By Nick DAngelo
The idea of national healthcare coverage has been part of the on-and-off political dialogue since 1934. In that year, Frances Perkins, the first woman to serve as a member of a Presidential Cabinet, pitched the idea to her boss, Franklin Roosevelt. Originally envisioned as part of the revolutionary labor reforms of the New Deal, a universal health care program was stricken from a package that included child labor laws, maximum work hour rules and Social Security. Even to FDR, synonymous with 20th century liberalism, universal healthcare seemed too radical.
For 79 years, the debate over how to implement a national health insurance system, and whether or not to, has continued to rage. That debate reached a milestone last week when the Health and Human Services Secretary Kathleen Sebelius was pushed to defend both the philosophical and physical aspects of the healthcare law. In the wake of that defense, President Barack Obama was forced to revise one of his strongest arguments for the Affordable Care Act. Although repeated almost constantly since 2010, the president’s assurance, “If people like their insurance, they can keep it,” was proven at least partially inaccurate.
Last week, Secretary Kathleen Sebelius, the woman who helped make the administration’s healthcare policy a reality, faced a hostile environment on Capitol Hill. Although the president’s second choice for the post, Sebelius was seen as a celebrity nomination: a popular governor from deep-red Kansas, she was once the state’s Insurance Commissioner and held a reputation as a skilled manager. If anyone could guarantee a flawless rollout of a controversial plan, it was Kansas’ Chief Executive. But not even Sebelius could have been ready for this.
During her long hours of testimony before the Senate Commerce Committee last week, Sebelius’ defense of the poor implementation of the legislation seemed to be “it could have been worse.” Time magazine reported her cold appearance under the headline: “Sebelius Whatever’s Congress.” Mid-way through the hearing, she was asked if President Obama deserved ultimate blame for the failing implementation of the law. She responded, “Whatever. Yes he is the president. Yes he is responsible for government programs.” It was cold, blunt and hardly sincere.
Meanwhile, the president was caught in a gaffe of his own that will no doubt become the political criticism of the year. Even as the administration assured individuals weary of centralized coverage, insurance companies began dropping members — hundreds of thousands of them — from their plans. The reason is basic economics: When you increase standards, you will increase costs. According to Kaiser Health, although the Affordable Care Act offers “consumers better coverage, in some cases, for comparable cost,” many consumers are being prodded to purchase plans with greater coverage (the higher standards that many of those dropped say they do not need), for much higher costs.
Patrick Johnston of the California Association of Health Plans confirmed my biggest fear: Increasing coverage at low cost to some still increases the tax burden, meaning someone still has to pay for it. That someone is the consumer who was forced to give up what was working for them. “The arithmetic is inescapable,” stated Johnston.
Whether or not the Obama administration can continue to defend the actual implementation of a worthy goal is yet to be seen, but you can be sure it will be a center-stage issue during the 2014 midterm elections. There is a basic narrative that should be at the center of this philosophical debate. Can national standards prove effective? Because the United States is a nation of drastically different demographics, the social models of countries like Sweden, Denmark and even Canada, although tempting, cannot just be supplanted.
It is a key problem in education too: National standards, such as “No Child Left Behind” or “Race to the Top” simply did not work.
It may also provide insight into the differing effects of Romneycare in Massachusetts and the national plan it supposedly inspired (both were developed by the same economic architect). Romneycare was a singular state plan for a specified demographic of less than seven million people. On the other hand, as Kevin Madden pointed out to Politico, Obamacare was “a disastrous attempt to rearrange one-sixth of the world’s largest economy, while creating a one-size-fits-all federal standard for what used to be a state-by-state marketplace.” As usual, cookie-cutter policy makes for good theory, but poor reality.
Some have compared the rollout of Obamacare to the Titanic. But as Peggy Noonan wrote for the Wall Street Journal last week, that comparison isn’t entirely fair.
After all, as Noonan notes, the Titanic had three good days and the captain went down with the ship.