Why are ObamaCare opponents so vehement?

A non-health wonk relative emailed me recently:

“Can you tell me in very brief terms, why the far right is so much against the Affordable Care Act?  To me, it makes good long-term economic sense, is immensely beneficial for the health and welfare of those currently without insurance, and puts us in sync with other advanced societies.  I just don’t get the opposition.”

For mainstream folks who aren’t health wonks or political junkies, it can be perplexing to try to understand why House Republicans are so eager to fight the Affordable Care Act that they are willing to shut down the government, possibly cause the government to default on its debts and steer us into a Constitutional crisis.

There are a variety of explanations. Among the more charitable readings:

  1. They feel the legislation was rammed down their throats and they were disenfranchised
  2. They honestly feel ObamaCare will be the ruination of the world’s greatest health care system
  3. They believe ObamaCare will bankrupt the country
  4. The bill is too complicated
  5. They want to appeal ObamaCare and replace it with something better

But none of those explanations hold water:

  1. The law is a moderate one and full of Republican ideas –like the individual mandate and marketplaces –that were included in the bill partly to try to bring moderate Republicans on board. The public option is out, there’s no single payer, and the use of comparative effectiveness research is neutured. And the notion of disenfranchisement rings hollow when we consider how President Bush acted like he had a mandate even though he lost the popular vote. Obama was re-elected and although the House stayed in GOP hands it’s only due to gerrymandering. The average voter voted for ObamaCare
  2. People who believe ObamaCare will ruing a great system don’t understand the US health care system and how broken it is. Those who actually work in it know it’s full of problems, is more costly than elsewhere in the world, and has less to show for the extra spending in terms of outcomes –never mind equity
  3. The GOP are the ones that wasted the Clinton surpluses and passed the Medicare Part D drug benefit without worrying about how to pay for it. ObamaCare was scored by the CBO as deficit-positive. Even if that doesn’t turn out to be the case it’s going to be cheaper than Part D
  4. ObamaCare is complex because it’s moderate. Single payer would be a lot simpler and shorter
  5. There’s very little substance to the so-called “replace” ideas, which anyway took two years to appear

A more objective read is that some opponents have whipped themselves into a lather over their revulsion to all things Obama and are living in an echo chamber where these views seem rational. It would be better for everyone if they went back to the Birther madness.

15 thoughts on “Why are ObamaCare opponents so vehement?”

  1. 1. The law is far from moderate, it contains tens of billions in annual taxes, billions in waste, crushing gov regulation, and was as poorly thought out as it was written. The claim it has Republican ideas is cheap dishonest propganda. Just because two Republicans 10 years ago considered it doesn’t make it a Republican idea. It would be more intelectually honest to say Democrats favor racism, you did in fact support jim crow and other racist laws, apparently it doesn’t matter it was the past and noone today does.
    2. And how exactly do you think our system was broken and got where we are today? 50 years of failed liberal ideas and half thought out programs. Ironic how you on the left break it then claim to have the solution, we would all be better off if you stopped breaking it.
    3. Well heck if the CBO scored it then it must be accurate. Have you never read the CBO estimates of Medicare, how have those turned out? And if you really think it was Part D that ate the surplus you can’t do math. Obama phones and food stamps cost considerably more.
    4. and quicker to fail. VA is single payor, Gov can’t do that right. Medicare is mini single payor and aca was passed to save that failure. ACA is complex because it was written by people who had no idea what they were doing. Thus all the changes and waivers.
    5. replace took 2 years to appear or for your limited and biased news sources to acknowledge? Conservative alternatives have been around for 20 years and blocked by Democrats. Lets discuss AHPs and why they never passed, truth isn’t very convienant is it?

    1. 1. The ACA is modeled on proposals created by the Heritage Foundation (a conservative think tank) in repsonse to Hilary Clinton’s health care reform proposals in the 90’s. It was successfully implemented in Massachusetts (Romneycare). Your claim is disingenuous.
      2. The regulations are hardly “crushing.” Changes to Medicare have already saved the government $4 billion in waste and fraud.
      3. Our system is broken not because of liberal ideas, but because we allowed corporate interests to turn the health care profession into the health care industry. Most of the problems with our health care system have little to do with the government. They have more to do with a system of perverse incentives perpetuated by insurance companies and hospitals that make unnecessary and expensive treatments and procedures pay better than conservative, effective, evidence based care. A great example of this is stenting vs medication for stable (not unstable) angina. Even though the medical evidence shows medication works better, stenting earns hospitals and cardiologists more. There have been several scandals related to unnecessary stenting (a invasive procedure): look up Tenet Healthcare and Redding CA to learn more.
      4. The surplus was gone long before Obama phones, which btw, merely replaced land lines for the poor (something we’ve been doing for decades, and simply updated to current technology). Part D was an expensive disaster that poorly served many patients because it is confusing and hard to pick out the best plans. Obamacare is already saving money by preventing Medicare fraud ($4 billion last year) and kept health care inflation from rising last year for the first time in decades).
      5. What current GOP ideas? The free market? That’s the same thing we’ve been doing for decades, and it was bankrupting our country.

      1. According to Politfact non the less

        “• Did Heritage originate the idea? Our research suggests that while Heritage has advocated for health insurance exchanges for many years, others did, too. Scholars credit Alain C. Enthoven — an emeritus professor at the Stanford University Graduate School of Business who worked in the Defense Department during the Kennedy and Johnson administrations — with popularizing the idea for an exchange as many as three decades ago.”

        I have 300 small business clients that would disagree on you saying the regulation is not crushing.

        You don’t seem to understand how the current system works. Insurance companies insure around 25% of the market, love to hear you explain how such a minority player manged to screw the system up. Further refute your argument if government was not part of the problem why does Medicare have the same problem with stents v Rx?

        There would be far less insurance if government didn’t mandate it, i.e. first dollar coverage, unlimited lifetime limits, coverage mandates. Medicare perverted the market and was the leading cause of many of the problems we have today.

  2. The arguments for and against the ACA boil down to the following: health care is a right vs. health care is not a right. Health care is certainly not a right or even a possibility in poor undeveloped countries. If the UK and France can accept health care as a right surely we can as well.

    1. Is Healthcare a right in the UK for those put on the Liverpool Care Pathway and denied food and water until they dei? What about those put in a queue so long they never receive treatment, is it really a right if it is promised and never delivered?

      1. The Liverpool Pathway was a British invention that spread to the US now called Hospice — every community has hospice. The queues in the UK have dramatically improved over the past 10 years — because the British are willing to improve their system — as all countries should. Don’t think the US does not have queues — if you have Medicare you will be in a queue for a new appointment with an Internist for 2-3 months. If you want an elective hip replacement in the US you will be in the queue for 1-2 months. People in the UK love their health care system. Compared to the US the UK system costs half as much and delivers twice the quality. Everyone in the UK has a primary care provider and people get the care they need — that’s only a dream in the US.

      2. Death is a certainty and is rarely welcomed by the dying, their family and friends. Not to defend LCP, (Liverpool Care Pathway) but this may be a proper way to allow death, IF there is a “living will” (no extraordinary treatment measures), proper medical judgment, proper criteria used to evaluate the patient, compassionate counseling of family (and patient, if aware), pain management, and hydration continues.

        My father passed in less than a week once HE decided that he could no longer endure the pain of his cancer. Pain management and oral hydration were continued until the end. It is very sad to see a life coming to a close, but on the other hand, we all “shed our physical skin” eventually. What may happen beyond that point depends on your belief system.

        Of course all of these decisions and treatments are administered by human beings, and money is always a factor, unfortunately. According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments, not from normal palliative care.

        The NHS is morally wrong to pay hospitals bonus for putting patients on a fast-track to death, as many would consider this path to be. This will continue to be a risk as governments and corporations, including healthcare, are highly motivated to cut costs under mandated austerity measures that target social safety nets first. The already poor and oppressed, and the newly-minted poor and oppressed will continue to suffer and die until the plutocrats amassing ever more of the global wealth become convicted of their own immoral behavior.

        And we haven’t even considered the fate of the billions on this planet who have no healthcare and barely survive in war-torn and/or third-world countries.

  3. A major issue is the fact that not enough of the industry players were involved in the development of this law to help understand what is a very complex issue. We did not need to focus on “how do we afford healthcare” but rather “how do we make healthcare affordable”. Too much to describe here, but this law will put pressures on areas where there was already issues to be dealt with (the shortage of primary care physicians for one). It certainly has a good chance of blowing up over time without some major revisions.

    1. I agree there are 2 issues. First is complexity: most countries solve that by only having a few benefit definitions (insurance companies all deliver the same products). It seems the ACA had too much industry input. Second is health care cost: this is the most pressing problem. Although ACOs are taking off there needs to be more incentive since the potential for cost reduction with that strategy is huge. Plus, the government should set prices for drugs and devices. The combination of pricing for ACOs, drugs and devices would bring the US in line with other developed countries.

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