Wednesday, November 20, 2013


Obamacare rage is all the rage at the moment and since I have been a supporter of healthcare reform I will chime in.  It’s not elegant but I’ve organized this into sections that reflect my thinking on the ACA.

Legitimate Healthcare System Problems Unaddressed by The Critics

·         Millions of people like myself are shut-out of health insurance outside of a large group, employment based plan.

·         Thousands of people are routinely dropped by their health insurers when they get sick and/or reach a lifetime policy cap

·         Thousands of the ones who get sick and don’t get dropped have their premiums increased to unaffordable rates because they are costing insurers too much.

·         49 million people are completely uninsured.  If acknowledging the basic immorality and inhumanity of this is too much to ask, just focus on the fact that these uninsured people are making YOUR healthcare costs higher via expensive emergency room treatment.  You’re already subsidizing them, just in the least efficient way possible.

·         60%+ of all bankruptcies in the US are medical bill related.  The majority of those bankruptcies are from people who HAVE health insurance.

·         The US spends twice the per capita average of the OECD countries for results that are average.

The people who are so giddy about all of the negative headlines are offering no solutions for these very real problems.  Why?  Because they don’t actually care about improving healthcare access and delivery, they only care about attacking a president who makes them crazy. 

Media Hyperventilation

If the media would have devoted this level of sensationalism and attention to the problems of the pre-ACA healthcare system Americans would have demanded reform decades ago and we’d probably already be on a single-payer style system like the rest of the civilized world.  The pre-ACA world has thousands of people who were suddenly dropped from their coverage, or told their favorite doctor is no longer in-network, or who had their premiums skyrocket from one year to the next, or who were just flat denied coverage altogether due to a pre-existing condition;  plenty of real-life cases that the media could have highlighted.   

If the pre-ACA and post-ACA healthcare systems were given a fair trial in the public media I have no doubt that “Obamacare” would come out the clear winner.  Interestingly, the media has given zero coverage to the people who have already benefited from the ACA or who will be benefiting over the next couple of years.  And many of the ACA victim stories have been roundly debunked, two prominent ones involved major features in the WSJ and on CBS news.  We are often presented with an incomplete story that turns out to be not as clear cut as the headline sounds.  The ACA has some very real problems. The rollout has been terrible, and many of the criticisms are legit.  But the media presentation is making it out like the new healthcare law is ushering in the apocalypse for what was a healthcare utopia.  And comparing it to Bush’s response to hurricane Katrina?  Because having some website glitches while you are trying to give people better access to healthcare is JUST LIKE leaving hundreds of thousands of people stranded and helpless after a devastating natural disaster. Please. 

Republican Paradox

Conservatives have claimed from day one that Obamacare will be an unmitigated disaster.  If they truly believe this to be the case then they should view it as political gold.  Allowing Obamacare to be fully implemented and then fail miserably could do more to discredit democrats/liberalism than Roger Ailes could ever dream of.  But they’ve tried 40+ times to repeal the law.  They’ve desperately attempted to sabotage and defund it at every step of the way, anything to prevent it from getting off the ground.  Why?  Because their true fear is that Obamacare will SUCCEED.  And their true expectations are evident from their actions.  If you really believe something will destroy your opponents, you sit back and enjoy the carnage.  You don’t fight desperately to stop it from happening.  If Obamacare does succeed it will be a devastating blow to the republican party.  For a party already suffering from considerable demographic and image problems this cannot be a pleasant prospect.   

Incidentally, it’s been hilarious to see conservative media and republican politicians all of the sudden playing the role of consumer advocate.  What hypocrites.  Where was this breathless concern when insurance companies were cancelling policies, denying coverage, and jacking up premiums prior to the ACA?

Rationale For The Healthcare Law

Insurance is simply the pooling of risk.  The larger the pool, the lower the cost per individual in the pool.  This is an actuarial fact.  The idea behind Obamacare is to get more people into the risk pool, thereby lowering the overall cost. It’s a sound concept.  Healthcare is not a “product” that a person can simply opt in or out of.  Everyone will use the healthcare system.  Therefore, everyone who can afford to should pay into it.  The main problem with Obamacare is that it relies on a patchwork of private, for-profit insurance companies to achieve this larger insurance pool.  It was set up this way in order to be “market based” and therefore more palatable to conservatives.  A single, mandatory, all-inclusive insurance pool (aka: single payer) would achieve the ACA’s objectives far more effectively.  It’s interesting that most of the ACA’s problems being pounced on by the opposition stem directly from the compromises in the law that were intended to placate them.  (Them being the republicans who believe in the magical fairy dust of the so called free-market.)

Democrats and ACA Supporters Have A Tougher PR Job

One of the central tenets of conservative politics is playing on people’s inherent fear of change. Whether it’s the government coming to get you, or the Muslims, or immigrants stealing your job and money, or “socialized medicine”, the conservative machine thrives on fear.  This is effective because fear of change is natural to the human condition.  Even if it’s changing from something terrible to something better, people are more comfortable with the devil they know.   Democrats and ACA supporters have always faced an uphill battle selling the idea that healthcare system can change for the better.  

My Criticism Of The ACA

On principle I hate the idea that government can require an individual to purchase a product from a private corporation.  But again, this strange and unfair sounding requirement stems from the fact that the ACA is a compromise designed to appease republicans who demand a “market based” approach.  Once it became clear that not a single republican would vote for healthcare reform and that democrats would be accused of being socialist Nazis no matter what they did, they should have scrapped the market-based compromised and crafted a more “socialistic” program.  At the very least they should have included a public-option that would have given individuals the ability to meet the coverage requirement without having to deal with the for-profit health insurance cartel.  At the time the law was being debated it was amusing to listen to the same people who say government can’t do anything right also complain that a public-option would have unfair advantage over our beloved private insurers. 

My second complaint with the ACA is how the individual mandate is structured.  The penalty for not buying insurance is too low.  And the enforceability of the penalty is too weak.  The viability of the ACA depends on younger, healthier individuals entering the insurance pool.  The mechanism designed to get them there has no teeth.   If the new entrants to the insurance pool are mostly older, sicker people, then health insurance companies will have no choice but to raise premiums.  This would be the true death-spiral for the healthcare law.


My Prediction
In one to two years time the benefits of the healthcare law will be evident and hundreds of thousands will be enjoying the benefits: grateful to be able to buy reasonably priced insurance even if they have a pre-existing condition, not having to fear being dropped from their insurance coverage when they need it most, and enjoying overall lower premiums due to an expanded insurance pool.  Not to mention the satisfaction of knowing their country has finally moved closer to making sure the basic human need of accessible healthcare is now a reality for most of their fellow citizens.  But I think this is just a stepping stone.  Within thirty years the absurdity and inefficiency of our privatized healthcare system will become so obvious and undeniable that no amount of right-wing fear mongering will be able to stop the move to a single-payer system.