For some, passing this bill is so distasteful as to somehow be associated with "Armageddon" (per minority leader Boehner). But when I step away from the hyperbole and fear-mongering (Glenn Beck, I'm looking at you), my short thoughts are: this is a good thing, it could have been a better thing, more is yet to be done. As to the title of the post, the reform that was passed was mainly a change in how we pay for healthcare rather than addressing the problems with the medical system itself, and I do believe it will have a positive net impact on us as a country. However, the most fundamental problem with how we finance health care has not been addressed, and that is that nobody--from the patient to the various team of healthcare providers--knows how much anything costs.
Maybe it's an extension of the obfuscated costs of healthcare, but discussions of healthcare as a "right" and the inevitability of "rationing" all stem from some absurd idea that the resources for healthcare follow a set of unique existential laws separate from all else we consume. Somehow many people seem to believe that nobody has a right to tell anyone when to pull the plug on Granny, but are hard pressed to explain who should pay for these expensive benefits Granny et al can't afford. The fact is, it's all expensive--very very expensive. And unlike everything else in my life that costs a lot of money, I'm prevented from doing cost research, taking advantages of sales and price breaks, or any of a zillion economic tricks that have kept my family living comfortably on a resident salary for years. But, it hardly matters when the bills are paid by the borg--some collective of University, government, insurance company, and hospital resources that combine to take care of things in a manner that recycles all the very real costs into a smattering of undetectable accounting tweaks that make me feel like I'm not really paying for it at all. It's an employment "benefit". Woop-dee-doo.
Anyway, all that is to say that in my view the real problem with the medical system is that people have not been allowed to understand the value of their care--how much it really costs. And until we are given that, other cost cutting measures are stop gaps that will only put bandaids on the severed arteries of our economy. This bill didn't address that fundamental aspect of cutting medical costs, and, somewhat understandably, that made a lot of people oppose it. I ignore the deficiencies in what the bill could have been in favor of appreciating what it did do.
As a nation, we've decided basic healthcare is a right. It's already done. That is to say, if someone shows up at the ER bleeding to death, we don't check their insurance status before saving their life. If they can't pay, we all pay for them. One can make the argument that this should change, but I don't see that as politically feasible, moral, or consistent with my own values. So, I accept as a given that everyone consumes healthcare in this country whether they pay for it directly or not. For healthy young people, the consumption is of the obviated risk of unfinanced catastrophic injury rather than direct medical care, but the consumed benefit is real just the same. Since everyone receives this benefit, it's only fair that everyone should be made to pay rather than freeload. And that's why I personally support mandated health insurance as an appropriate intrusion into our personal freedoms.
Detractors have many arguments against the reform, but the ones I hear most frequently are these:
- mandates are unconstitutional
- healthy individuals should not be made to pay for the benefits of the unhealthy
- those whose behaviors make their care more expensive should not be subsidized by their more personally responsible counterparts
- the government can't be trusted to do something this big correctly
I bit off more than I could chew by starting this post, because I realize to do it justice will take a lot longer than I have right now. But, add to my list of detractor arguments in the comments and I'll try to write more later. Thoughts?