During the long debate over health care reform in 2009 and 2010, the advocates for the legislation made several key arguments, suggesting most of all that a health care financing system that covered a large number of the currently uninsured would be fairer — that a primary goal of health care reform was redistribution. This argument reflected the conclusions of a 2000 study by the World Health Organization, which made fairness the most important single aspect in its evaluation and comparison of health care systems around the world.
This argument was not sufficient on its own to get the massive Affordable Care Act made into law. So advocates made several other arguments, including one that was buttressed by several studies that seemed to indicate, though not with great confidence in the numbers, that the lack of insurance led to a significant number of excess deaths among the uninsured population (tens of thousands each year). Hence, reform would lead not only to more equality, but also to higher quality and better outcomes.
Some who were opposed to the legislation pointed to the fact that the new program would add hundreds of billions in new federal outlays at a time when the federal deficit was running in excess of 40% of federal expenditures, and by spurring demand without any increases in supply, inevitably drive up health care inflation.
The advocates for reform countered by arguing that the bill, according to CBO estimates, was in fact a deficit reduction measure, and that over time, due to higher taxes on wealthier Americans and reductions in some Medicare expenditures, the bill would be fully paid for with a net surplus remaining — a contribution to deficit reduction. Finally, advocates argued that as a result of the legislation, the rate of increase in annual health care costs in both federal programs and private insurance would come down after new policies were developed following review of many new “studies” and reports by commissions reporting results to the secretary of HHS.
So what was not to like in a bill that provided more fairness and higher quality, reduced the deficit, and slowed the rate of health care inflation? How could a majority of Americans both then and now be opposed to such wondrous social legislation?
One of the reasons for the legislation’s unpopularity was related to its legislative history — a bill jammed through by budget reconciliation in the Senate, and the only major piece of social legislation in American history passed on a party line basis, with virtually no input from the opposition party in its over 2,000 pages of new rules. In addition, it is certainly the case that many Americans were skeptical of the claims about the magic deficit reduction elixir that the Democrats in Congress had allegedly found. There was great skepticism about the real cost of the legislation, which could be much higher if a significant number of corporations elected to drop their health insurance coverage and instead pay a modest penalty, leaving their workers to join the new and heavily subsidized exchanges.
Then there was the CLASS Act, a new long term insurance program within the reform bill that collected premiums for several years, but showed no outlays during the same period. Not surprisingly, this contributed some pixie dust to the tune of tens of billions to that magical deficit reduction calculation in the first ten years of ObamaCare. Some actuarial analysis suggested the program would be a long term financial disaster, and one Democratic senator called it a “Ponzi scheme.”
Finally, within a short period of time of the passage of the legislation, the administration started granting waivers to various parties from various provisions of the new law, with many of the waiver recipients groups that were, not surprisingly, politically connected to the Democratic Party. With each waiver, some of the projected deficit reduction disappeared.
But one reason that is almost never offered as an explanation for why many Americans have remained skeptical of the claims about the new health care reform bill is that they no longer behave like sheep when presented with the claims by “experts” who are, in many cases, no more than partisan advocates. The Climategate scandal, which appeared to show scientists working to insure their data fit their preordained conclusion about man-made global warming, may have contributed to skepticism about many of the claims about ObamaCare.