The right eloquence needs no bell to call the people together and no constable to keep them. ~ Emerson

Wednesday, April 2, 2014

How We Met Our Healthcare

Will Obamacare Turn Out to be a Mensch or a MacGuffin?

On March 31, two finales occurred.  The CBS sitcom How I Met Your Mother wrapped up production after nine years on the air.  The first year deadline to sign up for mandatory healthcare also arrived six years after the Affordable Care Act (ACA) became law.  Both events left respective fans with emotions ranging from confusion to betrayal.  And both events really were less endings than the end of the beginning.

The presumed point of How I Met Your Mother has always been protagonist Ted telling his children the convoluted story of how he met their Mom.  At the series debut, Ted was a romantic, determined to find “the One” with whom he could grow old blissfully.  In two-hundred plus episodes, Ted endures a long string of unsuccessful relationships, including infatuation with gal pal Robin.  In the final episode, he finally meets and marries his perfect woman, Tracy, only to have her die after a few years of marriage.  In the final scene, at the urging of his kids, Ted is back at Robin’s door for one more try at happiness, not with “the One” but with the one who is left at the end.

Sometimes getting what you
want does not guarantee a
lifetime of bliss

This finale left many viewers highly dissatisfied.  In the Washington Post, critic Alyssa Rosenberg called it, “The shallowest, if not easiest, answer to Ted’s lifelong quest for love that [the show] possibly could have arrived at.”  She was vexed that the eponymous Mother character was not really the point of the show after all but merely a MacGuffin – slang for a plot device, representing an object pursued by the protagonist, often with little explanation, which turns out be largely unimportant to the overall plot.

For its part, the ACA is the signature legislative accomplishment of President Obama, a candidate who debuted as “the One” for his admirers and to the derision of his critics.  The bill’s passage into law was a long, convoluted process that only continued as Republicans and other objectors attacked it with Constitutional challenges, implementation roadblocks, and negative ads.  The program has lived up to some of the fears they sowed and destroyed credibility with voters for Obama and Congressional Democrats.  What we got, supporters and critics rue alike, is not what we aspired to achieve.

Both the sitcom and the ACA still have their defenders.  Miriam Krule of Slate magazine notes, “Contrary to what some disappointed critics are writing tonight, if Ted hadn’t ended up with Robin, that would have been an enormous disappointment.  The way Ted ended up with Robin . . . was far more interesting and romantic than anything the show could have told us about the mother in forty-five minutes or less . . . [and] whose name we just learned tonight.”

Tracy was also unsatisfying precisely because she was so perfect for Ted, so much the ideal he had long sought.  Ted’s other pals, Marshall and Lily, were undoubtedly inspiration for his unyielding romanticism.  The couple met and fell in love on the first day of college and were still together at the series conclusion.  Yet as the unhappy Rosenberg concedes, their trials and tribulations throughout the series also provided a mix of realism to Ted.  They were forced on numerous occasions to balance their personal dreams against their marriage.  “Their relationship stood as testament to the idea that marriage is work . . . [but] that marriage is a place from which that work can happen from a place of strength.”

Yesterday, President Obama held a triumphal press conference to announce that the various online exchanges had exceeded expectations by signing up 7.1 million individuals for health insurance (never mind this was the original goal until it was downgraded after the exchanges’ disastrous rollout).  NBC News First Read adds, “When you add the folks who’ve gotten insurance via expanded Medicaid and those under twenty-six who are on their parents’ insurance, the overall total could be as high as 15 million.”

Opponents immediately charged the numbers were worthless, since the federal government could/would not report how many sign-ups had paid their first month's premiums, how how many were previously uninsured, how many lost existing coverage thanks to the ACA, and how many were in the all-important “young and healthy” category essential to the law’s economic viability.

Yet in a New York Times article far from friendly to the ACA, Sheryl Gay Stolberg and RobertPear also believe national numbers are largely irrelevant, although for very different reasons.  “[Today,] the program widely known as Obamacare looks less like a sweeping federal overhaul than a collection of individual ventures playing out unevenly, state to state, in the laboratories of democracy.”  They report that insurance companies are only starting to get a handle on the nature of sign-ups and quote one insurance executive, “This is really a two- to three-year process for the dust to settle.”

Just as Ted looked to Marshall and Lily as an example to handle his own romantic disappointment, so states with successful exchanges, such as Connecticut, may provide examples to states with disastrous exchanges, such as Oregon and Maryland.  Democratic candidates are talking about “fixes” to the system and Republicans are retreating from “repeal” to “replacement.”  Some sacrifice and compromise may prove them closer together than they currently would care to admit.

As for voters and the newly insured, we may need to face the fact that our disappointment with the ACA is partly a product of our own overblown expectations.  We yearned for Tracy only to find ourselves ending up with Robin.  Rosenberg grouses this character was always “someone who ducked out of emotionally difficult situations, that she could be blunt and not particularly considerate, that she preferred her own convenience to other characters’ comfort and emotional needs.”   Just maybe the healthcare we are getting is the healthcare we deserve.

Whether the ACA remains a MacGuffin – a distraction and deceit – or evolves into a mensch on whom we can all rely is clearly still in doubt.  But it is what we are left to deal with for the rest of our lives.  How we deal with it is a function of our own attitudes.   Selflessness, sacrifice, and compromise have not been on display much by either side.  It is time for all of us to decide what this story is really all about.

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