Obamacare but who cares?

This week I saw two interesting things that have driven me back to the blog: 1). Healthcare.gov did not spiral down into a political story. It somehow stayed relatively factual and 2). Everyone missed/is missing the point.

To me, this isn’t about public healthcare, President Obama’s leadership or the government being able to handle a major website.  Though all those things are true especially in the short term, these outcomes – ineffective launches, partial solutions/partial failures, and discord in addressing problems – are symptoms of a larger problem.  We, the royal we, all of us, do not want to have to put in the work required to solve problems, to get things right, to actually implement positive change (and not just change for change sake).

Our expectations about work, timing and sacrifice have so drastically changed as a result of technology that our perception of public policy is now totally unrealistic.  We want complete and beneficial solutions and we want them immediately.  We elected President Obama in the midst of a financial crisis and two wars but then pretended like that wasn’t a big deal and he should have us out of trouble in less than a year. Two or three years tops.  I’m as guilty as the next voter of unrealistic expectations 6 years ago.  The difference, I think, is that somewhere along the line I realized it.

Let me use Healthcare.gov as an example.  Throughout the last week or so, we’ve heard a series of complaints (larger issues than just a crashing website) – Obamacare was a bad idea, government cannot do “big things,” this is going to continue to fail now that the launch failed.  What we’ve forgotten is that the private marketplace wasn’t doing a great job prior to this attempt.  Healthcare was expensive, limited in its coverage and exclusive to certain types (or classes) of people.  So, in this era of quick fixes and high expectations, we’ve conveniently forgotten that one reason we had to resort to Obamacare was the private market failed.  Furthermore, we don’t know the government is going to do it well or even right.  Public policy is, by nature, trial and error.  But is that a reason not to try or to give up on Obamacare?  If so, what’s your idea? What’s a better idea?  Returning it to employer-based private healthcare returns us to a system of inflated costs, ballooning treatment, no prevention to speak of, and many of the most sensitive (the poor, kids, poor families with kids) left without help.  We’ve seen the private market fail, in some cases spectacularly so, in recent years.  The mortgage/financial crisis comes to mind. The point is not which is better because these are not mutually exclusive.  The point is where do we turn when we have a problem? How do we approach solving society’s big problems? I’ll try to stick to the issue de jure.

For those who complain the uninsured or underinsured is a made up problem and the private market can handle it, I have a quick example to the contrary.  A young woman who wants to start a family requires special medication in order to have a healthy pregnancy. Fair enough.  Other than the pregnancy, there are no major health concerns and the medication is temporary just until the pregnancy is considered out of the danger zone (in other words, you can start telling your friends).  As a result of temporary medicine, this woman is uninsurable in the private market.  Yup, preexisting condition.  But she’s not taking the medicine anymore? Get this – she might get or choose to get pregnant again, and if that happens, she may need the medicine again, and the medicine is kinda expensive, but will be required by the doctor should a pregnancy occur, and therefore the private health insurance does not want to risk the cost and will not cover the woman.  Forget that chain of “ifs,” and just look at the decision itself.  An otherwise healthy woman who has a family, provides for them and creates stability both in the community and in the insurance pool is rejected because of the helpful (temporary) medicine used in the early stages of conception.  Makes sense from a business sense, right? Obamacare says this person must receive healthcare and cannot be turned down.  Am I saying that this hypothetical alone is sufficiently evidence that Obamacare was the right decision or policy choice? No. Not at all.  What I am saying is – challenge! If you argue that Obamacare is a bad idea, fine. What’s your idea?

My guess is that someone out there, some health insurance executive or some other experienced veteran of the healthcare industry already knows what the solution is (Obamacare or otherwise) but for a variety of issues – cost, political climate, feasibility, etc. – the solution is not possible right now.  Ok. Then, we’re back to square one.  Which brings me to my original point, this is serious business.  We cannot just expect that we can create an “exchange,” pressure insurance companies into it, throw together a website, and get the right balance of people in order to lower costs and achieve broad healthcare offerings.  It takes time and commitment.

Nothing in life worth doing is easy.

I always use this example when talking about religion, but it fits for public policy too.  Why should being religious or being devout be easy? Working out and staying in shape isn’t easy.  It’s tough. It requires discipline and dedication.  Education isn’t easy.  It’s long, expensive and challenging.  A college degree, graduate degree or professional school degree is an accomplishment and educated workers are compensated accordingly because it’s valuable.  If medical school were easy, how much would you trust your doctor?  Ok, ok, you get the point.  For some reason, we don’t hold politics in the same esteem.  We just assume that the President, Congress and others should just “get it done.”

We, the royal we, all of us, need to roll up our sleeves and get to work.  Similarly we need allow our politicians the same freedom.  When they don’t, we have to be paying enough attention to hold them accountable.  But that’s not gonna happen, is it?

Not only do we not hold them accountable when they shut down the government and spout useless rhetoric (see the Tea Party, Rep. John Boehner, Sen. Mitch McConnell), but we also do not understand when politicians do not take us (the voters) seriously.  They know that we’re not paying attention. There’s no incentive to work hard or get things right.  The only incentives are soundbytes and re-elections.  We don’t like when it requires hard work, when the solution is complex and when it will take years (a generation?) of discipline to correct systemic problems.  If we don’t have the discipline to pay attention and hold public leaders accountable, why should we expect they’d stay disciplined to address these problems?

My take is this is part of a larger cultural issue, of which I’m just as guilty, that we talk a good talk but we can’t walk the walk.  I’m doing it right now. I’ve written this blog post and that’s as far as my observation or passion will take me.  I’ve got a job, family and limited time (just like everyone else) so I cannot take on the Washington establishment. I cannot try to change people’s minds about what government can do and what leaders should be or could be.  Why? I’m having trouble figuring out how to get paid to do it.  Until I can, I’ve got a regular job to go to and try to make enough money to pay for the mortgage, health insurance and student loans.  There is no incentive for me to take this on.  I’m busy.  Is Obamacare working? Is it not working? Who cares? Nothing is gonna change anyway…right?

Look. I’m not trying to be a Debbie Downer here.  All I’m saying is that we have no one to blame (see Obama, see Congress) except ourselves.  We maintain a double standard for public policy choices. These unrealistic expectations make it seem that things which are true in our own lives (valuable achievements are difficult and take time/discipline) somehow are not true in Washington. Yet at the same time, we do not have time or resources to get involved.  Where does that leave us on Obamacare? on public policy generally? What does it mean for “big” problems facing our generation?

I don’t know.  I’m still working on that.  But if I figure it out, I’ll let you know.  Hopefully you’ll be able to spare a minute.

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One response to “Obamacare but who cares?

  1. Just finished my thinking on this topic and published it here: disposableideas.com/2013/12/14/healthcare-reform/
    The name of the website should hint as to my confidence in making it happen.
    Diggin’ through all the rhetoric, Fed involvement in healthcare doesn’t work for three reasons: 1) number-crunchers can’t help but meddle, which is not in line with U.S. cultural beliefs, 2) most people tend to take better care of their health when spending their own money, and 3) one-size-fits-all fits none, we spend all our time arguing instead of healthcaring.
    K

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