(This is the first of a series.)
I was a foot soldier in the crusade to pass Obamacare.
Initially, it wasn’t by choice. I was the executive of a federally qualiﬁed community health center (FQHC) with outpatient clinics in rural mountain towns in Colorado. FQHCs, the linchpin of the national healthcare safety net, would play a frontline role in its implementation. Part of my job was to learn what was going to happen, when, and why.
I read books and articles, attended conferences and workshops, joined conference calls, and talked to high and low government ofﬁcials. Most importantly, I read all 906 pages of House Resolution 3590, the Patient Protection and Affordable Care Act (ACA), which became known as Obamacare. Hidden within the legalese was the thinking of our best clinical and health economics and ﬁnance experts translated into policy.
Among the healthcare communities with whom I worked, word got out that I knew a little about the ACA, so I was invited to summarize it to county commissions, hospital boards, and public health departments who didn’t yet. I’d show graphs like this:
Then I would explain that our healthcare system had become a ﬁnancial black hole, sucking in every free dollar, and closing in on 18% of GDP (it’s now 20%). Insurance premiums and deductibles were soaring out of control, as they had pre-Obamacare (and still are — in 2016 it was $25,826 for a family of four). They were squeezing out wage increases and other purchases, like vacations and college. Private sector American companies complained the cost of employee health insurance was making them uncompetitive in global markets. And uncompensated care delivered to the uninsured ﬂooding emergency rooms was hurting hospitals. I’d ﬁnally present how the ACA would change this.
My time in the ACA crusade was an eye-opening adventure. Had I been more astute, I would have seen the anti-Obama, ultra-conservative onslaught coming that now plagues our body politic, starting with this troubling scene at a pro-Obamacare rally in Grand Junction, Colo., on Aug. 1, 2009.
Or two years later when I was requesting the support of a Republican county commissioner who dressed like a Wild Bill Hickok, right down to boots, duster, shoulder-length hair and handlebar mustache. We were planning a new clinic, to be partly supported by federal funds, in a town that was overrun by uninsured natural gas fracking workers with their attendant health problems, e.g., respiratory ailments, VD, alcoholism, and meth. He took me in his computer to show the National Debt Clock (it’s really cool), and, with sincerity, said that as a patriotic American concerned about our future, he would not support any project using federal funds because that would increase the debt. He added warmly that he supported what we were going to do (and did).
These days when Republicans threaten to repeal Obamacare, it’s obvious that they don’t know what Obamacare actually is. They didn’t when it was passed in 2010, and they don’t now.
President Obama could have enjoyed a long tenure in the White House without ever getting tangled with healthcare. As the hapless Republicans are about to discover, healthcare is dangerous for politicians. Corporate healthcare is not heavily populated with leaders whose values are inspired by Mother Teresa. If you threaten their proﬁts, they will try to stop you. Obamacare has been proﬁtable! (Remember insurers sponsored the ads that ﬁrst branded Hillary Clinton as a cold-blooded, elitist bureaucrat when she tried to help Bill reform healthcare in the early 1990s, and the poisonous label stuck with her right up to her defeat in 2016.)
However, President Obama, a faithful Christian, believed that all people should have access to healthcare. Suffering, disability, and death may be part of the human condition, but access to modern medicine can often eliminate, reduce or postpone them. In his view, it was ﬂat-out immoral that almost 50 million Americans were blocked from it. The Bible commands believers to heal the sick.
Also, one of the most visionary presidents ever, President Obama realized that the healthcare system itself poses a long-term threat to the US economy. He needed to act. It would be dicey; he would be like the kid in the boat with a hungry tiger in “The Life of Pi,” only he would have to ﬁnesse multiple tigers — insurance, pharmaceuticals, hospitals, nursing homes, provider associations, equipment suppliers, laboratories.
This already dangerous task was made worse by the ignorance, hostility, and, let’s be honest, racism of Republicans in Congress.
On Feb. 25, 2010, I stayed home from work with a wicked head cold and happened to ﬂip on C-Span, which was live broadcasting the Health Care Summit, hosted by the President, for the leaders of both parties to exchange views about the bill.
Aware he was on national television, Eric Cantor, then Minority Whip, walked into the room with a hang-dog look on his face, carrying a foot-high stack of loose paper that he plopped down on a table with a dramatic sigh.
President Obama patiently watched this, then observed, “The truth of the matter is—is that health care’s very complicated. And we can try to pretend that it’s not, but it is.” At every opportunity, Republicans had been exaggerating the gross volume of the healthcare bill to frighten the public that it was packed with god-awful provisions such as death panels and socialized medicine. (Read the transcript here. President Obama knew his stuff.).
Senate Minority (now Majority) Leader Mitch McConnell, then and now the personiﬁcation of active aggression towards President Obama, was in the room that day, sulking like always. But to his credit, he was listening because just last week, after releasing the Republican’s 147 page tax cut for the rich posing as a healthcare plan, he conceded that healthcare is “a big complicated subject.” Republicans have no plan of their own to improve healthcare.
Many of us, me included, would have preferred a single payer system like those in the rest of the industrialized world. However, President Obama was a pragmatist. He inherited an economy in the worst recession since the Great Depression. Support was shaky because of turncoat, deﬁcit hawk Blue Dog Democrats. A single payer system was not a politically realistic option.
Facing reality, President Obama smartly neutralized the fears of the healthcare establishment, especially the insurance companies, by ensuring they would not lose money. He combined taxes on the rich, as well as several more obscure ones, and deﬁcit spending to create access quickly. As a result, Obamacare has provided healthcare access to over 20 million Americans. That’s an amazing achievement.
Today no contorted Republican free market math can accomplish the same for less. Under any imaginable scenario, no matter how you fund access for the poor and people with pre-existing conditions, it will never be proﬁtable and will have to be subsidized forever.
Obamacare was never just an insurance program. That’s why it was 906 pages long. It is the framework for a long-term transformation of our healthcare system to make it better and less costly.
It has already irreversibly changed the delivery of health care. You can see it when you go to your primary care doctor or into the hospital, if you know what to look for. In the long run, all of us, including Republicans, will be healthier because of it.