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Farah Stockman

A better way to tackle health law

In 1958, four years after the Supreme Court ruled segregation unconstitutional, the state of Virginia opted to shut down its public school system rather than integrate it. Virginia’s plan to stop integration by starving its own schools of funding was framed as heroic resistance to the federal government’s intrusion into the lives of ordinary Americans. The architects of Virginia’s partial government shutdown claimed the fight was about freedom. About halting creeping communism. And saving the country from certain doom.

Sound familiar?

Just like the leaders of our recent partial government shutdown, Virginian politicians magnified the greatest fears of their constituents and captured national attention. Virginia’s Governor J. Lindsay Almond Jr., made the cover of Time magazine. And just like the leaders of the 2013 shutdown, he failed. Within months, he reopened the schools.

The tragedy then, as now, was that the hysteria surrounding integration shifted focus away from serious thinking about the very real challenges integration would bring. Instead of preparing their people for what would come — and brainstorming ways to minimize the disruption of the new system — Virginia politicians hardened opposition to a policy they would one day be forced to implement.


Today, the politicians fighting the Affordable Care Act are making the same mistake.

Instead of pointing out the very real and serious flaws in the new health care law, they repeat hyperbolic dubious claims: That the act is in the “realm of socialism.” (Representative Steve King of Iowa.) That “individual liberty is gone.” (Representative Louie Gohmert of Texas.) That Obamacare “is going to destroy America and everything in America.” (Representative Paul Broun of Georgia.)

Wouldn’t it be better if, instead of mimicking a doomsday cult, these Obamacare opponents would highlight actual problems that really do exist?

For instance, there is a danger that the law makes it too easy for employers to “game the system” by choosing to pay the penalty for failing to provide health insurance instead of the premiums. The Congressional Budget Office estimates that some 7 million people might lose their current insurance because of that. Smart people who are worried about Obamacare ought to be talking about how to solve that problem.

Others fret that employees themselves might opt to pay the relatively small fine instead of signing up for a health insurance plan. Since they can’t be denied due to pre-existing conditions, there is the risk of moral hazard: People might sign up only when they are sick. That would make the system too expensive to sustain.


And perhaps the biggest looming challenge is how to handle the cost. We still don’t know whether the program will end up saving the federal government money in the long run, or end up costing lots of money.

The new law has created centers for innovation that could eventually pioneer ways to make health care more efficient. Paying doctors to keep clients healthy — rather than for each and every procedure — might result in better, cheaper health care. But then again, the Affordable Care Act could cause hospitals to consolidate and drive up costs.

The uncertain impact on the federal budget is a cause for concern — not just for the doomsday cult caucus, but for everybody. Wouldn’t it be nice if fiscal conservatives focused on problem-solving about that? Every new law has flaws, especially one as complex as this. The problem is that neither Democrats nor Republicans have an interest in fixing what’s broken here. Democrats don’t want to admit anything is broken and Republicans don’t want to admit it can be fixed.

So we are likely to live with the flaws in the Affordable Care Act for years to come, as long as Ted Cruz can make a bigger name for himself trying to end the law rather than mend it. Cruz is a lawyer, just like Lindsay Almond was. I suspect he knows, just like Almond did, that he’s fighting a losing battle. Almond eventually changed course, and helped Virginia take its first baby steps toward integration. A real leader prepares people for the future, however frightening, instead of pretending that he can stop it.


Farah Stockman can be reached at fstockman@globe.com. Follow her on Twitter @fstockman.