Letter to the Editor: Coming to grips with health-care dysfunction

Voters face critical issues in this fall’s election. One of them has to do with the proper place of capitalism and free markets in American health care. This pertains especially to the Affordable Care Act, also known as Obamacare, and whether it should be repealed or not.

Capitalism has played a huge role in the development of the United States. It has fostered vast wealth creation, the rise of a large middle class, and a culture of opportunity, enterprise and innovation. Yet it has had a harsh downside, too, especially in certain periods. We have experienced a stunning demonstration of this in recent years as the financial meltdown and deep recession inflicted heavy damage on the economy and spread suffering across the nation.

This disaster ties in with health-care issues partly because of its direct consequences. The resulting job loss, erosion of the middle class and increased poverty have made health care less accessible, less affordable and less secure for many Americans.

The financial crisis is also relevant in another way. For it raises a caution flag against the arguments of those who would rely heavily on “free market solutions” as a key answer to the conundrums of American health care and health insurance. Among the pitfalls of this agenda is that it can lead toward a loss of focus on how special, how different, health care is compared to almost all other goods and services.

As a general rule, free and fair commercial markets serve the public well. And they have a rightful, beneficial place in health care, too — as, for example, in being able to choose a doctor, hospital or health plan based on comparative price or quality of outcomes. But let us never forget that some of this nation’s best achievements — Social Security, the GI Bill, civil-rights laws, to name a few — lie outside the realm of the marketplace or involve its subordination to larger purposes. The Affordable Care Act is designed to be another step of that kind, rolling back barriers that have long blocked proper access to health care for many Americans. Under this law, insurance companies will no longer be allowed to make a “business decision” to deny coverage because of a preexisting condition. Subsidies based on income will make insurance affordable for people previously priced out of the market. And the individual mandate, requiring coverage or payment of a penalty instead, will address the problem of “free riders” — that is, those able to afford insurance but choosing not to purchase it, then showing up later for expensive treatment after illness strikes.

The Affordable Care Act does not, however, merit unqualified praise. It is a complicated law open to justified criticism from varied points on the political spectrum. It is the battle-scarred product of hard-fought legislative struggles in which reformers had to accept a lesser or different victory than what many of them wanted. Even so, they were able to come to grips with some of the most damaging forms of dysfunction in the health-care system, including the application of marketplace values in ways that have done much harm by obstructing proper access to needed care.

Despite its shortcomings and problems, the Affordable Care Act is a striking achievement, a historic breakthrough. Importantly, it has been endorsed by the American Medical Association. Assuming it is not repealed outright, its strengths and flaws surely mean it will remain a work in progress. But what is most important is that core elements of this law bring long overdue reform to some of the biggest, most deplorable failings in the nation’s health-care system.

Voters should bear that in mind in this election.