parties involved in healthcare: patients, physicians (clinical) and bureaucracy (insurances, government). All three are necessary, but the bureaucracy tends (and it does in case of healthcare as well) to serve its own interests instead of what it was originally created for – patients and physicians. Just two examples for you:
    if you are required to use ICD10 instead of ICD9 with way more diagnoses to choose from and I am your patient, will you treat me any better? More efficient? For less money? Right opposite – you will spend more time searching for the right code and thus, less time actually examining/treating me. And all these bureaucrats looking/not looking into these codes also do not work for free.
    If you see me in the office and bill for the office visit and at the same time give me a flu shot, you have to add a modifier 25 to your charge, otherwise your claim gets denied. So you have to hire an experienced biller. (of course for many more similar tasks). Why? If the insurances need somehow these modifiers to run the claims – they can add them on their end.
    2.I think that access to healthcare belongs to some basic human needs, just as access to food. And I do not want anybody in this country to be hungry or have no access to healthcare. I believe that we better or worse resolved the hunger problem. But nobody suggests forcing all the restaurants to offer free meals to anybody who claims not to have money to pay for. Why we cannot build a network of relatively inexpensive medical facilities (without marble walls, flat screen TVs and so on, but clinically as good as any other ones)? As a society we need to help those who are in need, but our help should be in a form and dosage not discourages them to get on their own feet.
    3.Discrimination by race, age, gender, etc. is rightly prohibited. But why we all are discriminated in regards to healthcare? If I work for a large company my access to the very same healthcare costs me way less (or even nothing) comparing if I work for a smaller company or self employed? Why the cost of the very same service/procedure is different? If I go to a grocery store (and there are more and less expensive ones) nobody asks me where I work. Thus, my access to food is not as discriminatory as my access to the healthcare.

    Even if we cannot make healthcare inexpensive (and it probably should not be), why not to make it reasonably expensive?

  10. Dear Boris,

    I couldn’t agree more with you that health care in America is much too expensive. But nowhere in the world has anyone figured out how to tackle the problem of health spending increases in a systematic way – even countries with nationalized universal systems that have global budgets for health. At best, some countries have figured out how to slow the rise of spending growth, but it outpaces economic growth nonetheless. To those of us in the U.S. with good health insurance and access to care, this is a concerning but ultimately academic problem. To everyone else, lack of access to care or inability to afford it can be literally a matter of life and death.

  11. Yes, m24, I’d hope that most if not all THCB readers know that death panels are a myth, but as of one year ago 4 in 10 Americans still believed that they were part of the ACA/Obamacare: http://thehill.com/blogs/healthwatch/health-reform-implementation/258753-poll-four-in-10-believe-in-health-law-death-panels

    That statistic may go a long way toward explaining why the law remains so unpopular.

    And thanks for complimenting my writing and linking to Peter Ubel’s very intelligent post.

  12. Dear Aurthur,

    Thank you for taking the time to reading the entire post, which I hope makes clear that I do not believe in death panels or any of the other myths I called Obamacare.

    I’m curious about your definition of “socialized medicine.” Is it when the government owns the medical facilities and salaries the doctors? Then the U.S. military medical system, the Veterans Health Administration, and the Indian Health Service are all socialized medicine.

    Or is it when the government subsidizes health insurance that is used to pay private doctors and hospitals? Then Medicaid, Medicare, the Federal Employees Health Benefits Program, and yes, parts of the ACA/Obamacare are socialized medicine.

    It’s worth noting, though, that not everyone who purchases health care on the exchanges will qualify for tax subsidies. Then the situation would be private payment, private doctor, private health care – hardly turning the U.S. into the United Kingdom or Canada.

  13. Dear Mark:

    1-Have to second Aurthur in part here. You should really, really read the entire piece. The “I support the ACA” part is kind of important.

    2-Seconding Boris here: no need to be rude. From what I’ve read of Kenny’s writing, he’s quite far from being an idiot.

    3-THCB readers are not your average bunch. No one here thinks death panels exist.

    Adding this one to your reading list from Peter Ubel:

  14. When insurance becomes mandatory, heavily regulated and paid by taxpayer’s money plus conditions are set to make it harder for private practices – it is to a great extend takeover.

    I would also advise you too stay within civilized limits towards your opponents. Rudeness shows your weakness.

  15. Mr. Jones. Apparently you only read the first part of the article (the hook) without enjoying the second cutesy part where Dr. Lin turns heel and extols the virtues of socialized medicine.

    “The ACA has flaws. Since it doesn’t do much to narrow the income discrepancy between different types of physicians,”

    Yep. Let’s pay PCP from St Kitts medical school the same as a pediatric brain surgeon from John Hopkins or some lesser school like Georgetown

  16. Without going into details, there are two problems with the healthcare in this country:

    a) it is unreasonably expensive;
    b) many people do not have the needed access to it.

    Just by looking at the above, why one would try to address the second issue (as Obamacare/ACA does) without properly addressing the first one first?

  17. Quite interested to hear your version of the news, Mark. Instead of gaping incredulously, why not elaborate?

  18. Spoken like it was read from the teleprompter at Faux News.

    Wow, do you actually believe this?