This past week, thousands of Americans attended rallies organized by Democrats to stop the Republican repeal of the Affordable Care Act. “I think people are waking up to the fact that the Affordable Care Act has been helping tens of millions of Americans,” said Democratic senator Chris Van Hollen at a rally in Maryland, one of many Democrats to issue a vigorous defense of the Affordable Care Act.
If you, like Senator Van Hollen or Bernie Sanders, are a supporter of Obamacare, you shouldn’t thank the Democrats; you should thank conservatives.
This is the ultimate irony in the Republican opposition to the Affordable Care Act:Obamacareisthe free-market solution to health care.
Why? Because the concept for the Affordable Care Act was actually created by a right-wing think tank in the 1990s. The original idea was seeded by the Heritage Foundation—in particular, the idea of having an “individual mandate” to buy health insurance. As Jim Hightower writes,
In 1989, the Heritage Foundation (a Republican-allied think tank) basically proposed the full privatized system embodied in the ACA, including the “individual mandate” that everyone buy an insurance policy. Such far-right GOP congress critters as Senator Orin Hatch and Newt Gingrich became leading champions of this scheme.
Kaiser Health News elaborated on the point of the mandate:
The health law was designed to extend insurance to nearly all people, including those who have medical conditions that require expensive care and are often denied coverage today. But to pay for their care, insurance companies need to have a large enrollment of consumers, especially young and healthy people who use fewer services. The mandate was adopted to guarantee a broad base.
The Heritage Foundation’s goal was, in their words, to “guarantee universal access to affordable healthcare” and achieve this by “mandat[ing] all households to obtain adequate insurance.”
Now the Republicans have lined up to repeal the ACA — and especially the mandate, which they particularly despise. This begs the question, why have the mandate at all? What makes it so important?
Well, in order to understand this logic, some background is in order.
The way the American system works is that the price of medical coverage — say, for example, an IV drip — is negotiated between the hospital and the health insurance company. The person who gets the IV drip doesn’t see the bill, outside of maybe a small copay. That’s why when you actually peruse your medical bills, the prices are outrageous. Case in point: I had an antibiotic IV drip a few years ago, and it cost $500, though I didn’t pay it, thank God—my insurance did. Moreover, the prices are outrageous partly because the healthcare system is for-profit, meaning said companies need money for advertising, marketing, PR, administration and lots of other things that have nothing to do with making you healthy.
What if you don’t have insurance? Well, the hospital price is still the same outrageous number; it’s just there’s no insurance company to pay for it — the consumer has to pay regardless. So uninsured people would often go into massive debt as a result of getting sick.
So if you’re trying to bring healthcare to everyone in the United States, you can do two things at this point. You can either regulate these costs on a federal level and decide that it’s barbaric to make healthcare for-profit. This is what’s called a single-payer system, in which the government manages the payments for healthcare, and no one profits off it, while all the doctors, nurses, surgeons, etc., get paid as they would normally. That’s what most progressives want, and what most similarly wealthy countries have, including Canada. (Notably, some Californians are fighting for statewide single-payer insurance.)
But if you’re a conservative, you probably don’t like this idea, because you believe that it’s OK for rich capitalists to profit off of sickness and misery. (Personally, I think that’s barbaric and fucked up, but to each his own.)
But this is what the Heritage Foundation believes, and in the late 1980s, they wrote up their vision for how to keep our shitty privatized health-insurance system intact and keep the shareholders happy while giving everyone in the country healthcare.
The simple and cruel way of doing this would be to just force everyone to get their own private health-insurance plan. That would make the health-insurance companies happy (and richer).
But pre-ACA, when there were no subsidies, buying private insurance on your own could get really expensive. Also, if you had a preexisting condition, health-insurance companies could reject you because treating you would cost a lot of money. (Then, as now, most people who have health insurance have it through their workplace, and hence don’t have to pay much, if anything.)
So here was the challenge the Heritage Foundation—and later Obama—set out to solve: how do you make private healthcare cheap and let people with preexisting conditions (who are expensive to insure) get cheap insurance?
Basically, to keep the price of health insurance low, you have to do a combination of the following: A) get a ton of young people on the plan, who aren’t sick, so that the money they’re paying subsidizes the old and sick and therefore expensive-to-insure people; B) apply a subsidy to poorer and sicker people so they can afford private insurance in the first place; and C) make it compulsory so that said young people sign up.
This Frankenstein public-policy solution is the Affordable Care Act: a means of keeping our shitty private health insurance system intact, keeping insurers rich and giving everyone health insurance. Massachusetts’s “Romneycare” system was the same deal, and it provided a model for Obamacare. Rhode Island attempted a similar system, yet without the mandate, and healthy people didn’t sign up; Rhode Island’s health commissioner at the time wrote it off as mostly a failure. “Getting rid of the individual mandate immediately risks a collapse of the individual insurance market,” said Kaiser Family Foundation senior vice president Larry Levitt.
So if the Heritage Foundation and many Republicans pioneered this idea, why are they so against it now?
This is the ultimate irony in the Republican opposition to the Affordable Care Act: Obamacare is the free-market solution to health care. It was pioneered by the right. And you need the mandate in order to make it functional; otherwise the health-insurance companies will go broke paying for only the sick and old insurees.
So if the Heritage Foundation and many Republicans pioneered this idea, why are they so against it now? Let’s put on our thinking caps for a second. Why was the mandate idea fine when the Heritage Foundation championed it, but totally unacceptable when coming from the mouth of Obama? It seems a pretty clear attempt at bipartisanship for him to champion this policy proposal.
Could it be that there’s something different about Obama, some subtle thing that made him different than any other president before him, and therefore made anything he said or did unacceptable to the Right? Can you think of anything about Obama, any physical characteristic, perhaps, that made the Republicans unable to accept him or anything that came out of his mouth?
Let me know if you have any ideas. I’ll be sitting here trying to work it out myself.
