The Common Good and the ACA

What does this say about us as a society?

Karen Black an actress whose roles in several signature films of the late 1960s and ’70s included a prostitute who shared an LSD trip with the bikers played by Dennis Hopper and Peter Fonda in “Easy Rider” and a waitress unhappily devoted to the alienated musician played by Jack Nicholson in “Five Easy Pieces,” died on Thursday in Los Angeles. She was 74.

The cause was complications of cancer, her husband, Stephen Eckelberry, said. Ms. Black’s battle with ampullary cancer, a rare form similar to pancreatic cancer, became public in March when she and Mr. Eckelberry sought contributions on a fund-raising Web site to pay for an experimental treatment.

Think about that a second. An actress important enough to rate an extended obit in the NYT had to crowdsource her cancer treatment. The ACA should, if it isn't completely subverted by the efforts to sabotage it, ameliorate this problem to a large extent, but here's my question to all the ACA opponents: What's your alternative? Because Karen Black was famous and successful, and this is what illness did to her. What's the solution for the non-famous, non-successful people? We hear a lot about "replace and repeal" but replace with what?

The problem is that the "market"for medical care cannot be free or for that matter an efficient market because of the disparity of bargaining power between the person who needs treatment or will die, and those providing treatment. Worse,the use of insurance distorts the market even further, because the insurer's is incentivized to delay or deny meritorious claims while profiting off premiums.

While the Affordable Care Act is far from perfect--I'm a supporter of single payer, myself--it in fact improves the situation of many:

ObamaCare Pros: New HealthCare Benefits

ObamaCare gives Americans access to hundreds of new health care benefits. There are too many to count, and would make for a pretty unbiased (looking) list. However these benefits,(aside form ones mentioned elsewhere on this page, include: No annual or lifetime limits, children can stay on their parents plans to 26, FDA can approve more generic drugs driving prices down and breaking monopolies and protections against discrimination for gender, disabilities and domestic abuse. Check out our ObamaCare Health Care Reform Timeline for a comprehensive list.

ObamaCare Pros: preventive and Wellness Services

Millions of Americans now have access to preventive and wellness services with no out of pocket costs. The specific benefits can be found on our Benefits of ObamaCare page.

ObamaCare Pros: Consumer Protections

ObamaCare regulates insurance, referred to as the "rate hike" review, enacts the "80/20" rule that makes health insurance providers spend at least 80% of their income on health and marketing expenses or must be returned as rebates and being dropped from coverage for being sick or denied from a preexisting condition are all out the window in the next few years. ObamaCare has a long list of protections that are protecting your new rights, including a mandate on fast food restaurants to display calories to promote wellness.

ObamaCare Pros: Cost Assistance for the Middle Class and Small Business

Those under 400% of the federal poverty level (Roughly 88k for a family of 4) could save up to 60% on their premiums via tax credits and subsidies on the health insurance exchanges. Small businesses with less than 25 full time employees have this advantage as well.

ObamaCare Pros: Medicaid Expansion

Those under 133% of the poverty level will (in states that have not opted out of Medicaid Expansion) will be able to be covered now that ObamaCare is expanding Medicaid to low income Americans who were left without enough money to afford insurance and too much to qualify for Medicaid.

ObamaCare Pros: Improvements to Medicare

ObamaCare does a lot for Medicare. For the most part these things are great and have already benefited tens of millions of seniors. ObamaCare closes the Medicare drug 'donut hole', provides improved preventive and wellness services with no out of pocket cost and reforms aspects of Medicare to improve overall care for seniors.

ObamaCare Pros: Quality Over Quantity

Doctors and hospitals will be moved to a system where they are rewarded for providing quality care, instead of being reward for quantity. May of the provisions to enforce this punish high turnover rates, this however has some unintended consequences. Some doctors and health care institutions are getting hit hard from this, although the overall reform will create a better health care system for all Americans.

ObamaCare Pros: Oversight Committees

159 new boards, agencies and programs are created by ObamaCare to oversee spending and to ensure ObamaCare is working correctly. Though sometimes listed as a con, having oversight on a reform of this size is mandatory to ensure to program works. It's important to note that ObamaCare doesn't ration healthcare, rather it regulates the health insurance industry who have been rationing our health care for years. Your health care is still between you and your doctor and determined by your private insurance.

Again, none of this is to say that the ACA is perfect, but it's a damn sight better than what we had before it.

I'm for allowing some room for market forces. In the UK, you can "go private" and pay a doctor or a clinic or a hospital. You have to pay your taxes, and remain entitled to be covered by the NHS, but if you have the resources and want to spend them on private care, live and be well.

The difference is that under the UK system, those who cannot afford to do that also have a chance at living and being well.

[NB: This post builds on an online discussion I had earlier today with several friends, two of whom offered critiques of my first blush analysis, and helped me sharpen my own thinking. Which is not to say that we ended up on the same page, though we all moved substantially closer by the end. I want to thank them for the engagement, which forced me to think the issues through a little more closely than I had done at first.]