Any healthcare reform requires that consumers have sufficient affordable options to induce them to participate voluntarily. There are many paths to that goal, but none of them will be reached so long as crossing the political aisle means committing political suicide.
Upon passage of the Patient Protection and Affordable Care Act in 2010, conventional wisdom suggested the law would extend medical coverage to many Americans without it, while failing to curb costs.
Seven years later, that prognosis appears to have been largely on target.
According to the Centers for Disease Control, the percentage of Americans without healthcare insurance fell from 16 percent in 2010, to just 8.9 percent in the first half of 2016. On the other hand, many Americans were unable to retain the plans and doctors they had, and many have faced sharply higher premiums and deductibles.
And in some states and counties, insurers have withdrawn from participation in public insurance options, leaving some consumers with but a single choice.
In the wake of a Republican electoral victory last November, conventional wisdom suggested the GOP would move quickly to reform or entirely repeal Obamacare. But Republicans have struggled to do so, in part because parts of the law are popular, and in part because GOP senators remain deeply divided on what reform should look like.
But unless Americans are ready for a single-payer system, which I doubt, some kind of Obamacare reform is a near certainty.
To understand why, let’s look at that conventional wisdom that had the coverage and cost aspects right from the start.
The term “conventional wisdom” can be traced to an 1830s volume, “An Inquiry Into the Moral and Religious Character of the American Government,” by New York lawyer Henry Whiting Warner, and Theodore Frelinghuysen, a one-time senator from New Jersey and Whig vice presidential hopeful in 1844.
Warner and Frelinghuysen asserted that when dealing with fundamental rights, such as religion and speech, Americans appealed not to legislation, books or documents, but invoked “the common law of our essential liberties.”
In other words, when faced with tough calls, Americans look to freedom as a guide.
That doesn’t dictate the exact shape of healthcare reform, but it does speak to the spirit needed to craft successful reform.
Such reform would, as Republicans have long argued, restore the real choices Americans enjoyed prior to the ACA, including affordable plans that might not cover everything Democrats think should be covered.
Those Democrats who insist the ACA’s mandates cannot be relaxed need to study the last three years, during which many opted to pay penalties that were less than the premiums they would have paid for coverage they felt they did not need. [Editor’s note: The penalty for not enrolling didn’t begin until 2014.] Whatever else Washington, D.C., can do, it can’t force Americans to act contrary to what they believe to be their own best interests.
Reform grounded in freedom would also address Democrats’ points about the freedom from fear that the ACA conferred upon many who are now less worried about being disabled or dying from a treatable condition, and better able to afford at least some coverage.
Yet we know that the economics of healthcare insurance depend upon broad participation, which requires that the right incentives be in place.
Simply put, any healthcare reform requires that consumers have sufficient affordable options to induce them to participate voluntarily. There are many paths to that goal, but none of them will be reached so long as crossing the political aisle means committing political suicide.
Could the GOP enact reform without a single Democratic vote? Yes, but that would be no more lasting a victory than the ACA itself, which passed in 2010 without a single Republican vote in the House.
And yet, we will someday have reform. We will have it because Americans are too jealous of their freedom to let a system of good intentions and lofty goals be eroded by a financial structure that triggers runaway costs, soaring premiums and long-term deficits.
Intolerable situations eventually end. And for all the good intentions and actual good that Obamacare has brought, it is financially unsustainable as currently structured. Opposing sides can blame each other all they like, and argue endlessly about whether health care is a right or a privilege, which taxes stay and which go, and much else. In the end, effective reform will require recognizing and retaining the good, while admitting to and reshaping the bad. To have expected perfection in 2010 was unrealistic. It may take several additional tries to get it right.
And if not right, at least closer to goals all should share: broader coverage and lower costs. For the Declaration of Independence does not impose upon Americans an obligation to form a perfect union — merely a “more perfect” one.
Chris Sinacola is a Worcester Sun columnist. His observations on politics, current events, history and more appear every Sunday.