Thursday, January 5, 2017

Obamacare As Bad Slasher Pic

The cliché being that the thing has so many false endings, you never really know when it's over, but Obamacare's demise looks closer than it did before Trump got into office. The Democratic defenders of the law continue to delude themselves about the realities on the ground there, but decreasing numbers of providers (many counties have only one now) and dramatically increasing premiums (around 22-25%, depending on who you listen to) have set in motion real problems that cannot be wished away. Well, they can be wished away, as witness Kevin Drum, one of the bill's big proponents at the time, now a peddler of bizarre counterfactuals that would have been politically impossible at the time. Megan McArdle takes him to task (emboldening all mine):
So “lying” was simply not an option. Neither was “doubling the cost and whacking up the mandate.” Democrats were already having trouble getting their $1 trillion bill passed. This was a bill so unpopular that the state of Massachusetts (!) sent a Republican senator to Congress to stop it.

Let’s stop for a moment and ponder that. It’s common to hear Democratic pundits lament that centrist senators like Ben Nelson and Joe Lieberman held the bill hostage, forcing it to be underpowered to the task and leading to the failures of today. But if Massachusetts balked at signing up for this, then the problem wasn’t just with a few squishy moderates. Had Democrats pushed for a $2 trillion bill with a much larger mandate, as Drum wishes, the issue wouldn’t have been a handful of DINO senators -- it would have been the folks from deep-blue states fleeing for cover ahead of a mob of angry constituents.
Democrats have been running from that mob for three straight Congressional election cycles now, and appear to have learned nothing from it. The most common defense of the bill, one I hear most often from the bill's promoters, essentially amounts to, "I got mine". That is, because the speaker has subsidized insurance (or at times, insurance at all), Obamacare has no perceptible flaws and thus needs no "fixing". I have some sympathy for this position; my autistic brother was ineligible for medical insurance prior to ACA passage, on the bizarre grounds that he had a preexisting condition of some sort that precluded it. (Insofar as I know, autism comes with no other health problems that would make him a bad risk in that way, but the insurers wanted none of him.) So he is one of the "winners" in this game. Ditto Mat Gleason, the retired Angels blogger (and still publisher of Coagula Curatorial), who needed very expensive life-saving heart surgery he could have never afforded otherwise.

But these anecdotal wins are not statistical or electoral wins. By clinging to "I got mine", ACA defenders ignore the real problems the law inflicts on others. This has gone on for a while now; I posted back in August about Sarah Kliff's delusional attempts to woo her way out of that deep well. Well before the late election, Democrats had started to distance themselves from the law:
In October, Minnesota's Democratic governor, Mark Dayton, complained publicly that although the health law had "many good features," it was "no longer affordable to increasing numbers of people." Around the same time, Democratic House Minority Leader Nancy Pelosi, whose determination to pass health care legislation helped push the bill over the congressional finish line in 2010, was asked on Meet the Press about the high price of health insurance premiums under the law. "Let's see how it works, and let's improve it," was her response. She also noted, as she has before, that what she would really "love" is a single-payer system. Just three years before, as the law's coverage expansion kicked in, she had touted it as a path to "more affordability, more accessibility, better-quality care, prevention, wellness, a healthier nation honoring the vows of our founders of life, a healthier life."

Also in October came complaints from former President Bill Clinton about a provision of the law that provides financial assistance to individuals at between 100 and 400 percent of the poverty line. "The people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies," he said at a rally in Michigan. He called the subsidy scheme "crazy" and declared that "it doesn't make sense. The insurance model doesn't work here."
 So, will the Republicans repeal the law? It's not clear; as Peter Suderman writes,
Several GOP legislators said that a provision allowing dependents up to age 26 to stay on their parents' plans would almost certainly be kept. In anonymous interviews, GOP aides suggested that the Medicaid expansion, responsible for much of the law's coverage gains, might also stay in place. And any major rollback that did occur would almost certainly be delayed for a year or two while Republicans tried to put a replacement plan together.
"Sen. Lamar Alexander (R–Tenn.), the chair of the Senate Health, Education, Labor, and Pensions Committee, which would be critical to the development of any real plan, suggested that crafting a detailed alternative would take around six years", which tells you that the political struggles are real within the GOP. The political will to change the law is there, but wholesale repeal is another matter, and unlikely. Sadly, it's the popular features of subsidies and mandated issue that cause the most damage in terms of higher premiums, yet those are the least likely to go away. Stay tuned.


  1. Not that I disagree with your overall conclusions, but it is important to note that the main reason Massachusetts was against Obamacare was because we already had the same basic thing. In fact, the MA state system was a model for the Federal system. However, with higher incomes and a young pop, plus being a thoroughly blue state, and a hub of medicine and medical schools, we could do it quite a bit cheaper and easier.

    We knew that going to a federal system would mean our rates would go up, and our choices would likely go down as we absorbed the rest of the country's risks. Kind of like why England never went to the Euro. Only replace Greece with Oklahoma. :)

  2. By the way, Rob, it is me, Jim Barabe. Not sure if that comes across in the comment. Good blog.

  3. Hi, Jim. I am perpetually skeptical of the narrative of a single cause of action being behind one candidate or another's election, so I imagine you're right. But I have my doubts about the Massachusetts' system's viability as scaled to the other states; in particular, there are problems with having single thresholds for penalties for nonparticipation. But I should also mention that the vastly larger problems (dealt with here) have more to do with supply of medical services than with subsidies and payment.