Tuesday, March 29, 2016

Ever notice how the...

...Affordable Care Act's critics are always warning that the health care law is just about to fail? Really -- seriously -- any day now -- just watch!

Today's Chicken Little is Ramesh Ponnuru, writing in Bloomberg, "Hold the Obamacare Celebrations" (all emphasis  mine):

...the law's harms look set to rise.

...And as flawed as the law already appears, worse days may be ahead for it.

...the exchanges could prove incapable of sustaining themselves.

...Obamacare will probably have to be changed substantially under the next president.

Ay yi yi!

(I was out with some other boring old white guys last night and the conversation turned to politics. When I suggested that Hillary would probably win in the fall they all groaned. And their moods didn't improve any when I said I thought she'd be president for the next eight years.

What is it with my fellow boring old white guys? When are they going to admit that the peace and prosperity of the Clinton and Obama years were far superior to the utter chaos of the Bush era? Is it that they still view the Gipper through the gauzy prism of nostalgia? Or is it that they only read The Wall Street Journal and watch Fox News and think America is hopelessly decadent?)

Anyway, back to Mr. Ponnuru and his critique of Obamacare. Let's take it point by point.

President Barack Obama and his allies are celebrating the Affordable Care Act, also known as Obamacare, on the sixth anniversary of its passage. They say it has provided insurance coverage to millions of Americans and come in below cost.

Oops! Ponnuru goes on to admit that it has. But,

Deductibles in employer health plans have been rising fast, leaving many people with policies that -- thanks to Obamacare regulations -- cover routine medical expenses but leave them on the hook for thousands of dollars in a medical emergency. A sensible insurance policy would have the opposite priorities.

Deductibles in employer health plans have been rising fast for decades. And where's this mythical "sensible insurance policy" to which he's referring? Did the Republicans come up with a replacement plan when I wasn't looking?

The administration argues that the law has contributed to a slowdown in the growth of health spending.  But that slowdown started in 2002. Obamacare can’t be the cause. The best that can be said about the law's effect on health spending is that its early years haven't interrupted that slowdown. 

So the ACA hasn't led to higher costs after all, like its critics feared.

The Congressional Budget Office believes that the law is having a negative effect on employment. It projects that Americans next year will work the equivalent of 2 million fewer jobs because of the law. That’s partly because the law’s subsidies decline when people work more. The subsidies thus reduce the rewards to work and induce people to work less.

Isn't this one of those zombie ideas that just won't die? If you don't need your job to get health insurance, then you may not need to work. Right?

More Americans dislike Obamacare than like it, which has been the case since before its passage. More think the law has hurt them than think it has helped them.

What if they're just plain wrong? Without Obamacare millions more would be without insurance. And you'd be on the hook for their emergency room visits. Also, as long as you have insurance through work you don't need the ACA. But if you should happen to lose your job -- not unimaginable -- you'll love the exchanges. (Especially if you have pre-existing conditions.)

Obamacare was a badly designed law. We could have achieved gains in insurance coverage without Obamacare’s regulation-heavy approach; we could have addressed the health-care system’s discrete problems without trying to overhaul it from Washington, D.C.

Those without access to employer health plans could have been given enough money to buy a policy that protected them against catastrophic expenses -- and that offered more protection if they put some of their own income into the policy. Modest regulatory changes could have been made to make it easier for people with pre-existing conditions to get coverage, too.

Yeah, we could have done all that stuff -- but we didn't. In the very next paragraph Ponnuru says:

Neither Republicans nor Democrats, for different reasons, were interested in going down that path when Obamacare was being debated. 

And that's the rub: Republicans never wanted health care reform because it didn't serve their constituents' (hospitals, drug companies, medical device manufacturers, health insurers, the rich) interests. So Democrats took the Republican health care plan from the '90s and passed it by the skin of its teeth.

To repeat for the millionth time: the ACA was the best health care reform plan that could get passed.

1 comment:

Ed Crotty said...

Well put.

"Conservative" folks don't like it because it gives subsidies to folks who are not "deserving". And it gives a small amount of freedom so that folks don't need to stay in awful jobs just to keep insurance.

In conservative world, employers "give" people jobs. A Gift! You should be thankful that someone "gave" you a gift! A Gift generously bestowed upon you!!

In liberal world, workers exchange their labor for money. A transaction. Like buying a toothbrush.