GRASSROOTS/Hank Kalet

Bread, Circuses and Obamacare

Let’s get something out of the way up front: The Affordable Care Act – better known as Obamacare – is better than the status quo as it stood in 2008.

The legislation will eventually expand health coverage to more Americans than have had access to it in the past and it ends the noxious practice of denying coverage for health reasons and, in doing so, it has to be viewed as nominally positive.

That said, Obamacare is not the panacea its supporters make it out to be. It will not cover everyone and it is not likely to – in the words of policy wonks – “bend the cost curve downward.” It is, pure and simple, a way of forcing insurance companies to cover more people, which in turn will increase insurance company profits. And that is all it is.

This is not the debate we are having, of course. The national news media, led by those crafty devils at Fox News, have focused on short-term computer glitches and President Obama’s foolish lie that everyone will be able to keep their insurance if they like it. The entire system – and the push for universal care more broadly – is being judged based on the experiences of what ultimately will be a small sample of Americans.

And that is unfortunate. We shouldn’t be debating the rollout’s flaws or focusing on computer-system crashes. Those things are incidental. What we need to talk about is the larger flaws in a healthcare system tied to private enterprise, a system that is focused on generating profit and that has distorted what should be the real incentives – quality care and positive health outcomes.

Earl Pomeroy, a conservative Democrat from North Dakota who lost his House seat in 2010 after voting for the Affordable Care Act, describes the system – pre-Obamacare – as one in which the insurance companies cut costs by cutting care. In an interview with The Daily Beast on Nov. 12, he said insurers were instituting “more rigorous underwriting standards” and “shrinking coverage provided to those with insurance.” This created “an insurance system where many faced complete exposure [if a major illness hit], and many with coverage faced more exposure than they would have known.”

That led to an “erosion of meaningful health coverage for the American people,” Pomeroy said. Congress had to act and Obamacare was better than the alternatives, he says. It will expand risk pools and it bans insurers from denying coverage for existing conditions. It encourages states to expand Medicaid, aiding lower-income families, and provides subsidies to others. And it is supposed to tweak Medicare payments to help rein in some costs.

All of these are positive developments, but they are just tinkering around the edges of a massively dysfunctional healthcare system. Pomeroy, who opposes a single-payer system, inadvertently makes that clear when he tells The Daily Beast that the Affordable Care Act was an attempt to “jerry-rig a private insurance system into a program that more broadly spreads risk and assures that everyone can get coverage.”

And that is the point. We need to do far more than jerry-rig the system. We need a complete overhaul. We still spend twice what most industrialized nations spend per capita on health care, but rank near the bottom on most measures of outcome. The Bloomberg Efficiency rankings – which uses life expectancy and cost to come up with an efficiency score – places the United States 46th. We rank 24th in life-expectancy, but have the second highest per capita health care costs and spend a higher percentage of our gross domestic product on health care than any other nation.

A report issued earlier this year by the National Research Council and the Institute of Medicine also found, according to The Atlantic Monthly, “a ‘strikingly consistent and pervasive’ pattern of poorer health at all stages of life, from infancy to childhood to adolescence to young adulthood to middle and old age.”

A number of factors contribute to the findings, The Atlantic said, which makes singling out a cause difficult. But there is no denying that our fragmented and dysfunctional healthcare system plays a role. We continue to have high numbers of uninsured and those that are ensured still have to run the gantlet of insurance-company reviews. The goal, ultimately, remains the denial of care and the maximization of profit – and that cannot change until we take profit out of the mix.

We need a single-payer system modeled on Medicare and a shift in treatment philosophy away from the provision of individual services – each of which has its individual cost and rationale for use – to a broader concern for the patient as a whole.

This should be what we are debating. Instead, we are engaging in a counter-productive discussion about computer glitches driven by the bread-and-circuses philosophy of cable news.

Hank Kalet is a poet and journalist in New Jersey. He covers poverty issues for NJ Spotlight (www.njspotlight) and teaches journalism at Rutgers University. Email, grassroots@comcast.net; blog, www.kaletblog.com.

From The Progressive Populist, December 15, 2013