Was the end goal of Obamacare to create the expectation of universal health coverage?

Charles Krauthammer thinks so:

On Friday’s edition of ‘Special Report’ on Fox News Channel, syndicated columnist Charles Krauthammer made the case that President Obama’s strategy for Obamacare was not to create a perfect health care system, but to create the expectation that health care is something the government is responsible for. He said Obama had been successful at “creating the expectation of universal care” and that as a result “the zeitgeist of the country has really changed.”… “That is the logic of Obamacare. It was a jerry-rigged system which would temporarily create an entitlement, but would not work because it is financially impossible… But they have succeeded at creating the expectation of universal care, and once you have that… What we’re going to get is Democrats going to a single payer,” he added.

This is indeed what most of us have been hearing and thinking ever since Obamacare was passed—that the passage and then the implementation of Obamacare would constitute a point of psychological and systemic no-return because entitlements cannot ordinarily be turned back. Even if the GOP could agree on a way to roll back Obamacare (and so far, they haven’t been able to), the idea was that the public would not accept a more conservative approach anymore, because they have become wedded to the idea that health care must be a government-guaranteed right and not a privilege.

But I’m also inclined to turn Krauthammer’s idea on its head. I reflect that Obamacare was preceded many decades ago by Medicare, and then in the early part of the 21st century by Part D (passed by the GOP, you may recall). In between (1986) we had EMTALA, the law that guaranteed emergency medical care at hospitals and didn’t really figure out how to pay for it—a law that was passed by a Republican Senate and Democratic House, and signed by Ronald Reagan, as part of a larger bill:

That’s government racketeering explained in a nutshell: create the problem (strain on hospitals due to mandated free care) and use it as an excuse for wealth transfer, which is what universal healthcare amounts to in the end. And look how perfectly it works. The requirements under EMTALA are ostensibly what led to “Romneycare” and inspired the Heritage Foundation and Newt Gingrich to propose government- mandated health insurance coverage, giving liberals and libertarians a fair basis for pointing to “conservatives” as the ones who first proposed health insurance mandates.

Our previous system of health insurance worked pretty well for most people, actually, but it was extremely complicated and some people fell through the cracks. Meanwhile, the growing entitlements (such as EMTALA) were at least part of the reason that health care was becoming more expensive and more often out of the reach of many of those without any insurance. Without going into the ins and outs and the details at the moment, I’ll just say that the expectation that the federal government do more to alleviate the burden was growing and growing and growing, and all the laws that I just mentioned were passed not just to expand those expectations but in response to expectations that had already expanded in a slow but seemingly inexorable progression.

I use that word “progression” purposely. “Progressives” of the left call themselves that in order to promote the idea that their policies represent a natural, normal, and morally good example of human progress going forward in time. But those policies also create dependence, restrictions on liberty, rising costs, and bureaucratic messes that are hard to fix and resistant to change.

Yes, as Krauthammer suggests, Obamacare has “create[d] the expectation that health care is something the government is responsible for.” But it’s also true that Obamacare reflected and was a response to the already-evident fact that the belief that “health care is something the government is responsible for” had been growing and growing for many decades. The details of Obamacare may not (and in fact were not) popular. The idea of it was. The whole thing was a system in which the expectation fed into the legislation, and then the legislation solidified the expectation that something similar would continue.

The current impasse among Congressional Republicans represents a split between those moderates who don’t think we can or should go back very far—those who prefer tweaking Obamacare somewhat to keep the general idea in place but make it “better”—and those further to the right who think that turning it back entirely (and replacing it with one or another far more conservative solution) is not only possible but necessary for the good of the country and its people. This is a profound split rather than a minor one. It’s also an obvious split, and anyone who worked on a new bill to replace Obamacare had to be cognizant of it.

[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]



