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A Spoonful of Sugar: On the Affordable Care Act | The Nation

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Inconvenient facts

Apparently, Bernard Avishai prefers to cast aspersions on critics of President Obama’s healthcare program, rather than actually addressing legitimate dissent. The president’s plan has two major components: expanding Medicaid coverage for the working poor, and a system of exchanges for other uninsured folks to purchase insurance from private companies. It is estimated that Medicaid coverage will expand by 12 million to 15 million beneficiaries. In my opinion, this in itself is such a huge gain for working-class people that Obama’s program merits support. However, the other portion is problematic because insurance does not equal healthcare.

If we look at the Massachusetts model, we can see the implications for Obama’s plan. As Marx might say, De te fabula narratur. Since Romneycare went into effect, there has been a marked increase in the sale of high-deductible plans. Not coincidentally, in surveys as many as 20 percent of Massachusetts residents say they forgo healthcare due to the expense. Furthermore, Romneycare has seen no significant decrease in bankruptcies due to medical expenses. Unfortunately, we can expect the same type of results once Obama’s plan goes into effect at the national level.

Avishai references Arnold Relman, but does not mention that Relman has written extensively on health reform, and predicts that Obama’s plan will fail in the medium term for some of the above reasons. One additional note: Obama’s former budget director (now with Citigroup), Peter Orszag, has predicted that employer-paid health insurance will go the way of the private pension, and be replaced by employers’ handing their workers lump-sum payment to purchase insurance on the private market. The health insurance exchanges may have the unintended consequence of fostering this shifting of risk from corporate America to working America. And contrary to Avishai’s argument, pointing out these inconvenient facts does not make one a tool of reaction.