RANCHO SANTA FE, Ca., November 11, 2013 – Obamacare is the single most significant piece of legislation passed in the last century. Period!
Some will argue that a few of the eleven Constitutional Amendments that have been ratified during that 100-year period may rival the Patient Protection and Affordable Care Act (the Act’s real name – ACA for short), but they would be wrong.
While a Democratic-controlled House and Senate created the income tax under the Sixteenth Amendment in 1913 and a Republican-controlled House and Senate finally granted Women’s suffrage under the Nineteenth Amendment in 1920, neither Party’s accomplishment measures up to the unique character and impact of the ACA. That is because those Amendments were subject to the standards imposed by Article V of the Constitution, which required a sufficient building of consensus to secure ratification by three-fourths of the States.
Conversely, the ACA made sweeping reforms to a sector that represents one-sixth of the United States’ economy while only passing the House by a vote of 219-212, with 34 Democrats and all 178 Republicans voting against it. The passage of a bill of this magnitude, without any cross-over support, is unparalleled in the annals of our Nation’s history.
As was mentioned in a prior column (Obamacare: The Good, the Bad and the Ugly – October 14, 2013), this “hardball” approach achieved political success where other Administrations had failed. It also provides a raw look at a political environment that appears to be more attributable to Machiavelli than to our Founding Fathers.
In that regard, the “end” was laudable: tens of millions of citizens may ultimately enjoy health care coverage that was beyond their reach prior to the law’s enactment, pre-existing conditions will no longer preclude individuals from securing necessary coverage, and people will no longer be able to be dropped from coverage because they fell victim to a disease or accident…just to name a few. However, the “means” were relatively unconscionable.
Rather than wasting time reiterating the backroom dealings, pork, regulatory bloat, and legislative irresponsibility that pervaded the process (i.e., “We have to pass the bill so you can find out what’s in it”), let’s examine the President’s own words as he delivered them to the American Medical Association on June 15, 2009.
In that speech, President Obama described the necessity for health care reform, underscored it with examples, suggested what was broken and how to fix it, and set the stage for repelling any resistance to his signature legislation. After an obligatory reference to the recession he inherited, he began:
“Today, we are spending over $2 trillion a year on health care – almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren’t any healthier.”
This statement highlights the three key components of real healthcare reform: cost, access, and quality. However, political healthcare reform is driven by only one of them: access. Interestingly enough, it even gets that one wrong.
The President equates access to health care insurance with access to actual health care. While they are related, they are not identical. Real healthcare reform would require access to actual healthcare. Political healthcare reform can stop with access to healthcare insurance and pass the responsibility for the other components of cost and quality to the insurance companies and healthcare providers.
We already have an example of this sleight of hand. The Administration has granted itself absolution with respect to the millions of policies that have been canceled. It is the insurance companies’ fault, not the Government’s; even though the cancelations were required for regulatory compliance reasons. Brace yourself for the next wave, which will address increased policy costs, copays, deductibles, and the shrinkage of in-network healthcare options.
The President then shared some interesting examples of:
- “…families who have seen out-of-pocket costs soar, and premiums double over the last decade at a rate three times faster than wages;”
- “…doctors (who spend) 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters;” and
- “… (a) family-run marketing firm (that) recently had to do the unthinkable and lay off a number of employees – layoffs that could have been deferred, they say, if health care costs weren’t so high.”
Who believes that the 11,000+ pages of regulations that have already been promulgated to implement the ACA will eliminate or even reduce these burdens?
The President went on to explain that “part of the reason (that health care reform hasn’t been achieved in the past) has been the fierce opposition fueled by some interest groups and lobbyists – opposition that has used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.” Yet, the chief architect of the ACA was a former (and current) lobbyist for the insurance industry, and she received strong assistance from PhRMA. The President even noted that he was “working with AARP to uphold (a) commitment (to the Medicare Trust Fund).” Who believes that the risk of lobbyist influence has been conquered?
Then, President Obama delivered what became his Party’s mantra to gain support for and overcome objections to the ACA when he said: “…we also know that there are those who will try and scuttle this opportunity no matter what – who will use the same scare tactics and fearmongering that’s worked in the past. They’ll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We’ve heard it all before – and because these fear tactics have worked, things have kept getting worse.”
He was astoundingly prophetic as this is exactly what the Republicans did.
To allay our concerns, the President immediately added: “So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage – they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.”
Recently, President Obama clarified any misperception we may have had with respect to that statement when he said, “Now, if you have or had one of these plans before the Affordable Care Act came into law and you really liked that plan, what we said was you can keep it if it hasn’t changed since the law passed.” How many of you missed that point at the time?
To avoid boring you, the rest of the President’s 2009 speech referenced such goals as:
- To “stop spending tax dollars to prop up an unsustainable system, and start investing those dollars in innovations” (with no reference to taxing medical devices, etc.);
- To “upgrade our medical records by switching from a paper to an electronic system” (with no reference to any related security issues or cost of conversion);
- To revamp “a system that automatically equates more expensive care with better care” (without any reference to how to change that paradigm);
- To “(reform) the way we compensate our doctors and hospitals…to bundle payments…to create incentives for physicians to team up” (again without reference as to “how”);
- To “(root) out waste, abuse, and fraud throughout our health care system” (while adding 159 new oversight committees and 11,000+ pages of new regulations to the mix); and
- To “scale back the excessive (practice of) defensive medicine” (while specifically avoiding any intrusion into the ripe field of tort reform, perhaps because of the power of the associated lobby).
The reason it is important to review these statements and promises is because they came from our Chief Executive, and they laid the groundwork for passing the ACA. It is very possible that, without them, the two vote margin in the House would not have been secured. It is also possible that, without them, the President would not have been rewarded with a second term. We will never know.
What we will learn over time is which of the statements will prove to be true; how many of the solutions will be effectively implemented; and, whether the results will parallel the promises. It will be interesting to observe whether the real ends will justify the means…and for whom.
We will begin to receive measurable results shortly. The Administration has promised to deliver performance numbers for Healthcare.gov later this week, and “the debacle” of a website is to be fully functional as of November 30, 2013. Hopefully, nuanced explanations and Presidential apologies such as, “I am sorry that they, you know, are finding themselves in this situation, based on assurances they got from me,” will no longer be required.
We should be indebted to the ACA (and not just literally). It is not only a landmark piece of legislation based on its scope, but it also provides us with as an important political lesson; more so than any other law in recent history. It provides us with a glimpse into how political messages are crafted and bills are passed at the Federal-level, and it gives rise to a host of questions:
- Does our current political divide require an “end justifies the means” approach to break the deadlock, or can we demand better?
- Will we hold our elected officials accountable for their statements, or will we accept the trend of recent years of allowing them to “walk back” what they say?
- Will we hold the Government accountable for the impact of its regulations, or will we allow it to insulate itself from responsibility by shifting the blame to the purportedly “evil” private sector?
- And finally, will we ever realize that all of this is within our control?
With respect to the latter, it would be remiss not to thank those who have served our Nation to preserve that right and the rest of the liberties that we enjoy. May all of our veterans enjoy this day which is celebrated in their honor.
T.J. O’Hara is an internationally recognized author, speaker, and strategic consultant in the private and public sectors. In 2012, he emerged as the leading independent candidate for the Office of President of the United States and the first nominee of the Whig Party in over 150 years.
This article first appeared in T.J. O’Hara’s recurring column, A Civil Assessment, in the Communities section of The Washington Times.