“Bertha, I have never understood why you don’t support Obamacare.” This, from an informed and astute friend with whom I have had many conversations.

Her statement came following my saying that I was almost disappointed that the Supreme Court ruled in favor of extending subsidies through all exchanges, whether operated by the federal or state governments.

Frankly, I am nearly as surprised as she is that I would not be in favor of a program that extended health care to millions of Americans. For more than 40 years, I spent more time on health delivery system and program development than I spent sleeping.

Since giving up full-time work, I have continued either consulting in same or participating in public education efforts around the imperative to improve access to and affordability of health care.

In the beginning and much to the eye-rolling of my single-payer advocate friends, I liked the idea of the Affordable Care Act (ACA) because I thought of it as a uniquely American solution. I thought there was a chance the “marketplace” actually could respond in a way that would balance pricing, cost and access.

Oh … how embarrassing to be so gullible, but I was — not for long. Early on it became apparent that political forces that I would have thought would have been relieved to have a more market-based approach instead of single payer were going to do everything they could to destroy the ACA.

None or nothing

The vehement political detractors of the ACA, now known as Obamacare, don’t want the government involved in health care even if it means that millions of people are unable to afford our expensive health care. I wonder what vision tells them that the marketplace will ever care if people making $30,000 a year can afford $6,000 or more a year for insurance with co-payments and a $1,500 or more deductible.

Surely they know the marketplace wants the government involved; that is, as long as it’s not too involved so that profits or CEO pay are reduced. It’s a win-win for insurance companies who get a greater pool of paying customers, providers who get paid and the above-mentioned person or family who get care at an affordable rate.

That is unless their income is just high enough that they still have a deductible and co-pay that may cause them to delay care.

Surely they know that some in the marketplace (you know who you are Walmart and McDonald’s) want government to provide health care subsidies to low-income earners so they won’t feel the pressure of our employer-provided health insurance system.

Surely they know that the most satisfied group of people (with perhaps the exception of the very wealthy) with health care are on Medicare, a fact that doesn’t stop the detractors from working to dismantle Medicare in addition to the ACA/Obamacare.

Distinguishing opinion

Justice Antonin Scalia expressed his distinguished and considered opinion in dissenting from the majority opinion by saying “interpretive jiggery-pokery.” Take that you Justices that reasoned that the ACA was meant to improve not destroy health care.

But that, of course, is what those who would impede people from having access to health care when needed want — the destruction of any government-funded medical care whether ACA, Medicare or a single payer system.

They see no value in the strength and economic good and certainly no responsibility to maintain a healthy populace and will keep picking at the ACA until it is a carcass.

The House has passed a gazillion bills to repeal the law and is now, along with the Senate, continuing to defund certain parts of the act, the most recent being to prevent the use of insurance fees to operate federal exchanges, cutting operational funds for Obamacare, Medicare and Medicaid and defunding the independent board that identifies ways to lower costs in Medicare and Medicaid.

Obama can veto any of these provisions, which he will no doubt do, but the detractors of good health for all have promised that once in power, they will repeal the ACA and begin picking at Medicare. It’s all “interpretive piggery-pokery” of the most uncaring kind.

The moral imperative or not

I don’t want a health care system that is dependent on the people in power. I have said before that I don’t understand a world in which we stand by and allow people to suffer without needed health care.

So that, my dear friend is why I don’t like the ACA/Obamacare and wished for a call for the question of the morality of letting people suffer and perhaps die, that a decision to unplug it might have brought. As it is, Obamacare is a slowly leaking political piñata.

Steve Tharinger, one of our state representatives, said it so much better and in fewer words than I when asked why he thought it was so difficult to provide health care for all in our state. He said, “As we, as a state, work to provide real health care for all, we are challenged by the fact that we have not accepted the moral imperative of providing care. Without this basic acceptance of a moral obligation, we commoditize health care, using the market to determine access with limited moral influence. This leads to an immensely complicated system that could be simplified by a single-payer trust that focused on health outcomes as opposed to fee for service.”

If only … those words reached into the heart of power.

Bertha D. Cooper is retired from a 40-plus year career as a health care administrator focusing on the delivery system as a whole. She still does occasional consulting. She is a featured columnist at the Sequim Gazette. Reach her at columnists@sequimgazette.com.