The Ship Has Sailed

ForwardLAKE MACBRIDE— All the people waiting for the Patient Protection and Affordable Care Act to collapse under its own weight had better find something else to do. Almost four years in, there’s no way to hop in the DeLorean, go back in time and undo the good the law has already done.

Don’t get me wrong. I expect to hear more laments and entreaties about how wrong it was for President Obama to do it, and that government is taking over health care, yada, yada, yada. Please people. Get a grip. We went through all of these arguments during the Clinton administration. When the Republican idea of filibustering health care reform to death the way Bob Dole did died, so did the idea of repealing Obamacare. If Republicans gained control of the presidency and both chambers of the legislature, how would the repeal even work three years from now? Could they go back in time and undo the mammograms already provided, the colon screenings performed, or take away the happiness people who didn’t have health insurance experienced when they got it? I suppose one Back to the Future reference is sufficient: they won’t be able to go back in time, and some form of the law is here to stay.

The ship has sailed for Obamacare, and by that I mean we are in a period of waiting to know how it will work out. The website is working. The reforms set in place are working. The number of enrollments is increasing. What seems most important about new enrollments is answering the question, what kind of medical treatment will people require? Even though part of the new fee structure includes a premium for excess insurance to cover a bad claims experience, if everyone who comes into a plan needs expensive treatment, it will skew the costs. How will that work out? We won’t know until insurance companies review the data and actuarial experience and set 2015 rates. So we wait. For the close of open enrollment on March 31, and to see the claims experience during 2014.

Josh Mitchell of Talking Points Memo has written that as enrollments increase above ten million people (not a typo, read the article), so does conservative rage. Chill dudes. Greg Sargent of the Washington Post has suggested there are three stages of Obamacare acceptance. Get with the program.

What seems clear to me is that once people get health insurance two things will happen. First, life will return to a semblance of normal, and people will discover that having health insurance is far from a perfect situation. Conservatives will be quick to point this out, although we all know this experience is logical and predictable. Secondly, Obamacare will become the paradigm, generating new struggles to reduce government costs for Medicare, Medicaid, nutrition and other programs, while at the same time attempting to do right by the American people. We’re moving forward in the incredible storm and stress that is living in this country.

If you don’t like it, either move into a yurt, or contribute something positive to the discussion, one our country has been having since Harry Truman was president. A discussion that is likely to continue for the foreseeable future.

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