Obamacare is coming

[HejiraNYC]

I don't know where to begin on this... there is too much manufactured outrage over Obamacare and too little discussion about the issue at hand: your health. A few points:

1. For those of you who are not insured for whatever reason, what is your Plan B? In other words, what do you expect to happen in the event of a catastrophic illness such as advanced cancer (which remained undiagnosed due to your reluctance to seek preventive medical care)? What about a sudden stroke? What if you take a bad fall and fracture your pelvis? Your spine? You become a quadroplegic? Do you have the tens-, hundreds-of-thousands of dollars saved up to receive the necessary treatment to save your life or quality of life? Or do you plan to wipe yourself out financially and declare bankruptcy in the midst of a debilitating illness? Are you willing to accept less expensive, substandard care? Or are you just going to forfeit treatment and let the illness run its painful course? Chances are, on some deep psychological level, I suspect most people assume that there is a safety net somewhere in the U.S. healthcare system. Uncle Sam will rise up and save the day! Well... that is indeed true in some cases- for people of retirement age on Medicare and the truly destitute who qualify for state Medicaid. But if you are solidly middle class and employed with some assets, you really don't have a safety net. Indeed, the reality of healthcare today in the U.S. is that people are literally dying from treatable illnesses because they don't qualify for government entitlements and they cannot afford insurance and/or medical care. The intent of Obamacare is to make insurance accessible to everyone, particularly the lower income middle class, via subsidies.

2. Health insurance today is expensive. It is not going to be much cheaper under Obamacare for most people. But it offers some critical advantages for some: healthcare portability (i.e., the ability to change insurance carriers without the risk of being denied coverage due to pre-existing conditions), access to health insurance for low income people who don't qualify for Medic-are/aid via substantial subsidies, etc. By forcing all people to obtain coverage, it forces more healthy young people to start paying into the system to offset the cost of keeping older, sicker people with pre-existing conditions insured. Indeed, as the Supreme Court ruled earlier this year, this is much like a tax along the lines of Social Security. Yes, nobody wants to pay more taxes. But at least this particular tax has the tangible benefit of improving your own quality of life as well as helping others. Expanding healthcare coverage also means more people are receiving check-ups and potentially averting expensive hospitalizations. Plus healthcare portability introduces an element of competition. All of these things should *theoretically* force insurance companies to drive down rates; however, this may or may not actually materialize.

3. Obamacare is not a single-payer system like much of the rest of the Western world. It's not ideal, but neither is a single-payer system. Yes, a single-payer system eliminates much administrative overhead and appears to deliver healthcare more efficiently and cheaply since the costs for salaries, hospitals, drugs and devices are all capped. However, in many instances, you get what you pay for. Money drives innovation. And money tends to attract the best talent. Although the current U.S. healthcare system is appalling, the U.S. has among the most important medical institutions and practitioners in the world. And it's also where the most money is funneled into research and development of new drugs. You will not see state of the art innovation and world reknown experts in their fields in state-run facilities making government salaries. This is critical when it comes to life-threatening/terminal diseases; in the U.S. you can always get a second opinion (if you pay for it or if your insurance covers it).

4. Most other Western countries have a single-payer system. However, they also have lofty value added taxes (VAT) of upwards of 15%+ levied on all goods and services. This is why a $15 CD in the U.S. costs $25 in the UK and it's the reason why foreigners everywhere come to the U.S. to bargain shop. It's a terribly regressive tax that places a disproportionate burden on lower income earners (as a percentage of income). Over time, if you buy groceries, eat at restaurants, buy clothes, go to the movies, etc., you will essentially be paying the equivalent of an Obamacare premium in VAT. Alternatively, if the U.S. took on a single-payer system that was largely funded by a VAT, the prices for everything will skyrocket while salaries remain stagnant and the economy will suffer. The quality of care will suffer as well.

Yes, everybody's situation is different, and some people are truly bummed about having to pony up for health insurance. But it really pays to review your options and to see how you will be personally impacted before passing judgment. It's not a perfect system, and it will certainly be tweaked over time. But it's a necessary start toward leveling the playing field and making health insurance affordable for lower income people and people with pre-existing conditions.