Obamacare in perspective
Obamacare is the ugly bastard offspring of an unloving Congress, conceived amid a vicious cycle of domination and one-upmanship.
Obamacare’s gestation was hampered by Republican’s repeated attempts to abort it, without first denying that health care reform was needed or presenting an alternative for it. Since its chaotic birth, they’ve repeatedly tried smothering and starving it.
If Obamacare survives, it will be a godsend. Millions who are uninsured, underinsured, or have pre-existing health conditions will qualify for health-insurance subsidies. Millions of others will qualify for Medicaid.
Obamacare holds the possibility of beginning to do for our unconscionably expensive and underperforming health care system what President Lyndon B. Johnson’s “War on Poverty” was designed to do in 1964. The ammunition in that war was economic opportunities for low-income people.
At a health-care outpost of that war, I had a life-changing experience providing services in an essentially un-served area including Baldwin and Lake County, Michigan. After attending an information meeting and asking questions, I was invited to become the medical director. The CEO promptly left and, for nearly a year, I was interim director of the 125 employee health-care project. I was there almost two years.
The project had a full complement of professionals and ancillary personnel, including transportation services. After a year, the state health department asked me what had happened: our obstetrical and neonatal statistics had dramatically improved.
I said we merely provided services people wanted and needed. For instance, we provided prenatal care, in home as necessary, and arranged in-hospital delivery for pregnant women. We followed moms and babies, in home as needed, and had parenting support classes. Local outreach aides were the core of our services.
What began as a government health-care project more than forty years ago is now the thriving, non-profit Family Health Care Baldwin. The Head Start program at FiveCap, the original parent organization, is now a national leader. FiveCAP continues to provide decent housing for moderate and low income families and helps them achieve independence. The two are spectacular examples of a local success in the war on poverty.
Some say, since the national poverty level declined only 3%, the war was lost. It’s not that simple. In 1964, thirty-five percent of seniors lived in poverty. Nine percent do now. The infant mortality rate is lower now and there is less malnutrition, thanks to food stamps, unemployment insurance and earned income tax credits.
One lesson we learned is that complex social issues can’t be solved by top-down government programs. They are better addressed gradually, in small steps tailored to peoples’ immediate wants, needs and circumstances. That applies to Obamacare.
There is definitely a role for government, which can provide seed money, leadership and coordinate health-care reforms. There’s an important role for community organizations, like FiveCAP, which can put together local and regional public-private initiatives for health-care reform. And there is a crucial role for the private sector in developing ideas for innovation and efficiently providing goods and services.
Health care reform will take several decades. Obamacare can jump-start the process, but will have to be modified over and over again by local government-private sector experiments and initiatives, like collaborative health care clinics.
Beginning with Social Security in 1935, then Medicaid in 1965, Medicare in 1966, and the Medicare Drug Benefit in 2003, Obamacare is the final step in the process of providing everyone with health-care security and socioeconomic freedom.
Obamacare deserves nurturance by a Congress that values its constituents more than petty rivalries.
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