Using Obamacare

My current job does not offer health insurance. Additionally, when I started working there my wife was, as they say, "between positions." So without the recently-implemented Affordable Care Act (Obamacare), we would not have been able to have had health insurance. As a political observer, I had already been pretty excited about the new government provision to supply insurance to everyone, as liberals had been implement this policy since the New Deal. But that had been somewhat abstract and I had not really been thinking of the program as something that I wold need personally. But I did: if Obamacare had not gone into effect, I would not have been able to leave my life of office-work drudgery in order to return to teaching. The politics of the Affordable Care Act became personal to me in a way that they had not been before.

But my initial enthusiasm gave way to a fairly negative experience of actually using Obamacare. Even with the substantial discount we received from the government, the policies were very expensive. It was important to my wife to continue seeing the same doctor, so we looked up the plan before enrolling to make sure he was on it. Finding that the doctor was only listed on the more expensive "silver" plan, we purchased that one in order to continue seeing him. Once the policy was in place, however, my wife called to make an appointment and was told that her doctor's office does not accept the plan we had selected. So were stuck with not only being unable to see her doctor, but also with paying a much higher higher premium in order to do so.

Eventually, my wife got a job and we were able to get health insurance through her employer. That is where our worst experience with the Affordable Care Act began. I called the Health Insurance Exchange—the federal agency that serves as a middleman between the customers and the insurance companies—three different times to cancel the policy. Each time I was told that everything had been settled, and each time I later received a bill. I continually checked my account online, and never found any evidence that the policy had been cancelled.

I was repeatedly given contradictory information. On my most recent call to the Exchange, the representative told me that the policy could be cancelled as of the end of the current month, but I would have to pay for the two prior months that I had never wanted. At that point, I asked to talk to a manger, who was able to find a note made from one of my previous calls. It said that my policy was supposed to have been cancelled two months previously. But, I was told, there was no automatic mechanism to get that information to the insurance company, so I would have to call them myself to give them my case number. Upon making contact with them, the insurance company's representative (also, eventually, a manager) told me that he had no idea what to do with that case number, and the company would be happy to cancel the policy when they received the automatic upload of information from the Exchange. To the best of my knowledge, we are still being billed for the policy that I cancelled two months ago.

I was put in mind of these experiences when I heard Terry Gross’s Fresh Air interview with Steven Brill. Brill is a journalist who writes about medical issues: he wrote a Time magazine cover story a little while ago in which he detailed several hospital bills in order to raise awareness of the exorbitant charges that are driving the cost of health care.

Brill has recently written a book called America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight to Fix Our Broken Health Care System. In the radio interview, he argued that Obamacare as currently constructed is doomed to fail because it does nothing to address the central problem with health care: its expense. Unlike conservatives who decry the plan’s alleged squeezing out of market mechanisms or liberals who argue that it is a big giveaway to insurance companies, Brill thinks that the fundamental problem is that big hospitals and pharmaceutical corporations simply charge too much for what they do. In trying to provide universal access to a good that is priced far too high, he argues, Obamacare is simply “unsustainable.” In his view, “we cannot continue to be a country where health care prices are 40, 50, 60 percent higher than they are in every other country where the health care results are as good or better than ours.”

Brill also argued that the administration of the program has been very poorly managed, a point that spoke powerfully to me after my own experience with the Affordable Care Act. “We can agree or disagree with the president on his policies, on his goals, on his aims,” Brill said, “but there [has] never been a group of people [to] more incompetently launch something.” He blames this on the president being sheltered from negative information, and I have no doubt that his book (which I have not read) documents this claim in detail.

Perhaps most important, however, is Brill's claim that the administrative problems with Obamacare allow the opponents of universal health care to plausibly discredit “the whole notion that government could actually run a program." The fact that the Affordable Care Act can pose nightmarish problems for those who might go without coverage, face unfair financial burdens, and endure endless hours on the telephone is a real issue. Obamacare is simply not working in some crucial ways. Progressives who ignore or minimize these issues—such as Paul Krugman, whose characterizations of specific problems as “fixed” and “solved” are narrowly accurate but come across as triumphant to the point of being misleading—run the risk of dismissing the experiences of those whose dissatisfactions with the program are quite legitimate. For Obamacare to meet its promise, those voices much be heard and their problems addressed.