Professor Victor Rodwin writes:
The House vote to repeal what critics call “Obamacare” (the Patient Protection and Affordable Care Act – ACA — signed by President Obama on March 23, 2010) was a key part of the GOP campaign to win back the House of Representatives in the November elections. It worked as an effective mobilizing call to arms.
HR2 (Repeal of the Job-Killing Health Care Act) passed the House by a vote of 245 to 189 on January 19, 2011. The Senate, however, killed the bill February 2, and the issue receded to a background murmur. Republicans and Democrats have drawn their swords over the President’s budget, instead.
Still, repealing the health care act is likely to return to the political agenda. House Speaker John Boehner (R-Ohio) states that “The Congress can do better in terms of replacing Obamacare with common sense reforms that will bring down the cost of health insurance and expand access for Americans.”
To assess such a proposition, one would have to know more details about his party’s solutions. But proposals so far are conspicuously absent.
After Congress passed the ACA, Boehner called it a “dangerous experiment.” Texas Gov. Rick Perry called it “socialism on American soil.” Many of their Republican colleagues have reread the script used by the American Medical Association (AMA) in opposing extensions of health insurance coverage propounded by President Franklin Roosevelt, Harry Truman, Lyndon Johnson and Bill Clinton. They suggest that the ACA will result in a “government take-over” of American medicine, at worst, and “government-run” health care, at best.
But such attacks are dangerously misleading because they distort present realities and generate ill-founded fears.
We already have a massive government role in American health care; and for good reasons. We have socialized expenditures for our highest-risk populations – the elderly and severely handicapped (Medicare) and for the very poor (Medicaid) – and we have a system of socialized medicine for our military veterans, which delivers health care of higher quality than what is received by the average American.
At the same time, most health care in the U.S. is provided by private non-profit hospitals and private doctors reimbursed on a fee-for-service basis. Clinical decisions remain largely in the hands of our physicians and to the extent that there has been increasing intervention and regulation of these decisions, it has come most forcefully from private insurance companies. Meanwhile, we have more government expenditure of biomedical research (NIH) and public health (CDC) than any nation in the world. And the system produces staggering rates of innovation in pharmaceutical research, medical devices and medicine.
The ACA is largely a bipartisan, half-way reform strategy inspired more by former Republican Governor Mitt Romney of Massachusetts than by left-leaning advocates of single-payer health insurance reform. It does not nationalize the health insurance industry. It does not increase the share of public hospitals. It does not set uniform prices for hospital and physician payment across all payers. And it does not assure universal coverage.
At best, the ACA, if implemented in 2014, will begin to increase coverage to 32 million of the more than 50 million Americans who are currently uninsured. It will achieve this objective through Medicaid expansion and the creation of health insurance exchanges that will strengthen federal regulation of the private health insurance industry through the prohibition of risk selection by insurance companies (the ban on refusals to cover pre-existing conditions and to set annual and life-time limits on coverage).
Finally, the ACA, passed before the extension of the Bush tax cuts for the wealthiest Americans, begins to reverse the post-Reagan policies of increasing income inequalities. It does so by increasing the existing Medicare payroll tax on all those earning over $200,000 ($250,000 for couples).
These are significant, but modest, steps toward what political scientist Jo White calls the “international standard” among health systems in wealthy capitalist democracies – Japan, Germany, France, United Kingdom, Canada, Switzerland, Australia, Netherlands, and many more.
This standard, met by all governments in such nations, either imposes taxes on its citizens or enforces a health insurance mandate to provide access to a minimum level of health care services. Without taxes or a mandate, there can be no universal health insurance coverage. Without universal health insurance coverage, we cannot meet the international standard.