6:46 PM EDT, September 30, 2013
"All of this would be funny if it weren't so crazy."
That was President Obama commenting the other day about some of the irresponsible, outlandish and just plain idiotic things critics have been saying about the Affordable Care Act.
We've now reached an important milestone: Pre-enrollment begins Tuesday for people to sign up for insurance through the online exchanges created by the healthcare reform law. Actual coverage will begin Jan. 1.
This is crunch time. Republicans know that once people get a taste of the benefits they'll receive under the Affordable Care Act, there will be no turning back. So the GOP is working overtime to misinform, frighten and dupe people into keeping their distance.
Think that's an exaggeration? Rep. Michele Bachmann (R-Minn.) said the Affordable Care Act must be repealed "before it literally kills women, kills children, kills senior citizens."
Literally. Kills. Children.
In reality, the law extends health coverage to 95% of kids and, among other things, blocks insurers from placing limits on coverage and prohibits them from taking insurance away if a child gets sick.
"Extremists are allowed to say whatever they want," said Glenn Melnick, a healthcare economist at USC. "So you're going to get people saying extreme things, whether or not they're true."
He noted that the Affordable Care Act "is actually not that big a deal," reform-wise. It doesn't do much to address fast-rising medical costs. It doesn't lay the groundwork for the long-term sustainability of the Medicare program.
"If you want people to have coverage, it makes progress on that," Melnick said. "But prices are still going up. Premiums are still going up. This will keep happening despite the Affordable Care Act."
So why are critics so apoplectic? Why do Republicans say they'd rather shut down the federal government and face the prospect of the United States defaulting on its debts than accept a law that extends health insurance to about half the 50 million people in this country now lacking coverage?
Richard Frank, a health economist at Harvard Medical School, told me he believed this isn't really a debate about healthcare. Rather, it's a debate about the role government should play in people's lives.
So when Sen. Ted Cruz (R-Texas) said during his fake filibuster last week that the Affordable Care Act poses the same sort of threat to America that Nazi Germany posed to Europe, he was apparently expressing his misgivings about fascist dictatorships.
Never mind that we willingly rely on our government to provide healthcare for seniors, low-income people and the disabled; to shield seniors from poverty; to protect us from unsafe food, water, medicine and consumer products; to maintain public order; and to perform countless other tasks.
"The truth about Obamacare is it's failing the men and women of America," Cruz said, ignoring the fact that the law's most important provisions, such as a rule preventing insurers from denying coverage to people with preexisting medical conditions, won't kick in for several more months.
Heavy-breathing hyperbole aside, a hallmark of reform criticism has been to cite every glitch and minor setback as evidence of catastrophic incompetence — a "train wreck," as Republicans have been fond of repeating over and over.
The Obama administration acknowledged last week that there would be brief delays in rolling out software to help small businesses shop for insurance and a Spanish-language version of the Healthcare.gov website.
It would have been a miracle if something as complex as the Affordable Care Act could have been implemented without some bumps and bruises. No law of similarly sweeping scope has ever been introduced without some tweaking required.
"This reform is here for a while," said Dana Goldman, director of USC's Leonard D. Schaeffer Center for Health Policy and Economics. "It's not like we get only one shot at getting it right."
But critics seized on these latest delays as proof of the Affordable Care Act's complete inadequacy. "This law is a disaster," declared Sen. Orrin Hatch (R-Utah).
Sara Rosenbaum, a professor of health policy at George Washington University, said it's baffling that opponents of healthcare reform have framed their criticism in the most ridiculous terms.
"I'm at a loss to understand the extraordinary rhetoric surrounding the Affordable Care Act," she said.
Rosenbaum was also struck by the cruel irony of people with government-provided health insurance arguing against a law that would help extend coverage to millions of people who lack coverage.
"Ted Cruz has insurance," she said. "Michele Bachmann has insurance. To have this coming from relatively affluent, well-insured people is beyond the pale when there are so many people who aren't as fortunate as they are."
The billionaire Koch brothers are undoubtedly well-insured. Yet they've funded ads that attempt to persuade uninsured young people not to sign up for coverage through the new exchanges.
One ad shows a scary-looking Uncle Sam preparing to give a young woman a gynecological exam. Another shows Uncle Sam preparing to give a young man a rectal exam. "Don't let government play doctor," the ads say. "Opt out of Obamacare."
There's a method to the madness: If enough healthy young people opt out of the reform law, insurance rates would become unaffordably high for those who participate in the system. This is, in other words, a deliberate attempt by conservatives to sabotage healthcare reform.
"There's nothing constructive about this," said John Petrila, chairman of the Department of Health Policy and Management at the University of South Florida. "It's as if there's no empathy for people who get sick."
Because this debate isn't about sick people. Nor is it about healthcare, or even the role of government.
It's about denying Barack Obama a legacy as the president who succeeded in tackling our shamefully dysfunctional healthcare system.
That was the conclusion reached by every expert I spoke with. They pointed out that many of the ideas in the Affordable Care Act originated with the Nixon administration and the conservative Heritage Foundation. And it's not as if Republicans are ideologically opposed to fixing the healthcare system.
"They're just determined to prevent Obama from getting credit for it like Roosevelt got credit for Social Security," said Robert Field, a professor of health law at Drexel University. "There are some in the Republican Party who will burn down the healthcare system and the economy before they let this happen."
It would be funny.
If it weren't so crazy.
David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to firstname.lastname@example.org.
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