2nd Anniversary of Obama-Care: Time to Move ON

Paul Krugman leads a chorus of celebrants as the 2nd anniversary of the passing of Obama-Care (the Affordable Care Act) approaches (find his editorial on this subject here: http://www.sltrib.com/sltrib/opinion/53747700-82/reform-care-health-act....). Excerpts:

It’s said that you can judge a man by the quality of his enemies. If the same principle applies to legislation, the Affordable Care Act — which was signed into law two years ago, but for the most part has yet to take effect — sits in a place of high honor.

Now, the act — known to its foes as Obamacare, and to the cognoscenti as ObamaRomneycare — isn’t easy to love, since it’s very much a compromise, dictated by the perceived political need to change existing coverage and challenge entrenched interests as little as possible. But the perfect is the enemy of the good; for all its imperfections, this reform would do an enormous amount of good. And one indicator of just how good it is comes from the apparent inability of its opponents to make an honest case against it.

To understand the lies, you first have to understand the truth. How would ObamaRomneycare change American health care?

For most people the answer is, not at all. In particular, those receiving good health benefits from employers would keep them. The act is aimed, instead, at Americans who fall through the cracks, either going without coverage or relying on the miserably malfunctioning individual, "non-group" insurance market.

The fact is that individual health insurance, as currently constituted, just doesn’t work. If insurers are left free to deny coverage at will — as they are in, say, California — they offer cheap policies to the young and healthy (and try to yank coverage if you get sick) but refuse to cover anyone likely to need expensive care. Yet simply requiring that insurers cover people with pre-existing conditions, as in New York, doesn’t work either: premiums are sky-high because only the sick buy insurance.

As I said, the reform is mainly aimed at Americans who fall through the cracks in our current system — an important goal in its own right. But what makes reform truly urgent is the fact that the cracks are rapidly getting wider, because fewer and fewer jobs come with health benefits; employment-based coverage actually declined even during the "Bush boom" of 2003 to 2007, and has plunged since.

What this means is that the Affordable Care Act is the only thing protecting us from an imminent surge in the number of Americans who can’t afford essential care.

So this reform had better survive — because if it doesn’t, many Americans who need health care won’t.

My comment:

Mr. Krugman forgets that even employment based health insurance does not work. In fact, the trend over time is for fewer and fewer Americans to have a health insurance benefit from work. We are all falling through the cracks. The reason is the cost of the benefit. Health insurance is the most expensive way to fund needed health care. So the fact that Obama-care would not change this losing formula is a, well, loser. To defend this legislation as an ugly compromise by saying that the perfect is the enemy of the good is disingenuous. No health system reform scheme will be or can be perfect. But in order for something to be good, it must be functional. And in the case of health system reform, that means that it must first and foremost reduce costs. Obama-care throws gasoline on the costly fires of health care costs.

To use the phrase of the left: It is time to MOVE ON.

Dr. Joe Jarvis