The Feb. 24 Brainerd Dispatch reprinted an editorial from The Grand Forks Herald titled, "Obama's original sin: Partisan passage." The Herald's opinion contains no negative judgments of the medical provisions or the cost effectiveness of the Affordable Care Act (ACA). On that scale the Herald gives the ACA higher grades than I have. In the Herald's view, the primary fault is "the manner of Obama's creation turned Republicans against the policy forever. ...The time to compromise was before passage." I find the Herald's analysis to be partisan - but praising the ACA with faint damnation.
First, as it stands, the ACA is a compromise because it is basically the 1989 conservative plan out of the Heritage Foundation that was used as an alternative proposal to defeat the Clinton single payer bill in 1993. Gov. Romney later adopted its main provisions (exchanges and mandates) for Massachusetts. Minnesota has an option for a similar state-based, money saving plan in 2017 if it wishes. Obama erroneously expected that the ACA's conservative roots with its application in Massachusetts would garner bipartisan support.
Second, Obama made a big compromise in dropping the public option in exchanges. The first three versions had this option that would have made the bill more competitive and cost effective. The option was dropped in the final version despite the fact that polls showed most Americans supported it. Any expectations that his would make it more bipartisan were also wrong. Major compromises were more conservative. What further compromises would the Herald suggest?
Third, almost the night after President Obama's inauguration, Republican leaders gathered to plan how to make Obama's presidency a failure, summarized some time later by Sen. McConnell's often quoted goal of "Making Obama is a one term president." Translated, this has meant that if Obama is for something, Republicans are automatically against it. In this context, I find an opinion unrealistic that suggests Obama should have patiently waited for more compromise or some viable alternative. It was not a good omen that, despite progressive cost inflation in the 17 years since the Clinton plan, there were no conservative major reform proposals.
My stance in previous opinions and letters has been that if we want the best care for the most citizens at the most reasonable cost the best option is single payer, like Medicare. That could save the nation up to a trillion dollars a year, or would have saved at least $10 trillion in the 20-plus years since the Clinton proposal. If you want to leave more of that kind of debt to our grandchildren, vote against reform.
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Massachusetts's citizens will not be affected by any adverse Supreme Court ruling on the ACA. A "loophole" in Obamacare allows states with a similar plan ready in 2017 to replace Obamacare. Such a plan has been readied for Minnesota. If the Supreme Court guts Obamacare, there would be more reason for Minnesota to consider a Romney version, with the onus then on our state government.
The Herald is correct that we are not likely to see any alternative from Republicans. They are on record now as against single payer, against the free-enterprise insurance exchanges, against a public option and against mandates. This means that Republicans are de facto back to unfettered capitalism that is supposed to ultimately give the highest quality for all citizens at the lowest price. This was discredited in theory 50 years ago, and in practice in the decades since. What else is there?
T.R Reid, who comprehensively studied and compared world health programs concluded, "A fundamental moral decision our country has made is that we have never decided to provide medical care for everybody who needs it." Any criticism of the ACA that does not include credible alternatives is presumptively against universal coverage. Tens of thousands in the U.S. are estimated to die every year for lack of basic insurance.
In 1997, the editor of The Journal of the American Medical Association posed a simple question: If the child of a rich American family and the child of a poor American family both contract the same illness, should both children have the same chance of being cured? This question found its way to the press and a surprisingly frequent response was "No." "Yes" was usually rejected as representing "socialism - other Americans would have to be taxed to pay for the cure." This allegation may not be true, because Germany and France, no socialist countries, work through insurance companies. But this is done with mandates, uniform pricing, public options and standard records. These efficiencies give costs similar to single payer plans in other countries, at 50-60 percent of per capita U.S. costs, with better benchmark outcomes,
Perhaps anti-socialist arguments against improvement in U.S. health care coverage have now been replaced with allegations that Obama was too partisan. It may be a small step in a better direction.
Charles R. "Dick" Peterson, MD is a Nisswa resident and a retired physician.
