The Affordable Care Act has provided a defining and pivotal moment
in American history.
Rarely has an event so distilled and clarified the difference between "Big"
and "Small" government, as well as brought the results of the program so
forcefully to the attention of Americans. How the results of this epic social
experiment will play out over the next few years will determine the path our
country will follow for generations.
The Affordable Care Act is President Obama's most striking effort to fulfill
his pledge of "fundamentally transforming" America. His intentions are good.
I believe he is honorably attempting to solve a real problem in the healthcare
industry in America. I believe he truly believes in the power of "Big
Government" to solve our problems.
The question is, does his solution help, or hurt, the majority of people in
the country? Do Americans feel the benefits offered to some outweigh the
price paid by others?
The original situation was...
1. Most people were covered by healthcare offered by their employer.
2. Most poor people were covered by Medicaid.
3. Most older people were covered by Medicare.
4. If you were in the minority of people not covered by the above,
a. you had to go without insurance and pay expenses out-of-pocket or...
b. go to the emergency room for treatment or...
c. purchase your own insurance on the individual market.
5. If you had pre-existing medical conditions, it was very expensive,
or impossible, to buy insurance on the individual market.
6. An older person in the individual market had to pay 6-7 times
as much as a younger person in the individual market, because
older people were prone to more illnesses.
7. If the average person ran into a catastrophic medical emergency
above the coverage offered by their insurance, many were forced
into bankruptcy.
8. I don't know if undocumented immigrants could buy health
insurance or not, but I think they fell into the group that had to
use the emergency room for any health care that they received.
9. Younger Americans often did not buy health insurance (or bought
very limited policies) because they figured the odds were such
that they wouldn't need health insurance until they were older,
and didn't want to pay for something they didn't feel they needed.
The majority of Americans were covered by health insurance, and most were
satisfied with their coverage. The minority who were not covered
by employer insurance, Medicaid, or Medicare, and those who could
not afford (or qualify for) individual insurance, faced the possibility
of truly difficult medical emergencies that could affect their finances and
life choices significantly.
Obamacare was sold as a plan to help those who, either by personal choice
or not, were not covered by the existing healthcare system. It was supposed
to bring the cost of healthcare down. And, it was NOT supposed to affect
those who were happy with their existing health plan. "If you are happy
with your plan, you can keep it. Period!" "If you are happy with your
doctor, you can keep him. Period" etc., etc.
But the way the plan was crafted may, or may not, fulfill those objectives.
In actuality, the plan creates some winners, some losers, and some who
are not affected at all...and the interplay among those groups will determine
the success or failure of the law.
The law mandates federal government-approved insurance policies, which
must include government-approved features, whether the policyholder
wants them or not. No one can be excluded for pre-existing conditions.
No older person can be charged more than three times the rate for a
younger person. There are no annual or lifetime limits to the policies.
If you had a policy that didn't meet these, and other, requirements, your
policy would have to be cancelled or changed to meet the new guidelines.
The new policies would cost more (to cover the new requirements), but
you may qualify for a subsidy to help cover some, or all, of the cost of
the policy.
Let's try to figure out who makes out and who loses under Obamacare.
NO CHANGE
1. If you were on Medicaid before, you are still on Medicaid
2. If you were on Medicare before, you are still on Medicare (no changes yet)
WINNERS
1. Those who didn't realize they were eligible for Medicaid and get
signed up for Medicaid.
2. Those who needed private insurance and had pre-existing conditions.
3. Those who have catastrophic medical conditions above what their old
policies covered.
4. Older people with private insurance (not on Medicare), who will pay
less for their health insurance.
5. Some working people with lower incomes will find that government
subsidies will make health insurance more affordable for them...others,
not so much. See losers section below.
LOSERS
1. Younger people who are forced to buy insurance priced to help pay
for some of the winners above, and for coverage they may not want
or need.
2. Some working people with lower incomes will find they cannot
afford the premiums, co-pays, and deductibles, even after the
government subsidy of the program...yet they will be forced to buy
the insurance or pay a penalty.
3. Taxpayers who will be stuck paying for the additional Medicaid
enrollees and for the subsidies that help pay for lower income
working people.
4. Consumers, who will pay higher prices as the taxes and fees on
medical devices, etc., get passed on from the medical companies
to the consumers.
5. Employees who may be forced from employer-sponsored health
health insurance onto Obamacare exchanges, because their
employer either drops health insurance, or keeps their weekly
hours under 30, so they will not qualify for employer-sponsored
insurance.
NOT SURE
1. I don't know how undocumented immigrants will, or will not, be
affected by this law.
So, here we are. How will it all work out? Will there be more winners than
losers? Will the losers accept the cost as the price to pay for "the
greater good"? Will the economy and employment suffer as unintended
consequences of the Affordable Care Act? Will healthcare costs to the
country rise or fall under Obamacare?
That's the beauty of Obamacare. It's all going to be out there to see in the next few years. For millions and millions of young Americans, this will be the first time they
will actually be able to see and feel the effects of big-time government programs
as they are being imposed on the population...a moment in time where the usually
theoretical arguments between big and small government become down-and-dirty
reality in their lives.
Even assuming that there was no intent to increase federal government power, and
granting President Obama the moral high ground that the Affordable Care Act was
designed to improve the lot in life of the people who were not well served by the
existing healthcare system, the question remains; were most Americans and the
healthcare system helped or hurt by Obamacare?
The basic idea of Obamacare is to force everyone to buy a product (health
insurance) that they may, or may not, want to buy, with more coverage and at
a higher price than they may want to pay, in order to provide coverage for
other people...even if President Obama neglected to explain that to the public.
Obamacare is also premised on the proposition that government officials were
more intelligent than the average citizen, knew better what the citizen really
needs, and knew better than doctors, nurses, and businessmen what the
healthcare industry needed. And finally, they thought they understood the
free market well enough to design a program to improve the situation
without creating havoc for millions of Americans.
Obamacare was also premised on the idea that the federal government is
supposed to regulate the healthcare industry, even though the Constitution
delegates that responsibility to the states and not to the federal government.
In addition, the idea that the federal government can force individuals to buy
health insurance is also constitutionally questionable.
The Affordable Care Act goes right to the crux of the relationship between the
federal government and the individual citizen. Is it right to take from some to
give to others (redistribution of wealth)? If so, how much? Who gets to decide?
What protection does the individual have from an over-reaching government?
If the federal government has the power to control, do politicians have the
wisdom, and the integrity, to do it wisely and fairly? Can good intentions and
big egos lead to bad policies?
Did Nancy Pelosi and Harry Reid inspire you with the confidence that they
were on top of the law they shepherded through Congress for President Obama?
The paths that led to our modern America were created over decades and
generations of battles over the nature of Man, individual rights, freedom, and
philosophy.
For the first time, this generation of young Americans will be involved in
deciding which fork in the path our nation will take...and what our nation
will look like generations from now. I don't know which direction they will
take.
I hope we do not continue down the path to more government control, but
that's not my decision to make. That decision is for the current generation of
young Americans to make, and it will be they who will live with the conse-
quences of the decision they make.
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