The thorn that fell the lion: the PPACA’s downfall

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Our Political Spectrum

Our Political Spectrum

How did the PPACA (healthcare reform) (Patient Protection and Affordable Care Act) with all its good intentions fall apart? How did the PPACA undermine the Democratic Majority in the House? What was the small but sharp thorn in the side of healthcare reform that took the PPACA down? Well, you know the saying, “the road to hell is paved with good intention.” In the end, good intention is exactly what fell the lion. The PPACA act along with the Affordable Healthcare Act sought, nobly so, to expand healthcare coverage to more of the public while slowing the growth of healthcare costs. These bills proposed various cuts in fee-for-service rates as well as the reformulation of what is billable to Medicare including how often. These new acts attempt to combine many doctors’ procedures once billed to Medicare as separate services as single billable procedures.  Another target of the PPACA’s (healthcare reform) was to expand coverage for those people whose income is above the Medicaid coverage threshold, but is still too low for that person to afford to buy private health insurance. The PPACA also sought to insure a greater number of people while preventing them from losing their coverage once they qualified for it.

However, why did our government even seek to change Medicare, to expand healthcare coverage and slow the growth of healthcare costs? As the costs of insuring oneself has risen and the number of Americans insured has dropped, the public’s desire for government intervention has grown. In plain words, these circumstances got to the point where we could not stand how much of our paychecks we were spending on healthcare and how little coverage we were getting for it. Our increasing concern over who gets to have healthcare coverage and how much it will cost us pushed healthcare reform onto the public policy agenda. Over the past two elections, we have expressed a very strong desire for the government to propose new rules, which would expand healthcare coverage, make it more affordable and lower overall expenditures on Medicare and Medicaid. This concern about affordable healthcare is very much warranted, maybe we disagree about how our government should attempt to solve the issues at hand, but we still all want to fix-up our healthcare system.

Again, our concern about the cost of healthcare coverage and access is justified because without policy intervention by 2015 the total number of uninsured could reach upwards of 56 million (Burton, Friedenzohn, & Martinez-Vidal, 2007). Compounding the levels of uninsured, employers are dropping coverage for employees all together, at an alarming rate. In addition, employers are making it difficult for employees to get coverage by tightening eligibility requirements. This is somewhat understandable because if we cannot afford health insurance how will they be able to pay for it, they are under the same constraints. Therefore, what this amounts to is this: if you have to leave your job, when you get another, you may not get health insurance or your most likely pay more for it than you would have before. In 2000, the average out-of-pocket costs that the employee had to pay for family health insurance coverage was 3,354 dollars; the 2008 figure for that same amount of coverage for that same family was four times that amount. The high cost of healthcare, in essence is forcing employers and employees to drop their healthcare coverage. Twenty million US workers do not have been employer-based, employer-sponsored or public-sponsored health insurance at all. They are now what we call the working uninsured (I might add that our jobless recovery has not helped any).

So how did the PPACA end up with such a thorn in its side? Why does it seem that the creation of this bill and the healthcare reform that when along with it backfired on us? The desire to have more than others played a big part in it, that is because we live in a democracy, our social and economic inequalities are copied right into the political arena, what we want is copied right into our policies. Our fractured views created a fractured bill. If the griddle is bent, the waffles will all come out with a dent in them. To make matters worse, healthcare reform was disarranged further by the private sector, which lobbied fiercely in shaping the debate and the bill. We of course delegate many public tasks to the private sector. This is done in part due to our government’s limited ability to provide for all of our citizens needs and is done in part for the efficiency it brings to our society. This is one reason why we are a market-based society, and it works well, except for when major companies push too hard in slanting new policy in favor of them. They have a powerful interest in how we distribute our resources because they profit from their use by the government. Private enterprises would naturally prefer then to bring to bear as much influence as possible toward shaping the outcome of any policy that would dictate the distribution of such resources. Insurance companies had a staked interest in how the PPACA was formulated because the bill could benefit or hurt them in the end. Insurance companies wanted to limit the negative effects of the developing bill on them. On the other end, because of the influence of private enterprises on policy, our government wanted to write regulations that could not be worked around by those same insurance companies. The result was a very large and unwieldy bill.

The debate seemed to be about the costs involved in expanding healthcare to those who have lost it or were not able to afford it and the costs involved in not expanding healthcare to them. The deliberation included who would be paying for this potential public insurance expansion and the amount of resources that should be transferred from one group to another to offer such services. As always, in life and in our government, it then was a debate between self-interest and social altruism. How much of each was rational in today’s economic environment? The result again was a reflection of our society today. The bill could have been short and direct. For example, it could have just been about the enacting of universal healthcare, but it was not. It tried to please everyone and in so doing, it became a bloated mess. The bill size (over 900 pages) created such a large surface area, which opponents could later pick to death. How we view the end law, whether we view the PPACA as good or bad for America the creation of such a large bill produced by any government agency is going to have much to look at and deride later. For example, take relationships; if right away on the first date you told your partner everything about yourself, later on when you have an argument with her, she would have plenty to hit you with (this goes for men as well). That is not smart at the beginning of a relationship and also for any party who just took office. How best to design a policy that would cut healthcare expenses and increase coverage came down to one’s ideology; the two most dominantly held in the United States conservatism and liberalism, the middle being the dividing line and source or contention. No one wanted to give in, and no one wanted to lose anything, so we got everything and nothing. This is the essence of the thorn that took the lion down and the PPACA with it.

During the 2009 healthcare reform debate, Congress’s views on just how to change the way our private/public healthcare system functions was a reflection of our nation’s dominant ideologies; conservative and liberal proposals, limited government versus social equality. Conservative ideology views that the role of government in public life should be kept at a minimum while Liberal ideology favors government intervention in society to mitigate the tendency of the free market to produce large income inequalities. Conservatives also view the rights of the person as paramount to the role and authority of the government. They place great value in a person’s right to property and limited interference of the government in the free market. Conservatives stress that a governmental redistribution of wealth from one group of people to another will cut the public’s incentive to work. Likewise, conservatives reason that too much involvement in the free market by the government will lead to inefficiencies and lower productivity.

As mentioned, the liberal ideological view, however, favors government intervention in the public to mitigate the tendency, or the free-market to produce very large income inequalities resulting from lack of regulation. Liberals stress the right to social equality of all citizens. Liberals view the goal of any new public policy is to extend social and economic benefits not just to those who have, but to those who may not have as much. Liberals seek to carry out redistribute policies through the transfer of wealth, or benefits from those who have extensive amounts of wealth to those who have much less wealth. The most used public method’s Liberals use to transfer wealth is through the issuance of taxes, the regulating of the market, the regulating of the workplace and through the mandating of insurances such as health, disability, old age benefits and disability benefits. However, the transfer of wealth from one person to another, or the regulating of markets, requires the government to limit personal liberty, which is at odds with those who are conservative.

The Crisis of Policy

The Crisis of Policy

This ideologies are compatible but only towards the center and when moderated. If you polarize each ideology you get a congress that is uncompromising and gridlock ensues. That is exactly what happened. The debate between the parties and their ideologies became so heated and inflexible that in order for healthcare reform to be passed, it had to be forced through by only one party. If no one wishes to compromise sheer strength in numbers is the only way to get anything done. Even then to get the votes necessary, so much bartering had to be done the end result was the production of a bill over 900 pages. Even then this bill was only able to be passed by the party in power which then controlled the House, the Senate and the Presidency, the Democratic Party. Unfortunately, because the bill passed with only one party the bill reflected a majority of that party’s ideology. This in itself may not be bad, but we all have to be aware of the potential ramifications. The fact that the resulting healthcare reform bill contained many liberal ideological regulations then became a target in the next election by those who are ideologically conservative because they saw it as too much governmental intervention into the private sector. With so much to choose from in a bill that large, it became fodder for the upcoming mid-term elections.

The PPACA had several flaws, which in the end undermined the bill and the Democratic majority in the House of Representatives. The debate over what was considered healthcare reform was so inflammatory that the only way to pass the bill was to offer a large quantity of regulatory “gifts” to those state senators who would not vote yes until they got what they wanted. In addition, because those who stood to lose the most, insurance companies could write around any new regulations in the bill, those who wrote the bill attempted to plug any potential future holes that would be used as a way to work around the new rules. Again, these actions by the Democratic majority lead to a rather large unwieldy bill. Therefore, once the bill was passed there were plenty of details to fight about in court and to lobby against afterward. In the end, it also contributed to the loss of House to the Republican Party. Finally, in the end I think what brought the lion down was the fact that you have to fight for a clear identifiable goal that stands on its merits AS IS. The PPACA act and the Democratic Party were undone by the sheer amount of horse-trading it took to get the bill passed. Whether a single payer, nationalized healthcare system is right or wrong, that is what the Democrats ran on, that is what the original bill was supposed to be about and that is what they should have stuck with. The bill should have been voted on AS IS. They should have stuck to what they believed in and have that in of itself voted on. They should have had a short, targeted, blunt, universal single payer nationalized healthcare bill that would pass or fail based on face value. If it failed, then it would have failed. If it failed to achieve the amount of vote’s necessary, then the debating could have begun on another bill, the next one different but short and to the point as well. The thorn was fear and no good is accomplished when fear is the motivator.

State Strategies to Expand Health Insurance Coverage: Trends and Lessons for Policymakers -Burton, Friedenzohn, and Martinez-Vidal

The PPACA Act (PDF)

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