I am an unabashed conservative/libertarian who doesn’t see the Affordable Care Act (Obamacare) as being the end of the world. There. I said it. You can cancel my membership in the C/L club if you wish, but before you do, I want you to hear my reasons for guarded optimism. Some might say that this article is late, since the ACA is already being implemented. But until the GOP gets off its never ending drumbeat of “repeal, repeal, repeal,” a voice like mine is going to be relevant.
Everyone in the U.S. for decades has admitted that there are serious problems with our health care system. I, like most conservatives, blamed the increased role of government in the system as the primary culprit. I still view it that way. But an idealistic, John Galt approach of “I refuse to claim power over you, not even for the moment before I set you free” is not going to work. Government got us into this mess, government will have to get us out.
For many years, conservatives have said that one of the main problems with the American health care system is that people had no way to gauge costs. If you had insurance (and most people who needed it or wanted it had it, no matter what liberals said) you just went to the doctor, paid your small co-pay and that was it. Yeah, you might look at the bill afterward and laugh about a $50 charge for your big souvenir water mug, but that wasn’t your problem. The insurance company paid for all that; that’s what you were paying them for. Meanwhile the cost of insurance to your employer or you directly kept going up and up, paperwork costs for doctors and hospitals kept going up and up, and the percentage of the bills that were actually getting paid was going down.
For better or for worse, Obamacare addressed this problem. The majority of people have higher deductibles and co-payments now. Pricing is way more transparent. Given a few years, people will become more personally invested in their health care choices and needs. They will be more aware of the costs of medical care, and will take notice when they are overcharged for things. It might be unpleasant to deal with that reality, but we conservatives are all about dealing with unpleasant realities, right? Liberals are the ones who deal in blissful ignorance. Blissful ignorance was all the average consumer of health care in this country had to deal with for decades. Obamacare is changing that. Personally, I think that is a change for the better.
It’s kind of like President Bush’s reform of Medicare about a decade ago. At the time, I was opposed to it. I still think the expansion of prescription drug coverage was a bad idea, but that’s not the point. I remember getting angry the first few years every fall when there would be an endless stream of commercials promoting the Medicare supplement open enrollment coverage. But then it hit me: Bush’s plan gets private companies in the business of underwriting and paying portions of Medicare that would have been paid for by my tax dollars before. That was actually a very conservative move, ironically one of the few conservative policies Bush actually implemented in his term of office.
And people are engaged with it. All the ads we will see this fall will encourage seniors to consider their options carefully. “Consider?” “Options?” That sounds pretty conservative to me. It sure doesn’t sound like a monolithic government imposing its will on the population. By all accounts, Bush’s reforms have actually reduced government outlays for Medicare. Hopefully, in time, as the rest of us become more engaged with our health care options we will see our costs go down through ACA as well.
Are there problems with Obamacare? Yes. I still believe the individual mandate violates individual rights, but the Supreme Court said it was a tax, which doesn't really make sense. Besides that, what I find most troubling is the way the Administration has chosen which parts of the bill it wants to implement and which it doesn’t. That sets a dangerous precedent for the future of the country. Letting any administration choose which laws, or which parts of laws, it wants to enforce and which it does not is a surefire recipe for injustice and anarchy. Is there a danger that people will be so angry over the higher costs that a liberal administration will step in and implement a single-payer system like the Clintons pushed for 20 years ago? Yes, there is, and conservatives need to be on guard against that. Are there other problems? Yes, and my next article will address two that I think need to be corrected immediately.
Most of the conservative criticism you hear about Obamacare these days has to do with the new higher out-of-pocket costs. I’m just not convinced that higher out-of-pocket costs are necessarily a bad thing. The more people realize what their health care actually costs, they might be more willing to forgo that trip to the emergency room for some penny-ante thing and instead pick up some bandages or pain medicine at the store. Or they might skip the unscheduled trip to the doctor when the little one has the sniffles. This would not be a bad thing. One of the reasons medical care has been so bad in this country is because people were flooding the system with minor problems because they weren't paying for it, the insurance company or Medicare or Medicaid was paying for it.
We conservatives need to be honest brokers. We need to challenge the Administration when we believe it is misleading the American people. We need to present our own ideas in a compelling, honest way. But we also need to be more concerned with doing what is best for the country rather than scoring political points. I understand that we have a different vision for what is best for the country than liberals do, and that is fine. We ought to be true to our vision. But hunkering down and waiting for the current administration to be over is not good leadership, nor is it true to our vision. And neither is pretending every detail in the ACA plan is a disaster, when if a Republican president had proposed many of the same concepts we would be defending it nonstop.