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I have seen a lot of opposition to the Affordable Care Act since October 1, particularly from my friends on Facebook, and, being me, I have not suffered in silence.  I have responded, made my own comments, linked to articles.  What I have not done is to write down my own thoughts about the law, or try to express how much I believe that the many people who so virulently oppose this really just have no case.  So this is that post, six things I hope opponents of the Affordable Care Act will think about before they complain about it again.

 I have seen a lot of opposition to the Affordable Care Act since October 1, particularly from my friends on Facebook, and, being me, I have not suffered in silence.  I have responded, made my own comments, linked to articles.  What I have not done is to write down my own thoughts about the law, or try to express how much I believe that the many people who so virulently oppose this really just have no case.  So this is that post, six things I hope opponents of the Affordable Care Act will think about before they complain about it again.

1. Last Place

 When you think about the United States, do you think of a country that lags behind other countries?  A country that just doesn't have the resources to provide for its citizens the way other, more prosperous countries, like, maybe, Columbia do?  Do you think that it's OK if it is just a disadvantage to be born here, because as a country, we just can't do what others can?  Well, when it comes to health care, this is exactly the case.  Columbia's healthcare system was in fact ranked above the United States by the World Health Organization, as were Portugal, Greece, Saudi Arabia, and Morocco.  The United States ranked 38th, just behind Costa Rica and ahead of Slovenia.  Have a look at that list.  Does it make you feel proud?  But if you checked out the list, you may have noticed that we do actually lead in one area:  We are number one in expenditure per capita.

 The truth is that the United States has one of the worst healthcare systems in the world.  We get pretty good care compared to other countries (although just comparable, not necessarily better), but a) the care we get is extremely expensive, and b) it is not is not administered fairly, because a good portion of our population is uninsured and so does not realistically have access to good care.

 More about the fair part later, but let's understand the expensive part.  Because you are an American, more of your income, and/or your company's benefits, and or your tax dollars, goes toward paying for your healthcare than if you lived anywhere else in the world.  This is like a tax on every American citizen, a price you pay for living in this country, because nearly every other industrialized country has figured out something that we have not.

 So I exaggerated, only 38th place, not last.  But bear in mind that the countries below us on that list don't have the resources we have, so we cannot really be compared to them.  The United States has a terrible healthcare system, one the rest of the world would never think of emulating.  We should be able to do better than 38th place.  If you don't think that the United States needed healthcare reform, you are saying that 38th place, with the most expensive system in the world (and it is a lot more expensive than almost anyone else), is great.  That's not right; it isn't great.  This is why we needed healthcare reform.

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2.  Republican opposition to Obamacare is a lie

 This is an important point that does not get emphasized enough:  When Republican leaders tell you that they hate this law, that it is an abomination that has to be stopped, they are flat-out lying to you.  I don't mean that they are lying about death panels, government takeover of healthcare, or how Obamacare kills jobs, although they are in fact lying about those things also.  What I mean is, they do not oppose this law as policy the way they say they do.  It's a ruse, a lie, political theater to make you think that everything President Obama does is terrible, even though they know that this law is good for the country and for their constituents.  This is a strategy they are using to try to get re-elected and to help their party gain power, plain and simple, and they are willing to pretend to oppose good legislation in order to attain their goals.

 Now, that's a pretty strong charge, so it's only fair to ask how I could know this.  Well, a couple of points.  First, refer back to the first section, 38th place.  Our system is so bad that in other countries, if a politician wants to get really negative, he will accuse his opponent of wanting to install an American system of health care.  Any politician slandered in this way will then be forced to respond that this is a heinous lie, that he or she would never support anything like we have in the United States.  This is a true thing; it really happens.  Republican members of Congress may not all be really bright, but they know where we rank.  They know our system is bad, and that it is hurting Americans.  They have never proposed any alternative.  Remember how Republicans proposed to deal with the healthcare problem during the Bush administration?  No, me neither.  It's not like they had some better solution available.  They cannot seriously imagine that the best solution for the country is to continue to spend more than everyone else -- more than double many other countries with healthcare that is just as good -- while leaving millions uninsured.  No one could think that.

 Second, it was Romneycare before it was Obamacare.  Republicans were not so adamantly opposed to Governor Romney's plan in Massachusetts, which was based on principles endorsed by the very conservative Heritage Foundation. There are possible options that are much more progressive, including just copying almost any European nation's example.  The Affordable Care Act incorporates conservative ideology by using existing, for-profit insurance companies and emphasizing personal responsibility.  This is a conservative solution, a compromise put forward to appeal to Republicans and conservative Democrats.  And yet, every single Republican in the house and the Senate opposed it?  And they voted 47 times (or so, I have lost count) to repeal it because it's so, so awful?  Heck, even Mitt Romney was against it, hated it, thought it was the worst thing ever.  Do you believe that?  You should not.  It doesn't make any sense.

 A good trick I use to evaluate reaction to some policies is to reverse the parties.  (This is a really good tool for evaluating progressive stances.)  So let's imagine, suppose a Republican President had proposed this legislation?  (It could have happened -- don't forget Romneycare.)  Would these same Republican legislators have opposed the same legislation so violently?  Would every single one of them have opposed it?  Not on your life.  Not even close.  No way.  They oppose it because it was passed by a Democratic Congress and a Democratic president, and their political strategy from the beginning of the Obama administration has been to oppose everything the President and his party propose.  They are lying to you, and you are falling for it.

3.  Under-reporting the impact of Republican obstruction

 If you don't think Republicans would really hurt their country and their constituents just for political theater, just to fool people into voting for them, consider the case of the many Republican governors who have refused to expand Medicaid as prescribed by the ACA.  I have not heard any actual justification to explain how this obstruction helps anyone.  I have heard ridiculous, meaningless phrases like "socializing of our medicine" or "will not allow President Obama to bully Louisiana"  (Wow that is so stupid!), but nothing that approaches the level you would associate with the word "reason."  On the other hand, the damage they are doing is self-evident, and it is really far-reaching.  About 5 million people who should be eligible for expanded Medicaid under the new law will not get it and will remain uninsured.  And this blind opposition will hurt more than just the millions who will remain uninsured for the benefit of making political points; the money that will now not flow to those states could have helped their economies and created jobs.

 Contrast coverage of that issue with the coverage of the bad healthcare.gov website rollout or of the many people who have had their insurance cancelled (more about these two issues later.)  The word I have heard most often to describe the rollout of the ACA is "disaster."  Everyone in the United States knows what a disaster Obamacare has been.  And yet this atrocious, disastrous disaster has already done a great deal of good and has not done anywhere near the harm that has been deliberately perpetrated by Republicans refusing to expand Medicaid, let alone their decisions to hurt their constituents by refusing to set up state exchanges, obstructing ACA navigators, encouraging people not to enroll, etc.  The lame-stream, "liberal" media loves their disaster, but the bigger story should be Republicans refusing to help their country by implementing the law of the land.

4.  People are losing their policies

 Well, what did you expect?  Did you think that we could implement a law that regulated health insurance across the nation and moved us toward universal health insurance, but no one would be negatively impacted?  In fact, a very small percentage of the population will truly be put in a worse position due to this law.  It's funny, for twenty years I read and heard stories about the abuses of insurance companies, how people were not covered for care they needed, went bankrupt even though they had insurance, lost their insurance as soon as they got sick.  Then suddenly, as January 1, 2014 approached, it was all about millions of people losing their wonderful insurance from their wonderful insurance companies.  And my more conservative friends were so eager to jump all over those stories.  Maybe it should have occurred to all of us that the stories about people's great insurance policies weren't exactly fair and balanced.

 In fact, almost all of the stories the media picked up at first turned out to be people who were going to be better off under the ACA, or had really crappy insurance and wanted to keep it, and the horror stories kept falling apart.  After a short time, the press got a little smarter and started selecting their stories more carefully, finding people who might have to actually pay more without getting substantially better coverage.  I remember one of the first actual examples I heard, on NPR, was a single dentist who had a good plan and did not need pregnancy coverage, for example, and he was going to have to pay more next year because of Obamacare.  OK, fine, that's one.  But he's a single dentist.  He's probably still going to be all right, better than all right.  I'm sorry, but that story just does not resonate with me in comparison to stories of tens of thousands of people, just here in Washington State, getting onto Medicaid or getting insurance through the exchanges, people who were not insured before and really needed that insurance.  And let's bear in mind that, as far as I know, no one really lost their insurance; they just maybe had to pay more and get into another plan, one that provided benefits their previous plan did not.  The whole story of people losing their policies was just way, way overblown.

 And don't forget, those policies were not just magically "lost."  The insurance companies knew that the ACA was coming, for three years, and they chose to continue to offer products that would not meet the new standards.  Those companies had choices; they could have upgraded their plans, prepared their customers for the new law and suggested different policies, or stopped offering policies that they knew would have to be cancelled, but they didn't.  While many of the consumers were caught off-guard, the insurance companies knew exactly what they were doing.  They created the situation by selling inadequate insurance, bringing customers in, then cancelling their insurance and directing them to more expensive plans.  It's called maximizing profits, and it's what corporations do.  Again, it's not surprising that the new law allowed insurance companies to find a way to make big profits.  But don't fool yourself.  Barack Obama didn't cancel anyone's insurance.  Insurance companies did that.

5.  A bad website

 Yes, it was a bad website.  A disaster.  But ask yourself this:  How well did Social Security work its first two months?  How about Medicare?  Do you care?  Does it matter?  How about Medicare Part D, how did that work out?  I remember that one, and the rollout was -- well, disastrous.  But years later, most of the kinks have been worked out, and it is help make prescription drugs more affordable for seniors.  It is making life better for Americans.  If you stop trying to score political points and look at the big picture, that is what matters.  A bad website can be fixed, and it has been to a large extent.  The law will affect millions of lives for years to come.  I said the stories of people losing their insurance were overblown; the national furor over the terrible, awful, website, the huge damage it did to the President's reputation and legacy, blah, blah, blah, was absolutely ludicrous.  Yes, it was bad.  It just wasn't the end of the world.

 And here, let's give another nod to the Republican governors who did everything they could to make sure that the residents of their states were not able to benefit from the law.  In some states, like Washington, Kentucky, and California, the ACA rollout went pretty well.  Why?  Because they set up their own exchanges, so people did not have to rely on the federal site.  But in Republican-controlled states, politicians wanted to be so certain that no one would benefit from Obamacare that they refused to set up state exchanges, leaving their residents to use the broken federal website.  This forced more people onto the federal site than it could handle, which didn't help matters.  Republicans have done their best to sabotage the law, and to some extent, they have succeeded.  Don't blame the law.

6.  A moral issue.

 Last one.  I don't usually write so much in one post, but I have a lot to say on this subject.

 In other countries, fairness in the distribution of healthcare is considered a moral issue.  A big part of their thinking, in many cases, is that they don't want to leave some of their fellow citizens without access to healthcare.  Everyone is taken care of.  We don't let our countrymen go bankrupt or die because they get sick and aren't rich.

 I just Googled a couple of numbers.  One article said that about 60% of personal bankruptcies in the United States in a year are due to medical bills.  That's 60% of about 1.5 million bankruptcies per year, so 900,000 bankruptcies due to medical bills.  Another source estimated 26,000 people die prematurely due to lack of insurance.  Lack of insurance ruins Americans financially, lots of them, and kills a lot of others.

 If you don't believe that so many people could die from lack of health insurance, consider a single case:  mine.  I have always had insurance, I'm in my fifties, and my parents both died by age 75, so I go to see the doctor every year like I am supposed to.  One routine checkup revealed thyroid cancer.  Fortunately, that's not really very life-threatening, but it was good to have it treated as soon as possible.  (Treatment cost tens of thousands of dollars before insurance, by the way.)  Another routine check revealed diabetes.  As long as it's under control, diabetes isn't terrible, although the medicines are expensive, but had I not known about it, I could have gone years undiagnosed.  Diabetes does bad things to your body and can affect your brain as well, but I went less than one year before I started to control it.  In addition, I have regular colonoscopies, and although I haven't had cancer, the tests have not been completely clean either, so they keep an eye on me.

 It's so easy for me to imagine that, without health insurance, someone like me wouldn't have noticed that lump in his neck until it had gotten much bigger, could have let diabetes tear down his body for a few years longer, could just put off that expensive colonoscopy until he found out he had colon cancer.  Multiply me by 48 million uninsured, and you can see that some of those people will die unnecessarily.

 I realize that the moral issue just doesn't get a lot of traction in the United States.  We have a history in this country of selfishness, a large contingent who simply do not want to care for their fellow Americans.  But understand that for a lot of supporters of healthcare reform, 26,000 dead and 900,000 bankrupt every year just is not acceptable, not when we know other countries are doing better.  It's a moral issue in this country too, at least for some of us.

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