It was just about two weeks ago that President Obama and the Democrats in the U.S. Senate took on the Republicans over the continued funding of the programs created by the Patient Protection and Affordable Care Act, also known as Obamacare.
House Republicans and a handful of their colleagues in the Senate wanted Obamacare defunded as part of the continuing resolution to keep the government open past the end of the fiscal year. The president and Senate Majority Leader Harry Reid stood firm, shoulder-to-shoulder, in opposition to the GOP's demands, even going so far as to allow a partial shutdown of the government, ruthlessly enforced by the National Park Service and other federal agencies.
That, of course, was then. This is now. And now, as Obamacare begins to come online, some Democrats have begun to sing a different tune. The days of partisan solidarity over the new health care law are past now that the harsh light of how dysfunctional it actually is has begun to shine. The defects in the healthcare.gov website that have made it nearly impossible for anyone using it to purchase coverage, coupled with the millions of Americans who like their current plan but are not (despite Obama's numerous statements to the contrary) going to be allowed to keep it, has created a political minefield that most savvy politicians, like West Virginia Democratic Sen. Joe Manchin, would just as soon be out of, and quickly.
Manchin is one of several Senate Democrats who have jumped on the bandwagon in favor of delaying the imposition of the individual mandate to purchase health insurance or pay a penalty – or what the United States Supreme Court and the Obama administration, some of the time at least, call a "tax" – for one year. Likewise GOP Sens. Mitch McConnell of Kentucky and Dan Coats of Indiana are getting ready to introduce legislation that would, under law, delay the start date for both the employer and individual mandates that are part of the ACA for one year, putting them off until 2015.
It will be an interesting vote if Reid ever lets it get to the floor. Vulnerable Democrats will be forced to stand with the president – who has, through the administrative process, delayed implementation of the employer mandate for a year – or stand with the folks back home who may have already gotten a letter from their insurance company letting them know that their plan is no longer being offered specifically because of the ACA, and that they must now choose other options if they can ever get on the website.
This is not the way it was supposed to work. The transition to the new system created by the ACA was supposed to be seamless, wasn't it? Shouldn't the federal government be able to mandate how health care is provided and paid for as efficiently as it administers other programs? In fact there were plenty of folks like Rep. Tom Price, a doctor and a Georgia Republican, who warned anyone who would listen as far back as 2009 that little if any good would come from what the president was proposing back then.
Both parties are surprisingly in agreement that medical care in the United States, which is the best in the world, is too expensive. That the federal government has, through Medicare and Medicaid, taken on a major share of the responsibility for providing access to it means that the collective burden for the costs involved is shared by each and every one of us. That burden was unsustainable before Obamacare, which has only made it more so.
The challenge ahead is to find ways to keep costs down. Rather than paying less for care while foolishly trying to preserve the expectations that the quality of care or ability to access it will not be adversely affected, those who are involved in health care policy should be looking for ways to make the services provided cheaper. This is the kind of challenge that America always seems to find a way to address, usually through the development of new technologies that allow consumers and providers to do more with less.
There's plenty of precedent for this. Back nearly 75 years ago, the United States was poised on the edge of a crisis as it tried to figure out how to manage the expenses associated with providing a lifetime of adequate care to victims of polio. The costs associated with such a mission would have busted even the most robust budget in the best of economic times, suggests health care scholar Jim Pinkerton, a former Reagan and Bush White House aide who has looked at the issue closely. Instead, because the scientific and medical communities developed first better treatments for the disease and then a vaccination to prevent it, the cost concerns were left in the dust with all the wheelchairs and crutches that were no longer as widely necessary as they had once been.
This is the real challenge America is facing on health care: to find ways to combat or eradicate cancer and Alzheimer's disease, to make routine blood tests more cost-effective on an order of magnitude that will be meaningful, to find ways to improve surgical techniques that shorten hospital stays and lessen the chance that patients will contract an illness while in recovery. This is what America does best. The first political party to figure this out and explain it to the voters will be the one that ultimately wins their confidence to address the health care challenges moving ahead into the 21st century.