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Michael Miller


By Michael Miller
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In the end, I caved. I lasted until about 24 hours before the vote on the Patient Protection and Affordable Care Act before deciding that it just had to pass. Whatever happens next, and insurance lobbyists have years to influence and game the final regulations, we had to get past this. I’m done with fear, rage, screaming bullies and cynical political gamesmanship. I am willing to ride the rapids of a flawed and inadequate health care strategy that may eventually make things worse, rather than empower those who would definitely make things worse.

Many Americans are relieved to get this screaming match over with. Support for the new law will grow for that reason alone. We are grateful that anything of significance can pass in Washington, and there are some significant things here, especially if you’re a child or have a child. Ending some of most blatant abuses by health insurers is very good and long overdue.

Some Democrats, starting with the president, are making a critical mistake in overselling all of this. It is change, but it’s incremental change, like most things. This is not equal to the passage of Social Security or the Civil Rights Act, which some people are saying over and over as if trying to convince themselves.

It is certainly the greatest event in the history of the American health insurance industry, which receives an undeserved gift of barely regulated monopoly and untold billions in additional profits. It preserves our Darwinian lifeboat mentality in public health. The lifeboat will eventually be bigger, but not as big as some think, and millions of families will continue to be squeezed overboard. This is an enormous waste of potential production capacity. The financial costs are not sustainable.

Most people won’t see any significant change, at least not for years. Eventually, insurance companies can’t deny you a policy, but they can continue to deny you payment for specific treatments or therapies that your doctors think you need. Hospitals and doctors will still have to employ people just to argue all day long with insurance companies. There are no significant cost controls. This law makes things more complicated, not simpler, which should be the goal of any reform of anything. But simply was taken off the table, despite the desire of most Americans.

Many of our democratic, free-market allies have retained private insurance companies. These companies aren’t allowed to make large profits from a certain level of basic health care, yet their CEOs still drive Bentleys. Meanwhile, hundreds of thousands of Long Islanders will find that they have a taxable “Cadillac” health plan, but still have no dental coverage, and rising co-pays. Some of our insurance CEOs can buy the Bentley company.

But then Mr. Bruce Blakeman, once presiding officer of the Nassau County Legislature and now a candidate for U.S. Senate, declares that this is all “a socialistic power grab.” When a politician talks that way, what I really hear is: “I don’t know what the word ‘socialist’ means.” I also hear a politician who has pandered himself into a place where there is no maneuvering, no compromise and no meaningful participation.

This law looks very much like the one passed in Massachusetts under Governor Mitt Romney. It looks very much like what Congressional Republicans were proposing in the 1990s, and what insurance industry lobbyists themselves put forth in 2008. If Republicans had played this straighter and participated, they could have claimed it as a major victory, and the campaign checks would have continued to flow.

Every time I hear about Marxism, Nazism, secession, nullification or Brownings, I’m ready to slap two “Yes We Did” bumper stickers on my car.

This country’s long–neglected needs must be addressed, or we will face some very difficult times. The United States is changing and our position in the world is changing. Clearly, some of us are not going to handle all this very well.

If this law turns out to be the first of many steps to truly address these chronic problems, then maybe it will be worth it.

Michael Miller is a freelance writer, designer and strategic consultant who has worked in state and local government. Email: