THE BLOG
09/13/2013 12:54 pm ET | Updated Nov 14, 2013

5 Reasons Republicans Should Embrace Obamacare... and Take Credit for It

The 5 Reasons:

1. Obamacare is primarily insurance reform, and avoids a government takeover;

2. Politics aside, because of scientific progress, the insurance industry as it existed was doomed to collapse anyhow;

3. Obamacare is, essentially, the Ryan Plan (aka, VoucherCare) for Medicare, but only for those under 65;

4. Because Obamacare is basically the Heritage Foundation proposal, Republicans have no alternative (or, at least, nothing that could withstand a CBO analysis to provide equivalent coverage);

5. Every time Republicans vote to repeal Obamacare, they are voting to cause Medicare to go insolvent in 2 years (2016).

Had Republicans not been so consumed by hatred, they may not have opposed Obamacare. It was, after all, their own plan, created by the radical right-wing Heritage Foundation, and proposed in the 1990s by such liberal firebrands as Chuck Grassley (R-IA). Had the president proposed "Medicare-for-all", Republicans may have counter-proposed "GrassleyCare" (ghastly as that sounds!), and pointed to the great success of Romneycare in Massachusetts. They could have waxed eloquent marveling at the wonders of free market competition.

Chastened by the demise of "Hillarycare" in the 1990s that had emerged from a top-down proposal from the White House and that was opposed by big-money interests without a counterweight, President Obama decided to press for health care reform, but allow Congress to develop it so long as certain key principles were fulfilled. Although big-money interests were still opposed, the legislative process created big-money allies who, regrettably for health care but positively for the bill, benefited and thus either remained silent or actually countered the opposing big-money.

What emerged was "Grassleycare, aka, Romneycare, aka, Obamacare."

But, like the first scene in "Django, Unchained", the image of a "black man on a horse" (i.e, in the White House), has been a bridge too far for some on the Right. When, for example, bin Laden was found, captured and killed, and the country celebrated together, the House of Representatives rejected honoring the president, his team and the SEAL team 6, reserving their muted praise for the intelligence community. And, no, I am not kidding.

There are 5 good reasons that Republicans should embrace Obamacare, and take credit for it:

1. Obamacare is primarily insurance reform, and avoids a government takeover. That should be an extraordinary outcome for Republicans and their ideology. Yes, I know that Frank Luntz, their wordmeister, told them to campaign against "government-run healthcare" because it scored best on his dial-a-thons. But, any congruity between Frank Luntz's words and reality has never been more than pure coincidence.

The core of Obamacare is ending the egregious practices of the insurance industry: denying coverage for pre-existing conditions, kicking people off coverage on technicalities when they become ill, imposing lifetime caps on coverage, charging women more than men, and so forth.

Almost everyone agrees with those reforms. But, those reforms cost the insurance companies money, real money. The actuarial calculations would compel a dramatic rise in rates.

To lower premiums, therefore, and to ensure that we are accountable citizens, taking responsibility for our own lives, it is critical that everyone participate. Hence, the individual mandate. With hordes of healthy people who will not cost the companies out-of-pocket expenses as part of the program, rates not only do not rise, but evidence suggests that they are falling.

IEven the young and healthy have accidents, and those formerly healthy become ill. [Ron Wyden (D-OR) relates the story of a healthy young man without insurance who, when asked by the Senator how he would pay if he were in a skiing accident, replied, "I will buy insurance then"!].

Nonetheless, it is unfortunate that the mandate was not called a "tax". People are accustomed to paying taxes for programs that benefit society as a whole, or that will benefit themselves in the future, but they are not accustomed to paying out-of-pocket expenses that they might not otherwise purchase, even if it is the same amount as they would have paid in taxes or even if it is less.

Now that the exchanges are publishing their lower rates, Republicans can tout the wonders free market competition to bring that about.

2. Politics aside, because of scientific progress, the insurance industry as it existed was doomed to collapse anyhow. Republicans' aversion to science notwithstanding, we are rapidly gaining knowledge of genes and proteins in cells that are associated with disease. This means that we will be able to predict what illnesses individuals may suffer, and determine strategies to halt progression to overt disease.

This extraordinary brave-new-world, however, undermines the very premise of insurance that depends on pooled risk. Insurance makes the most sense when actuaries know that X number of people in a population will develop a certain illness, but not which individuals. If they knew who was going to become ill, they would exclude that person from their pool. Premiums would be lower because payouts would be projected to be lower, and profits and market value of the insurance companies would soar.

More and more people, however, would be priced out of that market, defeating the primary purpose of health insurance.

Laws prohibiting genetic or proteomic discrimination would not be sustainable. Conceptually, they are just more sensitive and sophisticated versions of what we do today in taking a patient and family history, measuring blood levels of a variety of markers, and other tests that companies already use to deny insurance or boost premiums. In a future that is nearly upon us, those predictions will cover a wider range of illnesses, with greater and more sensitive predictive power.

Had Obamacare not been passed now, therefore, it would have had to be passed in the future anyhow... or, "medicare-for-all" that Republicans would like even less.

Republicans' embracing Obamacare now is just political insurance against the inevitable collapse of heath insurance as we know it due to the inexorable progress in science.

3. Obamacare is, essentially, the Ryan Plan (aka, VoucherCare) for Medicare, but only for those under 65. Republicans love the Ryan plan so much they anointed Paul Ryan (R-WI) with the vice-presidential nomination. They did not consider Ryan's plan socialism.

Democrats opposed the Ryan plan because it provided the elderly less support than Medicare, and threatened to price those who needed coverage the most out of any coverage at all. It changed a guaranteed benefit (Medicare) into a guaranteed (and declining) contribution (VoucherCare). But, Republicans loved it, extolling the virtues of the free market working its will to lower healthcare costs, exactly what happened in Massachusetts under Romneycare, and is occurring now in many places as Obamacare is approaching implementation.

It is, therefore, hardly a leap of faith for Republicans to endorse a system for under 65 year olds that they would love to impose on the Medicare population.

4. Because Obamacare is basically the Heritage Foundation proposal, Republicans have no alternative (or, at least, nothing that could withstand a CBO analysis to provide equivalent coverage). Hence, Republicans have nothing to offer, forcing them to invent ridiculous suggestions such as receiving chronic cancer treatments in emergency rooms and quickly going bankrupt (or not paying at all, driving up others' premiums). Does anyone believe that Jim DeMint, who suggested ERs instead of insurance, actually does not have insurance himself? In the Nevada Republican senate primary, "chickens-for-checkups" was proposed by the sane one in that race. [I kid you not].

With nothing to replace Obamacare, Republicans put themselves in the untenable position of literally denying people affordable health care as the only alternative. If they had something to replace Obamacare, one would think they would have attached it to one of the 41 repeal bills, let the Congressional Budget Office analyze it, and then vote on it.

Moreover, as Obamacare is implemented, millions of people will enjoy its benefits, in many cases without even knowing it is due to the Affordable Healthcare Act. By falsely labeling it government-run healthcare, which it is not, Republicans run the very high risk of convincing people who are enjoying its benefits that government is their friend, precisely the opposite message they have been trying to convey for a century. The irony of this is so thick one could cut it with a knife.

Republicans would be far better served embracing Obamacare, labeling it correctly, taking credit for it, and using it to "prove" the virtues of free market competition.

5. Every time Republicans vote to repeal Obamacare, they are voting to cause Medicare to go insolvent in 2 years. Everyone appears to forget that one of the results of the cost-savings in the plan is that Medicare's solvency was extended by 10 years, and, it now appears, two years longer. Repeal it, and Medicare no longer takes in more in taxes than it pays out, starting in 2016.

Precipitating a Medicare crisis is not likely to help Republicans win the '14 or '16 elections. The Ryan Plan would not help save it -- it is so wonderful, one recalls, that it is not to be implemented for 10 years.

On the other hand, Republicans see themselves as cost-cutters in a bloated system. [Bloated, that is, unless it impacts them, such as airport lines that were instantaneously refunded].

Congress asked the Congressional Budget Office for every cost-saving mechanism it knew that could be included in Obamacare, and they were. For example, there is an incentive to establish accountable care organizations (ACOs) that get to split 50/50 with Medicare any savings in their treated population that they are able to achieve, but penalize hospitals if discharged patients have to be re-admitted in less than 30 days. This has spurred a modern version of the old "house calls" that ensure compliance with medications and early-warnings if a patient is becoming ill so treatment can be instituted then to avoid hospitalization.

By embracing Obamacare, therefore, and claiming credit for it as their idea, Republicans could showcase how cost-cutting works while also improving quality outcomes.

Instead, other than spreading lies and painting nightmarish visions, what does the right-wing offer instead?

"Freedom." If by that they mean that we are all "free" to find our own health solutions, Obamacare imposes no behavioral changes on anyone, only that they have health insurance. If by "freedom" they mean that we are all "free" to find our own insurance, as indicated above, that is only a theory, as profit-driven insurers will increasingly exclude potentially expensive subscribers and drive up the price for those genetically predisposed to disease.

Thus, freedom really comes down to this: Freedom to die of otherwise preventable colon cancer (colonscopy can find pre-cancerous lesions and remove them)? Freedom to suffer repeated attacks of asthma (that could be reduced in severity if properly assessed and treated)? Freedom to suffer from shingles (because one could not afford the vaccine) and the post-shingles pain for the remainder of one's life)? Freedom to become pregnant with your rapist's child (unwanted pregnancy could have been prevented by free contraception offered under Obamacare)?

That is not freedom.

Disease is among the worst forms of bondage, unnecessary disease among the cruelest.