Straight Talk About Obamacare

By Dr Davidson (for the Lebanon Daily News)

The Affordable Care Act (Obamacare) is largely a failure but not for the reasons given by its Conservative opponents.  They would have the public believe that Obamacare is a government run health care system and often conflate it with Single Payer systems in Canada and much of Europe.

Nothing could be further from the truth.

Obamacare is faltering primarily because, in the face of needed reform, its framers chose to retain the market based private health insurance system which had proven so inadequate in the past.

In the decade prior to the passage of Obamacare premiums for private health insurance had more than doubled; 1 in 6 Americans were uninsured; and the percentage of employers offering insurance to their workers was in decline.

Sensing the looming demise of their industry, health insurance companies struck a bargain with the new Democratic leadership.   In exchange for their considerable financial support in upcoming Democratic re-election campaigns, the insurance industry was allowed to write the new health care legislation(Obamacare).  Predictably, that law required everyone to buy private insurance policies often subsidized through taxes.   While the Democratic Party was the biggest winner in this arrangement, Chief Justice John Robert’s decision to not strike down Obamacare as unconstitutional signaled to all who were watching that Republicans also had a vested interest in preserving the private health insurance industry.

Obamacare’s initial success in “bending the cost curve” proved to be short-lived and better explained by delayed care due to the Great Recession.  Six years into the ACA, America still retains the dubious title as the most expensive health care system in the world.  At $10,000 per capita, the U.S. spends about twice as much per person as France, Canada, or Germany…countries whose medical outcomes often exceed that of our own.

Defenders of Obamacare can rightly be proud that the law eliminated pre-existing conditions as a barrier to care.  Unfortunately, enthusiasm for that accomplishment must now be tempered with the reality that narrow insurance networks have created new impediments to healthcare resources especially for the seriously ill.

While the total number of Americans without insurance has been reduced under Obamacare from 50 million to 25 million, many of those with insurance find the deductibles so high they cannot afford to use their insurance.  This circumstance known as “under-insurance” has increased dramatically in recent years.

These barriers to care (narrow networks and “under-insurance”) make it unlikely that Obamacare will make significant inroads into the low life expectancy and high infant mortality rankings noted when the U.S. is compared to other industrialized countries.

Having retained the private health insurance paradigm, Obamacare remained at the mercy of the Pharmaceutical industry.  To curry their favor and support, Obama agreed to block legislation that would lower drug prices for Medicare patients and competition from drug manufacturers abroad.  In this, Obama, the Democrat, was following in the footsteps of his Republican predecessor, George Bush, who had made similar promises.

Both Parties have chosen to stay with a market based private insurance model for health care.  Neither have embraced real reform such as a Single Payer(Medicare-for-All) system.  Not surprisingly, universal care remains elusive, medical outcomes less than ideal, and escalating costs unsustainable.

As was once said so accurately… Stupidity is repeating the same actions over and over again, and expecting a different result.

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