Not that the Democrats are faring any finer in this health reform quagmire. According to a mid-December survey by Pew Research Center for the People and the Press, “Two-thirds (67%) think most members of Congress should be replaced. This exceeds – by double digits – previous highs set in 2010, 2006 and 1994 … Republicans and Democrats overwhelmingly blame the other party’s leaders for Congress accomplishing less.”

And health reform, at least since President Obama signed the bill into law in March 2010, no doubt is among the “less” Americans believe Congress is accomplishing. Once again, the individual mandate serves as a significant piece of the legislation that Republicans vehemently oppose and the Democrats struggle to explain in dollars and common sense.

The most contentious issue: Cost
While the triple-aim and individual mandate scramble party lines, the cost of healthcare is a more divisive matter altogether.

“In order to become elected or stay elected, there are different messages that are portrayed, there are scare tactics utilized by both parties to facilitate the political makeup or agenda,” said Dr. Marianette Miller-Meeks, director of Iowa’s Department of Public Health, and a former Republican candidate in her state’s 2nd Congressional District.

President Obama’s claims that health reform will lower care costs is seen by those on the right as among those political tactics. Pacific Research Institute’s Graham (pictured at right) said that a number of estimates, in fact, point to rising care costs.

[Q&A: John Graham on ACOs and the 'cartelization' of healthcare.]

“Health costs have gone up since the act was passed. The major perks of the act haven’t kicked in but health costs are up by a couple of grand or so a family just in President Obama’s three-year tenure,” Graham adds, emphasizing that Obama promised “costs were going to go down by the end of his first term. That’s obviously not going to happen; it might have just been a campaign speech.”

Amid criticisms of cost, though, John Clayton, vice president of communications of the pro-health reform New Hampshire Hospital Association (NHHA), says that the notion of improving patient care falls by the wayside.

“The patients are being lost in the discussion about dollars and the deficit, as opposed to quality of care, the necessary improvements that hospitals need to make to deliver the kind of care that our people are going to require in the future,” Clayton said. “And we are an industry that needs to be looking forward at a time when many of our elected leaders want to go backward to a rose-colored past that doesn’t exist anymore.”

Patient- or payer-centered?
Economic realities dictate that some budgetary cuts are necessary, and President Obama has about a half-trillion dollars of Medicare and Medicaid reductions in the legislation, of which Graham says “I’m very doubtful that the Medicare cuts in Obamacare are really going to happen in the intermediate term. The doctors already don’t get their scheduled cut, so will the hospitals successfully lobby against the cuts they got?”

Lest the American public not widely recognize the role lobbyists played in creating the Affordable Care Act, health IT evangelist Ahier reminds citizens. “The problem really is that the legislation is poorly crafted. And the reason why is because Scott Brown was elected to the Senate and they wouldn’t be able to accomplish anything in conference committees so the House had to take the Senate version of the bill and vote it up or down, rather than be able to change it,” he explains.