Ethiopian Review

This morning, President Obama signed into law the Patient Protection and Affordable Care Act. You’ve doubtless heard about its flaws and limitations ad naseum. Yet the fact remains that it is the most comprehensive attempt to improve the cost, quality and fairness of American health care in decades. It represents a legislative accomplishment for progressive change on par with anything we’ve seen in the last 50 years. But aside from its historical significance, what does it really mean for you, for me and for our country?

First, you should know that this law is not the end of health care reform. We’re going to immediately spend the next few days trying to make it better through the reconciliation bill. After that, still more reforms will be added on top of this law’s foundation.

Nor is this new law really as good as what we deserve — a health care system that covers 100 percent of its citizens, not just 95 percent. Many progressives will continue to remain unsatisfied with these reforms, no matter how we continue to build upon, refine and improve them. They’ll say this reform is too incremental — a fair criticism. But when you’re talking about families, about friends, about fellow citizens being able to get the care they need when they need it, those same increments are all too often the difference between suffering and treatment, between financial ruin and security, between life and death.

We live within a health care system that costs too much, leaves too many behind and is simply unfair. But with the president’s signature, this is already beginning to change. Some of the casual injustices and cruel paradoxes of our current system will now be turned on their heads. Yesterday, small businesses were some of the most financially squeezed due to skyrocketing premiums year after year. Today, millions of small businesses are among the most helped, with tax credits this year to help them purchase health benefits for their employees.

For years, the insurance company’s business model aimed for the lowest possible ratio of dollars spent on care to premium dollars received — the infamous “medical loss ratio.” It drove a corporate culture of cherry-picking the healthy and denying care to the sick. It put profits over people. But next year’s insurance game must be played differently. Insurers cannot spend less than 85 cents of every premium dollar on care for employer-sponsored insurance (or 80 cents of every dollar for plans in the health exchange when they open in 2014). If they do, they can no longer keep it for themselves — they must spend it on rebates to their customers. A simple step, but one that changes everything.

It is not too much to say that the America we wake up to tomorrow will be fundamentally different. After my first child is born a few months from now, he or she will live in a nation where no for-profit insurance company can deny him or her coverage or care, cancel the policy or jack up the rates on the basis of a pre-existing condition — period. By the time my child enters kindergarten, this will be a country where graduating college or switching jobs no longer means losing your coverage, where the working poor in Massachusetts and in Mississippi have equal access to the basic protection of a shored up Medicaid, and where the employees of IBM, Joe’s Book Shop, Jane’s one-woman business and Rep. John Boehner all have access to the same lower premiums through group rate purchasing power. It will be a country where co-pays on preventative care will be zero and total out-of-pocket expenses will not be infinite.

There are many, many more specific benefits I could discuss. But ultimately, the search for the full meaning of the president’s signature on a piece of paper this morning goes to the heart of what we cling to as the American Dream.

Over the past few years, our challenges have only become greater, yet our will to take on the tough choices, the self-sacrifices, and the unpopular disciplines needed to solve them has too often wavered. Our politics has alternated between paralysis, triviality and hyperbole. And for too many, the fear had begun to creep in that we would be the first generation to leave our children with a country worse off than when we found it.

When all else is said, the health care reform that the President signed into law today means that we promise tomorrow’s citizens that when they get sick, when they get injured, when they need help, the system that treats them will be fairer, better and more just than the one we inherited.

Photo credit: The White House

- Tim Foley