Evolution of the Health Care Debate Culminates in Pre-Election Limbo

With the U.S. Supreme Court set to begin hearing oral arguments about the “individual mandate” provision of the 2010 Patient Protection and Affordable Care Act the week of March 26, 2012, correspondent Matt Negrin reviewed the health care debate in the U.S. for ABC News in “Public Options and Death Panels: How the Health Care Debate Evolved.”

Where the Health Care Debate Began

The Negrin article, published on March 23, 2012, traced the issue to a single question in the 2008 presidential campaign. Negrin identified the moment when the health care reform controversy began, as the answer to a question put to candidates Barack Obama and John McCain at a town hall debate. Asked to define health care as a privilege, right, or responsibility, Obama said, “I think it should be a right for every American.”

The subsequent national argument that culminated in the passage in 2010 of the Affordable Care Act has not only split national opinion, but is forming one of the hottest party dividing lines in the current 2012 presidential election. A major complication has been a failure on the part of the general public to actually understand the reform law, with unfounded rumors and misconceptions flying wildly online, particularly on social networking sites like Facebook.

When CBS News conducted a poll in 2010, at the height of the debate when the most information should have been accessible to the American public, 54 percent of Americans said they did not understand how health care reform would affect them or their families. Gallup polls conducted in the same period never found a higher approval rating for the reform effort than 51 percent in October. At the time of the bill’s passage, only about 45 percent of Americans were in favor of the measure.

How the “Death Panel” Furor Began

One of the most prevalent and pervasive rumors about what conservative critics derisively call “Obamacare” is the notion of “death panels.” In August 2008, Republican vice-presidential candidate Sarah Palin wrote a post on her Facebook page using the phrase “death panel” for the first time, and the inflammatory misperception of “end of life counseling” went viral.

The truth of the matter is that although the counseling measure was actually stripped from the health care reform law itself, Medicare will now pay benefits for voluntary end-of-life counseling as part of annual physicals for seniors. Rather than an attempt to cut costs by “killing off” the elderly by denying them medical care, the benefit policy is a recognition of the graying of the American population. More than a fifth of the U.S. population will be over age 65 within the next two decades.

Rising Health Insurance Costs Are the Real Cause for Concern

It is perhaps a more relevant point of debate for most Americans coming out of the Great Recession that the aggregate affect of health care reform has been an 8-9 percent increase in insurance rates for most Americans. Employers say their healthcare costs are up 2-5 percent. An additional complication is that less than 30 percent of employers have been able to keep grandfathered status for their health care plans, a rate far lower than that estimated by the Obama administration, which suggested a figure closer to 78 percent at the end of 2011.

The recent Willis Report of Employers said, “The accelerated loss of grandfathered status suggests that employers have had to make many plan changes to offset cost increases, and perhaps employers have been more willing to give up grandfathered status in order to take other steps to control costs.”

Controversy and Heel-Dragging Creates Sense of Limbo

This situation, combined with the reluctance of most states to move forward with the required health care exchanges, has largely created a sense of limbo over the progress of the overall health care reform effort. Most Americans feel no progress will be made in this arena until after the November elections, and many are hoping a Republican will be moving into the White House who will dismantle the entire system. At this point, that would certainly lead to even greater confusion, and likely to higher costs. And it would do little to change the fact that more than 50 million Americans still have no insurance coverage whatsoever two years after the passage of the Affordable Care Act.

In addition to being considerably less successful than first envisioned, a fact largely attributable to the Great Recession, health care reform has become an election year headache for President Obama. Not only is he in a position of defending rising insurance costs in the midst of a recession, but he is also being forced to defend statements he made during the 2008 campaign including his initial opposition to the individual mandate the Supreme Court will be reviewing next week.

It is impossible to predict where the status of health care reform will be in 2014 when the bulk of the Affordable Care Act’s provisions will be in place, but now the only fair assessment is to say the measure has elevated costs and contributed to a political stalemate. The losers in that scenario are cash-strapped consumers who, given the astronomical costs of health care in this country, live one major medical crisis away from financial ruin.

Fully 60 percent of the personal bankruptcy proceedings filed in this country are directly attributable to medical debt. And those are the people who will be going to the polls in November. Whether they will be voting for a candidate or against health care reform may not be a matter of semantics so much as a realistic assessment of the current political climate in the nation.