I write this on March 29th, 2014. The inscription period for President Obama’s Affordable Healthcare Act has been moved from two days from now to mid-April, as long as subscribers start their sign-up process by March 31st. Around Albuquerque, information tables have been operating in cafés and especially in places where young people congregate. There is some attractive literature, although I must admit I was a bit put off by red foam cutouts of giant hands, their index fingers raised. I couldn’t help thinking of one medical procedure that might better be left unadvertised.
The massive effort is obviously to get as many of our 43 million uninsured citizens enrolled in what is being advertised as inexpensive comprehensive health coverage, that doesn’t reject people for pre-existing conditions and includes an emphasis on preventative medicine.
This has been President Obama’s signature effort. He prioritized it at the expense of many others. Under the guise of “bringing everyone to the table” he gave seats at that table to the very industries that have kept healthcare in the United States so perverse and expensive: the large insurance companies and pharmaceuticals. Not surprisingly, they had their say and, in many cases, got their way. The Affordable Healthcare Act, or Obamacare as the president’s detractors like to call it, passed Congress after a great deal of bitter back and forth. Since its passage, its opponents continue to try to erode some of its important benefits, most notably women’s reproductive care.
Discussion of this or any other of the president’s initiatives would not be fair without mentioning the outrageous discrimination his enemies have launched against him—from stupid “birther” accusations alleging that he was not born in the US, through vile racist epithets, and vastly more physical threats than any other president has had to endure. Many of us believe the Republicans, burdened with the debacle left by George W. Bush, were relieved to see a Democrat forced to pick up the pieces. In both of his runs, Obama drew on his community organizing experience to mount truly all-inclusive campaigns. He won a first and then a second term, but I cannot imagine he knew how difficult his presidency would be. He continues to be viciously targeted by the Right, and to disappoint the Left.
As one problem after another exploded on the national and international scenes, the President has had to try to save the country from economic disaster and its financial and automobile industries from ruin, exit two major wars and put an end to sanctioned torture, juggle all manner of international crises while facing the country’s well-earned hatred from peoples around the world, reform a failing public education system, put people to work or keep them on welfare, fix immigration, and rein in a healthcare system that had gone stratospheric in cost—both to the country as a whole and to individuals. Huge tasks, all, and of course these are only the most important. He couldn’t be expected to succeed at most. Healthcare became the flagship endeavor.
So, how has it gone to date? Admittedly, we are still at the beginning of the change. The enrollment program began disastrously. Almost every state and federal Internet site worked badly or not at all. People spent hours, days, weeks, trying to sign up. The problems were so severe that it seemed likely they were intentionally created by those hoping to see the program fail. Doggedly the administration went back to work, and gradually the enrollment process began working better. Most major glitches seem to have been fixed.
But those are only the glitches inherent to enrollment. What about the problems with the program overall? Most complaints about the plan have been offered by those who would rather see our nation’s healthcare remain in the hands of private enterprise. I am someone who would much rather see a state-run healthcare program, similar to what our elderly have with Medicare or our military personnel and veterans through the Veterans Administration. I favor universal health such as that which exists in in Canada, England, Scandinavia, Cuba, and so many other countries—large and small, capitalist or socialist—in which governments consider it a social obligation to care for their citizens’ health.
Universal healthcare. No more, no less. President Obama favored another way. His requires that everyone carry a health insurance policy, and the Affordable Healthcare Act will penalize those who have not purchased one by the end of 2014. Mass enrollment by the younger, healthier, segment of the population is supposed to offset the needs of the older, more vulnerable segments. Government aid, in the form of stipends or tax breaks, are available for the poor.
But let’s not kid ourselves. Fewer young people are signing up than the administration hoped. Mortality and the possibility of eventual serious health problems are not prominent concerns of the young. And as for the poor, well most of them have no extra money at all to spend on trying to insure their health. Since our recent massive economic recession with its consequent loss of jobs, its been all many people have been able to do to make it from one meal to another. For hundreds of thousands, those meals are now being eaten in homeless shelters or soup kitchens. Whether or not you will be penalized for not enrolling in Affordable Healthcare, if you don’t have the money you cannot enroll.
This is a superficial overview of a frustrating situation. So many competing interests are at stake. But the bottom line is that we are days from the cut-off date for 2014 enrollment and only six million of our forty-three million have signed up. The figures bear repeating: six out of forty-three million. There is no way this can be considered success.
Let me be clear. Lacking better alternatives, I support President Obama’s Affordable Healthcare Act. I consider coverage of pre-existing conditions to be particularly important.
A little is better than nothing, but too little still isn’t enough. The rollout of affordable healthcare has been a failure so far. Perhaps this failure will bring us, in saner times, closer to universal healthcare for all Americans, the only real solution to keeping a nation healthy.
(Photo by Neon Tommy)
April 10, 2014