Obamacare has become one of the great political Rorschach tests of our time. The far right (which now controls the vast majority of the GOP) sees in it a disaster of government intrusion into the private market. Centrists in line with Max Baucus and pre-presidential-run Mitt Romney see a healthy mix of public-private interests that maintain market incentives while still offering reasonable prices to those in greatest financial need. And progressive liberals see in it Rube Goldberg Frankenstein’s monster that guarantees profits and new customers for insurance companies while doing little to solve the problem of outrageous healthcare costs.
The fact that different perspectives exist on the same situation doesn’t mean that all of them have clarity of vision, however. And in this case, it’s increasingly obvious that progressives have been using the proper prism all along.
Obamacare fans will be quick to point out that the program has indeed lowered costs for most people, and that it will likely survive more or less in proper form going forward. But increasingly troublesome problems have been cropping up with insurers raising prices or simply backing out of the exchanges entirely, as Aetna did this week. The price surges are creating complications for Democrats trying to retake the Senate. The challenges facing Obamacare are big enough that it is re-emerging as a major campaign theme in a year that had seemed prepared to move beyond it for the first time in three election cycles.
While the Affordable Care Act will likely continue in some form for the foreseeable future, the challenge is that good healthcare policy cannot be reconciled with the market-based profit motive for insurers. Obviously, drug manufacturers, hospitals and the like need to be able to make enough money to keep the lights on, develop new treatments and attract top talent. But the experience of other developed nations shows that healthcare professionals can make very good livings without the need for high-profit private insurance intermediaries. Governments can control costs by being the national insurance provider and negotiating directly on the cost of drugs while fostering quality medical innovations and adequately compensating doctors, nurses and surgeons.
The recent controversy over Epi-pen price gouging is another example: when drug manufacturers are allowed to nearly corner markets and the government doesn’t negotiate directly on costs, affordability problems can spiral out of control.
Creating healthcare exchanges and regulating insurers can help blunt some of the most egregious advantage-taking and make it remotely possible for previously uninsurable patients to get some version of health insurance, but it is not a durable long-term solution. It’s merely a band-aid on a burgeoning infection caused by the private insurance industry.
That’s why we’re seeing renewed calls for a public option to be added to Obamacare, just as it should have been when it was first enacted. Many centrists ridiculed the progressive movement for its strident insistence on a public option in the first version of Obamacare, declaring that it wouldn’t be necessary, that it would make the Affordable Care Act too partisan, that insurance companies would work to kill the exchanges if it were enacted, etc. But on all counts progressives were right: it is necessary, the Affordable Care Act couldn’t possibly be more partisan than it already is, and insurance companies are already working to kill the exchanges because there just isn’t enough profit there for them.
It’s probably not possible to bring single-payer healthcare to the United States fully formed like Athena from Zeus’ head. But it would be the best solution. In the meantime, Congress desperately needs to create a public option once Congress can be wrested from the hands of the Republican obstructionists. Until then, individual states may need to look into setting up their own versions of the public option. Blue states have been reticent to mess with healthcare policy in the hope of helping the Affordable Care Act exchanges to establish a solid footing. But it’s well past time they began taking proactive steps to give people a choice that dodges private insurance altogether.