AEI’s Thomas Miller on Obamacare

On Tuesday, Thomas Miller, a health policy expert from the American Enterprise Institute in Washington, DC, spoke at Baylor University about the past and future of Obamacare.

The law’s past is certainly plagued with dysfunction, said Miller. Enrollment success was limited, with most of the gains in people becoming insured coming from Medicaid expansion – not the state exchanges as was expected.

Open enrollment was a “mitigated disaster,” said Miller. Though it wasn’t an all-out catastrophe, the website debacle was a significant challenge to the public’s opinion of the effectiveness of the law. Miller referenced several marketing and technology problems that characterized the flawed rollout of enrollment into new plans.

Additionally, the disruptive nature of the law (changing people’s existing coverage) hurt approval ratings. When Obama’s “if you like your plan, you can keep it” quote turned out to be untrue, many people turned against the law.

Miller also criticized the implementation strategy of Obamacare, which can be summarized by “Just keep it going – by any means necessary,” he said. The theory is that as time goes on, it will be more difficult to scale back the provisions of the law.

The current promotional pitch also relies on flawed numbers that give a misleading perspective on the actual impact of Obamacare.

Miller compared the healthcare law to a “zonkey” – a cross-breed between a zebra and a donkey. The law sounded like it created a private market, said Miller, but it really contained many elements of centralization to keep those on the left happy.

One of the most distressing things about Obamacare? It uses budgetary gimmicks to collect future higher taxes in order to pay for the law. “Those are long-term claims that aren’t going away,” said Miller. This has resulted in plummeting support among young people as they come to realize what effects the law will have.

The result of these problems? Healthcare has become more politicized. The law’s developments are confusing and uncertain. And the whole process reflects our political system, creating a law that reflects mediocrity and adds extra layers of bureaucracy.

In the future, the law will continue to face risks from economic uncertainties, more regulation, privacy concerns, and further legal challenges. This month in particular has been pretty bad for the law too – with the off-the-cuff comments by Jonathan Gruber, one of the law’s architects, and the Supreme Court agreeing to hear a new challenge to the law.

Ultimately, Miller said the argument of those still supporting Obamacare is similar to the Brezhnev Doctrine, a Soviet foreign policy during the Cold War. Basically, the argument goes that once territory has been gained, it cannot be debated any longer. Essentially, the supporters of the law say that Obamacare has happened, there is no changing it, and it is time to move on to other issues.

Republicans will have an interesting set of choices before them when they take office early next year. They could make small, incremental changes to work together and see what happens. Or they could try to land structural blows to Obamacare (despite the imminent veto from the president).

A new law that maintains the status quo and avoids transparency in healthcare does not help the country, said Miller. In a September article, Miller advised a better strategy to reforming healthcare. “By providing [poorer Americans] with greater choice and control over how to improve their own health, and the opportunity to receive wider varieties of community-based counseling and coordination, we might start to learn that they want something better and how they can find it.”

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