By Andrew D. Coates, M.D., F.A.C.P.

WAMC Northeast Public Radio, Nov. 22, 2013



The Republican Party projects a perpetual political war against Obamacare. The talking points include things like “Because of Obamacare, I Lost My Insurance,” “Obamacare Increases Health Care Costs,” and that old chestnut, “You can’t trust the government.”



Progressive Democrats, in response, have called for a defense of the president and the changes the Affordable Care Act will bring. If the president’s health care law is not defended, the editors of The Nation magazine write, the result will be “a crisis not just for healthcare in America but for the notion that government can and should repair the breaches that threaten civil and humane society.”



Within this mainstream debate both sides agree about the stakes – the legitimacy of the government. Yet beneath the narrow terms of the debate, there is an undertow of irony. For all of the Sturm und Drang, neither side proposes fundamental change. But by placing health care at center stage, the real question of the nation’s health can’t be avoided, in spite of efforts to focus and spin the debate.



One side says that without the Affordable Care Act we would have the best of all possible worlds. The other side says that although it may be “flawed,” the Affordable Care Act puts us on a path to the best of all possible worlds.



Yet in focusing the debate narrowly upon getting or keeping private health insurance, the whole process loses credibility. Instead of one side embarrassing the other side, each side in this debate embarrasses itself.



That is because getting private health insurance is not the same as getting health care. Those us working in hospitals and clinics and nursing homes, as well as those of us who are patients have to ask ourselves, “What are they talking about?”



To mobilize opposition to Obamacare, congressional Republicans plan to seek out stories from their constituents about the ongoing problems with the health system. To mobilize support, Democratic loyalists vow to help get more people to sign up for private health insurance available through the Affordable Care Act.



Any real attention to what this means for patients and their families will highlight the fact that private health insurance has progressively become an unaffordable, defective product. To make premiums “affordable,” co-insurance fees, co-payments and high deductibles have become standard issue. Any serious illness threatens bankruptcy upon our families, even when we have private health insurance.



When it comes to getting care, in spite of being the wealthiest nation, in spite of spending more than twice as much per person on health care, the United States lags behind all developed nations in health indicators. We have shocking problems – mediocre and poor health outcomes, unjustifiable disparities, communities that are woefully underserved, with a great burden avoidable illnesses and even outright harm to patients.



Private health insurance is what got us into this mess. Private health insurance won’t get us out of it.



Most ironically of all, perhaps those who see attacking or defending the president’s health care law bound up with the legitimacy of the government will turn out to be right. Can we call a nation a modern democracy it if fails to meet the health needs of its population?



Dr. Andrew Coates practices internal medicine in Upstate New York. He is president of Physicians for a National Health Program.



You can listen to Dr. Coates’ radio broadcast here: http://wamc.org/post/coates-private-health-insurance-got-us-mess

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