The Flathead Valley’s Leading Independent Journal of Observation, Analysis, & Opinion. © James R. Conner.


28 May 2013

Obamacare and the curse of gratuitous complexity

Providing affordable health care to all Americans should not be complicated. At birth or naturalization, automatically enroll all citizens in what I will call American Care, a federal single-payer system that covers everyone for everything and requires no copays or premiums. When Americans need medical care, they present a small card with their medical records, and receive treatment and medicine from the physician, hospital, nursing home, or pharmacy of their choice.

There were no financial or technical barriers to American Care — but there were formidable political barriers, and so this nation, which is throwing away its greatness, chose the Affordable Care Act (aka, Obamacare), a multiple private-payer system so complicated that

Families USA, a liberal advocacy group and strong supporter of the law, would like to see more money to pay for “navigators” to help enroll the uninsured in the new health care marketplaces. NYT 26 May 2013.

The alternative to hiring Healthcare Enrollment Navigators (HENs), of course, is simplifying the system, but that won’t happen for two reasons.

  1. The architects and supporters of Obamacare revel in complexity and disdain the elegance and efficiency of simplicity. They want to be the only ones who really understand the subject. What’s the point of owning a Ph.D. in economics if high school dropouts can understand what you’re doing?

  2. Congress in its current configuration will do nothing to modify the Affordable Care Act. Republicans are willing to repeal or sabotage the ACA, but not to improve it. Democrats are willing to tinker with it (but not to replace it with American Care, or otherwise simplify it), but know even that’s impossible while the House of Representatives is controlled by Republicans.

And so Americans are stuck with a health care system that’s hideously expensive, so complex that Rube Goldberg would blush in shame, relies on the authoritarian Individual Mandate, and fails to cover millions of poor people because mean and stupid governors (Rick Perry, to name one) and legislatures (Montana’s, to name one) refuse to accept a Medicaid expansion that’s mostly paid for by the federal government.

When I was younger, I hoped and believed the country would come to its senses and replace private health insurance with American Care, or the functional equivalent thereof. Now, doubts largely replace my hopes. It no longer seems to me that humankind, at least in the United States, has the collective wit, courage, and decency to adopt a rational health care system. Consequently, we not only have Obamacare — we are condemned to it. And many impoverished Americans, denied health insurance by the likes of Rick Perry and Republican Legislators in Montana, are condemned to die for want of medical care. As long as this reprehensible situation persists, we should shed the illusion that we are a great nation.