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Determinations about the efficacy of health care reform need to take place in a manner that is free from the murky waters of partisanship. The purpose of such examinations is not to determine if the legislation is good or bad, right or wrong, capitalist or socialist — but to ascertain if the legislation will work.
So, will it work?
In pursuing an answer to this question, there are many variables that could be considered. This article will briefly examine three relevant issues.
- What is the role of the individual mandate?
- What impact could the 2012 elections have on the legislation?
- What problems does the Affordable Care Act seek to address? As it turns out, the individual mandate has the potential to derail the legislation. If it were to be ruled unconstitutional, health care reform would be like a car without wheels — big and heavy, but unable to go anywhere.The Affordable Care Act must have the cooperation of the health care industry, and insurance companies simply will not go along unless they can have access to young immortals by way of the mandate.
Yet while high-profile figures in Utah such as Sens. Orrin Hatch and Mike Lee challenge the constitutionality of the mandate, most legal scholars anticipate that the Supreme Court will rule in favor of the mandate.
However, another aspect of the mandate also threatens the efficacy of the Affordable Care Act.
When running for president in 2008, President Barack Obama stressed, “In order for you to force people to get health insurance, you’ve got to have a very harsh, stiff penalty.” Agree or disagree that the mandate is constitutional, Obama makes a valid point. If the fines for not purchasing insurance aren’t high enough, people may not cooperate.
And one would be hard pressed to describe the fines for noncompliance in the Affordable Care Act as sufficiently harsh or stiff.
The staff of the Washington Post reported in Landmark: America’s New Health-Care Law and What It Means for Us All that the issue of a mandate was so politically sensitive that legislators were afraid to assess a penalty adequate enough to make the legislation work.
The bottom line is this: if young immortals revolt as a group and refuse to purchase insurance, the resulting fines would be insufficient to keep the reform legislation financially viable.
Thus, the individual mandate would be a threat to the efficacy of the Affordable Care Act even if the Supreme Court rules that it is constitutional.
The 2012 elections also will play a role in determining if the legislation will work.
When Republicans took control of the House in the 2010 elections, soon- to-be House Speaker John Boehner vowed, “We are going to repeal Obamacare.” Boehner and his fellow Republicans in the House did pass a bill overturning the Affordable Care Act, but it never made it through the Senate. And if it had, it would have been vetoed by Obama.
But 2012 is a different story. If Republicans hold steady in the House, gain enough ground in the Senate and secure the presidency — health care reform could be repealed. And every Republican candidate for president has promised to work toward repeal if elected, including front- runner Mitt Romney.
If that were to happen, the mechanics of the legislation would be moot. The Affordable Care Act can’t work if it no longer exists.
For now it does exist. But can it be effective in its current form, even assuming the individual mandate is flawless?
That is a difficult question to answer. One of the basic tenets of public administration states that the less incremental the policy change, the greater the likelihood of unforeseen consequences. Make a small change and you can probably estimate the impact with a fair degree of accuracy. But make a big change — such as reforming health care reform on a national level — and the consequences become nearly impossible to predict.
Still, there are clues as to the eventual efficacy of the legislation in its beginnings.
The health care debate focused heavily on the fact that insurance is too expensive. As a result, most of the heavy lifting in the legislation focuses on strategies designed to lower the cost of health insurance.
The cost of health insurance is too high. It is rising at unsustainable rates. But there is far more wrong with America’s health care system than expensive health insurance.
In order for you to force people to get health insurance, you've got to have a very harsh, stiff penalty.
–Pres. Barack Obama
In an academic analysis of what factors are contributing to the high cost of health care, Harvard scholar Clayton Christen and his associates identify several problems that need to be addressed in a truly viable solution. Among them are issues of anachronistic medical education, flawed objectives of clinical research and inefficient business models.
The Affordable Care Act does little to resolve these and other recognized problems. It focuses narrowly on a few select problems, thereby making it difficult to see the proverbial forest for the trees.
Democrats initially wanted to address far more than what the legislation actually entails, but the realities of the political process made that impossible. The end result is a piece of legislation that focuses heavily on a few problems while neglecting many others.
In other words, if the Affordable Care Act is successful in lowering the cost of health insurance, the overall cost of health care will likely still continue to rise.
These holes in the legislation may be addressed in the form of Democratic amendments. They may also be addressed in the form of Republican alternatives — or even market innovations. Yet as the health care debate rages on, popular myths continue to blur the line between fact and fiction.
The next article in this series will examine two of the most popular myths surrounding the health care reform legislation.
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This is the sixth in a series of nine articles addressing the topic of health care reform.
Kurt Manwaring is pursuing a graduate degree in public administration at the University of Utah. He is the owner of Manwaring Research & Consulting and maintains a personal blog at www.kurtsperspective.blogspot.com.
