In Defense of Obama
HEALTH CARE
When Obama signed the Affordable Care Act, an excited Joe Biden whispered audibly, ”This is a big fucking deal!” He was right.
The enactment and implementation of the Affordable Care Act, a.k.a. Obamacare, has been a perils-of-Pauline experience. When an upset in the special election to replace Ted Kennedy cost Democrats their 60-vote Senate majority, health reform had to be rescued with fancy legislative footwork. Then it survived a Supreme Court challenge only thanks to a surprise display of conscience by John Roberts, who nonetheless opened a loophole that has allowed Republican-controlled states to deny coverage to millions of Americans. Then technical difficulties with the HealthCare.gov website seemed to threaten disaster. But here we are, most of the way through the first full year of reform’s implementation, and it’s working better than even the optimists expected.
We won’t have the full data on 2014 until next year’s census report, but multiple independent surveys show a sharp drop in the number of Americans without health insurance, probably around 10 million, a number certain to grow greatly over the next two years as more people realize that the program is available and penalties for failure to sign up increase.
It’s true that the Affordable Care Act will still leave millions of people in America uninsured. For one thing, it was never intended to cover undocumented immigrants, who are counted in standard measures of the uninsured. Furthermore, millions of low-income Americans will slip into the loophole Roberts created: They were supposed to be covered by a federally funded expansion of Medicaid, but some states are blocking that expansion out of sheer spite. Finally, unlike Social Security and Medicare, for which almost everyone is automatically eligible, Obamacare requires beneficiaries to prove their eligibility for Medicaid or choose and then pay for a subsidized private plan. Inevitably, some people will fall through the cracks.
Still, Obamacare means a huge improvement in the quality of life for tens of millions of Americans – not just better care, but greater financial security. And even those who were already insured have gained both security and freedom, because they now have a guarantee of coverage if they lose or change jobs.
What about the costs? Here, too, the news is better than anyone expected. In 2014, premiums on the insurance policies offered through the Obamacare exchanges were well below those originally projected by the Congressional Budget Office, and the available data indicates a mix of modest increases and actual reductions for 2015 – which is very good in a sector where premiums normally increase five percent or more each year. More broadly, overall health spending has slowed substantially, with the cost-control features of the ACA probably deserving some of the credit.
In other words, health reform is looking like a major policy success story. It’s a program that is coming in ahead of schedule – and below budget – costing less, and doing more to reduce overall health costs than even its supporters predicted.
Of course, this success story makes nonsense of right-wing predictions of catastrophe. Beyond that, the good news on health costs refutes conservative orthodoxy. It’s a fixed idea on the right, sometimes echoed by ”centrist” commentators, that the only way to limit health costs is to dismantle guarantees of adequate care – for example, that the only way to control Medicare costs is to replace Medicare as we know it, a program that covers major medical expenditures, with vouchers that may or may not be enough to buy adequate insurance. But what we’re actually seeing is what looks like significant cost control via a laundry list of small changes to how we pay for care, with the basic guarantee of adequate coverage not only intact but widened to include Americans of all ages.
It’s worth pointing out that some criticisms of Obamacare from the left are also looking foolish. Obamacare is a system partly run through private insurance companies (although expansion of Medicaid is also a very important piece). And some on the left were outraged, arguing that the program would do more to raise profits in the medical-industrial complex than it would to protect American families.
You can still argue that single-payer would have covered more people at lower cost – in fact, I would. But that option wasn’t on the table; only a system that appeased insurers and reassured the public that not too much would change was politically feasible. And it’s working reasonably well: Competition among insurers who can no longer deny insurance to those who need it most is turning out to be pretty effective. This isn’t the health care system you would have designed from scratch, or if you could ignore special-interest politics, but it’s doing the job.
And this big improvement in American society is almost surely here to stay. The conservative health care nightmare – the one that led Republicans to go all-out against Bill Clinton’s health plans in 1993 and Obamacare more recently – is that once health care for everyone, or almost everyone, has been put in place, it will be very hard to undo, because too many voters would have a stake in the system. That’s exactly what is happening. Republicans are still going through the motions of attacking Obamacare, but the passion is gone. They’re even offering mealymouthed assurances that people won’t lose their new benefits. By the time Obama leaves office, there will be tens of millions of Americans who have benefited directly from health reform – and that will make it almost impossible to reverse. Health reform has made America a different, better place.
In Defense of Obama, Page 2 of 5