Time to make imperfect health care law better

The media’s reporting on the Supreme Court’s decision basically upholding the Affordable Care Act was predictable but still disappointing. The decision had a literally life or death impact on the lives of millions of Americans, but the headlines were all about the politics of the decision.

In 2000, the World Health Report ranked the U.S. health care system 37th in the world. As our most prestigious medical journal, The New England Journal of Medicine, said in 2010, “It is hard to ignore that in 2006, the United States was No.1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy … Why do we spend so much to get so little?”

Doing something to address the facts in that paragraph is what the ACA is all about. It has been hard for us to keep that in mind as the law was attacked from all sides. But let’s review a few facts about how the ACA did become law and what has happened since.

The individual mandate was invented by the conservative Heritage Foundation and served as the basis for Gov. Romney’s health care program in Massachusetts. “I was very pleased that the compromise between the two houses includes the personal responsibility mandate,” Gov. Romney said in 2006. “The individual mandate, that is essential for bringing the health care costs down for everyone and getting everyone the health insurance they need.”

Gov. Romney’s point was valid, then and now. The only way to bring down health care costs is to assure that everyone has insurance.

The Court’s decision said the mandate was constitutional only because it was really a tax. Ironically, the original health care reform proposals back in 2009 included a tax on those who did not choose to buy health care insurance. The only reason this tax morphed into the individual mandate was to make the bill more palatable to Republican members of Congress who had signed a no new tax pledge.

Polls tell us that, when asked if they like the ACA, a majority of Americans say no. While there is no doubt that most of those who dislike it believe it goes too far, others oppose it because it doesn’t go far enough.

It must also be pointed out that many say they oppose the act because they oppose provisions the act doesn’t even contain – most famously, the “death panels.” The polls also tell us that a majority of Americans oppose “Obamacare,” but at the same time support most of its major provisions. This is the same phenomenon that happened with President Clinton’s health care proposal; people favored the provisions in the proposal, but opposed “Hillarycare.”

Why? Certainly one thing both health care proposals had in common was the barrage of attack ads against them. According to a recent study by Kantar Media’s campaign Media Analysis Group, since its passage the ACA has been attacked in $204 million in advertisements and defended in only $57.9 million.

I don’t know anyone who thinks the ACA is a perfect law. But I remember the case people like President Clinton and Vice President Biden made to Senate Democrats back in 2009. They pointed out that the original Social Security and Medicare acts were hardly perfect when they were passed, but were improved over time. They argued that presidents from Theodore Roosevelt to FDR, Truman, JFK, LBJ, Nixon, Carter and Clinton had all tried and failed to pass a comprehensive health care legislation. Pass it, they said. Then perfect it.

That was good advice then, and even better advice now that the constitutional issues have been resolved. Perhaps after November, when we are not so totally concerned with politics, legislators who agree with the majority of Americans about keeping its major provisions will begin to amend and perfect the ACA. One thing just about everyone should agree on is that having the world’s 37th best health care system is nowhere near good enough.

Originally published 30 June 2012 on delawareonline.com