Health Care Fantasies and Realities: 'Obamacare' debate overlooks how the healthcare system actually works

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By Josh Rogers

John Edwards' name resurfaced in the news last week with a report that he was a client of the Upper East Side's "Millionaire Madam" during his 2008 presidential campaign. Regardless of the truth in the allegation, there was a better reason to bring him up again.

It's hard to remember, but before the first caucus four years ago, Edwards appeared to have a plausible chance to win the Democratic nomination over the two better-financed candidates, Barack Obama and Hillary Clinton.

All three had roughly similar plans to provide health insurance to more Americans, but Edwards talked about a strategic maneuver he planned to pull in the face of certain Congressional roadblocks. His idea was to introduce a bill to end health coverage for Congress, thus challenging opponents to vote for their health care while denying it to others.

With the two-year anniversary of the passage of President Obama's health care law coinciding with the Supreme Court debating its legality, congressional opponents have had a chance to revive their "rationing medicine" criticism. It's as if they believe we live in a country where doctors, not insurance companies, decide on the best treatment for patients.

It may work that way under Congress's gold-plated health plan, but it is not typical in the United States, where medications, tests and doctor referrals are often held up for approval by insurance companies.

When Republican opponents debated "Obamacare" two years ago, they clung to fantasies about what health care is like for many people with insurance. It was so easy for them to say that Obama's plan would "lead to rationing" that it sounded like a misstatement borne out of genuine ignorance.

Rationing has been going on for a long time. Bureaucrats do make medical decisions. Those decrees are just not the ones we usually hear about because they are made in the private sector.

It still has not sunk in that Obama's plan was an outgrowth of what used to be conservative mainstream thinking. The Clintons probably could have gotten a similar plan passed almost 20 years ago, but they rejected Republican counter-proposals. Mitt Romney and Newt Gingrich were not only for Obamacare before they were against it, they were for it before Obama was.

In more recent years, Republican health care plans have become less reality-based. When Rudy Giuliani ran for president four years ago, he repeatedly said that he would let individuals shop for the best health insurance at the lowest price. While it's possible to imagine companies getting into bidding wars to insure young people who have no health problems, the free market is not so kind to people with red flags in their medical records.

Health insurance has become so expensive it can often be an overriding factor in families' job decisions. I left my full-time job a few years ago to take care of my infant son. It's something I wanted to do, but it was also something my wife would have wanted to do. The difference was that I worked for a small company with a health plan that would have cost me many thousands of dollars more to add my wife and son. She works for a large corporation which can bargain for better rates-it costs her an extra $10 a week to cover me.

Ours is by no means a hard-luck story. We were fortunate to have options and were able to pick one we liked. For too many others, health costs forces people to make choices they hate and live in fear

That's the real-world health system Obamacare is trying to change.

Josh Rogers, contributing editor at Manhattan Media, is a lifelong New Yorker. Follow him at @JoshRogersNYC.

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