Straight Talk on Affordable Care
by Stephen Tryon
Over the past several weeks, we have witnessed our government shut down and nearly default on its debt payments amidst bitter political debate over the Affordable Care Act. The Affordable Care Act, usually referred to as Obamacare by those who oppose it, became Public Law 111-148 after being passed by the Congress and signed by the President on March 23, 2010. For me, the most concerning aspect of the recent debate was the campaign of misinformation about both the nature of the conflict over Affordable Care as well as the actions and responsibilities of senior congressional leaders relative to the budget stalemate.
According to a National Journal poll taken in July of this year, 57 percent of Americans supported implementation of the Affordable Care Act. Yet in the years since the Act became law, opponents—mostly so-called Tea Party conservatives—have consistently claimed they represent the majority of Americans as they have repeatedly tried to repeal the law. Some photos show opponents carrying signs claiming 72 percent of Americans oppose the law. Certainly it cannot be the case that 57 percent of Americans support implementation and 72 percent oppose it, but the fact is that polls are susceptible to large swings based on how the questions are asked. According to an editorial last week by Michael McGough of the Los Angeles Times, for instance, a CNBC poll shows 46 percent of Americans oppose Obamacare while only 37 percent oppose the Affordable Care Act.
Given that it is possible to frame questions and apply labels in any one poll so as to skew results, it is more critical than ever that Americans become better consumers of information and government. We cannot expect to form reasonable opinions based on what the information stream serves to us each day. Our information distribution channels are businesses. These information businesses target information to specific audiences based on their ability to sell advertisements and drive the most visits, clicks, and viewers or listeners. Like it or not, you have a profile based on where you live, what you drive, how you shop and how you spend your free time. Your profile influences how often you hear news about Obamacare versus news about the Affordable Care Act. If you are a passive consumer of what the information industry serves you, you are likely to consume information that reinforces your views and alienates you from those who think differently.
And not all of the information slanting is as subtle as changing a label—some is blatantly incorrect. For instance, opponents have mischaracterized the Affordable Care law as socialization of health care in the United States or, in the words of Tea Party lobbyist Michael Needham, “the end of the American free-enterprise health-care system.” The Affordable Care Act is neither socialized medicine nor the end of the American free-enterprise health-care system. A socialized medical system is one in which the government owns all the hospitals and all the doctors work for the government. By contrast, the Affordable Care Act, at a very high level, is simply a network of exchanges for buying private medical insurance, along with government requirements intended to ensure that just about everyone gets coverage, whether they want it or not.
Misrepresentations aside, however, there are good reasons for concern about the implementation of the Affordable Care Act. A successful insurance executive once told me the secret to the insurance business was increasing the number of low-risk consumers covered, decreasing the number of high-risk consumers covered, and administering the coverage efficiently. Obamacare should increase the number of low-risk consumers covered, but it will also increase the number of high-risk consumers covered. It will introduce a complex new system of government subsidies and penalties intended to ensure almost everyone gets medical insurance. Even if this system operates efficiently, it is going to be expensive.
At a time when our government seems incapable of passing a balanced budget, it is perfectly legitimate for fiscal conservatives to be concerned about a massive new government program. But the fact is that the Affordable Care Act is now public law. The law was passed by the Congress, signed by the President, and has survived a review by the Supreme Court, all in accordance with the mechanisms provided for in our Constitution. Those who claim the law is somehow unconstitutional or a violation of our fundamental rights, therefore, are either misunderstanding or misrepresenting the facts. The additional expenditures necessary to implement the Affordable Care Act make it essential for our leaders to cut back on expenditures in other programs in order to balance the budget. There is nothing in the Affordable Care Act itself to prevent our elected public servants from carrying out this basic duty.
This brings us to the most egregious mischaracterization of all: the myth that Congress was somehow prevented from negotiating a meaningful budget by the intransigence of President Obama and congressional Democrats. In fact, nothing could be further from the truth. In November of 2012, when Americans re-elected President Obama and preserved the Democratic majority in the Senate, we effectively denied opponents of Obamacare the votes needed to repeal it. The President delivered his budget request to Congress on time in February of this year. Congress failed to pass appropriations bills by September 30, the end of the federal fiscal year, and that caused the government shutdown. In the weeks and months before the shutdown, polls showed 65 percent of Americans felt that Congress passing a budget on time was more important than the debate over Obamacare. However, according to the Wall Street Journal, 31 year-old lobbyist Michael Needham had other plans—he was the conservative strategist behind the shutdown. “The strategy from day one once it was passed was repeal, repeal, repeal,” Mr. Needham says. “Some said, ‘Look, it’s the law of the land, how do we improve it?’ Our response was we‘re not going to tweak it, we’re not going to fix it, we’re going to get rid of the whole law.” In light of this quotation, it seems likely that Speaker Boehner, Senator Lee and Senator Cruz’ repeated characterizations of the President as unwilling to negotiate were nothing more than cynical maneuvers stemming from misguided Republican strategy. Even Senator John McCain, a staunch opponent of Obamacare, said on NBC News last week that the Republican strategy to use the shutdown to attack the health law “deceived a lot of Americans” and did not stand any chance of succeeding in light of the 2012 elections.
In an era where the information industry and even some unscrupulous officials serve us “news” that caters to our prejudices, Americans must become active consumers of information and government to ensure the viability of our republic. We must seek a balanced view of the issues by understanding the reasoning of those with whom we disagree. With more information at our fingertips than ever before, we can honestly evaluate our personal views only if we are diligent in rejecting misinformation and arming ourselves with the best information available.
Stephen Tryon, a former fellow in the office of Senator Max Cleland, is a Senior Vice President at internet retailer Overstock.com and the author of Accountability Citizenship.