Thursday, March 26, 2015

ObamaScare

My grandfather was an insurance guy. He married his secretary, my grandmother and they moved around a lot on behalf of one of the insurance behemoths. My own foray into insurance was as a third grader selling policies to my parents friends for their pets. We stumbled across one of my “invoices” a few years back where I wrote a cover note congratulating this person on insuring their cat with me – because cats had 9 lives so I’d never have to pay out.  March 23, 2015 marked the fifth anniversary of the Affordable Care Act – dubbed ObamaCare. It’s an act that has almost as many lives as the cats I used to insure.

Some 60 times since the Act was signed into law (which works out to an average of once a month) Congress has voted some sort of repeal. In their FY16 budget proposal the defunding of the program is proposed again. The Act has survived.

The Supreme Court took up a case and, against most people’s expectation, ruled in the Acts favor. Another case is pending and a ruling is expected in several months which will determine the viability of the key funding part of the Act.

Who is most responsible for ObamaCare? Mitt Romney. Not because most of the provisions of the Act replicate his health plan instituted in Massachusetts where he was Governor. In May 2007 in his quest for the Presidency Romney co-opted the name Obama’s opponents were using by saying: “If the Democrats do it, it will be socialized medicine; it'll be government-managed care. It'll be what's known as Hillarycare or Barack Obamacare, or whatever you want to call it.” To this day most people who oppose the program do so because they think the government runs it. The narrative around FY16's budget is not having government run your healthcare. 

The Affordable Care Act is an insurance program. It’s not a healthcare program. A healthcare program is Medicare or Medicaid which allows patients to see medical professionals. The ACA/ObamaCare requires people to get insurance or pay a fine. The idea is if people have insurance then they would have more likely access to seeing medical professionals. There’s a lot of pro’s and con’s to the concept – but that’s what the law is. It’s not socialized medicine.

The number of uninsured has dropped from 18% in 2013 to 13.4% in 2014. Stocks for Healthcare companies were up 52% in 2013. For that same year Forbes reports that profits in the industry remain high and constant. The cost of healthcare jumped after the Act’s passage but has remained a steady 17.9% of the GDP for several years though the inflation rate of medical costs has plummeted to 3.9% - nearly half what it was prior to the Act.

Those statistics support the idea that the stated goals for the Act – to provide people with insurance, stabilize costs and keep the private insurance market competitive – all seem to be on track. The funding mechanism to support the cost of the program hasn't kicked in. Still, there’s a lot of vitriol about the Act even though it’s performing as intended. I remain opposed to it.


Healthcare is one issue where I deviate from the Libertarian philosophical ideals I usually favor. Conceptually I agree that having a competitive market without government regulations and interference should produce a vibrant, effective and low-cost model for healthcare. The United States will never be able to go back and re-establish that model…so it’s a nice idea that’s not practical. The hybrid that exists today is just terrible. It may be incrementally better than what preceded it by providing access for more people – but it’s still an industry driven by something other than its core purpose – which is providing for healthy human beings.

Let’s get the insurance companies out of the day-to-day business of healthcare. Medicare for All. Fund the program through continued payroll deductions for employees and employers with no caps. Establish core services that the system covers. There will always need to be limitations of services. That’s where insurance companies can find a new niche market. For the person who wants a cosmetic or non medically necessary procedure – insurance companies can build financing models around that.

Most industrialized countries other than the U.S. have a single payer system because they recognize that keeping their citizens healthy isn’t a business, it’s a right. Only in the U.S. – whether under the Affordable Care Act or not – is your health, well being and care determined by your ability to pay. That’s ObamaScare – a chilling view of how to care of its people. 

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