Tag Archives: trainwreck

The Pre-Obamacare Trainwreck

20 Nov

Obamacare-symbolSome of my friends are conservatives. Shocking, I know. They occasionally post things to social media that are critical of people whom I support, and policies with which I agree. Occasionally, I will argue or even troll, but once in a blue moon, I will try to present a reasonable counterargument that is factual and not particularly argumentative. Rare, but it happens. 

On Tuesday, I saw a post linking to this article. My Facebook friend annotated his post by declaring that “progressives…really do all suck”.  I read the article, which detailed the travails of a single mom trying to buy insurance on the Washington State exchange, and having problems with bad advice and equally bad results. I feel horrible for her and anyone else similarly situated. The new insurance mandate, and the fact that the policies have to maintain a minimum standard of coverage means that some people are paying more, and the subsidy schemes are complicated. 

But it’s the “Affordable” Care Act. Not “inexpensive”, not “cheaper”, not “free” – affordable. But once you argue the semantics, you’ve lost. People’s perception is that everyone’s cost would go down, and whenever this proves not to be the case, it gets blown up into a scandal. 

So, let’s take a step back for a second. The Affordable Care Act – Obamacare – is not what I think is best or perfect for this country, but it’s 1,000x better than the utter trainwreck that preceded it. Here’s what I posted as a comment to my friend’s Facebook indictment of “progressives” in general and Obamacare in particular: 

At some point between 1990 – 2009, the Republican Party decided that universal health care coverage was no longer a societal goal, regardless of how it was to be implemented. When “HillaryCare” was proposed, conservatives pushed as an alternative the model now known as RomneyCare and ObamaCare – a regulated and partially subsidized marketplace of private insurance policies that you are (a) mandated to participate in if you have no employer-based coverage; and (b) meets some minimum standard of what qualifies as “insurance”. 

Now that we have Obamacare, which is a regulated individual marketplace of policies, different in each state, conservatives have not just refused to go along with it, but have actively and passively worked to sabotage it. 

Big laws that do big things aren’t going to be perfect in an imperfect world. Under normal circumstances, we would at least have consensus on “everyone should be insured” as a societal goal. We don’t even have that starting point, so everything else must fail. But even if, hypothetically, Republicans did agree that we should all have decent health coverage, under normal circumstances and in a responsive representative democracy, they would work to help fix problems that arise. This, too, we don’t have. That’s why things that have come up as problematic now have to be amended through regulation and executive rulemaking. 

If the right wanted to present an alternative to Obamacare – which is itself the alternative to HillaryCare – then they should have done so. They never, ever did. All they’ve done is try to block it, then sabotage it when they weren’t done repealing it. Oh, sure they bleat on about “tort reform” and the anti-federalist notion that policies should be one-size-fits-all across the country to enhance “competition”, just like the Telecom act of 1996 enhanced cable TV “competition” and the breakup of Ma Bell enhanced telephone “competition”. Just like the merger of Exxon and Mobil or United and Continental enhanced “competition”. 

In the end, government exists, in part, to fill in the holes that private industry can’t – or won’t – fill. Our private health insurance system in this country is unique in its user-dissatisfaction, physician time-sucking, inefficiency, and waste. It has proven to be almost completely unworkable in contemporary society, and its problems are underscored by the fact that no other country in the world sees fit to implement anything resembling it. 

By the same token, the German, Swiss, French, British, and Canadian models are also imperfect. They do, however, produce better results for far less money – and they do it in a way that satisfies the health care consumer. 

ObamaCare’s lack of situational perfection doesn’t take away from the fact that you no longer face lifetime policy maximums; you can no longer be denied coverage due to a pre-existing condition; insurers can no longer arbitrarily drop you when you get sick and use your coverage; preventive care and immunizations will be free of charge with no co-pay or deductibles; females are treated equally now; myriad consumer protections are put in place to help people appeal adverse insurance decisions. All of these changes are significant – so much so that it’s disgusting that these sorts of things were not implemented before. 

But, you know, glitchy website. 

Yes, I’m disappointed that ObamaCare isn’t perfect. But that disappointment is tempered by my disgust with the pre-ObamaCare status quo. I would much prefer a hybrid NHS single payer system that had public care with private sur-care policies. This will not happen in this country in my lifetime unless it’s proposed by a nominal conservative. In the meantime, have fun pointing out the problems that 1/300,000,000th of the population has with an individual policy under a state-run scheme and not only indict the federal program, but anyone who supports it, as horrible.

The Obamacare Trainwreck

18 Jul

While freshman congressmen vote – yet again – to weaken or eliminate Obamacare, the news was actually quite good yesterday.

Good in a “it’s not Medicare-for-all, but it’s a vast improvement over the status quo” sort of way.

Yesterday, New York State revealed that rates for individual health insurance plans will plummet by over 50% next year, thanks to Obamacare. These are the “exchanges” you’ve been hearing about. If you can’t afford a plan, there will be a sliding scale of federal subsidies to help you pay for it. Why? Because it is far cheaper for the government to subsidize health insurance plans than to reimburse municipalities for unpaid bills resulting from uninsured people using the emergency room as a primary care facility. In the long run, prevention is cheaper than dealing with acute problems.

About 40 – 50 million Americans remain uninsured, and caring for their emergencies is something that we all subsidize. Our healthcare system is the most expensive in the world, and gets results that have plenty of room for improvement. For instance, Canada – with its socialized single-payer system – has lower maternal mortality than the US. Canada also spends a bit more than half on health care per capita than the US.

We’ll let Professor Krugman explain why this is going to work – and work spectacularly well.

To understand what’s happening in New York, you have to start with what almost everyone at least pretends to believe: Americans shouldn’t find it impossible to get health insurance because of pre-existing conditions that aren’t their fault. Two decades ago, New York tried to deal with this by imposing community rating: insurance is available to everyone, and the price doesn’t depend on your medical history.

The problem was that this created a death spiral: young, healthy people didn’t buy insurance, worsening the risk pool, driving up premiums, driving out more relatively healthy people, etc., until you were left with a rump of very ill people paying very high rates.

How do you deal with this? Well, ideally, Medicare for all. But since that wasn’t going to happen, you improve the risk pool by requiring everyone to buy insurance — the individual mandate. And since some people won’t be able to afford that, you also offer subsidies. Voila! ObamaRomneycare!

Where does the money for the subsidies come from? Partly by reducing corporate welfare: reducing overpayments for Medicare Advantage, reducing tax breaks for very generous insurance plans; partly with new taxes on the wealthy.

And while a few people will be hurt — young, healthy individuals too affluent to qualify for subsidies, wealthy taxpayers, etc. — a much larger number of people will be helped, some of them enormously.

Does this amount to “redistribution”? Well, yes — not as an end in itself, but yes, a lot of people will be made better off at the expense of an affluent few.

The reason why Obamacare will be popular? People who are happy will stay happy, while people who are uninsured will become happy with their new coverage.

Implementation won’t much affect the 78 percent of Americans currently covered through Medicaid, Medicare, or employer group health plans,” and among the remaining 22 percent, the predominant effect will be to get some subsidized health insurance.

Because the Obama administration decided to postpone the employer mandate for health insurance on businesses with over 50 full time (over 30 hrs/week) workers, congressional Republicans – who have a pathological, partisan, political vested interest in the failure of universal health insurance – voted yesterday to delay the implementation of the individual health insurance mandate, which is Obamacare’s quid for the insurers’ pro quo of guaranteed coverage for people with pre-existing conditions. That mandate is why rates are going down in New York next year.

Among the people voting to postpone affordable insurance for millions of Americans was Chris Collins (NY-27), who has taken it upon himself as a clout-free congressional freshman to demonize Obamacare at every step.

The failure of Obamacare is a particularly acute need for Collins because he believes that he defeated Kathy Hochul on that issue alone. If the people in the 27th district suddenly have access to cheap, subsidized, quality health insurance, and discover that Obamacare isn’t the Stalinist Kenyan train wreck Collins has sold, they may very well turn on him and demand to know what his problem is.

Collins constantly talks about all the people who write to him, explaining that they will lose their hours at work thanks to Obamcare’s employer mandate. So, if he’s so concerned about these people, why doesn’t he sponsor legislation to protect those workers from that sort of thing? Could you imagine? Chris Collins sponsoring a worker protection law? I know, it’s a ridiculous notion because Collins exists only to protect business owners and the very wealthy. The idea of individual people having the government meet a need that private industry can’t or won’t is anathema to Collins and his conservative cohorts.

So, you’ll see Collins and other congressional Republicans constantly refer to Obamacare as a “trainwreck”, a catchphrase likely forged by Frank Luntz in the fires of Mount Doom. When Obamacare is implemented, and people begin to benefit from it, the conservatives will be exposed for the lying frauds they are.

The best part about this is that Republicans are so short-sighted and beholden to political expediency that they don’t realize that their constant “trainwreck” language is lowering the public’s expectations of Obamacare. If they are made to think it’s a disaster, and it doesn’t become a disaster, they’ll all look like idiot chicken littles.

Medicare Part D and the Children’s Health Insurance Program … got through their rocky implementations in large part because benefits obtained with bureaucratic difficulty are better than no benefits at all. He’s right, and this is why conservatives are “magnanimously” offering to delay implementation of Obamacare. They realize that once people have guaranteed access to health coverage, they won’t want to give it up, even if there are implementation problems.

The political landscape is already dire for those who still hope to repeal Obamacare, and they’re actually making their position worse by talking constantly about what a nightmare implementation is going to be. This fall, as the exchanges come on line, tens of millions of people are going to find they can get health coverage they never could before. They are likely to be quite happy about that, especially if they’ve been hearing for months in advance that it will be a mess.

So, when Obamacare is implemented and people are happy about it, I hope the voters take Collins’ scare tactics and throw them back in his face.

As an aside, I have asked Collins and his people numerous times in various media whether he holds health insurance through the federal government for himself and his family. I will conclude from the deafening silence that he does, and that excellent, federally subsidized health insurance is something to which he and his family are entitled – but you and I are not.

Not only that, but he will work tirelessly to prevent you and me from being guaranteed quality health insurance. Who goes into public service to screw the public?