Today the Obamacare health insurance exchanges open. The tea party has been in a frenzy over this event. But there is less here than meets the eye.
Most of us will see no change in the availability, the affordability and quality of our health care. Our national cost for health care will drop a little over time.
What was considered a radical change at one point becomes the new - and uncontested - normal a few years later. That prospect has the tea party frothing at the mouth. They do not fear the failure of Obamacare, but rather its predictable success.
For those who still hunger for a scoop, I have a doozy for you. The federal government has built or bought hospitals in cities all up and down the eastern seaboard. For those that qualify, care is to be given for free using government salaried doctors, nurses and attendants. The government is both the provider of services and the payer. The private sector is not involved in any way.
There are no copays. Leaders of the tea party are strangely silent. And all this is done per an act of Congress signed by President John Adams.
Yes, the government's first foray into what is clearly socialized medicine occurred in 1798. And although the missions and clientele of what is now the United States Public Health Service have changed, we accept its existence without much complaint from anyone.
During the Great Depression, hospitals and doctors had problems getting paid for their services. So the idea of health insurance, or prepayment if you will, arose with Blue Cross, sponsored by the American Hospital Association, and later Blue Shield, sponsored by the American Medical Association. Over time, these became accepted ways to handle health-care financing. Later, private insurance policies also became popular.
But many Americans, especially the elderly, had to depend on charity for their health care. So a government program for seniors, Medicare, was created and paid for like Social Security by a mandatory payroll tax.
You may remember the home-made tea party banners proclaiming "Keep government hands off my Medicare" held up by those who had only a dim idea of what Medicare actually was.
Medicare is more socialist than Obamacare or Romneycare in that it has a single payer but retains multiple providers. But there is still a profit niche carved out for the insurance companies called Medicare Advantage.
In 1960, all federal employees and retirees were offered an exchange of insurance plans, with the government picking up about 72 percent of the cost. Private insurance, HMO and union plans were offered.
From 1910 onward, but most notably from 1971 onward, we have had the growth of payers known as HMOs. These are insurance plans that mandate the use of health-care providers under contract to them. President Nixon pushed for such arrangements in 1971. From 1973 onward, employers of 25 or more employees were required to offer at least one HMO or similar plan to their employees.
The providers of health care, both hospitals and individuals, have over time undergone radical changes. Most individual providers (doctors, physician assistants and certified nurse practitioners), do not run individual practices, but are clustered in for-profit corporations to share diagnostic equipment, computerized record-keeping and clerical staff. It is estimated that setting up an individual practice today would cost at least $100,000 and often more.
Like banks, hospitals are being bought up by huge corporations. You see their ads on television.
Obamacare preserves the role of private insurers and for-profit provider corporations. Thus, it is more conservative than Medicare, which in turn is more private sector oriented than the original marine hospitals of 1798.
Obama ruled out a public option for Obamacare early on. Maybe the next president will be more forward looking. A public option would have a real impact on our premiums and on our national health-care costs, now the highest in the world.