Throw stones at Obamacare, if you like. Its good intentions can't excuse false promises and sloppy implementation.
But if we're going to trumpet the bad, we might also weigh it against the good. Obamacare - whatever its faults and fallouts - will be a plus for millions of people. It should significantly reduce the number of folks for whom emergency treatment is the sum of all health care. Despite the many criticisms of health care reform - some warranted, some overblown, some invented - it will accomplish that.
A Gallup-Healthways Well-Being Index found that 15.6 percent of U.S. adults were uninsured in February, down from 17.1 percent during the last quarter of 2013. That drop translates to more than 3 million people gaining coverage.
It's too bad it's not more. Unless, of course, you're rooting for Obamacare to fail.
What does it mean to be uninsured? For a serious condition, it means access to health services will likely depend on the charity of providers, or their interpretations of the Emergency Medical Treatment & Active Labor Act (EMTALA) of 1986.
Under EMTALA, all Medicare-participating hospitals are required to ensure public access to emergency health services, regardless of ability to pay. They must also provide stabilizing treatment.
As systems go, EMTALA, signed into law by President Reagan, is preferable to denying critical care for our friends and neighbors ... or maybe, one day, you or me.
It also leaves much to be desired. An obvious drawback, from a patient's perspective, is that a health condition has to be an emergency before treatment is obligated. The number of deaths that can be linked to a lack of insurance in the U.S. has been widely debated. One study estimates it at 45,000 per year.
Even if the actual figure is none, it's fair and humane to ask if death should be the only measuring stick.
Health care is both an economic activity and a humanistic one. Worldwide, inevitably, there are conflicts between money and compassion. In the U.S., for tens and tens of millions, that conflict is settled by the question: How sick are you, really?
At its core, Obamacare is an attempt to make that painful question less prevalent. Great as the U.S. may be - impressive as our health facilities may be - we're nearly alone among developed nations in lacking universal health care. The majority of the uninsured are in low-income working families.
The American Hospital Association (AHA), which conducts an annual survey, says the cost of uncompensated care - a combination of unpaid bills and charity care - totaled $46 billion at U.S. hospitals in 2012. That expense, about 6 percent of all hospital costs, inevitably has to be shifted elsewhere.
Besides the uncompensated care, AHA reports, underpayments from Medicare and Medicaid totaled an additional $56 billion. With Medicare and Medicaid accounting for nearly 60 percent of care provided, the window of patients keeping facilities viable appears limited. The exact impact of unpaid and underpaid care on private insurance is hard to quantify. But let's allow that, just as there no "free" lunches, there are no "free" appendectomies.
From an economic standpoint, the Affordable Care Act could still be a success, curbing health care inflation, stabilizing the insurance market, and living up to its "affordable" billing. Or it may well be a disappointment, restricting access for patients already insured and driving premiums higher yet. If you already know the answer, I'll defer to your insight.
Meanwhile, the Institute of Medicine estimates the U.S. health care system in 2009 wasted about 30 cents of every dollar spent - $210 billion on unnecessary services; $130 billion on inefficiently delivered services; $105 billion on overpricing; $75 billion on fraud, $55 billion on missed prevention; and $190 billion on paperwork and unnecessary administrative costs.
No system is flawless, but understand that this is the health morass into which Obamacare is wading.
Drown reform at your own risk.
In Texas, Congressman Louie Gohmert has pledged to go without insurance, rather than accept an employer subsidy under Obamacare - a benefit that's similar to what Congress has enjoyed in the past. At age 60, Obamacare foe Gohmert apparently wants constituents to congratulate him for rolling the dice - their dice - on whether he has a health catastrophe.
I wish him no harm. I wish Obamacare no more stumbles.
Jim Anderson's email address is firstname.lastname@example.org.