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Did Obamacare Create the Expectation of Universal Health Coverage?

Did Obamacare Create the Expectation of Universal Health Coverage?

And did Obamacare solidify the belief that the federal government should provide it?

Was the end goal of Obamacare to create the expectation of universal health coverage?

Charles Krauthammer thinks so:

On Friday’s edition of ‘Special Report’ on Fox News Channel, syndicated columnist Charles Krauthammer made the case that President Obama’s strategy for Obamacare was not to create a perfect health care system, but to create the expectation that health care is something the government is responsible for. He said Obama had been successful at “creating the expectation of universal care” and that as a result “the zeitgeist of the country has really changed.”…

“That is the logic of Obamacare. It was a jerry-rigged system which would temporarily create an entitlement, but would not work because it is financially impossible… But they have succeeded at creating the expectation of universal care, and once you have that… What we’re going to get is Democrats going to a single payer,” he added.

This is indeed what most of us have been hearing and thinking ever since Obamacare was passed—that the passage and then the implementation of Obamacare would constitute a point of psychological and systemic no-return because entitlements cannot ordinarily be turned back. Even if the GOP could agree on a way to roll back Obamacare (and so far, they haven’t been able to), the idea was that the public would not accept a more conservative approach anymore, because they have become wedded to the idea that health care must be a government-guaranteed right and not a privilege.

But I’m also inclined to turn Krauthammer’s idea on its head. I reflect that Obamacare was preceded many decades ago by Medicare, and then in the early part of the 21st century by Part D (passed by the GOP, you may recall). In between (1986) we had EMTALA, the law that guaranteed emergency medical care at hospitals and didn’t really figure out how to pay for it—a law that was passed by a Republican Senate and Democratic House, and signed by Ronald Reagan, as part of a larger bill:

That’s government racketeering explained in a nutshell: create the problem (strain on hospitals due to mandated free care) and use it as an excuse for wealth transfer, which is what universal healthcare amounts to in the end. And look how perfectly it works. The requirements under EMTALA are ostensibly what led to “Romneycare” and inspired the Heritage Foundation and Newt Gingrich to propose government- mandated health insurance coverage, giving liberals and libertarians a fair basis for pointing to “conservatives” as the ones who first proposed health insurance mandates.

Our previous system of health insurance worked pretty well for most people, actually, but it was extremely complicated and some people fell through the cracks. Meanwhile, the growing entitlements (such as EMTALA) were at least part of the reason that health care was becoming more expensive and more often out of the reach of many of those without any insurance. Without going into the ins and outs and the details at the moment, I’ll just say that the expectation that the federal government do more to alleviate the burden was growing and growing and growing, and all the laws that I just mentioned were passed not just to expand those expectations but in response to expectations that had already expanded in a slow but seemingly inexorable progression.

I use that word “progression” purposely. “Progressives” of the left call themselves that in order to promote the idea that their policies represent a natural, normal, and morally good example of human progress going forward in time. But those policies also create dependence, restrictions on liberty, rising costs, and bureaucratic messes that are hard to fix and resistant to change.

Yes, as Krauthammer suggests, Obamacare has “create[d] the expectation that health care is something the government is responsible for.” But it’s also true that Obamacare reflected and was a response to the already-evident fact that the belief that “health care is something the government is responsible for” had been growing and growing for many decades. The details of Obamacare may not (and in fact were not) popular. The idea of it was. The whole thing was a system in which the expectation fed into the legislation, and then the legislation solidified the expectation that something similar would continue.

The current impasse among Congressional Republicans represents a split between those moderates who don’t think we can or should go back very far—those who prefer tweaking Obamacare somewhat to keep the general idea in place but make it “better”—and those further to the right who think that turning it back entirely (and replacing it with one or another far more conservative solution) is not only possible but necessary for the good of the country and its people. This is a profound split rather than a minor one. It’s also an obvious split, and anyone who worked on a new bill to replace Obamacare had to be cognizant of it.

[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]


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We want the Government OUT of our lives, and our healthcare. The Progressives on both sides want to control us, so they want us to be under “their” idea of healthcare….I say if it is good enough for us, it should be good enough for them and their buddies….This is sickening..they promised us REPEAL!!

DINORightMarie | March 28, 2017 at 7:37 am

Anyone who believes Trump to be conservative is deceived, at best.

However, the people’s voice was CRYSTAL CLEAR – FULL REPEAL. Trump ran on that, when he wasn’t being two-faced, double-sided, fork-tongued. His supporters wanted, and he supposedly promised, FULL REPEAL. His own outline stated he supported FULL REPEAL.

That is NOT radical.

The government has NO PLACE in our health care lives. Since the 1960’s, with Medicare’s passage, it has been a part of our lives. Since the VA hospitals came into being, it has been a part of the picture in health care.

But is is a FAILED SYSTEM. Europe is seeing it…..other nations as well. Yet we can’t get these bureaucrats, these elitist career politicians, to HEAR AND SEE and STOP the madness!

Full repeal is the only way. Then, reform the existing laws to make the markets drive down costs, open up options for those who can’t afford insurance – or, better still, make the prices go down to levels where insurance is ONLY NEEDED when there is a catastrophic illness, like cancer or a congenital defect needing special care.

THAT is what insurance should be – not this pay for everything, which only drives up the cost!

    inspectorudy in reply to DINORightMarie. | March 28, 2017 at 10:44 am

    You are correct about Trump and his campaign promises. He is not going to be able to deliver on most of them. Or if he does they will be so watered down that they will be unrecognizable. His ardent supporters will blame the RINO’s and the “Never Trumpers” but in reality, we all knew that he had no experience with dealing with a body of people like Congress. There is no common goal among them except to get re-elected. There is no profit motive like he is used to working with on both sides. What we are going to see under Trump is the need for a third party. There are a lot of blue-collar Dems who voted for Trump and lean to the right socially. There are a lot of Repubs who are socially conservative as well as smaller government types. Then you have the progressives and the North East Repubs that love big government and its programs. Unfortunately, Paul Ryan is one of these and he made very little effort to include anyone that wanted to cut anything from obamacare. Also, reading lately that affluent college-educated people, on both sides, were the most likely crowd to believe “Fake news” is an eye opener. The Trump supporters were not in this crowd. I see a third party out there somewhere the only thing missing is a leader and it ain’t Trump.

As a freebie, a highly politicized freebie, maybe Obamacare did provide the illusion of ‘healthcare’ for everyone, and the numerical majority who pay no taxes and pay little for their care are natural boosters of more free stuff.

But- the American healthcare system, rooted in free enterprise, is responsible for the majority of the medical advances that allow many people to defy the odds and live with diseases that kill you in Europe. Our survival rate for certain cancers, curing hepatitis C, medical devices that keep a failing heart going, these only came about thanks to Capitalism. Our legislators need to wake up and read some papers, some books like (oldie but goodie) Porter’s ‘Redefining Healthcare’-creating a value-based system.

When the free market prevails (this doctor will tell you, healthcare performs best when it is run like a business!) quality goes up, people automatically choose the best value for their particular situation, and price goes down, thanks to good old competition.

Who would go to the expensive hospital for a poor quality procedure, when the super-center in the next town had better quality, better outcomes, and cost the same? When you manage to a budget (single payer), this all goes away and all of our care is at the 60th percentile, or the 70th, whatever the budget is set for by congress.

So I am not mourning what happened last week, but our leaders and the public better wake up and demand quality over price, which only exists in a competitive free market.

    Mac45 in reply to Chicklet. | March 28, 2017 at 11:28 am

    While this is a rosy outlook, a few things are missing.

    The first is market forces. Since the late 1960s there has been a large government sponsored, third party payer for healthcare, Medicare. It presented guaranteed payment for a large percentage of a person’s medical charges. This encouraged healthcare costs to rise at several times the rate of inflation for the next 50 years. This necessitated people not covered by Medicare to be required to have health insurance to cover any medical costs. Even Medicare recipients required supplemental insurance. Medicaid also contributed to this continual rise in healthcare costs. Whenever you have guaranteed payment, no matter the amount charged, then there is no incentive to keep charges down. In fact, as insurance companies often paid a percentage of the charge for a medical procedure, this actually encouraged the practitioner to overcharge, simply to gain the desired reimbursement. The healthcare system was sliding down to terminal collapse for decades. Obamacare only accelerated it.

    As to the American healthcare system being rooted in free enterprise, this is not true. As noted above, the industry relies heavily upon healthcare insurance in order to survive. The existence of a guaranteed payer caused a tremendous explosion of the corporate healthcare industry. Hospitals sprang up on virtually every corner. They are so under utilized that they run specials on surgical procedures and set up billboards touting the shortest ER wait times in the areas. There is a glut of specialists, who, even though saddled with hundreds of thousands of dollars of education debt, still manage to live extravagant lifestyles, while people wait for hours to see their GP. And, elective procedures now far outnumber medically necessary ones. Medical practices now need highly trained and certified personnel simply to handle the billing of insurance companies.

    Guaranteed payers hopelessly skew the free market system.

Connivin Caniff | March 28, 2017 at 8:18 am

The laws enacting a new, free-market health insurance system will have to be built like one builds a stone arch. First, strong, structural stones are chosen and cut to proper size. But the stones cannot be simply stacked on their own, leaning toward the center, until the keystone is installed – obviously they will fall over at that point, as the system is not capable of supporting and transferring its own weight. A temporary structure must be built under it to hold it up until it can stand on its own. In the case of a new, free market health insurance system, that means temporarily providing overly-generous non-market insurance incentives that will entice people to obtain insurance, but those incentives must sunset as the free market system takes hold. That is the only way a conservative, non-governmental system can be achieved. Conservatives will have to bite he bullet for a good while to reach the ultimate objective.

By the time of the late Roman Republic, the people had been conditioned to expect subsidized bread and free entertainment in exchange for their votes. This popular mindset eventually made the unthinkable idea of a Roman dictator permissible, leading to the gradual erosion of the Roman Constitution. The rest is history.

Creating the “expectation” of universal health care as something the government is responsible for… a story line worthy of Ben Rhodes.

According to Senator John Cornyn, the GOP will not try to repeal Obamacare via reconciliation again. Instead, they’ll work with Democrats.

They hung conservatives out to dry, blamed the House Freedom Caucus, and are now giving away the game. They never intended to repeal Obamacare in the first place. If they did, they’d try again via reconciliation instead of surrendering altogether.

They were not serious, but they had to set up conservatives to be the fall guys.

I think that’s entirely plausible, and they’ll do it if we don’t stop them.

This could be the decisive battle for conservatives this century. So much else hangs on the outcome of this crisis, and make no mistake; crisis this is.

    Mac45 in reply to Ragspierre. | March 28, 2017 at 11:04 am

    Correct. The HFC, for whatever reason, has done the rest of the country a service. By killing this terrible bill, they keep the cross hairs of Obamacare correction squarely on the Congress. And, the rest of the Republicans in office are going totry to blame them for the continuing death spiral of Obamacare, even though the AHCA would have done nothing to stop, or even slow, it.

    What will likely happen is that nothing meaningful will be done about Obamacare and it will collapse within the next 5 years. When it does, the natural inclination of our elected officials will be to “save” people’s insurance by imposing a single payer healthcare insurance entity. It will naturally be controlled by the government. That is when the real battle will have to be fought.

    mariner in reply to Ragspierre. | March 28, 2017 at 2:05 pm

    Well written, Rags.

Mo Brooks has filed a clean repeal bill, but it’s EXISTENCE is getting no reporting.

John Cornyn is basically a RINO- he’s only pretended to be more conservative since Ted Cruz was elected.

There’s a good article by Dr. Tom Coburn on the web today and yesterday there was an excellent article on Patterico- both worth reading.

The GOP needs to have some backbone to change the system- and so far, I have seen little spine from the Paul Ryan contingent.

Krauthammer gets it. The majority of Americans now feel that health insurance is an entitlement. This means that it is unlikely that Republicans will repeal the ACA. I have repeatedly stated that any repeal or replacement of Obamacare, which reduces government participation in healthcare or healthcare insurance, will mean the loss of healthcare insurance by soe portion of the population. There is simply no way to reduce costs to the consumer without socializing [nationalizing] healthcare and healthcare insurance. And, as the main complaint of the populous is that the premiums and deductibles on their current healthcare insurance are too high [even with government subsidies], doing anything which may cause them the loss of that insurance is political suicide.

This is the reason why the Dems are not concerned that the Republicans will repeal, or replace, Obamacare. They know the score. And, when Obamacare collapses, they know that the Republicans will do the politically expedient thing and pass legislation to advance a government supported, single payer healthcare insurance system.

Government third party healthcare insurance programs [Medicare and Medicaid] created the current crisis. But, the elected representatives will not make the sacrifices necessary to remove the cause of the problem and allow the market to adjust to allow for affordable healthcare.

Was the end goal of Obamacare to create the expectation of universal health coverage?


Anyone who tells you otherwise is either deluding themselves or is purposefully obfuscating the issue in order to try to set up the framework to argue that health care IS a right and SHOULD be universally “free” (to the end recipient).

I argued this point extensively WAAAAYYY back in 2009 (unfortunately on Aberrant Templar, a blog that no longer exists) when the Patient Protection and Affordable Care Act (PPACA, aka Obamacare) was in the drafting stages, that it was:

1.) designed to make the populace believe that health care was a “right” that they were entitled to;

2.) designed to drive the health care insurance companies into the ground after 3 years (and that they would move to abandon the state insurance exchange “marketplaces” as soon as the guarantees regarding losses were removed);

3.) that the federal government would then make it a requirement to participate in the state insurance exchanges as a prerequisite to offering coverage at all;

4.) set the process for “single payer” by creating a pathway for “medicaid” to accept all applicants as soon as a critical mass of insurers had abandoned the state insurance exchanges; and

5.) once a critical mass of “sick” individuals had joined medicaid and the medicaid funds were depleted so as to make medicaid “bankrupt” due to the abnormal ratio of sick-to-healthy, the federal government would make it illegal for any company to offer health insurance except FOR medicaid, and would require doctors to only accept payments THROUGH medicaid (no direct payments allowed). They would do this on the idea that “the expense is too high, and we have to distribute the cost of paying for the sick to the rich, who can afford to pay ‘just a little bit more’ by taking them out of their ‘platinum’ plated plans, and making them ‘share the burden.'”

1 and 2 came to pass, but the populace rebelled before 3 could be imposed by the Democrat controlled Congress. Once the Tea Partiers held a portion of the Republican Party, and the Republicans were in control of the House, 4 became impossible to pass, which now leaves us where we are: with a completely broken system where the big players have extracted their profits from the early “guaranteed” years, and abandoned ship, ne’er to return, because they know that if they do, they will HAVE to accept pre-existing conditions AND they WON’T be able to extract the payment for those pre-existing conditions from the individuals, but will have to distribute the cost over the entire purchase population, which will make the insurance excessively priced to all, which will cause government to attempt to re-regulate pricing.