In ancient Israel, on the Day of Atonement, the High Priest took two goats. One of these goats he sacrificed to the Lord, and the other he laid hands upon–symbolizing the affixing of sins to the goat–before symbolically sending it away into the wilderness to represent God’s removal of sin from the people. This, as you may have surmised, is where our term “scapegoat” comes from, meaning one who is blamed for the sins of others.
As implementation of the Affordable Care Act continues, it seems that “ObamaCare” is the perfect scapegoat for the health care system. Initially, the debate over health reform centered on the hypothetical scenarios that might occur if Congress did or did not pass the legislation. Of course, none of us has the prescience to forecast with any certainty what will happen, and the wisest of us in the world of health policy and health services research are quick to acknowledge our limited foresight.
I don’t find this particularly concerning. If the ACA works well, then some measure of success shall have been achieved. If the ACA–or parts of it–fail to work as intended, then we go back to the drawing board and fix things. With the certainty that the current state of the health care system was unsustainable, the uncertainty of ACA implementation and its consequences was an entirely necessary risk to take.
What I am much more concerned with, however, is the potential role of ObamaCare as the scapegoat for anything and everything that goes haywire with the health care system–regardless of whether the ACA was actually the driving force behind it. If, for example, insurers want to raise rates, they can do so–within the bounds of the new law–and they can simply pass the buck by blaming ObamaCare. If physicians, many of whom have notoriously refused to accept Medicaid and even some Medicare patients, want to continue this behavior, they can do so and exclaim: “ObamaCare made me do it!” You get the idea.
So, going forward, it will become extremely difficult for the public to know how well the ACA is or isn’t working, because any number of health care payers and providers will be blaming ObamaCare for their own self-interested business practices. And, of course, the political rhetoric will evolve to incorporate this same theme—ObamaCare doesn’t work, because some in the health care industry say it doesn’t. The American people will need to think back to the time before ObamaCare and ask themselves a simple question: Did my insurance company always look out for my best interests and keep rates low before ObamaCare? Of course not. This will be nothing new. It’s just they have a convenient scapegoat to blame it on now.