What Did ObamaCare Do, and Was it Enough?

I’ve summarized what’s wrong with our health care system, according to TR Reid’s The Healing of America:

  1. Coverage – Our health care system allows some people to die while others receive care.
  2. Quality – The quality of care is lower by many measures than that of other countries.
  3. Cost – Despite its major flaws, our system is the most expensive in the world.

I’ve also summarized Reid’s broad solutions, based on things superior systems have in common: 1) unification, 2) universal coverage, and 3) nonprofit financing.
So… Did Obama’s health care reform bill manage to do any of these things?

The Patient Protection and Affordable Care Act (PPACA, otherwise known as “Obamacare”) was signed in March 2010, and was a sweeping reform to the U.S. health care system. It’s extremely complicated, and I’m by no means an expert—I recommend visiting the following websites for fairly simple summaries of what the law achieved:

  1. Obamacare: A short summary of the health care reform law (American Affairs)
  2. What’s In the Bill (a timeline by the Wall Street Journal)
  3. Focus on Health Reform (the Henry J. Kaiser Family Foundation)
  4. Health Reform Hits Main Street (a 9-minute video by the Henry J. Kaiser Family Foundation)

From what I can tell, PPACA was generally a step in the right direction, but did not do enough to truly fix our convoluted, over-expensive system.

In terms of UNIFICATION: Far from simplifying our health care system, it seems that PPACA is in keeping with the previous level of complexity. The reform package itself is 400,000 words long; Reid mentions that at a policy briefing for Congress after the bill was passed, “I noticed that the Senators and Representatives were all diligently taking notes about the bill they had just approved.”

A huge proportion of our health care costs go into administration: sorting out who’s covered under what plan and at what rate. In most countries, this cost is virtually eliminated because the same rates apply to everyone, and sometimes under a single, unified plan. As far as I can tell, our administrative costs will still be quite high within the reformed system.

As far as UNIVERSAL COVERAGE, the law does make great strides in that direction. According to Reid:

The number of Americans without health insurance has been increasing steadily for decades, reaching nearly 50 million in 2010. The new law will reverse that trend and provide coverage to millions of people who can’t get it today. How many millions is not clear, but the Congressional Budget Office estimates that as many as 32 million more people could have some form of health insurance by the year 2019. (That’s the good news; the bad news is that the same office predicts about 23 million Americans will still be uninsured in 2019.)

This expansion in coverage will come partly through expanding Medicaid; “The late Nikki White, the thirty-two-year-old lupus victim we met on the first page of this book, would likely have qualified for Medicaid under the new rules—and would have had a good chance to live.”

The law will require most people to sign up for health insurance, and will expand options (and cover some costs) for people who aren’t covered through their employer. This “individual mandate,” though controversial in this country, is necessary for keeping the overall costs of health care low. The law also prohibits health insurance companies from denying coverage based on preexisting conditions, a common practice prior to the law.

The third and final piece of Reid’s solution is NONPROFIT FINANCING, another piece that is not fixed by Obamacare. American health insurance companies will still be for-profit, and “will get away with some practices that are banned in every other rich democracy. The U.S. firms will still be allowed to deny your claims…When they do pay, they can still take weeks or months to do so, without the strict time limits that are common elsewhere.”

In summary: “[T]he sad truth is that, even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the most inequitable health care system of any developed nation. The new law won’t get us to the destination all the other industrialized democracies have reached: universal health care coverage at reasonable cost.”

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4 Responses to What Did ObamaCare Do, and Was it Enough?

  1. Gwen says:

    Thanks for tackling this Katie. There is something about the new healthcare rules that I still don’t understand. I was recently denied health insurance because of a “pre-existing condition.” I wrote to them and asked them to explain how this was in compliance with the new rules but never got an answer. I am guessing that there is a loop hole where you aren’t completely denied, but you are only eligible for the $1000/mo. premium. If this is the case then the whole thing is just a sham. If you are sick and aren’t rich (but not poor enought to get Medicare/Medicade) you are probably screwed. Have you come across this in your research? Another thing, although I agree with the idea of the personal mandate, I don’t think it will work until the health care system here improves. For a person who can’t afford to put much towards insurance (maybe $100/mo.) the “insurance” you get is ridiculous and might as well be nothing. With a $10,000 premium and no doctor visits or meds covered, what are you getting? Maybe it is just for extreme emergencies, but if that’s the case you’ll go bankrupt anyway just to pay the premium, let alone the additional 20% you owe after that. If a person is going to go bankrupt with or without insurance, then why even have it? Any thoughts on that? Its just my recent perspective :)

  2. Gwen says:

    ooops, I mean $10,000 deductible!

  3. Aric Vander Werff says:

    The pre-existing condition requirement doesn’t take effect until 2014…

    Obamacare will not help the healthcare situation in this country. It will probably make it worse.
    1) unification? No! This was not addressed. Complexity was increased.
    2) universal coverage? No! Epic fail in this regard.
    3) nonprofit financing? No! Costs will go up… No cost controls were put in place. Medi-gap is still looming. Increased complexity will raise costs as well.

    Obamacare grade: F

    The law seems to prove my theory… To reform a government entity, it is necessary to eliminate it and start over. Sometimes the entity should not be replaced.

  4. songerk says:

    Gwen, I’m so sorry to hear that you were denied coverage and I hope you can stay healthy until the 2014 law kicks in (and that it’s not repealed before then). I agree that it’s ineffective and unjust that non-rich, non-poor people have so few options and can go bankrupt because of health care. Nikki White, the 32-year-old lupus victim that T.R. Reid describes in his book, was apparently not poor enough to receive Medicaid but not rich enough to cover the costs of care for herself, which is part of why she died of her treatable illness.

    I hear what you’re saying about the personal mandate, but the idea behind it is to keep the costs low: if we all have to enter into the health care pool, theoretically the costs won’t be unreasonable for us. But I’m doubtful about how that’s going to work without a nonprofit mandate: like you, I worry that we’ll be forced to get health care AND it will remain expensive, with the for-profit companies lining their pockets instead of reducing costs. Hopefully that won’t happen.

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