How Republicans have already won on Health Care Reform

The US Supreme Court is hearing arguments this week (principally) over whether the “individual mandate” in President Obama’s signature health care reform bill is constitutional. This issue is dominating political news coverage this week, just as the issue of the individual mandate has dominated coverage of the Affordable Care Act since Obama signed it into law. This is why Republicans have already won the messaging war on health care reform.

Unfortunately, when most people hear the words “health care reform,” “Obamacare” or “Affordable Care Act” they immediately think of the individual mandate, which (starting in 2014) will put a tax penalty on people who have not signed up for health insurance. It is a tragedy (though not an unpredictable one) that this one small part of the bill has become its best-known feature. The bill does so many good things for people in America, but the continuous media coverage of the court challenges have made sure that the individual mandate is the one thing people associate first with Obamacare. In politics, name association and messaging are everything and the strong popular connection between “health care reform” and “individual mandate” is probably the main reason why health reform remains unpopular.

This is extremely ironic because the individual mandate was originally a conservative idea, advocated by Republicans as an alternative for Pres. Clinton’s proposed health care reforms. Obama didn’t like it when he ran for President, and liberals have never liked it. Conservatives (predictably) turned against it when Democrats included it in their health reform package. And the only reason it made it into the Democrats’ bill was because of a desire to make the bill more appealing to Republicans and centrists. But alas, the mandate is now integral to giving people the good parts included in health reform. I could go on for 10 posts about this but here are some of the good parts:

  • Over 30 million people will be given access to health insurance. Anyone without money to buy insurance will be given a government voucher or will be added to expanded Medicaid rolls.
  • People can no longer be denied coverage because of “pre-existing conditions” or whatever other reasons insurance companies can come up with to deny health coverage.
  • The plan will save tens of thousands of lives every year.
  • The plan will reduce the deficit by over $100 billion in its first 10 years.
  • The plan also starts experiments in payment reforms which could hold the key to bringing down our skyrocketing medical costs.

Imagine if any of these major parts of the bill were what was dominating the news coverage around Obamacare. The individual mandate is a provision that will affect very few people in America but is given out-sized significance. Its too bad, because if people knew the Act contained all these beneficial and popular provisions, our health care debate would be very different. Instead of focusing on the most unpopular part of the Act, we could all be talking about how the US is joining the rest of the world in offering health care to all of its citizens. And that, my friends, is why Republicans have already won the messaging war over Obamacare.

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