We are slowly (or not-so-slowly) but surely moving toward a much more finely gradated class-based system of healthcare. Compared to where we were before Obamacare passed, the top is moving up and the bottom is moving down faster than ever, leaving a thinner middle where most Americans with employer-provided health insurance have typically been—somewhere in the murk between HMOs and PPOs of various descriptions. Now, those who can afford it will increasingly pay more and get more. Those who cannot afford it will pay less and get less.
As Garfinkle notes, this makes the US more like other countries, where richer citizens are often able to afford private care that is better than the public care offered to everyone. The challenges facing the working and middle classes are only mounting—and Obama’s presidency has done little to improve their lot. Both parties need to refocus their energy on policy frameworks that can address the mounting struggles lower income Americans are facing.