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Hullabaloo


Wednesday, January 01, 2014

 
Obamacare is up and running. But that's not the end of the story.

by digby

When Capitalism: A Love Story came out I was lucky enough to be at a screening with Michael Moore present and there was, as you might imagine, quite a bit of discussion about the Health Care Reform that was ending its way through congress since Moore was so influential in raising the public consciousness about the horrors of the system with his previous film Sicko. He was, at the time, very positive about President Obama and optimistic about the eventual outcome.

But he's been watching the law unfold with clear eyes and is unsparing about the shortcomings of the new program. In an op-ed in the NY Times he pointed some of them out including this one:
For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)
But he's also clear-eyed about the benefits:
And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.
There are lots of people like that and it's a Big Deal.

Moore offers up the right analysis and the best advice:
Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let’s get started. Obamacare can’t be fixed by its namesake. It’s up to us to make it happen.

That's a fact. It's going to take years to build up a real, universal system and much of that is going to come from work in the 50 states. It means we will be living with an unequal system for many years, but that's an old story in America, isn't it? Maybe the best we can hope for is that the speed of eventual universality is faster than it used to be.

It's better than it was, but it needs to be better than it is. Hopefully it will be excellent for everyone very soon.


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