Even after three years, the nation remains divided on Obamacare. The people who already had health insurance—as well as those who have lost their insurance since Obamacare became law—still seem to hate it. The people who didn't have insurance before, and don't yet have insurance now, seem to love it because they think it means free health care. Obviously they have never heard the old saw about the free lunch.
Health care and health insurance are two distinctly different things. Having health insurance helps insulate a family against the costs of a catastrophic illness, for example, but really does nothing to guarantee any kind of quality care. All the insurance in the world will be of no use to the person who has a fatal illness science has not yet figured out how to cure.
Too much of the discussion about health care is really about the cost of health care and not enough is about quality. Some of the big thinkers out there, like former Bush White House senior aide Jim Pinkerton, have been sounding the call for even more spending on health care and on research. He makes the very salient argument that the economic costs of not doing so could be crippling 50 or even 25 years out as the nation grapples with the declining health of an aging population that is, overall, living longer—which is exactly why Obamacare is the wrong prescription for moving forward.
As many health care experts have explained, the route that the president's signature legislative achievement puts the country on is one that makes stops at places like rationing, denial of care, quality of life determination boards and other backwaters where, it will become clear uncomfortably soon, people go to die. To put it simply, America needs to spend more money on health care, not less, an idea that really is at the heart of most of the conservative proposals to transform the nation's health care industry.
Nevertheless it is the GOP that gets the rap for being parsimonious and uncaring. It's the GOP that gets ads run against it showing prominent elected officials pushing grandma out of her wheelchair and over a cliff. It's the GOP that needs to get to work talking up real reforms that will replace the sham that is Obamacare; reforms that will improve the quality of the health care available and, over time, make more health care available to more people.
The first step down this long road is for the GOP-controlled House of Representatives to once again take up the mantle of "repeal and replace" and take Obamacare apart brick by brick, beginning with the individual purchasing mandate.
Whether it's a tax, like Chief Justice John Roberts says it is, or a penalty for not buying insurance, like the Obama Administration said when trying to get its bill through Congress, the individual purchasing mandate is the singularly most unpopular part of Obamacare. Previous efforts to repeal just that section were set aside while the constitutional challenge made its way to the U.S. Supreme Court on the grounds that no one wanted to change the law before the court had a chance to rule.
Well, the court ruled and, contrary to what just about everyone expected, the law stands. So Congress is free to attack the mandate, head on. The House should vote on repeal of the mandate just as soon as it can. It will pass. And it should vote on it again in the fall, when key parts of Obamacare are supposed to be coming on line.
In fact, House Speaker John Boehner should make it a monthly event, forcing a wedge between the supporters of Obama and his health care plan, who like the mandate, and the folks back home, who hate it. Make congressional Democrats go on record again and again until Senate Democratic Leader Harry Reid is willing to let the issue come up for a vote on the other side of the Capitol. Get everyone one record as to just where they stand on the issue of the individual mandate. Then check and recheck to see if anyone has changed their position. The political media may laugh, may think it's all just political theater, but it will underscore to voters the essential point that one party really does want to repeal Obamacare, just like they do, and the other doesn't.
There may be some on the other side of the issue who would welcome this, thinking it would make the GOP look ridiculous. And they would be wrong. Right now, with the Obamacare bureaucracy still in its infancy, no one has really had to deal with how dysfunctional it will be. Over time, as the health care exchanges fail to come on line, as the system malfunctions, as it proves to be worse than anyone but its most severe critics believed it could be, public attitudes in favor of repeal will grow stronger. And when that happens it will be, for most politicians, good to have been on record as a "long time critic" of Obamacare rather than a "Johnny-come-lately" advocate for reform.
The voters may not have long memories, but the people who run the public interest groups and super PACs do. And they're still willing to spend millions on ads and grassroots development to get rid of this awful, awful law—before we all really do have to send grandma out on the ice floe and toast her memory.