Kokomo Tribune; Kokomo, Indiana

June 26, 2013

MARK HEINIG: Affordable Care Act: Imperfect, inevitable

Conservatives, liberals must implement it

Kokomo Tribune

---- — We’re nearly half-way through 2013. It’s time to start looking ahead to 2014, and hope we fare better in the coming year than we have so far in the present one.

Unfortunately, the outlook for 2014 isn’t as promising as we might wish. Our economic and employment prospects seem to be improving, but what about the Patient Protection and Affordable Health Care Act of 2010, usually referred to as the Affordable Care Act or Obamacare? Isn’t it supposed to go into effect in 2014? That’s the plan, but such huge undertakings rarely happen as planned. It’s destined to become the most controversial domestic issue of 2014 and probably for many years thereafter!

Obamacare has survived one Supreme Court challenge, and another one probably wouldn’t be more successful. The court is very cautious about reversing its rulings. Congress isn’t likely to repeal the law. Its opponents don’t have the necessary votes. They may never have them. The longer a piece of social welfare legislation remains in effect, the harder it is to repeal. It morphs from a law to an entitlement to a right with amazing speed.

None of that renders the critics of the act powerless, but they need a different strategy. Instead of trying to kill something that just won’t die, they should be trying to change it in ways they like more or dislike less.

The full impact of the act will emerge slowly. In its current form, I think many of us find it intimidating. We may have to make life-altering choices about things we don’t understand. I don’t understand much of it myself, and I used to be a licensed insurance agent. However, I do understand how important it is for both conservatives and liberals to play a role in implementing it.

Surprisingly, the first modern political leader to introduce national health insurance was an archconservative. Otto von Bismarck, Germany’s “Iron Chancellor,” did it in 1883. He also introduced compulsory accident insurance in 1884 and old age pensions in 1889. Bismarck was no friend of the common folk, but he realized these concessions would relieve their discontent without weakening the monarchy. What he really wanted to ensure was the continued prosperity and power of Germany’s ruling class. Nevertheless, his reforms served as the original model for the modern welfare state many nations later followed.

Other leaders, both conservative and liberal, have subsequently brought universal health care to their countries. When the Affordable Care Act passed, the U.S. became the last developed nation to do so, according to World Health Organization data. On this issue, I prefer the terms conservative and liberal to Republican and Democrat. They have similar meanings in many countries, and they are less tainted by the emotions and the bias of partisan politics.

We’re headed for a long period of trial and error in universal health care. We need to discover what works for us and what doesn’t. Ultimately, we must create a plan that meets our unique needs. However, the experience of other nations can help us. Part of what worked for them may also work for us. Part, but not all!

Some type of universal health care seems inevitable, because we can’t say no. Medical research, new pharmaceuticals and improved treatments will always be possible, but they will always be tremendously expensive, too. I’m alive today because I had coronary bypass surgery 20 years ago. It cost nearly $30,000 then. Today, it probably costs much more but has less risk. Other things cost a lot, too, but we have more alternatives.

Gasoline is nearly $4 a gallon, but most of us can drive less. We can carpool, use more public transportation and purchase smaller cars that consume less fuel. There was a time when I bought a new car as soon as I paid off my old one. Now, I drive my car until the repairs cost me as much as buying a new one. I can say no to a new car, but how could I say no to a heart transplant if I would die without it?

The best way to make health care affordable is to share the cost with as many people as possible. Every kind of insurance involves sharing the risk and sharing the cost. Universal health care will never be perfect, but what is?

Mark Heinig Jr. of Kokomo is a retired Indiana principal and teacher. Contact him at markjr1708@gmail.com.