Obamacare repeal without replacement is an immoral experiment

In the scientific world, the forbidden experiment is a study that might have interesting results but is morally and ethically wrong. The classic example is deliberately raising a child without any language exposure to determine if communication is learned or inherent. It would be wrong to knowingly deprive someone of something so vital—so human.

In the name of social policy, governments often conduct natural experiments that no research ethics oversight board would ever approve. In 2008, the state of Oregon used a lottery to randomly assign some people to its Medicaid program because it didn’t have enough funding to provide health insurance coverage for all the eligible people. This created an opportunity to test the hypothesis that health coverage promoted better health.

Researchers piggybacked on Oregon's policy by measuring the difference in outcomes between those given health coverage and those without. They found that by some measures lives were improved but they didn’t detect a change in major health outcomes  over the first two years of the study. Since two years of health insurance may not be enough time to demonstrate better health, the work should continue.

Purposely denying a family health insurance in the name of scientific research would be considered morally wrong, but it’s ok when governments do it. Twenty million people have gained coverage since the passage of the Affordable Care Act (ACA, aka Obamacare) and the rate of uninsurance has dropped to a record low.

My fellow blogger, Robert Field has detailed the various proposals under consideration by the GOP in the new Congress. Each of them share repeal of significant parts of the ACA as a starting point, but are fuzzy on whether the replacement will match what’s been achieved since the law’s passage.

We now see an effort by Congressional Republicans and President-elect Trump to paint the ACA as a failure that is in danger of imminent collapse. By denying that the law helped people and saved lives, they can justify tearing it down to start over without taking responsibility for the consequences if the replacement comes up short.

Criticisms of the ACA remind me of the old TV commercial where we see a kid hitchhiking in a snowstorm holding a sign that says “Miami.” A car pulls up and a woman rolls down the window and says, “We’re only going as far as Fort Lauderdale.” The kid says, “oh, ok,” and looks down the road for the next car.

Sure, the ACA isn’t perfect but it’s accomplished more to improve health coverage and outcomes than any previous health reform effort since Medicare and Medicaid were passed in the ’60’s. Any attempt to repeal or alter it will be judged against its accomplishments. There are real families with real benefits from the ACA, and they are sure to tell their representatives in Washington how their lives have gotten better with health insurance.

The Republicans would be wise to consider this before rushing to conduct this forbidden experiment in conservative policymaking.


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