So House Republicans will vote to repeal the Patient Protection and Affordable Care Act, aka Obamacare, probably on Wednesday. Critics say the vote will be “symbolic,” because there’s little chance that the Senate will go along and no chance that President Obama will go along. But even so, it’s good when parties keep their campaign promises. Moreover, there’s nothing symbolic about Republicans’ long-term determination to repeal Obamacare.
But if Republicans are to be admired for the clarity of their anti-Obamacare resolve, the politics of health care remain nonetheless murky. And without additional reinforcements--the advocating and encouraging of medical and scientific progress--it’s no sure bet that Republicans will, in fact, repeal Obamacare anytime soon, if ever.
Why? Because at present, the debate over Obamacare is essentially ideological--there’s a left position and a right position--and the two sides are relatively evenly matched. Yes, Republicans won big in 2010, but Democrats won big in 2006 and 2008, when national health insurance was a major plank in their platform. And even in the Democratic disaster year of 2010, stalwart champions of Obamacare, such as Sen. Majority Leader Harry Reid (D-N.V.), were re-elected by wide margins.
Matters of ideology are hard, if not impossible, to resolve. That is, ideological debate about, say, liberty vs. equality, or public vs. private, can go on forever. People have always disagreed on these gut-instinct judgments, and will always disagree. By contrast, matters of science and technology can be ultimately resolved, as the weight of empirical evidence piles up on one side or the other. Nobody argues anymore that the propeller engine is preferable to the jet engine, or that rotary telephones are better than push-button models, or that the vacuum tube is preferable to the transistor.
Looking back at our country’s past, we can note that one party has benefited electorally from close association with a particular technology. In the 19th century, for instance, the Republicans were the railroad party; GOP support for the “iron horse” epitomized a commitment to industrialization and national strength. A century later, over these past two decades, the Democrats have gained a reputation as the Silicon Valley party, the party of choice for Googlers and texters. Which party will emerge as the party of heath care modernization? Right now, it’s too soon to tell.
Meanwhile, let’s look at three polls, showing different aspects of American health care ideology. First, according to Rasmussen Reports, 75 percent of Americans want to see the bill changed. But here’s the catch: Folks want to see it changed in different directions. As Rasmussen explains, 20 percent want the law repealed and nothing done to replace it; 28 percent want it repealed while seeing its most popular provisions put into a new law; and 27 percent want to leave the law in place but get rid of the unpopular provisions. Or to put things another way, 55 percent want to see a middle-ground approach--repeal-and-replace, or leave-it-in-place-and-improve.
Second, an AP/GfK poll found that 40 percent of those surveyed said they support the law, while 41 percent oppose it. How’s that for even-steven? Indeed, support for Obamacare has actually increased since last November’s elections; opponents outnumbered proponents by nine points then, but opponents are up by just one point now.
Third, when the American people were asked who they were more afraid to see running health care, the government or the insurance companies, 45 percent told Rasmussen that they were more afraid of the insurance companies, while 41 percent said that they were more afraid of the government. So to the extent that Congressional Republicans are seen as advocating private-sector solutions that would help the insurance companies, a slight plurality of Americans is saying a loud “whoa!” to such GOP efforts.
To be sure, many leading market-oriented activists--most notably, Rep. Paul Ryan (R-Wis.)-- have been arguing for an “empowerment” approach to health care, hoping to elevate the sovereign consumer over both the government and private companies. But those ideas are still being developed and will not be voted on by the House this week.
So in the meantime, Democrats will be free to say that repealing Obamacare means re-empowering the much-disliked insurance companies--who will go back to being able, for example, to deny coverage to those with pre-existing conditions. How will that play in a “purple” district?
On Sunday, a New York Times editorial made the case for Obamacare; it’s a safe bet that these words will soon be Democratic National Committee talking points:
Thanks to reform, it is now illegal for insurance companies to deny children coverage because they have pre-existing medical conditions, or to rescind a policy after a person becomes sick, or to cap the amount that insurers will pay for medical care over a lifetime. After 2014, it will be illegal for insurers to set annual limits on the amount they will pay for medical care or deny coverage to adults with pre-existing conditions.
Young people are now allowed to remain on their parents’ policies until age 26. And insurers are now required to cover preventive care in new policies without cost-sharing, and to spend at least 80 percent of their premium income on medical care and quality improvements, not profits or administrative costs. Repeal would eliminate all of these new protections.
In other words, Democrats and the MSM are ready to accuse Republicans of undermining middle-class gains--allowing insurance companies to deny coverage to folks with pre-existing conditions, as well as to young adults, while at the same time expanding their corporate profits.
Indeed, on Tuesday, the day before the scheduled House vote, The Washington Post front-paged an above-the-fold headline: “Study: 129 million Americans have preexisting conditions.”
The methodology of the study was pure “junk statistics,” deriving that nine-digit number through surveys and inferences, but nonetheless, there it is--enough to scare people about the Republicans efforts at repeal, or so the authors hope.
And yet we might note that the actual figures are somewhat scary: According to a Congressional study, between 2007 and 2009, the four largest insurance companies turned away 650,000 applicants based on their medical history. Yet might note that this smaller number--650,000 is 1/200th of the claim in the headline--is still scary to middle-class Americans.
Whatever happens this week on the House floor, one can anticipate a barrage of Democratic TV spots and direct-mail pieces, accusing Republicans of voting to take away these new health care benefits. We might note that if aggrieved and fearful Tea Partiers could throng to Democratic Congressional town halls in the summer of 2009, there’s nothing to stop liberal-left activists from thronging to Republican town halls in the summer of 2011.
Thus the fight: Americans will be asking, and arguing, “How much of Obamacare to keep?” And, “Who do you trust more, the feds or the insurance companies?” Looks like a stalemate in the making.
How do stalemates get un-stalemated? Breakthroughs happen when one side introduces more and better resources--often decisive new technologies. A classic example of a stalemate is the trench warfare of World War One, which was resolved by the innovative technologies of the airplane and tank.
So what’s the health care equivalent of these stalemate-busting technologies? We can start by noting that Obamacare actually hurts current technological advancement. Grace-Marie Turner of the Washington-based Galen Institute notes that Obamacare, through its tax-raising provisions, will stifle technological innovation: “The $20 billion tax on medical-device companies, to take one example, will force companies to lay off researchers and curtail development of new products.”
So there’s a strongly popular goal for Congressional action: repeal of that tax-increase provision will protect the health care technology sector from shrinking.
In addition, Republicans could argue for what is currently ignored by Obamacare--the encouragement of further medical and scientific advances, as opposed to mere health insurance shuffles. They could argue that it is these new technologies that would truly advance the nation’s health--as well as save money. For example, Alzheimer’s Disease (AD) costs America $172 billion a year; if the incidence of AD quadruples in the next 40 years, as is projected, everybody’s health care budget will be blown wide open. It won’t matter much whether AD treatment is public or private; either way, it will be ruinously expensive.
Yet at present there is no cure, nor even proven treatment, for AD. If we could do something about AD--push back its onset, vaccinate against it, or cure it outright--we would save a lot of money. Indeed, we could then talk about raising the retirement age for Social Security and Medicare, as part of a “grand compromise”--better health for more work.
And of course, if we could develop such a treatment here in the U.S., we would have an export to sell to the world. The over-60 population of China, for example, is projected to reach 400 million in the next three decades; that’s a lot of potential customers.
There’s no guarantee of success in any medical-science undertaking, of course, but based on our past history--with polio, AIDS, even cancer--there’s reason to be optimistic that we can do it if we put our collective national mind to the challenge.
Aside from AD, we could find plenty of other med-tech opportunities. What if, for example, the nation launched a “moon shot”-like effort to cure brain and spinal cord injuries? What if we provided such a boon to our wounded warriors, as well as to many Americans injured on the homefront? Would that be a political winner for the party making the offer to the American people?
Of course, there’s nothing stopping the Obama administration from doing the same thing, but as we have seen these last two years, Democratic politicians haven’t seemed interested in medical research. The Obamans have put all their political capital on insurance; they evidently assumed that people would be happy to be covered, even if the coverage itself was inadequate relative to worsening medical challenges. Yet the Obamans should have realized that one can’t beat an illness with an insurance card.
So the opportunity for Republicans, then, is to introduce the 21st-century health care equivalent of the airplane and the tank--that is, harness science and technology to their side of the Obamacare debate. It is technology that can break the stalemate. If Republicans offer cures, while Democrats offer only finance, it is Republicans who will win. And the insurance debate will take care of itself--because in the long run, science and medicine trump finance and insurance.
James P. Pinkerton is a writer, Fox News contributor and the editor/founder of SeriousMedicineStrategy.
Get the recap of top opinion commentary and original content throughout the week.