Jonathan Gruber actually said Washington politicians thought the average voter was too stupid to understand or discuss health care reform. So far, you really have to agree with him. I sure haven't seen any easily accessible or mildly intelligent comments about health care reform since before Bill Clinton was president from either side. That doesn't mean the ACA wasn't a great idea. It just means no one has bothered to explain it properly.
Let's see how well I can do in under five hundred words. Maybe more. I got a couple cigars.
First and foremost. This is America. No matter what some conservative voters have cheered, no one is going to be allowed to die in the streets. Gawd! Some of these people couldn't survive in the society they would create.
C'mon! We gave conservatives 6 years where they could do pretty much what they pleased. They invaded the wrong country, killed upwards a million innocent people, racked up an impressive string of what can only be called war crimes. Set off chaos in the Middle East that will last at least a generation. Parts of Texas started to spontaneously explode. They wrecked the economy. There's a question. How the hell do you kick off a deep recession while waging two wars? But I digress.
Universal healthcare has been a plank of the Democratic Party platform since, 1948. That's a long time. Even then it was recognized, first world governments should make first world provision for their citizens. It is our money. Attempts to act like there was no problem are wrong.
Bill Clinton was a small-state governor for 9 years. He knew his biggest budgetary problem and thus the problem of other states was the cost of Medicaid. By extension he knew it was a major federal problem as well. He did not bother to explain that. I think he thought it was too complex. There was something else at work there too. Sometimes people get so far into a problem and become so familiar with all it's aspects they can no longer discuss it clearly with people of lesser knowledge.
I also think what he and Mrs Clinton came up with was impossibly byzantine and for that reason alone, doomed to failure. At that time (the early 90's) we spent 18-20% of GDP on health care. In return we got second world results. One big fear raised was the prospect of health care being administered by a bloated, unresponsive bureaucracy run by the government. That fear ignored that healthcare was, in fact, run by a bloated, unresponsive bureaucracy at an obscene level of profit with little government oversight.
That the attempt failed may have been a good thing. That reform was essentially abandoned for nearly 15 years was a bad thing. The problems only became worse.
The primary problem from a government stand point was the increasing cost of Medicaid . In the intervening years all costs combined had gone from 18-20% of the economy to 22-27% of the economy. Our health metrics in comparison to the rest of the world had gotten no better and in some cases even worse. France still spent 9% of it's GDP on health care to all it's citizens and we had increasing millions with no health care at all.
Can you imagine what would happen if we slammed the brakes on 25% of our economy? The system we had and have may be flawed, the profits may be unconscionable but they are reality. Moving to a single payer system may be moral and in a perfect world it may be what we should have but in reality it would not be reform. It would be economic suicide. Obama got that. He should have told us.
What the ACA does is pretty simple. It streamlines and extends Medicaid so it is less costly to administer. It eliminates some of the more egregious practices of the for-profit health care industry, ie: insurance companies and hospitals. It addresses our dismal metrics in relation to the rest of the world by bringing millions into the delivery system. It's a simple fact. People with a personal care provider live longer, healthier lives. It is a grim fact that a 78 year old guy who dies from a stroke is less of a financial burden on the system, public or private, than a 46 year old who dies from colon cancer. With a personal care provider the 46 year old has a better chance of having his problem discovered and resolve quickly and early. It's cheaper.
As for that bloated government bureaucracy: Aside from the surprise of having lived to retirement age with a cigar stuck in my kisser and a scotch-rocks on the dinner table, one big surprise was the ease with which I registered for Social Security and Medicare. Four months before retirement I contacted Social Security expecting a protracted exchange of information. One contact set the whole thing up. The same was true of Medicare and Medicare initiated that contact. It is a responsive, efficient bureaucracy. They're very good at what they do because they have been doing it for decades.
If you actually examine it, the government does a vast number of things very well. It's the Congress that seems bungle-footed. When you consider Congress is composed almost entirely of lawyers, that's no surprise.
The ACA seems to be growing into that level of efficiency.
A lot has been made of the cancellation of "hundreds" of plans that were commonly offered by insurance companies as a result of ACA regulation. In fact, what happened was all plans were subjected to scrutiny for fitness to receive subsidy thru the exchanges. A number of these plans were found to be little better than fraud. The simple fact of the ACA eliminated that grand scale fraud. Nobody bothered to take credit for that service.
I think one of the big errors was the failure to refute erroneous criticism and take credit for positive things achieved. Obviously, everyone agrees covering pre-existing conditions and extending coverage to eligible children to the age of 26 makes sense but no one stood up and took credit for the elimination of waste, fraud and abuse coming from the bloated, non-responsive bureaucracy for-profit health care had become. Nor did anyone take credit for the boom in employment and compensation in the extended care industry. Those are middle class jobs created in response to the extension of coverages by the ACA.
One of the things that struck me in the debate of Clinton's attempt at reform was never mentioned. In one year the AMA alone spent 300 million dollars on efforts to defeat reform. They didn't borrow that money or mount public fundraising efforts. They just reached in their pockets and spent it. I always thought the idea there was that much excess wealth available to them starkly illustrated the need for reform. This was money that came from Little Johnnie's leukemia, your Aunt Minnie's gall bladder and that 46 year old's colon cancer. That's shameful.
Here's another thing I noticed in the '93-'94 debate. I came across a magazine ad from the early '50s touting Buicks as "the Doctor's car." In those days a Buick cost about 25% more than the everyman's Chevy. By the early nineties the "Doctor's car" was a Mercedes which costs 6 times the price of the everyman's Chevy. A visit to the Doctor cost about 6 times what it did as well. How you address that disparity in compensation is a problem beyond government but it is a real problem.
The ACA has widely been called socialism by people who couldn't define socialism if you pelted them with rocks and gave them only a civics book to defend themselves. The individual mandate is no more socialist than the individual mandate for car insurance or no-smoking ordinances It actually shares the same justifications. As near as I can determine there is one feature that is socialist in conception and practice. Executive compensation is limited to 15% of total profits. You can bet our republican friends will target that provision and maybe they should. At what level of providing for the common good does government become a legitimate arbiter of compensation? I dunno.
I believe the entire concept of for-profit health care is a soul staining obscenity eventually doomed to failure. I think that's why our system ranks so low in the world in effectiveness but I don't believe my morality should be a concern of the government.
Here's something that Obama seems to have understood but I have never seen expressed. We have learned that we have to extend aid to our fellow citizens in order to benefit all of us. That's a selfish equation but the reality is people are selfish. Right?/ Wrong? It just is. It's called human nature. Surely our fellow citizens have a right to our aid but those obligated to actually pay for that aid have a right to have that aid limited to only what benefits the common weal. There is a difference between government services benefiting the common weal and charity. The ACA seems to have balanced that equation.
So, was the ACA a good idea? Yes. Is it's conception sound? Yes. Does it benefit all of us including the one percent? Yes. Is the current debate healthy? Yes. Will we achieve nirvana? No. Can we do better? Certainly.
Maybe I'm right or maybe I just wasted two panatellas proving Gruber was right. We'll see.
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