I railed against Obamacare (officially the Patient Protection and Affordable Care Act) in these pages when it was enacted in 2010.
On the other hand, it really hasn’t had much of a practical impact on me and my family. For just about all my adult life, I’ve had health insurance one way or another. Going without is not an option: a trip to the hospital for almost anything costs tens of thousands of dollars. Many of the features of Obamacare (equal premiums for men and women, no exclusion of pre-existing conditions, etc.) were already the law in New York. I didn’t have a health insurance plan that I was particularly attached to, so it didn’t bother me when the insurance company changed my plan at renewal time to something compliant with the new regulations.
In fact, the only thing I really noticed was that there was a little bit of a lull in premium increases for a couple of years (and even a cut at one point, on changing plans), and then the premiums resumed their skyward march (between about 7% and 22% every year).
In one of my posts, I anticipated that health care might end up swallowing even more of the nation’s GDP than the 17% or so in 2010, but that hasn’t happened: health care as a percentage of GDP has remained steady since Obamacare was enacted.
Nevertheless, although my objections are more philosophical than practical, I still consider Obamacare the worst public policy decision of our time. For years, the Republicans railed against it, and swore they would repeal it, given the chance.
Last week, they tried, and failed. A bill was drawn up, then withdrawn as there were not the votes to pass it.
And now, all sides are engaged in pointless posturing. The Democrats are crowing that they saved Obamacare from the jaws of the Republicans; President Trump is blaming everyone but himself.
But the plan to ‘repeal’ Obamacare was fouled up from the beginning:
- House Speaker Paul Ryan went to great lengths to discuss the process by which Obamacare would be undone, but there was little discussion about what the Republicans would do. (Not coming across anything in the press, I finally had to turn to Wikipedia for a coherent explanation.)
- As a result, the opposition was able to seize the narrative: they’re trying to take your health care away from you!
- The most salient feature of the American Health Care Act was that it dropped the requirements for individuals to carry insurance, and for large employers to make it available to their employees. But many if not most of the people for whom this is an issue have the means and the inclination to secure their own health insurance (whether on their own or through their employers), and would do so even in the absence of a mandate.
- The most toxic features of Obamacare, including the requirements to issue insurance regardless of pre-existing conditions and to allow children to remain on their parents’ policies until halfway to middle age, are the most politically popular, and were taken off the table by President Trump before any of the negotiations started.
Ultimately, it’s on the Republicans to present a compelling alternative to Obamacare, rather than nibbling around the edges. Sadly, I’m not sure that’s possible.
When countries have implemented ‘socialized medicine,’ there have always been limits. Whether they are designed into the program to begin with, or are worked out in implementation, there are necessarily limits, because the resources of even a prosperous nation are finite. But under Obamacare, everyone has the right to health insurance that can, in theory, provide infinite benefits. (After all, one’s health is priceless!) This theory hasn’t been tested yet, but that will come in time. And while Obamacare does admit administrative limitation of benefits, that hasn’t happened yet.
Consequently, the Republicans are in a position where they must compete with the theoretically infinite benefits of Obamacare. They can’t argue that Obamacare is unsustainable, not only because the problems haven’t emerged, but because the whole Federal government, on its present course, is unsustainable. They’re constrained to keep the elements of Obamacare most in need of change because those elements are politically popular. And ultimately, they can’t practically propose to really repeal Obamacare, and they’re stuck with uselessly fussing with it.
At this point, we’ll have to wait until the whole enterprise keels over to try again.