As the date for the implementation of “Obamacare” looms closer and the congressional GOP tries for the umpteenth time to defund it, talk about the ACA has increased in the general public. I’d like to share some things that I’ve heard in the blogosphere, on facebook, in the media, and in conversation with people and offer my take as both a nurse in training and a citizen.
Obamacare is causing businesses to cut hours
While it is true that part-time work seems to be a paradigm of the new economy, this is a trend that started long before the ACA and before Obama even became president. Many businesses have been cutting hours back in order to avoid having to offer workers benefits for years. This personally happened to me back in 2006, long before Obama and the ACA. I used to work for a corporation where it was standard practice to automatically schedule any non-mangerial employee below the minimum number of hours required for enrollment in any benefits package. But more to the point, healthcare costs (for both individuals and employers) have been rising disproportionately for a very long time now–that’s one of the many reasons we enacted healthcare reform in the first place. So it’s somewhat disingenuous to claim that this is all the fault of the ACA.
Obamacare is going to bankrupt the country
Well, despite the fact that the CBO has repeatedly projected the the ACA will save us money in the long run, this idea still persists. But more to the point, I think that a lot of people don’t realize that the number one cause of bankruptcy in this country is medical bills. Medical bankruptcy is a HUGE problem and a huge drain on the middle class. The previous model of care we were delivering was financially unsustainable. In other words, medical care before the ACA was already bankrupting us. Plus, like it or not, the ACA is going to be a boon to the economy. In fact, the stock market loves it. There will be a slough of new jobs in healthcare, insurance, construction, financing–it will have a positive ripple effect through the country. Increasing the number of insured people in our society means that we’ll need more nurses, more lab techs, more pharmacists, more of all the administrative personnel that work in healthcare.
Why should I have to pay for the healthcare of other people?
Well, the short answer is that you already do. It’s medically unethical and quite illegal to refuse someone medical treatment. Many hospitals have charity funds to help cover the costs of uninsured patients, but those funds are often severely limited. So how do hospitals make up the difference? They pass the buck to the paying customer. Part of the reason why healthcare costs are escalating so sharply is precisely because uninsured patients are draining the system and the paying customers with insurance have to pay more to make up the difference. In other words, the more uninsured people there are, the fewer paying customers there are, placing more of the the burden on the few remaining people with insurance. So you already subsidize the healthcare of other people, you just never realized it.
If I’m young I don’t need insurance
Well, that’s all great–until of course you need healthcare. There’s this idea that a lot of young people have that health insurance = being sick, and since young people don’t get sick they ergo don’t need health insurance. A more accurate phrasing would be health insurance = healthcare, something that young people need just as much as anyone else, albeit for different reasons. While it’s true that most young people aren’t likely to get cancer, it’s also true that young people are much more likely to be in horrible accidents: motor vehicle accidents, athletic injuries, other forms of trauma, etc. So yes, you’re less likely to suffer end stage renal disease, but you’re much more likely to break a bone or suffer trauma, which requires healthcare. So unless you want to be one of those uninsured people draining the system and increasing the problem, you need health insurance. There’s even an option in the ACA that young people can choose that only covers catastrophic health problems if that false sense of youthful invincibility is impossible for you to shed.
Obamacare is going to cause small businesses to close down
The argument here is that, facing stricter taxes and having to provide health insurance to all employees, places are going to go out of business. To the ear that initially makes sense. But remember how healthcare costs have been increasing disproportionately? Yeah, employers are going to face rising costs no matter what. Even if the ACA magically disappeared tomorrow, they would still be facing rising costs. So if the ACA succeeds in decreasing costs it should basically come out as a wash for employers. Sure, they have to pay more to cover all employees, but at the same time the costs to cover them should come down, basically balancing it out or representing an increase of only a few percentage points. And if a 3% increase is enough to run you out of business, I’d have to question your solvency anyway regardless of the ACA.
This is all just part of Obama’s socialist agenda
I really think that most people in this country don’t truly know what socialism is, and that they already take part in it everyday. Anyone who went to or sends their kids to public schools is technically a socialist. Anyone who supports a publicly funded military is technically a socialist. In reality, this is actually the least socialist plan ever. The insurance exchanges that are part of the ACA are capitalism to the hilt: they introduce a vastly greater degree of competition into the health insurance market, which, as any capitalist would normally decry, will drive down the prices. In fact, in many states the exchanges are already lowering prices.
Obamacare is a plan to crash the economy and make everyone dependent on government assistance
I’m not sure where this conspiracy came from, but if you think about it for a second it really makes no sense. What pays for all of those government programs? Tax money. So if the plan is to cause massive unemployment and force people to become reliant on the government teat, the tax pool drastically shrinks and we’re no longer able to afford the very government programs these people think Obama wants us to become reliant upon.
I shouldn’t be forced to buy something
Ah, the individual mandate. I can definitely see why a lot of people would argue against essentially forcing people to buy a product, no matter how much money it saves. If the idea is to lower costs and make healthcare more affordable and accessible, then why the mandate? If the exchanges lower costs, wouldn’t healthcare then become more affordable, and wouldn’t more people choose to buy it of their own free will? It’s impossible to say. But the SCOTUS already ruled that it’s constitutional, so it’s a moot point. It seems like a bizarre argument when you consider all of the other things people are forced to participate in. It’s illegal to drive without car insurance, but I don’t hear anyone saying, “I should be allowed to drive without insurance, it’s my risk to take–down with car insurance!” But beyond that, why are the only two choices fund it or completely gut it? There’s no gray zone. Fine, let’s have a debate about the mandate, but what about keeping everything else? I’m sure most people, regardless of political affiliation, wouldn’t argue that denying people with preexisting conditions coverage is a good thing. I’m sure most people wouldn’t argue that dropping people once they become sick is a good thing. I find it hard to believe that anyone would argue that lowered costs are a bad thing, or that the exchanges lowering the prices are a bad thing. Don’t people want more options? Don’t they want to be able to compare plans side by side, apples to apples?
Personally, I think the whole individual mandate is something worth debating. But the other components of the bill have merit and shouldn’t automatically be dismissed. I think the biggest mistake here has been a total lack of dialogue with the American people on the part of the administration. The only thing most people know about the ACA is that it’s coming–and that’s it.