Here are a couple of things about the rollout of the Patient Protection and Affordable Care Act (aka Obamacare) that aren’t about the government shutdown.
For one, today is a key day in the rollout of the PPACA, the first day that the health insurance exchanges become somewhat operational in many states. As Phillip Cryan of the SEIU writes elsewhere on MinnPost today, it’s possible to believe that the new, higher level of Republican desperation to repeal/defund/delay the implementation of the law is that they fear that the more people experience the effects of the law, the weaker the anti-Obamacare ObamaScare campaign becomes.
Personally, I believe that most of the critics are sincere in their belief that the new law is a blow against freedom, including the freedom to go without health insurance, but mostly because any time the government does something additional to help the poor, sick and/or needy, they seem to see it as a step toward the all-encompassing nanny state. And, minus the highly perjorative word choices, I suppose they have a point. Obamacare makes the government bigger.
I wish the law were simpler. All of those thousands of pages of provisions create confusion and provide opportunities for critics to sow fear, some of it utterly false fear like the famed “death panel” lie. (I also wish that everyone who participated in those lies would publicly own up to them and retract and apologize. If you can’t hope to win the argument without lying, it may say something about your underlying argument.)
But the critics often seem to be oblivious, perhaps willfully oblivious, to the main purpose of the law, which was not to grow the government nor to euthanize granny but to get more Americans covered by health insurance. We’re not talking about the poorest Americans, since they already qualified for Medicaid. Nor granny, since she’s already on Medicare.
We’re talking about the working poor who have the kind of lousy jobs that don’t come with employer-subsidized health insurance benefits, and those with pre-existing conditions who cannot get affordable coverage in a system that is based on pure free-market principles, and various other groups that fell through the cracks of the status quo hodge-podge that we call the U.S. “system” of health insurance.
During the original debate on the bill, opponents often glorified that system as the greatest in the world, seemingly oblivious to some of its problematic aspects such as being the most expensive in the world while leaving a huge portion of the population uninsured and producing (along with several other socioeconomic and cuiltural factors) some of the worst health results in the developed world, as measured by such seemingly relevant statistics as life expectancy, infant mortality, death by treatable disease and more.
Atul Gawande, a physician and frequent writer on health care matters for the New Yorker, brings us back to the reasons for the PPACA in the current issue, managing to write without mention of the government shutdown. His opening paragraph is an anecdote:
“Ours can be an unforgiving country. Paul Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. “I should have known better,” he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.”
Of course, Paul Sullivan doesn’t make a perfect case. He should have bought health insurance when he was healthy and apparently wealthy enough to afford it. Who knows whether he would have eventually been bankrupted anyway, once the cost of his treatments ran into a “lifetime limit” on his insurance costs, which is banned by Obamacare.
But as they denounce Obamacare as the latest slippery step on the path to socialism and tyranny, I wish Republicans would explain their plans for extending affordable, quality health care coverage to as many of the currently uninsured as the awkwardly named PPACA is about to do.