Preparing for the Worst

If I were President Obama, or the head his re-election campaign, I might, in a purely strategic and cynical way, hope that the Supreme Court does, indeed, strike down the Affordable Care Act.¹

I say this on the premise that an old adage is true, that people do not appreciate what they have until it is gone. As it stands, millions of people currently benefit from the ACA, though they don’t necessarily realize it. According to the Kaiser Family Foundation study (Linked in the first graph), 59% of respondents admit that they do not know enough about the ACA. Between 49% and 65% of respondents do not recognize key provisions of the law. In fact, 14% believe that the Supreme Court has already struck the law down!

However, once they start losing their subsidies, and preventive service, once their adult children are kicked off of their insurance, or they are denied payment due to pre-existing conditions, people will better understand their benefits under the ACA.

The right wing propaganda machine has effectively destroyed the legitimacy of the ACA in the eyes of the public. That’s not hard to do when a majority of people do not know what’s in the law. It’s also easy to do when health care advocates, like myself, are disappointed by the anemic outcome of what could have been a true reform, the passing of a moderate conservative idea. Such activists find it difficult to cultivate the necessary zeal to defend the law against extremely zealous attacks.

Despite general disapproval of the law, however, people largely approve of the actual provisions of the lawby overwhelming margins. Outside of the individual mandate, the specific elements of the ACA are very popular. Let’s face it, who like’s any “mandate”? However, if the more popular provisions of the ACA are to be sustained, the individual mandate is necessary. I don’t like it any more than anyone else, but it is the truth. Insurance companies cannot be required to sell insurance, a provision that 69% of respondents approved of, if people can simply wait until they are diagnosed to purchase insurance.

So if the ACA is struck down, that provides the Obama campaign a Marc Antony type opportunity to soliloquize over the bloody corpse of the ACA.

Conservatives are honorable people, and they say the ACA is evil. They must be right

but here is Mrs. Smith who was able to provide health care for her daughter who is just starting out in her career. Now here daughter must purchase her own insurance, without help, because her entry level position does not pay enough to secure those benefits.

But conservatives are honorable people, and they say the ACA is tyrannical. They must be right

but here is Mr. Jones, whose cancer was in remission because he was able to get care despite his pre-existing condition. Now his cancer has come back because he can no longer afford the treatments.

But conservatives are honorable people

Few are satisfied with the American health care system. Sixty percent of respondents say that they would expect lawmakers to develop alternative health care reforms if ACA is struck down. More people would prefer the ACA to be expanded or kept as is over replacing it with a Republican proposal (ironic, since the individual mandate was a Republican proposal) or simply letting it go. Americans want health care reform. The elimination of health care reform, if the Obama administration can inform Americans of what they have lost, can be a rallying cry for even more viable reforms.

Unfortunately, in our musings about political strategy, we must not lose sight of the fact that loss of the ACA, as inadequate as many of us believe it is, would inflict a devastating blow against the uninsured. Mr. Jones above may make for effective political theater, but he still has cancer and will, most likely, die.

The greatest failure of Democrats and the Obama Administration is in allowing the right wing fringe to “educate” the public on the value of the ACA. Now the health of millions of Americans is speculatively in the hands of Justice Anthony Kennedy. Health care activists and the Democratic Party, at this depressing stage, have little else to do but hope for the best and prepare for the worst, hence this rather cynical post.

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¹I am neither of those, so I am not so hoping.