Obamacare's pregnant politics

By Dan Carpenter
Indianapolis Star, Aug. 13, 2013

Republicans and their media allies may be feeling heightened urgency as they saddle up Obama-Scare for 2014, according to a guy who has his own reasons for dissatisfaction with the Affordable Care Act.

“While the Republicans are so incredibly strident about how the ACA will fail, if they really believed it would fail, they wouldn’t make so much noise,” said Robert Stone, M.D., a Bloomington emergency room physician and a high-profile advocate for health-care financing reform. “They obviously fear it won’t fail.”

Stone and his wife, Karen Green Stone, are among the leaders of Hoosiers for a Commonsense Health Care Plan. He also is a board member of Physicians for a National Health Program. Both these organizations of medical professionals and consumers seek a universal “single-payer” approach on the model of Medicare, which just celebrated its 48th anniversary as one of government’s most popular services after a birth greeted with conservative hysteria.

Obamacare is not the expansion of Medicare; in the eyes of Stone and his troops, it is a gift to the for-profit insurance industry that raises huge cost-control worries.

At the same time, it delivers goods for the people — to list just a few highlights, protection from being refused or dropped for being sick, inclusion of dependent coverage up to age 27, purchasing exchanges to help modest-income folks with costs, and the extension of Medicaid to an estimated 35 million poor people now uninsured.

Although he would have written the ACA differently (and feels the insurance companies essentially wrote it), Stone likes these provisions and expects voters will also, as implementation swings into full bore in 2014.

“What Democrats are counting on, Republicans are fearing. It’s all so polarized. Both Republicans and Democrats see how the ACA plays out as crucial to their political ambitions. When I criticize the ACA, I offend my Democrat friends; and when I say something positive, I offend Republicans. I’m an equal opportunity critic.”

So much so, he sees even failure as an opportunity — perhaps.

With understated glee, he cites warnings by various conservatives that Obamacare will in fact lead to government health care because costs will rise to the point where the public will tire of the middleman — the insurance companies that must please their shareholders and enrich their executives on top of the bills they pay.

Or, maybe the middleman will get out on his own. Some health insurers already are diversifying as the law tips the scales more toward the customer and the gravy thins.

“The ultimate answer — and I’m impish here — to ‘Is the ACA a step in the right direction?’ is, yes, because it is a government takeover of medicine. There’s this underlying assumption the free market can do more, and government is inept. And yet, the irony is, in Indiana, for instance, they’re going to let Washington run the exchange.”

Chris Stack, a retired Indianapolis physician and leader in Hoosiers for a Commonsense Health Care Plan, agrees the next couple of years could be decisive in any direction.

“If it’s a fiasco, what will prevail?” he said. “Even conservative people can look at the economics of private insurance and see that it’s not working. It’s never worked. It’s possible the failure of Obamacare could lead to something more radical. There’s a glimmer.”

By “radical,” he actually means “established.”

“Medicare — you set the rules, you buy in bulk to keep costs down. Private insurance is in the game as long as it pays off. Then they’re gone.”

For most adult Americans, it would not be at all difficult to recall when we lived without them.

Carpenter is Star op-ed columnist.

http://www.indystar.com/article/20130813/OPINION/308130046/