The never-ending war on Obamacare
What is behind the continuing campaign to repeal Obamacare? The Patient Protection and Affordable Care Act, the name by which it is never known, was signed into law by the president in March 2010 and, after a legal challenge, was confirmed as the law of the land by the conservative-leaning Supreme Court in June last year.
Yet Republicans and conservative commentators continue to urge its overthrow. As that is not going to happen, at least not until there is a Republican president backed by a Republican Senate and House, which may be some time off, why are they wasting their time and our money?
The best chance of overturning Obamacare without benefit of all three departments of government was in the legal challenge on the grounds that Congress should not oblige a citizen to buy a certain product. That cut to the heart of the new law, for if a later Congress were to insist we buy Kellogg’s Corn Flakes under pain of a fine we would all be up in arms at the overreach of government.
But Justice Roberts couldn’t bring himself to invite a constitutional crisis by nullifying a law overwhelmingly passed by both houses of Congress with the approval of a president elected by a majority of 10 million and two-thirds of the electoral college votes, and he caved. By sophistic contortions, the compulsory purchase of healthcare was defined by the Court as no more than a legitimate tax or levy.
And that might have been the end of the matter. Since then, however, Republicans have persisted with the fiction that by passing endless pointless motions in the House they can bring about an end to what they portray as the socialization of medical care. House Republicans have spent one day out of every eight and wasted nearly 50 million taxpayer dollars banging their heads against the Obamacare brick wall.
Republican commentators have piled on, suggesting that Obamacare is broken, unworkable, and on the brink of extinction. Even Jim DeMint, whose conservative think tank the Heritage Foundation came up with the idea of compulsory health insurance, now says it is “a very destructive law that’s going to hurt our country.” Obamacare’s opponents appear to be under the illusion that if they will something hard enough it will disappear, like a Las Vegas magic act. So what’s their game? Are they simply in denial?
No. This is internal Republican politics at work. Obamacare is the perfect vehicle for rallying dissent against big government and the president. The visceral hatred of Barack Obama for who he is and what he looks like, just as much as what he has achieved and what he stands for, is directed at the president’s signature legacy achievement. By giving universal healthcare Obama’s name, the president’s opponents have personified a hated piece of legislation; conversely, by dubbing universal healthcare “Obamacare,” the president’s opponents have reified him, deliberately diminishing and dehumanizing him.
Although they know their efforts to overturn Obamacare are futile, the libertarian wing of the GOP is establishing a standard by which all future House, Senate and presidential candidates will be judged. Repeal has become an act of faith and only those who subscribe to it will pass the eligibility test. Woe betide practical, moderate, centrist Republicans who dare suggest the Affordable Care Act should be amended to make it fit for purpose.
Only outright repeal of Obamacare will be acceptable as a statement of principle for primary candidates, just as over the last few years a solemn commitment not to agree to any raising of taxes has become an essential prerequisite for elected office in the GOP. In this way the Republican Party is fast transforming itself from a broad-church political party willing to tend to the public mood to win elections into a disciplined dogmatic protest movement tied to non-negotiable absolutes.
Concentrating on the repeal of Obamacare distracts from the absence of an alternative Republican universal healthcare policy. Before the Tea Party insurgency, every postwar GOP presidential candidate and president, including George W. Bush, offered a plan to supersede the chronic state of affairs where nearly 50 million Americans (18 percent) have no health coverage and either go untended when sick or present themselves to hospital emergency rooms, the most expensive and wasteful means of treating illness, which passes on the costs in increased insurance premiums to the rest of us. By the way, 18 percent is the national average; in 17 states the figure is far higher. In Texas, Nevada, New Mexico, Florida, Louisiana and South Carolina about a quarter have no health insurance.
More than 60 years after every western European nation provided healthcare to all its citizens, Obama delivered on that perennial unfulfilled promise. Those who demand the repeal of Obamacare do not suggest a replacement other than a return to the status quo ante. That is likely to be the healthcare policy demanded of potential GOP candidates by libertarian supporters in 2016. Those who propose alternatives will severely diminish their chances of selection.
The foreign experience is of particular note to those who wish Obamacare to fail. Whichever version of universal healthcare is enacted abroad, whether single payer, government-run systems in Canada and Britain, or compulsory insurance like Obamacare in France, after a brief bedding period the system becomes efficient, cost-effective, and held in high affection. It presses down on healthcare and drug costs and makes health bureaucracies, as well as doctors and nurses, more accountable for their policies and actions.
There are few better examples of how market solutions were abandoned by a conservative when it came to healthcare than Margaret Thatcher’s wholehearted embrace of the British National Health Service. Behind closed doors she preferred a commercial solution to health, as in all things, but such was the popularity of the NHS among Brits that she embraced it and promised to defend it against socialist reform.
“Let me make one thing absolutely clear,” she declared at the height of her privatizing powers. “The National Health Service is safe with us. …The principle that adequate healthcare should be provided for all, regardless of ability to pay, must be the foundation of any arrangements for financing the Health Service. We stand by that.” To win elections, she boasted how she had extended and expanded it.
Nor did the Iron Lady see an incompatibility between commercial health insurance and a single-payer, state-run, taxpayer-funded health service. “Of course we welcome the growth of private health insurance,” she said. “There is no contradiction between that and supporting the National Health Service.” Are libertarians clamoring for repeal of Obamacare, and the columnists who relish its demise, really better conservatives than Thatcher?
Thatcher’s belief that healthcare overseen by the state was good for Britain and good for her electoral chances may explain why Obamacare’s adversaries are so eager to besmirch it before it is fully implemented. They need to frighten Americans into believing Obamacare will diminish human rights and undermine their existing insurance, and persuade allies in the states not to cooperate with its enactment so it won’t work. If Obamacare ensures that all Americans are covered and paying their way, and that it has helped reduce costs and cut the price of premiums for individuals, it will be well-liked as such schemes have been everywhere else.
Like Social Security and Medicare, once voters become used to Obamacare’s benefits they may give short shrift to those who threaten to take it away. Of course, there will always be confused individuals, like those who cry “Keep Government Out of My Medicare.” But, although a flawed and complicated system, Obamacare is on course to be a vote-winner. And that is bad news for those who so vehemently oppose it.
Nicholas Wapshott is the author of Keynes Hayek: The Clash That Defined Modern Economics. Read extracts here.
PHOTO: Buttons reading ‘Repeal Obamacare’ are displayed at the American Conservative Union’s annual Conservative Political Action Conference (CPAC) in Washington, February 9, 2012. REUTERS/Jonathan Ernst