What are the strengths and weaknesses of Obamacare now, and what do you believe to be the strengths and weaknesses of our country's healthcare policy up until now?
This is, in many ways, a matter of opinion. Whenever we look at strengths and weaknesses, we are making judgments that are typically subjective. Therefore, different people can have different views on this topic.
It is also very difficult to say what Obamacare’s strengths and weaknesses are because it has not actually been implemented at this point. This means that we have to speculate to some degree about how the program will impact Americans’ lives.
In my view, the main strength of Obamacare is that it tries to expand the reach of healthcare coverage. Up to this point, there have been many people in the US who do not have health insurance. This is very bad for them and it can be very bad for the country as a whole. A second major strength of Obamacare is that it reduces the degree to which people rely on their work for health insurance. Right now, it is very difficult for people to quit a job to look for another one because they tend to lose their health insurance when they quit. This is also a problem for people who want to quit work to start their own businesses. Obamacare is likely to help alleviate this problem.
Obamacare's main weakness is that it is very unpopular. Many people think that it is an example of governmental overreach. This means it has little support and is vulnerable. A second weakness is that the implementation has been terrible to this point. People have had terrible trouble trying to enroll and this does not bode well for the overall strength of the program as it starts to come into effect.
To this point, I would say that the main strength of the US healthcare policy is that those people with money and health insurance can get rather good care. Our system allows us to get essentially any procedure that we want done so long as our insurance will pay for it. For those people who have good insurance, this means that they can get many procedures that enhance their health and their quality of life. However, the main weakness is that we overpay for these procedures because there is little transparency and little competition. When we buy a typical good or service, we know what price various sellers offer. We can then decide whether the product is worth it and, if it is, where to buy it. With health care, this is not the case. We rarely know how much a given procedure actually costs beforehand and we cannot do comparison shopping to get a lower price. This means that there is little competition. When there is little competition in a market, prices tend to rise higher than they ought to. This is certainly the case with our healthcare system up to this point.
The previous answer was very strong. I would like to offer up an additional strength of the legislation. One particular strength of the Affordable Care Act is its coverage of pre- existing conditions. The law's insistence to address people who have a pre- existing condition made it singularly distinctive:
There’s no broadly accepted estimate for how big the problem is. A 2011 study by the Department of Health and Human Services said the number of people with pre-existing conditions could be as low as 50 million non-elderly Americans or as high as 129 million, which is a pretty wide range. But even if you use the lowest number, 50 million, that’s almost one out of five Americans under age 65, including 25 million who are uninsured.
One of the strengths of the Affordable Care Act is that is speaks to these individuals who could not find health care coverage. Prior to the law, health care companies turned away people with pre- existing conditions or have had to live with the constant insecurity that they would be turned away due to a pre- existing condition. This changed with the Affordable Care Act. The Act provides coverage, regardless of pre- existing conditions. Its insistence for their voice to be heard when it was previously silenced is a benefit. The legislation addresses the needs of more people who are being denied coverage or people who are suffering under coverage limitations. This inclusion would have to be seen as a potential benefit of the President's health care law.
I think that an interesting drawback to the health care law has nothing to do with the law itself. Given the intensity of disdain towards the law, the President has had to scale back some of his other policy goals that were so much a part of his campaigning on a platform for change. The need to radically reform our immigration policies is one issue that has had to be put aside because of the political capital spent on the Affordable Care Act. Another such issue is gun reform, a legislative response to the rather alarming number of gun violence incidents. This is not the fault of the Affordable Care Act. However, since the President has had to spend so much political leverage and capital in alleviating the legislation's negative reception, it has made tackling these issues that much more challenging.
The Affordable Care Act may have generated more controversy than any legislation in recent memory. As with most political issues, opinions break down along party lines, with almost all Democrats supporting it and almost all Republicans opposing it, with many even calling for its repeal.
Previous posts have noted ACA strengths that include access to health coverage for Americans who cannot get it through an employer as well as coverage for those with pre-existing conditions. The ACA also set higher standards for insurance companies that result in more comprehensive coverage than some Americans had access to in the past. For example, “wellness visits” and certain preventive tests may now be provided by many plans at no additional cost. The goal is reduce overall health care costs by keeping people healthier in the first place. The same objective applies to prenatal care, which must now be covered to a greater extent than before the ACA was passed.
Unfortunately, the ACA has not been able to achieve its goal of providing access to almost everybody. When the law was initially passed, its framers envisioned that low income citizens would be covered by an expanded Medicaid plan. However, due to an unexpected Supreme Court decision in 2012, the individual states have control over whether or not Medicaid will be expanded, and 19 of them have balked at incurring the extra expense of increasing this entitlement.
According the Atlanta Journal Constitution, here is the result of this unforeseen problem:
Statewide, more than 400,000 of Georgia’s poorest, most vulnerable citizens have been left behind by the health care law that was supposed to benefit them the most. Georgia chose not to expand Medicaid . . . creating a gap into which these hundreds of thousands fall. Those in the gap make too much money to qualify for Medicaid, but too little to get federal tax credits to help buy coverage on the health insurance marketplace.
Because of this a significant goal of the ACA, helping get insurance to those who can least afford it, is not a reality for many. With the upcoming mid-term elections, which may result in more Republican legislators, wrangling over the program will probably only become more intense.
Another downside to Obamacare is that the new policy will be disruptive to many people who already have insurance:
"According to the Congressional Budget Office’s most recent estimate, by 2018, after the law is fully implemented, 7 million people will be dropped from their employer health plans and 5 million people will shift out of private plans" (Kessler).
The implementation of Obamacare will cause rates to increase, and even people who may be content with their current health care coverage may find themselves being forced out of their plans as those rates and the overall price increases. Employers may have to limit aspects of their provided insurance to their employers to limit costs to their company, and people who had just payed for their insurance independently may find that they can no longer afford the company of their choice; they may be priced out of what they would prefer to use and have to turn to Obamacare as a last resort.
Besides increasing insurance rates, Obamacare also has had and will have an increasingly detrimental effect on Medicare.
"Meanwhile, the Medicare actuary also has warned that the sharp reductions in payments to Medicare providers could force the closure or exit from Medicare of 15 percent of hospitals, skilled nursing facilities, and home health agencies by 2019 — and 40 percent by 2050" (Kessler).
Many of our more elderly citizens are not going to have the means or resources to find adequate health care under the new plan. Losing Medicare, something that they have depended on for security in their retirement, is a big concern, a genuine worry and stressor to the newly retired or the elderly, especially in regard to the loss of skilled nursing facilities that provide valuable services like nursing homes or retirement communities with paid nursing staff.
Kessler, Glenn. "A Guide to Obamacare claims, pro and con." The Washington Post. The Washington Post. 27 Sep. 2013. Web. 7 Apr. 2014.
According to figures reported by the Fact Checker of The Washington Post, the cost to date as of October 24,2013 for Healthcare.gov are as follows:
A conservative figure would be $70 million. A more modest figure would be $125 million to $150 million. Or one could embrace the entire project, as outlined by GAO, and declare that it is at least $350 million.
Certainly, the Affordable Care Act is costing the taxpayers more than was projected. It has also brought additional costs to certain states, such as Maryland which has had so many problems that it is going to use the Conneticut IT platform to upgrade the current technology for the website for enrollments. A spokesperson for the Maryland Health Exchange stated,
"We determined that re-mediating our current system would take over 12 months and cost more than $66 million, and the resulting product would likely still not meet our needs -- it would not be stable, sustainable and adaptable to our future business model."
And, some insurance companies have been forced to use manpower to sort out things, a cost that will be passed on to consumers.
Whether socialized medicine will work for America remains to be seen; there can be no judgment on this at this point. It is noteworthy, though, that in other countries with socialized medicine there are some disadvantages, certainly for older citizens. For example, a German man with dual citizenship was denied a hip replacement with Germany's socialized medicine because of his age (88), but he was able to receive it in the United States with his individual insurance. Of course, people have learned that they may not be able to keep the doctors they prefer or the plan they already have as statistics have shown.