On ObamaCare, Bill Is Right
In every way, ObamaCare is crazy.
What was the goal of the ACA?
Essentially, it preserved the private health insurance markets, the dominance of the large pharmaceutical companies and the largest providers of health care like large hospital groups. Sure, it gained health insurance for some. But did it get many real health care? Who knows?
Did it lower costs?
Not on your life.
Did it improve quality?
Who the heck knows? What is medical quality anyway? The currency of the magazines in the waiting room, the availability of free parking, the congeniality of the doctor’s staff? Is it checking all the boxes in EPIC to guarantee full payment for a visit of maximal acuity? Or is it outcomes—what really matters? Don’t look to Congress or the White House to answer that one.
In the ACA there is no public option like Medicare for people under 65. Why not? You want to know how good Medicare is? Try to take it away from a senior. If people over 65 can be guaranteed health insurance and they are likely to carry the largest disease burden due to age, why not get everyone into Medicare?
Medicaid could have provided some coverage for all the poor and those with incomes up to 138% of the federal poverty level. It would have under the ACA if the Supreme Court had not declared that overly punitive to the states which pay about half of Medicaid. So many Red states did not expand Medicaid and many of the poorest Americans have no insurance and no subsidies to buy policies on the federal exchanges.
And, as President Clinton noted, what about those making more than 138% of the FPL, but just enough to make the subsidies out of reach or inadequate? These folks are still without health care and many more are finding their premiums rising, their current physicians are pushed out of their available networks as insurers desert certain counties, and they have lost coverage altogether in some instances.
I was on Capitol Hill when ObamaCare was formulated. The GOP did everything in its power to weaken what little benefit might have been derived from the ACA. The Republicans succeeded.
Mr. Clinton is right. ObamaCare is crazy in its construction, in its financing and in its implementation. Furthermore, you can’t fix it. It would be best to start again and have the interests of the American people in the forefront not the interests of the insurers, the drug companies, and the large hospital chains. What a concept!