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Five Obamacare Myths
by Bill Keller
July 15, 2012
ON the subject of the
Affordable Care Act — Obamacare, to reclaim the name critics have made into a
slur — a number of fallacies seem to be congealing into accepted wisdom. Much
of this is the result of unrelenting Republican propaganda and right-wing
punditry, but it has gone largely unchallenged by gun-shy Democrats. The result
is that voters are confronted with slogans and side issues — “It’s a tax!” “No,
it’s a penalty!” — rather than a reality-based discussion. Let’s unpack a few
of the most persistent myths.
OBAMACARE IS A JOB-KILLER. The House Republican majority was at it again
last week, staging the 33rd theatrical vote to roll back the Affordable Care
Act. And once again the cliché of the day was “job-killer.” After years of
trying out various alarmist falsehoods the Republicans have found one that
seems, judging from the polls, to have connected with the fears of voters.
Some of the job-killer scare stories are based on a deliberate
misreading of a Congressional Budget Office report that estimated the law would
“reduce the amount of labor used in the economy” by about 800,000 jobs. Sounds
like a job-killer, right? Not if you read what the C.B.O. actually wrote. While
some low-wage jobs might be lost, the C.B.O. number mainly refers to workers
who — being no longer so dependent on employers for their health-care safety
net — may choose to retire earlier or work part time. Those jobs would then be
open for others who need them.
The impartial truth squad
FactCheck.org has debunked the job-killer claim so many times that in its latest update you
can hear a groan of weary frustration: words like “whopper” and “bogus” and
“hooey.” The job-killer claim is alsodiscredited
by the experience under the Massachusetts law on
which Obamacare was modeled.
Ultimately the Affordable
Care Act could be a tonic for the economy. It aims to slow the raging growth of
health care costs by, among other things, using the government’s Medicare
leverage to move doctors away from exorbitant fee-for-service medicine, with
its incentive to pile on unnecessary procedures. Two veteran health economists,
David Cutler of Harvard and Karen Davis, president of the Commonwealth Fund,
have calculated that over the first decade
of Obamacaretotal spending on health care,
in part by employers, will be half a trillion dollars lower than under the
status quo.
OBAMACARE IS A FEDERAL TAKEOVER OF HEALTH INSURANCE. Let’s be blunt. The word for that is “lie.” The
main thing the law does is deliver 30 million new customers to the private insurance
industry. Indeed, a significant portion of the unhappiness with Obamacare comes
from liberals who believe it is not nearly federal enough: that the menu of
insurance choices should have included a robust public option, or that Medicare
should have been expanded into a form of universal coverage.
Under the law, to be sure,
insurance will be governed by new regulations, and supported by new subsidies.
This is not the law Ayn Rand would have written. But the share of health care
spending that comes from the federal government is expected to rise only
modestly, to nearly 50 percent in 2021, and much of that is due not to
Obamacare but to baby boomers joining Medicare.
This is a “federal takeover”
only in the crazy world where Barack Obama is a “socialist.”
THE UNFETTERED MARKETPLACE IS A BETTER SOLUTION. To the extent there is a profound difference of
principle anywhere in this debate, it lies here. Conservatives contend that if
you give consumers a voucher or a tax credit and set them loose in the
marketplace they will do a better job than government at finding the services —
schools, retirement portfolios, or in this case health insurance policies —
that fit their needs.
I’m a pretty devout
capitalist, and I see that in some cases individual responsibility helps
contain wasteful spending on health care. If you have to share the cost of that
extra M.R.I. or elective surgery, you’ll think hard about whether you really
need it. But I’m deeply suspicious of the claim that a health care system
dominated by powerful vested interests and mystifying in its complexity can be
tamed by consumers who are strapped for time, often poor, sometimes uneducated,
confused and afraid.
“Ten percent of the
population accounts for 60 percent of the health outlays,” said Davis
LEAVE IT TO THE STATES. THEY’LL FIX IT. The Republican alternative to Obamacare consists
in large part of letting each state do its own thing. Presumably the best ideas
will go viral.
States do have a long history
of pioneering new ideas, sometimes enlightened (Oregon ’s
vote-by-mail comes to mind) and sometimes less benign (see Florida
You’ve heard a lot about the Massachusetts Massachusetts Massachusetts
OBAMACARE IS A LOSER. RUN AGAINST IT, RUN FROM IT, BUT
FOR HEAVEN’S SAKE DON’T RUN ON IT. When
Mitt Romney signed that Massachusetts
Unfortunately, the benefits
of Obamacare do not go wide until 2014, so there are not yet testimonials from
enthusiastic, family-next-door beneficiaries. This helps explain why the bill
has not won more popular affection. (It also explains why the Republicans are
so desperate to kill it now, before Americans feel the abundant rewards.)
Blendon believes that because
of the delayed benefits and the general economic anxiety, “It will be very hard
for the Democrats to move the needle” on the issue this election year.
He may be right, but shame on
the Democrats if they don’t try. There’s no reason except cowardice for failing
to mount a full-throated defense of the law. It is not perfect, but it is
humane, it is (thanks to the Supreme Court) fiscally viable, and it comes with
some reasonable hopes of reforming the cockeyed way we pay health care
providers.
Even before the law takes
full effect, it has a natural constituency, starting with every cancer victim,
every H.I.V. sufferer, everyone with a condition that now would keep them from
getting affordable coverage. Any family that has passed through the purgatory
of cancer — as mine did this year, with decent insurance — can imagine the hell
of doing it without insurance.
Against this, Mitt
Romney offers some vague free-market
principles and one unambiguous promise: to dash the hopes of 30 million
uninsured, and add a few million to their ranks by slashing Medicaid.
If the Obama campaign needs a
snappy one-liner, it could borrow this one from David Cutler: “Never before in
history has a candidate run for president with the idea that too many people
have insurance coverage.”
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