Debating the Affordable Care Act while in line at Starbucks

On a recent Saturday morning, I thought I was going into Starbucks on Broadway to increase my caffeine level and get some reading done. Instead, I got a lesson on America's political polarization.

I was standing in line to order a “grande” coffee, which, by the way, means “add 40 cents to my bill” in Italian. A tall white gentleman, several people behind me in line, called out to me in a voice loud enough for everyone in our little Starbucks community to hear. He wanted me to know that he was laughing at my book.

I’m reading Reinventing American Health Care: How the Affordable Care Act Will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System, by Ezekiel Emanuel. The author was a special adviser to the White House on health-care reform, and is the brother of Chicago mayor and former White House chief of staff, Rahm Emanuel.

I looked at my fellow caffeine addict inquisitively. He continued: “Obamacare will never improve anything. It is a disaster. Look at my hand.”

His hand had a crooked finger.

“This is going to cost thousands of dollars to fix, even though I have health insurance.”

I had just been called out. So, I responded, and in a voice that also could be heard by all in our little Starbucks community. I told him that I was glad that a couple of million Californians now had health-care insurance, that the cost of health-care inflation was being brought under control, and that people with pre-existing conditions could now get insurance.

My fellow patron then tells me that this is all a smokescreen. Obamacare is just an income transfer.

I assume he means an income transfer from people like him to poor people. Although I’m normally interested in discussing health policy, I instantly became uninterested. This would be like discussing biology with someone who did not believe in evolution.

I took my overpriced coffee and sat down.

Later, my new acquaintance came over to my table. He wanted to click paper cups. We did. We recognized, I guess, that two Homo sapiens living in parallel universes just had an encounter and nobody got hurt.

In my universe, the Affordable Care Act, despite its problems, is working. Emanuel has identified trends which will transform our health-care system, including:

Moving away from fee-for-service payments, which will take away the incentive for unnecessary procedures and tests.

VIP care for those in the first stages of a chronic physical or mental illness, which will reduce the expense of treating these illnesses later on.

Insurance companies focusing on effective health-care implementation, instead of health-care denial.

Care moving away from hospitals and toward home care, resulting in better and less expensive care.

The end result will be a better and less expensive system. Emanuel believes we can stop health-care inflation, despite an aging population. In my universe, this is very good thing.

Like getting a venti coffee for the price of a tall.