Saturday, June 30, 2012

Observations on Public Opposition to Health Care Refrom

I've noticed something of a disconnect among liberal commentators on why many Americans are opposed to health care reform. Living in a more conservative area, and having a lot of contact with individuals of all income levels, I've heard a fair amount about why people don't like Obamacare.

On an anecdotal level, the main thing I'm hearing is that Obamacare does little more than create another bill to pay for people that are already having trouble making ends meet. Sure, they will have healthcare now, but probably on a high deductible plan. This doesn't help their pocket book issues any, if they have a major illness, they don't have the assets to get through any time out of work, not to mention the health care deductibles and coinsurance. The stark reality they're facing is that they were ruined before Obamacare if they got sick, and they'll be ruined after if they get sick (now, they'll at least receive better medical treatment, but it's still a bitter pill if they lose all their assets in the process).

What these people want help with is the costs of the kind of medical care that they can afford and have more contact with. They want cheaper regular check ups, cheaper minor procedures, like setting their kid's broken bones, and less regular medical expenses, like their monthly health insurance bill. Obamacare doesn't really deliver any of this, so they remain opposed. They see it as increasing their monthly expenses when they're already nearly broke, doing nothing to reduce the cost of the medical care they do seek out, and not being strong enough to protect their assets when they do get gravely ill.

There is a lot of truth to these criticisms. Obamacare does do a lot more to make sure doctors and hospitals get paid than it does to make costs lower for the average working class American (various sub-categories, like people with existing health conditions, are thrilled about the health care law, but for the general, healthy, lower and middle class there are much more mixed feelings). However, I believe there is a sequencing issue here. I don't see any way to have a properly functioning marketplace without certainty of payment. I'll write more about this later, right now the system is like a game of hot potato, everyone is trying to pass the bill along and not be the one stuck with it when the music stops. To get the changes that the average American wants, this aspect of the system needs to be eliminated. Obamacare is a significant step towards eliminating the systemic problem, though it necessarily leaves the need for later reforms to get at the pocketbook issues that concern the average guy.

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