Who pays more for health care?

There’s a rough consensus that Steven Brill’s massive story on health-care prices is an impressive piece of reporting with some less compelling analysis. Brill’s right-leaning critics defend hospital profits or blame regulation and/or employer-sponsored insurance. More liberal folks see in Brill’s reporting an oddly unmade case for price controls or a single-payer system or both.

I agree with the latter group. But what really bothers me about Brill’s article is how dismissive it is of the progress represented by Obamacare.

That’s because the most troubling thing his reporting illuminates isn’t the overall cost of health care. It’s the fact that the people who are charged dramatically more than the rest of us are those who can least afford to pay: the uninsured and underinsured. And whatever its shortcomings, Obamacare is doing a lot to get people insured.

On that front, it’s good news that some Republican governors are coming around on Obamacare’s Medicaid expansion. Medicaid ostensibly serves the poor, but access to it varies dramatically by state. So there are places in this country where some poor people have no real options for coverage, leaving them vulnerable to enormous bills like the ones Brill picks apart in his article. Meanwhile, my middle-class job gives me comprehensive insurance, which not only covers the bulk of such expenses but gets billed far less for them in the first place.

That’s why I’m a fan of Obamacare even though I would prefer a single-payer system. Our health-care system offers many things to be outraged about, but the chief outrage is the fact that so many people of limited means can’t get good insurance. Obamacare’s a big step forward here, even if it doesn’t solve the problem of health-care costs themselves.