Perhaps the worst part of the Affordable Care Act, aside from the communism and socialism, is that it fooled some folks into thinking that government had actually fixed what ails America.
It's clear now that it didn't. In fact, it's clear the law didn't actually accomplish what it intended to accomplish, namely spreading coverage and driving costs down. Instead, it managed only one of those and not very well.
As a bonus, the one it sort of accomplished -- spreading coverage by turning insurance companies into willing agents of public policy -- is also the one that will accelerate the descent of the federal budget into chaos and deficit.
We could privatize Social Security and convert Medicare into a Ponzi scheme tomorrow, and it wouldn't prevent the reckoning we're due thanks to rising medical costs.
By the end of the next president's term, America will spend about 20 percent of its gross domestic product on health care -- one-fifth of the U.S. economy devoted to the upkeep of Americans. That reflects the relative importance of medicine in modern life, not to mention that aging and declining Boomers have ensured that health care has supplanted education in the pantheon of public goods.
In any case, we're getting lousy value. America spends more than any other developed nation, and our results are -- at best -- middling in infant mortality, life expectancy, cancer fatalities and deaths from heart disease.
The U.S. has the greatest health facilities in the world, but most of us will spend our lives and deaths without ever seeing them. Most will be born in local hospitals and die -- expensively, painfully, alone -- in similar facilities.
We will go to doctors who provide adequate care in fragmentary visits driven by illness and insult. They will not know who we are because they can't. They don't have time.
Doctors and hospitals account for 51 percent of total health care spending in America. The rest is divided among pharmaceuticals, insurance, nursing home care. All totaling more than $2.3 trillion a year in 2010, according to the Kaiser Foundation.
With the Affordable Care Act, that number will grow faster than inflation over the next decade. Without it, the number will grow at about the same pace, and more people will die because they don't have insurance.
Those are the extremes, sadly, of the presidential race. President Barack Obama clings to health care reform not because he thinks it's a good law -- nobody does -- but because it is an accomplishment.
Mitt Romney promises to repeal Obamacare not because he thinks it's a bad law (something indistinguishable was his most significant accomplishment as governor of Massachusetts) but because it's unpopular.
What neither man promises -- because it's laughable on its face -- is that either approach can fix the health care problem. In fact, both men have traded an argument over a law for the argument over the problem.
Obama's solution is to stick with reform, with all its cowardices about cost control and all its inadequacies in extending coverage.
He'll stick with it despite the fact that it's a giveaway to the insurance industry massive by comparison even with President George W. Bush's gift to drug companies.
He'll stick with it despite the fact that Obamacare doesn't affect the cost trajectory of medicine in America, at least not noticeably.
Romney's solution is to repeal the law on Day One of his term, essentially returning the nation to the state of medicine before health care reform. That means at least 40 million Americans without coverage, a scandal in the civilized world.
Repealing the law also means kids tossed off their parents' policies, illness and preexisting conditions as an excuse to deny coverage, and rapacious insurance companies again allowed to make whatever profits the market allows.
Romney has said over and over that he'll keep those popular protections. But the only way to do so while abandoning the rest of the Affordable Care Act is by making health care even more expensive than it is now.
That leaves us with awful choices on the most important issue of our time, 10 days before the election: A president who clings to an overly complicated law so incoherent that it doesn't do what it's supposed to. And his opponent, who promises only to take a bad situation and make it worse.
Obamacare needs to be repaired or replaced, but not with nothing. Our rabies-mad politics make that an especially difficult task. Especially since fixing the faults of the American medical system -- cost and coverage -- requires a radical re-examination of how health care is delivered. Anything less amounts to malpractice.
Donald Luzzatto is The Virginian-Pilot's editorial page editor. Email: donald.luzzatto@pilotonline.com. ___
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