aNewDomain commentary — For Americans who live in a country whose legislature hasn’t managed to enact a major social safety net program since the 1970s, the Affordable Care Act (ACA, also known as Obamacare) marked a major political shift in thinking.
After all, the Reagan Revolution convinced us that we’re all on our own, that the greater good is best served when everyone acts in his individual best interest. Trickle-down selfishness, anyone?
The trouble with the ACA, critics (ahem) worried aloud at the time, was that it didn’t go far enough. Like the Family and Medical Leave Act of 1993, the ACA was a move in the right direction that sated part of a need. In the case of Clinton’s law, that need was to care for a loved one or spend time with a newborn child, but at a cost: the political will necessary to get the job done completely, i.e., paid rather than unpaid leave.
The trouble with the ACA is that it satisfied the need and desire of patients for government to step into the Wild West of for-profit healthcare without getting rid of the insurance companies responsible for driving up costs year after year — and also their profits.
Socialized medicine, nothing less, was what we needed. It still is. The kind that every country in Europe has.
Because of the ACA, however, it may a long time before we get the same quality of healthcare available to the rest of the developed world, and much of the developing one, too.
This is an issue that, for me, recalls the legendary Wisconsin progressive Robert LaFollette. “In legislation no bread is often better than half a loaf,” he said. “Half a loaf, as a rule, dulls the appetite, and destroys the keenness of interest in attaining the full loaf.”
Here’s The New York Times to confirm Fighting Bob’s aphorism:
Obama administration officials, urging people to sign up for health insurance under the Affordable Care Act, have trumpeted the low premiums available on the law’s new marketplaces.
But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.
‘The deductible, $3,000 a year, makes it impossible to actually go to the doctor,’ said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. ‘We have insurance, but can’t afford to use it.'”
There is no polite way to say it. And anyway politeness has no place when talking honestly about politics, right? So here it is: Insurance deductibles are a scam.
Insurance deductibles should be illegal. And companies that have them ought to be closed and their executives sent to prisons, and not the ones with tennis courts, either.
What is a health insurance deductible? The deductible is the amount you pay for out of pocket before insurance kicks in. It’s true that, if you have cancer, a $3,000 annual deductible is actually a really good deal. But where exactly is someone who has cancer supposed to come up with the money? So change that to: It’s a relatively good deal, which in America means it sucks — but not as badly as it could.
For people in relatively good shape, though, you might as well not bother with insurance at all with a deductible like that. And not having insurance is an option that has the secondary advantage of being allowed to see the physician of your choice as opposed to those on the short list of doctors authorized by your provider.
According to the Times:
In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more. ‘Our deductible is so high, we practically pay for all of our medical expenses out of pocket,’ Wendy Kaplan, 50, of Evanston, Illinois, told the paper. ‘So our policy is really there for emergencies only, and basic wellness appointments.'”
That’s my situation, too.
How could the United States improve its ranking for access to high-quality healthcare? Currently it is dead last among industrialized countries so any improvement matters. Well, it might take a look at the top 10 countries on the list.
Every one of them has, you guessed it, socialized medicine.
Thanks to the ACA, however, our political appetite for healthcare reform has dulled in a sadly LaFollettian way. Healthcare isn’t an issue in this year’s presidential campaign, not even between Democrats.
Which means that the only practical difference for the average American between the bad old pre-Obamacare days and today is that they have to pay insurance premiums — and still pay their doctor out of pocket as well.