Will The ACA - "ObamaCare" - Be A LONG TERM Benefit, Or A LONG TERM Burden To The USA?

(Commentary posted by Roger Erickson)

A popular sentiment among early supporters goes as follows:

"ObamaCare doesn't regulate Your Health Insurance,it regulates Insurance companies that bankrupt you!"

In response, RH writes privately:

"GIVE ME A BREAK ... It was written by the health insurance companies.

Yes ... Obamacare eliminates the denial of insurance on a pre-existing condition.

But that reduces the profits of some private entity, somewhere.

The solution suggested by the Insurance Industry Lobby? Increase insurance plan rates across the board, reduce access to as many treatments as possible, and also cap allowable fees for clinicians of all stripes. [RGE: No income cap for insurance firm CEOs, obviously.]

And if given citizens can't afford the cost, have the public-at-large subsidize the cost.

The only incomes NOT regulated are insurance company incomes. This is a net money maker for the insurance companies as well as the pharma and medical device firms. The key issue is that the ACA does NOT allow the government to use its purchasing power to bring down prices.

Further, the ACA is a net burden for Middle Class citizens (especial healthy young adults) ... for clinicians of all stripes, and - I will call this one - for all retirees, who will see both increased costs and reduced access to services.

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The ACA "does not allow the government to use its monopoly purchasing power to [set price limits]."

I suspect RH put their finger on it. That seems to be the clearest, killer mistake in the ACA policy approach to public health maintenance. 

Look at it this way. One, universal component of all public organization is to set a floor service level, that all citizens are guaranteed. Life, liberty and the pursuit of happiness are just a start. Every service that an electorate decides it wants universal access to, as a public minimum, is most easily regulated by imposition of a "public option." For a long time, public schools were a good example. Mandatory, free access to minimal public education did wonders for the USA. 

Should mandatory access to the most basic public healthcare be any different? The approach of establishing a "floor" automatically puts a cap on how much private services can charge for presumably enhanced services. A public option never harmed private universities. Nor does it guarantee the demise of private health insurance or services. It only sets, by default, a reference for citizens to refer to, when considering health services. With no public option, that reference is zero. So it's a question of what level of mandatory, minimal health service the public wants to set for itself, at what cost.

How long will it take our country to catch on? Will we love ObamaCare for a year, then loathe it forever? If policies have warts, we can always adjust them, you say. That's true, yet it's also true that when we make adjustments, we can make things better, or worse. Our real need is to always have enough perspective, feedback, analysis, testing and assessment to be agile! Is the entire ACA implementation process agile? Hardly. Show me a single Congressperson who has read the entire act, start to finish? Show me a citizen who grasps the options that insurance companies can explore, going forward?

Given that insurance companies wrote the ACA, surely they had ONLY the best, long term interests of the US Middle Class in mind, every step of the way? :) 

Ok, all laughter aside. Instead of maintaining insurance company profit margins, we need to embrace indirect methods for chasing our enduring goal, ensuring adequate income for the Middle Class? Right now, citizens may want to hope for the best, and prepare for the worst. Basing national policy and election choices on hope hasn't served us very well so far.

We may not survive this.

It's death of the Middle Class by a thousand narrow cuts ... inflicted by our own, "successful" merchants, sprinkled among ourselves? Forgive ourselves? We certainly don't know what we're doing, since we haven't discussed any policy step widely enough to even find out!

This whole process reminds me of a bad cancer-care joke.

"Any chemotherapy will work. The trick is to keep the patient alive long enough (or to see which one works fastest)."

It's just now that we're talking about our own cultural-auto-immune disorders, on a national scale, not just cancerous cells in the body of one person.

All the individuals and lobbies clamoring to sway policy have lost system perspective? The patient usually doesn't survive those situations. The policy staff is not only impossibly slow and clueless, they've become agents of the social-cancers themselves! That's what "cancers" and parasites do in all systems, they hijack the policy apparatus - to narrow rather than systemic benefit.

Loss of policy perspective is possible only when an electorate loses system perspective. Once perspective is lost, policy agility soon declines and policy space goes unused. Then the Control Frauds, aka social cancers, aks system parasites inevitably take over ... for lack of effective resistance and regulation.

Instead of being distracted, confused, divided and conquered by narrow lobby interests, over a succession of single issues like Healthy Insurance of, by and for the Insurance Lobby, we as the Middle Class, need to define our own, Desired Outcome, and then elect OUR own policy representatives, tasked with listening to US well enough to matter.