Thursday, December 26, 2013

2013 Winds Down

As 2013 winds down, I'm reminded that I've been writing here for several years. In that time, I hope I've become better at articulating what is on my mind. I also hope that writing here has given me an opportunity to better understand what I believe, and in some ways I've seen some shifts in my perspective on several worthy issues.

Rather than feeling guilt over possible wishy-washiness (haven't we mocked candidates for their changing stances?), I'm going to embrace the changes in my view on politics and life. John Maynard Keynes once quipped "When the fact change, I change my mind. What do you do, sir?" Abraham Lincoln talked about the silent artillery of time (when discussing how over decades points of view might change on great issues due to the withering fire of logic). Some long-held ideas of mine have tumbled due to that silent artillery, or in recognition of the changing circumstances.

The problems of the Affordable Care Act's rollout have been a source of fascination for me. Four or five years ago, I think my feelings would have been simple revelling in the embarrassment of a president for whom I did not vote. Since then, I've come to think more and more about the lack of alternatives offered by the opposition. I've come to think that nobody wins from a flawed piece of legislation or a troubled rollout. I am starting to see how the legislation and its rollout, as flawed as they might be, are doing something very good in that they are accelerating a shift in consciousness regarding healthcare costs, a consciousness that we need to be awakened to. Namely, medical coverage costs a lot. Its costs are borne unequally and arbitrarily. Healthcare requires cost-shifting and cost-sharing, where the young and healthy overpay and the old and sick over-receive. It's been that way for a long time. The lopsided and uneven nature will only get more acute over time. The ACA makes that more apparent and more apparent sooner.

The ACA has also disabused me of the notion that the market handles this best. It's led me to embrace the idea of a single-payer, taxpayer-based system. This is a position I never would have embraced years ago. But I've come to see medical care as a merit good, or one all citizens are entitled to. In the status quo, it is in part paid by government, in part paid by individuals. As a result we have something very expensive that doesn't cover everyone. To me, it's more important that it covers all than that it be done inexpensively. In a perfect world, it would be both. Right now, we might only have time to do the former, and figure out the latter later. Obamacare has helped me realize this, and I hope it helps more realize sooner that our system needs change. ACA isn't the right change, but it's better than nothing, which is what the opposition, a party to which I'm a member, has offered.

One other perspective-shifting moment on this: my grandmother continues to battle a chronic condition that defies easy diagnosis. Despite her limited means, the coverage is there through Medicare. That coverage is hers by right of age and citizenship. Since she is in her 80s, she doesn't need to forego medical treatment due to cost. Why shouldn't someone in their 50s or 40s enjoy the same protection?

In my next post, it'll be time to tackle the "evolution" (paraphrasing the president) in my views on same-sex marriage. A post by William Eskridge on Politico prompts me to write on that. Next.

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