OP-ED

Why You Shouldn’t Succumb to Defeatism About the Affordable Care Act

Whatever happened to American can-do optimism?  Even before the Affordable Care Act covers its first beneficiary, the nattering nabobs of negativism are out in full force.

“Tens of millions more Americans will lose their coverage and find that new ObamaCare plans have higher premiums, larger deductibles, and fewer doctors,” predicts Republican operative Karl Rove. “Enrollment numbers will be smaller than projected and budget outlays will be higher.”

Rove is joined by a chorus of conservative Cassandra’s, from Fox News to the editorial pages of the Wall Street Journal, all warning that the new law will be a disaster.

Robert Laszewski, president of Health Policy and Strategy Associates, anticipates a shortage of doctors. “There just aren’t going to be enough of them.”

Professor John Cochrane of the University of Chicago predicts the individual mandate will “unravel” when “we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance.”

The round-the-clock nay-saying is having an effect. Support for the law has plummeted to 35 percent of those questioned in a recent CNN poll, a 5-point drop in less than a month. Sixty-two percent now say they oppose the law, up four points from November.

Even liberal-leaning commentators are openly worrying. On ABC’s “This Week,” Cokie Roberts responded to my view that the law eventually would prove popular by warning of “a whole other wave of reaction against it” if employers start dropping their insurance.

Some congressional Democrats are getting cold feet. West Virginia Senator Joe Manchin recently fretted that “if it’s so much more expensive than what we anticipated and if the coverage is not as good as what we had, you’ve got a complete meltdown.”

Get a grip.

If the past is any guide, some fixes will probably be necessary – but so what? Our current healthcare system is the real disaster — the most expensive and least effective among all developed countries, according Bloomberg’s recent ranking. We’d be collectively insane if we didn’t try to overhaul it.


But we won’t get it perfect immediately. What needs fixing can be fixed. And over time we can learn how to do it better.

If enrollments are lower than anticipated, the proper response is to keep at it until larger numbers are enrolled. CHIP, the Children’s Health Insurance Program, got off to a slow start in 1998. The Congressional Research Service reported “general disappointment … with low enrollment rates early in the program.” CHIP didn’t reach its target level of enrollment for five years. Now it enrolls nearly ninety percent of all eligible children.

Richard Nixon’s Supplemental Security Income program of 1974 – designed to standardize welfare benefits to the poor — was widely scorned at the time, and many states were reluctant to sign up. Even two years after its launch, only about half of eligible recipients had enrolled. Today, more than 8 million Americans are covered.

If mistakes are made implementing the Affordable Care Act, the appropriate response is to fix them. When George W. Bush’s Medicare Part D drug benefit was launched, large numbers of low-income seniors had to be switched from Medicaid. Many needed their prescriptions filled before the switch had been completed, causing loud complaints. The website for the plan initially malfunctioned. Pharmacies got the wrong information. Other complications led even Republican Representative John Boehner to call it “horrendous.” But the transition was managed, and Medicare Part D is now a firm fixture in the Medicare firmament.

If young people don’t sign up for the Affordable Care Act in sufficient numbers and costs rise too fast, other ways can be found to encourage their enrollment and control costs. If there aren’t enough doctors initially, medical staffs can be utilized more efficiently. If employers begin to drop their own insurance, incentives can be altered so they don’t.

Why be defeatist before we begin? Even Social Security — the most popular of all government programs — had problems when it was launched in 1935. A full year later, Alf Landon, the Republican presidential candidate, called it “a fraud on the workingman.” Former President Herbert Hoover said it would imprison the elderly in the equivalent of “a national zoo.” Americans were slow to sign up. Not until the 1970s did Social Security cover most working-age Americans.

As Alexis de Tocqueville recognized as early as the 1830s, what distinguishes America is our pragmatism, resilience, and optimism. We invent, experiment, and fix what has to be fixed.

Of course there will be problems implementing the Affordable Care Act. But if we’re determined to create a system that’s cheaper and more effective at keeping Americans healthy than the one we have now – and, in truth, we have no choice – we have every chance of succeeding.

Robert Reich, former U.S. Secretary of Labor and Professor of Public Policy at the University of California at Berkeley, has a new film, “Inequality for All,”  released in September 2013. He blogs at www.robertreich.org.

 

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22 replies »

  1. The enactment of the Affordable Care Act is meant to help people obtain health insurance coverage and prevent catastrophic financial losses due to unforeseen health complications. Though there is a lot of negativity towards the new health care reform, it is meant to be beneficial. Some aspects of the reform includes providing preventative care services at no charge and access to health care services and regulating health insurance providers. Preventative care services such as vaccinations, screenings and counseling services will help Americans improve and maintain their health. The marketplace insurance exchange will allow people to obtain more affordable coverage outside of their employer so that health care services will be more accessible. Regulation of health insurance providers will prevent denial of coverage, yearly and lifetime limits. This also forces insurance providers to have minimum benefits requirements so that basic services such as ambulatory, emergency, hospitalization and maternity care are covered. This reform will get people to invest in their own health and help millions of Americans gain access to affordable health insurance, and as Reich pointed out, “the current healthcare system is a real disaster-the most expensive and least effective among all developed countries”

  2. It’s a mad, mad, mad world and affordable care remains a distant dream. Hope the politicians get their act together and start working for the people!

  3. All I can say is clueless, clueless, clueless. Has no idea what is involved in actually getting into medicine, getting into primary care, getting into private (and personal – one to one with patients) business. PPACA will create and is creating all sorts of unintended consequences on patients as well as the primary care practices necessary to care for the population.

  4. @archon41 says:
    December 31, 2013 at 3:45 am
    I was tickled by a comment on an op-ed by Mr. Reich I saw in the NYT the other day: “Obama is a mad scientist using the American people as lab rats, with Reich acting as his twisted assistant.”

    Yup, and not only for PPACA but for HITECH as well. The devices mandated by HITECH have never been approved as being safe and affective as required by the FD and C Act. Thus, the EHR, CPOE, and CDS devices governing Obamacare are experimental as unapproved. Where is the OHRP when needed? Humans are being experimented on sans consent.

  5. I was tickled by a comment on an op-ed by Mr. Reich I saw in the NYT the other day: “Obama is a mad scientist using the American people as lab rats, with Reich acting as his twisted assistant.”

  6. Obamacare inspires “rage” because it is perceived as class-based redistribution, orchestrated with a view to partisan advantage.

  7. Note to Archon:

    Both conservatives and moderates support Medicare, and this program is chock full of redistribution. Young workers pay for the old through payroll taxes, and the wealthy pay for the old through the income taxes that fund most of Medicare Part B and D.

    These forms of redistribution are not obvious to most Americans. Ask people who are politically literate how the payroll tax works, and how much of their income tax goes to Medicare B and D. Not one in a thousand would give you the right answers.

    Obamacare inspires rage because its redistribution is right out in the open.
    The individual insured who gets no subsidies is looking at $300 or $500 a month right in their face. The taxpayer who earns over $250,000 is looking at a surtax right in their face.

    FDR was a lot smarter than this. His programs all had very diffuse taxes, and very visible beneficiaries.

  8. @Reich, considering your intellect and experience, you should know better.

    The $ billions spent on this wasteful morass of rules, with health care being run by EHRs that serve as impediments to care costing $ billions, if deployed to the peoples’ need for care by improving hospital and nursing home staffing ratios would better the outcomes in short order.

  9. Two logical fallacies in this posting (and I apologize for making excessive use of car analogies) :

    1) Because the old system was bad, anything we do will be an improvement.

    Congratulations, you just traded in your Edsel for a Yugo with a bad transmission and flat tires. (The old car was an eyesore and didn’t run very well but the new car doesn’t run at all.)

    2) Because we can fix it, we should.

    Congratulations, we just spent $30,000 fixing your Ford Pinto. (You could have bought a Toyota Corolla for $12,000.)

  10. Conservatives and moderates aren’t going to support redistribution of health care, period. They will also bow their necks at talk of increased levels of taxation.

    Had the “progressives” not proceeded in a spirit of “Occupy Wall Street” zealotry, much might have been accomplished here. I don’t know anyone who would not have supported the individual mandate, had it been based on actuarial realities, and not enclosed in a poison pill of redistribution. Most would also have supported a preemptive federal law authorizing all emergency rooms to refer to the appropriate community facilities, where available, attempts to obtain routine medical care. There can be no excuse for the failure to vigorously address defensive medicine, overtreatment and abuse.

    But that wouldn’t even be a good start, would it? That mindset is what has led to the imminent, and virtually certain collapse, of your grandiose project.

  11. Well Reich never ceases to entertain. Like most pseudo-progressives he is overly wedded to style rather than function. There were any number of ways to make HC accessible to all, but it had to be big govt. (control) and all at once (ego).

    A true progressive would have only been focused on how to make HC a reality for all in the quickest, yet most sustainable/affordable fashion = the style is irrelevant and it’s the end result that matters.

    It’s odd that he quotes Toqueville in that there’s nothing pragmatic about letting something crash and burn, which is what he is very much advocating with his blind optimism. I can only surmise he is doing this as his true goal is expanded govt. not workable and affordable access to HC for all.

    The modifications necessary to make ACA work are so massive that if done the bill will be unrecognizable, which is fine. This of course begs the question will either party be willing to work together to pass the requisite modifications?

    Reich also far too cavalierly glosses over the problems that ACA is creating and will create for the medical system and the economy. This isn’t some incoming freshman’s science project at Bezerkeley in need of a few tweaks rather the economy and medical system for over 300 million people.

    Reich should be a lot more responsible given what’s at stake.

  12. In my view, the regulations that outlawed existing policies were not motivated by deficit neutrality.

    Instead they were motivated by a desire to give people more comprehensive policies, whether or not they wanted this or could afford this.
    For example, because one person in 10,000 might exceed a $250,000 annual claims limit, every policy now has to have no lifetime maximum.

    The budget double counting and cats and dogs little taxes constituted the deficit neutrality part. I am criticizing the regulatory overkill.

  13. From the good ship MV Akademik Shokalskiy: “Sea ice is disappearing due to climate change. . . .” (Scientists Trapped in Record Sea Ice Announce That It Is Disappearing, Real Science, 12-29-13.)

    Orwell would have savored this.

  14. Aurthur’s first sentence above is worth re-reading. We could indeed see a rise in the net number of uninsured, even after the website is more or less fixed.

    The ACA regulations have effectively caused many plan cancellations in the individual market, and will do the same thing in the small group market.

    Sometimes the cancellations are right in the HHS rules, and sometimes the problem is with state regulators, but that is a minor point.

    I think history will show the greatest blunders of the ACA did not involve helping the uninsured. Instead the real damage was in the picayune and perfectionist nit-picking against persons with existing insurance.

  15. “Every law has winners and losers, so whatsa big deal?” Here’s the “big deal”: The “winners” are part of the Democratic “base,” while many of the “losers” voted for Obama, and are incensed by the discovery that they have been manipulated into subsidizing the “winners.” Those presently covered, largely to their satisfaction, under group plans, now fear that they too will be “losers.” The ACA is now like that ship of “global warming” scientists caught in a crush of ice in the Antarctic, and its hull isn’t nearly as thick.

  16. “But if we’re determined to create a system that’s cheaper and more effective at keeping Americans healthy than the one we have now – and, in truth, we have no choice – we have every chance of succeeding.”

    Neatly sums up the core problem with the ACA, its belief that it can defy the fundamental laws: provide everyone with access to high quality care, miraculously save costs as well and nobody feels a pinch in their pocket.

  17. Social Security did not destroy all other private institutions citizens could use to save for retirement. The ACA does.

    Mr. Reich continues to be a cowardly (he will not debate anyone) shill for the destruction of the private sector.

  18. It would be better to try to revise and troubleshoot the ACA than to allow it to continue to slide slowly from one stage of dysfunctionality to the next, but even better would be to get rid of it and start over from scratch, this time coming up with something that’s actually well-designed.

  19. “If there aren’t enough doctors initially, medical staffs can be utilized more efficiently”

    WTF does that mean?

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