The rush to sign up for health insurance under the Affordable Care Act shows that, despite all the computer glitches and hyperventilating by politically motivated critics, millions of Americans saw it was in their interest to make use of the avenue to health care provided by the government.
Vermont exceeded its goal. The federal target for Vermont was an enrollment of 56,000. As of deadline on Monday, 46,800 individuals had enrolled, and an additional 30,000 to 40,000 had enrolled through their employers. Nationally, the surge of sign-ups over the weekend brought the number to 7 million, which had been the goal before website problems caused federal officials to lower expectations.
Not everyone was happy about enrolling. Some, no doubt, enrolled in order to avoid paying a penalty. Some felt coerced into abandoning their private policies in favor of the choices offered by state and federal websites.
There is a reason for coercion. Public health care coverage is workable only if the public participates, and participation means not only receiving benefits but chipping in to pay for everyone’s care. The penalty is a message that you will have to chip in whether you want to or not. It is really a form of tax.
Another form of coercion comes in the standards the government has set for insurance policies. Much as the government regulates medicines — prohibiting quack medicines that do no good — the government decided it was in the public interest to disallow insurance policies that do no good. These are the high-deductible plans that individuals have turned to because they are the only affordable option. In fact, high deductibles generally mean that the policy does the policyholder no good except in the event of catastrophe. People with this sort of policy have faced higher premiums because their new policies cover much more than their previous policies did.
Health care will now be affordable to millions of people because the government is subsidizing coverage on the basis of a person’s income. Conservatives believe that, as a matter of principle, it is better to refrain from helping low-income people obtain health care, even if they have no way to obtain it on their own. They are blind to the fact that health care is beyond the means of millions of people, not through any fault of their own but because the only pathway to coverage under the present system is through an employer. For millions of people, employers don’t even pay enough to live on, much less provide health care coverage.
The fiasco of the state and national websites, including Vermont’s, points to political and practical difficulties, not to an inherent flaw in the idea of government-sponsored health care. Work on the websites was delayed because of political and legal challenges to the Affordable Care Act, and the companies building the websites relied on inexperienced personnel. Government personnel also suffered from inexperience. These shortcomings have been documented.
But personnel at the state and federal levels are gaining experience, and through a variety of improvisations and delayed deadlines, the systems are taking shape. Some states have been more successful than others. Connecticut and Kentucky have been held up as models of success. Oregon has been a disaster. Vermont is doing OK.
What’s important to remember is that the whole process is about bringing medical attention to people who have never had good care before. They have not had it because the system was designed to deny it to them. Some of them aren’t even used to the idea that they deserve to have care. It will take time for people to learn that getting healthy is possible for them.
Just as an educated populace makes the nation stronger, a healthier populace, in addition to allowing the lives of millions of individuals to flourish, makes the nation stronger and more productive. There is still a ways to go. Vermont is intent on taking the next step — away from an insurance-based system and toward a single-payer, government-sponsored system. It would be a pioneering step, and state officials are still in a learning mode. Let us hope they keep at it.
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