An Unthinkably Modern Miracle

 John Fischer

Much of the recent debate over healthcare reform has been cast in terms of personal finance. Politicians on both sides of the aisle have cited a 2009 American Journal of Medicine article claiming that more than half of all personal bankruptcies are the result of large medical bills. But while that particular statistic sounds compelling, it actually downplays the full scope of issue. Politifact, a political fact-checking website, crunched the data and determined that during the term of the Journal’s study, the total number of declared medical bankruptcies was only about 500,000. For context, that’s somewhere above gun deaths but below traffic accidents. More recent stats, from a price-comparison startup called NerdWallet, suggest that 10 million Americans with year-round health insurance face the broader and more troubling onus of “medical bills they are unable to pay.” Which is a bit more than double the amount of foreclosures completed during the financial crisis.

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But for all the sloganeering—death panels and socialism and Obamacare—that will mark the early 2010s as indelibly as O.J. Simpson and Monica Lewinsky marked the 1990s, the Affordable Care Act simply isn’t that revolutionary. It is basically a stew of incentives and regulations meant to incrementally decrease costs and increase standards. It seeks to turn health insurance companies into something more like public utilities, and applies the same “race to the top” logic of performance-based (rather than pay-per-service) evaluation used in school systems to hospitals. Even its most controversial provision, fining individuals who don’t carry a policy, is not all that different than car or homeowner’s insurance. In other words, the Affordable Care Act is a partial fix, not a fundamental redefinition. Like most of President Obama’s other policy initiatives, it works to adjust rather than re-invent.