Obamacare I: A Brit’s Eye View

April 18, 2014
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Above: View of the healthcare.gov website in Caldwell, Idaho on December 6, 2013. Image by txking / Shutterstock.com.

In a brand new series of articles looking at the Affordable Care Act, Henry Vespa dives into the controversial waters of Obamacare. He begins by paddling in the shallow end…

Okay, before I begin, I’m going to have to own up to a little bias and ignorance on this topic. First, I’m a Brit and when it comes to healthcare, I grew up with the NHS (the National Health Service), a publicly funded, state-run health service open to everybody regardless of income, class, etc. It ain’t great a lot of the time, we moan about it a lot, and the current UK government seems determined to grind it into the dirt. But… it’s left me with a basic value that people are entitled to healthcare – I don’t see it as a service, I see it as a right. Compared to the States, this probably sounds like pretty socialist thinking.


That’s the bias; the ignorance is simply that until I came to write this article, I hadn’t paid much attention to Obamacare. I knew the term, I was vaguely aware that it was about giving more people access to healthcare (good, I thought) and that the right-wingers didn’t like it so much (big surprise, I thought). But a little research goes a long way, and with constitutional challenges, panicky talk of ‘Death Panels’ (refusing healthcare to the old and infirm), state-sponsored contraception, and the basic premise of sign-up-for-a-health-plan-or-else… it all turned out to be far more complicated and interesting (and certainly less black and white) than I expected.

So, join me on a partisan Brit’s trip through the story so far of Obamacare…

First, a little context: by and large, US healthcare is privately owned, privately run and is funded either by individuals or by their employers (as part of the employee benefits package). In other words, you get sick, you better have some health insurance otherwise it could cost you an arm and leg (one way or the other). Now, in the spirit of public welfare, there is some government funding that ensures access for ‘needy’ segments of the population; namely Medicare for the elderly and Medicaid for those on low incomes but by and large it’s about being covered. The quality of service varies but it always has a price tag and if your insurance doesn’t cover it, well, that’s that. Very different to the NHS where the principle is still largely healthcare for those that need it (although we have our own restrictive reforms in motion, so I won’t be getting too smug about that).


Anyway, in the US, healthcare tends to be measured on the macro-scale by how many people have health cover. That’s the metric, and the big driver for Obamacare (more formally known as the Patient Protection and Affordable Care Act or PPACA) was the almost 50 million or so Americans with no health cover whatsoever (US Census Bureau, 2009).

The PPACA is meant to drive up the level of insured Americans by, wait for it, making it illegal not to have health insurance. That’s right, at its heart, Obamacare says, pay for health cover or your government will fine you. Maybe if you’re American there’s a logic to that, but in large parts of the rest of the world (and certainly to me) the reaction is, “Huh”?” Put bluntly like that, it just sounds like another restriction of freedom of choice; in this case, the choice to take your chances and hope you don’t get ill or need medical attention.


Now, of course, there is more to it than that: government subsidies to help make it all more affordable; laying some responsibility on employers, making any business with more than 50 employees offer health cover; and online policy marketplaces have been set up to help people shop for the best deal (more on that disaster later). Finally, the PPACA prevents insurance companies from denying cover to people with pre-existing conditions.

But I guess, as an ignorant Brit, that first impression was one of shock that a controversial healthcare reform bill – the biggest of its kind since the 1960s – boils down to an instruction to buy something. If that isn’t a purely capitalist solution, what is?

To be continued…

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