Obamacare approaches, anxiety and political games

Healthcare accounts for nearly one-fifth of the US economy while America is by far the world’s largest economy.  Obamacare represents a serious economic concern for everyone in the global economy.  More than that, healthcare is a very personal matter that thoroughly affects our overall wellbeing as well as the wellbeing of our families and communities.  With key provisions of the Affordable Care Act coming into play over the next few weeks, most notably the individual health insurance exchanges know as the Health Insurance Marketplace, people are very anxious.  Not only do these changes impact what type of healthcare services will be available to every American, healthcare alone represents such a significant portion of the average American’s income that the burden could easily bankrupt most families, if something goes wrong.   

Beyond the anxiety of waiting for unanticipated failures, most Americans are at a disadvantage when it comes to understanding changes in law.  Americans focus on what we are good at and just want to do our jobs.  Carpenters just want to build and writers just want to write.  Unfortunately, the world more and more requires individuals to think and act like businessmen, accountants, lawyers, etc. even if most people lack the innate qualities, education, and time required to pursue the skill sets involved.

 When it comes to policy changes, this is problematic since most people only have the time and skills required to understand proposed legislation as a handful of overall bullet points.  Quite frankly, people get frustrated and tend to ignore serious issues for this very reason.  This inability to engage the political and legislative process has, however, hurt our democracy while it has resulted in public policies that go against the interests of most Americans.  When it comes to personal and financial matters like healthcare, people find themselves in a situation where they cannot simply ignore policy changes and must deal with the paperwork, to put in the simplest of terms.  As such, I think it is fair to say the impulse of most Americans is to reject changes like those created by Obamacare, because of the confusion and frustration involved in the process of change. 

Although political leaders on the right are capitalizing on this impulse to push their agenda, Obamacare does address some serious issues that were only certain to grow.  Most importantly, Obamacare deals with the precondition clause that prevents anyone with a supposed precondition from obtaining health insurance while it also prevents insurance companies from capping benefits.  It is essential to remember health insurance came into existence as a means of ensuring those who happened to get sick would be able to afford healthcare; the precondition clause and the lifetime limits run counter to this basic goal.  In addition, Obamacare sets meaningful standards for health insurance benefits while forcing insurance companies to spend the majority of health insurance dollars on healthcare, i.e. the 80/20 split, instead of displacing the costs of research solely onto American consumers and putting profit/bonuses above benefits. 

What Obamacare does not do is thoroughly address the affordability issue directly, among other shortcomings.  Looking closer at the aforementioned benefits of Obamacare, guaranteeing basic healthcare for more people was certain to drive costs up, though overall cost projections seem to be coming in lower than they would have without Obamacare.  Because a basic public option was not politically feasible, the Affordable Care Act adopted the individual exchanges as well as the individual/business mandates.  (It is important to remember the Republican alternative was similar to this exchange idea, except it directly imperiled employer-sponsored health insurance by transferring tax credit from businesses to individuals while it failed to set standards for insurance plans.)  Because Obamacare did little to address the affordability issue, the individual and business mandates have grown more frightening while they have always conflicted with the innate need of Americans to have the freedom of choice, no matter the cost.

Clearly, Obamacare has problems and many of these problems have existed since the basic plan was put forth by Republicans in the 1990s.  Many of these problems, however, could have been addressed by political leaders had the Republicans been willing to fix these faults.  Instead of running a continual campaign to repeal Obamacare since its passage in early 2010, the Right should have been trying to amend the Act to address these problems.  At the very least, they should have pushed a replace and repeal campaign with improved legislation versus trying to push already rejected “solutions” that would have created even bigger problems.  With the 2012 election leaving the Democrats in control of government and the Supreme Court rejecting Constitutional challenges to the individual mandate, Republicans have only redoubled their efforts in form of foolishly threatening to shut down government with the desperate hope of defunding Obamacare. 

If Republicans are going to use issues like the Debt Ceiling to respond to Obamacare, they should, at the very least, pursue legislation that will address the shortcomings of the original Act, instead of provoking a fight they have no hope of winning.  In other words, our political leaders should be using these “showdowns” to get something done by actually addressing issues with legislative solutions that have some hope of passing.  For example, our tax code needs reworked and moderate Democrats want to demonstrate they too are deficit hawks.  A large part of the problem is that both sides have gotten into the habit of trying to get ahead by undoing and undercutting each others’ legislative efforts.  What they should be doing is using what progress has been made, whether or not they would have pursued the path taken, as a starting point to address problems that have been created or were left unaddressed.  In the case of Obamacare, repeal is not necessary to address its short falls while Republicans can find solutions that are palatable enough to Democrats that more progress can be made on healthcare reform as well as other issues like the economy and National Debt.  Since our political elites do not feel the need to do that, we will simply have to anxiously await the consequences of this past action and present inaction to play out.