The current problem with the health care market place enrollment under ACA and the driver behind Obamacare beg the question of the role of government in our daily lives but particularly when it comes to improving health. Obamacare is essentially a conservative program, market-driven private insurance exchanges, built on means-testing, state decentralization and promise of billions of dollars in future subsidies to expand coverage for those in the lower income brackets. The ultimate beneficiaries might be insurance companies, corporate medicine and a relatively small number of Americans with new insurance coverage and fewer out of pocket spending.
Opponents to ACA cite cost, government bureaucracy, economic impacts but probably the core value and beliefs at stake are the role of government, charities and what we should do about inequalities in our society, if at all? I would like to tackle our love-hate relationship with charity.
Americans are known to be very charitable people globally as individuals, corporations, nonprofits and government. Republicans (speaking in generality) like charities but favor market-approach or they just don’t like governments to be the facilitator. Ricardo Salinas, founder and CEO of Grupo Salinas said in a recent interview by Charlie Rose: “Charity is limited….not self-sustaining.” He himself has supported a Mexican non-profit organization that promotes microfinancing and social responsibility. This issue has been and is currently studied and explored globally.
GiveDirectly is an organization that allows governments and foundations to provide direct cash transfer to the extreme poor. It collaborates with Innovations for Poverty Action (IPA) to conduct a RCT in western Kenya where recipients received an average of $500 over 9-12 months. Recipients were free to spend the transfer as they wished. The study (May 2011-Jan 2013) found that GiveDirectly’s transfers allow poor households to do home improvements, increase livestock holdings, spend on food, health care, education and social and family events which led to reduction in hunger and food insecurity and increase in psychological well-being. Transfers do not increase spending on alcohol and tobacco and have little impact on health or education over this short evaluation period.
A November 2013 publication in AJPH by Guanais examined the combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil from 1998-2010. There are 13 million families enrolled in the federal program as of 2010 which provides cash to poor families if they comply with regular school attendance and use of preventive care services. His analysis confirms earlier evidence that the primary health care expansion contributed to the reduction of the postneonatal infant mortality rate in Brazil and adds new evidence that conditional cash transfers from the Bolsa Familia Program may have helped to overcome important barriers to some forms of primary health care because of low family income.
So what’s the connection to Americans and Obamacare? We are not the same as Africans and Brazilians you say. By the way, we call cash transfers by government/tax payers to poor people welfare and entitlement programs; cash transfers by foundations/corporations charity, gifts, donations; by business groups and non-profits: social enterprise. We disdain the first category and glorify the latters. Contrary to the views of many, Obamacare is NOT really an entitlement program. What do you call cash transfers from government to corporations? As a whole, we don’t have the patience to wait and reap the impacts of cash transfers to the poor. We accept the fact that as our economy is recovering, US income inequality is still on the rise. We accept random acts of kindness over large-scale programs in the name of libertarian ideals and personal responsibility. We (speaking as a country) did not endorse health care as a human right and so single payer system. In health care, we need to innovate beyond neoliberal ideology because confined within that framework, we got Obamacare and all its mess (and it’s just the beginning).
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"