I received an email that was sent to her friends list by a good friend of mine who is very concerned about what she insists on calling “Obamacare.” She had a list of questions about the Affordable Care Act (ACT) ending with the question: “Is all this going to work out and be the best for America??????” I dare to say her concerns reflect those of a great many other Americans an alarming number of whom seem to have pushed the panic button and are convinced we are on the verge of Armageddon.
Now I don’t claim to be an expert on the Affordable Care Act. By no means. But I can read and I have checked a number of items. In spite of the glitches that have shown up in the early days — inevitable some would say — there are a number of questions that have yet to be answered. But, on balance, it would seem that the Act is a good idea though it has a great many rough edges yet to be ironed out. We must remember that this country is one of the very few “developed” nations with inadequate health care. Indeed, according to a recent story on PBS, health care costs in the United States are the highest, per person, in the world. And, despite the fact that for those who can afford it the care is outstanding, it is not clear that as a nation we are getting the most for our money. As the story relates, in this country
- There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people — well below below the OECD average of 3.1.
- The number of hospital beds in the U.S. was 2.6 per 1,000 population in 2009, lower than the OECD average of 3.4 beds.
- Life expectancy at birth increased by almost nine years between 1960 and 2010, but that’s less than the increase of over 15 years in Japan and over 11 years on average in OECD countries. The average American now lives 78.7 years in 2010, more than one year below the average of 79.8 years.
The ACT is designed to lower costs and extend health care to most, if not all, of those who could not otherwise afford it. This, it seems to me, is a lofty idea and the overriding principle that should always be kept in mind when weighing costs and benefits. In the end, what matters is what kind of country we want to live in: one that worries more about the businesses that might suffer because of the enforced costs of extending health care to employees or one that cares about its citizens and their health regardless of the monetary costs.
We know, for example, that a great many young people who would otherwise have no health insurance can now be included in their parents’ insurance — until they are 26 years of age. My understanding is that thousands of young people are now covered who were not covered previously. And given the growing number of young people who are unable to find employment, this is an unmitigated blessing. Further, Medicade coverage is extended under this plan, thereby allowing a great many of the poor and elderly to receive care that they were not able to receive previously. In fact, the number of uninsured under this plan will be reduced by 32 million, a fact that cannot be ignored.
The number of states that have opted out of their commitment to the ACT has reduced estimates of the eventual financial benefits to the nation from $200 billion to $84 billion. Still, every little bit helps when it comes to the budget deficit. Despite the benefits in the form of a reduction to the national debt, however, there will be costs to small businesses — which concern my friend — and these must be factored in, since the Act requires that businesses employing more than 50 people must provide them with health care. This has resulted in all sorts of shenanigans by companies — cutting the hours of their employees to reduce the number of full-time employees, refusing to employ more than 49 full-time people, and the like. The fact that small businesses that operate on a low profit margin will be required to assist their employees in paying for their health care will, in fact, place a burden on those businesses and in the end force some of them to close down, and it does appear to be the weakest link in the Affordable Care Act. But, given the fact that an estimated 200,000 small businesses closed down during the recent recession, it must be admitted that small businesses are a risk and always have been and one suspects that with careful planning and intelligent cost-cutting fewer will go under as a direct result of the ACT than have been predicted by the knee-jerkers among us. In any event, one must wonder why a federal mandate is required to insist that employers take care of their employees’ health needs, which many regard as one of our basic human rights. In any event, the plan has generated more heat than light among the fearful due to its complexities.
And there’s the rub. My friend’s email stems from her fear that this plan will bring America to its collective knees. She starts with FDR’s famous quote that “the only thing we have to fear is fear itself,” which is a good thing to keep in mind. Any plan this encompassing that involves inevitable glitches and also involves controversial elements such as mandatory contraception will raise the hackles of the nervous element among us — and that element is growing as those who have political axes to grind have learned how easy it is to control the population through fear — of terrorists, or increased taxation, or sex education in the schools. But as I said above, it comes down to what sort of country we want to call our own: one that cares about the health of its citizens or one that cares more about “the bottom line.”