Conservatives should love the Affordable Care Act

Conservatives should love the Affordable Care ActAnd progressives should want health reform to fail.

No, you read that right.

Counter-intuitive?  Let me explain.  As the fate of the Affordable Care Act hangs in the balance in the Supreme Court, both progressive and conservative pundits have been working overtime to discern the future of health reform.

The traditional thinking is that progressives direly want health reform to move forward, and conservatives can’t wait to repeal the Act.

Both have it wrong.

I wrote back in 2010 that health reform repeal is the rare point that Tea Party activists and those on the far left can agree upon:

So, where will destroying the Affordable Care Act lead us? An increasing number of uninsured Americans and unabated, rising health costs. And worse, it is politically unlikely that anyone would address health care for decades.

Eventually, health costs would be so crushing, that the government would be forced to act — akin to their bailout of the auto industry. The most feasible solution then would be an expansion of Medicare, or Medicare-for-all — a true government takeover of health care.

That scenario is precisely why far left progressives want the current iteration of health reform to fail, which, strangely, is becoming a rare point that Tea Party activists and Huffington Post bloggers can agree upon.

The problem with repeal is that we will have to wait several decades before health reform is approached again.  In a piece by progressive columnist Ezra Klein, he notes that after the Clinton plan failed in the 1990s, it was 18 years until Congress touched health care again.

I wrote in CNN recently that the Affordable Care Act is seriously flawed.  Hardly enough is proposed to shore up our primary care foundation, and the broken malpractice system is barely touched. But it does give help to patients who need it the most, and it’s a start that can be built upon.

Ironically, by keeping the private insurance industry intact, the current iteration of health reform’s roots lay in the hands of the conservative Heritage Foundation.  It’s baffling to me why conservatives would want to repeal the Act, which would make a Medicare for all, single-payer system much more likely down the road.  And that’s a scenario far more nightmarish to those on the right.

So, instead of a more ideologically pure vision of reform, conservatives should want the Affordable Care Act to pass.

By celebrating the potential for repeal, conservatives should be careful what they wish for.

is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

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  • Anonymous

    I have to disagree with your assessment that the industry will have to be bailed out like the auto industry. Maybe I missed it but the two industries are completely different, both in the market place and structure. The problem conservatives see with the ACA is that most will be on government insurance with a decade or two if it stands. Recent polling showed that 60% of corporations would drop healthcare coverage, leaving the most viable, independent option, the government plan. I may have missed it in your first post, but reading through the law, I didn’t see anything in the bill to control costs, other than the government only reimbursing “successful” procedures for medicare patients, which will actually force the hospitals to charge more to people who are not on government plans. I think most americans want some sort of reform, but the ACA seems to have come up short of any meaningful progress. 

    • civisisus

      “Recent polling showed that 60% of corporations would drop healthcare coverage”
      Nonsense. No credible poll has suggested half that figure. Months ago, McKinsey staff let some junior analysts’ draft that asserted around 30% of employers would drop coverage get released, and they were laughed out of the room.

      Most US employers are in service businesses. That means they require people performing, day in & day out – even more than manufacturers, for whom effectively performing employees is still really important. 

      That means keeping them healthy, and beating the competition  means keeping your employees healthier than the other guy’s. 

      So employers will always be in the health business. If you’re an employer, not having a health strategy IS your health strategy – and it’s not a winning strategy. Employers need, and benefit from, a robust health financing infrastructure like they need,, and benefit from, a robust telecom infrastructure, from a robust interstate highway system. Only in the crazed minds of 21st century “conservatives” are such obvious points the stuff of tyranny. 

  • Anonymous

    Maybe I’m not understanding your terms. Wanting the ACA “to pass” muster with the Supreme Court is one thing. Wanting it to succeed or to fail is something else. Are you really saying that the best option for conservatives is that the ACA actually succeed in bringing about affordable, accessible health care without significant governmental involvement otherwise, because that is the only way to avert a complete government takeover of the health system? If so, it would be only a hope and not a position to be favored by conservatives. The reason is that if the ACA passes and gets implemented, it will ultimately result in a government takeover, since its success seems ordered to discouraging private insurance in favor of governmental programs and its failure will require it. If on the other hand some sort of reform that forestalls a government takeover seems desirable to conservatives, then we have to wonder if the ACA is what will do it. Conservatives might acknowledge that the health system needs reform, but object completely that the ACA is the answer.

  • Anonymous

    This sounds like a liberal trying to get into the head of a conservative.  This healthcare law goes against everything conservatives and libertarians believe in; the ability to exercise free will without penalty or harassment from Washington.  Health insurance, just like if I’m going to eat lunch today, should be my decision, and the federal government has no standing to decide for me whether I will purchase either one.  More importantly, it’s a states rights issue, and a constitutional issue, all of which are extremely important to conservatives.  Even though most conservatives have health insurance already, what we’re talking about is the principle of the issue, not the issue itself.  History has shown that the government doesn’t infringe upon the liberty of its citizens by leaps and bounds; it does it slowly and insidiously.  Even the supreme court justices fail to see how the government forcing its citizens to buy healthcare is any different from forcing its citizens to buy, well, anything.  It’s an incredibly dangerous principle that’s at stake, and no, conservatives will never love watching liberty die before their very eyes.  And it’s not like this is some crazy radical individual challenging the law; it’s 26 states, a majority consensus even a liberal should be able to appreciate.

    • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

       The flip side of that is that if you don’t have insurance, but then end up in the hospital, you’ll end up with possibly 6-digit bills that may bankrupt you. In this case, you may end up poor and the government will have to pick up the tab. In this case it becomes other people’s business.

      I am not arguing for- or against- the bill by the way, I haven’t spent enough time studying it to make a really informed opinion, just write it because of something that just happened to my internet friend. She ended up in a hospital for a relatively minor surgery (and before you ask, she is slim, active, otherwise healthy, with a healthy lifestyle who because of some bad investments ended up near broke; she has a small business, but it doesn’t make that much money, not-yet medicare age but not young), and after a short stay in the hospital ended up with 6-digit bills she can’t afford. She is uninsured. So now, she applied for the state aid and got it. So, the fact that she was uninsured, ended up costing state money.

      • Anonymous

        There are many tragic stories like that out there, I think it’s terrible.  It does beg the question how we got here in the first place; why has our healthcare system become so expensive that the economics of supply and demand only function when individuals are separated from the economics of healthcare- either because most are insured, or secondarily because if they aren’t, the state is willing to pick up the tab.  What the hospital expects to receive is but a fraction of what the bill actually says, and the true costs are only a portion of that.  Insurance probably would have made things easier for her, but I believe there are more fundamental problems in the system that need to be addressed.

        However, more to the point (of the healthcare law), I think it was best stated by the justices during the debate.  It’s true these individuals may end up costing the state in the long run, but it would also end up costing the state (directly or indirectly) if she hadn’t been thin and healthy.  So if it’s ok to force her to buy health insurance (via a tax penalty), why isn’t ok to charge someone a penalty for being over a certain BMI, or not having a gym membership, or not eating enough fresh vegetables, or not having life insurance (the state is the payer of last resort for burial, after all).  That’s why the principle here is so important.

        Healthcare reform is desperately needed, but not like this.  I find it curious that those who are most critical of health insurance companies seem to be in favor of this law, which everyone agrees will result in windfall profits for the companies they despise.  There are many way to start tackling the issues; passing a law that says “well, everyone just go get insurance” is a complete cop-out.  Politically easier to pass than true reform, but a cop-out nonetheless.  I do think in criticizing the law, however, conservatives often forget to advocate for something to replace it.

    • sFord48

      “This healthcare law goes against everything conservatives and libertarians believe in…”

      This statement is partisan politics….Many Republicans supported the individual mandate.  

      In 1993, two bills were introduced to congress that included an individual mandate…

      The Consumer Choice Health Security Act SB1742 introduced by Don Nickles R-OK and 24 other Republicans

      The Health Equity and Access Reform Act SB1770 introduced by John Chafee R-RI and 18 other Republicans (and 2 Democrats) 

      And from the conservative Heritage foundation:

      “[N]either the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement…Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself…
      A mandate on households certainly would force those with adequate means to obtain insurance protection.”

      and…

      “Step #2: Require all households to purchase at least a basic package of insurance, unless they are covered by Medicaid, Medicare, or other government health programs.All Heads of households would be required by law to obtain at least a basic health plan specified by Congress…The private insurance market would be reformed to make a standard basic package available to all at an acceptable price…Employers would be required to make a payroll deduction each pay period, at the direction of the employee, and send the amount to the plan of the employee’s choice.”

      • westeasterly

        To the contrary, I would argue YOUR post is about partisan politics….Republicans this, Democrats that.  I couldn’t care less about either.  I’m talking about conservatives vs. those who believe the use of unconstitutional government force is appropriate.  There are democrats, republicans, and independents on all sides of these issues, and the original post addressed “conservatives,” not “republicans,” nor did my post.  I should note my use of the word “libertarian” refers not to the libertarian party, but simply to those who believe in the ideas of liberty.  That should, of course, be true of all of our political parties, but it isn’t.  For the most part, politics is about resting the reigns of power in order to control others; true “conservatives” are those who fight for the liberty of individuals, and unfortunately, there are few of those in either party.  But at least the constitution helps hold them both back, a little bit.

        • sFord48

          So your claiming that that Republican party of the 1990′s not conservative?

          So you are claiming that the Heritage Foundation is not conservative?

          Otherwise, I don’t understand your statement that conservatives “against everything conservatives and libertarians believe in…”

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Thank You, Kevin!!!  I was starting to think that I’m the only crazy person alive.

    Conservatives should support a mandate for all Americans, and the Federal Government on behalf of poorer Americans, to funnel ever increasing amounts of cash to private corporations, for increasingly less services.

    It is the ultimate extraction scheme. Better than the mortgage gig or anything else because it’s a mandate and it applies from cradle to grave. Not to mention the myriad of opportunities such precedent opens up for future mandates to buy stuff, or have the Federal Government buy the stuff on every citizen’s behalf. Yes, health care is unique, but everything “threatening” the Nation is going to be unique in its own time.

    If the mandate is upheld, insurers will have a few more billions in guaranteed annuities, and everybody will have a piece of paper saying that they have health insurance.

    • Anonymous

      You’re forgetting the medical loss ratio requirement – 80-85% of premium must be spent on actual care.

      Insurer profit margin is pretty low, compared to pharma and medical device makers. But 2% of more money is still more money. But what about the 85% that will go to actual care — who will curb THAT part?

      What you’re describing is that everyone will end up with the equivalent of castastrophic insurance, instead of first-dollar coverage for every whim. That, in fact, is the only thing that WILL curb spending, since we can’t rely on doctors and patients (or govt)  to use sense when it comes to spending other people’s money.

  • Anonymous

    Everybody talks about the mandate to buy. What about the mandate to sell? Govt wants to force an entire industry to sell product at a loss. That’s what will happen if the mandate to sell (aka guarenteed issue) survives and the mandate to buy does not. Even with the mandate to buy, it’s still a risky proposition. 

    What if the govt forced doctors and hospitals to sell their services at a loss? Oh, wait…it already does, via Medicare pricing. And how’s that working for you?

    The mandate to buy is the counterbalance of the mandate to sell. Of course, if insurers take the individual product off the market, govt can’t regulate it.

    And THEN we’ll have to go to Medicare/Medicaid for all. Which won’t save money, because health care costs – and delivery as currently practiced - are already breaking the bank.

    • http://pulse.yahoo.com/_YIGK4HUT37EYL75GSYBTKL7OMY John

      good post

      • Anonymous

        Thank you, John. I was starting to think that I’m the only crazy person alive.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Very funny… :-)
          You need not worry about the mandate to sell though. “Our” government argued today that the mandate to buy and the mandate to sell are not severable, and nobody is forcing the sellers to sell at a loss – their 15% to 20% is built in, because we have to please the corporations.

          • Anonymous

            The 15-20% isn’t profit, its overhead. And the more rules there are, the more overhead there’ll be. Even for for-profits net 4-6% in a good year, compared to 16-18% for pharma and device/supply mfrs. The nonprofits – and yes there are still a lot of them – are netting in the 1-2% range. That averages all lines of business. Individual policies often are operated at a loss already, before “sell” mandate goes into effect.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            “Overhead” includes all sorts of “stuff”, such as buying real estate, paying executives, etc. Also the 80-85% is not entirely spent on paying doctors and hospitals and it includes various administrative activities. There may be many non-profits in title, but they are all for-revenue in reality. Pharma and device are at least adding some value to care, what exactly are insurers adding that warrants that we waste our money on their profits?

          • Anonymous

            Don’t know where this fantasy comes from that payments magically appear. There’s the fleets of lawyers to make sure all the rules are followed at state and federal levels; there’s scads of accountants to track those billions; cubicles of techs to make sure computers work so the automated payments go out to providers, et al. Not to mention the loads of customer service reps taking millions of calls. You know, just the usual stuff any business has to do. And while phama and devices add value, they also add risks and costs. Just check out Shannon Brownlee’s “Overtreated.” It’s not all medical miracles.

          • civisisus

            You could run a reasonably effective health insurance claims payment and premium collection operation on the back of QuickBooks and Paypal. 

            Insurers are preposterously clumsy enterprises run by the planet’s C students.

  • Anonymous

    Medicare for all? With our current political system? I’ll take the over on 18 years, thank you very much.

  • Anonymous

    I’m sorry.  I usually really like your posts, but this one seemingly is making a serious complicated subject into a trite one.  The way I see it, the only way the feds could make medical care overhaul work, and keep it in Constitutional grounds, would be to totally take over the medical insurance industry, and tax and spend for all health care.  They have done that with Medicare and Medicaid, and Social Security is just another example of government control.  They can’t mandate you spend for something, but it is well established they can tax for services provided.  For some political reason, the Bozos in Congress just didn’t think they could vote to take over 1/6 of the American economy (even though they already controlled 1/12th of it, because Medicare and Medicaid already account for 1/2 of health care spending).

  • http://pulse.yahoo.com/_6C65YWGCC7P5C6CGMMBK7VMFXE JenniferL

    Dead wrong.

    If ObamaCare is defeated, it will be on grounds that will make the totalitarian plans of the “progressives” impossible in the US.

  • Anonymous

    The only thing the Democrats did not allow to get past them was a “severability” clause in the individual mandate. The amount of money the individual must pay in the “non-tax” penalty is very small that it will likely be ineffective as a stick, but at least it will not be a wedge for the cherry picking of all of the parts  “popular” with the GOP base like keeping adult children on parents plans and pre-existing condiions and claiming responsibility for them in the next election cycle when those are not financially feasible clauses in the marketplace without a bigger risk pool.
    FYI—JenniferL. Your comment is incomprehensible–the progressives are totalitarians? Did you ever take a humanities class or a political science class or read a newspaper?

  • http://twitter.com/moving4wellness Bobby Fernandez

    This logic runs along the same lines pushing meds prior to lifestyle adjustment. Our system is a little out of whack but simultaneously is the best in the world. Conservatives seek to build the health of our system rather than assult the whole thing with drugs and side-effects.

  • Anonymous

    The problem with the health care bill concerns the ever expanding Federal
    government intrusions into the life of Americans. . On a practical basis
    the current healthcare debate is stifled by a lack of vision on all
    sides. The biggest problem in healthcare is the lack of accurate market
    pricing. Both private insurances and public insurances distort accurate
    pricing. We need free-market healthcare with affinity groups that share
    healthcare costs, and perhaps a return to catastrophic health insurance
    only. Btw, I participate in a health shares group where we pay each
    others medical bills. I do not have private or public health insurance.
    But everybody’s bills get paid. The system does attempt when possible to
    shop or negotiate cheaper prices for medical care. I can go on the
    internet or look at the advertising inserts in the newspaper to see the
    flyers from various grocery stores. Then I can compare prices to see
    where I want to buy various items. We need to get to the point in
    healthcare where all prices and procedures are upfront and clearly
    disclosed. That will start the trend for reduced healthcare costs. Also,
    a return to charity hospitals,clinics,nonprofits services, churches,
    family assistance will also help deal with folks who have fallen on 
    hard times. The current system will collapse with or without the public
    options/mandate. Free market with accurate pricing is the way to go if
    we are to have a soft landing. show less

  • Anonymous

    There is a free market to the degree that there is less government,
    monopoly, and crony capitalist interference in the market. The lack of
    accurate market pricing in healthcare is the fundamental problem.
    Without it medical care either ends up too high or rationing care goes
    on steroids. The kind of government that can institute universal
    healthcare is the kind of government that will acknowledge no bounds to
    its authority and its right to intrude and regulate your life. Btw,
    crony capitalists always depend upon a socialistic leaning government
    that selectively offers the largesse of the public treasury to protect
    them from the free market and possible failure in the market. Crony
    capitalism in healthcare will grow more powerful under a government that
    offers universal healthcare. Accurate market pricing, accurate market
    pricing should be our mantra. Also, for the record, I do not wear the
    Republican jersey.

  • Anonymous

    Anyone who would want “Medicare for all” has never experienced Medicare.  I continually help my neighbor with appeals and now have had to secure a lawyer for her.  Medicare is paying for Obamacare on the backs of seniors.  Test the water before you jump in.  It is slimy.  Any problem with HSAs and high-deductible insurance for all?  Right now, seniors have NO choice but Medicare.  They are prohibited from having an HSA or private insurance.

    • civisisus

      “seniors have NO choice but Medicare”

      Sure, as long as you leave out Medicare Advantage plans, which in some states DO include Medical Savings Accounts, which may as well be High Deductible Health Plan/HSAs. 

      Other than that, perfect score!

  • Robert Luedecke

    Very astute comments, Kevin.  The before ACA system in the US cannot continue.  Businesses are looking for a solution.  Individuals are looking for a solution.  The ACA is definitely not perfect, but it is a big step in the right direction.  If Republicans had come up with the ideas like they did in Massachusetts, it would be considered reasonable “personal responsibility” to be forced to buy health insurance to protect those who already have health insurance from having to pay for those who do not.  Better for us all to stop playing politics and use everybody’s best ideas to help our country.

  • http://profiles.google.com/campanas127 Yocheved Leah

    What ever happened to Tort Reform?  Buying insurance across state lines to create some healthy competition?  As a MA resident, I can say first hand that insurance here SUCKS.  The state has so much control over choice that you are forced into plans that the state approves.  Doctors are running from the state because the payments are so low, and many doctors don’t even want to take the state subsidized plans anymore and I can’t blame them.  Residents are indirectly penalized if they buy private insurance from companies vs. going through the state “connector.”  Case in point: I chose my plan on my own through BCBS and it is a very expensive HSA at over $500 a month, but after meeting the deductible, I can at least choose whomever I want to see.  The same plan in PA is  THREE HUNDRED DOLLARS LESS.  So much for MA keeping the price of premiums down.

  • http://twitter.com/Dan983 Dan Ross

    If 5% of Americans incur 60% of health expenses (yes–on commercial for sure and damn close on the uninsured) why not beef up the federally qualified health centers (FQs) for primary care and pay the MCOs an annual capitated fee to care for the sick uninsured? FQs have the ability to spread price brand drugs under 340B (big bucks) and the MCOs will care about quality as they will be looking for profit from better outcomes and the program could “tack” members to them for long time periods!

    MCOs provide better care for MA patients than any of their commercial members!  

  • civisisus

    ” It’s baffling to me why conservatives would want to repeal the Act”

    Kevin, you underestimate the power of fanatical ideological rigidity. It can make a pipsqueak like Grover Norquist look threatening.
    Oh, and then there’s the consanguine racism thing

  • Kishan Bhoopalam

    You are wrong regarding the expansion of Medicare and Medicare if health care costs escalate. While this is a desirable outcome for progressives, the truth is that the only way to finance these programs would be with debt and the only way to pay for out debts is it with inflation. Taxation is not enough anymore.

    Sure, you can expand these programs infinitely in an ideal sense. But what happens is that the added inflation is the hidden cost. So the government would be handing out checks for health care, but in dollars that are essentially valueless. I could see the federal government attempting to do this, but it will fail miserably.

    Also, I think its important to move away from bipartisan bickering. Conservatives have done terrible things to health care in the past. For instance, passing Medicare part D without any solution to financing it. This has significantly added to our deficit.

    As government continues to expand in all aspects of our lives, it does does by printing and borrowing money. The money ultimately becomes useless and the control is forced to come to a halt. At this point, the only plausible solution is market drive health care. And what is market drive health care? Nothing to the likes of what we have seen in over a 100 years in this country. Here are some simple steps to drastically reduce our health care costs as outlined by the Mises Institute:

    1. Eliminate all licensing requirements for medical schools (i.e. remove the AMA’s monopoly on medical education), hospitals, pharmacies, and medical doctors and other health care personnel. Their supply would almost instantly increase, prices would fall, and a greater variety of health care services would appear on the market.
    Competing voluntary accreditation agencies would take the place of compulsory government licensing–if health care providers believe that such accreditation would enhance their own reputation, and that their consumers care about reputation, and are willing to pay for it.
    Because consumers would no longer be duped into believing that there is such a thing as a “national standard” of health care, they will increase their search costs and make more discriminating health care choices.
    2. Eliminate all government restrictions on the production and sale of pharmaceutical products and medical devices. This means no more Food and Drug Administration, which presently hinders innovation and increases costs.
    Costs and prices would fall, and a wider variety of better products would reach the market sooner. The market would force consumers to act in accordance with their own–rather than the government’s–risk assessment. And competing drug and device manufacturers and sellers, to safeguard against product liability suits as much as to attract customers, would provide increasingly better product descriptions and guarantees.
    3. Deregulate the health insurance industry. Private enterprise can offer insurance against events over whose outcome the insured possesses no control. One cannot insure oneself against suicide or bankruptcy, for example, because it is in one’s own hands to bring these events about.
    Command economies inevitably fail.

    The Soviets tried to control supply and demand in all aspects of their economy and it was a grand experiment that failed. Likewise, our nation attempts to control supply and demand of health care via various private insurance companies protected by law, Medicare and Medicaid. This is a grand experiment that is coming to an end as well. Let’s move away from corporate medicine! It is a system that is designed to protect the health care providers at the expense of the patient. In a truly free system, the patient is served best!

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