Jay Fleitman: Why Republicans hate Obamacare
NORTHAMPTON — There have been few national political issues during my lifetime that have caused such widespread and enduring bitterness as Obamacare. Perhaps only the controversy triggered by Roe v. Wade has had such persistence. Warfare over this program is continuing in Washington between Democrats and Republicans, the most current battles being fought over the federal budget and the debt ceiling.
The roots of this rancor are twofold.
The process with which Obamacare was passed was a hand grenade going off in the body politic, and the political wounds simply will not heal. Both houses of Congress were controlled by the Democrats and Senate Majority Leader Harry Reid and his House counterpart, Nancy Pelosi, seized the opportunity to force through a major overhaul of one-sixth of the national economy with no avenue for advise and consent for Republicans, and no allowance for discussion or amendment.
There was no support at all by the opposition party and deep unpopularity among the general public. The Democratic leadership could not have been given a clearer message of the public hostility toward this bill in 2010 when Republican Scott Brown was elected to the Senate seat previously held by Ted Kennedy in overwhelmingly Democratic Massachusetts, his campaign dedicated to the proposition that he would be the 41st vote to kill this bill.
Reid and Pelosi pushed forward anyway. Democratic membership in Congress was itself uncertain of the content and ramifications of this 1,200-page bill, which led to Pelosi’s famous statement of “Alice in Wonderland” logic that Congress had to “pass this bill in order to know what’s in it.” With not a single Republican vote in either the House or the Senate, the Democratic leadership bypassed usual procedures in the Senate to cram through to passage this bill of profound national implications.
Any political foresight would have anticipated that this process would lead to a deep polarization of our politics. It is easy to understand how Republicans would refuse to cooperate with subsequent Democratic initiatives after the crass steamrolling of this bill through the House and Senate.
We often hear as an argument against continued Republican resistance to Obamacare that this should now be accepted as the “law of the land.” There is no reason why Republicans as the opposition party should ever accept the legitimacy of this bill or render to it any respect.
Clearly, some goals of this bill are important for Americans. Eliminating penalties for pre-existing conditions, making insurance portable and finding ways to extend affordable health care coverage to those Americans who want it are worthy goals. Equally important is controlling the societal cost of health care without damaging its quality, which is not addressed by this bill.
On the other hand, there are practical arguments against Obamacare. Provisions of this bill are already limiting full-time employment as employers are switching to part-time workers, health care premiums are rising for many Americans and health care costs are being shifted to the younger population of Americans who already suffer from high unemployment and whose career paths are already in peril in the current economy.
There is a core philosophical divide at the heart of the struggle. The Democratic leadership of Obama, Reid and Pelosi sought an opportunity to project the fundamental belief in the central government as the prime agent of change in the solution of national problems. Conservatives, on the other hand, see this bill as a large step in the intrusion of central government into the economic and personal lives of Americans, an action contrary to their view of the nature of American society. Regardless of the Supreme Court ruling that this bill with the individual mandate is constitutional, conservatives believe it is a body blow to the constitutional impetus to limit the reach and scope of a potentially oppressive central government.
And then there is the Massachusetts state health care finance reform bill of 2012, a massive bill passed with scant public discussion that may herald the national future of Obamacare. Massachusetts state financing has suffered under the health care reform bill of 2006 (so-called Romneycare), as its individual mandate led to over-enrollment in state-subsidized health care insurance rather than into private insurance, as was expected. In order to control the budget hemorrhage, this bill of 345 pages whose authors are impossible to identify was passed by a legislature that did not have time to read it.
It builds a massive bureaucracy that will control all money spent on health care in Massachusetts. Medical care will be delivered throughout the state by an experimental structure called an accountable care organization (ACO) that creates a perverse financial incentive as health care providers and hospitals will profit from delivering as little care as possible to Massachusetts citizens.
It is essentially a government takeover of the Massachusetts health care system, but this is Massachusetts.
Government is deemed good and so nobody cares.
How the political turmoil in health care plays out is impossible to predict. The changes that these bills trigger will be impossible to reverse. In Massachusetts, the new financial reforms may change health care delivery profoundly. Whatever these bills ultimately do to health care delivery and the economy in the future will become the “new normal” and Americans may then wonder how we got here.
Jay Fleitman, a Northampton physician, writes on the first Tuesday of the month. He can be reached at firstname.lastname@example.org.