Obamacare Reality vs Partisan Bombthrowing


The nature of our political discourse these days, unfortunately, is that everything must be painted in black and white. Obamacare is either a panacea or a total failure. Jonathan Cohn at the New Republic calls out such simplistic reasoning by pointing out that it’s going to be good for some people and bad for others.

RULE #4: ACKNOWLEDGE COMPLEXITY AND TRADE-OFFS.

The Affordable Care Act’s critics say premiums for people buying coverage on their own will actually increase. That’s true. The law’s defenders say tax credits offset the cost for many and probably most of those people. That’s also true. The law’s critics say some people will lose coverage from employers and won’t be happy about it. That’s true. The law’s defenders say most of those people will be better off, because they’ll be low-wage earners getting subsidies on the exchanges or they’ll be older workers who had stayed working because, previously, it was their only way to get benefits. That’s also true.

You may notice a theme here. Obamacare sets in motion all kinds of changes. They will typically affect different people in different ways—creating winners, losers, and all sorts of people in between. Are there more winners than losers? How much worse off are the losers? Those are the kinds of questions we need to answer if we want to make a judgment about the law. And the answers are rarely simple.

The other day on Facebook someone noted that Ezra Klein may be leaving the Washington Post and the first comment on that status update said, “Good. He’s been slamming Obamacare.” This is a perfect example of how partisan reasoning overrides rational analysis. Klein is one of the very best policy wonks we have and he generally avoids such simplistic tribalism, which means he is capable of acknowledging reality even when it may not favor the political side he belongs to.

Obamacare has been a great thing for me. I’m saving over $130 a month and getting much, much better health insurance. But I’m self-employed with preexisting conditions, which most others are not. Others may well see their premiums go up. There is no utopia here, every policy has tradeoffs.

Comments

  1. says

    Has anyone else noticed that, when you provide a nuanced, rational analysis of x instead of saying “go x!” or “x can fuck off,” you’re immediately dismissed as a “concern troll?” That’s by far my least favorite internet-ism.

  2. raven says

    1. Obamacare is a minor tweak to our already kludged together health care system. They are aiming for 7 million enrolled in 2014. Out of a popualtion of 317 million, this isn’t much.

    2. The CBO is estimating it will save the feds $20 billion a year. The ACA will cost money. It will also save money. By some maneuver I’m not clear on, they have it extending Medicare solvency for 8 years to around 2030.

    3. The feds were aiming for 7 million enrolled the first year. They already have 6 million enrolled. It looks like it will be a success.

    4. This is despite a huge amount of active sabotage by the GOP/Tea Party. Endless lies and passing laws prohibiting people from helping other people from signing up. In some states, I would now be a criminal for helping an old friend sign up for Obamacare. Fuck you Texas, Florida, and Ohio.

    5. The rollout was a fiasco. Predictable. They should have started a year ahead instead of 3 months and expected huge problems. This always happens in these new programs.

    But that is a transient problem and fixable. In a year or two, no one will care.

  3. jamessweet says

    Yeah. As a plan for getting everyone insured, Obamacare is mediocre at best. Maybe even a little worse than that. The fact that it is a plan for getting (nearly) everyone insured is really important, though. Once people get used to the status quo of (nearly) every American having adequate health coverage, two things will happen: 1) it will become politically untenable to support a return to a pre-2014 configuration, and 2) it will start to become more acceptable among Democrats to acknowledge just how shitty Obamacare is compared to other possibilities.

  4. Michael Heath says

    Jonathan Cohn writes:

    The Affordable Care Act’s critics say premiums for people buying coverage on their own will actually increase. That’s true. The law’s defenders say tax credits offset the cost for many and probably most of those people. That’s also true.

    This reminds of the debate on tax rates. The rich argue we need to cut the corporate income tax because it’s so high, avoiding or denying the fact the effective rate of taxation is very low and therefore that stated rate is effectively irrelevant* when it comes to addressing the impacted factors (revenue, change in growth rates).

    Liberals like to point to how high personal income tax rates were in the Eisenhower years for top earners as if that’s evidence we can bear a higher marginal rate at the top end now, where they also fail compare the effective rate of that time to the projected effective if they were able to raise current rates.

    Ed reports:

    The other day on Facebook someone noted that Ezra Klein may be leaving the Washington Post and the first comment on that status update said, “Good. He’s been slamming Obamacare.”

    Yes Virginia, there’s tribalists in the liberal movement just like the conservative one.

    Ezra Klein’s arguments played a key role in my understanding Obamacare and energetically supporting the initiative (with my time and my money). Given econ classes I took in the late-1980s coupled with my observations on how the U.S. was becoming less economically viable and less competitive globally when I worked for some global tech companies, I’ve long been on-board to reform healthcare financing. That’s because U.S. healthcare financing been a known market failure since at least the 1980s, and rapidly getting worse. Some of the biggest promoters of capitalism are also the most ignorant on how to successfully operate a capitalistic approach to the market.

    *Even when budgeting the stated rate is effectively irrelevant. I was occasionally chartered with doing some what-ifs when I worked in corporate American where we never used the stated corporate rate. IIRC. the finance dept. mostly expected us to use 17% as the effective rate. All other analyses I reviewed used a similar assumption.

  5. says

    It’s a cobble built in a cobbled together healthcare system (Medicaid, Medicare, Tricare, employer-provided & individual market) that expands part of the cobble (Medicaid) and was designed specifically to support, not replace, an existing but badly broken area (individual market) by raising standards (minimizing the “catastrophic coverage” that didn’t cover catastrophes), creating transparency (public exchanges), improving fairness (cost disparity for similar coverage between the sexes, for example), improving access (subsidies) and stopping being banned for “pre-existing conditions” (which hit more and more people every year), “bending the cost curve” (helping hospitals with paperwork, reducing overpayments to Medicare, cutting the Free Rider problem, and the CFPB) and paying for the whole thing (scattered taxes and the Individual Mandate).
    And on top of this were the Republicans (who can’t agree with Democrats), the Democrats (who can’t agree with Democrats), lobbyists from all sides (each arguing that they should get all the benefits and other companies should get all the taxes), and a FoxNews-sponsored populist uprising that forgot populists punch up not down.

    In short, it tries to repair part of a system that was failing, and was failing badly (see: recissions), and along the way it tries to improve other areas (less future, unnecessary, Medicare spending, increasing access, etc), too. It’s the kind of middle-of-the-road Act that, in a rational world, would be controversial only in that it didn’t go far enough.

  6. thascius says

    Not to mention some of the “horror stories” people have related to me personally about how terrible Obamacare is have been things like their premiums going up, their company changing providers or dropping healthcare coverage altogether, things that companies were doing all the time long before healthcare reform came about, but if it happens this year it’s all because of Obamacare.

  7. says

    My position doesn’t qualify for health care(part timers get it, but I’m contingent, no guaranteed hours so I don’t get crap). Obamacare has been quite good to me.

    I just hope we get some sensible elections this year, and congress looks at places where people fell through the cracks of the reform, and fixes those spots up to make the reform a more consistent good for all people.

    I have doubts. Politicians like grand gestures that get their names in the news, not the tweaks that laws actually need. They’d rather toss out a mostly working law to put in another mostly working law than fix what we have and make it work completely.

  8. felidae says

    I am one of those people whose plan was cancelled, so I was forced to change from the choice of one crappy, costly plan (a state high risk pool due to my preexisting conditions) to a bewildering array of 33 plan choices, most of which, before the subsidy, offered better coverage at a lower price. With the subsidy, my health insurance drops from $720 to $136 which is important because I am living on Social Security and trying to make it to Medicare age without going broke. Yes, Obamacare is a rickety, complicated, imperfect system but that is a consequence of our fucked-up political system. I seems the people with no viable options for fixing our health care are the ones making the most noise. Also,can any of these GOP assholes explain to me what the fuck “patient centered healthcare” is, other than a Frank Luntz focus tested buzzword?

  9. says

    felidae “Also,can any of these GOP assholes explain to me what the fuck “patient centered healthcare” is”
    That’s where the (deregulated) insurance industry and (deregulated) hospital monopoly gather around you, centered around your wallet.

  10. says

    I’m one of those people negatively affected by right wing sabotage of the ACA. I live in Florida so the republican controlled state government has bravely defended me from the Medicare extension.

    As a result I make too much money to get Medicare and not enough to qualify for subsidies. This makes healthcare cost about 20-30% of my current yearly income.

  11. says

    Alareth, by turning down the Medicaid expansion they’re protecting you from the Big Government spending that they’d have to raise taxes to pay for, if the Feds weren’t paying for it, and if Florida was a “have” state that sends more to DC than it gets back.

    You should be glad that your state government respects you so much that it’s willing to sacrifice making your life a little better to save people in states that aren’t even yours (ironically, probably a Blue state), people that your state government hates (hello, New York!) a smidge of taxes.

    Didn’t you know by “Small Government” they meant “Not you”?

  12. says

    I’m on the VA and will be on Medicare in 10 months or so. I get my meds for free and I get my healthcare with no co-pays, but… I have to go about 40 miles to a hospital for anything other than blood work and basic health checks. You know what? I’m good with that.

    You know what I hate?

    I hate that Modusoperandi is so damned funny when he’s doing snark and so eminently sensible when he’s being serious. For GOD’s sake, man, PLEASE, just one or the other!!

  13. Ichthyic says

    For GOD’s sake, man, PLEASE, just one or the other!!

    seconded.

    sometimes razor wit is not appropriate.

  14. billyeager says

    Under the ‘Affordable Care Act’, do you still have to pay a percentage of the healthcare costs, I believe you call Copay?

    Because, if you do, you are all being so screwed over by the medical services industry it would be hilarious if it weren’t so tragic. Every ‘copay’ amount I hear being quoted by American friends of mine they have paid as part of their ‘share’ of a prescription cost or for medical treatment is generally in excess of what I pay for the entire cost of private prescriptions and treatment in the European country I live in, that I pay entirely out of my own pocket, without insurance.

  15. says

    @14:

    Putting on my Gene Wilder persona.

    I was KIDDING, it was a JOKE, I’m such a KIDDER.

    “democommie, you’re not the boss of me.”

    WTF! You didn’t get the memo? Great, now I have NO direct reports!

  16. dogmeat says

    Raven @2

    5. The rollout was a fiasco. Predictable. They should have started a year ahead instead of 3 months and expected huge problems. This always happens in these new programs.

    Raven,

    To be fair, they did stagger the rollout and part of the problem involved the state insurance exchanges that were intentionally eliminated by Republican legislatures and governors. While there would have been problems with the ACA website regardless, the problems were magnified by at least a factor of 10 by those states that flatly refused to set up their own exchanges. New York and California set up exchanges, incorporated major portions of the ACA with few problems. Massachusetts already had its own version, again few, if any, problems. I don’t know that any of the so called “red states” created their own exchanges; on top of that many erstwhile blue states currently have Republican legislatures or governors (WI & PA prime examples), and they too went out of their way to avoid participating in the implementation. Put it all together and you have the fiasco that was the ACA website.

    James @ 3

    2) it will start to become more acceptable among Democrats to acknowledge just how shitty Obamacare is compared to other possibilities.

    Other than supporting the administration and the legislation that they manged to pass, are there that many Democrats that argue that the ACA is anything more than a temporary solution prior to a more effective response to health care? Isn’t a public option or universal coverage still generally the goal of the Democratic party?

  17. Michael Heath says

    dogmeat writes:

    Isn’t a public option or universal coverage still generally the goal of the Democratic party?

    The public option certainly enjoyed majority support from Democrats, but whatever momentum it had prior to the passage of Obamacare has since died down. I think time will tell regarding future support based on how the current insurance providers perform.

    Universal coverage is a stated goal of Obamacare. The major impediment now is that some of the predominately confederate states are refusing 5 million people access to Medicaid, 1 million of whom live in Texas. The second impediment is conservatives energetically lobbying that people do not secure health insurance, especially young people who are so necessary to better controlling the cost curve. The latter in an era where young people are increasingly denied insurance from their employers.

    I just signed-up with Blue Cross Blue Shield of Michigan. In some ways they’ve already been a kind of public option for many years now (they’re a non-profit). One reason I picked them was for the same motivation I supported a public option. I trust the government far more than I do for-profit health insurance companies, for reasons the latter repeatedly earned over four decades. (I include employees of mine that were also screwed by health insurance providers). BCBSM isn’t the government, but the closest thing to it in MI.

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