With Obama Care, we were never angry at the right people

            There have been years of bellyaching in regards to the passage of the Affordable Healthcare Act. Most of it has come from Republicans decrying the temerity to mandate the purchase of something which is considered essential by most developed countries. Some came from earners in the subsidy gap left by the structure of the bill. As time went on, more voices joined the chorus to note the rise in premiums that were inevitable, and then egregious, to give everyone with preexisting conditions coverage.

            The anger flowed freely and ran hot against President Obama and the Democrats that voted for it. A sharp irony now that 23-24 million stand to lose insurance who clearly were the beneficiaries of that law. It was so bad and worth complaining about for seven years but the prospect of it going away and millions of our fellow Americans losing their coverage appears to be untenable. This uproar should indicate that the ACA was not all bad. And the things that weren’t bad maybe, definitely, are worth saving. Like the subsidies that allowed more than 20 million people to sign up for insurance in the first place. Or the requirement that insurance companies cover preexisting conditions and what people are paying for will actually cover the illnesses they could get.

            Our problem is that we were never angry at the right people. People raged against the president but never questioned why insurance companies were pulling out of marketplaces other than the reasons on the company press release. Instead of believing that they couldn’t make any money in the insurance marketplace, we should have questioned why they could not make money while insurance rates were doubling or tripling, and a record number of insurance customers were paying along with the federal government. Not to mention, company profits never took a sustained hit. Yes there were some growing pains but by 2016 there were profits for all who had stuck it out. If a company cannot make money in this environment it appears to be more a result of incompetence rather than the failure of legislation.

            One of the most important customers that the insurance marketplaces managed to get in this process was the federal government. If these companies really cared about the health of their customers, they, with their enormous lobbyist arms, could have reached out to congress to help prod for more subsidies. On passage even Democrats admitted the bill was not perfect, the companies could have taken the lead in how to reform the markplaces payment structure. Instead they just kept raising prices and they did so because of a clear assurance from an important interest group of the insurance companies. The Republican Party, led by their congressional delegation gave the companies political cover to continue to raise the rates. They complained loudly and often about the bill. So much so that the insurance industry saw that they would not get those subsidies quickly and the path of least resistance would be to play in to the hell-scape that Paul Ryan was promising.

            The other major group that one could credit with not getting enough flack is those  people who were complaining about the individual mandate and the media that enabled them. People who refused to buy insurance were depicted as patriotic cowboys fighting for their right to die of whichever disease they so choose. They were allowed their indignation without the serious check that they did not understand how the purchase of insurance might benefit society at large, or them in the long run, as preventative care is far cheaper than trying to pay for some unforeseen illness. The media allowed them to not have to deal with the fact that their principled stand against Obama Care should have been conflated with a desire to see their neighbors die of cancer.

            The Democrats were not totally blameless, though they were not criticized enough for the right things. They should have been dragged in to the streets for not creating a public option, or the ability to buy in to medicare for all. They were likely lobbied hard; any sign of public insurance will lead to the end of private health insurance in the ten years that follow it. That’s hard to end an industry. Democrats chose not to end dying of preventable disease in their own country instead. They do deserve praise for one thing, though. The bill was never designed to go on forever, and it may fail, but it will do so in a way that proves that people prefer to have healthcare rather than not. And that may mean that Obama Care hastened the coming of the public option, and for that we should thank those who crafted this whole mess.