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Love It or Hate It, Obamacare’s Spurring Interest in the Pathology of Health Care

Even if ObamaCare never fully achieves its intended benefits, it has already had some unintended ones.

Love it or hate it, even if ObamaCare never fully achieves its intended benefits, it has already had some unintended ones.

First, it has destabilized our deeply dysfunctional health-care system. By doing so, the law has created a real opportunity to fundamentally restructure the way we finance and deliver health care.

Second, the troubled rollout of the Affordable Care Act has shined a spotlight on how unnecessarily complicated our fragmented health insurance system is, and how great is the need to fundamentally reform it. That in turn has reignited public interest in further reform, and strengthened a growing popular movement.

For example, this past October well over 100 people turned out in Portland on the second night of the World Series to view a movie and discussion about health-care reform. Here in the heart of Red Sox Nation, that is notable.

Last week, Maine’s legislature held a hearing on LD 1345, a bill that would create a path to a state-level single-payer system for Maine. Such proposals have been around for years, met with tepid interest from the public and vigorous opposition from insurance companies and other corporate interests.

This time it was different. The hearing room was packed to overflowing with enthusiastic supporters. Forty-five members of the public took the day off and traveled to Augusta to testify in person. Another 15 to 20 submitted written testimony. Of those, 57 testified in favor of the proposed legislation, two against and one undecided. Only representatives of the health insurance industry openly opposed the bill.

The media frenzy surrounding the troubled rollout of the ACA since early October has provided commentators (including myself) many opportunities to point out publicly that although the functionality of the ACA’s websites fell short in many states, the underlying problem is not bad software. It is the expensive complexity baked into the law. That level of complexity can only be justified by politics — the perceived need to preserve a central role for private health insurance companies, despite their widespread unpopularity, as a means of financing health care.

A simple expansion of Medicare, at the federal or state level, would eliminate 95 percent of that complexity, and with it much of the public confusion and distrust surrounding health-care reform. Largely because of its requirement that people, including large employers, buy private health insurance, the ACA has forced large numbers of people who, to date, have had little reason to care about health-care reform to pay attention.

The level of public apathy in Maine about the pathology in our health-care system has been significantly reduced. That has created new opportunities for public education. For example, one of the health insurance lobbyists testifying at last week’s hearing complained that the proposed legislation would provide “free health care” to lawyer-lobbyists, such as himself. He thought that was unfair. That has provided me and people like me an opportunity to point out that we agree.

There is no such thing as “free health care.” The question is not if health care will be paid for, but when and how it is paid for, how fairly its costs and benefits are distributed, and how well the way we pay for it is going to control total costs for everyone.

The evidence shows we could cover everybody in Maine by replacing insurance premiums and most out-of-pocket expenses with a much simpler and fairer broad-based and progressive tax system. At the same time, we’d reduce the costs of unnecessary paper shuffling by an estimated $1 billion per year, according to Dr. William Hsiao’s testimony before the Legislature on Oct. 19, 2010.

Such an approach would be much more effective in restraining future increases in the rising costs of medical care than our current uncoordinated and fragmented insurance system. It would also essentially eliminate the fear of financial ruin from those needing care. That is already the reality in all other wealthy countries, as T.R. Reid notes in his book “The Healing of America.” What’s not to like about that?

Thanks to partial health insurance reform, the long odds of real health-care reform succeeding in Maine and other states have become a bit better. The Vermont legislature has already enacted a strong reform law.

We shall soon see whether the Maine legislature is yet up to that task.

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