Subtlety versus Bombast

The Patient Protection and Affordable Care Act, H.R 3590—otherwise known as “Obamacare”—is Agamemnon or the most significant social legislation since Medicare. It either has “death panels” or life-saving preventive care for the elderly. It will either kill jobs and increase health care costs or increase demand for healthcare providers and bring new efficiencies to that sector of the economy, effectively bringing down costs over time. One congresswoman actually claimed that Obamacare will “kill woman, children and the elderly.” Further, small businesses will die, U. S. deficits will explode, and the Government will unravel in red tape. When the Republicans stood on the sidelines while the Democrats struggled to pass H. R. 3590, they threw every brick they could into the process. Now that the bill is about to be fully enacted, the Democrats are quietly enjoying the internecine skirmishes within the Republican ranks over futile attempts to scuttle its implementation with threats of government shutdown and debt ceiling perversity. Given all this political uproar, one might ask what are the specific problems with PPAC and, more importantly, what are our elected officials doing to correct them? So far, there is no evidence that small businesses are reducing staff or converting staff to part time. Also, 98% of large businesses already provide healthcare insurance and may be immune to new penalties under this law. Some health insurance premiums have increased in lieu of implementation of the individual mandate. Will these premium increases reverse course after implementation of the individual mandate? Meanwhile, the rising costs of healthcare have slowed to its lowest point in the last 50 years. Will the impetus for efficiency in the new law continue to prod healthcare providers in this direction? These concerns and others, yet to be discovered, may well require legislative action. Will it be possible for our legislators to act responsibly when many of them have taken such extreme positions?

The political discourse is so polluted that it is almost impossible to sift out any factual analysis, most especially since PPAC is just on the cusp of implementing healthcare exchanges (ironically, a Republican brainstorm). Its success or failure rests with a future yet to be determined. My purpose here is not to vet the President’s signature legislation of his first term. Instead, I want to dwell on the nature of the political discourse. Recently, we heard a U.S. Senator compare his fellow Party members to those who refused to stand up to Hitler, as if denying 30 million people the right to affordable healthcare was paramount to relinquishing the European continent to a brutal tyrant. Actually, the only comparison to Nazi Germany that might fit our current circumstance is the blizzard of misinformation foisted on the American people. Fortunately, unlike Nazi Germany, neither Party’s leaders can control the press or the dissemination of actual facts. For example, PPAC is not the 3,000 page tome its opponents inveigh against. It is about 1,000 pages (though, I have to admit, font size may be the relevant factor here). When Democrats imply that it will save the government one trillion dollars, or Republicans claim it will cost 1.4 trillion dollars over the next ten years, both sides are fudging the numbers to mislead the electorate—that is, you. These numbers are “quoted” from the Congressional Budget Office written analysis of PPAC’s impact on the Federal budget. But they are deliberately taken out of context.

Let me quote from the CBO’s executive summary:
“CBO and JCT (joint congressional taskforce) now estimate that, on balance, the direct spending and revenue effects of enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits of $118 billion over the 2010–2019 period.”

Further, the CBO concluded:
“CBO expects that the legislation, if enacted, would reduce federal budget deficits over the decade after 2019 relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP.”

When the Democrats talk of savings, they include non-coverage savings (which are not part of the Federal budget) and ignore the costs of implementation. The Republicans, on the other hand, include the net costs of additional insurance coverage (which are not part of the Federal budget) and ignore the new revenue and cost reductions built into PPAC. Even in our elementary schoolyards, these contradictory assertions would be called lies. So what do we citizens do with this level of misbehavior? First, we have to understand that political tactics are means to an end. If a Party believes in its fundamental goals and strategies, then any means is justified. Secondly, we have to understand the ideology that supports the avowed goals and strategies. Republicans believe in that typically American self-reliance that demands personal accountability and freedom to take risks—even with an individual’s health. Democrats, on the other hand, are dedicated to that typically American altruism that promotes the general welfare. However unconscionable are the tactics, the goals are understandable and are, in fact, enshrined in our Constitution. We Americans are both self-reliant and altruistic. These attributes of our national character seem to conflict if we outweigh the worth either of the individual’s responsibility for his/her health or of the state’s responsibility for assuring the health of its citizens.

The obvious answer to this dilemma is an equitable counterbalance: both the state and the individual have responsibility here. The state can assure that healthcare is provided, but its citizens have to make intelligent use of it. A substance abuse program, for example, is useless if the abuser does not participate in the program. Likewise, the state cannot assure a universal healthcare provision without the support of its citizens. If we appraise the way in which political tactics have poisoned the well of understanding, we can readily see why the majority of Americans don’t support Obamacare. According to recent polls (which I generally ignore), there is an 8% favorability boost when this same healthcare provision is called simply the Affordable Care Act. The result of all this political bickering and leveraging may be self-defeating for both sides of the argument. If H. R. 3590 were not to be implemented or subverted in such a way as to make it unworkable, then we would both vitiate its beneficial provisions for a majority of Americans, not just for the 10% of our population without healthcare, AND increase the deficit spending of our government. Then all the children fighting in the schoolyard return to class with bloody noses.

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      I can appreciate your response. This particular subject is complicated and convoluted. When the political parties contend on the facts, they further muddle the waters. The initial debates were disingenuous because the Democrats included savings estimated in the private sector while ignoring implementation costs and the Republicans did the opposite, using the costs of private insurance made available by ACA while ignoring the new revenues and cost savings cooked into the bill. Both parties argued on false premises. When politicians lie, they destroy trust in our system. We elect them to figure out the complexities and consequences of the laws they engender. They receive a handsome allowance to hire staff and support any required research. As citizens, we cannot be expected to do their jobs for them. But when they fail to win our trust, then we must do what we can to right the ship.In the end, we still have the power of the vote.

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