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POV: Opposition to Obamacare Is Maddening

Ignore the critics: here’s what the law really does

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“POV,” a new addition to BU Today, is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact Rich Barlow at barlowr@bu.edu.

Predictably, this week’s rollout of the Affordable Care Act (ACA) received attention high in volume and intensity. While the administration signs up uninsured Americans flooding the health insurance exchanges, the government is shuttered thanks to a deadlock over opponents’ efforts to repeal the act, or failing that, to starve the implementation process for funds.

As one who has written about health policy for many years, I find the opposition to be nothing less than maddening. Some, like Senator Ted Cruz (R-Tex.), are just nasty and cynical. As the New York Times’ Gail Collins points out, he wants to kill the act because it is bound to be popular, and therefore, hard to take away from people later on. Others continue to spew falsehoods about the law. Either they have not taken the time to inform themselves of the facts or they just don’t care what the facts are. It is maddening because the issues are serious, they affect us all, and those guys treat it like a game in which the only prize is a government job for themselves in the national legislature, where, historically at least, the object was to pass legislation.

While the law is hard to master because it is long and has many parts, most of the ideas are pretty simple and have been around for a long time. What follows is an attempt to set the record straight on the assumption that not everyone is taken in by the cacophony from the far-right chorus.

The first point to make—and the place where the debate should begin—is that reform is critically important to the future of the American health care system. One reason, of course, is that millions of Americans have not had insurance, and therefore, have lacked access to beneficial medical services. In addition, US health care spending, which already is the highest in the world by far, is still growing, thus making it harder both for employers to continue to provide good coverage to employees and their families and for individuals to buy insurance even when their employers offer it. Finally, quality of care is too unreliable. Quality measures vary widely from state to state. Even doctors, when they or their families are patients, have trouble getting the care they know they need.

These are serious problems, and the continuing failure to deal with them makes them worse. In 2010, the president and his congressional allies were able to pass the ACA, which, while not perfect, addresses all of these problems in ways that are reasonable. If fully implemented, the health care system will improve, and we will all benefit.

What are some key provisions? Practically all Americans must obtain health insurance (the “individual mandate”). Those who have trouble paying for it may be eligible for subsidies to help. Moreover, insurers must provide coverage for all who seek it, even those with prior medical conditions, and except for age, may not charge individuals more because of personal characteristics, even factors that increase the risk of needing care. Thousands of young adults up to the age of 26 are still covered on their parents’ insurance policies while they continue as students or look for a job with coverage. According to estimates, in 2012, almost 13 million people received rebates totaling more than $1 billion because private insurers spent more than the maximum permitted by the law (85 percent for large-group insurers; 80 percent for those in the individual and small-group markets) on overhead, executive compensation, and profit instead of on medical services and efforts to improve quality of care. Health insurance exchanges should make it relatively easy for individuals to compare competing insurance policies and to choose the one that is best for them. And many provisions encourage reform of the way care is delivered and paid for to increase quality and save money.

Opponents claim that government will “play doctor” (without identifying provisions that could lead to that conclusion); that the law takes away personal freedom (though it is not clear how or what freedom); and that it will cost people too much (though early indications are that premiums will be lower than expected). They also claim it will add to the federal deficit, even though the Congressional Budget Office has long estimated not only that the deficit will be reduced, but also that repealing the law, as the House has voted to do more than 40 times, would add $109 billion to the deficit. While the administration and others valiantly try to answer them, the growing list of false charges causes lots of damage. Recent surveys show that many disapprove of the ACA (although most tend to want lawmakers to “do what they can to make the law work as well as possible”). Many do not understand it very well—partly because, if they already have insurance, it may not affect them directly or because they are confused by the “facts” the far right makes up.

The new law is not perfect, but Senator Cruz is probably right that it will be hard to take away from people when they see the good it does.

Stephen Davidson, a School of Management professor, is the author of A New Era in U.S. Health Care: Critical Next Steps Under the Affordable Care Act (Stanford University Press, 2013); he can be reached at sdavidso@bu.edu.

This article originally appeared on the Huffington Post.

27 Comments

27 Comments on POV: Opposition to Obamacare Is Maddening

  • The forest for the trees all ideology aside on 10.04.2013 at 5:38 am

    Th affordable care act is bad for two reasons. First because it uses tax coercion to force people to buy something they may not want under the assumption that someone else must pay for their healthcare if they opt not to have it. This ignores that fact that people have free will and are entitled to live their lives as they see fit. Per the US constitution I should be able to simply sign a waiver saying thanks but no thanks and opt out of the US healthcare system entirely and not have to pay a fine to do so. But thanks to decades of stare decisis and bad case law pertaining to the commerce clause the SCOTUS has ruled that this is not the case.

    Second affordable care act ignores the effect free market competition has on the costs of healthcare per se by focusing wrongly on the cost of healthcare insurance and expecting that this will drive down healthcare costs. The end user in the best position to negotiate the cost of anything be it an MRI or a physical exam. My auto insurance company has to pay for the cost of repairs on my car but this has vary little impact on the price of the car per se.

    Finally many viable alternatives including tax free healthcare savings plans that allow families to build up a fully transferable nest egg for their healthcare costs have been completely marginalized by the affordable care act. The idea of saving tax free dollars that can be used both for annual physicals etc. and to pay for the higher deductibles associated with lower cost insurance policies has been forsaken in exchanged for a one size fits all plan based on the political ideology of one party that seeks to gain votes by feeding and burgeoning dependent class.

    All Americans have to live with the healthcare system we have and being that we are not a democracy but a republic wherein the rule of law and individual rights trump majority rule we need to sit down at the table and come up with plan that works better for everyone not just for those who heretofore were underserved at the expense of those who previously were pleased with their plans.

    When one party tries to force its ideology down the throats of the other you have the moral equivalent of two wolves and sheep deciding what to have for dinner.

    We should abolish the affordable care act and go back to the drawing board. As James Madison said the political jealousy of some among us would lead one to believe their is not enough virtue among men for self governance but trust me when I say we can come up with a better plan than the affordable care act if we all work together.

    • Greg on 10.04.2013 at 10:09 am

      I disagree with everything you just said.

      1) Your notion that as an American you can just sign a waiver and live your life is flawed and has been deemed by our courts to not be a valid lifestyle choice in the USA. Henry David Thoreau attempted this lifestyle when he was protesting the US-Mexican War and civil disobedience, while a nonviolent way of protesting, did not change the fact that he was committing tax evasion and was therefore arrested. Your notion that stare decisis and “bad case law” allows for individual taxation goes against all judicial development of this country.

      2) While you are correct that individual rights trump majority rule, your present argument ignores the fact that access to healthcare is a fundamental civil right in the 21st century (and has been since we helped draft and then signed the UN Declaration of Human Rights). Thus, while those who are “pleased with their plans” may not like change, for those that currently are denied access or cannot afford plans this is a necessary switch.

      At some point you need to step out of your ideologue view of living in a 1770′s America, wake up to the 21st century, realize the human rights crisis taking place in this country, and move for immediate action so that people can start getting the treatment they need. Writing and acting as if you’re James Madison does not change the present facts and needs of this country.

      • The forest for the trees all ideology aside on 10.04.2013 at 1:27 pm

        Access and having something paid for by others are too entirely different concepts and you should note that I have said nothing negative about the part of the law that mandates coverage from pre-existing conditions.

        Second you are dreadfully wrong about the right to opt out as the Amish and Scientologist can do so. And the last time I checked we were still a sovereign nation and not under the rule of the UN. Unless you can show me where we have been deemed by the UN to be in violation of basic human rights as an American I take huge issue your allegations.

        You seem determined to force your will on other people irrespective of their right to live and die as they see fit.

        It is funny how history has repeatedly shown that when it comes to human nature the more things change the more they stay the same yet you insist that it is different this time; I guess we will all just have to wait and see on that one.

        • Greg on 10.04.2013 at 2:53 pm

          We are not under rule of the UN, but we have made an obligation to uphold international treaties that we’ve signed with the UN. If we don’t recognize international law that we’ve signed then what validity does any law hold that we’ve signed? Is your suggestion that the Charter of the United Nations holds less significance as a codified constitution than the Constitution of the United States?

          Not to be anti-America, but the age of American isolationism and the Monroe Doctrine that fueled that time have been long dead since the 1940′s. If we are to uphold our place amongst other nations on this Earth we need to start upholding the same values that we expect of those other nations. Per the UN Declaration of Human Rights, allowing and providing access to basic health care is one of those rights.

          • The forest for the trees all ideology aside on 10.05.2013 at 10:17 am

            I respectfully disagree. Americans are not evil as you imply and we are not now nor have we ever been in violation of any UN treaty. But there are serious implications in your comments that could lead the uninformed reader to assume we are or will be by in violation by not enacting the ACA which is simply not true. Since this is not a matter of fact these allegations need to be defended against.

            The US continues to attract people from far wide who come here to escape oppressive regimes wherein basic human rights are really denied. For these people America has been and continues to be the bastion of liberty the world over. The US is not the bastion of socialism or communism and we have never aspired to be since the inception of this nation. Yet it seems you think this is what we should become to appease the UN.

            That said let me now quote Benjamin Franklin who said “Those who will sacrifice essential liberty for temporary security deserve neither.”

          • Pete on 10.06.2013 at 8:16 am

            Greg… Let’s try this again… Access and having something paid for by others are too entirely different concepts.

          • Pete on 10.06.2013 at 8:35 am

            The health care law was described deceitfully, enacted into law dishonestly, implemented inefficiently, and affecting far too many people adversely. The bad outweighs the good, which is actually why you need to wake up from your delusional thought & join a majority of people who detest it.

    • sceptical on 10.04.2013 at 10:23 am

      “Per the US constitution I should be able to simply sign a waiver saying thanks but no thanks and opt out of the US healthcare system entirely and not have to pay a fine to do so.”

      If you have a medical emergency, how would a first responder know to withhold all medical care from you because you have exercised your right to opt out of healthcare entirely? And if your life was saved, even though you had chosen with eyes wide open to have no health insurance, who would pay for your treatment after the fact? You? Or those who have bought into the system but not needed to use it (yet)? I really don’t see how opting out entirely can work as long as our impulse is to treat, and be treated, in emergencies.

      • Peter on 10.04.2013 at 11:59 am

        Acute care(ER) is perhaps 1.9% of the total health care delivered. This is inflated due to the number of visitors illegally residing in the US, who then use it as their Primary Care.

        Acute care would be more affordable under a plan outside of traditional insurance and Government restrictions. Individual physicians have already set up some low cost concierge plans where a patient would pay perhaps $50/month for unlimited visits.

    • Rupert Manlove on 10.04.2013 at 11:27 am

      apart from the fact that MA already has a system in place like this? Keep in mind that the basis of this was Mitt Romney’s Romneycare….

  • AP on 10.04.2013 at 8:39 am

    If health insurance is tied to full-time employment, everyone gets cut down to part-time. Then people are working less hours and still don’t have health care. Please address this.

    • Greg on 10.04.2013 at 9:51 am

      Don’t support companies that behave in this way. Employees should picket, and customers should not shop there. Businesses need their employees and customers just as much as customers/employees need the businesses. It’s a two-way street, and employers of America should never hold basic life protections such as healthcare hostage over their employees.

      • Remembertothink on 10.28.2013 at 11:58 pm

        You’re delusional if you think all these companies are trying to screw over their employees. They simply cannot afford to pay for health care for all their workers. Those companies that can are simply passing the increased costs on to us, the consumers. This raises prices on everything. This so called “basic life protection” isn’t a fundamental right. A fundamental right is something that is inherent and unalienable. The requirement to buy some good or service at a certain price is not a right at all. How would you feel if everyone could buy groceries at a set price, but then your groceries were rotting or subpar because of it? Individual vs the group is what our country was founded on (Free Speech) and cutting some people’s rights to suit others is still wrong.

  • Sam Kauffmann on 10.04.2013 at 8:56 am

    Thank you for this thoughtful, easy to follow explanation of the ACA and its disingenuous critics.

    • The forest for the trees all ideology aside on 10.04.2013 at 10:09 am

      Is attacking the messenger the best you can do? So in your mind anyone who disagrees is disingenuous and any who agrees is not?

      I think it logically follows that your response support the thesis that it is those who support the ACA who are not open to discussion nor to writing a truly better law that does not serve to divide our nation.

  • Student on 10.04.2013 at 8:59 am

    -Cruz was taking major risks in terms of job security by standing against Obamacare
    -If one party votes 100% for it and another votes 100% against it, it shouldn’t be a law. Checks and balances are what this country was built on.
    -If it’s so great then why won’t congress use it?
    -This bill has been changed so many times since it was first passed that it’s simply not the same thing anymore.
    -Most peoples’ health care costs will increase dramatically just to give a few low wage workers coverage when only a minimal amount of people don’t have healthcare who want it. Capitalism doesn’t care.

    Not to get too deep into this but it’s not even an argument about the health care itself, the basic principles of how this bill has been handled is simply un-American.

    • Dan on 10.05.2013 at 4:04 pm

      -Cruz, a senator from deeply Republican Texas, was taking a risk in opposing ‘Obamacare’? I find that hard to believe. Maybe in shutting the Government down over it, but even then, I don’t think there’s going to be a big backlash against him. He’ll only face a credible challenge in the primary… and moderates don’t do well in republican primaries according to recent history.

      -Who cares if one party is against it? Maybe that would matter if each party had exactly 50% representation in Congress. But that wasn’t the case when the ACA passed. It was legally passed by the House, Senate, and signed by the President, as well as validated by the Supreme Court – if that’s not checks and balances, I’m not sure what is.

      -Congress does have to use it. Part of the law states that the only insurance plans that are offered to Congressional employees are those offered through the ACA on exchanges. They get their plan subsidized by their employer, the same as almost all other big companies do for employees.

      -Source on how people’s health care will dramatically increase?

  • ep on 10.04.2013 at 10:07 am

    The way I understand it, if the employer doesn’t offer health insurance (to a part-time worker) the person is eligible to apply for federally supported exchange insurance. The company then does not get to take the tax deduction for offering insurance to its employees. The trick becomes what is part-time… and this is where people have to stand strong and insist that if they are part-time it needs to be true part-time so that they can take another job if they want. This can work to the benefit of both employee and employer. Hourly wage needs to increase to make it worthwhile.

  • cletus van damme on 10.04.2013 at 10:12 am

    I pay for my own health insurance. Its around 100$ per month. Starting next year it will be 270$ a month. TIA.

  • Peter on 10.04.2013 at 10:30 am

    Polls continue to show an every increasing majority of voters do not want the ACA. Why would I want to degrade or triple the cost of my own plan? The fact is this plan is written in (you’ve read the whole 2,400 pages of course)discretionary language that will allow it to be used as a political tool, much the way the IRS has been used against political enemies. Expect if you don’t choose to participate, and you are not one of the elite platinum club members working in congress, or Exempt Unionist, they will reach into your bank account, deny you your drivers license, put a federal lien on your property. Fail this will, because once people attempt to sign up the will see it what a totally broken system it is. This is all as planned, because it’s really about getting to a single payer end.

  • The forest for the trees all ideology aside on 10.04.2013 at 11:30 am

    “Opponents claim that law takes away personal freedom (though it is not clear how or what freedom).”

    Really how about my freedom to choose not to be insured without being punished for that choice? And do not give me that nonsense that it will cost other people money if I am not insured because frankly people do have a choice with respect to whether or not they want to pay for my healthcare. No one is forced to pay for anyone else’s healthcare; that is a choice we make and if anyone is being disingenuous it is those who claim we “have” to pay for this when frankly we do not. The Amish and Scientologists are legally allowed to opt out so why can’t I? Why do I have to be part of some special group to conscientiously object to being forced to buy healthcare insurance? It is i my body and my right to choose to insure or not or receive the benefits of modern healthcare or not.

    “They also claim it will add to the federal deficit, even though the Congressional Budget Office has long estimated not only that the deficit will be reduced, but also that repealing the law, as the House has voted to do more than 40 times, would add $109 billion to the deficit.”

    What a profound joke this comment is, we waste much more money nearly every year (with no benefit to our economy) simply paying the interest on the national debt. How about getting our fiscal house in order “before” we expand the size and scope of the government? Try going to your bank and asking for a loan when your fiscal house is mess and see what tell you.

    Is it not ironic that the places we see the greatest levels of inflation have been those sectors of the economy where the government already has its hands namely healthcare, higher education and housing?

    And the number one solution is: more of the same!

  • DM on 10.04.2013 at 1:02 pm

    “Ingnore the critics” he says. Sounds like good open minded liberalism (oxymoron intended). What if the critic is educated on the matter and on point? It appears that Steve Davidson is a good propagandist and a tool for the administration. I’m surprised that BU allows this kind of closed mindedness.

  • Trish on 10.04.2013 at 3:16 pm

    DM – You’re surprised BU “allows” this kind of closed mindedness?? Whose the closed minded one here?

  • TC on 10.04.2013 at 4:15 pm

    THE IRONY with this new health care law, is that it was originally a Republican proposal put forwarded by a conservative think tank (I forget which one), adopted by then governor Mit Romney of Massachusetts, which presumably operates on Free Market Principals. Obama, when he first ran for office (if memory is correct) was not thrilled with the individual mandate and was a big proponent of a public option.
    – The truth is, there is no free market, where the provision of health insurance is concerned. Corporate tax deductions for employee policies, medicare, Medicaid, and Veterans health benefits are all government policies to provide health insurance. Many, many people fall though the cracks, prices are rising to the breaking point, and this patchwork quilt is no longer working.

    • Peter on 10.04.2013 at 5:39 pm

      This was never really a Republican proposal.

      Romney care began as a Bill put forth by then State Senate president Travaglini. With a super majority in both the houses Romney could veto the legislation which would probably be overridden, or offer his own proposal. Eventually a conglomerate House bill was put forth, with input from insurer BlueCross’s Foundation, that did not resemble Romney’s original plans. When the final bill was passed Romney line-item vetoed eight items, including the individual mandate. These were all overridden.
      The individual mandate coverage was greatly increased under Patrick.

    • The forest for the trees all ideology aside on 10.05.2013 at 10:23 am

      It does not matter whose proposal it was, it is still bad law that needs to be repealed and replaced with better law. You are correct that there is no free market in healthcare currently and that we need reform but the ACA is not the solution we need.

  • matha on 09.02.2014 at 5:22 am

    In Texas, by explanation – an insured party will be “named insured, spouse in addition to residents of the residence.”

    So, by definition, you no longer need to be listed and also coverage will apply.

    As soon as you get your license, just like someone else said – it all depends on how a lot of autos versus how numerous drivers. If there tend to be drivers than cars (or maybe trucks) you could see as a part-moment driver and the pace would not be of up to the full time number one wood.

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