Smerconish: 'Obamacare' is many things, but it's certainly not socialism

A woman looks at the HealthCare.gov insurance exchange

A woman looks at the HealthCare.gov insurance exchange internet site in Washington, DC. (Oct. 1, 2013) (Credit: Getty Images)

You know who should be angry about Obamacare? Real socialists. The tea party opponents of the Affordable Care Act promised them a government incursion that the new law does not deliver.

Think back to the rallies of 2009 and 2010. All those signs mocking President Obama with the word socialist emblazoned upon them were as common as Gadsden ("Don't Tread on Me") flags. But the health-care exchanges that launched Tuesday bear no resemblance to what Merriam-Webster defines as "a way of organizing a society in which major industries are owned and controlled by the government rather than by individual people and companies." And actual socialists have noticed.

"Obamacare cannot be considered socialist in any way," according to Greg Pason, the national secretary for Socialist Party USA.


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"The ACA program relies on private health insurance companies to manage health services," Pason said. "A socialized system would not include 'health insurance,' but would be an actual national health-care system which would be publicly funded through progressive taxation and controlled by democratically elected assemblies of health-care workers and patients."

He's right. Under the ACA, health insurance in America is still being delivered by private practitioners and paid for by private insurers. In fact, the vast majority of Americans who receive their health insurance from employer-paid plans will see no discernible change in their coverage or delivery, and need not access the exchanges. The only people who have to access the exchanges are the uninsured or those in the individual market (the 12 million to 15 million who purchase insurance for themselves). Soon, small businesses with 50 or fewer workers will go on the "SHOP exchange." Seniors are another group that should experience no change.

"Those who are reliant on Medicare need not be concerned, either," Mary Agnes Carey of Kaiser Health News told me. "Medicare has its own separate enrollment period. It starts in just a couple of weeks. The Medicare enrollment period is if you want to switch within Medicare to a different plan. ... But regarding the Affordable Care Act and the health insurance exchanges, you don't have to do anything."

The ACA as implemented bears little resemblance to the fears that were once expressed in fierce opposition. Typical was an event that occurred Aug. 2, 2009, when Kathleen Sebelius, secretary of Health and Human Services, and Sen. Arlen Specter faced a raucous crowd at the National Constitution Center prior to the passage of Obamacare.

On that summer Sunday, an overflowing crowd booed and jeered the duo. The Philadelphia Inquirer reported that a group in the back continually disrupted the gathering with shouts of "Assisted suicide," "Abortion," and, of course, "Socialism." One photograph shows a sign that said, "Welcome to the United States Socialist Republic." On Friday, I asked Sebelius whether those complaints bore any resemblance to what has just been implemented.

"Well, it actually, Michael, couldn't be further from socialism," she told me. "These are private insurance plans being sold in a very competitive market. So one of the things the Affordable Care Act has done is to create a market. We had monopolies in many states for people who were in the so-called individual market - one company selling whatever they wanted and actually very few consumer protections. So, many of the people now eligible for not only financial assistance from the federal government, but insurance products for the first time, have the same kind of easy way to shop that people could shop for a television and look at an amazon.com website."

The further irony is that those who were quick to level the "socialist" charge were advocating for the right of people to remain uninsured and burden everyone else, which CNN's Jake Tapper recently raised with Sen. Mike Lee, R-Utah: "When did Republicans start saying, 'That's OK, you can freeload'?" "I don't think that's a fair characterization of the Republican position on this at all," Lee replied.

Tapper responded: "If you're against the individual mandate, or any sort of requirement that people have health insurance, then that is your position." The only liberty interest being sacrificed under the ACA is one's ability to be uninsured. And even that is violable. Carey reminded me that you can still exercise your right to be uninsured, but you will pay a fine.

Obama never effectively rebutted the socialism charge, not that it would have made a difference. The proof that the opposition was rooted in something other than the S-word was evident when Mitt Romney captured the GOP nomination, even though Romneycare and Obamacare have so much in common: Each fashioned a government solution to the problem of the uninsured, and both provided universal coverage, utilized exchanges, offered a subsidy to those who cannot afford coverage, and included no opt-out provision.

Only time will tell if the "affordable" portion of the act's title is warranted. In a Time magazine piece in February, Steve Brill explained that the disparity in health-care costs was often dependent upon who was paying the bill, and argued that we need government regulation of pricing. He worries that Obamacare is all about who pays rather than how much is paid.

It's much too soon to know if it will work, and surely it will be tweaked. The only thing for certain is what it isn't - socialism.

Michael Smerconish writes for The Philadelphia Inquirer.

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