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Goodman Commentary: Obamacare better than came before


Six years ago, my wife and I came back home to Florida after a two-year sojourn to China, and found ourselves in some serious straits.

We were over 60, we weren’t employed and, just at the age when our bodies were likely to start breaking down, we didn’t have health insurance. What’s more, we couldn’t get it.

The Affordable Care Act (ACA) — also known as Obamacare — had not yet kicked in. It may be hard to remember what the world was like before Obamacare existed. Understandable: it’s hard to remember what happened 24 hours ago, given how fast and intense the news cycle is these days. And how many times we’ve heard conservative politicians and commentators tell us that Obamacare is a job-killing nightmare straight from the jaws of hell.

But think back. Once there was a time when there was no law that said insurance companies couldn’t reject you because of a pre-existing condition. Which meant, in practice, that insurance companies, squinting at their actuarial tables, looked for every conceivable type of pre-existing condition to reject you.

That’s what happened to my wife and me. We didn’t dare go without health insurance because of another feature of the pre-Obamacare years: Costs were rising explosively. Get checked for a possible sore throat from strep and expect to pay a couple of hundred dollars. Get hit by a car and, assuming you survive, hope you don’t go bankrupt.

So we shopped around for health insurance. One company after another turned us down. We were basically healthy, but our health care records were there to haunt us. I have a congenital problem with my hearing and had a number of surgeries dating back to 1978. A doctor sent me to a hospital in 2008 for tests because my heart was racing — a panic attack, it turned out. No one would sell me a policy: pre-existing conditions. I offered to sign a waiver promising never to use insurance for an ear problem. No dice.

My wife has arthritis. I think the basic treatment is aspirin. That, too, went down as a pre-existing condition. No insurance for her.

We were, at that moment, among the 57 million Americans who were uninsured. It was a scary thing.

My unremarkable story

Earlier, for years and years, we’d had health insurance on plans offered through our employers – and largely took it for granted. But in 2009, I was laid off. The next job I was offered was in China. When we came home two years later, there was no employer, and, all too clearly, no health insurance.

In China, ironically, we had great health care. And it was cheap. I walked into one of Hong Kong’s sleekest hospitals with an infection, and within an hour I was screened by a nurse, diagnosed by a doctor and sent home with a shopping bag full of drugs by a pharmacist. It all cost less than $50.

I bring all this up not because our story was especially remarkable (or that we prefer living in China over the U.S.). Just the opposite. Not so long ago, the worry of securing health care was extremely common. It was in fact considered a crisis. In 2009, TV’s “Dr. (Mehmet) Oz” called the 40 million-plus uninsured “a national catastrophe” and set up a day of free health screenings in Houston, where one in three adults lacked health insurance. Almost 2,000 people showed up. So many Americans were unable to pay for medical visits, the Kaiser Health Service reported on a surge of bartering — auto mechanics, for instance, swapping car checkups for health checkups.

Obamacare relieved a lot of that.

The number of uninsured has gone down to 27 million. The drop is especially dramatic in some of the reddest of red states: In 2013, nearly a quarter of Arkansas residents were uninsured; by 2016, when the ACA was in full effect, that number had plunged to 10 percent. Kentucky had 20 percent uninsured in 2013; less than 8 percent in 2016, according to Gallup. Both states, unlike Florida, chose to expand Medicaid as part of putting the ACA into effect.

And the dire predictions made for Obamacare – still being repeated – never happened: This wasn’t a socialistic, government takeover of medicine (instead, it’s a mandate that everyone buy private health insurance) and the economy didn’t collapse (under Obama, unemployment fell to under 5 percent while more than 9 million jobs were added, the S&P 500 rose 139 percent and corporate profits soared 166 percent, according to FactCheck.Org).

It’s worth remembering the world before Obamacare, now as the Republicans in Congress forge ahead with their vows to dismember it.

Repeal and replace? With what?

They are intent on repeal. But replace? President Donald J. Trump’s promise of something better, cheaper, grander is looking dimmer and dimmer. The nonpartisan Congressional Budget Office projection of the impact of U.S. House Speaker Paul Ryan’s American Health Care Act — 24 million people losing health insurance over 10 years, higher costs for older, poorer and rural people – caused some Republicans to immediately bail, especially those from states that expanded Medicaid. The plan, which Trump endorsed even as White House spokeswoman Kellyanne Conway begged reporters not to call it “Trumpcare,” would slash Medicaid spending by $880 billion over 10 years.

Kicking 24 million people to the curb sounds pretty awful, but Ryan’s reaction to the CBO estimate was delight. The report “exceeded my expectations,” he bubbled, making the misleading claim that his plan would lower premiums (they’d soar for older and poorer people) and stabilize the market before getting to the real source of his glee: “It’s a $1.2 trillion spending cut, and $883 billion tax cut and $337 billion in deficit reduction …Compared to the status quo, this is much better.”

Well, yes, deficit reduction is nice. But at the cost of millions of people’s well-being? Or their very being?

The Congress’ most conservative members, meanwhile, grouse that Ryan’s “Obamacare 2.0” was still too generous. Their moans cleared up a mystery. No wonder we haven’t seen much in the way of alternatives to Obamacare after all those years of voting to repeal it. For this “Freedom Caucus,” helping Americans get better health care was never the goal. It’s now apparent that the real aim was the ideological dream of cutting big government and federal spending. Or giving wealthy Americans a whopping tax cut.

If the outlines of this GOP plan hold, we’ll see a return of health insecurity for millions of Americans to make life more comfortable for the super-rich. It’s Robin Hood in reverse.

One of the funniest – or saddest – remarks out of last week’s congressional jabbering came from Sen. John Cornyn, R-Texas, who said to Democrats, “If you don’t like this proposal, then what’s your suggestion?”

Really, dude? That plan exists, and it has been helping Americans, despite mighty efforts to undermine it. It’s called Obamacare.

Is it flawed? Yes. Can it be improved? Sure.

Does it deserve to be discarded and the country taken back to the old days? That would be one sick joke.



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