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The End of Obamacare? Think Again

Despite its serious flaws, Obamacare has benefits, some intended and others not.

Earlier this month, the Obama administration announced a delay in the the requirement that many employers offer health insurance to their employees or pay a hefty fine, a key part of Obamacare, the federal health care reform legislation. This was greeted (with glee) by many who oppose the law as a sign that it is beginning to unravel.

I disagree. Unless we are able to do something much simpler and more effective sooner, implementation of this incredibly complex and imperfect law will continue, in fits and starts, for many years.

Given the law’s complexity and reliance on so many unpredictable factors, I am not surprised that its implementation is encountering glitches. But I am surprised that there haven’t been more, due both to technical problems and efforts by opponents of universal health care to sabotage it.

The objectives of any effective health care system are to provide access to health care of high quality and reasonable cost to everybody. By international standards, the current U.S. system fails miserably. Even if Obamacare were to work perfectly, it would leave tens of millions of our people uninsured and do little to control overall costs or improve quality, although it does attempt to make some moves in that direction.

Obamacare tinkers with our existing system of private, employment-based, for-profit health insurance, with its thousands of different and unequal programs. Not only is this approach unfair, but it creates almost insurmountable barriers to achieving those three cardinal objectives.

Equality, expressed as equal de jure and de facto rights, is a strong theme in American politics. Since the Civil War, we have seen fitful but unmistakable progression toward a more equal society. Women’s suffrage was passed through a constitutional amendment in 1920, after a 70 year struggle. The Civil Rights and Voting Rights Acts were passed by the Congress in the mid-1960s after a struggle of well over 100 years. The marriage equality movement has made steady progress, initially through the courts and more recently by legislative actions and by popular vote, after many years contentious struggle.

Each of these human rights incubated for a very long time, and were characterized by fitful progress, as last month’s Supreme Court decision gutting an important part of the Voting Rights Act has recently demonstrated.

The Affordable Care Act represents a major lurch (although a belated and imperfect one) toward health care as a human right in the U.S. We still have a long way to go. But as the sea change in attitudes toward gay rights in recent years demonstrates, progress can accelerate when conditions are favorable.

Despite its serious flaws, Obamacare has benefits, some intended and others not. One major barrier to reform of our health care system has been apathy on the part of people who already have good health care coverage (“I’ve got mine”) or who have been lucky enough not to need health care (the young and healthy), and are therefore unaware of our system’s many problems.

That’s about to change. Due to its requirement that as many people as possible have health insurance (the individual and employer mandates) the apathetic population is about to become dramatically reduced. Like it or not, many more people in the U.S. are about to become engaged in the health care system.

Additionally, once the government has gotten into the business of requiring that people buy private insurance, a product that is costly, unpopular and may be of poor quality, the federal government’s exclusive focus on Medicare and Medicaid will have to broaden to include the newly mandated private insurance products.

Control of overall health care costs has been an elusive goal in every country. Because of our private health care system’s massive wastefulness, the problem is much worse in the U.S. Our system costs almost twice the international per-capita average.

This situation persists largely because of the reluctance of our politicians to directly control the prices of health care, the extreme fragmentation of the way we finance care, and our ill-advised and ill-fated obsessions with health care as a business and “letting markets work.” As is becoming increasingly clear ( and as I have written before), markets don’t work in health care.

How much easier our lives would be and better our health care would be if we, like every other wealthy country, had a unified and universal system that would benefit everybody, and provide us with a means to budget our system’s overall costs. That would go a long way toward elimination of the intrusive micromanagement of health care decisions and denials of care that doctors suffer under and patients suffer from.

Such restrictive micromanagement of health care by the private sector would not be tolerated by doctors or patients in any other country and should not be tolerated in the U.S.

Over the long arc of policy evolution in the U.S., we are actually approaching the goal of health care as a human right. Health care was overwhelmingly privately funded until the passage of Medicare and Medicaid in 1965. More than 60 percent of health care costs in the U.S. are now publicly funded. Obamacare will increase that percentage.

Let’s do all we can to continue and accelerate that trajectory. Let’s realize we’re all in this together and finish the job.

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