The political price of health carePosted: 27/07/2012
By Andrew Parasiliti, Executive Director, IISS-US; Corresponding Director IISS-Middle East
My colleague Dana Allin wrote a compelling essay earlier this month on health care and the American state from his perspective as a self-described ‘American liberal’. Following the US Supreme Court’s decision to uphold the legality of most of the Patient Protection and Affordable Care Act (ACA), and in response to Dana’s essay, I thought it worth taking stock of the politics of health care as we head into the US elections in November.
The ACA is among the most partisan and divisive of any major legislation in recent memory. An NBC News/Wall Street Journal poll this week revealed that 44% of Americans believe that President Obama’s health care plan was a bad idea, while only 40% think it was a good idea. This latest poll is consistent with previous surveys regarding the ACA.
Washington Post columnist Robert Samuelson describes the Act as a ‘massive feat of social engineering that, by its sweeping nature, weakens the economic recovery and antagonises millions of Americans’.
Samuelson’s argument against the ACA is primarily its effect on a depressed economy via an increase in already spiralling health care expenses and by raising the costs of hiring staff (discouraging job creation).
Despite securing the ACA’s passage, Obama and the Democrats have paid a political price for the ACA and can probably expect to do so again this fall.
For example, to secure the support of Democratic Senator Ben Nelson of Nebraska, a key swing vote, Senate Majority Leader Harry Reid agreed to the ‘Cornhusker kickback’, which allowed Nebraskans to be reimbursed for Medicare at a higher rate than the rest of the country. This backroom deal offended even Nelson’s own constituents and was repealed by subsequent legislation.
The victory of Republican Scott Brown in a January 2010 special election to replace the late Senator Ted Kennedy of Massachusetts also revealed the unpopularity of health care reform in a solidly Democratic and mostly predictably liberal state. Brown ran on a platform to be the ‘41st vote’ to allow a filibuster on health care and thereby kill the bill in the Senate. Although Brown’s opponent, Massachusetts Attorney General Margaret Coakley, ran a lacklustre campaign, most would have assumed a Democrat potted plant running on Kennedy’s legacy would have crushed Brown or any Republican.
That a Republican could win in Massachusetts, running against health care, Kennedy’s legacy issue, was a stunner for the Administration. White House Chief of Staff Rahm Emmanuel argued for scaling back on the Administration’s initiative. Speaker of the House Nancy Pelosi, however, convinced Obama to press on with his more ambitious health care reform proposal, despite the backlash against it.
In the end, the Affordable Care Act passed in March 2010 with no Republican votes in either the House or Senate. In November, Republicans retook the House of Representatives energised by the Tea Party and the opposition to health care reform.
The president and his party dodged a bullet with last month’s Supreme Court decision, as did the country by avoiding a potentially unsettling spat between the Executive and Judicial branches of government. The president had said on 4 April that ‘I’m confident that the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress.’ (In fact, there is plenty of precedent.) President Obama also that day described the Supreme Court as ‘an unelected group of people’.
The Democratic enthusiasm for the bill pales in comparison to the passion of the Republican opposition. Those opposed to the ACA are unlikely to be converted by the Supreme Court decision, and those who oppose the ACA are likely to be energised by it.
Health care may not be the issue that decides the 2012 election, but it will have its place. The political advantage, if any, of the ACA tilts toward the Republicans in November. President Obama will make the case, as Dana Allin does, that the ACA is good public policy. That is the burden of leadership on health care that the president will carry into November.