The New York Times
July 15, 2012
See also First Step in
Health Cost Containment.
Five Obamacare Myths
By BILL KELLER
ON the subject of the Affordable Care Act -- Obamacare, to reclaim the
name critics have made into a slur -- a number of fallacies seem to be
congealing into accepted wisdom. Much of this is the result of
unrelenting Republican propaganda and right-wing punditry, but it has
gone largely unchallenged by gun-shy Democrats. The result is that
voters are confronted with slogans and side issues -- "It's a tax!"
"No, it's a penalty!" -- rather than a reality-based discussion. Let's
unpack a few of the most persistent myths.
OBAMACARE IS A JOB-KILLER. The House Republican majority was at it
again last week, staging the 33rd theatrical vote to roll back the
Affordable Care Act. And once again the cliché of the day was
"job-killer." After years of trying out various alarmist falsehoods
the Republicans have found one that seems, judging from the polls, to
have connected with the fears of voters.
Some of the job-killer scare stories are based on a deliberate
misreading of a Congressional Budget Office report that estimated the
law would "reduce the amount of labor used in the economy" by about
800,000 jobs. Sounds like a job-killer, right? Not if you read what
the C.B.O. actually wrote. While some low-wage jobs might be lost, the
C.B.O. number mainly refers to workers who -- being no longer so
dependent on employers for their health-care safety net -- may choose
to retire earlier or work part time. Those jobs would then be open for
others who need them.
The impartial truth squad FactCheck.org has debunked the job-killer
claim so many times that in its latest update you can hear a groan of
weary frustration: words like "whopper" and "bogus" and "hooey." The
job-killer claim is also discredited by the experience under the
Massachusetts law on which Obamacare was modeled.
Ultimately the Affordable Care Act could be a tonic for the economy.
It aims to slow the raging growth of health care costs by, among other
things, using the government's Medicare leverage to move doctors away
from exorbitant fee-for-service medicine, with its incentive to pile
on unnecessary procedures. Two veteran health economists, David Cutler
of Harvard and Karen Davis, president of the Commonwealth Fund, have
calculated that over the first decade of Obamacare total spending on
health care, in part by employers, will be half a trillion dollars
lower than under the status quo.
OBAMACARE IS A FEDERAL TAKEOVER OF HEALTH INSURANCE. Let's be blunt.
The word for that is "lie." The main thing the law does is deliver 30
million new customers to the private insurance industry. Indeed, a
significant portion of the unhappiness with Obamacare comes from
liberals who believe it is not nearly federal enough: that the menu of
insurance choices should have included a robust public option, or that
Medicare should have been expanded into a form of universal coverage.
Under the law, to be sure, insurance will be governed by new
regulations, and supported by new subsidies. This is not the law Ayn
Rand would have written. But the share of health care spending that
comes from the federal government is expected to rise only modestly,
to nearly 50 percent in 2021, and much of that is due not to Obamacare
but to baby boomers joining Medicare.
This is a "federal takeover" only in the crazy world where Barack
Obama is a "socialist."
THE UNFETTERED MARKETPLACE IS A BETTER SOLUTION. To the extent there
is a profound difference of principle anywhere in this debate, it lies
here. Conservatives contend that if you give consumers a voucher or a
tax credit and set them loose in the marketplace they will do a better
job than government at finding the services -- schools, retirement
portfolios, or in this case health insurance policies -- that fit
I'm a pretty devout capitalist, and I see that in some cases
individual responsibility helps contain wasteful spending on health
care. If you have to share the cost of that extra M.R.I. or elective
surgery, you'll think hard about whether you really need it. But I'm
deeply suspicious of the claim that a health care system dominated by
powerful vested interests and mystifying in its complexity can be
tamed by consumers who are strapped for time, often poor, sometimes
uneducated, confused and afraid.
"Ten percent of the population accounts for 60 percent of the health
outlays," said Davis. "They are the very sick, and they are not really
in a position to make cost-conscious choices."
LEAVE IT TO THE STATES. THEY'LL FIX IT. The Republican alternative to
Obamacare consists in large part of letting each state do its own
thing. Presumably the best ideas will go viral.
States do have a long history of pioneering new ideas, sometimes
enlightened (Oregon's vote-by-mail comes to mind) and sometimes less
benign (see Florida's loopy gun laws). Obamacare actually underwrites
pilot programs to reduce costs, and gives states freedom -- some would
argue too much freedom -- in designing insurance-buying exchanges. But
the best ideas don't spread spontaneously. Some states are too poor to
adopt worthwhile reforms. Some are intransigent, or held captive by
You've heard a lot about the Massachusetts law. You may not have heard
about the seven other states that passed laws requiring insurers to
offer coverage to all. They were dismal failures because they failed
to mandate that everyone, including the young and healthy, buy in.
Massachusetts -- fairly progressive, relatively affluent, with an
abundance of health providers -- included a mandate and became the
successful exception. To expand that program beyond Massachusetts
required ... Barack Obama.
OBAMACARE IS A LOSER. RUN AGAINST IT, RUN FROM IT, BUT FOR HEAVEN'S
SAKE DON'T RUN ON IT. When Mitt Romney signed that Massachusetts law
in 2006, the coverage kicked in almost immediately. Robert Blendon, a
Harvard expert on health and public opinion, recalls the profusion of
heartwarming stories about people who had depended on emergency rooms
and charity but now, at last, had a regular relationship with a
doctor. Romneycare was instantly popular in the state, and remains so,
though it seems to have been disowned by its creator.
Unfortunately, the benefits of Obamacare do not go wide until 2014, so
there are not yet testimonials from enthusiastic, family-next-door
beneficiaries. This helps explain why the bill has not won more
popular affection. (It also explains why the Republicans are so
desperate to kill it now, before Americans feel the abundant rewards.)
Blendon believes that because of the delayed benefits and the general
economic anxiety, "It will be very hard for the Democrats to move the
needle" on the issue this election year.
He may be right, but shame on the Democrats if they don't try. There's
no reason except cowardice for failing to mount a full-throated
defense of the law. It is not perfect, but it is humane, it is (thanks
to the Supreme Court) fiscally viable, and it comes with some
reasonable hopes of reforming the cockeyed way we pay health care
Even before the law takes full effect, it has a natural constituency,
starting with every cancer victim, every H.I.V. sufferer, everyone
with a condition that now would keep them from getting affordable
coverage. Any family that has passed through the purgatory of cancer
-- as mine did this year, with decent insurance -- can imagine the
hell of doing it without insurance.
Against this, Mitt Romney offers some vague free-market principles and
one unambiguous promise: to dash the hopes of 30 million uninsured,
and add a few million to their ranks by slashing Medicaid.
If the Obama campaign needs a snappy one-liner, it could borrow this
one from David Cutler: "Never before in history has a candidate run
for president with the idea that too many people have insurance
See also First Step in
Health Cost Containment.