Is there anyone left that realistically believes that the Patient Protection and Affordable Care Act aka "Obamacare" was truly about getting healthcare for Americans that do not have it? I would hope not, but I am sure there are. I understand the lure and appeal of getting everyone in the country healthcare coverage, I truly do. From a humanitarian perspective it is a no-brainer. Who could argue that everyone should have the access to care when they are sick or injured? Why should anyone in the richest country in the world suffer needlessly or possibly die when proper medical care could prevent it? The problem I have with this is the way in which the government/administration decided to handle it.
The number of people without healthcare in this country is subject to a lot of debate as well as discussion over how that number is determined. There are a lot of young adults that are usually included in any number given that although not insured are so due to their own choice. My two youngest are in this group. Both do not have health insurance. They have both had it offered through their employers at various jobs but choose not to allocate their money towards it. Any care they have needed has been handled at urgent care centers or hospital emergency rooms. As 20-somethings healthcare fears that strike fear into the hearts of us older folks are not a reality for them. So be it. Also included in the number of people that do not have healthcare are illegals and their children (who may or may not be legal). The range I have seen in researching this number is from a low of under 20 million to a high of 50 million. A very common number given, and one that just happens to be in the middle of the above two extremes, is 35 million. For the purposes of this discussion we will use that number.
My opening "provocative" statement shows my doubt that the Patient Protection and Affordable Care Act (to be from here on referred to as the ACA) was primarily about getting healthcare coverage for those millions without it. I really don't see how anyone could argue the point. Here is why I feel that way -
1) the agencies and programs to handle the issue already existed - The VA administration, Medicare, and Medicaid were and are already set up and providing healthcare to veterans, poor, and the elderly. The infrastructure (admittedly needing work, but that is a subject of another discussion) exists. It would have just needed to be expanded. Everyone that coverage needed to be provided for either already did, or could have fallen into one of these agencies with a little reclassification and regulation.
2) I know Congress has a great ability to complicate anything. However, thousands of pages of law and regulations is overkill. (this is one of those areas that is subject to great hyperbole - I have heard 11,000, 20,000, and up to 32,000 pages - I have pretty much confirmed that the law and regulations contain many, many more words than the Bible) It almost guarantees that at sometime anyone runs the risk of being in violation of the law. It also guarantees that no one will ever fully grasp what exactly is going on. This, to me, is the scariest part of the law. A government official can now tell a hospital, doctor, and/or citizen that they are in violation of the law and need to do such and such to be in compliance. This is way too much power. It is similar to the existing problem today with our federal tax codes. I personally have had a tax issue that I have put before a CPA and gotten one answer. Then I put it before the IRS answer people and got another answer. I then called the IRS help people and got a third answer. When I told the last guy and my CPA that they just said -"the law is complicated and subject to interpretation". I told him I did not think that would work in a court of law as my defense. I see the same issues coming up here. A cynic might say this is on purpose to allow the government to come in at some point and get absolute control with a single payer government run system.
3) With over half a Billion dollars spent on the website (that does not work) and almost $50 Billion dollars allocated (and surely to be spent - almost half has been so far) for promotion and education.
The money spent that does not have any aspect whatever to do with healthcare makes all of this smack of the cronyism that permeates most legislation these days. If this money had been put into the agencies I mentioned in #1, I feel a lot more would have been accomplished in the name of healthcare.
4) Even the most optimistic projections I have seen show tens of millions of people still not having healthcare at the end of 2014. I have actually seen a figure as high as 35 million - look familiar? The lowest number I have seen is 10 million plus. So, just the $50 billion allocated for education and promotion could have come close to getting the same number (25 million) of people covered with insurance, or close for the same period.
I will not get into the new IRS agencies and reporting that the bill and regulations call for. (FYI, this too has been subject to a lot of hyperbole with the "16,000 new IRS agents" claims that have been thrown around - not true as much as I can tell - probably more like 1,600) Also, the regulations and reporting that medical personnel will have to deal with and navigate through are a problem I mentioned somewhat in #2, but I will not cover in detail except to say that none of that serves patient needs any better. The extra taxes and fees that will be assessed on medical equipment providers and other medical companies is a drain on services and money. As a libertarian, I am greatly worried about the increase in power, complication, and structure of the government. That is actually my biggest concern.
Back to my opening remarks. Although I admitted that the humanitarian aspect of offering healthcare to any and all is appealing and understandable, the problem is cost. Who pays for it? Do we pay for the person that is morbidly obese when they have a heart attack? Do we pay for the meth-head when the OD and are dropped at the ER by their friends? How about the diabetic that eats the ice cream and cake because they want some and know they can just shoot some extra insulin? There is a cost to this that is real. There are personal responsibilities to healthcare that cannot be regulated. All of this is not handled by the knee-jerk feel-good response to the "right" to healthcare.