COMMENTARY
 by Paul Waldman |
Talk to a Republican about their objections to the domestic policies President Obama has pursued, whether it's about taxes or the environment or health care, and before long you're bound to hear the word "uncertainty." It's a handy comeback when the facts aren't actually on your side. So maybe Obama hasn't instituted the huge tax increases Republicans imagine (in fact, tax revenues are at or near historic lows, both as a proportion of the economy and in terms of their burden on the middle class). But because of the size of the deficit, he might some day, and that creates uncertainty. Sure, he hasn't actually unleashed the regulatory tsunami Republicans would like people to believe. But he might, because that's just what big-government liberals do, and that creates uncertainty.
And most of all, the Affordable Care Act has all along created job-killing uncertainty among American businesses large and small because they just don't know what to expect. Conservatives might not be able to tell you in specific terms what awful things the ACA is supposed to do to businesses, but that just shows how much uncertainty there is. Employers, consumers, dogs and cats—we're all supposedly paralyzed by what House Majority Leader Eric Cantor calls the "cloud of uncertainty" hanging over our heads thanks to Obama.
Paul Krugman famously coined the term "confidence fairy" to describe the mythical creature who is supposed to reward nations with economic growth when they create "confidence" by imposing merciless austerity programs. Conservatives believe in the equally mythical uncertainty demon, who just happens to punish us for whatever Democrats do when they're in charge.
So now that we know the Affordable Care Act is going to stand (barring a successful Republican effort to repeal it under President Romney), perhaps it would be a good time to take note of what the ACA actually does with regard to business. Because there's no reason to remain uncertain any longer.
There is an employer mandate within the ACA, but it does more to help businesses than impose new costs on them. First, businesses with under 50 employees are exempt, so if they don't want to offer their employees insurance, they don't have to. But if they do, many will be able to get government subsidies to defray part of the cost. And they'll be able to get insurance through the new exchanges, which should make comparing plans easier and may bring down premiums. Businesses with more than 50 employees do have to offer insurance, but almost all of them already do: According to (pdf) the Kaiser Family Foundation, 92 percent of businesses with between 50 and 100 employees offer insurance now, as do 97 percent of businesses with over 100 employees.
The fact that most Americans get their health insurance through their employers is largely an accident of history, and you can argue that it would be better if we moved to a different way of providing insurance. But now that the ACA has been upheld, there really isn't much more uncertainty in health coverage for employers, other than not knowing how much premiums will rise in the future. That, of course, was uncertainty with which they've always dealt.
And that points to what is so laughable about the uncertainty argument: It presumes that before President Obama came along, businesses were certain about everything—or about anything. The truth, however, is that every business has to deal with uncertainty all the time. You don't know if the materials or labor you depend on will increase in price, or if an economic downturn will make your customers reluctant to buy, or if dynamic new competitors will emerge. Uncertainty is baked into private enterprise. And as for a business's relationship to government, things can always change. Taxes can go up or down, regulations can be created or eliminated, the government might build a new road to your store or bulldoze it to create a new highway. Things are uncertain no matter which party controls the White House. But if Mitt Romney wins in November, you can be pretty certain that Republicans will stop talking about uncertainty.
Paul Waldman is a Contributing Editor with The American Prospect magazine and the author or co-author of a number of books about media and politics, including The Press Effect: Politicians, Journalists, and the Stories That Shape the Political World. His writing has appeared in The Washington Post, The Los Angeles Times, The Boston Globe, and many other newspapers and magazines.
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I welcome the ACA as something long overdue for America. I lived in Britain for three years while on active duty. I simply can not say enough good positive things about the British National Health Service. Nearly all the things American conservatives say about the United Kingdom, Canada, Australia, and New Zealand or other Western European health care systems are nothing but distortions, falsehoods, and outright lies. All of these countries get better medical care than in the U.S. 50 million Americans are uninsured with 45,000 of these people dying annually from treatable conditions. A further one million Americans file for bankruptcy because of expensive medical bills. Costs in America are also out of control with double digit annual increases the norm. Much of this is paid for by the $1100 extra American families pay for health insurance policies for the uninsured. So we pay for those 50 million uninsured every single business day. More importantly the American system is twice as expensive per capita as any other industrialized country in the world.
The ACA will take care of many of these problems by covering another 30 million people. I am afraid however, that more will have to be done before everyone is insured. I am thinking that more expansion of Medicare and Medicaid will be necessary if we still have segments of our population who are still uninsured once the ACA goes into effect in 2014. The key concept to remember is that we must have universal coverage so that all Americans can see a family care provider in a clinical setting for routine examinations and treatments. The reason the Canadians, British, Australians, and Western European countries beat us at costs and public health outcomes are the fact that their systems all provide universal coverage with a family care provider in a clinic setting. We Americans need to focus in on this fact like a laser beam cutting through steel. All the other stuff you hear about health care is of much less importance than the routine access to a family care provider that universal coverage provides.