Many of us on FDL knew from the beginning that the Affordable Care Act, which I prefer to call “The Rube Goldberg Health Insurance ‘Reform’ Act of 2010,” was a bad law. To begin with, it was overly complex and clotted with industry terms of art. The only part of it that John and Jane Q. Public understood was the individual mandate, which they hated and which the Republicans harped on.
President Obama and the Democrats compounded ACA’s flaws with the worst job of advocacy imaginable. Their political malpractice was a major reason for the party’s disastrous performance in the 2010 election. (Running Howard Dean out of town, dismantling his 50-state strategy, and telling progressives they were retards who needed to be drug-tested, didn’t exactly help the party’s standing either. But I digress.)
Opinion polls show that the Democrats have not only failed to persuade voters about ACA, but they’ve also alienated millions more thanks to the botched rollout of Healthcare.gov, which I prefer to call HealthKludge.gov.
Simply put, the ACA is a political stink bomb.
But try telling that to the mandarins of the Democratic Party. They’ve decided to double, triple, and quadruple down, and make the ACA the centerpiece of the 2014 midterm campaign. And in their desperation, they’ve chosen to ignore legitimate objections, belittle critics, and put out arguments that either defy common sense or will eventually be exposed as untruths.
Based on what I’ve seen from the White House, Democratic-leaning websites like DailyKos.com, and pro-administration pundits, here are the ten worst pro-ACA talking points.
10. Republicans sabotaged the insurance exchanges. Rebuttal: Hanlon’s Razor states, “never attribute to malice that which is adequately explained by stupidity.” There was a colossal amount of stupidity surrounding the design and launch of Healthcare.gov. And let’s not forget that (a) exchanges already existed in Massachusetts and (b) other states and the feds had three years to get ready for the rollout. So the government’s excuses are lame indeed.
9. Once Healthcare.gov gets fixed, the rest of ACA will work fine. Rebuttal: Healthcare.gov epitomizes what is wrong with the law itself: it grafts an unfriendly government bureaucracy on top of an even more unfriendly insurance bureaucracy. Mrs. Tiger spent more than 80 hours trying to buy insurance on the exchange; and once she did, the insurance company delayed processing our application so long that we had to physically deliver a check to one of its offices. Which doesn’t inspire confidence.
8. People forced to pay higher premiums can afford to. Rebuttal: Speak for yourself. People getting socked with higher premiums might not be able to afford them because they’re already struggling to meet family obligations such as caring for aging parents or paying their children’s college tuition. And I have a word of advice to ACA defenders: Wagging fingers doesn’t win friends or influence people.
7. But the Republican policies are worse. Rebuttal: Send out the fire brigade to hose down this straw man. Of course Republican “reform” proposals are worse. Health Savings Accounts, tort “reform,” and allowing rapacious insurance companies (but I repeat myself) won’t make care any more affordable. Almost anything looks better than what the GOP is serving. But “we suck less” hasn’t exactly worked as a rallying cry for the Democrats.
6. The policies canceled by insurance companies were “junk”. Rebuttal: There’s Mrs. Tiger’s and my story for openers. Our expiring plan isn’t junk. Granted, it isn’t ACA-compliant (no coverage for doctor visits or prescription drugs) but our out-of-pocket expenses were capped at $1,000, making the ACA noncompliance moot.
And while I’m on this subject, I’d like to put a lump of coal in our state’s two U.S. senators’ stockings. Carl Levin’s email response to Mrs. Tiger’s complaint about HealthCare.gov started out with the assertion that cancellations affected “a portion of the 5% of Americans who…purchase coverage on the exchanges.” In other words, you’re too insignificant to help. And the staffer at Debbie Stabenow’s office who answered Mrs. Tiger’s call about the exchange website was downright rude to her–at one point, she asked “don’t you know this is the day before a holiday?”–and made it quite clear she had no desire to help. Great moments in constituent service these weren’t.
5. Isn’t Medicaid expansion wonderful? Rebuttal: Not necessarily. To begin with, if you’re 55 or older, Medicaid is a loan that will be collected out of your estate after you die. And even if you’re younger, your home state might treat you like a minor in need of supervision. Example: My home state of Michigan wants to create a Health Savings Account for each recipient. The motivation for this? Creating a tool that state employees can use to humiliate recipients.
4. ACA was the best we could hope for. Rebuttal: No, it was the best Democrats were willing to support. The fix was in long before the bill got to the floor of both houses of Congress. By that time, the White House and Senator Baucus had made backroom deals which extracted eentsy-weentsy concessions from the pharmaceutical and hospital industries in exchange for killing the public option and prescription drug price controls. The whole sordid process makes one wonder whether elections have consequences, at least when Democrats win.
3. Flawed as it is, ACA gets us one step closer to single-payer. Rebuttal: Don’t bet on it. In the unlikely event that the Democrats recapture both houses of Congress, they’ll avoid health-care reform like the plague. And you can be damn sure that Hillary the Inevitable will avoid even talking about this issue. Even if Capitol Hill Democrats try to change the system–the probability of that happening is vanishingly small–the pharma, hospital, and insurance lobbies will fight to the death to keep what they won in ACA negotiations.
2. Competition among insurers will make health-care costs stop rising. Rebuttal: The ACA did little to nothing to control price-gouging by hospitals, pharmaceutical companies, and medical device manufacturers; and left in place an inefficient and unfair system under which insurers have an incentive to deny claims for reimbursement for overpriced care. And don’t expect the invisible hand of the marketplace to rein in costs. The health-care industry is no model of transparency; and, if you’ve ever dealt with hospitals or insurance companies, you know how little bargaining power you have.
1. ACA will make care affordable. Rebuttal: The title of this law is the ultimate deception. Having insurance is not the same as getting affordable care. Before ACA, the uninsured avoided seeing a doctor because they had to pay for care out of their own pocket. Once they buy coverage, they’ll soon discover how much they have to pay out of their own pocket for care because of steep co-pays and deductibles. Meanwhile, those who bought fancier plans on the exchange will learn what “out of network care” means and how much they’ll have to pay for it. And the price-gouging will continue unabated.
Prediction: Although the ACA won’t be repealed anytime soon, it will continue to suffer the death of a thousand cuts. Each year, people will find that their insurance costs more and more and covers less and less. Millions of Americans will continue to go bankrupt because of medical bills, and Congress will shrug at their plight. Ironically, the exchanges will function well enough for Paul Ryan to resurrect his proposal for Medicare Groupons, which will be redeemable on the exchanges. The over-and-under for that happening is 4.5 years.
Image by Charles Fettinger released under a Creative Commons license.