Roughly Speaking Dan Rodricks: Commentary and conversation on life in Baltimore, Maryland and the USA

Ten years since 'Sicko,' still seeking a cure

Ten years ago this month, Michael Moore's "Sicko" offered a blistering survey of the for-profit health insurance industry. The two-hour polemic focused not so much on the 48 million Americans who were at the time uninsured, but on men and women engaged in futile battles with their private insurers to get affordable — in some cases, life-saving — medical treatment.

"Sicko" showed the disastrous aspects of the U.S. health insurance system — in striking contrast to those established in other Western democracies — and argued for a better, more generous and humane system, operated by the government and financed with taxes, that would relieve us of the worries associated with paying for care.

I watched "Sicko" again recently, and while parts of it still left me feeling ashamed and angry, I took consolation in the substantial progress that has been made since the film's release in 2007. In fact, some of the central complaints of "Sicko" are conspicuously dated because of Obamacare, and Americans should celebrate that.

Barack Obama was elected president the year after the film hit theaters, and by March 2010 he had signed the Patient Care and Affordable Care Act. It survived two Supreme Court challenges and dozens of votes for repeal by the Republicans in Congress. Persistent opponents of the ACA, including the Koch brothers and well-funded libertarian think-tankers, were desperate to crush the law before it took hold in American life. But they failed.

Based on a conservative, market-based model, the ACA addressed the costly problems related to the uninsured and provided certain benefits to those of us who already had insurance through our employers. The ACA also tackled one of the most disturbing problems in U.S. health care: The refusal of insurance companies to cover people with pre-existing conditions.

Since the ACA took effect, more than 20 million Americans gained insurance, according to the most recent data from the National Center for Health Statistics. Some received coverage through the Obamacare exchanges, others through the expansion of Medicaid.

In Maryland, more than half of the estimated 750,000 people without health insurance in 2010 are now covered. Some of the biggest gains occurred in rural areas, on the Eastern Shore and in Western Maryland, and in Baltimore. That means fewer people are putting off getting care. Fewer are putting off buying food or clothes — or even a new car or truck — because of hospital bills. And Maryland hospitals are seeing reductions in uncompensated care.

Nationally, filings for personal bankruptcies, many of them caused in the past by outrageous medical expenses, have been in steady decline since 2010, according to Consumer Reports.

Obamacare is nowhere near perfect. Some customers are still paying too much, and not enough young adults have bought insurance to make the market math work and keep insurers in the exchanges.

But for a law that has been attacked incessantly by members of Congress — Maryland's lone Republican, Andy Harris, among them — the ACA has held up pretty well. It is not a "disaster." If anything was a disaster, it was the system Moore depicted a decade ago in "Sicko."

Imagine how much better things would be had Republican governors and members of Congress supported the ACA from the start. The issue would have been settled and behind us by now.

Being American and being ashamed — that's not a good feeling. But the fact that we're still arguing about government's role in serving the fundamental need of all Americans to have affordable medical care is shameful. We are 17 years into the 21st century. We should have figured this out by now.

The British did it a couple of years after World War II.

In "Sicko," Moore interviewed Tony Benn, the longtime Labor Party politician, about the British national health system. Benn, who died in 2014, said it was democracy — with the poor and middle class fully engaged — that made such a system possible and permanent. And he described, presciently, the counterforce that could keep it from happening here.

"I think there are two ways in which people are controlled," Benn said. "First of all, frighten them, and secondly, demoralize them. An educated, healthy and confident nation is harder to govern, and I think there is an element in the thinking of some people that we don't want people to be educated, healthy and confident because they will get out of control."

Republicans in Congress, bent on erasing the Obama legacy, are still attempting to gut a law that became increasingly popular under their noses. They offer a replacement that would put insurance out of the reach of millions of Americans while transferring wealth back to the wealthy. It makes no sense.

What makes sense, for starters, is a repair of Obamacare that includes an affordable public option, with a path to a single-payer, Medicare-for-all system down the road. The Republicans won't pursue that. Democrats should. If politically it's a heavy lift, then they should gather reinforcements.

drodricks@baltsun.com

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