Obamacare: one more time

I have an unfortunate addiction to the Sunday morning talk shows, especially This Week with George Stephanopoulos, which I remember fondly from its beginnings, when the wry, sardonic David Brinkley hosted.  Stephanopoulos is a good host–a tough interviewer, mostly–and he sometimes books interesting guests, but still, it’s a show for Washington insiders, an hour on Sunday mornings dispensing Beltway wisdom. Everything’s political, everything’s hyperbolic, and everything’s short sighted.  And the vaunted roundtable–that exercise in meaninglessness where five or six journalists and opinion-makers, carefully balanced ideologically, shout at each other.  Blarg. Don’t know why I watch it, but I do.

Anyway, President Obama’s Presidency is over, apparently; a total disaster. His approval ratings are at their lowest ebb, and his signature achievement, the Affordable Care Act is seriously flawed.  The roll-out went badly, the website doesn’t work, plus, he lied about it. (Which, by the way, he didn’t. I even said he did earlier in this blog.  I was wrong.)  Liar, liar, pants on fire: the ACA fiasco is (I’m not kidding, there are people saying this) Obama’s Katrina.

Katrina.  As in Hurricane Katrina. A natural disaster, where the federal response was so horrifically incompetent that hospitals in New Orleans were forced to triage which of their patients they were going to euthanize. So we’re to equate the launching of a somewhat buggy government website with that?  Ah, but it makes sense; Katrina lowered Bush’s approval ratings and the ACA rollout lowered Obama’s: equivalence!

But here’s the thing.  Obamacare is the central issue in American domestic politics right now.  That’s pretty sad, when you come to think of it, given how many other really really important issues there are, like, oh, education, welfare, immigration, global warming and environmental issues related thereunto, gun violence, incarceration reform, the penal code, infrastructure repair and modernization, transportation, unemployment, racial polarization, income disparity, unionization and labor issues, and the national debt. But no, none of that matters; it’s Obamacare!  Worse than slavery!  Equal to the Holocaust!  Or so our Republican friends would have us believe.

So the House of Representatives has passed something north of 50 bills canceling Obamacare, none of which has ever even come to a floor vote in the Senate, and none of which ever will be, quite properly.  Nothing in the Constitution requires either House or Senate to actually vote on silly symbolic bills originating in the other chamber.

But here’s the thing.  Obamacare is either going to work, or its not going to work.  The healthcare.gov website got off to a bad start; it’s either going to get fixed or it’s not.  The ACA is either going to help people, or it’s not.  Which means this: if the ACA works, it’s going to be good for Democrats, and if it fails, that’s going to help Republicans.

There’s going to be an election in 2014, midterm elections for Congress, and those elections are either going to be ‘won’ by Democrats or by Republicans. And since Republicans have made so much noise about Obamacare, their electoral success is tied directly to the success or failure of that program.

And it’s going to work. It’s already getting fixed, and it’s going to work fine.  Here’s some evidence:

Kentucky decided to set up its own health care exchange and not participate in the national exchange (something the ACA not only allows, but encourages).  It’s called Kynect.  This story in the Washington Post shows how it’s going: brilliantly.  In fact, it’s quite remarkable, to read about dirt-poor rural folk with serious health problems who suddenly, for the first time in their lives, can afford to see a doctor.  Fifteen percent of Kentucky residents–around 600,000 people–had no health insurance.  So far, over 50,000 of them have signed up, with four more months left to sign the rest of them up.

In California, same story.  They went with their own exchange, and after a slow start, they’re seeing 10, 000 people a day sign up.  And costs are quite a bit lower than projected.

Long-term, how does it work?  The best comparison to Obamacare is still Romneycare, in Massachusetts.  This article gives a pretty balanced and reasonable assessment of the Romneycare experiment: it worked pretty well.  A lot more people got insurance, and most health metrics improved.  Fewer sick people, better health outcomes.  Costs were reasonable, and affordable.  Some people figured out ways to game the system–inevitably.  Certainly voices that say that Obamacare is going to be economically catastrophic have little support for that view based on Massachusetts.

And how’s this for anecdotal evidence: it’s worked great for John Boehner. Yep: the Speaker of the House of Representatives.  He decided to get rid of his government provided health care plan, and get insurance via Obamacare.  In various interviews, he talked about how hard it was for him to navigate the healthcare.gov website; how he kept getting error messages. It turned out that while he was giving an interview complaining about it, a representative from healthcare.gov was waiting on hold, having called him to see if he could fix the problem.  And waited for 45 minutes.  Finally, though, the Speaker got through, and it turns out that his Obamacare policy is going to cost him more than he was paying via his government policy.

Sixteen dollars more a month.

Okay, so it cost more.  But his government policy (something called FEHBP) was a group policy, specifically designed for government employees.  You’ll need to see the linked story above for details, but his FEHBP insurance policy was very heavily subsidized by the federal government.  The bottom line is that a 64 year old smoker was able to get a first-rate insurance policy, for $433 a month. So how much would an equivalent policy have cost in the bad ‘ol pre-ACA days?  My guess is that he wouldn’t have been insurable, not at all, not by anyone.  Or the only insurance options available would have been insanely expensive.  But the fact is, insurance companies weren’t exactly racing to insure 64 year old smokers in high stress jobs.  And now they are insuring people like Boehner. Because they have to.

Next fall, there’s going to be a national election, and the big issue will be Obamacare, and everything will depend on whether or not the ACA works, whether or not the healthcare.gov website works.  And the website is working a lot better now, and will continue to improve.  And the best evidence from the states shows that the health exchanges likewise work really well.

And that’s why I predict that in the 2016 Presidential race, Republicans won’t have any interest in Obamacare as an issue.  Because by then, it will be working pretty well.  Not perfectly, because nothing invented by man works perfectly.  But well enough.  It’s not a great law, but it is a pretty good law; it’s going to help a lot of people, and it’s going to save a lot of lives.

Or not. But right now, most of the evidence is trending towards the ACA working.  Glitchy websites get fixed.  And sick people have a much better chance of getting well.  Something to root for.





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