The basic framework for Obamacare was developed by President Richard M. Nixon in the '70s and solidified by the Heritage Foundation, a conservative think tank, in the aftermath of President Bill Clinton's failed health-care proposal.
The basic framework for Obamacare was developed by President Richard M. Nixon in the ’70s and solidified by the Heritage Foundation, a conservative think tank, in the aftermath of President Bill Clinton's failed health-care proposal.
The conservative approach proposed to provide universal health care at lower cost by fostering greater competition among private insurance companies (health-care exchanges) and by requiring universal participation, to create broader pools and spread the costs more equitably (the individual mandate). It also proposed government subsidies for the poor and small businesses.
Massachusetts Gov. Mitt Romney implemented such a program in his state, saying he got it from former Republican U.S. House Speaker Newt Gingrich, who got it from the Heritage Foundation.
It took Massachusetts a full year to get everyone enrolled, after many initial glitches. However, when President Barack Obama implemented essentially the same program nationally, the Republicans immediately denounced it as “socialistic” and have condemned it ever since.
The Heritage Foundation disavowed its own brainchild and now is one of its most vociferous critics. This obstructionism obviously is motivated primarily by a visceral hatred of Obama himself, rather than by a reasoned evaluation of his programs.
Obamacare is not socialistic or even liberal. Liberals favor Medicare for all or at least as a public option. Obamacare, by contrast, is based completely on efforts to foster private-enterprise competition in the health-care marketplace.
The only truly socialistic health-care system in the developed world is the British system. The only national health plan organized around a single payer, or roughly Medicare for all, is the Canadian system. All others use a mix of public and private, and they manage to provide universal coverage while spending about 10 percent or less of their GDP on health care.
In the U.S., we spend 18 percent of our GDP on health care. Why? Because we are the only country that permits the profit motive to shape health-care decisions. Other developed countries regulate health-care insurers and other players to function like public utilities on a non-profit basis.
Their overhead expenses average under 10 percent. American private insurers, by contrast, have an operating overhead of 30 percent, which is used to pay off shareholders, to pay large salaries to top-level executives, to advertise extensively and to lobby. They pay out only 70 percent of premiums for health care.
It is no wonder that the insurance industry fought tooth and nail against having to compete with a public option, since the operating overhead of government-run Medicare is a fraction of that of the private sector.
The private-insurance industry wrote many sections of Obamacare and already have sought numerous exemptions from sections of it that cut into their profits. These are the same private insurers that have long rationed health care, by rejecting customers outright, refusing to cover certain preexisting conditions and looking for ways to drop clients who end up with expensive medical problems. They also frequently have limited our ability to choose the doctors we want.
Part of the stated public disapproval of Obamacare comes from liberals, who see it as essentially a conservative program borrowed from Republicans, and believe it is unlikely in the long run to reduce medical costs.
It does represent a huge improvement over the status quo, by covering millions more people, helping the poor obtain coverage, subsidizing small businesses, protecting people with pre-existing conditions and trying to divert a larger percentage of premiums collected toward actual health-care provision.
Since it was implemented, we also have seen the lowest annual increases in health-care costs in the last twenty years.
In the meantime, Republicans have not really offered a comprehensive alternative, since Obamacare, or something like it, was really their original philosophical approach.
STEPHEN K. STOAN