MedSmarts

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Obamacare Critics Focus on the Lawn While House is Burning Down

Both Obamacare & Its Critics
Miss the Big Healthcare Picture

obamacare supporters reopresented by democratic donkeyobamacare opponents represented by republican elephantA recent column at CommDigiNews caught my attention as it seemed to be one of the less inflammatory broadsides against Obamacare. That this is noteworthy reflects the level of discourse on America’s most divisive political issue.

Written by a college professor, it was thankfully short on the usual anti-Obamacare polemics.  It suggests, basically, that many Americans are paying a price for Obamacare. This takes the form of higher taxes to cover more low-income Americans on Medicaid and purportedly higher premiums for many Americans because of the expanded coverage by private insurance mandated by Obamacare.

While there’s some merit to his basic observation that not everyone is well-served by Obamacare, the conclusions he draws are, in my opinion, ill-considered.

Here’s the reply I posted on this column:

“This piece seems to me to lack the very balance it accuses Obamacare proponents of displaying. All the ill effects you attribute to Obamacare were ‘pre-existing conditions’ – some of which are exacerbated by Obamacare and others ameliorated…

“Narrow provider networks are nothing new and are an essential tool for containing costs; neither are physicians refusing patients with coverage in plans they don’t accept…

“I’m not a ‘true believer’ in Obamacare and have criticized it extensively on my own blog. I am a realist, however, and recognize the deep-rooted flaws in our healthcare system that have nothing to do with Obamacare. Its failure to grapple with the greed, incompetence, and outright threat posed by our broken healthcare system are among its greatest flaws…

“But do you really think repealing it will solve those problems? Get real – all undoing Obamacare will do is give even freer rein to these abusive practices that thrive most in our least regulated states (see Our Healthcare Sucks, where these states dominate my list of ‘Rip-Off States’)…

“As for the costs to cover more of our poorest citizens, I consider that a matter of priorities. If we’re OK subsidizing corporate interests in all other spheres – from farming to defense, from colleges to prisons – then why aren’t we OK with subsidizing what’s needed to protect human lives, our fellow Americans?…

“I’m extremely comfortable with that. Why aren’t you?”

We Don’t Need No Stinkin’ Regulations…

Of course, I didn’t expect this to go unchallenged – and wasn’t disappointed. Although this commenter’s icon read “Don’t Tread On Me”, his reply was also short on the usual heated rhetoric. He correctly assigns blame to corporate ownership of politicians and voter apathy about it, but also suggests there are – and will be – too many “unintended consequences” with Obamacare that outweigh its benefits (see his complete comment).

I responded that massive legislation like the ACA – or Obamacare – almost always requires refinement while being implemented to mitigate those unintended consequences, while he’s of the view that laws shouldn’t need rules or regulations to be implemented.

This is silly, of course, but I tried not to be rude in responding. I hope I succeeded…

“I appreciate your constructive tone and absence of vitriol…laws SHOULD have rules and regulations to implement them. You seem to abhor this necessity, but…laws aren’t…written in the detail required for their implementation. Virtually all laws require rules and regulations – and often legislative revision – to be properly implemented…Without them, laws would sit on the books without enforcement…

“What I find most interesting is your apparent presumption that we didn’t have great price pressure before Obamacare. Healthcare costs have been increasing at multiples of non-medical inflation for decades – and have, in fact, slowed down since Obamacare was passed (I know, lots of reasons for that – but wouldn’t Obamacare be blamed if it were the other way around? You know it would)…

“Look, this thing ain’t perfect – by a long shot – but the responsibility we all share is to make it better. That’s what usually happens with such epic legislation. But the current toxic political climate has thrown that usual legislative function into limbo in favor of the repeal construct – back to business as usual. No thanks…”

Messin’ With the Lawn
While the House is Burning Down

“…Your most glaring omission is your complete lack of acknowledgement of responsibility beyond the political realm. The real problem with our healthcare system is very much driven by doctors and hospitals, not politicians

“Yes, they buy off the pols with campaign contributions – no industry more so than healthcare – but it would be even worse with no government constraints. I refer you to the data of our least regulated states – which virtually all manage to rank among our worst performing and highest cost states for healthcare (my ‘Rip-Off States’)…

“It’s not just political and corporate corruption – it’s medical corruption that’s even more culpable. Nothing gets done in healthcare without a doctor’s order. Nothing…

“And no industry has a fraction of the fraud settlements with the government as our healthcare industry – responsible for more…than all other industries combined – times FOUR! Where’s the outrage about THAT?…

“You’re looking at the wrong set of problems. You’re messing with the lawn while the house is burning down.”

They’re ALL Messin’ with the Lawn

Our politicians are messing with the lawn, too – even Obama. He abandoned his campaign promise favoring a single-payer approach – let’s call it “Medicare-For-All” for now – in favor of the industry-favored (and previously Republican-favored) approach of mandated private coverage. Combined with expanded Medicaid coverage for low-income Americans, he may have had the right political calculus to get through what all his predecessors had failed at doing.

But that political calculus failed to predict the extent of Republican intransigence to their bill. They can be partially forgiven for this because it was, after all, a Republican plan they passed with Obamacare. That intransigent opposition, however, has prevented the kind of “repair” amendments that would improve the law as it’s being implemented – mitigating the rough edges that do, in fact, hurt many Americans.

We can blame Republican opposition for denying this time-honored approach to legislative implementation – focusing on fixing legislative flaws rather than repealing bills entirely – but that’s not how many Americans are likely to see it this election cycle.

By capitulating on the public option that would have at least given the newly-insured the choice of a private plan or a publicly-run insurance plan like Medicare – the administration lost its most crucial distinction from what had been the darling of the Republican opposition to Hillary-care in the 1990s and since.

Add to this the Supreme Courts’ decision that the proposed Medicaid expansion had to be optional for each state – since they foot some of the bill for it – and both groups expected to benefit most from Obamacare get far less benefit than they otherwise would. Fully two-thirds of those who’d benefit from an expanded Medicaid program are now denied because they live in the 26 states that have decided not to cooperate in expanding Medicaid for their states’ poorer populations.

And those required to purchase private health insurance by the end of this month – or pay a federal penalty – would be able to get far cheaper insurance had they access to a Medicare-like alternative. Although there are those who dispute this (aren’t there always?), Medicare costs are consistently considerably less than their counterparts in the private insurance industry. This is to be expected, since there are no shareholders to satisfy with profits and no 8-figure corporate salaries to absorb.

So kudos to Team Obama for getting something passed, but had they stuck more to their guns – and been more realistic in assessing their opposition – they might not have abandoned the public option. And their obstacles now would be fewer.

Wasting a Good Crisis

Obama had the wind at his back – “Hope and Change” and a Nobel Prize to boot – and an economic collapse that made radical measures easier-to-swallow. This was the perfect climate to finally tackle real healthcare reform , not just health insurance reform. Because what good, really, is better access to a healthcare system as broken as ours?

Will some of those with newly-won access to healthcare be better off now? Sure, but there could be as many who are newly-victimized by medical errors responsible for up to 440,000 needless deaths every year. Most of those victims had health insurance.

Perhaps it’s naive to think you could take on not only the health insurance industry, but healthcare providers as well. But that’s what we needed – instead we have neither truly reformed.

“Never waste a good crisis” should have been taken more to heart, it seems.

More Political Hardball to Come

And, of course, the failed launch of the healthcare.gov website – the central hub for implementing Obamacare – was incomprehensible, a screw-up of epic proportions that further discredits the law in the eyes of a skeptical public.

But the issue now isn’t Monday-morning quarterbacking – that helps no one now. The issue now is what, if anything, can be done to mitigate whatever damage is being done by Obamacare as it’s being forced to be implemented – meaning without recourse to the usual legislative amendments that might smooth any rough edges from the law.

When Obama uses “rules and regulations” to try to do so, of course, the opposition cries foul – so it’s a bit of a damned-if-you-do and damned-if-you-don’t for the President.

But that’s the political reality. It will be used by Obamacare opponents to preserve a worst-case scenario for Obamacare, at least through this year’s elections – and very likely through the 2016 presidential cycle as well (oh joy!).

Which means we’re in for more sharp elbows and body blows as the nationally-orchestrated dump-Obamacare campaign plays out in congressional elections across America later this year.

And, no surprise, the folks who may actually be harmed by Obamacare – and it’d be disingenuous to deny they exist even if their numbers are wildly overblown by the law’s opponents – are prevented from having their problems repaired by the very people pretending to defend them. And that’s because their vitriolic opposition to the law includes refusing to fix it where it needs fixing.

A Catch-22 for the administration and a big F.U. to those left holding the bag.

Ain’t politics grand?

Check out my brand new eBook on Obamacare –

It’s…

obamacare for smarties image with albert einstein

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