During the 2012 presidential campaign, President Barack Obama proudly described his signature legislation, the Affordable Care Act of 2010, as Obamacare, because, as he put it, I do care. At least in comparison with Mitt Romneys patrician aloofness, the public gave more credence to Obama as caring about average people.
But theres a big difference between caring in gauzy political prose versus implementing a massive, grinding, omnipresent governmental system trying to force uninsured citizens, employers and states, to endorse the medical establishment as we know it.
Obamacares basic design is either to coerce or cajole individuals and employers to purchase medical insurance that they now choose not to buy, while forcing the hapless remainder to submit to the deeply problematic, largely ineffectual and practically dangerous system of Medicaid.
States that are already justifiably wary of Medicaid are being pressed to expand it. Meanwhile, Obamacare also threatens existing arrangements for people who have already found a niche in the medical system.
There are plenty of reasons for the administration to be concerned about implementing Obamacare as is, quite apart from the fact that plenty of Republicans are warming up their myriad versions of I-told-you-so. The administration knows that too, and is frantically trying to make the roll-out work.
But you just cant cover up Obamacares basic conceptual problems with ad campaigns replete with militaristic, hard-sell messaging to pressure people to spend money on medical insurance that they dont want now and can buy later anyway should something catastrophic or even merely serious come along.
On the affordability factor, the act appears likely to cost the federal government more than originally anticipated. In 2010, Obama insisted the act would be revenue neutral, with total costs of $900 billion. Now the Congressional Budget Office says insurance subsidies alone will cost over $1 trillion, with total costs about twice the original estimate.
Affordability is also a concern for many uninsured people wholl either pay a penalty tax or purchase insurance designed in large part to subsidize older, less healthy people. Uninsured Americans required by Obamacare to buy insurance cant be thrilled about the financial implications to them of buying an unwanted insurance product. Many of them, typically younger, healthier and under-employed, are concerned that older and/or sicker folks are already getting health care effectively subsidized by the young. Why should the young further subsidize older and sicker groups who have pumped up the national debt already while sucking the jobs pipeline dry?
Affordability is also a concern for many states that appear reasonably skeptical about expanding Medicaid for the poor and lower middle class, even if the immediate surface expenses will largely be shouldered by federal taxpayers. Those states suspect that expanding a system of total dependence on government to bigger swaths of their citizenry will have long-run implications that may forever leave their citizenry divided, with a crushing number of permanent wards of government.
The Obamacare roll-out, with its emphasis on websites and advertising, funneling money to insurance companies while simultaneously trying to manage insurance company profiteering, and ominous oversight of personal details by the widely despised Internal Revenue Service, all add up to trouble on a gargantuan scale.
Its ironic that President Obama has embraced a system that has many of the problems that lost Romney the 2012 election. Its a system thats just too cozy with the big insurance companies and the medical establishment. Its surprisingly insensitive to uninsured people. It also ignores many fair concerns of average Americans who are already playing by the rules and pulling their own weight.
Obama magnified the Romneycare template, and though Romney was therefore neutralized in 2012 as an Obamacare critic, it seems quite possible that the design of Obamacare is a historically colossal mistake. Obama might have been wiser to stick with a reduced, basic universal care program with no bells and whistles. That would have been less grand and extravagant, but it would also have truly been caring and affordable. This monstrosity is neither.
David Oedel served as counsel to the state of Georgia and 25 other states in their constitutional challenge to the Affordable Care Act.