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Robert Field on Obamacare

January 06 2014

Robert Field

Is President Obama’s historic new health care law, the Patient Protection and Affordable Care Act, a government takeover of health care, as opponents have charged — or simply a continuance of the government’s long-standing (and supportive) role in the health care market? Drexel’s Robert I. Field, a professor in the School of Law and School of Public Health, argues the latter in his new book on the U.S. health care system, “Mother of Invention: How the Government Created ‘Free-Market’ Health Care” (Oxford University Press, November 2013).
He spoke with DrexelNow about the rocky rollout of “Obamacare” and the future of the embattled law.
Is the government up to the task of restructuring American health care, or do the problems with Obamacare show it is in over its head?
The government is very much up to the task. In fact, it is the only entity capable of effectively reforming the system. The government has restructured American health care many times in the past through programs like Medicare and Medicaid. If we are to have anything approaching universal access to health insurance in the United States, it will take another government program of similar magnitude, like Obamacare. No private entity has the resources or national perspective needed to accomplish the task on its own.
Is there any precedent for the shaky rollout of Obamacare?
The problems are pretty much par for the course. Every major health reform program has had a shaky start. Even Medicare experienced a rocky launch back in 1965. The Medicare drug benefit is another example. Its rollout was extremely difficult in 2006, when seniors had to visit confusing websites to select coverage plans. In time, the bumps in these and other programs smoothed themselves out, and today they are accepted as part of the fabric of our health care system. Obamacare is likely to follow the same course.
How important has the government been to American health care up to now?
The government can be credited with literally creating the system we have today. Many people fail to recognize this seminal role because it is largely hidden behind a huge private sector that provides most of the actual care we receive. Private health care plays a larger role in America than anywhere else in the world. However, it would not exist in anything close to its present size or shape without government support.
In my new book, I describe the series of government regulatory and funding programs that created and that sustain each major industry sector. For example, research funding from the National Institutes of Health has made possible the development of modern pharmaceuticals; Medicare has supported the operation and expansion of most hospitals and the training of most physicians; and a law passed in 1973, the federal HMO Act, facilitated the rise of managed care. Without initiatives like these, most of the modern technologically advanced health care we enjoy today would not exist.
Is there a chance Obamacare will be repealed or dramatically modified because of the glitches with

As serious as the computer problems have been, they will not lead to major changes in the law. As with most computer systems, the initial glitches will eventually be resolved.  In fact, many of them have already been, and the website now operates fairly smoothly. New glitches will almost certainly arise in the future, but none are likely to make the system unworkable.
The long-term effects of the computer problems will be mostly political. They have provided Obamacare opponents with new ammunition for attacks on the law and have sowed further seeds of public doubt as to whether it will work. However, any major changes would require that Congress revisit the law, something it is unlikely to do in its present state of bitter partisan division. Repeal would require Republican control of both houses of Congress and the White House, something that could not occur before 2017 at the earliest. By then, the website problems will be a thing of the past, and public concerns over the law will likely have faded.
What do Obamacare’s problems mean for the private health care industry?
Despite Obamacare’s rocky start, it will be a bonanza for the private health care industry.  The law will bring insurance companies millions of new customers, substantially reduce the number of nonpaying hospital patients, significantly expand the market for pharmaceuticals and fund the work of countless other providers of goods and services.
As I discuss in my book, this has been the pattern in American health care for more than half a century. New government programs almost always expand the private sector. Even programs that directly fund health care like Medicare and Medicaid rely heavily on private insurance companies for their administration. There is so much to be gained from Obamacare that the private health care industry will be among the strongest advocates for keeping it in place.