ACA – No Retreat

The average rust-, corn- or biblebelter never had a passport, and might regard as exotic travel a trip to another county’s fair. To them, Copenhagen is chewing tobacco, Dutch Masters are fancier tobacky, and Monte Carlo was the best durn Chevy ever built. The notion that America is just one among a growing number of rich, developed countries is at best an abstraction. And so when they’re told that, relative to the residents of other rich countries, Americans live shorter lives, American babies are less likely to survive infancy, and American children are less likely to see 1st grade, they become angry, confused and incredulous.

And then come the usual lame excuses. Americans are richer, have cheaper happy meals, and watch hours of TV on their ginormous flatscreens. And over in fascist Western Europe you cant buy a gun at a show, plug a pesky co-worker, and be home in time for dinner, y’all.

But as a matter of empirical fact, Americans are not particularly sedentary. And while they are fatter (and better armed!) than other westerners, neither diet nor guns adequately explain why Americans are so much more likely to die from the day they’re born till age 75, compared to people in other rich countries. The most comprehensive review to date significantly blames the US healthcare system itself for poor US health outcomes – while costing Americans double the OECD average in per capita healthcare expenditures.

Enter the Affordable Care Act, also known as the ACA, or Obamacare. The ACA has several policy objectives – chief among them are reducing the number of uninsured, and controlling the growth of healthcare costs. And contrary to misinformation passed on by conservatives at every opportunity, the ACA is proving to be a great success.

Rates of uninsured are dropping nationwide – fastest in states that have participated in expanded Medicaid, but rates are even dropping in those who opted out. Enrollment through the exchanges has exceeded its target, despite a sloppy rollout that cost HHS Secretary Sebelius her job. And, amazingly, the growth in healthcare costs has slowed to its lowest level since measurements were first taken in the 1960s, which is all the more remarkable given that the economy is still recovering from a sharp recession – a period during which health care costs have traditionally spiked.

The notion that a country can pay less for healthcare and get better health outcomes is not theoretical – it is demonstrable. Nearly every western country pulls off this feat vis-a-vis the US, year-in and year-out. The notion that public health insurers (like Medicare) can outperform private insurers is likewise not theoretical, but demonstrable, both between and within countries. Medicare beats Medicare Advantage. Other countries’ primarily public systems beat the US’ primarily private system.

The GOP has a good chance of taking control of the Senate in the coming midterm elections, and should that happen, we should expect to see yet more congressional attempts to repeal the ACA. But Americans should be steadfast in their support of the law – there can be no going back to the failed system of old.


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