Making the case against the case for Obamacare

Last updated on: September 27, 2013 at 9:08 am by Jane the Actuary

Making the case against the case for Obamacare 2013-09-27T09:08:00-06:00 Jane the Actuary

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Yes, usually, the phrasing would be simply “making the case against Obamacare.” Why have I chosen the convoluted title above?

Because the anti-Obamacare pundits, as far as I can see, aren’t really trying to react to the claims of its supporters. They point to the new opportunities for healthcare coverage, and the subsidies that will reduce costs for people with lower incomes and larger families. Complaints of cost increases for those not cushioned by subsidies are met with disdain — they merit no more regard than people who complain about high taxes; if you can afford it, you should pay your fair share. And complaints about overall impact on the health system produce the response that it’s uncaring to complain about the small details when the bigger picture is the alleviation of the misery of the uninsured.

By “they” — the “supporters of Obamacare” — I’m not simply referring to the latest speech that Obama, or Pelosi or Reid gave. I’m referring to newspaper coverage, which is really ramping up into a targeted campaign in support of the program, citing the most favorable figures of affordable, net of subsidy, figures.

And the line in multiple newspaper columns is that, once Obamacare is implemented, all the bumps in the road will be forgotten, but prying the subsidies away from voters will be no more possible than any other cuts to major entitlement programs.

So, look, first of all, complaints that Obamacare will increase the demand for doctors, and people won’t be able to find a doctor accepting new patients because of that just sound petty. That’s an “I’ve got mine” approach that is thoroughly unpersuasive. Emphasizing the small size of the networks insurers are providing on the exchanges really isn’t going to get anywhere either — at least not as long as people can still continue to buy individual coverage through an insurance agent (which I understand is the case), for those who use the exchanges, subsidized coverage with a smaller network is better than full-price coverage with a large network. (And it’s not clear to me yet what the final outcome of the small networks will be — are these the doctors having difficultly building up their practices so they’ll accept lower reimbursements, or is there more going on?)

But anti-Obamacare-ites really have got to have a clear message — something like this:

Fellow citizens, here are the problems with Obamacare:

First, the subsidies, while great for the individuals who receive them, are ultimately, a major new spending program that the federal government can ill-afford. It’s supporters played budget tricks and instituted lots of hidden taxes to make it seem free, but there is no free lunch. (Yeah, I know, my Vouchercare involves even more government spending, but done so honestly, without tricks but openly increasing taxes to fund it.)

Second, the entire structure is full of cut-offs and breakpoints and thresholds which can be incredibly destructive. If you’re income’s at 400% of poverty, you get a subsidy. 401% — nothing. If you employ someone 30 hours, you’re required to provide healthcare, 29 hours, not. Or, as a blog the other day (don’t remember where any longer) pointed out, if you’re married, your subsidies are significantly lower than if you’ve just shacked up.

Third, the entire system is too full of regulation and control by the government by its very nature. The exchanges suck up too much information, putting people at risk of identity fraud. Electronic medical records imperil medical privacy. Government determinations of acceptable coverage (maximum allowed deductibles, which “preventive care” services are covered with no out-of-pocket cost and which not, etc.) increase costs.

OK, I just typed that up without too much effort so it’s not very persuasive — but my continual irritation is that our elected GOP leadership, while opposing Obamacare, just isn’t making a coherent case, nor coming up with a coherent plan, despite years to make such a plan rather than 15 minutes. “Defund” or “delay” isn’t really going to do much but repeat the same battles and you know how that’s going to be covered in the papers. There has to be a systematic repair plan offered to the Democrats as a way of saving face, in order to move forward — something that says, “if you like the exchanges, you can keep them,” for instance. A more honest way of providing premium support. (But please, not the idea of 2,500/5,000 tax credits that’s continually trotted out! Having a single flat benefit for single people of all ages and health conditions, and another for all married people/families shows that there’s been no serious thought to the proposal!) Instead of an ongoing “no pre-existing conditions” rule, a “grace period” at the start of implementation, and a “continuous coverage rule” covering group and individual plans.

Maybe, maybe the Republicans have such a plan — but I haven’t seen it, and I follow the relevant blogs and news sites pretty regularly. Oh, sure, I’ve read claims that they do have a plan, but it turns out to be nonsense like “buy insurance across state lines.”

And this is where I get really frustrated at the fact that there is no way for a private citizen without political connections to do any more than, well, write an irritated blog post before starting work for the day!

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