The Flathead Valley’s Leading Independent Journal of Observation, Analysis, & Opinion. © James R. Conner.


11 July 2012

GOP Care fails the moral test of government. Does Obamacare?

The Affordable Care Act, aka Obamacare, is constitutional. But it still doesn’t cover everyone. And if it doesn’t cover everyone, how well does it meet the moral test of government that Hubert Humphrey so eloquently described two years before his death?

The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick, the needy, and the handicapped.

In the table following my comments, I offer my assessment of how well three systems of health care — single-payer, Obamacare, and GOP Care — meet Humphrey’s test.

But first, some observations on the health care choices facing the nation.

If Democrats retain control one house of Congress, and/or the White House, this fall, their strategy for Obamacare will be amend and improve. If the Republicans capture control of the federal government, their strategy will be repeal and replace.

“Replace with what?” is a fair question (asked today by Mike Jopek in his must-read column in today’s Flathead Beacon) that the GOP dodges, but the answer is clear: replace with the status quo ante, and then try to privatize Medicare, Medicaid, CHIP, and every other government program that helps Americans in need, so that the greediest of the greediest on Wall Street can rake in more money at the expense of the commonweal.

But — and this is important; and not just important, but mighty damned important — money is not the only issue for Republicans, especially those who are soaked in tea and steeped in Ayn Rand’s icy libertarianism. As the Washington Monthly’s Ed Kilgore put it recently:

…we have to remember that this is an ideological and even a moral issue to conservatives, who view dependence on any form of public assistance as eroding the “moral fiber” of the poor (as Paul Ryan likes to put it), and as corrupting the country through empowerment of big government as a redistributor of wealth from virtuous taxpayers to parasites who will perpetually vote themselves more of other people’s money.

This cruel argument — that suffering builds character while accepting help produces moral decay — is why there is not, and never will be, common ground for Republicans and Democrats on health care. Improvements to Obamacare will occur only when Democrats have the votes and will to pass the necessary legislation. Perhaps that will happen someday. Perhaps. But for now, the nation’s choice this fall is between Obamacare, a flawed and hideously complex program, and a GOP policy that, by shifting all of the risk to the individual, would fail the moral test of government.


A comparison of three health care systems

Best Single-Payer Obamacare GOP Care
Population covered-1 Everyone. Leaves 27 million non-elderly uninsured in 2022. Leaves at least 60 million uninsured.
Annual deaths caused by lack of health insurance-2 0 ~ 26,000 ≥ 40,000
Coverage Everything, including long term care. Depends on what people can afford. Long term care abandoned. Depends on what people can afford. Long term care: bankrupt the families plan.
Payment Government collects money through taxes, pays providers and suppliers. One risk pool. Subsidized private insurance for most ≤ 65. Many risk pools Private insurance — if you can afford it. Many risk pools.
Means testing and pauper’s oaths No. Yes. Yes — and paupers are loathed.
Health care providers Salary, reasonably generous. No stock options. Predominately fee for service. Almost exclusively fee for service.
All providers must accept Yes. No. No.
Private health insurance Prohibited. Subsidized. Eventually, the only system allowed. Subsidizes disallowed.
Prevention of private insurer misbehavior DNA. Private insurer is a null class. None. None.
Medical records Centralized, standardized, electronic. Slow move to electronic. No centralization or standardization. Whatever health care providers like. No centralization or standardization.
Complexity for patients Not complex. Simple check-in, check-out, buy medicine and equipment with a card or flash drive. Hideously and gratituitously complex. Hideously and gratituitously complex.
Hospitals Only public, and private non-profit. Allows all kinds. Transition to private for profit.
Pharmacuetical and equipment manufacturers, search & rescue, etc Regulated private, regulated public. Non-profit encouraged. Private and public. Private, minimal (and probably insufficient) regulation.
Health care quality Highest, provided voters stay mindful of their enlightened self-interest. Varies. Excellent for those who can afford the best, lethal for those who cannot.
Economic efficiency Highest. Low. Insurance companies get a cut yet perform no health care service. Lowest. Insurance companies get a cut yet perform no health care service.
Fate of the uninsured Everyone is covered. Emergency care. Minimal help for chronic illness and preventive care. Eventually, good luck if you get sick. Until then, emergency care and minimal help for chronic illness and preventive care.
Risk of medical bankruptcy for patients Zero. Reduced from pre-Obamacare, but still significant. High. Take personal responsibility: live cleanly & don't get sick. It’s you fault if something bad happens, so if you go bankrupt, you deserve it.
Political feasibility Most western democracies: very high. United states: shamefully low. Enacted into law. Lead pipe cinch if GOP captures White House and Congress.
Meets the moral test of government Yes. Some will say so. No.


(1) Congressional Budget Office. CBO and JCT's Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance. Table 2 (page 27 of PDF). Estimate for 2022.

(2) Calculated by Flathead Memo using data from Physicians for a National Health Care Program ( Obamacare unnecessary deaths = 27 million uninsured * (45,000 deaths/46 million uninsured).