Misleading Bipartisan Demagoguery on Obamacare

posted by David W. Johnson on November 14, 2014 - 2:45pm

Neuroscience teaches that our brains see individual letters as pictures and string them together to create meaning. Perhaps that's why word pictures themselves are powerful tools for capturing public sentiment. The July 30th Morning Consultfeatured Republican and Democrat word pictures capturing responses to the following question:

In a word or two, could you please tell me what comes to mind when you think of the healthcare law?

It's no secret there's strong political disagreement about the Affordable Care Act. What strikes me, however, is the emotion has less to do with the Act's actual provisions than with Republican and Democrat philosophical beliefs about government. Let's look at the Republican word picture first:


Republicans believe Obamacare is a winning political argument and many are using strident language to urge its repeal. Interestingly, core provisions of the law originated with Republican think tanks. These include the individual mandate, health exchanges and insurance "risk corridors". As former Bush HHS Secretary Mike Leavitt observes, eliminating those market-based provisions, by necessity, will force America into a single-payor system. That is the last thing most Republicans want. Now the Democrats:



The Democrats own the Affordable Care Act and have embraced it despite its market-oriented provisions. Their love has not always been so profound. During the debate leading to the law's passage, many party leaders (notably Nancy Pelosi) argued fiercely to eliminate Medicare Advantage and apply its subsidies to other parts of the bill. This was an effective funding-based argument that masked a desire to eliminate a potent threat to single-payor healthcare. Medicare Advantage encourages private companies to develop care management capabilities necessary to manage the healthcare needs of large populations. To he extent private companies develop these capabilities (and they are), they reduce governmental assumption of health risk (the underlying basis for single-payor health systems).

No one is really telling the truth. The Republicans should like Obamacare more and the Democrats should like it less. Among my favorite quotes is "Hypocrisy is the tribute vice pays to virtue" from Reinhold Niebuhr. Hypocrisy is an active element of the long-running political debate on healthcare reform. Fortunately, energetic companies by the thousands are attacking the current system's inefficiencies with little regard for healthcare's politics. They're focused like laser beams on value creation, which translates into better healthcare at lower prices. Their collective actions will influence the shape of America's future healthcare system much more than the white-hot political debate over Obamacare.