Has ObamaCare Improved Your Health

Will Obamacare become Obamascare? - The healthcare reform in the USA [1]

by Eckardt Johanning

Initially praised worldwide as a socio-political achievement, the US President Barack Obama's health reform is turning more and more into a debacle. Not only political opponents, but also many citizens reject the reform called “Obamacare”. Eckardt Johanning reports on the current mood in the USA.

The other day I was in Brainerd, in northern Minnesota, not far from the Canadian border for work. In the bathroom, I heard an older man coughing and wheezing so hard that I thought he needed my medical attention. I asked him if he wasn't taking any medication for his bronchitis. Then he told me in a short breath that he had no health insurance and was waiting for the new "Obama insurance". Until then, he must try to survive as best he can - he cannot afford regular health insurance. If the man lived just a few miles north in Canada, he would not have this problem.

Compulsory insurance for everyone

The "Obama insurance" is part of the most significant health care reform in the US since the introduction of the state programs "Medicare" and "Medicaid" (see box on the next page) in the 1960s. The law signed by US President Barack Obama, “The Patient Protection and Affordable Care Act” (PPACA), or “Affordable Care Act” (ACA) or Obamacare, came into force in 2010. It comprises a large number of regulations that are being implemented in stages.

In essence, the law stipulates that everyone who has not or only insufficiently insured must take out private health insurance. The deadline for taking out such insurance expired at the end of March 2014. If you missed the appointment or refuse to take out insurance, you will have to pay a fine with your next tax return. The next date for enrollment in an insurance company is planned for autumn 2014.

Obama declared it as a success of his administration that by the cut-off date, April 1, 2014, out of around 50 million uninsured people in the US, 7.1 million had taken out insurance. For this purpose, so-called health exchanges had been set up on the Internet, provider platforms on which citizens could choose from the various offers of private health insurers and process the contract - which did not go smoothly due to technical problems and opponents of the reform were visibly pleased. According to estimates by the Congressional Budget Office (CBO), the non-partisan research institution of the US Congress, the number of insured persons is expected to grow to 13 million in 2015 and to 22 million a year later.

However, there are conceptual problems because the majority of the elderly and “disease-prone” people initially registered and therefore there are not enough young and healthy contributors. In this way, the bill for private insurers will not work out. And whether the law can really improve the situation in the US, which has a very expensive and at the same time ineffective health system, is doubted by many.

Health expenditure

In 2012, 17.2 percent of the US's gross national product, equivalent to $ 2.8 billion, was spent on health care - an increase of 3.7 percent over the previous year. With the steadily increasing health expenditure, the country is at the top in an international comparison. The average annual income of an American in 2012 was $ 51,017. Of this, an average of $ 8,915 was spent on health care.

The income gap between the middle class and the rich is widening. While the middle class has seen an income increase of around 19 percent since 1967, the top 5 percent achieved an increase of 67 percent over the same period.

Access to the health system

In 2012, 48 million people or 15.4 percent of the US population (approximately 313 million) had no health insurance, of which 6.6 million were children (8.9%). About 20 percent of the uninsured are so-called illegal immigrants and other non-US Americans.

In a 2013 survey, more than half (57%) of those questioned with health insurance stated that they postponed visits to the doctor because they could not afford the co-payments that have to be financed privately. Among the uninsured who delayed timely treatment, the number was 83 percent. A fifth of the insured stated that their health insurance would not cover certain necessary medical services and that they had already got into financial difficulties as a result.

Unaffordable hospital and medical bills were the number one cause of personal bankruptcy in the US in 2013, ahead of credit card or mortgage debt. Around two million people are affected each year. About 15 million people use all of their savings to pay hospital and medical bills.

That should change with Obamacare. The law is intended to secure access to the health system financially for those who have too little income or who work for one of the many small and medium-sized companies that do not offer health insurance as a company benefit. People who have previously been rejected by health insurers because of certain previous illnesses because the risks and foreseeable costs of care were overestimated should also benefit from it.

Reform as an election campaign issue

In the upcoming congressional election campaign in the fall, health care reform is likely to become the main political target for Republicans and Tea Party supporters. Debates and decisions on long overdue immigration reform have been postponed indefinitely so that political opponents can focus on Obamacare's criticism and sabotage. All bureaucratic problems when taking out “Obama insurance”, such as problems with the website for registration, complicated registration procedures, increased insurance premiums for those already insured and much more, are already being exaggerated in the media and at town meetings. The health reform is being reinterpreted by the Conservatives as an attack on the American principle of personal freedom.

Promise not kept

The already existing complex, expensive and inefficient health insurance system in the US will certainly not get any easier or better with the new law. It is itself complicated and long (the mountain of paper of the rules and regulations is over two meters high), the insurance premiums are different regionally and in the different states despite comparable insurance customers and companies.

Another problem: some insurance companies canceled existing contracts in order to be able to reassess the “risk” with a new insurance contract and to be able to adjust the premiums accordingly (usually upwards). And although the law has the adjective “affordable” in its name and claims that everyone can now “afford” insurance, many citizens prefer to pay a tax penalty and not be insured - at least while it is still there goes.

Critics also accuse Obama that the reform would not solve the fundamental problems of the private insurance market in the US. This includes, for example, that there are increasing supply bottlenecks in the clinics for frequently used drugs and that drugs that are needed in the basic care of diabetics, hypertensive patients or other chronically ill patients are becoming more and more expensive. The US pharmaceutical lobby blames Europe for this development, as drug prices there are often limited by law. The Americans would have to make up for the company's loss of profits with additional payments. "The Europeans live at our expense," it says in an article by New York Times, which was published at the beginning of April. The drug and pharmaceutical industry is now global and through states like Germany, which state control of prices, the same amount of money can be earned in Europe as in the USA.

Criticism from medical organizations

The critical medical association Physicians for a National Health Program (PHNO), which calls for a comprehensive and uncomplicated health insurance system, criticizes the reform as inadequate and incomplete. The PHNO, which has more than 19,000 members in the US, has been advocating a model since 1987 that is similar to the pension system in Canada. There is a government-controlled and tax-funded system based on the Canada Health Act of 1984, which is comparable to the National Health Service in Great Britain. It guarantees Canadian citizens access to largely free primary care provided by mostly private health providers, with the government controlling the standard of care. Other medical associations such as the American Society of Clinical Oncology as well as prominent professors and clinic directors advocate such a system.

Margaret Flowers, a pediatrician who has been campaigning for a new, broader, government-funded and controlled healthcare system in the US since 2007 - "One Medicare for All" - called Obamacare a "fraud". The law would spend billions of dollars in public funds on a huge bureaucracy machine and private insurance companies. Flowers has no health insurance. She conscientiously refuses Obamacare and also takes part in a constitutional lawsuit. This should clarify whether the state can oblige its citizens to take out private health insurance.

Negative attitudes predominate

The "health insurance refuser" Flowers is far from alone with her criticism. In a survey in March 2014, most of the respondents (46?%) Stated that they had a negative attitude towards the law. Only 38 percent had a “positive impression”. The first reason given for the negative attitude was the costs (23?%), Followed by the "state compulsion to take out insurance" (17?%) And the rejection of any "state interference" (10?%). Proponents, on the other hand, said that the reform would facilitate access to the health system (61?%) And make health insurance affordable (10?%) And that it would represent an improvement for the country and the population as a whole (7?%).

Touch up!

The majority of Americans are currently discussing health care reform. The general negative attitude is slowly changing - it seems to be becoming more and more clear how the positive aspects of the law could work. Meanwhile, a majority is in favor of keeping the law, but improving it (49?%). Just 11 percent, like the Republicans, want to replace it with a new one or abolish it entirely (18?%).

There are astonishing similarities in the political camps as well. Both Democrats and Republicans want several points of the reform: including children in the family plan (up to the age of 26), reimbursement of drugs that are not covered by Medicare, financial support for low and middle earners, the abolition of personal contributions for preventive services, the expansion of Medicaid and the ban on private health insurances from rejecting people with previous illnesses.

A state as a bearer of hope

Perhaps Vermont, the small “green” state in the northeast of the USA, will lead the nation by example when a state-organized “Single-Payer Health Plan” comes into effect there in 2017. The aim is to create health insurance in the future that will enable general health insurance for all citizens of the state of Vermont with less bureaucracy and lower costs.

But as we all know, Vermont is not Texas! And a “solidarity principle”, as I know it from Germany, is seen by many in the USA as a swear word and bogeyman rather than an achievement. Personal responsibility and individuality are still defended as constitutional and cultural goods.

Meanwhile, the only non-partisan and somewhat headstrong progressive Senator from Vermont, Bernie Sanders, has been examining health systems in Canada, Taiwan, Denmark, and France on a "Committee of Inquiry into Primary Health Care, Education, Labor and Pensions. The systems in these countries would regard health care as a "fundamental human right". Almost complete care was achieved there and universal access was made possible. Says Sanders: "It is time for the US to join the rest of the industrialized countries in the world and anchor and secure access to the health system as a fundamental right, and it is no longer just a privilege of the rich."

More information on the topic:

  • Physician for a National Health Program: www.pnhp.org
  • The Henry J. Kaiser Family Foundation - Health Reform Source: www.kff.org
  • Commonwealth Fund is a private foundation: www.commonwealthfund.org
  • American Academy of Family Physicians:
    www. aafp.org/advocacy/informed/coverage/aca.html
  • American Public Health Association - Health Reform Resources:
  • Healthcare Reform - Seven Things You Should Know (Consumer Report):


Info box: Distribution of healthcare costs in the USA in 2012

blue US states / red households / green private economy / purple US Confederation (Medicare / Medicaid)

Medicare is a national health insurance system that was introduced in the United States in 1966 and is centrally administered by a federal agency. It is intended to give all US citizens over 65 years of age who have paid monthly social security contributions during their working life access to the privately organized health facilities in the USA. It also covers people with kidney failure, sclerosis (ALS) and certain disabilities. Medicare covers almost half of hospital costs (47.2% or around US $ 183 billion) (more information: www.cms.gov).

Medicaid is a state health insurance scheme for the poor of all ages. It is administered and funded by the individual states in the United States. It is the largest insurance system for welfare recipients with an income up to 133 percent above the poverty line. In 2012, 46.5 million people, or 15 percent of the US population, received Medicaid benefits (more information: www.medicaid.gov).

[1]Source: Dr. med. Mabuse, Journal for All Health Professions, May / June 209, 2014; Reprinted with the kind permission of the editor and the author.