This is the great hidden truth about Obamacare. It was never a program for improved medical coverage. It was a program for redistributing wealth by force from the healthy to the sick. It did this by forcing nonmarket risk pools, countering the whole logic of insurance in the first place, which is supposed to calibrate premiums, risks, and payouts toward mutual profitability. Obamacare imagined that it would be easy to use coercion to undermine the whole point of insurance. It didn’t work.
And so the Trump executive order introduces a slight bit of liberality and choice. And the critics are screaming that this is a disaster in the making. You can’t allow choice! You can’t allow more freedom! You can’t allow producers and consumers to cobble together their own plans! After all, this defeats the point of Obamacare, which is all about forcing people to do things they otherwise would not do!
I chose not to argue that Obamacare was going to collapse and be repealed in its entirety, but rather, that Obamacare would not, and could not, be the program that had been promised or intended. It had already failed to deliver on key promises for coverage, affordability and of course, the infamous promise that “if you like your doctor, you can keep your doctor.” It was also dangerously unstable, requiring steady executive intervention just to keep the program from collapsing. I argued that these executive interventions, enthusiastically supported by the law’s proponents, were setting a precedent that would eventually be used against it. Worried that health care was too hostage to the vicissitudes of the markets, Democrats had instead made it the prisoner of politics.
“Essentially they’ve made it so that Republicans can undo two-thirds of this law with a stroke of the presidential pen,” I said at the close of my opening statement. “Obamacare is now beyond rescue. The administration has destroyed their own law in order to save it.” Four years later, we are watching those dominos fall.
Remember how we ended up with the particular version of Obamacare that became law. Democrats had 60 votes in the Senate, and a growing sense that they were on the verge of a second New Deal. They thought they didn’t need Republicans, and they thought they couldn’t get Republicans, so they made little effort to involve Republicans in drafting, beyond offering token concessions to a handful of liberal Republicans who might have made nice bipartisan window-dressing at the signing ceremony. Republicans, predictably, spent a year talking down the bill, and by the time it was nearing passage, a majority of the public opposed it.
Then Massachusetts — Massachusetts! — sent Republican Scott Brown to Ted Kennedy’s old Senate seat, a phenomenon that was widely (and in my view correctly) put down to a desire to block Obamacare. Rather than saying “if we’ve lost Massachusetts, we’ve lost America,” Democrats rushed a draft version of the bill into law through a parliamentary procedure that obviated the need for Brown’s vote.
This draft bill, unsurprisingly, had problems. It also overhauled almost a fifth of the economy. It also had the implacable hostility of the opposition, and a public that was pretty angry at politicians for passing it. By the end of the year, Democrats had lost control of Congress, and with it, any hope of making all the changes they’d fantasized after they passed the bill and found out what was (and wasn’t) in it.
That put Obama in the nasty situation of presiding over a program that couldn’t work as written, and couldn’t be legislatively altered. So he proceeded with the only avenue open to him: dubious executive measures that temporarily shored up the program, but weakened even further the slim foundation of political legitimacy that held it up. And here we are seven years later, watching as one by one, those supports sway or snap.
And thanks in part to the voter revolt that Obamacare triggered, those powers have now been handed over to a president who doesn’t simply take political legitimacy for granted, but seems actively hostile to it. The scramble to pass and sustain Obama’s signature initiative may have badly hurt the cause: to make the health-care system fairer, broader and more efficient.
If Obamacare dies now, in this way, the country will be worse off than if it had never passed. And I’m not just talking about the growing notion among both parties that the idea of elections is to get into power and exercise whatever power you can, by whatever means you can get away with, until voters take your toys away again.
In the worst-case scenario, large swathes of the country will have “bare” individual markets where everyone will be magnificently equal in their inability to purchase insurance. And the memory of Obamacare staggering onward for years, down a trail of broken promises and underwhelming results, will make voters reluctant to trust any politician who suggests that we embark on another such journey.
Is Obamacare beyond rescue? If not, it could certainly use some. And at this point, it’s hard to see who is going to swoop in to save the day.
The best statistical estimate for the number of lives saved each year by the Affordable Care Act (ACA) is zero. Certainly, there are individuals who have benefited from various of its provisions. But attempts to claim broader effects on public health or thousands of lives saved rely upon extrapolation from past studies that focus on the value of private health insurance. The ACA, however, has expanded coverage through Medicaid, a public program that, according to several studies, has failed to improve health outcomes for recipients. In fact, public health trends since the implementation of the ACA have worsened, with 80,000 more deaths in 2015 than had mortality continued declining during 2014–15 at the rate achieved during 2000–2013.
As the New York Times explains, one way plans can save money is to “make it harder for patients to get care — so that they get less of it. Narrow network plans may do this if they don’t cover enough nearby providers, with the ones they do cover too busy to take new patients in a timely fashion.”
“Clearly this would be especially problematic if appointments with one’s preferred primary-care doctor are hard to obtain,” the story noted.
Which is precisely what’s been going on in ObamaCare. A study published in Health Affairs last year found that just 30% of the “secret shoppers” it enlisted for the study were able to get an appointment with their first pick of doctor through an ObamaCare plan in California.
Despite these narrow networks, insurers still have had to impose substantial deductibles and jack up premiums by double digits, and are still losing money on ObamaCare. Having an ObamaCare card, in other words, is no guarantee that health care will be affordable or high quality.
Would Billy Kimmel have fared as well had his parents been stuck in one of these ObamaCare HMO plans? Maybe, maybe not.
The point is that, even if your goal is to guarantee coverage to everyone with pre-existing conditions, which was Kimmel’s plea, ObamaCare’s approach is clearly not working. It is destabilizing individual insurance markets across the country and providing mediocre insurance benefits to the very people who need it most, and insurance companies continue to bail on the program leaving consumers with little or no choice of plans. It is unsustainable in its current form. There aren’t even many Democrats who would disagree with that.
Republicans think they have a better way to achieve these protections without all of ObamaCare’s adverse side effects; their plan should be judged on those merits, not on emotional appeals from rich celebrities.
I learn from my patients every day about the benefits, limitations and contradictions of their health insurance. One charming 60-year-old with severe seasonal allergies insists on seeing me every few weeks this time of year, even though I tell her she doesn’t need to — her antihistamines and nasal spray treatment rarely changes. But she worries that her allergies could be hiding an infection, so I investigate her sinuses, throat, lungs and ears. I reassure her, and her insurance (which she buys through New York’s Obamacare exchange) covers the bill.
If she was responsible for more than a small co-payment for these visits, I’m sure I would see her less often.
We pride ourselves on being a compassionate society, and insurance companies use this to manipulate us into sharing the costs of other people’s excessive health care. Meanwhile, 5 percent of Americans generate more than 50 percent of health care expenses. Why shouldn’t a patient who continues to see me unnecessarily pay more?
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The government’s job is to maintain public health and safety. It should ensure that insurance plans include mandatory benefits like emergency, epidemic, vaccine and addiction coverage. The Republican bill would let states apply for waivers to define these benefits differently; it would be a big mistake to drop such coverage entirely. But Obamacare went well beyond these essentials, by mandating an overstuffed prix fixe meal filled with benefits like maternity and mental health coverage that drove smaller insurers with fewer options out of the market. The few that remain often have a monopoly, and premiums rise.
Speaking of compassion, how about some for the 20-something construction worker who can’t afford to pay his rent because his premiums help subsidize overusers like my allergy sufferer? Why shouldn’t a patient who is risk-averse pay more for coverage she might never need, while that construction worker be allowed to choose a cheaper insurance plan that might cover only the essentials?
In addition to limiting the menu of essential benefits, the House bill would let states create high-risk pools for patients with pre-existing conditions who had let their insurance coverage lapse, and who could then be charged premiums more in keeping with their health care needs. This is the only way to make insurance affordable for most consumers; pre-existing conditions will continue to drive up premiums if everyone is compelled to pay the same price.
These risk-pool premiums can and should be subsidized by the government. A recent report from the Kaiser Family Foundation found that high-risk pools can work, but have been historically underfunded. Trumpcare should change that — though it will cost more than the House bill’s $8 billion in additional funding. Drastic cuts to Medicaid should also be reversed, which could help the bill pass the Senate.
But the bill is on the right track. Americans believe that insurance provides access to care, when in fact it is the gatekeeper that often denies care. Many think Obamacare is generous, and yet I often have to fight for essential care for my patients. We need to be more pragmatic, and less emotional, about this issue.
Jimmy Kimmel’s contention this week that a child like his would not receive lifesaving surgery for his congenital heart problem without Obamacare may tug at the heartstrings, but it is neither fair nor accurate. Employer-based health insurance, which covers 170 million Americans, including, no doubt, Mr. Kimmel, would have paid for this infant’s needs with or without Obamacare. Even if the Republican plan replaced Obamacare, and even if the infant didn’t have employer-provided insurance, the treatment would still be covered, either through a traditional plan or a high-risk pool. And at the end of the day, a federal law, the Emergency Medical Treatment and Labor Act, guarantees this kind of treatment, whether we have Obamacare or Trumpcare.
The final question concerns the skyrocketing costs of innovation, and how one-size-fits-all insurance can possibly continue to pay for it. My 93-year-old father, a retired engineer, just received a $50,000 catheter-inserted aortic valve, which was covered by Medicare. But if all such high-tech devices are covered, it will be practically impossible for any insurance company not to go belly-up. The tax-free savings accounts that the House bill would expand and make more flexible are a far better way to pay for this kind of care. Shouldn’t my father and those like him be asked to save their own money for just this sort of rainy day?
Or should we continue to overload health insurance with all our fears and expectations?
Contrary to popular belief, ObamaCare was never a healthcare bill. As healthcare, it was designed to fail, and then be replaced by single payer. It was actually an outrageous tax increase. It was designed to pull billions of dollars out of the pockets of the American taxpayer and into the hands of the feds, where it could be spent on all sorts of priorities the Left holds dear,with the side benefit of completely subsidizing healthcare for important Democrat voting groups. It may have dismally failed as healthcare policy, but it definitely succeeded as a money machine for the Obama Administration’s progressive agenda.
Any slander will do in support of Teh Cause.
Update | May 6, 11:30 a.m.: Since I posted this, several other media outlets have investigated the rape-as-preexisting-condition claims and come to similar conclusions as mine. Politifact declared the claim “mostly false,” and The Washington Post—which yesterday morning published an op-ed yesterday perpetuating the rape claim—ran a Fact Checker column today giving it Four Pinnochios. “The notion that AHCA classifies rape or sexual assault as a preexisting condition, or that survivors would be denied coverage, is false,” wrote the Post’s Michelle Ye Hee Lee. In addition, “almost all states (at least 45 to 48) have their own laws protecting survivors of domestic violence and sexual abuse.”
Here are Eight False Premises of The Left. Learn to recognize and counter them, and the argument will flow your way every time (at least until you’re called Hitler, invoking Godwin’s Law). Which false premise of The Left drives you craziest?
1. Mass shootings are on the rise! If we could just get rid of all the guns, people wouldn’t be so violent!
This argument bears all the hallmarks of a False Premise of The Left. Take a crisis, blow it out of proportion, and demand emergency action. Voila! Rights revoked, and everybody feels better! This is the classic argument of the advocates of gun control. This argument presupposes that humans aren’t naturally predisposed toward violence to assert their dominance in a dispute.
In order to defeat this argument, one must know the freely available stats on the rates of violent crime. Every outlet you can find, left-leaning, right-leaning, government stats, whatever is out there — they all show a dramatic drop in violent crime since its peak in the early ’90s. This article from National Review gives a good overview. The upshot is that as funding for police increases, violent crime decreases. About those mass shootings? According to John Lott, France had more deaths from mass shootings in 2015 than the U.S. had in all eight years of the Obama administration. This is not a uniquely American problem, and the frequency of attacks is a mere 0.078 per million people. Statistically, the chance of dying in a mass shooting event is roughly equivalent to dying in a severe weather event. Is it awful? Of course. Should we do more? Absolutely. Should we trample the rights of law-abiding gun owners? What do you think?
2. Police target minorities more for arrest and harassment
The common refrain among Black Lives Matter protesters is that police all across the country are killing our young black men and white America doesn’t care. The movement has been enabled and encouraged, in large part, by white liberal guilt and limousine liberals who rarely care about more than appearing to be sympathetic while not actually socializing with those in lower income tax brackets.
The problem is that this underlying premise is not accurate. If you analyze the FBI data, as self-proclaimed “radical moderate” Clay Travis has done, you come to the clear conclusion that black men are less likely to be shot during arrests than other races. Since black men commit murder and violent crime at about twice the rate of other races, to say that police are unfairly targeting them for arrest is also inaccurate. So before you let a BLM activist browbeat you into submission, remember that the entire movement is based on a false premise of unfair police targeting.
3. The gender pay gap
Women make seventy-seven cents on the dollar compared to men! America is misogynist! The free markets are unfair! That’s why we need Equal Pay Day and action by the president and for the government to make those evil capitalists be more fair!
When one takes into account the different professions towards which women gravitate versus those preferred by men, along with time off taken for family reasons (thereby affecting overall experience levels), it becomes fairly obvious that women simply make different career choices than men, generally speaking — especially younger women 25-34, who make 90% of what men of the same age earn.
4. 97% of scientists believe that man-made global warming is real
The problem with this claim, endlessly spouted by the likes of Barack Obama, John Kerry, Bill Nye, and Al Gore, is that it is 100% bovine fertilizer. It is made up out of whole cloth. The statistic doesn’t exist. One guy named John Cook once published a paper analyzing the available research on climate and determined that 97% of the papers he analyzed said that “the Earth is warming up and human emissions of greenhouse gasses are the main cause.”
Right off the bat, it’s obvious that the premise never even says that the Earth’s warming is “dangerous,” despite the Tweet From On High By The Lightbringer™. Furthermore, if you examine the papers analyzed by the author of the study, there’s no way of knowing how exhaustive his research was, or if he left any papers out that disagreed with his premise. Alex Epstein gave a ton of detail about this in a column at Forbes.
Several of the scientists whose work was included in the 97% study protested that their work was mischaracterized as an endorsement when no such opinion was intended.
5. The rich are getting richer and the poor are getting poorer, proving capitalism is evil
Anyone saying this doesn’t actually understand economics. I’m serious.
Liberals have this consistent weakness of taking a snapshot in time and making it the ultimate definition that serves as their basis of arguments. They use this tactic in all sorts of dynamic, ever-changing systems, like economics, the environment, societal conditions, racial interactions, and many others. Of course, when those dynamic systems inevitably express dynamism and conditions change, the Left is great at moving the goal posts and redefining what injustice means. We solved many of the problems faced by African-Americans in the 20th century. Invent institutional racism and redefine what it means to be bigoted! Predictions around man-made global warming weren’t even close to accurate? Call it climate change! You can see the game they play a mile away.
The gap between rich and poor is a feature of capitalism, not a bug. Capitalism is the ultimate dynamic system — the polar opposite of a command economy. People are constantly making financial decisions, working to increase their pay, and moving up and down the economic spectrum. People in the bottom 20% of income in America live better than the wealthy in most countries across the globe, and within five years, most of those folks are no longer in the bottom 20%. That’s how the free market works.
6. Health care is a human right
The argument has been going on since the early 20th century: “If we can afford to go to war around the globe, we can afford to provide health care to all Americans. Health care is a human right. Nobody should be denied care.”
Admittedly, these are powerful arguments that are difficult to overcome. The emotions involved can sway us away from the logic of the situation. The mistake made by those advancing this argument is a fundamental misunderstanding of what the United States Constitution and the Declaration of Independence are all about. They clearly spell out, for the first time in human history, that human rights are innate. Rights are not, and cannot, be granted by the state. The foundation of America is a direct result of the state — in our case, England — taking away the right to assembly, the right to free speech, the right to practice our religion freely, and other usurpations.
Any American is free to pursue whatever health care strategy they choose. The problem comes when the federal government mandates that we buy a product, thus paying into a system so that others can be subsidized. This is not the state providing a right, this is mere theft. In any event, the free market works much better than any interference by government, just like with any other product bought freely on the market.
7. If we took the time to understand the demands of terrorists, we could stop them
Leftists often take a sympathetic approach to terrorists, believing that the evils of the West and the economic exploitation of free markets are what spur radicalization. Noted geopolitics expert Bill Nye has said as much: “It’s very reasonable that the recent trouble in Paris is a result of climate change.” Leftists will twist themselves into endless knots to blame Western culture for the terrorism they believe we’ve brought on ourselves. They blame unemployment, capitalist economic exploitation, globalization, and marginalization where a political solution is not available.
Just one problem: That’s all poppycock. There are plenty of examples of terrorists having been fully integrated into Western culture, some with affluent positions such as doctor or Army psychologist, only to re-radicalize later. There is no correlation, despite what the Left wants us to believe, that it has to do with anything but their own interpretation of Islam. To say otherwise is to try to apply political correctness to a situation that patently disproves any truth to the PC orthodoxy.
8. Planned Parenthood and PBS need public funding
Leftists often defend the funding of these programs with a mixture of straw man arguments and misdirections. When asked if the federal government should fund these programs, they’ll say they are vital to the American cultural experience, while cutting them would not balance the budget or fix our national debt. They often throw out the notion that if these federal programs were eliminated, people in rural areas would suffer without media options, without access to women’s health care, and without art.
Now, the idea that a small spending cut is not progress because it’s small, is, of course, absurd on its face. The federal government is way too big and involved in way too many aspects of our lives. We should seek out every opportunity to shrink the leviathan. On the other hand, Planned Parenthood’s budget has already been enhanced by several hundred million in private donations on the mere rumor of its federal funding being cut. If taxpayers — a large proportion of whom vehemently oppose the Planned Parenthood mission — are no longer on the hook for their funding, Planned Parenthood will survive just fine on fundraising drives.
In the case of PBS, far from killing Big Bird, we’ve already seen a free market solution to this supposed problem. Big Bird is on HBO now. So the idea that we’d be killing educational programming is ridiculous. There are dozens of cable channels dedicated to children’s educational programming. The free market, once again, rides to the rescue.