It's been a nutty week in Congress, as the GOP continues to be obsessed with Obama, six months after he left office. But while I'll get into the politics of the Affordable Care Act in a moment, I think it's worth talking about its effects in real terms, outside of the effort to repeal the law.
Let's first be clear about the problem with healthcare in the United States: Healthcare is dependent on insurance, which is dependent on full-time employment. Premiums have outpaced inflation, and overall, the US per capita spending on healthcare and insurance is 17% of GDP, higher than any other nation. This, despite the fact that we rank around 40th in terms of life expectancy, a sort of proxy to quality of healthcare.
That Obamacare is a disaster is a drumbeat we've heard now for seven years, and it was a key tenant of the GOP candidate campaigns last year. But is it? The numbers suggest that the rise in healthcare costs has stabilized to align with inflation. Healthcare costs were up 1.2% in 2016, same as inflation. Having nearly everyone in "the system" does align with the theory that it reduces cost. At no time in history were so few people covered with insurance, and the consumer protections, particularly around pre-existing conditions and parent sponsored coverage have been huge. On the other hand, the law has arguably also made non-subsidized plans for individuals more expensive or simply harder to get (I had this issue when we moved in 2013, because my plan was no longer written in FL). Many insurance companies have pulled out of many markets for individual coverage because it's not profitable. There are a lot of market segments that don't work well under the new system.
So the long and short of it is that it's, at best, imperfect legislation, but more people have coverage than ever before. That said, the CBO has indicated an increase in premiums over time with or without Obamacare, but worse without it. Also, within a decade, 30+ million people would not be covered at all, which certainly drives up the cost of healthcare since in most states, providers are required to provide care without regard to ability to pay, and it has to be paid for somehow. All of the plans presented by Congress in the last few weeks result in higher premiums.
The politics seem pretty clear to me: The GOP has had seven years to come up with a better plan, but all they have is repealing what the black guy with the funny name championed seven years ago. That isn't leadership. It's a huge missed opportunity. Voters aren't interested in inflexible ideology, they're interested in easily available healthcare that won't risk bankruptcy. The moral reality is that we don't get to choose much of our health. We can't control if we are prone to cancer, depression, chronic disease, etc., but our ability to deal with it is tied solely to our ability to have good jobs with good health plans. The worst part of that is that it makes us risk averse, which isn't good for the "job creation" that comes with entrepreneurship.
I probably sound like a Republican when I talk about wealth inequality and higher education, but when it comes to healthcare, I think "the system" is hopelessly broken and immoral. It doesn't help that I worked for a health insurance company for a year, and saw the inefficiency of it first hand. I think the overhead introduced by the system of insurance companies is the problem. Think about it... last time you were at a doctor's office, how many people there weren't the doctor or nurses? On my last visit, I observed my doctor, two nurses and three front-office people, and that was inside a hospital system that likely had countless people dedicated to billing. If there was only one place to bill to, it would be vastly simplified. I am all for a single-payer system.
That said, if my idea isn't universally palatable, I get that. The opposite extreme, of saying "fuck it" because they don't want to acknowledge anything good about a law that came from an administration from the other side, is not acceptable. Just don't call it "Obamacare." The ACA is absolutely flawed, but to repeal it just because it wasn't your idea is so universally stupid and lazy that it doesn't move us forward. The GOP defectors in voting against the repeal were right, because the goal isn't supposed to be "the opposite of anything Obama was for," it should be to make sure people get healthcare. Giving them tax credits when they're poor does not achieve that.