Review: Remedy and Reaction: The Peculiar American Struggle over Health Care Reform by Paul Starr (2011 book)

Princeton professor Paul Starr, co-founder of The American Prospect magazine, has written extensively on the healthcare and public policy and was involved in healthcare reform efforts prior to latest one. His book clearly written and concise and corrects some common misconceptions found in other sources.

Reading it gave me a better appreciation for the necessary compromises that led to the Affordable Care Act. It’s clear, incidentally, that Mitt Romney’s conservative critics are right: What they call Obamacare is remarkably similar to the successful health insurance reform adopted by Massachusetts while Romney was governor. (Starr doesn’t mention it, but in mid-2009 Romney wrote a USA Today op-ed urging Obama to adopt the Massachusetts reform as a model for a national plan, in particular recommending a tax penalty to encourage people without insurance to carry it. Romney now tries to deny he ever suggested that.) In fact, as Starr documents, almost all of the ACA is based on proposals made or supported by Republicans over the years.

Starr cites evidence that most of the opposition to “Obamacare” is driven by misunderstandings of what the law actually involves, including outright falsehoods spread by opponents and cranks, the most outrageous being the ridiculous “death panel” lie popularized by Sarah Palin. Starr mentions a man who wheeled his disabled son forward during a town hall meeting with Representative John Dingell (D-Michigan) and demanded to know why Dingell wanted to take away his son’s healthcare. When Dingell (who is handicapped himself) calmly tried to correct that misapprehension, the man began shouting “Liar! Liar!”

Those on Medicare, the Americans most satisfied with their current health insurance, tend to be the most opposed to the Affordable Care Act, to a large extend because of misinformation. A survey by the Kaiser Family Foundation found that half of of those on Medicare incorrectly thought the new law cuts Medicare benefits, that only a third knew it eliminates co-pays and deductibles for many preventive services, and that just half realized it does away with the “donut hole” in prescription drug coverage.

Weirdly, a lot of those on Medicare complain that the Affordable Care Act is “socialism” even though it’s a lot less “socialist” than Medicare itself, which they generally like. A deeper look suggests that they view the Affordable Care Act as involving income redistribution, which to an extent it does. But so does Medicare, and probably more so.

Opponents of the law spout so much nonsense that Starr doesn’t bother to mention more than a fraction of it. For example, last year an editorial in the newspaper Investors Business Daily attacked the Affordable Care Act by association with Britain's very different National Health Service, and bizarrely suggested that if physicist Stephen Hawking (who has Lou Gehrig's disease, also known as amyotrophic lateral sclerosis and as motor neurone disease in the UK) had the misfortune to live in England, the NHS wouldn't deem his medical care worth the expense. But of course, Hawking is English and like other people with his disease in the UK, he gets his care from the NHS. When he learned of the editorial, Hawking responded with praise for the NHS for saving his life.

Incidentally, Starr points out alternatives to the toothless so-called "individual mandate," and as I mentioned a couple of weeks ago, it's a shame those other approaches weren't used, because they wouldn't have handed the law's opponents an excuse (however weak) for attacking it in the courts.

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