We do not learn from experience… we learn from reflecting on experience.
― John Dewey

The past eight years with my President have been really good. Mr. Obama is a brilliant man who shows himself again and again and again. Unlike many others who extol his praises in social media, I do not consider him “classy.” To me reducing his courage, intelligence, use of logic, and editorial prowess to “classy” puts an unnecessary limiter on him and associates his skill with capitalism over everything else.

That said, my President has indeed been skilled at capitalism and so his formidable – and I dare say quite obviously racist – opponents have done well to undermine him using their considerable skills at subterfuge to block some of the successes of the landmark healthcare legislation of the last 50 years, the Affordable Care Act – so-called Obama-care. His deep trust in capitalism (ironic, isn’t it when Republicans repeated tried to label him a socialist) had allowed him to believe that the marketplace would serve the nation well. Without what would currently be seen as impossible regulations, the markets no longer serve most Americans. The majority of us who have invested our retirement savings in the markets count on them doing well. We are lulled into avoiding the confusing details about our mutual funds, details that support businesses and business practices that undermine our own well-being.

Before the 1980s, insurers like Blue Cross Blue Shield enjoyed tax exempt status, but other insurers episodically prompted congressional efforts to change those exemptions. Still, congress repeatedly saw them as engaging in efforts that were for the common good and community welfare, so the status was modified at times, but their tax burden remained far less than their publicly traded competitors.

In the 1990s and early 2000s, Blue Cross and other companies similarly sought and successfully negotiated settlements that allowed them to convert from exempt to non-exempt corporations. At the time, I was peripherally involved in discussions about this conversion in Wisconsin and was struck by the government, voter, and non-profit greed that appeared to fuel these discussions. Initially it just seemed too good to be true that these giants were going to roll over as the sale of their initial stock offerings were turned over to universities and governments in acknowledgement that their assets had been tax exempt for decades. I smelled something fishy in the rush to resolution. I reasoned that if the settlements were too good to be true, they probably were not true. I raised my concerns openly and often. In a matter of months, I became a non-entity in my field, viewed as a buffoon by many.

Within 18 months, my own beloved late husband was cheated out of the insurance benefits for which he had paid high premiums for years as an individual. The chaos in our lives then wreaked further havoc on his health and required that he declare bankruptcy. Our only consolation at the time was that my former employer which stood to benefit from the insurance company conversion was left holding the bag for his bills from their hospitals and clinics which he could not pay.

Many will not like to read this, but I know it to be true: What happened to our family is not an outlier. It is actually the system playing out as intended. Profit ventures like Anthem, United Health Care, and others will do what they must to off load as much cost as they can to boost revenues. The days of mutual risk are gone once healthcare is traded on the stock market. The potential losses by benefit pay outs trickle down hill and others, namely tax payers, pick up the expense.

In 2002 we were terrified when Paul was diagnosed with MS and had no insurance. We ultimately realized that our health insurance system does not provide insurance. We have all been sold a bill of goods.

The real struggle is not between East and West, or capitalism and communism, but between education and propaganda.
― Martin Buber

The Affordable Care Act is not and has never been a hand-out to working class and poor people. Rather, the Obama Administration, a cohort of technocrats with deep beliefs in their ability to craft legislation that will serve the common good, erected a plan with many interlocking parts, including some unpopular ones, which could provide a long-term, healthy alternative to the inhumane and inequitable system that had been in place for decades. The plan is a long series of “if, then” statements that needed to be in place for it to work. If states would expand Medicaid, then those who could not afford even minimum premiums could be insured. If others would be required to have insurance, then insurers could drop restrictions on pre-existing conditions. The list goes on.

It may have not been an oversight, but I am left wondering how government, voters, and non-profits could underestimate the power of greed. The largest insurers on the so-called exchanges (United Health, Aetna, Anthem, Humana) are publicly traded. These stocks show up in many mutual funds. For some they are the lynch pin of their retirement investment plans. But to produce wealth, they require greater profit. If the contracts don’t produce more money, then the insurers will not play.

For months now, United Health has been crying about their need to move out of many exchanges and increase premiums greatly in others. However, despite their so-called losses, the company made $1.6 billion in net income in the first quarter of 2016 (on target for a $6 billion gain for the year). It isn’t like they have not made boatloads of money, they just haven’t exceeded their targets. They are playing hardball with congress and the President. They are not considering us as people, but rather as health care consumers.

While some hospital systems are not fairing anywhere near as well big insurers, many others have reported $0.5 billion gains in income over their projections. Most of these systems, by the way, retain a non-profit status. Pharmaceuticals have similarly profited, except even more so. While congress and the public are clutching pearls over price gouging for epi-pens, many other increases of 5%, 8%, and 12% have gone unheralded, like we should be silently appreciative by the slight insults to our intelligence and well-being. After all, we are all enjoying similar economic gains, right?

Leaning tower of Pisa, Italy

Now we have a president-elect and leaders in the Republican majority who would point out the problems with the Affordable Care Act. The problems are plentiful, particularly as the “if, then” premises have been thwarted both by Democratic technocratic hubris and Republican duplicity. The marketplace is not going to magically start behaving in the best interest of America as long as it is unregulated and greed-fueled. The recent stock market gains show us that Wall Street likes the new guy because they recognize him as one of their own.

Can the ACA be salvaged? I am not sure. I just know that a lot of work and some good engineering has kept other similar structures upright much longer than expected.

It is justice – not charity – that is wanting in the world.
― Mary Wollstonecraft