Since there’s a reasonable chance Obamacare will be piled on the ash heap of discarded policy, it’s worth noting the good and the bad. It did two critical things. First, for people with pre-existing conditions, the ACA made it possible for them to get healthcare insurance at a reasonable (or any) price. This was hurting even upper-middle and gentry class families. Second, as a preventive measure against catastrophic healthcare costs, it was effective–it prevented people from having tens of thousands of dollars of medical debt. Again, even upper-middle class and gentry class families have a hard time getting out from under that level of debt.
But as Democrats in Massachusetts noted from the get-go, lower-middle class and middle class families were screwed by Romneycare. Families were being asked to pay thosuands of dollars just to then be allowed to pay thousands more for co-pay and deductibles. This is money these families didn’t have. In Massachusetts in 2015–one of the wealthiest states in the U.S.–one third of households said they did not receive medical treatment because they couldn’t afford it. And Massachusetts isn’t one of the asshole states refusing the Medicare expansion.
One out of three.
Which brings us to this tweetstorm from a doctor in rural Texas. He notes (I’ve cleaned up punctuation etc. for clarity; boldface mine):
Obamacare had kicked in. but I kept seeing [people] coming in far too late, refusing followup care, etc. Why? They had insurance! Obamacare meant that they’d be spared from truly financially disastrous illnesses like cancer. So what was the deal?
Talk to guy [with family] history of esophageal cancer. Guy has severe acid reflux. Recommend endoscopy. He refuses. Why? See his deductible: $5000!
…Answer is obvious: [he] can’t afford [it]. [The] cost just of scoping to diagnose problem: ~$1500. Biopsy, $100. Add a $100 specialist followup, and you still haven’t even touched treatment….
The effect was to transform healthcare from totally unaffordable to totally unaffordable. Most [people] still had impossible barriers to care…
In medical treatment, there’s a ~guideline of the simpler the better. One pill a day, OK. Two pills, not good. Three pills, too difficult. Every single extra step a patient has to take reduces the odds that a patient will/can be treated properly. It’s a big deal.
All this wonk bullshit in Obamacare? I’ve seen grown adults cry [because] they can’t figure out wtf is going on [with] their care. It’s a nightmare. If me, the doc, the nurse, a social worker, the patient, and the insurance [company] can’t figure out what’s going on, maybe your bill sucks. If you need a team of economists, Vox, and two hundred men wearing lanyards to explain how you’re helping the poor, maybe you aren’t….
For the poor, in the case of Obamacare the test came when they went to the doctor for the first time and it was still hellish and unaffordable. Oh, and I can’t tell you whatever happened to the reflux + family history of esophageal cancer guy. Because he never came back.
Yet when Democratic surrogates such as Paul Krugman repeated over and over how amazing Obamacare was–in contradiction to the lived experiences of many Americans–this oddly didn’t rally people.
That doesn’t mean repeal of the ACA won’t be a disaster–it will. But, as we often say on this blog, people have to like this crap–and there were many lower-middle and middle class families who needed better and didn’t like this at all.
If the Democrats ever manage to regain power, they’ll have an opportunity–and the need–to remake healthcare. If they do, please don’t fuck it up again. Make it a system that works.