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I’ll first tell you what I like about Obamacare.

It’s a start, I suppose…

It will cover additional uninsured people.

It makes an effort to reduce the deficit by forcing down health care costs.

On the last point, I’m not certain if that vector is sustainable

There are two things at battle in my mind for the top of my list of dislikes…

Obamacare fails in its coverage goal by providing health insurance to almost as many people it leaves behind. Then, short of meeting its coverage goal – a primary objective, mind you – Team Obama takes a revisionist’s perspective on claiming victory by touting other accomplishments like the inclusion of twenty-somethings on parents’ insurance plans, as well as the provision of insurance to people with pre-existing health conditions.

Cool stuff, but not necessarily the three main things Obama wanted to get done with reform.

Hell, even the administration’s decision to selectively market health insurance to three of the six identified segments of the uninsured (pdf) shows how Obamacare continues to leave some people behind without any apparent sign of regret.

A broader thought hit me — President Obama’s refusal to fight for a single-payer, national health care system has resulted in a series of whack-a-mole episodes to make his compromise cobbling of state Medicaid expansions, health exchanges and divisive policies work.

Some of you may not believe my charge.

Well, ask the unions.

Or the 21 state Governors, supported by the Supreme Court, who refuse to provide additional insurance coverage through Obamacare’s proposed Medicaid expansion, thus leaving behind millions of Americans living below the poverty line.

How about the health insurance exchanges initially acting as if millions of unbanked Americans do not exist?

Or the businesses who will not have worry about an employer mandate since the Obama administration delayed its implementation until 2015? That will likely push some of those uninsured employees to Medicaid or exchanges. In other words, the federal government will pick-up those health care costs through tax subsidies and straight payments. Almost sounds like a micro version of the dreaded public option…

And what about the insurance companies hilariously taking  backdoor advantage of President Obama’s “Keep your current insurance plan if you like it” pledge by exploiting a loophole in Obamacare, enabling them to cherry-pick and sequester young and healthy members of the insured? Premiums will NOT go down with this practice in the short term.

I won’t get into the federal government’s technical problems with implementing these insurance exchanges.

In fairness, the Party of No Brains attempted to starve Obamacare implementation of funding.

But whether the current implementation problems are driven by financial challenges, execution competence, or project risk and complexity, Obamacare’s rollout will likely not be smooth, and will subsequently present a credibility issue for the administration.

On the brighter side, most of these implementation problems can be corrected…

Okay, back to Obamacare’s policy layer…

Given President Obama’s small thoughts about single-payer advocates despite his stated desire for a similar future state, I wonder if smashing in a bill was more important to him than ever doing the right thing, let alone fighting for it.

Look, I get it. Single-payer would eventually disintermediate the health insurance companies and destroy a ton of shareholder value. This is why the insurance companies fought so hard against the public option.

But do you remember how “efficient” the current US free market for health insurance is…?

I’m all for Capitalism, but the US health care system is dysfunctional. Obama is intelligent enough to know that.

I can’t say this for other industries, but I’d love for a catalytic act to erase the present inefficiency and dysfunction in health care, even if it takes the form of a public option.

My next guess could be wrong, but short of some shocking, unilateral policy move on President Obama’s part at 11:59 pm on January 20, 2017, we shouldn’t count on him revisiting health care reform with an eye for a single-payer process.

His part is done. He’ll toss this project over his shoulder next year after the exchanges are up, the employer mandate is in place, and the mid-term elections are over.

Perhaps we’ll see change come from a future administration…

song currently stuck in my head: “harmuni” – tim exile


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