A Millennial’s Take on Obamacare
I signed up. But long term, is it worth the cost?
In my early 20s I lived and worked in Scotland and Canada. I was enrolled in their single-payer government health care systems, as are all legal citizens of those countries. I only accessed health care three times during my three years abroad. Each time was a test for sexually transmitted infections. Once I spent the better part of a day at a clinic because of the wait. But I was never charged a dime. (By the way, all results were negative, ladies.)
Like most young people, I’m prone to feeling invincible. In November my illusions were shattered in a clandestine boiler room in small-town Oregon. My foot got caught on a piece of upturned metal that briefly kept my leg from joining the rest of my body down an incline that functioned as a slide. A sports medicine professional diagnosed it as a torn ACL and recommended an MRI. The only problem is that I don’t have the money for an MRI and possible knee surgery.
I’m rich, just not in the money or property sense of the word. My credit union account doesn’t accurately reflect the value of my life’s work. I have a wealth of knowledge and experience. [Insert fancy way of saying I’m low-income.] I moved back to Milwaukee the day after I hurt my knee, though not because I hurt my knee. Then I made the classic millennial move and shacked up with my parents while seeking employment.
My resume is mostly videography jobs (my first degree). I’ve been able to land full-time and freelance gigs, but never with health insurance. Lately I’ve been freelancing as a journalist (my second degree), which doesn’t amount to a living wage, let alone enough for health care coverage. I don’t mind being poor because I love my work. But when I turned 27 and got kicked off my mom’s state health care plan my poverty became an issue.
Enter the Affordable Care Act, the most toxic political issue since the move to ban blowjobs in the White House. Before learning I was eligible for a subsidy I was resigned to my fate of settling down, giving up my freelance lifestyle and getting a “real job,” aka one with health insurance. It was only after dialing up the Marketplace Call Center and chatting with an exuberant young lady that I realized I qualified for a rebate. (I’ve never done my own taxes, so sue me!)
The Affordable Care Act was relentlessly advertised to millennials like myself, including an appearance by President Barack Obama on the brilliant but obscure web series “Between Two Ferns with Zach Galifianakis.” This makes sense as millennials are disproportionately uninsured. We’re also healthier by comparison, so our costs are generally lower than those of our elders. Under the Affordable Care Act, 18 to 40 year olds are basically subsidizing care for 40 to 65 year olds (who are not yet on Medicaid) and people with chronic conditions. The risk is pooled and resources are slightly redistributed. That modest bit of redistribution is what inspired opponents of the bill to label it “socialist.” This ideological divide is tugging at the soul of America.
The dominant American train of thought (which would no doubt prefer a gas-guzzling, private automobile analogy, maybe a “flatbed truck” of thought) sees this as the land of pure liberty, where an individual can make his fortune and keep every last penny, free from taxation. This way of thinking worships unregulated capitalism and secretly believes Leonardo DiCaprio’s character in The Wolf of Wall Street is a hero. This way of thinking is mostly found in the suburbs and rural areas, though it is peppered throughout the cities. And this way of thinking doesn’t care if poor people without health insurance get sick and die.
The other American train of thought fits this phrase and doesn’t mind riding a train, bus or even commuting via bicycle. This way of thinking sees America as a manic, multicultural, melting pot that won’t function unless we work together. While this way of thinking is usually not excited about paying taxes, it is aware of their purpose. These folks believe the market can’t be trusted to handle certain sectors of society, like prisons, schools, libraries and the fire department, and believe access to health care should be a right.
And this divide is why the Affordable Care Act has generated so much heated debate.
Don’t get me wrong, the Affordable Care Act is not a perfect program. Not even close. It relies on the same system; the same health insurance companies, the same pharmaceutical companies, the same hospitals and clinics. Still, it’s an important ideological shift. It’s setting a precedent. It’s a step in the right direction. Ten years down the road we will see that single-payer is the next logical step, or so hopes my friend John Weissert, a research associate at the Laboratory for Public Health Informatics and Genomics at the UW-Milwaukee’s Zilber School of Public Health. I asked him to explain how the program would work. These questions and his answers capture our conversation.
Who gains the most from the Affordable Care Act?
For people that are lower income it’s a better deal because they get a federal rebate. But for somebody who makes middle income, say you make $35,000 a year or above and your employer doesn’t provide insurance, maybe you work at a small business or you’re freelance and make over $35K, you’re basically being taxed.
What’s your take on Gov. Walker’s decision to reject the Medicaid expansion?
It’s an unfunded federal mandate. I think Medicaid should be expanded, but the problem is that they wanted all the good things about expanding Medicaid, that is the political coverage and providing more people with health care, but they didn’t want to spend the money to do it because it’s politically unpalatable.
How can we pay for it?
The biggest thing is to start taxing pharmaceuticals more. They got away scot-free in the Affordable Care Act. We just need to raise revenues. I’m a progressive, so I think there should be a progressive income tax, reinstate the estate tax, normalize the corporate tax, close corporate loopholes, that could generate a couple hundred million dollars. We could cut defense spending, you know, any one of a laundry list of progressive ideas to get more revenue for health care.
The other thing that nobody is really talking about is that there is no funding for additional medical residencies. We’re adding all these patients to the system, right? But there’s already a predicted shortfall by 2020 of 74,000 physicians, many primary care physicians. You can expand medical schools all you want, but if you don’t have residencies for those medical students, they’ve got nowhere to train. We’ve already completely filled up every single available residency in every possible spot, as of two years ago. And there’s no additional money in the Affordable Care Act to expand residencies. It’s a huge issue.
Okay, there’s a bunch of specific problems with this bill, but it’s still an improvement, right?
This is how American policy changes. It generally builds off previous policies and previous systems. Our tax code is an excellent example of that. We have one root system, and then we continue to layer it. The Affordable Care Act is not a revolution in the system. The Marketplace is the big idea. The government establishes a Marketplace that allows the current resources to function more efficiently, to provide more for various people. But it’s not a change in the system at all.
How does a single-payer system work?
Well, they administer less care. That’s the dirty truth. I was just talking with my aunt about this, she lives in France. She pays one Euro everytime she goes to the doctor. My uncle has MS, which is a chronic condition, and he doesn’t pay anything. That’s an incredible system. Here in the states, so many people go bankrupt when they get a chronic condition, or they don’t get treatment. It happens all the time. But another example within the same family is my cousin, who hurt her wrist. It was not really urgent, but it was giving her a lot of pain, and it was a six-month wait to see an orthopedic surgeon. So it’s a way of rationing care.
It’s the same thing for the elderly. They get very good chronic care, but if they need to have a stent put in or if they need some kind of dramatic surgery that could extend their life, maybe only by six-months, it’s non-existent. It’s the same for pharmaceuticals. In France, they have a government board established to determine which pharmaceuticals are worthy of getting payment and which pharmaceuticals should be free.
And we don’t have anything like that?
Can you imagine that?! It would be totally, politically unviable.
What does the FDA do then?
The FDA determines safety.
Whenever I watch late-night cable TV it seems like nothing but commercials for non-FDA approved drugs or commercials for a lawsuit against non-FDA approved drugs.
I know, it’s absurd. It’s basically a huge underground market. It’s so unregulated, there could be dog shit in there.
During the last week of open enrollment in the Marketplace I overheard some people wondering whether it would be cheaper to pay the fee than actually sign up for health care.
That’s bonehead thinking. Just look at the price tag. You think a new computer is expensive, that’s like one CT scan. One night in the hospital can be $10,000, depending on how many tests they run. It won’t even come with breakfast in the morning sometimes…
Which closed our conversation, dear readers, and brings us back to my situation. When my new insurance plan came in the mail, the outside of the envelope read “Generic drugs work just as well and can save you $$.” In your face, billion dollar drug industry! No wonder my local coffee shop has flyers for a Greenfield-based business called “Canada Drug Service.”
Opponents of the Affordable Care Act have nicknamed it “Obamacare” in an effort to channel hatred for our President against the legislation, which makes me want to reject the use of the nickname. However, the bill does epitomize Obama’s Presidency. He has not ushered in any fundamental changes, but the program is an improvement on the status quo.
If you were uninsured and signed up for health care during the grand opening of the Marketplace, I think it was a wise decision. If not, you’ll have to pay a fee next Tax Day, which will help make health care more affordable for more people. If you haven’t already, you should probably pay for that sweet relief of knowing you’ll be covered if anything happens. It might not be free, but it’s a kind of freedom. It’s an expression of liberty to be able to pursue your passion without fear of bankruptcy. Dare I say, it’s downright American.