The other day I had a chat with someone close to me about the Affordable Care Act. I have been curious (dumbfounded) about the opposition for two main reasons and while I thought she and I had a positive and congenial conversation, we seemed to be speaking different languages at times - or at least getting our information from different sources. This is not a new issue when it comes to politics - indeed it seems to me to be fundamental in understanding our severe political polarization of late. But I decided that I could take my considerable energy about the issue and purge it with relative impunity here.
The ACA is particularly close to me for a number of reasons, and the current public debate is particularly confusing to me given the information I have about it. Here are my thoughts:
One - it seems to be the position of the many opposed that the bill will raise the deficit because it will increase costs. My understanding is that we REDUCE the more expensive emergency care visits (which we currently pay indirectly) by providing people with less expensive preventive care. We also add people to the insurance pool (through the tax or mandate). Besides making logical sense, the non-partisan Congressional Budget Office reported that this "would yield a net reduction in federal deficits of $132 billion over the 2010-2019 period". That some people insist that the plan would raise the deficit seems almost willfully obtuse to me.
Two - that the main principles of the law (mandated participation in a private and competitive health care market) was a conservative position twenty years ago. As I understand it, their plan was in opposition to the 'Hilarycare.'
I was not able to find the Heritage Foundation report on this but plenty of others have referenced it and I have to imagine that when Clinton was pushing the government plan in the early 90s, the opposition at the time were paying attention to the alternative plan offered by Gingrich et al (sources here and here - again, not my preferred source, but the quotes are real). While it has been well known (and criticized) that Romney created a very similar plan in Massachusetts, it seems lost on many that the plan was a widely accepted Republican platform in the 90s.
Finally while Roberts' ruling did not permit congress to assign an economic mandate in the realm of health care, it remains plain and logical to me that the health care market is not and cannot be a self-selective market. We talk of the freedom for someone to buy or not buy a house, to buy or not buy a car, but health care like the highways, the traffic laws, the regulations on the food we eat and plenty of other ancillary benefits we gain by being physically in this country are ours not by choice. I cannot 'opt out' of safe drinking water or 'opt out' of benefitting from the highway system. I cannot 'opt out' of police and military protection. People cannot currently 'opt out' of health care! Hospitals MUST provide emergency care! To everyone! This boggles my mind!
This is an extremely personal issue to me. When I traveled, I paid for insurance out of pocket through CDH. Something went wrong with the paperwork and my drugs were not covered for a while - there was a chance that my coverage might have lapsed because of a mistake - CDH did not file paperwork. While the HIPPA law of 1996 requires that group health care cover anyone with any condition, you MUST have comprehensive coverage going in - you cannot lapse for 63 days or they may deny you.
"HIPAA imposes limits on the extent to which some group health plans can exclude health insurance for pre-existing conditions. For instance, if you've had "creditable" health insurance for 12 months, with no lapse in coverage of 63 days or more a new group health plan cannot invoke a pre-existing condition exclusion. It must cover your medical problems as soon as you enroll in the plan." That insurance companies did this - that they have a separate deductible for mental health does not make me sympathetic to their bottom line. The law need not protect insurance companies - they have plenty of laws (including title 2 of HIPPA) that protect them. I could have lost coverage and no one would be required to pick me up again. My life would have been altered fundamentally and permanently.
With this Affordable Care Act, I and anyone who 'lapsed' for whatever reason could not be denied health coverage that we want and can pay for. No other market denies participation like health care has. I can think of 4 close friends of mine who have been desperate to get coverage and have been denied for pathetic reasons. They could pay for it, they were denied coverage. When I thought I had lapsed C and I talked about moving to Sweden or Canada. Seriously. That was the option afforded us as the law stood.
It is hard to keep up with the false and misleading claims about it - one is the claim that this is a 'government takeover' of health care. there is no new government health plan that people can buy - there is no 'government run' health care other than what is already provided to government workers! It is all private! How in hell is this a government takeover of health care when the government is only telling people that they need private insurance! The death panel claim is more egregious and insidious. The actual issue (as explained by a close friend) is a standard living will document - only a doctor in a nursing home could withhold resuscitation/
I cheered out loud when I heard the news about the law being upheld. It fundamentally changed my relationship with my health care, my job, how I think about my personal choices. C's co-workers congratulated her ON MY BEHALF. I cannot understand opposition to this law, other than bullheaded politics. Can someone help me out here? How can so many be so opposed to this?
End of screed. Thanks for reading!
