Obamacare health reform rises from the ashes

Out of America: The President's unpopular healthcare policy is finally finding favour – much to the hysteria of the Republicans

Share

Whisper it not, but the beleaguered Barack Obama may have a success on his hands, in a distinctly unexpected quarter. Remember Obamacare, his health reform approved by Congress in March 2010 amid much contention and without a single Republican vote? It now looks as if it's going to work, after all.

Traditionally, most Americans have had health insurance through their employers. And if you're covered by the system, it works very well indeed, as I can personally testify. A month ago, I was diagnosed with cancer. A fortnight later, I underwent surgery and, touch wood, that will now be the end of it. The speed and quality of the care were terrific. With the exception of a few co-pays of $15, everything was covered by my wife's health insurance from work. Would the treatment have been as swift and efficient under the NHS? One can but hope so.

But if you were among the 45 million uninsured Americans, or the millions more whose coverage was inadequate, it was a different story. Hence President Obama's reforms, aimed at both lowering healthcare costs that are the highest of any major Western economy, and introducing something close to universal coverage.

The scheme has three key elements: the so-called "individual mandate", requiring everyone to purchase coverage – if needs be, with help from the government; a system of healthcare exchanges, where newcomers could buy the coverage best suited to them; and a major expansion of Medicaid, the federal healthcare programme for the poor. But the 1 October launch of the government website explaining the exchanges was an unmitigated disaster. HealthCare.gov couldn't cope with the traffic and crashed repeatedly. Republicans had a field day and the President's job approval ratings plunged to Bush-like levels.

But, six months on, the mood is changing. One reason was last week's announcement that the government's sign-up target of seven million people by the end of March had been met (even though the figure may have been massaged). But, more broadly, public opinion seems to be shifting. Albeit by a tiny margin, supporters of the 2010 law now outnumber opponents, and a recent poll showed that six out of ten Americans want the scheme to be improved, not scrapped as Republicans continue to demand. One thing is becoming clear. Love it or loathe it, Obamacare is here to stay.

The measure is anything but perfect. If you set out to build a healthcare system from scratch, the Obama reforms are the last way you would go. Ideally, this president would almost certainly have preferred some form of government-run single-payer system. But he wasn't building a system from scratch; he was seeking to modify one that, in 2012, represented 17 per cent of the national economy – or $2.8trn, more than Britain's entire GDP – and with vested interests to match. So he kept the existing structure of employer-based coverage and for-profit insurance companies and hospitals, abandoning early on any notion of a government-run "public option" to compete with private insurers.

The Patient Protection and Affordable Care Act, to give Obamacare its formal title, is unwieldy and desperately complicated, and will continue to require fine-tuning. Even at full throttle, it won't cover everyone. Huge questions remain: have enough healthy young people signed up – or will the newcomers be the old and infirm, leading insurers to increase premiums further? Even Obamacare's impact on federal spending is lost in a fog of conflicting statistics. And although the Supreme Court in 2012 upheld the "individual mandate", the law's most controversial provision, legal challenges are continuing.

But despite the undiminished drumbeat of Republican criticism, something psychologically has changed. The law is now part of the landscape. It may not quite match the great welfare advances of the 20th century under earlier Democratic presidents: Franklin Roosevelt's introduction of social security, and the creation of Medicare for the elderly, and Medicaid by the Johnson administration in 1965. But it most certainly builds on them. Indeed, Obamacare may contain the seeds of the demise of employer-based insurance, as companies encourage workers to switch to the exchanges.

As were social security, Medicare and Medicaid in earlier days, the Affordable Care Act has been lambasted by the right as creeping socialism, and as another step towards a despised European-style nanny state. This time, however, Republican behaviour has been especially disgraceful. No serious alternative has been put forward: just scorched-earth opposition, and mendacious hysteria over "death panels" and the like.

This implacable hatred has seen Republican-run states refuse to implement the expansion of Medicaid – despite the fact that the federal government would pick up the entire bill. More than 40 times, the Republican-controlled House of Representatives has voted to repeal the law (including the individual mandate which was a Republican idea in the first place).

But, with every extra day Obamacare is up and running, that becomes less likely, even if a Republican wins the White House in 2016, and (rather more probable) his or her party controls the Senate as well as the House. Huff and puff they surely will, but Republicans won't tamper with Obamacare's most popular elements, such as the coverage for children on their parents' policies up to the age of 26, and bans on insurance companies rejecting people for pre-existing conditions, and imposing limits on lifetime payments to an individual. And the larger the health exchanges grow, the more market forces will promote competition and lower premiums. Isn't that what being a Republican is all about?

A lame duck pallor may be settling over the Obama presidency. But, just possibly, healthcare reform is set to be his monument for the ages. Who would have said that six months ago?

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Account Manager (Junior)

Negotiable: Clearwater People Solutions Ltd: Account Manager (Junior) Account ...

Solar Business Development Manager – M&A

£50000 - £60000 Per Annum: The Green Recruitment Company: The Green Recruitmen...

Accountant,Reconciliations,Bristol,Bank,£260/day

£200 - £260 per day + competitive: Orgtel: Accountant, Reconciliations, Bristo...

Test Analyst

£20000 - £30000 Per Annum: Clearwater People Solutions Ltd: An experienced Tes...

Day In a Page

Read Next
 

Voices in Danger: The innocent journalist kidnapped by Russian separatists for 'spying'

Anne Mortensen
A Bengal tiger captured by a camera trap in Nepal  

Save the tiger: The success of the Bengal tiger in Nepal shows you can make a difference

Harvey Day
A new Russian revolution: Cracks start to appear in Putin’s Kremlin power bloc

A new Russian revolution

Cracks start to appear in Putin’s Kremlin power bloc
Eugene de Kock: Apartheid’s sadistic killer that his country cannot forgive

Apartheid’s sadistic killer that his country cannot forgive

The debate rages in South Africa over whether Eugene de Kock should ever be released from jail
Standing my ground: If sitting is bad for your health, what happens when you stay on your feet for a whole month?

Standing my ground

If sitting is bad for your health, what happens when you stay on your feet for a whole month?
Commonwealth Games 2014: Dai Greene prays for chance to rebuild after injury agony

Greene prays for chance to rebuild after injury agony

Welsh hurdler was World, European and Commonwealth champion, but then the injuries crept in
Israel-Gaza conflict: Secret report helps Israelis to hide facts

Patrick Cockburn: Secret report helps Israel to hide facts

The slickness of Israel's spokesmen is rooted in directions set down by pollster Frank Luntz
The man who dared to go on holiday

The man who dared to go on holiday

New York's mayor has taken a vacation - in a nation that has still to enforce paid leave, it caused quite a stir, reports Rupert Cornwell
Best comedians: How the professionals go about their funny business, from Sarah Millican to Marcus Brigstocke

Best comedians: How the professionals go about their funny business

For all those wanting to know how stand-ups keep standing, here are some of the best moments
The Guest List 2014: Forget the Man Booker longlist, Literary Editor Katy Guest offers her alternative picks

The Guest List 2014

Forget the Man Booker longlist, Literary Editor Katy Guest offers her alternative picks
Jokes on Hollywood: 'With comedy film audiences shrinking, it’s time to move on'

Jokes on Hollywood

With comedy film audiences shrinking, it’s time to move on
It's the best of British art... but not all is on display

It's the best of British art... but not all is on display

Voted for by the British public, the artworks on Art Everywhere posters may be the only place where they can be seen
Critic claims 'I was the inspiration for Blanche DuBois'

Critic claims 'I was the inspiration for Blanche DuBois'

Blanche Marvin reveals how Tennessee Williams used her name and an off-the-cuff remark to create an iconic character
Sometimes it's hard to be a literary novelist

Sometimes it's hard to be a literary novelist

Websites offering your ebooks for nothing is only the latest disrespect the modern writer is subjected to, says DJ Taylor
Edinburgh Fringe 2014: The comedy highlights, from Bridget Christie to Jack Dee

Edinburgh Fringe 2014

The comedy highlights, from Bridget Christie to Jack Dee
Dame Jenny Abramsky: 'We have to rethink. If not, museums and parks will close'

Dame Jenny Abramsky: 'We have to rethink. If not, museums and parks will close'

The woman stepping down as chair of the Heritage Lottery Fund is worried