Insight, analysis & opinion from Joe Paduda

< Back to Home


So you want to repeal Obamacare?

Quick, who said “A mandate on households [to buy health insurance] certainly would force those with adequate means to obtain insurance protection.”?

How about :”If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.

See below for the answer…

For the gazillionth (okay, only 7,386th) House GOP members recently voted to repeal or defund Obamacare.  That principled effort has consumed 15% of the House of Representatives’ floor timeone out of every seven hours has been devoted to this Quixotic effort.  

Back in the day, there were calls to “repeal and replace”; those have disappeared of late, replaced by…nothing. Rather, the thinking seems to be “it’s not our job to fix this mess.”

Because there’s no question our health care system is a mess – expensive and horribly inefficient, while delivering outcomes that are far worse than embarrassing. And somehow the current system does not need oversight/repair/re-configuration?

Here are a few things to consider when pondering solutions to the current health care mess.

1.  Insurers won’t cover people with potentially expensive pre-existing conditions unless they are forced to.  That’s just common sense, and responsible behavior.

2.  Because insurers won’t cover high-risk individuals, we have “high-risk pools”.  Unfortunately, these  have always been and are now seriously underfunded.

3.  If a) insurers won’t cover people with history of heart disease, diabetes, obesity, asthma, depression, or a few hundred other conditions, and b) there’s no other coverage, these people will not get insurance coverage.  Unless they are super-wealthy, they won’t get care, either.  

Some make the principled argument that this is not their problem, that the Federal Government’s role does not include anything involving the health of Americans.  I respect that position, as long as it is consistent with their policy views on other matters. I would also note that it is at odds with most Americans who view Medicare – a Federal program – as sacrosanct.

Which gets us back to the original question, who wanted the mandate first?

The lede quote came from the Heritage Foundation; here’s what Heritage’s Stuart Butler said:

“[N]either the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement…Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself…A mandate on households certainly would force those with adequate means to obtain insurance protection.”

BTW, Butler authored the Porsche quote as well…

A question.

Why is Obamacare now anathema to the very people who originated the idea?  

Is it the policy, or the person who’s name is now attached to the very idea first advanced by conservatives?

Note: As always, happy to engage in spirited debate; if you want to posit a different argument, use citations of primary sources to back up your positions.  I do, so you have to.

11 thoughts on “So you want to repeal Obamacare?”

  1. Unfortunately, without any citations to support my theory, I believe that the GOP’s reasons for hating Obamacare is thinly veiled bigotry. The white male establishment simply couldn’t accept that a black man won the White House. Their constituents on the whole will benefit more from the implementation of Obamacare, yet they use covert racial language to convince their constituents that it is in their interests to support the repeal of Obamacare. The link below shows the amount of federal tax dollars collected in each state and the amount received in federal funding. You’ll find that the ‘red’ states on average collect far more than they contribute. Therefore, they would be the ones to benefit most from the expansion of Medicaid contained in Obamacare.

  2. The race card? Really? I’m sorry, but why is that always the fall back position.

    This is nothing more than politics as usual. It has been going on as long as I remember. Democrats attacked Reagan, Democrats attacked Bush. Republicans attacked Clinton. Democrats attacked W Bush. Now Republicans attack Obama. We have an incredibly dysfunctional political system. The focus is not doing what is best for the American people. Instead, the focus is on pandering to your focus groups and trying to get reelected. Nothing important gets done because the focus is on showmanship, not the greater good.

    On the topic of the insurance mandate….personally I think this is a good idea. We require people to have liability insurance to drive a car. Why not health insurance so the government does not have to pay the bills. But I don’t think the mandate goes far enough. The individual penalty is too low to encourage young, single, healthy people to buy health insurance. Pay $2000-3000 per year for employer provided health insurance, or pay a $200 penalty. That’s a no brainer. The biggest issue I see with Obamacare is the adverse selection. The sick and unhealthy get coverage, without the young and healthy to balance things out. That does not work from an purely economic perspective.

    One other big issue. Obamacare does nothing that I can see to solve the fact that our healthcare system is both inefficient and expensive. That to me is a bigger issue than the coverage. Everyone gets health care coverage now. The emergency room cannot turn any one away. Hospitals write off billions each year for indigent care.

    No one wants to really address the cost issue. We passed Medicare Part D which included NO price controls for pharmacy. Why? Money. Money rules in Washington. All that cost generates a lot of political donations and lobbying. The politicians don’t want to kill off the golden goose.

    There is a solution to all this. If you are dissatisfied with the waste and inefficiency in government, vote EVERYBODY out of office. Send a message. It will never happen….but that is the only way things will ever change from the status quo.

  3. When I first read the summery of the Obamacare plan my analysis was it was designed to blow up so we would have a reason to scrap the whole system . It’s a stupid plan that is so convoluted with forced benefits and forced compliance that it is not affordable for most people . Certainly not the young and healthy.
    It is not racist to disagree. Obama is not the problem. We re elected him so most of us preferred him. I think it’s safe to say with out a majority of democrats in the house and senate and one at the helm this bill would not have seen the light of day. Mandatory benefits , underwriting , and participation is not freedom . I would not be sorry if Obama care is not funded. I won’t cry over spilt milk either. Either way Obamacare is a temporary solution.

  4. Joe, you seem to have hit a nerve – although I can totally understand the reason for the fervor. Whatever the outcome, I agree with Mark that the real problem is our political system. John astutely points out that it wouldn’t have passed without the Democrat majority in House and Senate and a Democratic President. What does that say about our political system….? All issues are decided almost entirely along party lines. There is no longer an air of compromise, or better still, common sense. I’m with you Mark. Let’s get rid of the lot. And while we’re at it, let’s get rid of K Street. Then we’ll be on to something……

  5. I found an article by Stuart Butler in USA Today on 2/6/2012. He gave the following reasons for opposing the mandate in the ACA:

    a. He wanted a mandate to purchase catastrophic coverage, not comprehensive coverage.

    b. He wanted changes in the tax code, not direct subsidies to individuals.

    c. He wanted to see risk adjustment for insurers to cover pre-existing conditions.

    I find that items (b) and (c) are pretty pale arguments.
    Item (a) is actually addressed to some extent by the Bronze plans in the Exchanges.

  6. While I can’t say I agree with the Affordable Care Act, and I can’t say I disagree – there remains a whole lot of people out there without health care. On the other hand, there is a means to provide this care and each state has the means – it is called Medicaid, {unless you have the privilege of living in a state like CA in which they have their own spin, Medi Cal}
    The simplest, and I think the most cost effective option, is simply to expand the eligibility requirements for these plans. The Bureaucracy is already in place so why not make it earn a little more of its keep.
    It is correct in that Carriers only want to provide services for those that have not illnesses, duh – who wouldn’t if they could get away with it. Is this not the way of business? And as an individual, why would I purchase insurance if I did not have to? Isn’t that part of the American dream, the freedom to make my own choices? On the other hand, yes, if I want to drive, I am supposed to have insurance – yet many do not, otherwise there would be no need for uninsured motorist coverage, would there.
    OK – all that being said, wouldn’t it take the burden off of a lot of things if the majority of people had some type of health care coverage? Since 80% of the health care dollars are spent by 20% of the people, isn’t this a drain on so many resources. How long do employers have to experience a double and triple dip? The cost of health insurance for employees, the cost of worker’s compensation insurance and the cost of medical care for those injured employees that must have their non industrial medical treatment completed in order to receive the care they need for their work injury.
    Perhaps I am wrong, but if there is coverage for all, I think, there would be less bleeding out in so many other areas.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.