Principled Opposition and the Affordable Care Act

[rowyn]

A recurring sentiment I keep seeing on Twitter is 'Those conservatives oppose the ACA because they want poor people to suffer!' That's about the nicest way I see it phrased. Most of the other ways are more hyperbolic. 'I didn't think that real evil -- the kind of monsters who want to make people suffer -- existed on a large scale in the world. But

Comments

[tagryn]

Good post.

* I can say, I have one relative that works in medical billing, and another who is a doctor. They both hate the ACA, as I understand it because it created a maze of regulations which didn't improve care of patients in any meaningful way. I know the doctors I talk to lament how much time they have to take away from patients to make sure their record keeping is complete, just so that they can get paid. Electronic records held a lot of promise that AFAIK hasn't panned out to date.

* On Twitter, I have a number of people I follow regularly who would be directly and negatively impacted if the preexisting conditions clause went away. I'm deeply sympathetic, while also recognizing that emotional testimony along the lines of "my son will DIE if we can't afford his medicine!" is perhaps not the best way to guide public policy that affects millions upon millions of people. Then again, if it were someone I loved who couldn't afford their medicine, I really wouldn't give a d**n if premium increases were making health insurance increasingly unaffordable for large groups of people I didn't know. I'd want that insurance, end of discussion. I'd also probably view the people who wanted to take that away very personally as people who wanted my kid to die; there's certainly enough of that going around on the Twitter these days, too. Again, very understandable, but not the basis for any kind of discussion.

* My very basic understanding about ACA is that they had enough political capital to deal with one of two problems: either fix lack of coverage, or fix ballooning costs. The first got (mostly) fixed, while the second is threatening to swallow those gains. The best ACA could manage was enacting some promising pilot projects to see what might work at controlling costs; larger reforms, like tort reform, were off the table.

* Even the story of how the ACA got passed varies considerably, depending on which "side" you listen to. To the Democrats, it was a vital needed reform of a dying system that the GOP refused to go along out of spite, despite it borrowing heavily from Republican plans like Romneycare...and then couldn't be reformed where needed because of GOP stubbornness. To the GOP, ACA is a convoluted mess ("we need to vote on it before we can find out what's in it") that was rammed through without the usual compromises between the parties, and is too fundamentally flawed to be saved; they also note that their previous plans to reform the HC system pre-ACA were blocked by the other party.