Sunday, March 15, 2015

Ramblings on Obamacare and Church

Every month, someone from a charity comes to speak to my church, and the church supports that charity for the month.  This morning, someone from a health care charity spoke to us.  Essentially, the charity helps people who need prescription medicine.

I walked in a little late, so I did not hear the beginning of the speaker’s speech, but he did appear to be rather critical of the Affordable Care Act.  He said that, as a result of the Affordable Care Act, a number of large corporations have reduced people from full-time to part-time jobs so they could avoid providing them with health insurance.  The speaker also said that the health care exchanges have high deductibles, and this puts a strain on a lot of people.  I do not think that this guy was a fire-breathing right-winger; after all, he quoted Desmond Tutu and lauded him as one who spoke for the voiceless.  The speaker was just sharing how certain results of the Affordable Care Act have impacted his charity: more people are now coming to it for help, some of them from the suburbs.

As this speaker was sharing, I was thinking about something that I recently read by Robert Reich, a progressive professor and commentator who was President Bill Clinton’s Secretary of Labor.  Reich was lauding Obamacare as a success, and one of the things that Reich noted was that the copays and deductibles are slowing down the rate of health care spending.  I thought to myself, “And this is a good thing?  Doesn’t that put a financial burden on people and families?”

Some may say that Obamacare is not to blame—-that one should blame the large corporations or the insurance companies.  I am not entirely convinced by that argument, though.  For one, Obamacare, as far as I know, established the health care exchanges that have the high deductibles.  Second, part of constructing a successful program, in my opinion, is realistically determining how people will respond to it, in light of their own interests.  There are many cases in which we have to work with how people are, warts and all, rather than with our idealization of how they should be.  President Obama himself recognized this when he decided against pursuing a single-payer system and instead proposed requiring everyone to have health insurance: it would be better to appeal to the health insurance companies and the profits they would get and thereby to get them on board with Obamacare, than to push for something that would destroy them, and thus to provoke opposition to reform.  Obama decided to work with people’s selfishness rather than against it in his pursuit of reform.  In light of this, one cannot simply say that Obamacare deserves no blame at all for what corporations and health insurance companies are doing: the corporations and health insurance companies are responding selfishly to Obamacare’s policies.  How people are likely to respond to a policy should be taken into consideration when the policy is being developed and implemented.

Do I now regret voting for Obama?  I don’t know, honestly.  Of course, there have been conservatives and Republicans who have long said that everyone should have skin in the game when it comes to getting medical care, and who have criticized health insurance as a third-party payer that drives up the cost of health care.  You would think that they would be happy about the high copays and deductibles.  But I can play partisan games all day, and whom exactly does it help?  People are still bearing the burden of the American health care system.  I can say that Obamacare has failed—-though I would say that it has helped some people, such as the people who now have Medicaid and can get dental care.  But can I say that the Republicans have offered anything better?  Republicans proclaim tort reform as a major solution, but observers have said that it has not reduced health care costs in Texas (see here); the conservative Heritage Foundation, however, says that it has given more Texans access to health care (see here).  Competition across state lines can be good, as long as it does not become a race to the bottom.

Some may tell me that I should abandon trust in the political system because it is corrupt and instead wait for Jesus to come back to fix things.  But people need help now.  That is why I applaud this charity for trying to redress people’s situations.  Moreover, who is in office does matter.  You either have people who care, on some level, or people who do not.  For me personally, not showing up to vote is not an option.

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