Last updated: Aug 23rd, 2011
The Obama Health Care Plan:
The Obama Health Care Plan (or reform, bill, or law, whatever you call it), dubbed "Obamacare" mostly by its opponents, was a massive health care package passed by US Congress in early 2010 and signed into law Mar. 30, 2010. The official title of the package is the Patient Protection and Affordable Care Act.
Pros and Cons of Obama's Health Care Bill:
Rather than being uniformly for or against this reform, I have a nuanced take on it. There are aspects of the package that I think are a good idea, and aspects of it that I strongly disagree with or think are bad ideas.
Worst aspects of the bill:
- The 1099 provision (since repealed) - This was a poorly-designed attempt to cut down on tax evasion. The bill included the extremely burdensome requirement that all businesses issue IRS form 1099 to any contractor or business from which greater than $600 of goods or services were purchased in a tax year. This would have been a massive recordkeeping requirement with huge costs to business, and it was thankfully quickly repealed.
- Requirement to purchase private insurance or face a penalty - Never before has the US government required its citizens to purchase a product that is only available from private corporations. I believe that this provision in the law is both unethical and unconstitutional -- there is no constitutional basis for which to make this requirement.
- It was a large package bill - In accordance with my official political platform, I support passing bills in as small packages as possible. While it is true that some of the different provisions of the Obamacare bill needed to be included together in order to make sense, I believe that many of them could have been separated out. I also do not believe that the "ends justifies the means", and I think from a political perspective, it is shady and unethical to force through large packages. I would have preferred breaking this package into as many separate bills as possible and voting on them individually. This would have most likely prevented some of the more unpopular and counterproductive provisions, such as the two discussed above, from passing.
- The bill was complex and included numerous exceptions - Simplicity is something I highly value in laws. Even when exceptions seem fair or are well-intentioned, they rarely come out fair in the end, because for every case where an exception is given, there are often other cases where an exception is equally deserved but not given. If there are problems with a law and a need for exceptions to it, I would rather fix the law and keep it simple, than make the law more complex by introducing exceptions.
- Supports and even requires health insurance to be associated with employers - In my ideal world, health insurance would not be tied to employment or provided by employers. There are numerous problems to having employers provide health benefits, the largest of which is that this system results in problems for people who are unemployed, and unnecessary complexities when people change jobs. The Obama health care package requires certain companies to provide health insurance for their employees--I think this is a move in the wrong direction as I would rather move away from health insurance being provided by employees, and towards some combination of a base universal health coverage provided to all people, and private insurance purchased independently of an employer.
Best aspects of the bill:
- Preventive care - The package contains numerous requirements that insurance companies provide greater preventive care, in many cases, with no co-pay or deductible. This will help to keep costs down.
- Health insurance exchanges - Health insurance exchanges are entities that allow the pooling of large numbers of businesses and individuals in order to leverage their numbers to receive better deals on healthcare, the sort of deals typically only available to members of large organizations. The bill made space to allow the creation of these exchanges, but without actually creating them, which I think is an ideal role for government to play: it allows individuals, businesses, and the free market to create solutions. It also gives states the flexibility to handle health care in different ways, as states could choose to create their own official governmental exchange. The bill also paves the way for later changes which could allow national exchanges for even greater benefits to people and businesses.
- Reducing the numbers of uninsured - While I do not agree with all of the bill's provisions or methods, it is hard to deny that the bill will have the effect of insuring some Americans who are currently uninsured. This will reduce health care costs for everyone: uninsured people place a huge burden on the health care system as they are often cared for only in high-cost emergency facilities, and they often do not pay their bills. Furthermore, uninsured people can postpone preventive care or care for less serious conditions, which can cause greater costs later in life when they may be insured. Any amount that the bill reduces the number of uninsured Americans will result in benefits and cost savings for society as a whole.
Moving Forward:
I would not support a complete repeal of the bill. A repeal would worsen the back-and-forth partisan fighting. In addition, my comments about big package bills also apply: while I do not like the passing of big package bills, I also do not like the repeal of big package bills. Both of these approaches avoid the tough work required to hash out each item in a big package to determine whether or not it is truly beneficial. I would support a tweaking of and simplifying of this bill.
In particular, I would remove the mandate and penalty requiring people to purchase private insurance, and instead focus on making insurance more accessible and/or providing a minimal public insurance option for people who cannot afford to buy private insurance.
I would also repeal the provisions in the law that promote the system of tying health care coverage to employment. I believe that in an ideal world, health care would not be tied to employment. I would want to instead create incentives that would move America in the direction of having no health insurance ever provided by employers, and instead having it either privately purchased or provided by the government, or some combination.
Further Reading:
Because organizations are so biased when it comes to covering this plan, I have chosen to only link to two sites, which I consider to be the most neutral on this issue:
- Patient Protection and Affordable Care Act - Wikipedia - A comprehensive page on the topic of the Obama Health Care Reform
- HealthReform.gov - The official website of the Obama health care reform package.
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