Coming soon to a computer near you -- Obamacare 2013

It's been a while since we've talked about Obamacare -- formally known as "Public Law 111 - 148 - Patient Protection and Affordable Care Act"  and oftentimes shortened to ACA.  Click on that link to download your very own copy.  I did.

It's hard to believe that over a year has passed since the last big excitement on this; that would be the Supreme Court's decision that was released in June 2012.  Since that time anything newsworthy on this subject has been mostly regarding the drudgery of creating the various on-line insurance exchanges that are scheduled to be active on October 1 of this year.  Not much excitement in writing about another Internet-based business, is there?

Not to let boredom reign, the various spokespeople of the Republican Party--in what we are probably expected to assume is a burst of alturistic public service--have lately been exclaiming that the date of 10/01/2013 is really the current End-of-the-World Scenario; the End will come as a result of the efforts to implement these public insurance exchanges.

Last year's "End scenario" was the Mayan Prophecies.  That turned out to be wrong -- we're still here. Do you think the odds are pretty high that this year's end-of-the-world prophecy will also turn out in the same way?  Yes, I think so, too.

The New York Times wrote about some of this in an excellent article on July 23.  I offered some other thoughts, which were accepted as a comment to the article.  Here's my comment as it appears on nytimes.com:

My oh my, what short memories we have! It wasn't all that long ago that most of us--Dems and Reps and Declines-to-States, conservatives and liberals and middle-of-the-roaders--were moaning about the high-and-getting-higher costs of healthcare, and the unfair discriminatory behavior of insurance companies that would arrogantly and arbitrarily use their absolute power to whimsically deny coverage; and finally saying "why doesn't somebody do something about this?" Rightfully so, too, as America's healthcare costs have for many years been on a trajectory to consume almost 1/5 of the nation's economic activity, while the benefits of premeditated healthcare were being denied to a growing segment of the population.

And so, since the fee-for-service, private sector model of healthcare--which we have been using for more than a century, unencumbered with government leadership--continued to sate its voracious appetite for our hard-earned dollars, somebody came along and actually did something about the problem. We defined the problem as something that was growing in an environment that had little or no national leadership, and therefore we now have a solution that involves national leadership.

Obamacare is certainly not perfect. It's a complex solution to a complex problem. Anything that's complex has lots of moving parts, and moving parts must be maintained and replaced over time; future replacements allow opportunities for improvements.

Well, you can say only so much within a 1500-character limitation; in my case, that's barely enough space to introduce myself.  If they had allowed me as much space as I wanted--and if I thought that anybody would take the time to read as much as I wanted to write--then I would have added a few other thoughts, including these:

• Features of Obamacare that most people like -- you have a pre-existing condition?  No problem now with the ACA; but it used to be a big problem if you wanted to change insurance carriers or if you were a first-time purchaser of insurance.  No charge ("co-pay") now for preventative care; that's new.  The Medicare "doughnut hole" for prescription drug coverage is finally being closed.  No more lifetime limits on how much care an individual can receive.  There's more, but that's enough for now. 
• Length -- at 906 pages the text of the law is substantially long, but how does that compare to other things that we might read?  Looking at the bookshelf, here's a copy of Executive Orders, by Tom Clancy; it's 874 pages, so that's similar.  How about Years of Upheaval, by Henry Kissinger?  That's 1283 pages, including the Index and a few pages of pictures.  James Clavell's Whirlwind is composed of 1147 pages.  And, considering that these laws get printed up with wide margins and large font size, the word count is much less than in these books.  Yeah, I know what you're thinking:  A Tom Clancy novel has lots more entertainment value than a law does.  But, on the other hand, what with all the TV (think Fox News) and Internet chatter about death panels and so on, it seems to me that Obamacare has provided a great deal of entertainment to a lot of people over the last few years.
• Speaking of death panels -- one of the reasons I have my very own copy of this law is because of all that chatter about death panels, coverage for undocumented immigrants and other nefarious things that the ACA was supposedly written to include.  You've probably seen at least one analysis of the law that was done by some so-called "expert" and which provided a page-by-page enumeration of its supposedly faulty provisions.  So, I looked at the text of the law, using the page and section numbers that were so convincingly provided in one such analysis.  What did I find?  Let's just say that as analytical experts, those folks might make pretty good writers of stories about zombies and vampires.
• What's with all the voting to repeal the law? -- At last count, the Republican majority in the House of Representatives has voted 40 times to repeal or "defund" Obamacare; and yet, the law still stands!  What a waste of time and money.  That's right, the same people who preach about the virtues of fiscal restraint and austerity are the ones who are responsible for these 40 votes.  You didn't think that these things are done automatically and without cost, did you?  For each vote, Congressional staff are engaged, procedures and processes are followed, paper is printed on, bits and bytes are energized, and wheels turn.  This involves lots of time and money, and the end product is always the same, and always non-productive.  It makes a person think of that Albert Einstein comment about how insanity is doing the same thing over and over again and expecting different results.  With that thought, go and come to your own conclusions on these continual voting events.

The insurance exchanges go on-line October 1.  HeathCare.gov is a great resource; anybody can use it regardless of whether a person already has insurance, or not; and, it includes guidance for businesses.  Also there is a state-by-state pull-down menu that links to those states that are doing their own marketplaces, such as California, Colorado, Hawaii, Minnesota, New York and others.

Everybody's entitled to their own opinions, and some of those opinions are going to continue to be something like "I don't like Obamacare."  Okay, I get it, that's not a problem for me.  Frankly, my opinion is "I like it until something better comes along."  In time, there will be something better.  It's notable that in all the votes taken by the House Republicans to repeal the ACA, none of them has included any proposed replacement that would retain the features described above that people say they like to have in their healthcare plans.  Without that kind of thoughtfulness, these elected Representatives who have cast their 40 votes have convincingly proven that they are all about show and not about substance.

In the meantime, the state and federal insurance marketplaces are being built.  They will contain a great deal of substance, and I think we can reasonably expect that they will be open for business as planned on October 1.  Will it all go perfectly?  My guess would be "no."  But, just like any business, you try for perfection as something new is being built, and when it's rolled-out you make it "good enough" to get the job done, and go on to make it better over time.