The ACP Advocate Blog

by Bob Doherty

Wednesday, July 3, 2013

If extreme partisanship and ideology didn’t rule the day . . .

Then the Obama administration’s decision to delay the requirement that employers provide health insurance or pay a fine would have been greeted by Obamacare’s critics as a sign that the administration was willing to meet them halfway.  And they would have responded in kind, by offering to work with the administration to smooth out other concerns about the law, rather than citing the delay as being another reason to repeal Obamacare.

If extreme partisanship and ideology didn’t rule the day . . .

Then the Obama administration’s repeated willingness to allow more conservative states to enroll Medicaid recipients in private health insurance plans would have been greeted by the states that are resisting Medicaid expansion as a sign that the administration was willing to meet them halfway.  And they would have responded in kind, rather than continuing their effort to block the expansion and with it, the entire law.  A few did, but most did not.

If extreme partisanship and ideology didn’t rule the day . . .

All members of Congress would help their constituents understand and enroll in the new coverage options created by Obamacare, even though some of them disagree with it, because that is what members of Congress are supposed to do, help constituents navigate government programs, not just the programs they voted for.  But many anti-Obamacare members of Congress have indicated that they will do nothing to help their constituents understand the law and get the Obamacare benefit that they are entitled to. 

If extreme partisanship and ideology didn’t rule the day . . .

Then conservative critics of Obamacare would acknowledge that, “The core drivers of the health care act are market principles formulated by conservative economists, designed to correct structural flaws in our health insurance system — principles originally embraced by Republicans as a market alternative to the Clinton plan in the early 1990s.”

If extreme partisanship and ideology didn’t rule the day . . .

Democrats and Republicans would work together to enact changes to improve the law and fix its flaws, just like they did with Social Security, Medicare, and Medicare Part D, laws that also were very controversial at the time,  just as they’ve done with just about every other major law enacted over the past 75 years.  But this is all but impossible in the hyper-partisan, hyper-ideological 113th Congress, with the result that those “seeking changes are finding, to their dismay, that in a polarized Congress, accomplishing them has become all but impossible.”  The only way they can get changes, then, is when the Obama administration itself provides more flexibility.

(If you have any doubt that extreme partisanship and ideology rules the day to an unprecedented degree, read what the “carefully nonpartisan” congressional scholars Norm Ornstein and Thomas Mann wrote in their provocative book, It’s Even Worse than It Looks, in which “they posit that democracy in America is being endangered by extreme politics.”

The fact of the matter is that Obamacare is the law, and starting as soon as October 1, it will provide tens of millions of Americans with new coverage options.  It could be made better, but partisan gridlock in Congress makes it impossible to make legislative changes.  It is complex, because our health care system is complex, so of course closing the gaps was never going to be a walk in the park.  Doing nothing to help people understand it won’t make the law go away, but it will hurt constituents who could benefit from having access to Medicaid or coverage through a health exchange.  And because Congress can’t agree on improvements to the law, the only way to get changes is when the Obama administration on its own makes changes,  as it just did by delaying the requirement that large employers provide coverage.  

Today’s question:  Do you agree that extreme partisanship and ideology is not only undermining efforts to improve Obamacare and make its implementation go smoother, but poisoning our democracy itself?


Blogger ryanjo said...

Mr. Obama continues to reap the whirlwind. After setting a deadline for negotiations with the Republicans during the passage of the ACA in 2010, and then refusing to negotiate on the mandate, his package passed with no Republican votes. But I guess that our ACP Advocate doesn't find that "extreme partisanship and ideology". Now the Obama administration is compelled to defer the mandate for big companies (read that "big donors"), trying to help Democrats by postponing the changes until after the midterm elections. Industry groups are complaining about reporting provisions that are too burdensome and uncertain. Just an early taste of the way the ACA will continue to roll out, creating new problems at each step. Ever the ideologue, Obama just kicks the can down the road.
And while ACP leadership continues to lament the lack of payment reform and failure to address a looming primary care shortage, this blog calls for politicians to "work together" on this hot potato that no one wants to own.
ACP should have and should now push for structural reforms to the healthcare system, such as meaningful payment reform, support for primary care, eliminating insurer dominance of decision making & obscene insurer/hospital/Pharma profits -- before supporting extending a broken system to millions of patients at an enormous cost.

July 4, 2013 at 9:32 AM  

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Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog

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