There are lots of things I don't like about “Obamacare”. I'd prefer single payer, or at least a Medicare buy-in. I'd like some real cost constraints instead of accounting gimmicks. And, <shudder> yes, Virginia, tort reform is desperately needed. Not because of the small overall amount of excessive lawsuits but the very real and huge distortion in wasted defensive care.
I'm supporting it grudgingly because I believe that once we go down the road of Universal Care, its inevitable and unstoppable. We'll spend the next two decades recasting this bill but at least the principle is established, once and for all, that everyone should have health care. (Even though not everyone will under this plan.)
Oddly enough though, here in Florida, I will be worse off potentially by far because we already have single payer, sort of...
When I moved to Florida in 2005, I discovered Florida Blue Cross and Blue Shield. Like all of the Blue's, this is not your father's Blue Shield. They are non-profit but pay their CEO $5 Million. (An amount I don't begrudge because its a tiny fraction of their administrative overhead).
On the positive side though as far as I can see they aren't the evil empire that most insurance companies are held out to be. They pay their claims on time, any profits go back into reserves, and they don't appear to cancel people randomly. After 2 years of membership you cannot be canceled except for fraud.
When we applied in 2005, the were pretty much the only company that would take us because we have some relatively minor pre-existings. We were slapped with a bit of a surcharge but accepted anyway, something the private companies generally don't do.
Blue Cross rates tend to be a bit higher, because they are more generous in whom they take, and they don't usually make money by canceling honest subscribers. In Florida rate hikes have to be approved by a state commission and have not been outrageous, recently 11% to 15% for example. While high, thats a reflection of the soaring heath costs and not their fault.
My monthly premium is just shy of $1100 for the 3 of us for $5 million in coverage and $25 primary care visits and $1,000 deductible (each) That sounds shocking but is actually about the nationwide average. Most people get health coverage, if they have it, through their employer, so they have no idea just how high it is.
In Florida, Blue Cross is so huge that they almost are a monopoly, although last time I looked I think they have well under 50% of the market. But because of their prominence they have huge bargaining leverage.
The problem with Obamacare in a nutshell, is that anybody who is sick will climb into the system as soon as possible, something they couldn't do before. However because of a very weak mandate, there is no incentive at all for the young and healthy to pay.
I am afraid my Blue Cross rates will rise so high because of this, that I would be likely to cancel myself. Why in the world would I pay $1100 a month (and by then presumably far more) when I could just cancel and sit tight and wait until the day I really come down with something life-threatening and then get insurance by guaranteed acceptance? This is a death spiral for health insurance companies, and why they oppose reform.
And this is why health coverage really should be paid through some sort of general revenue, collected from everyone.
As rates soar and healthy people opt out (because they are guaranteed they can buy coverage later) it will become unsustainable, even worse than it is now.
Until the day comes that we change the conversation to the things nobody will talk about today, its hard to see an end to medical inflation. Those unmentionables include rationing and the disconnection between the service and payer. We spend most of our entire lifetime of costs in the last year of our lives trying to delay the inevitable for no apparent purpose in my view.
In spite of all my reservations, and the near certainty that the proposed system won't work, and will cost me an arm and a leg, I heartily endorse and support it.
Because its a good start, and the beginning of a long march down the road towards true universal coverage, and because presently I don't see any other way to get there.
And frankly I'd vote for it in a heartbeat entirely on Rush Limbaugh's promise to leave America and move to Costa Rica if it passes. That, and watching the Republican heads explode, is enough in my view to get every thinking person on the planet behind these bills.