Alternative Medicine

As Speaker of the House in 2010, Nancy Pelosi famously said Congress needed to pass the Affordable Care Act “so you can find out what’s in it.” This summer she said the process of its implementation has been “fabulous.” Why am I not so sure?

Of course, everyone knows the coming months will be chaotic. Reasonable people can disagree about the magnitude of the chaos. I mostly think it will be a muddle, but conventional wisdom says the Democrats face most of the political peril. With any government program, those who feel aggrieved tend to shout louder than those who feel happy. While sticker shock may not be as big a deal as health insurers suggest, younger, healthier Americans will face some hefty price increases. They’re the ones who are subsidizing—by the age-band mandates—those who are older and sicker. Democrats are rightly worried they will pay a dear price at the polls next year if millions of Americans think Obamacare is a raw deal.

With only one exception in the last 100 years, midterm congressional elections in a second presidential term are a rout for the party out of power. “Opposition party voters are usually more motivated to turn out to express their discontent with the president and his party than voters from the president’s party are to turn out to express their support,” wrote Alan Abramowitz in University of Virginia political scientist Larry Sabato’s Crystal Ball newsletter. “In addition, candidates from the president’s party no longer have the benefit of whatever coattails the winning presidential candidate had two years earlier. Finally, if the president’s party made substantial gains in the presidential election, they have to defend those seats, including some that may typically lean toward the opposition party, in the midterm election.”

Republicans need six seats to regain control of the Senate. That’s possible when one considers that 21 Democrat-held seats are up for grabs next year versus just 13 Republican-held seats. Meanwhile, Democrats need to gain 17 seats to retake control of the House. Unlikely.

Then again, on the subject of Obamacare, Republicans conceivably could screw it up. Before the August congressional recess, a number of Tea Party conservatives in the House and Senate demanded their party be willing to shut down the government in September, when the fiscal year ends, if the ACA is not defunded. This is extraordinarily wrong for several reasons.

First, defunding the agencies that enforce Obamacare doesn’t end Obamacare. The spending and taxation of the Affordable Care Act are mandatory under the law. Second, there is no possible scenario in which President Obama will relent on the signature domestic accomplishment of his administration and bow to conservative pressure. Nada, zip, zilch, none.

And the chance that Congress would then override his presidential veto? Less than that.

Third, remember how the last federal government shutdown—for 28 days in 1995 and 1996—turned out for Republicans? At least that shutdown was for “nonessential” governmental services. The path being pursued by the Tea Party Republicans would be worse, crossing over into essential services.

There has always been a breed in Washington of politicians (from both parties) who would rather have 100% of nothing than 80% of something. The environment is worse today than ever before. A couple months ago, I sat next to the engaging wife of an establishment conservative Midwestern senator. She put it well: “It used to be that there were two or three litmus tests that you had to pass to be elected as a Republican. Now there are 35 or 40, and you have to be perfect.”

One of those litmus tests is to make sure that Obamacare fails. If the rollout of the Affordable Care Act is indeed the “train wreck” that Sen. Max Baucus, D-Mont., fears, maybe the act could collapse. But what is the alternative? For many, it is the evisceration of the employer-sponsored insurance marketplace through elimination of the employer exception from taxation for benefits.

The free-market American Enterprise Institute proposed just a solution again in August. I understand the philosophy of pure consumer-driven health insurance—the idea that Americans need to feel the costs of healthcare to extract financial efficiencies. Certainly, progress is being made through some aspects of high-deductible plans that are more consumer- and behavior-driven. But if you think that 40 million uninsureds are a problem today, just blow up the employer-based health insurance system for 162 million Americans and see what you get.

Honestly, though, most of the extreme elements within the GOP don’t advance any particular alternative. They just say no. Their world does not require us to be responsible for securing and paying for our health coverage. They talk a big game on medical malpractice (who in our industry doesn’t agree with that?) but won’t acknowledge that the savings from med mal reform are picayune. They talk a big game on the specter of death panels but offer no alternative cost savings.

They would be wise to heed the words of Teddy Roosevelt: “In any moment of decision, the best thing you can do is the right thing. The worst thing you can do is nothing.”