Obamacare.

I hate Obamacare.

The day Obamacare passed, I was livid. I was so angry I stopped talking to my husband, an ardent supporter. I thought this was the most ill-conceived piece of legislation I’d seen.

I was right.

Obama care was a patch to a national health system crumbling under its own weight. It had no rhyme or reason. Have you seen “The Money Pit?” Put in a little money. A little more. You fix this glitch. That creates another, leading to a loophole, that the shrewd take advantage of. The others? They crumble under the weight of unfunded mandates.

The good news? We create more and more well-paid jobs. We get more regulators to implement more metrics in the elusive hope to cut costs. They won’t recoup the money their jobs cost. So what? Let’s cut some nurses.

More employees, more computers, more EHS. We need them to count the exact number of days a patient has to stay in the hospital before going to a nursing home.

His doctor knows, his family knows, his cat knows. He doesn’t need the hospital. He needs long term care.

Not so fast! Criteria, established by people who\’ve never touched a patient say otherwise. He needs the ER visit. At least three nights before long term care. You wonder where the money goes?

Obamacare talked about expanding Medicare and Medicaid. As if that helps my patients.

My patients in Upstate NY, they haven’t seen a neurologist for years. She went bankrupt and moved to Maine. Nor a urologist – they don’t take Medicaid. The pay doesn’t cover the office cleaning. Our last ENT is retiring. He’s 90. Our dermatologist has a six months wait.

Giving them Medicaid is like giving them Monopoly money: There. Go shopping.

They may get St. James’ place, but not lithotripsy.

As more and more criteria bog down Medicare, fewer doctors accept patients who don’t help their bottom line.

Bad doctors! Greedy doctors, you say.

Not mine. Where I come from, doctors wear jeans and drive Subarus and Chevys.

But I digress. We were talking about Obamacare. Making more rules created by non-clinicians to regulate clinical work to better compliance and improved safety. More paper-pushers draining the hospital budget to regulate care. That\’s OK. We’ll just cut down on nursing jobs. Safe staffing, anyone?

I hated Obama care. I still do.

It’s like putting new tires on your 250K Chevy truck. It’ll help until the breaks fail or the engine falls off. Like painting the walls without fixing the roof.

Obamacare is not universal healthcare. Civilized nations and some less civilized have it.

Communist Romania in the 80s had it. We didn’t have enough to eat, but I had a doctor. So did my mother, my grandmother, everybody else I knew. I got free vaccines and free meds. I’d never heard about not having a doctor. I never went to the ER. When I got sick, I saw my doctor. I saw her even when I wasn’t sick, for my yearly check-up.

Not here. In the richest, most powerful country in the world, our life expectancy is falling.

What’s life expectancy? For the simple-minded like me, it’s how long is a kid born today likely to live. The longer the better.

In 2016, the WHO put the USA at #31 in the world in life expectancy.  Sandwiched between Costa Rica and Cuba. Behind Chile, Slovenia, Greece, and Cyprus.

The 2018 CIA World Factbook puts us at #45. We’re behind Turks and Caicos but ahead of Wallis and Futuna.

What’s Wallis and Futuna, you ask? CIA again: “The Futuna island group was discovered by the Dutch in 1616 and Wallis by the British in 1767, but it was the French who declared a protectorate over the islands in 1842…In 2003, Wallis and Futuna\’s designation changed to that of an overseas collectivity.”

My paranoid patient was right. CIA knows everything. They must have cameras in his pills, just like he said.

So: The good news: we’re doing better than Wallis and Futuna.

Our ranking is falling. We expect to be #61 in 2040, when Spain will reach #1, overtaking Japan. It must be either the shorter work hours or the health benefits of Rioja compared to Sake.

As per CDC, “(USA)…life expectancy at birth decreased for the second consecutive year in 2016, mainly due to increases in mortality from unintentional injuries, homicide, Alzheimer’s disease, suicide, and Parkinson’s disease.”

Not good news. Regardless of how you feel about guns contributing to homicides, suicides and unintentional injuries, healthcare plays a huge part in life expectancy.

Back to Obamacare. The main reason I hated it was politics. Once politicians could brag about giving health insurance – NOT HEALTHCARE  – they had no incentive to get real health reform. That, to me, is free healthcare for all.  Obamacare took that off the table.

That lost opportunity will haunt us for generations. Sadly, Mr. Obama, your reluctance to “go full animal,” as Mr. Bannon says, against your Republican opponents, got us here.

Don’t get me wrong now – I’m happy for every single person and every family who got healthcare. But that\’s not enough. Our healthcare got worse. Look at the statistics!

In his quest to dismantle the Obama legacy, Mr. Trump is about to take on healthcare. Again. He’s not into universal healthcare. He’s a busy man. In his priorities, healthcare runs low. Same with his friends, more concerned with immigration, economy, and guns.

For now.

Things may change if he gets his wish, and Obamacare falls.

The reality of losing their health insurance, as imperfect as it is, may catch up with their fading health. Once they\’re unable to pay for healthcare, they may feel differently.

Could this shape 2020? I hope so.

Rada Jones MD is an Emergency doctor in Upstate NY, where she lives with her husband Steve and his black deaf cat Paxil. She authored three ER thrillers, OVERDOSE, MERCY, and POISON.