Monday, December 28, 2015

Will ObamaCare Survive, and if Not, Why Not, and in What Form?

You see things, and you say, “Why?” But I dream things that never were, and I say, “Why not?”
George Bernard Shaw (1856-1950)
I do not believe ObamaCare will survive in its present form. 
At risk of survival are individual, employer, and religious mandates and taxes on medical innovation companies and “Cadillac health plans.  Not at risk are exclusions for coverage of those with pre-existing conditions and young adults under their parents’ plans.
Why won’t ObamaCare survive as it now exists?
·         It  has proven to be unworkable in many respects.

·         It is inconsistent with American cultural values of freedom and pluralism and the right to choose.

·         The majority of the  middle class opposes the health law, and is angry, afraid, and uncertain about their  health care, as well as the direction  of the country, domestically and abroad.
Since its inception nearly 6 years ago, in repeated national polls, Americans have opposed the health law  by 7 %  to 10% margins.  The public has seen broken promises of keeping your doctor and health plan.   It has seen premiums rise by an average of 12.5%  accompanied by  unaffordable deductibles.    As one observer lamented, “It’s like having no insurance at all.”
To be fair, the public  knows 15 million people have gained subsidized coverage through health exchanges and Medicaid,   but this coverage has  often come at the expense of 150  million Americans covered by private plans  who have seen wages lag,  taxes rise, health costs mount,  and access to providers narrow.
Uncertainty about  ObamaCare’s future reigns.    People are asking:  If ObamaCare fails, what are the alternatives?  
No one knows.  All we know for sure is that somehow we shall have to provide care for the 15 million newly insured.  As a New England Journal of Medicine puts it,
 “ Many conservatives still advocate ‘repeal and replace,” but the almost –certain backlash  against taking coverage from more than 15 million Americans make it hard to imagine this rhetoric become reality, even if Republicans control Congress and the White House after 2016  (B.D. Sommers, “Health Care Reform’s Unfinished Work- Remaining Barriers to Coverage and Access,” NEJM. December 17, 2015).
The Heritage Foundation,  a conservative think tank has put forth 5 proposals  that would make an alternative to ObamaCare acceptable ( see  for how to get Heritage’s ebook, A Guide to to a Better Alternative to ObamaCare,  which fleshes out the details to these 5 proposals).
1.       Promote personal choice and ownership of health insurance.

2.      Enable free market to respond to consumer demands.

3.      Encourage portability of coverage.
4.       Help civil society and free markets and states to assist those in need.
5.      Protect the right of faith, conscience, and life.
At the moment, these proposals are, of course,  mere words that  have yet to assume con concrete reality or to withstand political and partisan scrutiny or voter approval.
Meanwhile it may be worthwhile examining the American creed as set forth by our forefathers.
·         One, government is best that governs least.
·         Two,  majority rules.
·         Three, equality of opportunity.
It can be argued that at one time of another,  the Obama administration  have violated the  three components of this creed. 
·         One, through executive orders and policies,  it has governed most and compiled a federal budget deficit that exceeds that all previous presidential administrations combined.  
·         Two,  the House and Senate now have GOP majorities that  do not rule but are checkmated by the Obama administration..   

·         Three,  the majority of Americans feel , because of falling wages and a slow growth economy, and the administration’s stress on equal outcomes  and redistribution of incomes, they are being denied equal opportunity.
Instead,  in response to these perceived violations and low average approval ratings, compiled by Real Clear Politics of the president (43%),  Congress (13%),  wrong direction of country (66%),  and health law (42%), President Obama , instead of taking personal responsibility  and admitting policy failings,  to paraphrase President Lincoln, has adopted this philosophy , “ You can blame all of the critics  some of the time; you can even blame some of the critics  all of the time, but you can  blame all of the critics  all of the time.” In their turn,  some critics call this narcissism, others a Messianic complex.
ObamaCare is a massive social experiment  that is unworkable for many  people most of the time. We shall have to wait to see how the majority of voters react to bigger government,  to ignoring the will of the majority of voters, and to less opportunity because of a faltering  low growth , 2% of GNP during  Obama’s two terms ,the lowest  recovery rate from a recession since World War II.
My guess is the outcome  of the 2016 election will hinge on how voters respond to these questions.
·         One,  do you feel more secure  about your  future and the future of the country than you did in 2008?
·         Two, are you better off financially? 
·         Three,   is your health care more affordable and accessible?

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