Debunking the “ObamaCare is Conservative” Myth, Part 4

When I started this series, I wanted to systematically dismantle a myth that I’ve seen thrown in the faces of conservatives over and over. Specifically, I was inspired by a segment I caught on MSNBC, in which a panel of pundits were discussing the backlash to the Supreme Court’s ObamaCare ruling. The panel’s token conservative explained why conservatives aren’t just surrendering on ObamaCare. He highlighted a few of the policy issues with the health care reform law, pointed out its enormous cost and expansion of federal power, and began to explain why conservatives still think the law is unconstitutional.

It was at about this point that someone else on the panel cut him off with a smirking, “Please. The Affordable Care Act is a conservative law. You conservatives are just playing political games because you don’t like President Obama.” That’s not an exact quote, but that’s the gist of what he said. This is a myth that I’ve seen pop up repeatedly in debates between conservatives and leftists. One last time, here is the full myth:

“ObamaCare” is a conservative health care law whose main tenet (the individual mandate) was originally created by the conservative Heritage Foundation and proposed as a bill by conservatives in 1993. Now, a conservative-appointed Chief Justice leading a conservative Supreme Court has upheld that conservative law, and the only reason conservatives are so intent on attacking “ObamaCare” is partisanship/racism/political gamesmanship/fill in the blank.

In part one of the series, I explained that not all conservatives are Republicans, and that not all Republicans are conservatives, and that conflating the two is intellectually dishonest. So, while some of the accusations in the myth may be true of Republicans, they’re not true of conservatives. In parts two and three of the series, I looked at all eight of the myth’s individual claims and discussed whether or not they’re accurate. I determined that only one of the claims is clearly correct (that the individual mandate is the heart of ObamaCare), and acknowledged that one more claim (that the Supreme Court is predominantly conservative) could be arguably correct. I found that the other six claims are either flat-out wrong, or deeply misleading.

However, some liberals will argue that ObamaCare is still anintrinsically conservative law. This final defense of the myth relies on appealing to conservative support for personal responsibility and business.

Argument 1: ObamaCare promotes personal responsibility

The left loves to invoke this defense of the myth. Even President Obama himself often uses this defense:

“And the only people who may have a problem with this law are folks who can afford health care but aren’t buying it, waiting until they get sick and then going to the emergency room and expecting everybody else to pick up the tab. That’s not responsibility.”

Some leftist bloggers are a little more crude when explaining it:

“One thing that conservatives have been bitching about for decades is the unfairness of our society. …Why should people with medical benefits pay for people without medical benefits to get health care. Well, the liberals have solved this issue and the conservatives are still bitching about it.

…Under Obamacare EVERYONE pays for medical benefits. …The conservatives should be jumping for joy.  Obama did the one thing that you guys have never been able to do and always bitched about… but you can’t stand the thought that a liberal did your work for you.  So now you bitch about that too.”

Here’s one last liberal blogger. Sorry for the quotation overload, but this one gives a nice and full account of the argument, and I want to ensure that we understand the case being made in the myth’s defense:

“Personal responsibility is not only a conservative idea but a good idea. Those who can afford their own health care should because it shouldn’t be the taxpayers and those who do have health insurance to pay for everyone who doesn’t.

With the old system, when someone who doesn’t have health insurance shows up in an emergency room because of some unexpected health crisis, it means that everyone else paid for that person’s health care if that person can’t afford the out-of-pocket cost. With the new health care law, that individual will most likely have health insurance and if not, they’re at least paying a tax that will help cover the cost of their health care.”

To summarize, they’re arguing that the individual mandate forces everyone to be personally responsible to obtain health insurance. The idea is that people irresponsibly decide to forgo insurance coverage, and that when these people get sick, they just go to the emergency room and incur huge costs for hospitals and taxpayers alike. Therefore, the mandate is a means to force Americans to be responsible for themselves.

I’ll concede that personal responsibility is beloved by conservatives and that it can be referred to as a “conservative” idea. However, this whole conception of “the individual mandate promotes personal responsibility” is grounded in an enormous misunderstanding of our health care system.

Let me put a question to you: Why is it that people know that they can skip buying health insurance, and that if they get sick, they can just go to the emergency room at the last minute for life-saving treatment? It hasn’t always been that way. Isn’t that a little strange, isn’t it a perverse system of incentives in our health care system? Who made it that way? The answer is the federal government.

In 1986, Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA). As part of this law, Congress also passed the Emergency Medical Treatment and Active Labor Act (EMTALA). Simply put, EMTALA is the cause of the problem. I’ve written on this subject before, so allow me to quote myself in explaining the EMTALA mandate:

EMTALA mandates that hospitals provide emergency screening and stabilization care to those who present themselves at the emergency room, regardless of citizenship, immigrant status, or ability to pay. This mandate applies to every hospital that accepts federal payments on behalf of Medicare beneficiaries. In effect, this means that virtually all hospitals fall under this mandate.

Yes, the federal government created the “free rider” problem that leftists are now clamoring for the federal government to solve by increasing the power and influence of the federal government. Makes sense, right? The EMTALA mandate destroyed personal responsibility, and now the left wants to use another mandate to force Americans into buying health insurance in order to fix the problem that government mandates themselves caused in the first place.

By the way, the EMTALA mandate was also an unfunded mandate, which caused the cost-shifting that the left is complaining about. If you’re curious and you want to learn more about EMTALA, I would recommend this excellent article by health care policy expert Avik Roy.

Here’s a novel idea: Let’s get rid of these onerous government mandates and promote personal responsibility in a free society with a patient-centered health care system.

Argument 2: ObamaCare is good for business

This argument relies on another misunderstanding of conservatives. It goes all the way back to the early days of progressivism, and the demonization of “robber baron” capitalists and corporations. If you’re interested in the subject (and why the progressives got it wrong), I’d advise you to look into a book by Dr. Burt Folsom of Hillsdale College titled, “The Myth of the Robber Barons: A New Look at the Rise of Big Business in America.”

Anyway, the argument goes like this: “Conservatives are pro-business. (More pejorative versions of the argument will claim that conservatives love greedy corporations or something like that.) ObamaCare’s individual mandate will give private insurance companies tens of millions of new customers. If ObamaCare were a liberal or progressive health care law, then it would have created a single-payer system or at least a public option. Instead, it’s a boon for private business, which gets all of these new customers (who will mostly be young and healthy) in exchange for a few piddling regulations that they really should’ve been following anyway.”

I won’t get into the wisdom of those regulations right now (primarily guaranteed issue and community rating, I think they’re a bad idea), but I will take umbrage at the rest of the argument. Here’s the misunderstanding: Conservatives aren’t blindly pro-business.

Conservatives support free markets. While a lot of businessmen will pay lip service to maintaining a free market, few would resist the temptation to take a subsidy from the federal government, or to use federal regulations to create heavy barriers to entry in their market, thereby restricting competition. Indeed, many businessmen whose industries receive plentiful support from the federal government are terrified of free markets.

In reality, conservatives are pro-entrepreneurship, not pro-business. We want there to be as few barriers to entry to markets as possible. Take heed once more of the difference between Republicans and conservatives. Many Republicans do cozy up much too closely with corporations and use the power of the federal government to help their friends, but these are not conservatives.

Think of the conservative Tea Party. The Tea Party began as an outpouring of conservative anger over the Bush bank bailouts, and then the Obama bailouts, and not to mention the various stimulus packages. If conservatives love it when the government forcibly transfers wealth to corporations, either through bailouts or the individual mandate, then why would the Tea Party have even begun? It doesn’t make sense. Conservatives don’t want the federal government to give insurance companies a massive handout, so this defense of the myth also falls flat.

Conclusion

I believe that I have discredited the myth that “ObamaCare is a conservative” law. If you disagree, feel free to comment below, I always welcome debate on this blog. In reality, ObamaCare is a law that appeals to few people in its entirety.  Its violations of individual liberty horrify conservatives, and its gigantic handouts to business anger liberals and progressives. Perhaps that’s why a majority of Americans continue to oppose the president’s health care reform law. Conservatives must continue to fight for full repeal of ObamaCare, and we must replace it with affordable, patient-centered care.

About Daniel Anderson

I am a 21 year old Michigan native completing the final year of my undergraduate education at Hillsdale College. I tend to categorize my political philosophy as "constitutional conservatism." I also advocate free-market economics.
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6 Responses to Debunking the “ObamaCare is Conservative” Myth, Part 4

  1. Pingback: Debunking the “ObamaCare is Conservative” Myth, Part 4 … | Health Care Advice

  2. GB says:

    This series has focused heavily on the individual mandate but it has ignored numerous pieces of Obamacare that have been embraced by conservatives in the past (and even in the present). You yourself have suggested that a conservative approach to health reform would include things like allowing insurers to sell across state lines, introducing more price transparency in health markets, encouraging greater use of consumer-driven health plans, and creating new options for small businesses–all of which are part of Obamacare.

    It might have been more accurate to call these posts “debunking the ‘individual mandate is conservative’ myth.”

    • I would agree that I did place a heavy focus on the individual mandate in this series. However, as I argued in the second part, the individual mandate really is the heart of the health care law. If you remove it (along with its related provisions, such as imposing guaranteed issue and community rating), you’re left with the shambles of a health care law, and what’s left is something that nobody would want.

      I don’t want to say too much here, just in case I do another series highlighting other elements of ObamaCare. Responding to one of your claims, however, I will say that the law basically destroys Health Savings Accounts, which are an integral part of consumer-driven health plans. Also, on a broader note, the law could have a couple of “conservative” elements while still not being a “conservative law.”

      • GB says:

        I’d suggest to you that the law doesn’t lend itself well to an easy ideological characterization. The goals in broad strokes–better health and wider access to care, slowing the rise of costs, and improving care quality–are, I assume, minimally offensive to most folks across the ideological spectrum. The wide array of mechanisms in the law for achieving those goals can be ascribed, variously, to liberals, conservatives, and pragmatists. That’s why you can find yourself in a situation in which states seeking more “liberal” solutions (e.g. Vermont) actually need to seek a waiver from the law to implement their approach. So when you say “the law could have a couple of ‘conservative’ elements while still not being a ‘conservative’ law,” I don’t disagree. But I would echo the same sentiment with the word “liberal’ substituted in. The law doesn’t lend itself well to ideological characterization.

        The reactions to it, however, are a different story. HSAs, for instance, are not “destroyed” by the law. The only change made is that they can’t be used to pay for non-prescription drugs. If that small change destroys them, then it would seem they weren’t used for much to begin with.

  3. GB says:

    Better health and improved care quality were not “assumed to be side-effects of an expansion of coverage,” nor was cost control neglected. There are much more comprehensive treatments of the law’s philosophy, approach, and contents and certainly there isn’t much space to get deeply into such things in comments like these. But suffice to say, Obamacare takes the approach that cost control must take place at every level. Providers are the target of a series of payment and delivery system reforms, insurers will compete in new competitive markets, employers are pressed to keep coverage affordable, individuals will gradually have more “skin in the game.” The law also represents a huge investment in the nation’s quality measurement and improvement infrastructure (and both price and quality transparency, e.g. through public reporting)–which feeds back into the cost control components.

    Coverage was an important piece of it but it certainly wasn’t the only piece of it.

    As for HDHP-HSA pairs and actuarial value, three points:

    1) The proposed approach they’re talking about really only affects the individual market/exchanges, which is a small segment of the market (most people with HSAs–and without them, for that matter–are in the large or small group markets and these standards wouldn’t have much effect on them). HSAs will continue to thrive.
    2) The suggestion as to how to calculate actuarial value for HSA-HDHP pairs was a proposal, is open to public comment, and is subject to revisions. It remains to be seen whether that will be the final standard.
    3) Among HSAs in use in the individual market today, at least half are coupled with an HDHP that achieves at least a bronze-level actuarial value anyway. So, no, even the actuarial value standard doesn’t destroy HSAs. At worst, it steers a portion of a small segment of the market toward a slightly more generous HDHP to be used in conjunction with their HSA. The hyperbole around these issues doesn’t help anyone’s case.

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