While Janalisa and I were driving out to see the museum, we talked about the Affordable Care Act, or Obamacare. Both of us have good health insurance through our spouses’ workplaces, so it’s a fairly abstract issue for us.
My impression of the ACA is that it a) provides affordable health insurance for people who wouldn’t otherwise have it and b) makes the uninsured responsible for their own care rather than leaving it to be paid for by taxpayers as a whole. I thought that it is required just as car insurance is required, and that people who are opposed to it are basing their objections on philosophical or political issues.
Janalisa said it won’t work. It isn’t really required, she said, and so it will be snapped up by the sick who needs lots of care, but won’t be used by healthy people until they need health care, at which point they will quickly sign up on their way to the hospital.
With few people paying in and many people taking out, she figures, it will be financially ruinous.
So I went to the website to see what I could find out. First, I found that the fine, or penalty, for not having insurance is the average cost of basic health insurance. You must therefore pay the price you would pay for health insurance even if you choose not to get it, and of course you won’t have any insurance and will have to pay your own medical costs or do without. It seems stupid to refuse to have coverage, but people do stupid things.
I went ahead and signed up for an account. It was not clear to me what people who already have health insurance were supposed to do, so it seemed as though I might have to do so anyway. It was easy and straightforward. They asked, in the course of verifying my identity, whether I had bought vet health insurance for my pets Sloane, Killian, or Ardsley, none of which exist, and then I was set.
I quickly learned that we earn too much for assistance with the healthcare costs. I was going to go on to the medical marketplace to see whether we’d be better off with the plans available there (it’s time to re-up for our healthinsurance through my husband’s work) but once we got into answering questions about household members the site slowed down severely.
Given that I’m just experimenting, I figured I should get out and let the system handle real customers, so I moved on to secondary sources. The Economist has a good theory about why the website is having so much trouble. I also found folks agreeing with Janalisa that it will only work if plenty of healthy people sign up. Those who are determined to see if fail are therefore putting plenty of effort into campaigns to persuade students not to sign up.
So which is it: is Obamacare a problem because it will fail or will the opposition make sure it fails because affordable health care would be a problem?
You can find a lot of objection to the ACA on the grounds that it gives things to lazy people who don’t deserve health care. It rewards indolence. People like Janalisa and me who get health insurance because we’re married to someone whose job includes it are not troubling to these writers, but people who work hard at jobs those writers would never consider accepting are freeloaders. This is a philosophical position. I linked to the most persuasive article I found taking this position.
I haven’t seen a doctor in years, myself, and pretty much don’t use the health care system, but I know that paying with my taxes for people who go to the emergency room because they can’t or won’t pay for their own cough syrup is costlier than getting those people preventive care.
There are also objections to Obamacare on the grounds that it leaves our extremely bad health care system intact instead of fixing it. That makes sense, but it’s clear that our government is not capable of producing something like National Health, any more than our health care consumers are capable of behaving responsibly about their own health. As one legislator from my state said to me when I interviewed him a few years ago, we want to be able to eat what we want, drink what we want, do what we want, and then have somebody fix it for us with a pill when it catches up with us — we can’t even compare our health care costs with those of people in healthier countries.
At the healthcare museum we looked at tools and medications from previous centuries. People were less likely, in those days, to have strokes, cancer, diabetes, or heart disease. They were more likely to have tuberculosis and cholera. Fair trade?