I support the Affordable Care Act, but not Obamacare

More than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly warm feelings toward President Obama. I think his foreign policy is a mess. The trillions in debt that the U.S. has run up over the past 5 years will hurt my generation and future generations, and if Republicans can be faulted for their fantasy that the federal budget can be balanced exclusively through spending cuts, Obama has sustained the Democratic fairy tale that raising taxes on “millionaires and billionaires” is all we need to do to pay the skyrocketing bills.

On multiple occasions during my time in government service, the president had no qualms about squashing science and scientists for political convenience. He is a perpetual campaigner, preferring theatrical gestures to the backstage grunt work of governing. And for all of his rhetorical gifts when preaching to the choir, he’s been one of the least effective persuaders-in-chief to have held the office.

And so, naturally, I oppose Obamacare. I oppose a government takeover of health care that includes morally repugnant death panels staffed by faceless bureaucrats who will decide whose grandparents live or die and make it impossible for clinicians to provide compassionate end-of-life care. I oppose the provision in Obamacare that says that in order for some of the 50 million uninsured Americans to obtain health insurance, an equal or greater number must forfeit their existing plans or be laid off from their jobs. I oppose the discarding of personal responsibility for one’s health in Obamacare. I oppose Obamacare’s expansion of the nanny-state that will regulate the most private aspects of people’s lives.

It’s a good thing that Obamacare, constructed on a foundation of health reform scare stories, doesn’t exist and never will.

Instead, the Affordable Care Act (which I support) is based on a similar law in Massachusetts that was signed by a Republican governor and openly supported by the administration of George W. Bush. It achieves the bulk of health insurance expansion by leveling the playing field for self-employed persons and employees of small businesses who, until now, didn’t have a fraction of the premium negotiating power of large corporations that pool risk and provide benefits regardless of health status. The ACA discourages health care “free riders” and provides support for people of modest means to purchase private health insurance in regulated open marketplaces, and it tells insurers that in exchange for new customers, they can no longer discriminate against the old and sick and make their profits off the young and healthy. Finally, the ACA rewards physicians and hospitals for quality and good outcomes, rather than paying for pricey tests and procedures that may or may not improve health.

The ACA has flaws. Since it doesn’t do much to narrow the income discrepancy between different types of physicians, it may overwhelm the capacity of primary care as millions of uninsured patients look for family doctors for the first time. The ACA’s provisions to discourage overuse of unnecessary medical services are limited and probably inadequate to the scope of the problem.

But it’s worth noting that these problems all predated the law. We don’t have enough family physicians and other primary care clinicians, specialists make too much money in comparison, and overdiagnosis and overtreatment are already rampant today. That the ACA tries to address these issues at all is a small victory of sorts.

It’s interesting to consider the counterfactual exercise of what might have happened if Mitt Romney had captured the 2008 Republican presidential nomination and then narrowly defeated Hillary Clinton, who was the odds-on favorite for the Democratic nomination in that year. No doubt affordable health care would have an important focus of that hypothetical contest, with Romney successfully linking Clinton to her husband’s failed 1994 reform plan that makes conservative objections to the ACA look insignificant by comparison. Once elected, a President Romney might have felt pressure to advance national health reform, and would have naturally modeled his proposals on his Massachusetts plan. We might have ended up with a conservative law with notable similarities to the Affordable Care Act, only criticized on the left for being too administratively complex and not generous enough in providing insurance coverage.

A farfetched scenario, you say? Perhaps. But it underlines the need for people of all political persuasions to set aside the overheated rhetoric about Obama and Obamacare and focus on making the ACA work.

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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  • Ron Smith

    What is it about all the pro-Obamacare posts right now? Is it because the rollout has been a total disaster. This is the same socialist sludge that has been proffered as a delicious chocolate milkshake.

    Simply continuing to say how great it is will not make it so. Already there are reports of buyers remorse such as the pro-Obamacare supporter in the Mercury News online who wanted the program but now is finding out that he, unexpectedly, is going to have to pay thousands more a year in his policy’s fees. Yeah he wanted it until now, when he’s seeing that he is the one that is going to pay, and pay big for it.

    It doesn’t sound so good to him anymore. You think?!

    Respectfully,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • bobsmith99

      “Socialist sludge”- you lose all credibility when you use such hyperbole. This is far from socialist medicine. You are willing to call the rollout a total disaster after one week? Hilarious.

      • Ron Smith

        Sure I am calling it that. A socialist agenda that masquerades as health care reform is socialist sludge.

        The rollout is a disaster because there have been three years to prepare to get this software right. The plane never got its engines started, much less off the ground. That is pretty much a disaster. Being a software database programmer I keenly understand what happened with the website. This mess will not be amenable to being tweaked…it will have to be rewritten entirely. Yes, this is clearly a software disaster, and others in the industry are calling it worse. Sixty million dollars and nothing to account for it.

        Respectfully,

        Ron Smith, MD
        ron (adot) ronsmithmd (adot) com

        • Martha55

          The Patient Protection and Affordable Care Act was based on the ideas from the conservative Heritage Foundation. I don’t see how requiring people to buy insurance is socialist…seems to me this is a case of “regulated capitalism sludge.”

          bobsmith99 is right…you lose all credibility by using the word socialist.

          • adh1729

            Ron Smith has plenty of credibility. Social-ism is where we are headed, even if we haven’t gotten there yet.

          • bobsmith99

            Please provide proof of this. Again, the ACA is far from “socialist”. Ronald Reagan famously claimed that Medicare would lead the U.S. to socialism back when it was past in the 60s- of course he has proven to be wrong.

          • lissmth

            The realistic word is “fascist.” That’s when government takes control of private business.

        • bobsmith99

          Please explain the “socialist” point further. How is creating a marketplace for consumers to purchase private insurers to enable access to privately employed physicians an example of “socialist sludge”.

          • ErnieG

            The marketplace is very regulated, with large parties essentially being the players in the market. Physicians are increasingly being forced to dance to the tune of gov’t and third party payers. The ACA is a ticking time bomb– I am sure the government will be coming in to the “rescue” in a few years with vast sweeping cost measures to essentially force social justice.

          • bobsmith99

            “Physicians are increasingly being forced to dance to the tune of gov’t and third party payers”- so your point is that the ACA promotes more involvement from private payers? That has been going on for years- one of the great inefficiencies of the U.S. healthcare system. The market is regulated due to the astronomically high cost of health care in this country.

    • Guest

      If you’re not happy with it, go somewhere else. People should have done something about it back when the law was passed. It’s too late now. Part of the reason we’re in this mess is because most healthcare workers just complain, but don’t actually do anything about the faults of the system.

  • Anthony D

    If you can use Google and do some basic research you will find out for
    yourself just how bad it is and come January 01 just how much worse it
    is going to get.

    But to get you started, a 2700 page bill backed by 13,000 pages – and
    climbing – cannot be good. Add in the IRS who is going to be handling
    the enforcement of Obamacare….what could possibly go wrong!

  • amohtap

    The debt incurred in the last 5 years is literally free money. The rate on treasuries has been so low that inflation alone wipes out any interest payments. Harping on the money incurred during Obama’s presidency is simple economic ignorance. Borrowing at 1-2% while inflation is ~2% and GDP growth is 2-3% is the greatest deal since WWII.

    • Guest

      “The debt incurred in the last 5 years is literally free money.”

      This is the mindset of the people who are setting our fiscal policy. Be afraid. Be very afraid.

  • doc99

    That the so-called Patient Protection and Affordable Care Act protects patients and makes care more affordable remains an open question. Time will tell.