A Dead Rose By Any Other Name

Let’s try to get this straight…again. The Affordable Care Act (ACA), better known as Obamacare, is primarily a health care concept first proposed by the Conservative Heritage Foundation in 1993 to counter, along with other Conservative initiatives, the health care plan delivered to Congress by Bill and Hillary Clinton.

The idea of Obamacare having its origins in Conservative lore is repugnant to Republicans. Their challenges to that history at best persuaded Politifact to rate the Heritage connection as only half-true. Politifact hung the “untrue” portion of that rating on fact that the proposal did not have universal Republican support. Of course, no other proposal did either.

I disagree with Politifact. The argument that the ACA wasn’t a Republican plan may have some legs, but to suggest that the origins were not Conservative is ridiculous.  Talk to Mitt Romney.

The delivery of health care in the US is unique in the modern, developed world. To my mind it was a natural result of how nations around the world recovered from the devastation of World War II. The US was the only major participant in the War to end it without homeland destruction.

Other nations were forced to construct health plans that were centrally controlled in order to serve dislocated and impoverished populations. The clearest example of this was the universal health plan created by the United States for the Japanese people in 1946. It was a plan US Conservatives today would label as Socialist mania. The Japanese, on the other hand, have been quite satisfied ever since.

The US after the War was more concerned with economic growth and finding the people to fuel that growth. People were making money and, frankly, health care wasn’t that expensive. Employers, in order to attract and retain labor, began to offer complete health care as a benefit of employment.  Health care slowly became an industry, and, like all industries, the measure of success was defined by profit.

Flash ahead 60 years and we find (which should be to the surprise of no one) that health care in the US cost multiples more than any other place on earth.  Given the expense, access to health care has been reduced or eliminated for large segments of the population. Yes Houston…we have a problem.

Conservatives however have an additional problem.  As they support and represent those on the receiving end of the multi-trillion dollar transfer of wealth (the health care “providers”) they needed to come up with some kind of plan that would increase access, reduce cost and still deliver satisfactory profits to the providers. By any standard, Obamacare does just that…well, except for the “reduce cost” part.

You see, Republicans and Conservatives generally have an almost religious zeal for Capitalism and supply-side economics. They feel if you give people enough choice the cost will find its naturally low level. They also tentatively accepted the idea of forcing everyone into the pool, i.e. the individual mandate.  The problem, of course, is that health care is a totally inelastic (service) commodity; the demand does not drop no matter how high the price goes up. Further, the choice of provider is generally not impacted by cost. You all know this. When my kid is sick I’m not going to go shopping down to Wal-Mart to see if I can find a doctor on clearance.

The Democrats knew this too, so they bet it all on including one additional factor into their 2010 plan – the Public Option.  This would have been essentially a “buy-in” Medicare, and if enough people chose it, it would have allowed the Federal Government to begin to have central control of pricing services, and likely force private insurers to match those costs.  However, in order to be politically successful the Obama Administration caved in (thank you Joe Lieberman), the Public Option was dropped, and the 1993 Conservative Heritage Foundation plan morphed into law.

So why don’t the Republicans and Conservatives want to keep Obamacare?  Why did the Republican House vote to repeal the law over 60 times? Why don’t they vote to repeal it now?

This is what I believe: I believe the primary thing they want to repeal is the name. Republicans named it Obamacare because they wanted to use it as a political wedge. Now they’re faced with eliminating a plan which is more closely aligned with their moneyed constituency than anything else they could devise. However, they can’t embrace it now. My God…it’s called Obamacare.  They named it. They’ll never get rid of that name unless it’s significantly revamped.  Yes Houston…they have a problem.

Obamacare was a step in the right direction. Access to health care was greatly improved and financial devastation as a result of ill health was curbed.  It was destined to fail in the critical area of cost; however no more than what was occurring prior to its inception.  It needed a back door to centralized control of cost. Even if Conservatives can find a way to change the name or simply take us back to the melee we came from in 2010 the problems will persist.  

Until the electorate begins to vote in their own best interest, and not unwittingly support the big dollars that profit from the obese health care industry, nothing is going to change. The dead rose that is Obamacare will smell just as bad and likely worse, with whatever label they choose to use.

It was American ingenuity that created the Japanese health care system and for me I think Cherry Blossoms smell just fine.