In the spin wars over the implementation of the Affordable Care Act, it was just a matter of time before the the law’s opponents countered the precedent of the slow and shaky—but eventually successful—implementation of the Medicare Rx Drug benefit during the George W. Bush administration with an incident from early in Poppy Bush’s presidency: the 1989 repeal of the Medicare Catastrophic Coverage Act. The New York Times’ Carl Hulse gives a big push to the meme that may startle those who don’t remember the saga:
Angry Americans voice outrage at being asked to pay more for health coverage. Lawmakers and the White House say the public just doesn’t appreciate the benefits of the new health law. Opponents clamor for repeal before the program fully kicks in.
The year was 1989, and the law was the Medicare Catastrophic Coverage Act, which was supposed to protect older Americans from bankruptcy due to medical bills. Instead it became a catastrophe for Democratic and Republican lawmakers, who learned the hard way that many older Americans did not want to be helped in that particular way.
Seventeen months after President Ronald Reagan signed the measure with Rose Garden fanfare, a series of miscalculations and missteps in passing the law became painfully evident, and it was unceremoniously stricken from the books by lawmakers who could not see its demise come quickly enough.
Using this analogy creates a real dilemma for Republicans, since it involves comparing St. Ronald Reagan to the quasi-totalitarian Barack Obama, and records his embarrassing complicity in an effort to enhance the Welfare State.
But it’s a lousy parallel in any event, as those of us who do graphically recall the implosion of the “Catastrophic Program,” as it was often called with intentional and unintentional humor. To make a long story short, the program failed because a large percentage of its main intended beneficiaries, Medicare recipients, (a) didn’t think they needed it, mostly because it duplicated (at the cost of additional premiums) private “Medigap” insurance commonly purchased by middle- and upper-income retirees, and (b) thought initially and wrongly it was going to provide something they did need and want: long-term care insurance for nursing home costs. The combination of grievances was overwhelming and politically irresistible.
Some of the pols quoted in Hulse’s piece are trying to make the argument that the angry Medicare beneficiaries of 1988-89 are similar to the angry individual health insurance policyholders who are freaking out over Obamacare. In terms of the size of the aggrieved communities, there’s really no comparison. I can’t immediately find numbers for the size of the Medicare population in 1989, but in 1999 it was over 39 million. 5 to 7 million is the usual estimate of people with existing individual policies that may be forced to change insurance, but a big chunk of them will either pay less or about the same for new policies, or will get significantly better insurance, or will receive subsidies that offset most or all of any additional costs.
More importantly, there is a vast population of Obamacare beneficiaries—approximately 27 million, though the number could rise if more states adopt the Medicaid expansion—who will gain access to health insurance they were denied or could not afford. And there’s an equally vast population of people—today’s 49 million Medicare beneficiaries—who have been deliberately misled that their health insurance will be negatively affected by Obamacare but who will soon learn otherwise.
The two situations simply aren’t comparable so long as Congress and the administration don’t together do anything to screw up the basic dynamics of the Affordable Care Act. The reaction to the unhappiness of individual insurance policyholders indicates a significant possibility they will do just that, but it’s by no means necessary or inevitable.
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