April 07, 2014

Obamacare: What next? And how good is it?

The Columbia Journalism Review has a good round-up of "the current state of affairs" now that we're past the end of the first enrollment period.

It covers what it likely will and will not do. Sorry, fellow liberal friends, the will NOTS included that it likely will NOT significantly reduce the number of uninsureds and it will NOT do much of anything for cost control
Obamacare further bakes in the inequalities that exist in the US healthcare system. The law makes these inqualities more transparent with the different options offered on the exchanges.
Note to Obamiacs — Again, this is what you get with a law largely written by and for insurers. Sure, it's "nice" that the House GOP is quietly passing a few tweaks to repair minor issues that Obama's wanted done for some time. But, none of those address major issues.

Those major issues begin and end with cost control, and cost control throughout our whole healthcare system. As I've blogged before, for example, electronic medical records, so far at least, are more a boon to the companies creating the software than they are to cost control. Chief Roberts ruling that Medicaid expansion couldn't be required will continue to be a drag, no matter how many other fixes are passed.  And, when a major newspaper columnist struggles with the paperwork of his private insurer, Obamacare will be a half a solution at best as long as its centered on private insurers in general and US private insurers in particular.

In other words, in reality, CJR isn't telling us a lot of new stuff. And CJR's roundup includes links to a number of mainstream news sites that don't have any tribalism skin in the game, whether Obamiac or Tea Party. This is all straight news, and per the links from my previous blogging, it's not anything that should surprise a thoughtful person.

Between the lines, it's asking us to examine our tribalism of political rooting on this issue. It's asking Obama's defenders how much they really want to defend a neoliberal half solution that like many a "good," may well indeed be the enemy of (and obstructor of) the "better" or "best."

And, it's that issue that goes beyond reading between the lines. A lot of Obamiac and Obamiac lite types still want to say one of two things:

1. It's the best he could have done at the time;
2. It's a foot in the door.

On the first? That's about as right, or as wrong, as the claim that what we finally got on a stimulus package was the best he could have done. Just as he "compromised away the compromise" in advance on stimulus negotiation talks (don't believe the BS that nobody knew the Great Recession was that bad, unless you want to say Obama's whole 2009 economic team was that fucking incompetent)

On the second? To expand on the good being the enemy of the best, this relies on several bad assumptions. The first bad assumption, never made by me, is that neoliberals like Obama want anything other than a market-based solution, or "solution," to our health care problems. The second is that, on top-down changes on health care, we'll have more than one bite at the apple in the next two decades or so. I never fully bought into that one, nor do I buy into a subset of that one, that a bunch of red-state governors will finally see the light on Medicaid expansion. The third is the one that CJR pointed out, the idea that this foot in the door would be transformative, when it's not.

And, I haven't even tackled, in this blog post, the number of mandates and requirements of what actually passed Congress and was signed into law by Dear Leader in 2009 that have since been delayed, with some of them likely to get delayed again. In short, with all the other scare quotes in this piece, to some degree, what we have right now is "Obamacare," not Obamacare. That said, there's no guarantees that the full deal will do much to tackle the primary issue of reining in health care costs. That said, a single payer system likely would not do the same in and of itself.

Obamacare may nip at the edges of the current "culture" of health care. But, it doesn't do a Kuhnian paradigm shift. And THAT is how it's ... not transformative.

Theoretically, we can do better, by basics of logic.

But, in actuality, maybe we can't.

And, if that's the case, we might as well he honest about it, rather than lighting Obamacare birthday candles or something.

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