Dr's In: Obamacare alive and recovering

Opponents of Obamacare (The Affordable Health Care for America Act, 2010) have relentlessly attacked the legislation, including dozens of attempts to kill the bill or thwart funding.  In spite of such efforts, 2.1 million Americans who could not afford coverage in the past have signed up thus far.

Opponents of the “New Deal” used similar tactics against President Franklin D. Roosevelt’s programs and 25 years later critics opposing Medicare blocked success for three years. If nothing else, conservatives are consistent. Two major blunders provided opponents fodder to attack Obamacare. First, the President said that no one would lose this or her insurance if they chose to keep it, which was not true. The other was the rocky rollout of the program’s website.

Opponents took full advantage of these failures to win public-relations battles, but probably have lost the war. And opponents have made a great gamble relentlessly assailing the program.  Obama’s claim that no one would lose their private insurance if they chose to keep it made little sense. When Hawaii became the first state to institute universal health access, most for-profit insurers left the marketplace. They did not want to live by the rules and accept reduced profits.

Obama’s advisers should have known that such an exodus of private insurers was likely. If an insurer decides to stop writing policies, that’s the company’s right.  The troubled rollout was a disastrous management breakdown. However, it now appears that the advantages offered to Americans by Obamacare are overcoming the criticism.

Critics’ claims about “death panels” and other exaggerations may well come back to haunt them, much the way voters have punished conservatives for their opposition to the “New Deal” and Medicare. Both programs have considerable public support and have improved the quality of life for seniors and helped strengthen their role as consumers.

Among many other needed reforms, Obamacare requires that insurers: no longer charge women more than men for coverage; insure regardless of pre-existing conditions; no longer have caps on what they will pay for care; accept regulation of their administrative costs.

What is often lost in this battle is the importance for equitable access. Citizens in countries with universal health care are healthier, live longer and pay less for health care than citizens in the United States.

The Obama administration has released data showing that 3.9 million additional Americans are now eligible for Medicaid and CHIP, which covers children’s health care needs. Critics of these programs should stop trying to obstruct them and work with the administration to make Obamacare work as successfully as possible.

If Obamacare accomplishes all its objectives, some 17 million people may still remain uninsured. The goal should be zero.

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sadie728 January 04, 2014 at 10:55 AM
Wonderful article! Thanks for publishing it. When I was in grad school studying medical anthropology, we learned how much money a lot of insurance companies (especially HMOs) wasted on administrative costs that could have been applied to patient care. I'm glad the ACA is addressing that. My kids were on Medicaid (Healthy Kids?) when we first moved to Florida and hadn't gotten jobs yet. I was pleased with it. (They're pretty healthy kids, though.)
Marc J. Yacht MD, MPH January 04, 2014 at 11:55 AM
Sadie: Thank you for the comments. Drastically reduced administrative costs can best be accomplished with a one payer system. Unfortunately, the lobbying efforts against one payer have been very successful and frought with scare tactics. Obamacare leaves a lot to be desired and the failure to provide a public option or reduce the age to 55 to qualify for Medicare are barriers to universal health coverage and affordability. Full universal health coverage will continue to be a very hard fight.


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