Many Republicans and Tea Party loyalists constantly remind us that the Affordable Care Act (ACA) is doomed to fail, notwithstanding that it is the law of the land. Some find their criticism unproductive, lacking substance and sometimes vindictive toward the President. In fact, Dana Milbank opines -- Washington Post, Nov. 19 -- that the fear-mongering rhetoric of Republicans is meant to sabotage the program.
Any rational observer of the debate would recommend that if Republicans do not like some features of the law, they could attempt to improve it. Repealing and/or nullifying will not solve the health care problem that has plagued this country for decades. In the Wall Street Journal -- Nov. 19 -- Sen. Marco Rubio criticizes the ACA's three-year provision, in which the federal government would compensate insurance companies for financial losses due to insurance pools of mainly sick and unhealthy people. Perhaps Senator Rubio is unaware of the economic problem of "adverse selection" in insurance markets. Insurance markets can only function if companies have diversified pools of sick and healthy people to keep premiums low enough to attract healthy people. The argument of Senator Rubio is disingenuous given the fact that fear-mongering to discourage healthy and young people works against the free market principles that Republicans tend to uphold. At the same time, it worsens the deficit.
A cooperative strategy to assure success of the ACA has a greater payoff to all parties concerned, including all Americans' aspirations for better medical insurance and coverage. The ACA is not a zero sum game in which one party wins and the other loses. A healthy society in the long run is a productive society. Human capital is not just skilled and educated labor. The country needs skilled and healthy labor to increase productivity and growth. I am sure congressional Republicans do not want a society of burdensome, unhealthy people.
One would be hard pressed to conclude from the features of the law that the ACA is not worth the investment in the present, so that the nation earns high returns in the future. The main focus of Republicans and media on failures of the web site of the federal exchange diverts attention from good features of the law and gradually emerging successes in enrollments around the country.
Some of the main features of ACA are as follows: 1) emphasis on preventive health care without co-pays to avoid costly interventions in the future, 2) pre-existing conditions cannot serve as basis for denial of insurance and higher premiums, 3) Americans age 26 years and under can stay on their parents' insurance plans, 4) self-employed who buy their own coverage and underemployed not covered by employer plans can get insurance coverage at reasonable premiums with government subsidies, if they qualify, 5) no discriminatory premiums for women and assured coverage for women in their reproductive years, with emphasis on preventive care, 6) coverage of millions of uninsured who show up in emergency clinics or free clinics, 7) mandating all to buy insurance coverage to fix "adverse selection" problem or pay a fee akin to a user charge, 8) no lifetime and yearly dollar limits on most benefits, 9) expansion of Medicaid coverage, 10) incentivizing providers and insurance companies to control costs, 11) requiring insurance companies to spend a greater fraction of premium dollars on medical care coverage.
Since the passage of the ACA in 2010, health care costs are declining due to the efforts made by the Obama administration. The fee-for-service-based system, the main source of high medical-cost inflation, is being replaced by a payment system based upon the whole patient and quality care. The ACA implements accountability for quality and cost of medical care. In the past, Republicans themselves have supported many of the above features of the law.
It is ironic that those who preach responsibility and accountability are now against the provision in ACA that all have to buy insurance coverage or pay a fee if they do not. It is well documented that the uninsured, who show up in emergency clinics or "free clinics," impose costs on others who have insurance and pay taxes. They are "free riders" and cost-shifters, and therefore should be mandated to pay for insurance coverage or a fee. "Free lunches" for the uninsured must end.
Labeling the ACA as a socialistic program is baseless and without any merit. It lacks an understanding of socialism. The federal government is only a facilitator for the insurance market through health insurance exchanges and assists those with inadequate incomes to buy insurance. In socialism, the government owns and controls means of production, as in Russia, North Korea and China. The U.S. is a mixed economy, in which government provides pure public goods like national defense and quasi-public goods such as education, and the private sector provides private goods, sometimes with the assistance of government. Perhaps for Tea Party conservatives, ignorance is bliss and ideology is triumphant.
Mathur is former chairman and professor of economics and now professor emeritus, Department of Economics, Cleveland State University, Cleveland, Ohio. His articles also appear in mathursblogonomics.blogs.com. He also writes blogs for the Standard-Examiner at http://blog.standard.net/economics,etc.