It’s time to focus on fixing the Affordable Care Act, not gutting it

The woman in the TV commercial is identified as Julie, a mother of two. She’s sitting on a bench in a nice yard containing a kids’ play structure. A little boy swings in the background.

“Two years ago,” Julie says, “my son Caleb began having seizures. The medical care he received meant the world to me. Now I’m paying more attention.

“I have some questions about Obamacare,” she continues. “If we can’t pick our own doctor, how do I know my family is going to get the care they need? And what am I getting in exchange for higher premiums and a smaller paycheck?”

Good questions. Just one thing: There’s nothing in Obamacare, a.k.a. the Affordable Care Act, that prevents a patient from picking his or her own doctor. Nothing at all.

The ad is part of a $1-million ad campaign begun this week by Americans for Prosperity, a conservative group bankrolled by the billionaire Koch brothers, who are said to be a potential buyer for the Los Angeles Times and other Tribune Co. newspapers.

“The American people have serious questions and concerns about the negative impact of Obamacare,” said Tim Phillips, president of the group. “They are waking up to higher premiums and fewer choices, but are being told by the White House and outside groups that everything is just fine.

“We feel it is important to provide education on the true consequences of government intrusion into the private healthcare decisions of families, and provide a counter to disinformation that’s out there.”

And that would be fine, if what the group is saying were true. But Americans for Prosperity, like many conservative critics of the reform law, is offering its own disinformation rather than constructive improvements.

Julie’s concern about not being able to pick her own doctor simply isn’t valid. As is the case now, people would be limited only by private insurers’ own physician networks, not government rules.

As for those higher premiums and smaller paychecks, that would depend on a number of factors, such as the overall health of Julie and her family and whether they qualify for federal subsidies.

Yet it’s likely that any increase in premiums would come with a commensurate boost in coverage when compared with many of the bare-bones policies currently available to those who don’t receive insurance from employers.

In any case, Julie’s son wouldn’t even have qualified for such coverage in the past, because of his preexisting condition. Obamacare fixes that.

Larry Van Horn, a healthcare economist at Vanderbilt University, said both sides, Republicans and Democrats, are entitled to their opinions about healthcare reform. The law isn’t perfect, he said.

“But this is the law of the land,” Van Horn told me. “The Supreme Court upheld it. Move on.”

The real discussion we should be having, he said, is how we should reshape our healthcare system in light of the more than $27-trillion shortfall that Medicare is expected to run over the next 75 years as medical costs rise and the population ages.

A study published this week by the Journal of the American Medical Assn. found that the United States has a “mediocre” healthcare system compared with other wealthy countries.

“The United States spends the most per capita on healthcare across all countries, lacks universal health coverage and lags behind other high-income countries for life expectancy and many other health outcome measures,” the authors of the study wrote.

Van Horn said we have to make some challenging decisions if we want to improve things.

“There is no way we can provide all Americans with Bill Gates’ level of healthcare,” he said. “We need a conversation about what level of healthcare we can provide.”

Obamacare, in theory, provides a starting point for that conversation. It lays the groundwork for a healthcare system that, like it or not, maintains America’s commitment to private insurers and employer-based coverage.

Yet Republican legislators refuse to be part of the solution, unless voting 37 times so far to repeal all or part of the law can be viewed as a worthy contribution to the reform process.

Conservatives have married their political fortunes to the notion that Obamacare is a catastrophe and must be discarded in its entirety — even though some of the signature elements of the law, such as a requirement that most people be insured, are ideas that they originated.

“There’s plenty of blame to go around for what’s wrong with the law,” said Mark Pauly, a healthcare economist at the University of Pennsylvania’s Wharton School. “What we need now is an informed debate about how it can be made better.”

And that’s precisely what we’re not getting.

President Obama recently announced a one-year postponement to implementing a requirement that businesses with more than 50 workers provide employees with health insurance. The delay, the White House said, will give companies more time to adjust to the complicated change.

Republicans are entitled to grouse about the half-baked status of the regulation, and they undoubtedly have valuable input to offer on what is needed by businesses to make the transition smoother.

But, like Americans for Prosperity, their sole priority so far has been to obfuscate and mislead.

“This further confirms that even the proponents of Obamacare know it will hurt jobs, decrease economic growth and make it harder for families to have access to quality and affordable healthcare,” said House Majority Leader Eric Cantor (R-Va.).

He called for the entire law to be scrapped and for “patient-centered reforms” to be enacted instead.

Obamacare has plenty of patient-centered reforms, as Republicans well know. The law’s guarantee of coverage to all is among its most popular features, as is an end to lifetime spending limits by insurers and a provision enabling young people to remain on their parents’ insurance policies until age 26.

Polls show that such benefits are popular among Republican and Democratic voters alike. Polls also show general approval for provisions that reduce the number of uninsured.

But any law this complex is all but guaranteed to need some rethinking as it encounters the real world.

Jeffrey McCombs, a healthcare economist at USC, drove this point home by sharing with me a list of changes he thinks should be made, including a healthcare insurance tax deducted from people’s paychecks and vouchers to buy coverage.

Those are the sort of ideas we should be talking about, he said. Instead, we’re having a schoolyard fight over who has the better lunch.

“Both sides are basically cherry-picking information,” McCombs said. “What we’re seeing are mostly half-truths.”

It would be nice to think we’re better than this. Obviously we’re not.

It also would be nice to think that the American people aren’t easily duped by shameless propaganda. But it’s been shown again and again, since the days of Joseph McCarthy, that irrational, unsubstantiated fear is among the most potent of weapons in the American political arsenal.

Healthcare reform is too important for politics as usual. On this issue, if no other, we should at least agree to act like grown-ups.

David Lazarus’ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to david.lazarus@latimes.com.