What would I say about Obamacare, compared with the health care finance problems I identified, and solutions I proposed, in early 2008 before President Obama was elected? (You can read my entire series on health care in the MS word document attached to this post). I would say that legislation makes reform possible, but it is not reform in itself. As I noted at the time, U.S. healthcare is mostly government financed, directly or indirectly, but with complicated flows of public money under a wide variety of deals, the distribution that money is horribly inequitable. The tie between government health insurance subsidies, via a tax break, and a particular place of employment is bad for workers, entrepreneurs, and the economy. The U.S. healthcare system is extremely expensive, and delivers poor value. From the point of view of consumer protection, it engages in abuses that would not be tolerated in any other industry.
While Obamacare will reduce some of the inequities, it left the most of the complex and inequitable U.S. healthcare finance system in place, and punted much of the responsibility for further progress to the states. Which is not a good thing if you have a corrupt and poorly run state. The only reason New York will have a state health insurance exchange, as mandated by the Obamacare legislation, is that Governor Cuomo somehow was able to get around our parasitic legislature and create one by fiat. Yet there are many abuses that a state could get rid of, if it were not controlled by a legislature whose MO was to allow abuses in exchange for campaign contributions. In a major development, the federal government shined a light on one just last week. I’ll talk about it, and how a more “progressive” (the early 1900s version, not the self-interest group politics of so-called NY “progressives” today) state might respond, on Saying the Unsaid In New York.