I was born, raised and live in the U.K. I am 24 years old. I remember, on the face of things, Obamacare being a step forward for the shenanigans which is the U.S. healthcare system. But, I often see posts stating it failed. Someone please explain 🙂
I hold our NHS in high regard. I cannot imagine a healthcare system which can leave people who have worked, paid taxes for 30 years+ and are all round good citizens in financial ruins. What exactly is Obamacare and why do people say it failed?
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It was an attempt to get as close as possible to the universal health care system you enjoy in the UK, while operating within the constraints of the existing US health care industry.
The major challenge was that the US health care industry is huge and powerful.
Even if corporate lobbying weren’t a factor, disrupting the careers of tens of millions of healthcare workers would be political suicide. So Obamacare kept the private health care companies and insurance companies intact.
The core of the Obamacare compromise was this: first, everyone was *required* to have health insurance, or they have to pay a penalty. Lower income people would get money for care from the government, which would expand Medicare (our government-funded, privately-delivered health care program). Middle- and high-income people would have to buy insurance from private insurers, at government-negotiated prices, and the insurers wouldn’t be allowed to turn anyone away.
So the hospitals get more paying customers, but have more cost controls on their services. The insurance companies get a guaranteed pool of healthy customers to offset the more expensive ones they’re now required to cover, and everybody gets health care, either from the government or at a (hopefully) fair price out of pocket. Everybody wins, nobody loses their job.
The program fell apart in two ways. First, the plan relied on expanding Medicare to cover people in lower-middle incomes who couldn’t afford private policies, but Medicare is operated by federal grants to individual states, and many Republican states refused to expand coverage. It was hundreds of billions of dollars of free money, and they turned it down in order to sabotage the plan.
Second, the Republicans argued that *requiring every American to buy something* was unconstitutional, but the Supreme Court argued that the penalty for not buying it was a reasonable exercise of the government’s power to tax.
So the Republicans in Congress set the penalty to zero. Now the requirement to buy health care is arguably *not* a tax so the government can’t do it. And if people aren’t required to buy insurance, healthy people will not buy insurance. This means insurance companies will have to charge more to cover the sick people that remain, and eventually *nobody* will be able to afford private insurance. Only way to solve that is to get rid of the requirement to cover everyone…. and now we’re right back where we started.
In the end, I think both sides of American politics now agree that the effort to nationalize health care “by the back door”, without disrupting existing industries, was a failure. It was a clever balancing act, but it turned out to be a house of cards. Most agree that our choices are either some sort of full nationally-funded system, or the status quo.
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