The other day I was ranting about the problems of the D.C. Metro system to another intern. For the fourth time that week, I had been trapped on a crowded, broken train for 40 minutes, completely uninformed and frustrated. Occasionally the train would jerk forward violently, jostling disgruntled riders, and reminding us that we were trapped at the will of the system. This ride, like every other morning’s ride, had cost me $5. No one absolutely loves the daily commute, but if I am paying up to $15 a day on transportation I want my experience to be less than irritating.
Mid-rant I was struck by what I thought was an interesting, albeit unconventional, idea: the current healthcare reform is very much like my train ride; so much so in fact, that out of context my rant could have been an argument against Obamacare. The Affordable Care Act (ACA) is complicated and therefore difficult to simplify and explain in an accessible way. This metaphor is of course, imperfect, but bear with me.
There are four main problems with the transit system: unreasonable prices that will only go higher, low quality with regard to cost, accessibility issues, and implementation problems. Coincidentally, these are four of the biggest issues that the public has with Obamacare.
Let’s start with cost. A D.C. metro ride ranges between $2.10 off peak, up to $5.75 one-way, and the new plan for fares in FY2014 includes $109 million worth of increases to combat a broken system in debt. No other U.S. city’s transit system exceeds $2.50 for a one-way ride. Now let’s apply this to healthcare. Consider a fare price to be the equivalent of a premium paid by consumers to insurance companies. In a structure already expensive for any given individual, Obamacare, like the Washington Metropolitan Area Transit Authority (WMATA), aims to improve the failing system and ease the burden on some individuals by increasing already incredibly high prices for the average consumer.
Now you might say, “If it is for the betterment of the system and other individuals, I don’t mind paying more. Who doesn’t want to help his fellow man?” The key word here is betterment. If quality were the result of paying more, perhaps we’d be more inclined to do so. But the quality of the D.C. metro is low. The intercom systems are notoriously unreliable, trains break frequently and the system is not equipped to deal problems efficiently. Now let’s go back to healthcare. When Obamacare is fully implemented, not only will premiums be higher for many Americans, but healthcare quality may even decrease. We will see doctors closing their doors because the economic effects of the reform make sustaining practices impossible. Medicine will become a cookbook procedure, as care decisions will be overly regulated and in the hands of bureaucrats instead of professionals. The value of insurance will be prioritized over the quality of care. Plans will be chosen based on cost only and costumers will be quality blind when purchasing. The reform could very well lead to plans that offer even less coverage, making care unattainable. The list goes on and on.
One of the biggest quality issues is accessibility. In metro terms, the station map is limited, trains are infrequent during off-peak hours, and they don’t run late enough. These issues are frustrating in the metro, but in terms of healthcare, they are serious and can mean the difference between life and death. Being able to see a specific healthcare professional when an individual chooses will no longer be a feasible option. Any given system of care will be overcrowded and inconvenient. There will be less incentive for individuals to go into the field of medicine, fewer healthcare professionals employed, and rationed care in regard to both quality and availability.
The WMATA has also had serious regulation and implementation issues. Oversights in the smart-trip card program, poor planning for future track expansion, and an employee system that does not incentivize quality are some examples. Not so surprisingly there have also been ACA implementation problems due to oversights in legislation, as I mentioned in my last article. Many provisions for expansion of the system have proven to be financially inviable and thus delayed or repealed. What’s more, a serious communication flaw between the government, system, and people continues to leave the average American in the dark about the future of his or her healthcare (43% of uninsured Americans are completely unaware of regulations that will apply to them), and let’s face it, no one likes to be stuck on a train in a dark tunnel without information from the conductor.
When we find ourselves in that moment, metaphorically or literally, stuck in the tunnel and trapped in a crowded car that we’ve paid an arm and a leg to ride, the biggest issue with the system becomes a lack of freedom. Simply, Obamacare is based on two pillars of regulation- an employer mandate requiring certain employers, based on a variety of factors, to provide affordable insurance to employees, and an individual mandate forcing every citizen to buy insurance through a virtual marketplace. These mandates are the law and carry a penalty if not obeyed. Paying more for a lesser quality system is one thing, but being mandated by law to buy into that system is a violation of civil liberties. Being trapped on a broken metro that you have paid $5 to ride is annoying, but being trapped in an expensive government insurance plan that you don’t want is infuriating. It is then that you begin to see that you are definitely not in the drivers seat. If only we could all walk to work.