KATHRYN JEAN LOPEZ: What is the worst thing about Obamacare?
GRACE-MARIE TURNER: It’s almost impossible to say there is one worst thing — the list is just too long, from half a trillion in cuts to Medicare, half a trillion in new taxes, and mandates on individuals, employers, and the medical profession to follow Washington’s rules. Obamacare puts one-sixth of our economy under government control, and yet there’s absolutely no evidence that the government will be able to manage this $2.5 trillion industry. We describe in detail in the book the devastating effects this law will have on everyone who relies on health care — families, young people, senior citizens, employers, employees, taxpayers, and vulnerable Americans! But the damage isn’t limited just to our health care. Obamacare will cause a staggering increase in the national deficit, will limit the creation of new jobs by discouraging companies from hiring, and will cripple innovation and research.
LOPEZ: Are we still actually asking why Obamacare is wrong for America?
TURNER: A lot of people know something about the health-overhaul law, but it’s been hard, until now, to find one book where people could get a comprehensive look at the legislation and the impact it will have on all of us. That is what we have tried to do — help people understand that this law is very much in place and the destruction it will bring to our economy, our health care, and our freedom.
The health-care-reform law grants the federal government dramatic and unprecedented power: the ability to reach into our lives, into our pocketbooks, and our doctors’ offices, and it will change the way medical decisions are made — putting government, not doctors, ultimately in charge. President Obama and his allies have been busy talking about some of the early provisions in the law — high-risk pools, keeping 26-year-olds on their parents’ policies, free preventive care, tax credits for small business, etc. — and people are starting to calm down and many think that maybe this law isn’t as bad as they thought it was. But it is! We explain what’s really coming to make sure people understand the huge impact that this law is going to have.
LOPEZ: On the first anniversary of Obamacare, what are you most surprised to have to report?
JAMES CAPRETTA: One of the main “early benefits” that the Obama administration keeps touting is the high-risk-pool program in the new law. They have sold this as an interim measure to cover people with preexisting conditions. But the program was so poorly conceived that it has been a total failure. As of last month, there were only 12,000 enrollees. It is a very inconsequential program that they are trying to say justifies the entire trillion-dollar monstrosity. It’s absurd. Worse, it gives high-risk pools a bad name. Properly constructed and funded pools really are needed to cover those with expensive preexisting conditions, but not the way Obamacare goes about it.
LOPEZ: Will there be a second anniversary?
TOM MILLER: It’s very likely, despite the wishes of many Americans. The current political lineup in Washington means that Capitol Hill Republicans can harass, educate, and nibble away on the edges — but it will take a new president (accompanied by a very likely Republican takeover of the Senate) to change what only appears to be “permanent law” at the moment. But don’t count on a third anniversary.
We might hope for a deus ex machina rescue from the Supreme Court next year, but there is a lot of terrible, older case law to overturn. The high court is just as likely to deliver a 7–2 ruling upholding the health law as declaring its individual mandate unconstitutional by a 5–4 margin. We will have to, can, and will win this one “old school” — at the ballot box.
LOPEZ: What if it isn’t repealed — a likely scenario for the time being?
CAPRETTA: Repeal and replace is going to be a multi-year endeavor. Those who oppose the new law need to dig in for the long haul, because this is going to be a protracted battle. Between now and the 2012 presidential election, the key is to make sure Obamacare’s flaws remain front and center in the public debate. House and Senate opponents of Obamacare can help in that regard by targeting some provisions for repeal in ways that bring public attention and highlight the law’s deficiencies. For instance, they could take up a bill that repealed the worst of the Medicare cuts and thus force postponement of the rest of the law.
LOPEZ: What do you find people are most surprised to learn about it?
TURNER: Early readers of the book say they found many things they didn’t know. Seniors, for example, know that this law is bad for Medicare, but many are surprised to learn that Obamacare takes more than $500 billion out of Medicare to pay for two massive new entitlement programs. They know that they will have an even harder time getting the care they need. People are shocked to learn that the law doesn’t even come close to universal coverage but will leave at least 23 million people uninsured. And they are surprised to learn that Obamacare will be particularly disadvantageous to vulnerable Americans, especially those on Medicaid today who already have an incredibly difficult time finding a physician to see them — which is why they have to wait for hours in hospital emergency rooms to get even routine care. Seniors fear that is the fate they are facing as well.
LOPEZ: What is the most prevalent myth?
ROBERT MOFFIT: The most prevalent myth is that Congress dropped the “public option” from the final version of the bill before it became law. In fact, it re-created the public option in a new form: In 2014, the federal government will sponsor at least two health plans, operating under unique rules, to compete directly against private health plans in every state in the nation.
LOPEZ: Is the judiciary a good or hypocritical conservative strategy (we don’t want policy made by courts, after all)?
TOM MILLER: The new health law was jammed through Congress “by any means necessary.” It needs to be overturned and then drastically replaced by every legal, political, and persuasive tool available. In this case, conservatives are seeking relief from the courts as a defensive shield against a full-fledged assault on their rights, the fundamental structure of our Constitution, and the necessary and proper limits on the role of government in our lives. Courts are not “making policy” when they just return to interpreting the Constitution properly. That said, I would not recommend over-investing solely in a court-based strategy. We still face a much bigger set of problems in health policy to address and solve than any favorable court ruling can handle.
LOPEZ: Has it affected the doctor-patient relationship?
MOFFIT: The president has repeatedly said that you can keep your doctor. The problem is that your doctor may no longer be able to keep you. The new law will add new layers of bureaucracy on top of the existing regime of red tape and paperwork. Increasingly demoralized doctors will be subject to new rules and reporting requirements, and, with the massive Medicaid expansion, more of their practices will be subject to government payment rules and reductions. The time, energy, and effort to comply with bureaucracy steals doctors’ time and focus away from patients as they are forced to make sure they are following Washington’s rules. Most doctors are hostile to the law, many will leave practice earlier than they had originally planned, and this will exacerbate the doctor shortage.
LOPEZ: What is wrong with health care in America?
MOFFIT: There’s a lot wrong. The federal tax treatment of private health insurance is inefficient and unfair. The tax law undermines portability of coverage, fuels higher costs, discriminates against those who do not or cannot get health insurance at their place of work, and this directly contributes to uninsurance. State health-insurance markets are not competitive, and the giant public programs, Medicare and Medicaid, are outdated and plagued with fraud and waste and threaten to drown current and future taxpayers in red ink. Meanwhile, millions of Americans are uninsured, millions suffer from gaps in coverage, and the quality of care is uneven.
LOPEZ: What is right?
MOFFIT: There’s also a lot right. America is the home of the post–World War II pharmaceutical revolution, a fountain of exciting biomedical research, and the premier training ground for dedicated doctors and medical professionals. For patients, especially those with good private coverage, the best feature of American health care is the rapid response in treating and curing serious disease, particularly cancer. Our challenge is to expand access to coverage but to do it in a way that rewards quality and innovation.
LOPEZ: How big a role will Obamacare play in the presidential race?
MILLER: It will be one of the top issues. The American public does not appreciate incumbents who essentially tell them they are going to get what’s “good for them,” whether they like it or not, particularly when the early results are so poor and the future looks more dismal. Of course, the overall economy still trumps everything else as the biggest issue. A slow-growth scenario in 2012 would magnify the unpopularity of Obamacare and tie it further to broader economic malpractice. A “dead cat” bounce upward for several quarters early next year — for whatever short-term reasons — could push voters toward more support of the president. We simply don’t know yet whether a Republican nominee (finally) will have something interesting, serious, and inspiring to say about health policy next year.
LOPEZ: Do you find Mitt Romney plausible on this issue? Does he deserve some credit for taking reform on at the state level?
TURNER: Former governor Romney talks a great deal about the damage that Obamacare will do to our health sector and economy and says he is committed to repealing the law. He gets credit for understanding the importance of health reform and the need for states to get involved in solutions. But he went way too far to the left in compromising with the Democrats in the Bay State, and the architecture of Romneycare is indeed very similar to the federal law. His claims that the law he helped write in Massachusetts is different from Obamacare are not going to withstand the withering debate of a presidential primary. He has to give a speech devoted to health care that explains what he hoped to do in Massachusetts and that repudiates his support for what the legislature ultimately passed.
LOPEZ: Are Republicans credible on the issue? Is anyone?
MILLER: If we grade them on a very generous political curve (compared to who else?), they are credible in terms of what they do not like and what they oppose. Like the broader public, there’s not much credibility or consistency in what they propose to do about serious and persistent health-care policy problems. There is plenty of blame to go around, and not just in the political realm. Hence, the only consensus position widely held among almost all actors in this tragi-comedy is, “It’s someone else’s fault!” One credible starting point involves recognizing that the most essential solutions will have to come outside of politics, legislation, and regulation. But reducing the heaping pile of public-policy debris that clouds this issue and stands in the way of private parties and civil society taking more responsibility for fixing this mess would constitute a necessary, if not sufficient, first step.
LOPEZ: What are the best states for health-care reform?
MOFFIT: Utah stands out in pursuing a pilot program to create personal, portable, private health insurance for small businesses and their employees in its market-based health-insurance exchange. Consumer choice and competition are the key features of the reform, and there is virtually no bureaucracy. Starting as a pilot program in 2009 with eleven employer groups, it has grown to 68 in 2011, and there are 88 more waiting to enroll in the next two months. Indiana has been successful in controlling costs through a popular expansion of health savings accounts. And Texas has enacted medical-malpractice reform that has dramatically improved the climate for medical practice. States should move ahead as quickly as possible on their own reforms, and change the facts on the ground. They should not wait for Washington to tell them what to do, and they should tell Washington what they are going to do. Inaction is tantamount to surrender.
LOPEZ: Who in Congress should people follow?
CAPRETTA: House Budget Committee chairman Paul Ryan fully understands the importance of getting American health-care policy right. He introduced a market-based alternative to Obamacare in the last Congress, and he understands that existing federal health-entitlement programs are a big part of the cost problem. So he definitely has the right vision for where we need to go. There are many other terrific leaders on health care in Congress, especially the physicians. Congressman Mike Burgess has really taken on all aspects of this issue at the Energy and Commerce Committee, and Sen. Tom Coburn is a strong advocate for moving power and control from the government to citizens
LOPEZ: Republicans seem to be poised to take on entitlements. Is that ignoring the will of the people, like Obama and the Dems did with health care? Or is that an absolutely wrong analogy?
CAPRETTA: We are at a pivotal moment in our history. If Obamacare goes into effect in 2014, it will be very difficult to unwind, as millions of people will get signed up for new entitlement benefits. Moreover, there is no getting around the fact that avoiding a debt-induced economic crisis is going to require entitlement reform. Those who want to avoid a massive increase have no choice but to begin the conversation about an alternative vision to the president’s high-tax, high-spend approach. Moreover, the president himself appointed a bipartisan task force last year to address these very issues, and Senator Durbin and others have endorsed cuts to Social Security as part of that process. Entitlement reform will never be easy. But there is no more time left for delay.
LOPEZ: So it’s January 2013 and there is a Republican president, House, and maybe Senate or maybe not. What now? How much does the Senate matter?
CAPRETTA: If a Republican president is elected in 2012, it will almost certainly be in part based on a platform of “repeal and replace.” It’s hard to see a Republican candidate getting the nomination without that kind of a governing program. So, if elected, a Republican president would have a pretty strong mandate to go in a very different direction from Obamacare. Remember that Obamacare made it across the finish line only because the Democrats employed “reconciliation” to make final changes in the legislation, and the reconciliation measure required only a majority vote in the Senate. The same game plan could be used for “repeal and replace.” The Senate does matter, but it may not be necessary to get 60 votes for a different approach.