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A Non-Crazy View of…”Obamacare”

I follow this pretty strict rule on my Facebook page 90% of the time where I don’t talk politics, because Facebook is basically a never-ending episode of Crossfire nowadays, and because I try to be a positive voice on social media while everyone else is yelling at each other.

That said, I figure I can break my vow of political silence and post my opinions here, outside Facebook, where I can properly police behavior and make sure anyone who wants to comment civilly can do so without fear of being yelled down. So I’m toying with the idea of “A Non-Crazy View of…” series to highlight topics I’m interested in, and provide a chilled-out view as objectively as I can muster. I’m not much into the whole politics thing, and am usually just an observer from afar, which, ironically, I think keeps me more or less balanced in my views (I hope).  I do not fashion myself a conservative or liberal, so hopefully I can display no bias either direction.

Let’s Argue on the Internet!

So, let’s start this blogging experiment with a discussion of the Affordable Care Act (ACA), more popularly referred to as “Obamacare”. I will refer to it as “ACA”, however, since the whole point of dubbing it “Obamacare” adds an emotional slant to it right out the gate. So let’s call it what it actually is.

To understand what makes this topic such a mess, we need look no further than any given Facebook “discussion” on it.  On the one end, liberals praise it as Obama’s crowning achievement and a step toward European-style single-payer universal healthcare,  a (albeit flawed) solution to our society’s healthcare problems.  On the other end, conservatives have for  years fiercely denounced the program as evolving us toward a socialist authoritarian welfare state where everyone is dependent on the government for health.  Most arguments I’ve seen are some variation on these two ideological views, rinse and repeat.  Is that all this is about though?  “Socialism good” vs. “socialism bad”?  If you listen to TV news, talk radio, or anyone’s Facebook feed, this is all that’s presented, so it certainly is pitched as such.

So what’s the rest of us, who aren’t into yelling each other down and painting absolutely everything in black-and-white good and bad, to do?  I propose this is a far more nuanced topic.

So Who’s for Survival of the Fittest?

Let’s start withe what everybody agrees on: there’s a healthcare problem.  Insurance premiums for lower income households (poverty line and lower-middle class) have long been expensive, too often cripplingly expensive.  The one thing I don’t see either side ever saying is that there’s no problem and everything’s fine.  I’ve literally been the penniless guy who was sick and couldn’t afford care with insurance, so I can vouch from direct experience that there is undeniably a problem.   My saving grace was an uncle who stepped in to help, but many people don’t have such generous people in their lives.

With that understood, I think everybody can also agree that there isn’t exactly an obviously easy solution landing in our laps.  If you’re liberal, you look at Scandinavian countries and might conclude “hey that seems to work, let’s do that” and turn to socialized medicine.  If you’re conservative, you probably conclude there’s a problem with how we’re managing the free market and we can tweak the current system to solve the problem.

But Their Party is Evil and My Party is Awesome

This where things go crazy — If you’re a Republican, you are almost required to absolutely loathe anything the other party proposes, because Democrats are corrupt and evil socialists.  Likewise, if you’re a Democrat, you cannot be on board with anything the other party has to offer because they are bigoted racists and evil.  So while these two forces running our country bash heads, any actual discussion of actual solutions really falls to the wayside.  (This is why I’m insistent on saying “ACA” instead of “Obamacare”, since if you hate/love Obama you must hate/love Obamacare by extension.)

You think they’re debating solutions, but they’re really just yelling at each other, like they do on every topic.  The world we live in is now one where Obama is a Kenyan Muslim, W. Bush is a war criminal, Clinton is literally the antichrist, and Trump is a Russian spy.  This is a fantastic way to make every debate about character assassinations instead of actually focusing on the issues that are going to either help or wreck our lives even if some of those guys are really actual supervillains.  Consider: this solution X President is proposing will destroy the country because X President is evil so everything they propose has to likewise be sinister.  Liberals are socialists or conservatives are fascists and the end of the Republic is upon us!

I don’t know how folks have the stamina to hold to such polarized views 365 days a year.

So here, we will abandon all the above ideology and just look at a problem and proposed solutions.  I’ll offer my opinion, which, as I will always note, is not really worth anything, and I am often quite mistaken about many topics.  I am not an economist nor do I hold a political science major.  I’m a layman, just a dude, if you will, trying to make the best sense of things as I can. In other words, I’m totally unqualified to speak on the topic but I’m driven by caring about it and thus giving it a good college try.

So the Truth is…Nuanced?

Today we have the ACA.  To the Democrats credit, it is working to some degree.  When you see people — individuals — speaking up and saying they can finally afford care, can finally get long-debilitating health issues solved, and have some real livelihood restored, one can safely conclude something is working.  Fair?  This is why liberals insist the system is a victory.

Similarly, we have no shortage of stories that those under the poverty line still cannot afford healthcare because ACA premiums have only been on the rise.  So you have poor people post-ACA who are still poor and still cannot afford healthcare.  This is why conservatives insist the system is a failure.  I will say this means something isn’t working.

So for some people, the ACA works great. For others, it’s not working and they’re still thrown to the wolves.  So I propose the ACA is both a success and a failure – or, better stated – it’s a critically flawed but not entirely broken system.

Why is it broken?  Personally, I think the political climate has fuzzed the details beyond objective assessment.  Obama’s personal vision of the ACA never came to pass, so I don’t know about you, but I can neither confirm nor deny that his original plan would have worked or not.  The ACA that was implemented was only a shadow of Obama’s vision, which I think is safe to conclude, whether that vision was good, bad, whatever.  Why is it a shadow of the original ideal?  Because Republicans only allowed the ACA to come to life by stripping a bit of the original vision out of it, for better or worse.  This modification of the ACA, liberals may propose, is Republican obstructionism in order to break a system then complain it’s broken.  Conservatives propose their modification is what prevented it from being a massive disaster (more so than they claim it is already).  Whatever the case may be, this makes it really tricky for average Joes like myself to really make heads or tails of the whole mess. Perhaps that was intentional, perhaps not.

Ok, so everyone agrees there’s a problem, no one agrees on the solution, a solution was implemented if only in a modified form, and the result of that solution is some success and some failure.  That’s not anywhere near as easy an answer as “it’s good” or “it’s bad”.   That said, it shouldn’t be a surprise that it was neither a runaway success or absolute failure; “version 1” of any system is never the one you place final judgement on.  It’s like judging software solely based upon the beta version.  You have to tweak, adjust, modify a system several times over before you can really make that call.  Nonetheless, that call has been made on ACA beta version 1.0, so here we are.

The powers that be must figure out a solution since “sometimes it works, sometimes it doesn’t” isn’t exactly a desired outcome, at least at the current ratio.  So our options are:

  • Remove the system (revert to previous system).
  • Modify the system.
  • Replace the system.

So let’s consider these three potential solutions.  If you remove the system, you inevitably harm those for whom the system did work.  For those for whom it never worked, you have a net sum of nothing; the previous system didn’t work for them to begin with.  Even if the system should have never been implemented, this is where we are, and these are the real consequences of pure removal.  I think the cost/benefit outcome of this is just bad news all around.  No impoverished citizens benefit from the removal, while some impoverished citizens are harmed by its removal.  It would strike me as strange to try to pitch that as a viable solution.

Next, we could modify the system.  This poses less of a threat to those already benefiting from it.  Perhaps some tweaks would correct the significant flaws of rising premiums leaving others in a harmful state of being exactly where they were before the system was implemented.  If tweaks could adjust the success/failure ratio in favor of success, then I think that would be worth taking a go at.  This could benefit those currently benefiting and those currently not benefiting.

Lastly, we can replace the system.  I figure that’s worth considering too.  If the failure side of the ratio is due to core mechanics of the system, it might not be fixable, in which case you figure out what worked and what didn’t, then invent a new, superior replacement system. If the replacement process is implemented correctly, those benefiting from the current system aren’t harmed since they can be transitioned right over to the new system.  This could likewise benefit those currently benefiting and those currently not benefiting.

So, as I see it from this simple layman’s point of view, the first option is largely a lose-lose scenario, while the other two options may possibly provide a win-win.

But Wait, There’s More!

We haven’t covered all the nuances though.  What is one of the more common retorts to ACA or anything similar?  “My premiums/taxes went up!”  Those in the middle class and especially those in the upper class pay into the system for those in the lower class to be able to benefit from it.  In other words, the money has to come from somewhere.  I personally don’t fully understand this concern because I myself am in the middle class (hovering about upper-middle perhaps), yet my premiums have more or less stayed business as usual; changes have been somewhat negligible.  I’m not experiencing any crippling rise in healthcare cost, and I use a major insurance company and have no shortage of healthcare expenses.  So if the cost/benefit ratio is a little more cost to me for a big benefit to others, then I don’t see any problem.  My experience is purely anecdotal though, so I would be interested in seeing how others in the middle class have been impacted, and if they have been impacted differently, I want to understand how in the world I’m an exception.

One other thing that shouldn’t go ignored: this is a raise in cost for employers.  For big corporations (ironically the most likely to complain about it), that cost can be absorbed, so no biggie; however, for small businesses, every additional cost adds up in a big way.  So I think this factor should not go ignored, especially since most liberals and conservatives tend to favor the “little guy” small business owners over the mega-corporations, if only in word but not deed.

So Democrats, You Have Me (for Now)

So with all the above considered, for now, I side with the Democrats on this one, and I maintain my right to switch sides as the situation evolves.  Current Republicans (a) are rushing a full repeal or at least a severe gutting of the ACA, (b) claim they will offer a replacement, (c) have claimed this for years now, but (d) have offered no replacement whatsoever.  And look, it’s not like they haven’t been given a million opportunities to do so.  This threatens a tragic cost/benefit shift: yes, taxpayers who always have been able to afford insurance benefit, but both those benefiting off the current system and those impoverished not benefiting simply move into a bigger bucket of none of them benefiting, since full repeal simply means a reversal to the previous system.  So, Republicans, I can’t give you leeway on this one; I have no idea what you’re doing and I don’t know if you know what you’re doing.  Go hang out with the Space Race era Republicans to learn how pitching ideas works.

Does this mean I’m a liberal Democrat now?  No.  Once upon a time, Republicans were known for being the nerdy folks with red ink who knew how to implement systems without breaking the bank, at least more so than today.  This was before the political climate turned purely and viciously ideological.  With that in mind, if the Republicans could pitch a replacement system in time for the repeal, then I’d lend them an ear.  If they could present a superior replacement system that would benefit those we’re all concerned about while providing a smooth transition from the old system, then I would totally flip over to backing the Republicans on it in a heartbeat.  In other words, I don’t care which side solutions come from; I care about solutions that work or at least are articulated.

And let’s be fair in addressing the elephant in the room sporting curiously orange hair: there’s an extensive list of things that terrify me about Trump, but I will at least give benefit of the doubt that since not all of his businesses went bankrupt and it’s reasonably safe to assume he himself isn’t bankrupt, that maybe the guy knows at least something about implementing successful systems with a balanced cost/benefit ratio.  A stretch, perhaps, but I am an eternal optimist.  Unfortunately, all he and his party have provided so far are just typical empty political promises (between twitter wars), the kind that often only serve to win votes.  “It’ll be so much better!” means nothing without at least a semi-detailed proposal — a rough draft, even — something a walking corporate success story would be especially aware of.

In conclusion: I agree with the liberal who points out we can no longer pretend that there aren’t impoverished Americans sick and dying only because they can’t afford private insurance.  I agree with conservatives in taking caution with how much we tax who for what.  I also agree with conservatives that we should be cautious how dependent we make ourselves on flawed government.  Dependence grows power.  Similarly, I agree with liberals that individual “socialist” solutions are not necessarily “evil red socialism” and worth consideration at the very least.  I believe there are nuances and effective solutions usually exist on a spectrum between extremes.  I understand everything has a cost, costs cannot be avoided, and yet oftentimes costs are necessary.  Anybody who pitches a solution that can reasonably achieve this balance gets my support.  That, unfortunately, is not the goal of the modern political system by and large, at least as far as I can see.  I am up for giving the Democrats another chance to improve their system, and I am also up for letting conservatives attempt to introduce a superior system…if they’d stopping bickering and actually do it.

Update: Right after writing this, I saw the news about the late-night repeal vote.  So…that happened.

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