The Basics of Obamacare

Few people would be surprised to hear that the majority of those who scream the loudest about health care reform in the United States seem to know the least about it. When these people express their fears they speak in platitudes and slogans, almost all of which are either non-sensical or have little to do with what Obama is actually proposing. Those on the right do not have nearly enough of a reason to be afraid as they think they do, and those on the left shouldn't raise their hopes to high. "Obamacare" is actually a very modest proposal. It's nothing like the kind of health care system we have in Canada. In fact, if such a program were proposed by a Canadian politician, it would be considered radically conservative and unjust. While it is still arguably a significant improvement over the current American system, it is still far from a single payer system no matter how much Fox News would like to scare people into thinking it is.

What Is Actually Being Proposed
What is actually being proposed is not universal health care. It is not a system in which the government covers all of everyone's health care costs with taxpayers' money as is done in Canada. What we will see is something like a non-profit, government-run HMO, and it will be optional. In many ways it will be run just like any other health insurance company. People will have to make regular payments like they would any other insurance coverage. The important difference is that these payments will be supported by government funds and be much more affordable than what the regular HMOs are offering. They'll also provide greater coverage and have fewer restrictions based on things like pre-existing conditions.

This system has significant advantages for those who find it difficult to find health care. Lower payments will allow more people access to coverage. Fewer people will end up bankrupted by medical bills. The economic advantages are a bit more ambiguous. It could be less expensive than the current system. Right now, there is a program for people who cannot afford coverage. It's called Medicaid, and like the program Obama is proposing, you have to pay into it. The only catch is you have to be a senior citizen. The public option would expand this to the entire population.

There are a couple of reasons why conservatives are so afraid of this. The first is that this very well could end up costing more than what the government currently spends on health care. The second reason, and the one you hear the most about, is that this will put the private health insurance companies out of business, leaving everyone with no choice but to buy their insurance from the government. There are good reasons to be skeptical of this second assertion. As Obama himself has argued, having a government run post office has not put FedEx and UPS out of business. Indeed, even in Canada we still have private HMOs providing coverage for things that are not covered by our national plan. Ironically, those who supposedly have the most faith in the ingenuity of the free market system seem to have the least confidence that they will be able to compete with a publicly administered program, especially one that they claim is going to be so poorly run.

In order to pay for this program, some of the funding from Medicare (upwards of $500 billion), will be transferred to the public option, and the Republicans are trying to scare people by saying that this will mean that seniors will lose their coverage. Interestingly enough, the Republicans opposed the adoption of Medicare when it first passed, and now their styling themselves as its loyal defenders. In the surreal, double-thinking bizarro world that is the Republican mind, the program is horrible, and never should have been implemented, while at the same time it must be protected from those evil Democrats (who actually want to expand Medicare to the general population, not restrict it).

"Death Panels"
There have been a few buzz words floating around that opponents of the Democrats' proposed health care reforms like to use. The most whimsical of these is "death panels". Part of the health care reforms, they say, is the mandatory consultation with a panel of doctors who are forced to obey the government, and who will decide whether or not your grandma will have the plug pulled on her or not. In fact, what is being proposed is that the government would pay for consultations with one's doctor, which, for the patients, would be entirely voluntary, in which a person's doctor could discuss with them the options available in the event that they end up like Terri Schiavo. This gives patients the opportunity to put in writing what their wishes are in the event that they become unable to speak for themselves. That this scares conservatives is deliciously ironic considering that, if Terri Schiavo had been offered one of these free consultations, she may very well have said that she wanted to be kept on life support, and her brain-dead carcas would still be alive to this day. Another objection is that doctors are incentivized to have these consultations with their patients, and may pressure them into having the discussion about what they want their palliative care to be, but first of all, the patient can always refuse, and secondly, even if they couldn't, all they would have to do is sit patiently throught their doctor's little speech and say "keep me alive at all cost!" And nobody would have to worry about having the plug pulled on them. In fact, if they were, in fact, forced into these consultations, it's actually less likely that they would be taken off life support against their wishes, then if they had not had the consultation. The only real objection is that, in order to get one of these consultations covered, the doctor must read from a list of options that the patient has, including do-not-resuscitate orders, and the discontinuation of life support in the event he or she ends up as a vegetable.