The Obamacare Trainwreck

While freshman congressmen vote – yet again – to weaken or eliminate Obamacare, the news was actually quite good yesterday.

Good in a “it’s not Medicare-for-all, but it’s a vast improvement over the status quo” sort of way.

Yesterday, New York State revealed that rates for individual health insurance plans will plummet by over 50% next year, thanks to Obamacare. These are the “exchanges” you’ve been hearing about. If you can’t afford a plan, there will be a sliding scale of federal subsidies to help you pay for it. Why? Because it is far cheaper for the government to subsidize health insurance plans than to reimburse municipalities for unpaid bills resulting from uninsured people using the emergency room as a primary care facility. In the long run, prevention is cheaper than dealing with acute problems.

About 40 – 50 million Americans remain uninsured, and caring for their emergencies is something that we all subsidize. Our healthcare system is the most expensive in the world, and gets results that have plenty of room for improvement. For instance, Canada – with its socialized single-payer system – has lower maternal mortality than the US. Canada also spends a bit more than half on health care per capita than the US.

We’ll let Professor Krugman explain why this is going to work – and work spectacularly well.

To understand what’s happening in New York, you have to start with what almost everyone at least pretends to believe: Americans shouldn’t find it impossible to get health insurance because of pre-existing conditions that aren’t their fault. Two decades ago, New York tried to deal with this by imposing community rating: insurance is available to everyone, and the price doesn’t depend on your medical history.

The problem was that this created a death spiral: young, healthy people didn’t buy insurance, worsening the risk pool, driving up premiums, driving out more relatively healthy people, etc., until you were left with a rump of very ill people paying very high rates.

How do you deal with this? Well, ideally, Medicare for all. But since that wasn’t going to happen, you improve the risk pool by requiring everyone to buy insurance — the individual mandate. And since some people won’t be able to afford that, you also offer subsidies. Voila! ObamaRomneycare!

Where does the money for the subsidies come from? Partly by reducing corporate welfare: reducing overpayments for Medicare Advantage, reducing tax breaks for very generous insurance plans; partly with new taxes on the wealthy.

And while a few people will be hurt — young, healthy individuals too affluent to qualify for subsidies, wealthy taxpayers, etc. — a much larger number of people will be helped, some of them enormously.

Does this amount to “redistribution”? Well, yes — not as an end in itself, but yes, a lot of people will be made better off at the expense of an affluent few.

The reason why Obamacare will be popular? People who are happy will stay happy, while people who are uninsured will become happy with their new coverage.

Implementation won’t much affect the 78 percent of Americans currently covered through Medicaid, Medicare, or employer group health plans,” and among the remaining 22 percent, the predominant effect will be to get some subsidized health insurance.

Because the Obama administration decided to postpone the employer mandate for health insurance on businesses with over 50 full time (over 30 hrs/week) workers, congressional Republicans – who have a pathological, partisan, political vested interest in the failure of universal health insurance – voted yesterday to delay the implementation of the individual health insurance mandate, which is Obamacare’s quid for the insurers’ pro quo of guaranteed coverage for people with pre-existing conditions. That mandate is why rates are going down in New York next year.

Among the people voting to postpone affordable insurance for millions of Americans was Chris Collins (NY-27), who has taken it upon himself as a clout-free congressional freshman to demonize Obamacare at every step.

The failure of Obamacare is a particularly acute need for Collins because he believes that he defeated Kathy Hochul on that issue alone. If the people in the 27th district suddenly have access to cheap, subsidized, quality health insurance, and discover that Obamacare isn’t the Stalinist Kenyan train wreck Collins has sold, they may very well turn on him and demand to know what his problem is.

Collins constantly talks about all the people who write to him, explaining that they will lose their hours at work thanks to Obamcare’s employer mandate. So, if he’s so concerned about these people, why doesn’t he sponsor legislation to protect those workers from that sort of thing? Could you imagine? Chris Collins sponsoring a worker protection law? I know, it’s a ridiculous notion because Collins exists only to protect business owners and the very wealthy. The idea of individual people having the government meet a need that private industry can’t or won’t is anathema to Collins and his conservative cohorts.

So, you’ll see Collins and other congressional Republicans constantly refer to Obamacare as a “trainwreck”, a catchphrase likely forged by Frank Luntz in the fires of Mount Doom. When Obamacare is implemented, and people begin to benefit from it, the conservatives will be exposed for the lying frauds they are.

The best part about this is that Republicans are so short-sighted and beholden to political expediency that they don’t realize that their constant “trainwreck” language is lowering the public’s expectations of Obamacare. If they are made to think it’s a disaster, and it doesn’t become a disaster, they’ll all look like idiot chicken littles.

Medicare Part D and the Children’s Health Insurance Program … got through their rocky implementations in large part because benefits obtained with bureaucratic difficulty are better than no benefits at all. He’s right, and this is why conservatives are “magnanimously” offering to delay implementation of Obamacare. They realize that once people have guaranteed access to health coverage, they won’t want to give it up, even if there are implementation problems.

The political landscape is already dire for those who still hope to repeal Obamacare, and they’re actually making their position worse by talking constantly about what a nightmare implementation is going to be. This fall, as the exchanges come on line, tens of millions of people are going to find they can get health coverage they never could before. They are likely to be quite happy about that, especially if they’ve been hearing for months in advance that it will be a mess.

So, when Obamacare is implemented and people are happy about it, I hope the voters take Collins’ scare tactics and throw them back in his face.

As an aside, I have asked Collins and his people numerous times in various media whether he holds health insurance through the federal government for himself and his family. I will conclude from the deafening silence that he does, and that excellent, federally subsidized health insurance is something to which he and his family are entitled – but you and I are not.

Not only that, but he will work tirelessly to prevent you and me from being guaranteed quality health insurance. Who goes into public service to screw the public?