In the Arena

Sanity on Obamacare

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Shawn Thew / EPA

U.S. President Barack Obama at the White House on Oct. 25, 2013

There’s been so much hyperbolic nonsense written about the Affordable Care Act that it’s hard to discern what’s really happening with this crucial new program.

But a terrific place to start is with two of my favorite young journalists — Ezra Klein and Ross Douthat. Ezra — who is still no relation to me, but a friend — does something courageous in the Washington Post: he writes about the other problems with Obamacare, in addition to the website issues. He also chastises fellow liberals who are saying that progressives shouldn’t publicize Obamacare’s travails. (I mean, it-ain’t-happening ostrichism worked so well for right-wingers when it came to shutting down the government, gay rights and a host of other issues.)

Douthat, who has become an indispensable conservative voice, does something courageous in the New York Times: he unpacks part of the conservative criticism of the ACA — that it was falsely sold by the President, that people will lose their existing plans — but explains that while some will have to pay more because of the law’s new parameters, they will be getting better health insurance and, in many cases, it will be cheaper because of the government subsidies. He allows the unthinkable: that the ACA might work. (Douthat has favored universal health insurance in the past.)

For the record, I hope it does. I’ve been critical of the Obama Administration’s slack-to-the-point-of-incompetent management style in the past — and the disastrous rollout of the health plan is dispositive confirmation of that. (If nothing else, this should convince the President to amp up the management aspects of his Administration across the board.)

But the importance of this program should not be lost in the Administration’s failure to implement it. This is not health care for deadbeats, as many Republicans assume. It is a highly moral piece of legislation: the people most affected will be the working poor and lower-middle class, people who have jobs, often at small businesses, but don’t have health care. (The unemployed and unemployable poor already have health care via Medicaid.) It is a matter of simple fairness that if we, as a society, provide health insurance to those who don’t work, we also provide it to those who do.

This has been part of my mystification with the Republican opposition to this program: they supposedly want to encourage people to work. The ACA, if well implemented, will do that. Another part of my mystification: this is not socialized medicine, as the Republicans charge, but health care via a regulated market system — the health care exchanges, if they’re ever straightened out, will be online health care superstores (think Orbitz or Various private insurers will compete for customers … with new, more humane ground rules. They’ll have to take all comers, including those with pre-existing conditions. This, too, is a very Republican idea — the idea of health care exchanges was born in the very same Heritage Foundation whose Heritage Action Fund is now trying to kill the plan.

Does Obamacare need to be changed or modified? Absolutely. It would have helped if the Republicans had participated and insisted on medical malpractice reform — Obama was willing to negotiate on this — and on perfecting the market aspects of the program.

In the end, the ACA may not work. The various interest groups — the hospitals, the doctors, the insurers and, yes, the trade unions who limited the ability to make gold-plated health plans eligible for taxation — may have crippled this bill beyond feasible implementation. If that happens, it will be a tragedy. The bottom line is this: the working poor, the small-business owners and the self-employed deserve affordable health care.

So let’s all calm down a bit, listen to voices like Ezra Klein and Ross Douthat, and see if the Administration can get its act together and make this work.