This morning at the gym, I was watching the House Committee on Ways and Means take up Obamacare. A very senior Democratic house member was lambasting the Republican majority as heartless, unfeeling and uncaring, not just in relation to Obamacare, but relating back to when Medicare passed in the 1960s which many Republicans opposed, and Social Security in the 1930s, also opposed by many Republicans (actually he was wrong about Social Security).
While the Democrat spoke, the Republicans stared at the ceiling, or at each other and smirked. I didn’t have time to stay for the Republican response but I would hazard a guess that the Democrats looked at each other, or the ceiling and also smirked. Such is what passes for a public policy debate in the Congress on a major program of intense public interest. I decided it’s time for a reality check and you’re certainly not going to get it watching a discussion in the House.
First, what drove the passage of Obamacare, or the Affordable Care Act, if you prefer? There were several factors and they have little to do with either you being a Democrat or Republican. Part of the reason is that we had 40 or 50 million Americans uninsured or underinsured who more often than not showed up in local hospital emergency rooms when something happened. The Feds, localities and most of all the rest of us pay much higher costs because we help to pick up the tab for those uninsured when we go to the hospital. The tab is expensive and the system very inefficient. As a nation we spend more and get less than most other developed countries, and most legislators realized that had to change.
Next, there is an enormous group of Americans who can’t buy or can’t afford health insurance because they have or had a preexisting condition like cancer, heart disease, diabetes, arthritis, asthma and many childhood diseases. Also fewer employers are paying for their employees’ health care, and this is not something due to Obamacare, but is a long-term trend that has been going on for years. So what we had was a perfect storm and a general consensus that we had to do something about it because the way the demographics were tending, this could only get worse and more expensive in time.
The Clintons tried to pass a health care bill in 1994 and it crashed and burned. It was fairly clear to President Obama and his team that unless they had a buy-in from all of the major stakeholders in the health game, it would never pass. That is not as simple as it sounds. Initially the buy-in had to come from the insurance industry, the pharmaceutical industry, the doctor organizations, the hospital organizations (profit and nonprofit), the states, the counties, the cities, labor unions, minority groups, disease organizations (like American Cancer Society), think tanks, patient advocates and mostly the leadership of the House, the Senate and many Committee Chairs.
Somehow, and it was nothing short of a miracle, they managed to get this bill through the process and signed by the President. But let’s be frank, this bill was not designed to be an efficient way to deliver health care: it was designed as an efficient way to get it through the political process, which means that everyone involved had to have an opportunity to dip their beak in the final product.
Bottom line, the bill, as a political document, is brilliant. As a document designed for the delivery of health care, it’s a bit of an abortion and it’s going to take several years to work it out, dump the portions that don’t work and refine it. That’s not particularly surprising since we went through a similar cleanup period for Social Security, Medicare and many other large, major governmental programs. Even some of the tech-giants like Apple and Microsoft don’t always launch clean.
The major problem is that it’s become a very large political football, which makes it very difficult to deal with all of the changes that will have to be made, including and especially the enrollment methodology. When I first heard they were going to have people sign up online, my thought was they have to be out of their cotton-picking minds, except that those are not the exact words that came to mind. I know from hard personal experience that entering the world of technology requires that you deal with people who speak “techese,” which is a language somewhat similar to ancient Sanskrit, except more obtuse. For the past year The Malibu Times has plunged into the world of new technology, redesigning our website, adding the Daily Newsletter, Facebook, Twitter, Instagram, social media, etc. and I have been pulling out what little hair I have left in frustration.
So folks, I suggest we take a deep breath, stop listening to all the crap and grandstanding we hear and see going on 24/7, and just figure it’s going to take some time to work it all out. Ultimately, it will work out, but you can bet it’s not going to be by Jan. 1, 2014.