Keeping score on health care 

Republicans see another electoral windfall thanks to the messaging opportunity from the disastrous beginning of full implementation of the Patient Protection and Affordable Care Act.

It's a simple message. Obamacare is all about losers. Somebody's insurance cost more. Somebody's current insurance policy has been cancelled. Somebody is paying for coverage they don't need.

It's effective. And when it's delivered by a cancer patient forced to change doctors, devastating at first glance. The afflicted state of the health exchange website and President Obama's unqualified promise about the ability to retain existing health coverage provide many more 30-second ad possibilities.

There's a simple counter-message, if it seems cold to say. There are millions more winners than losers.

Thanks to Obamacare, millions of people are guaranteed insurance coverage despite pre-existing health conditions. Millions of people with unemployed children can continue to put kids on parents' insurance. Millions of seniors have been relieved of a gap in pharmaceutical coverage. Millions of working poor get insurance for the first time with government help. Millions benefit from better insurance coverage.

Irony abounds. Republican Rep. John Burris has Tweeted repeatedly about the sad tales of canceled insurance. I asked him if a bigger story isn't the overall benefit, regrettable as screw-ups are.

Burris responded that those who supported the law wanted to talk about winners and those who didn't wanted to talk about losers. So what do you make of Burris? He was one of the architects of the legislative plan to implement Obamacare's Medicaid expansion here, a direct benefit to 250,000 Arkies. Now you'd think he wants his own plan to fail.

About the canceled policies: They constitute a tiny portion of the population. As many have reported, about 80 percent of Americans are covered already at work or through government plans. That leaves 20 percent. But 14 percent have no insurance (though they soon will, thanks to Obamacare.) That leaves 6 percent with the chance of losing current insurance, though guaranteed to get more comprehensive insurance, if at higher cost. Many of them are going to be thrown off plans that barely qualify as insurance (no hospitalization coverage, for example). But assume the worst for all of them. Isn't the won/loss ratio still 94-6? The problem, of course, is that 6 percent amounts to millions of people, a large and living tally of unhappiness.

MIT's Jonathan Gruber, who oversaw Romneycare in Massachusetts, told the New Yorker that he estimated about 3 percent of the public would be losers — losing insurance plans sufficient for their needs and forced into another policy that costs more.

"We have to as a society be able to accept that," he told the New Yorker. "Don't get me wrong, that's a shame, but no law in the history of America makes everyone better off."

There was a time, I think, that you could have sold universal health care as a good thing, the American ideal, as much as public education, national defense and a national interstate system, though some would pay higher costs than others. There was a time, too, when we were known for problem solving.

But I don't see a belief in shared purpose today. Far more in evidence are people taking delight in misfortune and intent on creating obstacles rather than solutions. Math tells me that when we share the risks (child birth, breast cancer, prostate cancer) and share the costs (taxes, mandates, curbs on spending), we all gain. But for too many others, it's every man for himself.

There's some additional irony in the political identity of that president who gave that famous house divided speech.


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