Friday, September 27, 2013

Four Days

In just four days from now--Tuesday, October 1--health care armageddon will descend upon America, if one accepts the predictions of Obamacare's opponents.  The start of the six month open enrollment period for qualified health plans offered through the ACA's state health insurance marketplaces will lead to the end of the patient-physician relationship, death panels, rationing, socialism, bankruptcy and the total destruction of personal liberty, or so they say.

Or, in just four days from now, on Tuesday, October 1, tens of millions of Americans who can't find coverage will finally be able to buy affordable health insurance, creating a health care nirvana where no one will go bankrupt because of their health, where everyone will have a doctor, where outcomes will be better, and where costs will be lower, or so say the ACA's supporters. 

Also, in just four days from now, on Tuesday, October 1, the federal government will shut down because Congress and the President were unable to agree on a bill to keep it funded.  The Centers for Disease Prevention will immediately stop its disease surveillance programs, the NIH will stop enrolling patients in clinical trials, federal employees (including those in uniform) won't be paid, parks will close, people won't be able to sign up for Social Security and Medicare Part B (although the checks will still flow to those already enrolled), and medical care for veterans may be disrupted.  (You can read the technical, gory details of which programs would shut down in this Congressional Research Service report. The Washington Post also has a good explanation of what the shutdown would mean for government services). But, even though the fight over funding the federal government is mostly over Republican's efforts to defund Obamacare as a condition of passing a spending bill, one government program that won't be shut down is the health care marketplaces created by the ACA that go live on Tuesday!  That's because the ACA is mostly funded by what are called "mandatory" federal dollars that are outside of the "discretionary" dollars subject to the disputed spending bill. 

Or, somehow an agreement will be reached over the next four days that will fund the federal government past September 30, perhaps only for another few weeks.  One thing that I can say with confidence is that such a bill will not include language to defund Obamacare, no way, no how will President Obama or the Democratically-controlled Senate agree to it.  (Most other independent experts agree with me.)

So either way--a government shutdown or agreement is forged to keep the government funded--Obamacare's marketplaces will go live four days from now.

As they should.  It is time to move on from the talking points about what Obamacare might do to allowing people to actually see what coverage is  available to them from the marketplaces, and decide for themselves it if is a good deal for them and the country.  Although there is much that we don't know and can't know until the marketplaces start up and people start enrolling over the next six months, I am sure of two things.  It will not result in the healthcare Armageddon that is the fancy of Obamacare's critics.  (You don't need to take my word for it, the Pulitizer prize winning independent and nonpartisan found that much of what the critics say about it just simply is untrue-- it is not socialized medicine or a government take-over, it won't lead to rationing or death panels, it won't take away your doctor, and it doesn't put the IRS in charge of your health.  But it also won't result in a healthcare Nirvana--yes, millions more people will get coverage and far fewer will go bankrupt because of health care expenses, and outcomes will be better as a result, but there will still be substantial financial and other barriers to care, we still won't have enough primary care doctors, we will still spend too much on paperwork and insurance company profits and overhead, and we don't yet know what the ACA's impact on cost ultimately will be, even though current trends (lowest cost increases in fifty years) are encouraging.

But if Obamacare ends up extending health insurance coverage to nearly all Americans, that in itself will be a very good--even historic--achievement for this country and its residents.  And it all begins in four days, even if much of the rest of the government shuts down over the certain-to-fail effort to defund Obamacare.

Today's questions: Are you ready for the roll out of the ACA's marketplaces on Tuesday?  And what do you think of the brinkmanship of shutting down the government over Obamacare?

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