Thursday, October 20, 2011


One of the recurrent sillinesses of our current political shouting match (in which everyone shouts as shrilly as possible, and no one really listens to anyone else) is the recurrent use of the term “ObamaCare” to refer to the health care reform proposed by President Obama and enacted into law by Congress a couple of years ago ("The Patient Protection and Affordable Care Act" of 2009). By analogy, the equally silly term “RomneyCare” is used to refer to the health care reform enacted in Massachusetts in 2006 during the governorship of Mitt Romney.
Reminiscent of the silly Republican custom of referring to the opposition as the “Democrat” party (instead of the Democratic party), “Obamacare” is obviously yet another example of the nearly universal tendency to resort to name-calling and sloganeering as an alternative to intelligent discussion and debate. But it is really even more than that. What it is also is a (so far fairly successful) attempt to obfuscate the bi-partisan background of President Obama’s healthcare plan – in particular, its most controversial element, the individual insurance mandate.
The legal controversy over the constitutionality of the mandate will presumably be resolved by the Supreme Court sooner or later – and probably sooner rather than later. My knowledge of constitutional law is too limited for me to anticipate the outcome of that case. This appears to be new constitutional terrain. Thus the Court will likely (to keep the analogy) break new constitutional ground when it finally rules. Philosophically, on issues on which the constitution provides no particular answer, I tend to favor judicial deference to the democratic branches of government. (The point of the constitution, after all, was to create a government that can actually govern, that is, solve the pressing problems confronting the country). Pragmatically, there is also a very good practical reason for the Court to follow this course. If the Act is declared unconstitutional, then the number of uninsured will likely continue to grow as health-care costs continue to increase. The result eventually (in politics, eventually need not be that far off) will be another outcry for health-care reform. Absent an individual mandate, it is hard to imagine how the problem can be resolved primarily through private insurance. Forbidding an individual mandate might paradoxically make some form of single-payer, public plan (“socialized medicine”) that much more likely.
It was to avoid that outcome (so unpalatable in our American political culture) that the individual mandate was adopted. Recall that candidate Obama opposed the individual mandate when it was proposed by candidate Clinton. The idea of the individual mandate, however, goes back much farther than the 2008 Clinton campaign.
It goes back at least as far as 1989, when it was advocated by thinkers at the conservative think-tank, the Heritage Foundation. The Heritage Foundation’s 1991 "Responsible National Health Insurance" plan incorporated the idea, which was also endorsed by another influential conservative think-tank, the American Enterprise Institute in 1992. During the debate occasioned by the Clinton Administration’s 1993 health care plan, some congressional Republicans introduced a proposal requiring the purchase of insurance coverage for emergency care. At the time it was seen for what it really is - a "free-market" alternative to a single-payer plan.
For this reason, despite his earlier campaign opposition to the individual insurance mandate, President Obama eventually accepted and incorporated the idea in his plan as the only realistic way to keep private insurance affordable for all.
So, whatever the substantive merits or demerits of "ObamaCare," calling it “ObamaCare” is more than just immature silliness. It represents a real effort to rewrite the history of how we got to where we are – something which is always deplorable and dangerous.

1 comment:

  1. I could not agree with you more about the phrase "Obamacare". Every time I hear it, it makes me wince!

    The National Health Service in my country (the UK) is full of problems but I am extraordinarily lucky to live in a country where access to health care is pretty much free. I feel very sorry for those Americans who cannot afford the care they need.