When the Supreme Court upheld the health-care reforms known as "Obamacare" as constitutional last week, there were not nearly as many people cheering as there were jeering, though often those jeers were for the wrong reasons.
And just as they were two years ago, when Congress approved the Patient Protection and Affordable Care Act, many people from all social strata are still scratching their heads, wondering what it will mean for them and their families.
"Will I pay less for better coverage? Will I have to pay more for less coverage? What about covering my employees? Do I still have to deal with the maze of insurance companies and their regulations? What if I can't afford to have insurance?"
They are all good questions, but being unclear about the answers apparently has little impact on the fact that only about half of Americans surveyed in recent months supported the reforms.
In effect, Obama's health-care law means just about everyone must be insured and that pre-existing conditions will be covered, even if patients need highly expensive care. The law helps the working poor and many middle-class people afford insurance. And it requires insurers to provide certain basic benefits, such as preventive care without co-pays from the patient.
Many of those opposed to the law are concerned about higher taxes and government intrusion; many others do not believe the reforms go far enough, falling far short of the single-payer, national health insurance that we need.
And most Americans reject the idea that government should force people to buy health insurance or penalize those who don't with a higher income tax. Business advocates also oppose a provision that will penalize employers of more than 50 workers if they don't offer health insurance to employees.
Though a major goal of "Obamacare" was to make coverage available to the 50 million people who are uninsured, estimates are that there will be about 20 million still uninsured even after the law is fully implemented. That group will include illegal immigrants, the working poor who still can't afford premiums, and those who just refuse to buy insurance whatever the penalty.
Affordable care is supposed to be made possible by higher Medicare and investment-income taxes for the wealthy, and an added tax for medical-device manufacturers. But it remains unclear if the actual cost of health-care insurance and the administration of it will decline. After all, those costs have been soaring for years, primarily because of profits, marketing and "administrative" costs.
According to the Centers for Medicare and Medicaid Services, about 12 percent of health-insurance firms' budgets goes to those items, while, as a direct result, hospitals, doctors and employers are then forced to spend time and money steering through the complexities of dealing with insurance companies. Researchers estimate the total costs of billing- and insurance-related administrative tasks in the U.S. at more than $400 billion a year.
Much of that $400 billion could be used to lower the price tag on actual care under a national, single-payer system. And that could mean no tax increases to pay for it.
For example, studies point to the comparison between Massachusetts General Hospital, which employs more than 300 staff members dedicated solely to billing, and Toronto General Hospital, which is similar in size but employs only three because of Canada's single-payer health-insurance system.
The real problem with the Affordable Care Act is that it may not make care any more affordable because it basically leaves our system of private health insurance intact. The goal of health-insurance companies is to make profits, not make health care available and affordable for American citizens. They don't care if people suffer with a pre-existing condition that might cost them money. That's why the government has to force them into such coverage.
Obama apologists explain the president's failure to fulfill his campaign promise of national health insurance by saying he had to compromise his real goal in order to get some reforms approved that would at least get most of the uninsured into some kind of coverage. OK, explanation accepted. But let's not stop with the Affordable Care Act.
As Sen. Bernie Sanders of Vermont put it last week: "The real solution to America's health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship."
If Obama is re-elected, he should begin paving the way for the universal, single-payer system that would permit our nation to be proud of taking care of its people, rather than having insurance companies boastful of profits and CEO salaries.
If Obama is not re-elected, the latter will continue to be the norm.
Cary Brunswick, of Oneonta, is a freelance writer and editor. He can be reached at firstname.lastname@example.org or through carybrunswick.com.