Last updated: April 03. 2014 7:37PM - 669 Views
By Mac McPhail Contributing columnist



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This past week, I was drinking my coffee and watching “Morning Joe,” listening to the talking heads discuss the Affordable Care Act. During the discussion, one of the contributors said, “The American people are pragmatic. They’ll decide if Obamacare is a success or failure based on how it works for them.”


After a rocky start, the signup period for enrollment for the Affordable Care Act ended last week with supporters highlighting that the goal for signups was met, with over 7 million enrollees. President Barack Obama, in a speech April 1 stated, “The Affordable Care Act hasn’t completely fixed our long-broken health-care system, but this law has made our health-care system a lot better. The debate over repealing this law is over.”


But those opposed to the law still have their doubts. They wonder how many of the 7 million enrollees were actually uninsured prior to the signup period. Vast numbers of those signing up had health insurance previously but were dropped because of the law. Also, many had their premiums go through the roof because of the mandates of Obamacare, and therefore, had to join the exchange. There are also questions about how many of the new enrollees will actually pay their premiums when they become due, since many had not been paying for health insurance in the past.


But the signup numbers and all the statistics will not determine the success or failure of the law. The American people will. And, like the analyst said the other morning, it will depend on how it works for them. That means us. Why? Because we are pragmatic.


Webster’s dictionary defines pragmatism as “a practical approach to problems and affairs.” The practical approach to the Affordable Care Act is, “If it makes my life better, I like it. If it doesn’t, I don’t.” But is it being pragmatic or something else? Maybe being pragmatic led to the conditions that were used as reasons for the law in the first place.


The insurance companies were being pragmatic when they would drop an insured person because of an expensive health problem. The insured would now cost the insurance company more than they wanted to pay, so the company would cancel their insurance. It was the practical thing to do. I had a self-employed friend who had been paying for health coverage with one company for years. When he developed heart problems that required expensive treatment, the company canceled his coverage. At sixty years old, he couldn’t find new coverage.


The politicians were being pragmatic by creating laws that limited competition among insurance companies, which could reduce rates. It was practical for the politicians because the insurance companies are one of the key contributors to their political campaigns.


Young adults were being pragmatic when they decided not to buy health insurance. They figured they were young and in good health, why spend the money? Besides, there was always the emergency room.


Those of us already with health insurance, whether group, private, or government, like Medicare, were pragmatic. We said, “Hey, whatever it takes and whatever the insurance company will pay for, do it! My claim won’t make health insurance cost more.” (But millions of claims like that did.) And the doctors and hospitals, being pragmatic themselves, were there to oblige, as medical costs soared. Of course, there were pragmatic malpractice lawyers and their pragmatic clients ready to get their piece of those costs.


All this pragmatism has contributed to the current healthcare crisis, which has resulted in the Affordable Care Act. Time, and all of us pragmatic Americans, will determine if Obamacare stays, goes, or is modified. It will probably be modified some over time, but it’s hard to remove or reduce a benefit once it becomes established.


I know a writer is not supposed to be too repetitive with his words. And I know I have used the word, “pragmatic,” way too much in this column. (That’s because I was writing about a lot of pragmatic people.) Maybe I should have wrote that the people mentioned were acting in their own self-interest. But that sounds too much like being selfish.


When does pragmatism and acting in one’s self interest cross the line and become selfishness? I suppose it depends on how our decisions and actions ultimately affect others now, and in the future. My three year old grandson often doesn’t want to let his five year old sister play with his toys. We try to teach him not to be selfish, and to share. But maybe he is not being selfish after all. He might just be learning the skills that he will need as a pragmatic adult. Like the rest of us.

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