The launch of Obamacare — aka the Affordable Care Act — is proving to be an exercise in confusion. So far, it looks as though the law should have been named the Unaffordable Care Act because costs will go up while quality of care will either stay the same or go down.
It could have been so much better. The Affordable Care Act was a long time coming. You may remember that President Clinton tried to establish a national health care program in the first months of his first term, but the effort died. Its death may have been due to the fact that the president’s wife, Hillary Rodham Clinton, was in charge of putting the program together, and proved to be inexperienced, intractable and self-deluded about what she was actually supposed to be doing. Her effort failed.
She had plenty of models to follow — at home and abroad. Medicare, for example, is a terrific system that not only provides health care but does it affordably. Medicaid also provides health care to many who otherwise would not be able to afford it.
Then there is Canada’s public health-care system, practically next door, which provides cradle-to-grave coverage. It has its own quirks — requirements for waiting periods for certain kinds of treatments, for example. But if given the choice, Canadians would not trade their system for that of the U.S. They certainly wouldn’t trade it for the Affordable Health Care Act.
The United States already spends more on health care than any other first-world nation. Yet, its outcomes aren’t always as good as those as in countries such as Canada.
Health care has come to be an expectation of employees of companies of a certain size. That is one reason the American system is as expensive as it is and less effective as it could be. Employers look for the least expensive care, while insurers, answerable to shareholders, seek to provide as little service as possible. This forces costs up on both sides.
It would have been so much easier, less expensive and more effective to simply expand Medicare and raise its rates to keep it actuarily sound.