Obamacare

One of the "Republicans" running for congress in my highly gerrymandered district just sent me a request for a donation, which began "If you think Obamacare is an unqualified success, I have sent this to you in error."  Is the PPACA an unqualified success?  No.  But is it a huge win for our nation, especially for the tens of millions who could not get health insurance at all and the tens of millions more who had been getting gouged outrageously, either by selling them what was effectively minor care insurance which would be cancelled if something serious occurred, or by overbilling them or their employer.  The PPACA has already made a huge bend in the rising cost of health care, has banned fraudulent policies, and has required efficiency improvements from insurers, providers, and more.  It has unquestionably improved the health insurance status for the previously uninsured.

There are basically three types of health insurance available in various countries around the world:

1: Fully Nationalized.  The government pays health service providers out of the general tax base, and no private insurers are involved.  Everywhere this has been tried, from the NHS in Britain and its counterpart in France and the Scandinavian countries, Medicare in Canada, the VA and Medicare in the US, this has worked extremely well.  It hasn't always been sufficiently funded--the drastic cuts to the VA that occurred under several Republican administrations have led to terrible wait times--but the actual cost and outcomes per patient actually covered are significantly better than any other approach.  This is sometimes called "Single Payer".   I'm not aware of any country that has single payer that does not permit you to buy premium coverage either through the private market or by paying special fees to the nationalized system.

2: Strongly regulated private insurance: Switzerland, Germany, Japan and a number of other countries have this.  It works differently in each place, and while it's not quite as efficient as single payer, it's dramatically better than the unregulated approach the US took until 4 years ago.

3: Weakly regulated private insurance.  There are only a few countries in the world that do this and it's a catastrophe in all of them.  The US has the highest health care costs of any country in the world by nearly a factor of 2, and this factors in our crazy quilt of far-more-effective nationalized systems, including Medicare, Medicaid, VA and more, which work way better than laissez-faire.  The PPACA was an attempt, designed largely by insurance industry lobbyists at the Heritage Foundation, to bring some of the worst abuses under control while not really changing much.  We now have slightly more regulated private insurance.  The insurers can't rip us off quite as badly.

The name "Obamacare" was an attempt at an ad hominem assault on the PPACA.  The theory was that people who hate Obama, whether because of the color of his skin or the party he represents, would be inclined to hate Obamacare, whether they actually know what it is or not.  In fact, while most of the provisions of the PPACA enjoy 70% or higher support of Americans, including strong majorities of Republicans, only the mandate and the name "Obamacare" score lower than 50%.  The exchange, extending coverage for dependents up to age 26, and disallowing denial for pre-existing conditions, have close to 90% support.  The fact that these guys are still trying to run against "Obamacare" and have not been run out of congress on a rail tells us that their ad hominem assault has been working, at least for some of the voters.

Is Obamacare an unqualified success?  No.  Is it a huge success, albeit flawed and incomplete?  Yes.  We should fix the problems--the biggest of two being that most insurance still comes through employers, and that there are still private insurers getting payments every month, including from some people who are pretty darned poor--but it's a huge step in the right direction.