One of the strangest aspects of the 2012 presidential campaign is that President Obama has barely bothered to make the case for the Affordable Care Act (ACA) and Mitt Romney has only rarely summoned the will to make the case against it. This is despite the fact that ACA is arguably the most consequential domestic policy legislation since 1965, when President Johnson presided over the creation of Medicare and Medicaid.
The usual explanation for why we haven’t had a serious debate over ACA is that Democrats recognize that the law is not wildly popular and that Romney is boxed in by his continued support for the universal coverage law he backed as governor of Massachusetts. All of this may well be true. But the foundations of America’s patchwork health system are unraveling before our eyes, and conservatives need to make the case for a more cost-effective reform sooner rather than later.
It is commonly understood that the United States spends an incredibly large amount of money on personal healthcare – the number was $2.19 trillion in 2010 – and that health spending is increasing rapidly as a share of GDP. A high level of health spending isn’t necessarily a bad thing. It makes perfect sense that an affluent country will spend a great deal of money to keep its citizens healthy, and medical care is a complex service that demands a lot of skilled labor.
What is worrisome is that the cost of medical care seems to be outstripping our ability, and more to the point our willingness, to pay for it. We tend to think about this in the context of the dramatic growth of Medicare and Medicaid spending, and understandably so. There is virtually no elected official, Democrat or Republican, willing to support the tax increases we would need to pay for these programs at their current growth rates, which is why the Obama White House and congressional Republicans alike have called for aggressive, and some would say unrealistic, cost controls.
Yet the clearest indication of our unwillingness to pay for rising health costs is the slow-motion collapse of employer-sponsored health insurance (ESI).