Obamacare. Love it, hate it, be indifferent to it - we've heard plenty about it. Yet most of what you've heard is just plain wrong. Either misrepresented or misunderstood (or both), the majority of the "American People" don't have, as Paul Harvey used to call it, 'the rest of the story.'
For all of the blustering on the Right and the defensiveness on the Left, what we know is that the Patient Protection and Affordable Care Act is a compilation of healthcare reforms centered around concepts of accessibility and affordability. That it has had a relatively small impact to date, aside from providing fodder for debate, is interesting in its own right. Most aspects of the legislation will not take effect for some time. For those of you who have children with pre-existing conditions and have changed jobs or have a particularly draconian private policy, you already have benefits and protections. Few can honestly argue that this is a bad thing. Furthermore, if you have a child enrolled in college or post-graduate studies, you can now carry them on your policy up to age 26, again a good thing. Some of the more odious provisions such as the 1099 mandate and prohibiting the purchase of Over-the-Counter medications with an FSA without a doctor's prescription may fall in the near future. Yet the core of the law remains, and what everyone can agree upon, but won't, is that the law itself is everything Republicans have wanted in healthcare for years but they are afraid to admit it. The Democrats sold their soul to get what they did, and should hide their faces for having done so. That's why, and I'll take odds on this, when its all said and done Obamacare will be the law in the land this year and in years to come.
What most of us don't realize is that this 'Franken-legislation' is actually a mish-mash of positions proffered year after year by both the Right and the Left. Most importantly, the foundation of the law is that it uses private insurance to accomplish public policy, just like GWB2 did in by instituting the Medicare prescription drug benefit in his second term. Many seniors saw this to be a blessing, and it was. But the way it was done blew a trillion dollar hole in the Federal deficit. Why? Because the program prohibits the Federal government from negotiating with pharma companies on price. Medicare, by far the largest 'purchaser' of pharmaceuticals in the nation, cannot by law negotiate the prices they pay for medications. Insane. A huge give away to Big Pharma and one of the biggest lobbying wins in Washington in the last 25 years.
Why is this bad policy? Because every time we have placed any program into the hands of the private sector, we increase costs without necessarily adding quality. To that point I bring you privatization of Medicaid on the state level - a fundamental and costly disaster in Ohio and other states - and the incredible tally we pay every year for the aforementioned Prescription Drug benefit.
How does this relate to Obamacare? By adding 35+ million people to the books of private insurers we have created an enormous boon to those companies. When the Dems dropped 'public option' to get what they wanted, they forfeited the high ground - without a 'public option', private insurers have no incentive to offer a superior product with true consumer protections. Before you go all "free market" on me, please note that insurance companies do not create plans to necessarily be competitive with one another and have been repeatedly found to have been in collusion with one another. I know this is getting complicated but be patient with me here - there is a point to be made. Let's add up what we have so far. We are adding 35+ million to the roles of private insurers. We are requiring that people obtain this coverage. We are not allowing the government to participate in the competitive side of this equation, offering an affordable alternative. We are going to rely on a for-profit entity like Aetna or Cigna to determine what coverage we get, when they will pay for what, how our doctors can treat us and what we will pay. People, this is the Republican dream come true vis-a-vis one of their largest contributors, the insurance industry.
Are you getting this? Obamacare is exactly what the GOP has pushed for in separate arguments over the years. The lawsuits trying to strike down the law based on the Constitutionality of the "Individual Mandate" are all Strawman Arguments intended to misdirect attention from the fact that there is a tremendous amount of money to be made here, but the GOP and Tea Party lot need to look like they are for free markets and less government while they are pocketing tens of millions in campaign contributions. The Dems? They are just as complicit in that they ditched the 'Public Option' knowing what the ramifications were in terms of cost. For you see, they too get money from the insurance lobby, just not nearly as much. The White House has their share of blame because they spent so much political capital on healthcare too early and too loudly so they had to sell out on the real fixes in order to pass the law and not get embarrassed a'la Bill Clinton.
Who else does that leave? Why, us, of course. The American People. We will end up with a lesser option provided by for-profit insurance companies with few checks and balances that will cost us all more as we collectively absorb the increased cost of the new millions on the books - many of them who have chronic illnesses left untreated for years, ironically because they couldn't afford treatment. Lovely.
A caveat, before we close. I work in healthcare and have for years now. Nearly universally, doctors and hospitals will agree that Medicare has evolved into the easiest payer to deal with. They pay their bills on time, rarely argue with the physician about care, and do not arbitrarily deny care. Meanwhile, every day countless hours and millions are wasted by physicians and hospitals trying to get private insurance companies to pay their bills, honor their contractual commitments and allow for our doctors to care for their patients as they see fit without interference. Our spineless politicians of all stripes, by not allowing the public option, are now going to force us all into the deep end of the pool with the private insurers as lifeguards. I hope we all know how to swim.
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