The willingness of congressional Republicans to shut down the government and threaten default in an effort to sabotage Obamacare raises a fundamental question: What is the GOP’s alternative for providing universal health insurance?
Before Congress approved Obamacare, polling showed that the public wanted all Americans to have health insurance. That continues to be the case. For example, a recent Pew Research Center poll found that 69 percent of respondents either support Obamacare (42 percent) or oppose it but want their elected officials to try to make it work as well as possible (27 percent); only 23 percent want their elected officials to try to make the law fail.
Similarly, a recent Princeton Survey Research poll found that 49 percent of respondents want to keep Obamacare while only 44 percent want to repeal it.
Congressional Republicans have implied that they have their own plan to provide affordable health care for everyone in a way that would be much more popular than Obamacare. Unfortunately, the Republicans have yet to present that plan. As a result, Obamacare is being judged against some mythical ideal rather than against a concrete alternative.
A frequent Republican charge is that Obamacare will cause insurance premiums to skyrocket. Democrats, on the other hand, predict that Obamacare will hold costs below what they otherwise would be. It is impossible to be certain what will actually happen.
However, even if Obamacare were repealed, we would face a crisis over rising health care costs. For example, according to the Centers for Medicare and Medicaid Services, health care spending has grown from about 5 percent of the U.S. economy in 1960 to about 18 percent today and will grow to almost 20 percent by 2022.
Doctors and hospitals have long complained about inadequate reimbursements by government and insurance companies, but Obamacare aims to cut costs by scaling back future increases in those reimbursements. In theory, because more people will have insurance and will seek care, providers will be able to make up in volume at least part of what they will lose in reimbursement rates.
Obamacare also will restructure the reimbursements in an effort to improve provider efficiency. Admittedly, it is impossible to be certain whether this strategy will work. However, according to the Kaiser Family Foundation, we spend much more for health care on a per capita basis than other developed countries but do not achieve substantially better results. Therefore, to be credible, the Republican plan would have to bring our health care spending more in line with those other countries.
The Republicans have been especially critical of mandating that individuals buy health insurance if they are not covered by their employers. That criticism conflicts with the Republicans’ concern about higher insurance premiums and with the traditional Republican principle that each American should take responsibility for his or her own needs to the maximum extent possible.
Obamacare seeks to control costs by insuring not only those who are sick but also those who are healthy. Although some healthy people object, the individual mandate essentially requires them to pay in advance for the care most of them will inevitably need. That is similar to the Medicare tax, which requires American workers to pay for health care that they will not receive until after they retire.
At least since the Reagan administration, federal law has required hospitals to provide emergency care for patients who do not have insurance. If those patients do not pay their bills, the costs are shifted to the rest of us. The individual mandate is an attempt to assure that health care recipients shoulder as much of those costs as possible. In that way, the individual mandate is similar to mandatory auto insurance, which helps keep uninsured motorists from shifting the cost of traffic accidents to those who have insurance.
As the Republicans point out, some employers are eliminating insurance coverage for workers’ families and for retirees. Furthermore, some companies are reducing workers’ hours, thereby avoiding the Obamacare mandate that employers with more than 50 employees provide health insurance. Other companies may eliminate insurance entirely and opt to pay a fine. However, as troubling as these developments are, Americans should not forget that many employers have been switching to part-time workers and cutting benefits for years in order to reduce costs. Simply repealing Obamacare would not reverse that trend.
To have a legitimate debate, Congressional Republicans must unveil their own plan. Until that happens, the fair conclusion is that they are more interested in playing politics than in solving problems.
William Lloyd of Somerset represented Somerset County in the state House of Representatives (1981-1998) and served as the state’s Small Business Advocate (November 2003-October 2011). He writes a monthly column for The Tribune-Democrat.