No Repeal

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  A bill was drawn up, then withdrawn as there were not the votes to pass it.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.

9 thoughts on “No Repeal”

  1. Colorado had a ballot proposal last year to start a single-payer health care plan for Coloradans that would have cost 10% of payroll plus 10% of interest and capital gains. It went down by at least a 3:1 margin for several reasons, among them the lack of an opt-out for people who had employer-provided health insurance, no clear information about how we would be covered outside of Colorado, lack of a guarantee that it would not cost more than 10% of payroll, and if you were retired, you would pay the full 10%. Otherwise, the split was 7% employer, 3% employee. We are used to paying a flat rate for health insurance that is not linked to income. Had it passed, I’d be on the hook for about $6000 per year and get back at most a $250 deducible, because I have health insurance as a federal retiree that costs about $125 per month.

    As I dug further into the proposal, I used Medicare as a basis for comparison. There are about 3 people paying Medicare tax for every Medicare recipient, so add the 3 times 2.9% that they are paying to whatever the Medicare recipients are paying in premiums, which do have a small income-based rate determination, and I came up with about 10% of payroll/income for Parts A (hospital) and Part B (doctors) coverage, leaving out Part D (prescription drugs). This amount is overstated somewhat because I believe that part of the Medicare tax goes to support Medicaid. This led me to believe that for someone who had no other coverage, 8-10% of payroll was not that unreasonable.

    Having lived in two countries (England and Germany) that have socialized medicine to varying extents, what I can say is that much more care is done by primary care providers than specialists under that model, and there is still a supplemental health insurance market for people who want care sooner, particularly from specialists. The NHS model (England) makes every primary care physician a government employee. They are paid decently, and get relief from the need to carry malpractice insurance and other considerations. I was covered by the NHS under the status of forces agreement between the US and UK, allowing me to use that program for free. I could have done without my federal health insurance for those three years. If you had certain medical conditions like diabetes or hypothyroidism, prescriptions were free, and if you didn’t have a qualifying health condition, they were about $4 for a 30-day supply. The price of a prescription has increased to about $6 in the intervening 20 years.

    A typical “limit” under the NHS was to have to wait for elective surgery to be done. There is a triage process where I might have had to put up with my gallstone for a couple more months.

    Germany gives a primary care physician a certain amount of money per year for each person in their practice. I paid about a $25 copayment for an office visit plus the cost of any tests, and the cost of removing my gall bladder was about half what it would have cost in the U.S., at least in part because it was done almost as an assembly-line process. There were stations for anesthesia, then you were moved on to get the surgery and then to recovery. I had to get my prescriptions through the clinic on post, and I paid cash for them, but the cost was comparable to what I would have paid as a deductible.

    A change that I would make is to charge an extra premium for the 18-26 year olds that is equal to what they would pay as a single person WITHOUT the employer subsidy, if one exists. They can be covered, but they will bear the full cost of the insurance. I believe that Tricare does assess an extra fee for 18-26 year olds who stay on the military retiree’s insurance.

    I used to work for part of the Defense Logistics Agency that negotiated drug prices for the military and VA. It made me laugh at the time (1987-88) that in terms of total number of doses, Valium and high blood pressure medicine were #1 and #2. I find it difficult to believe the pharmacy chains do not negotiate drug prices, if only to get quantity discounts.

  2. Obamacare just saved my life. I qualified for healthcare under the medicaid expansion and they found a few things they took care of. Other issues were severe before now and I can finally see doctors. As a result I have been able to return to school and am now working.

    1. I’m glad that things worked out for you, and you’re working again. Be mindful that when you earn more money and become ineligible for Medicaid, you’ll have to face what the rest of us have been railing against for years.

      There were, and are, practical alternatives to the Rube Goldberg contraption that is the Affordable Care Act. One could simply have expanded Medicaid to cover more people. It would have cost about the same, and yielded more practical benefits with less angst. A system like Canada or the UK, providing comprehensive but basic coverage to everyone, with necessary limits, would have solved the problem of access to care for the vast majority of the population, left room for a private sector for health care, and been intellectually honest.

      But I suppose that the Democrats in 2009 and 2010 figured that now was their moment, and they would enact health care reform regardless of the consequences.

      1. I’m not denying it has problems but for some it was a lifesaver literally. It does have its drawbacks for me (for example it doesn’t cover everything and the hospital in my network is garbage and dirty). However, it’s more than I’ve had for years.

      2. I’ve read articles that stated back in 2009 that the government could have bought out all of the health insurance companies for about $80 billion, their market capitalization at the time.

        Where the Medicaid expansion is available, the income cutoff is 138% of the federal poverty level for one’s family size, This is about $16,000 per year for a single person, so if one is working only part-time, it is unlikely that they will earn more than the income limit.

  3. NWP, what job are you doing? Also, what are you studying in school? I am glad that “Obamacare” helped you. It also has helped me. 🙂

  4. I’m BACK! My wife who I met over 20 years ago died of dementia in Jan. and I’m now a lonely widower who’s pretty been on my own for most of the last several years as I switched from being an equal in a couple to a caregiver of a scared, frightened little girl. I campaigned for Bernie Sanders, who I think we should have still had on the ballot in Nov., but the Dems cheated him out of it and I heard he was threatened into not taking Jill Stein’s offer to head the Green Party ticket. Such a pity. I pay $682 monthly for very good health insurance, a 90% coverage plan with low co-pays. Problem is who has the income to afford that kind of premium when they take home about $1200 on average monthly after taxes? I’m lucky I have that plan since Obamacare would be a worse option for me or at best about the same in my state. My plan is with Blue Cross and is a policy I was on with my wife as a spouse. She was a state employment retiree so I can stay on it until Medicare. I still say single payer is the only real solution for the working poor and moderate income people and for the system as well.

  5. Wanted to add that I am lucky enough to inherit about $300K from my wife. So I’m still a card-carrying member of the working poor with my measly $21K income from my school bus driver job, but I now own my own condo apartment in a nice senior retirement community and asset-wise am now back in the middle class for the first time in my adult life. What a game of chutes and ladders life is!! Now, the challenge is finding a partner to enjoy this money and the rest of my life with. Can you believe it NWP? Wish you’d have the same luck or for that matter, Dude Where’s…. Tom

  6. I am still here, still living where I am.

    I called to ask about “Obamacare” right before they tried to repeal it that first time.

    The only question they asked was about my age and they then told me that the least expensive plan would be $723.

    Some of us do not earn $723 per week….and if you do, wow, for 12 weeks out of the year, you are more or less furloughed from collecting your paycheck. You go directly to earning 28 grand a year *technically*

    They assigned me WellCare. The counselor down at the 55Plus unit has never heard of WellCare.

    I have never utilized the doctor who has been assigned to me — nor have I used it for the couple times a year I see the endo or when I report for my blood pressure check up.

    My stance on this bullshit where we are being taken for all we’ve got with necessities like health insurance:

    25 years ago is when this issue began to get out of hand, premium wise. Bush should have stopped the runaway train and demanded that the health insurance carriers roll back their premium prices. It would be no hit to their coffers if we were billed for $150 per month and get major medical out of it: full coverage for everything.. They can do it — but they won’t.

    I have told you about how hospitals and insurance companies are past masters at marking up prices of services. They will charge you much more than a drugstore price for a med you are taking at the hospital. Every other service is the same: marked way up. And now we don’t know how much of a mark up there is because we get no itemized invoices if we are hospitalized.

    And you do know you are charged twice and three times as much for a service if you are uninsured. Last May I got a nosebleed thaqt would not stop — I drove myself to the hospital.

    I was there for perhaps 40 minutes and the physician who was there packed my nose and told me to have the packing removed on Monday.

    I was billed in 2 parts for this service: $525 by the ER billing department (the ER is outsourced and technically isn’t *part* of that hospital) and then — a year later, because the hospital had the address wrong, somehow — $1750 from the hospital itself.

    I am in question about that $1750 because there’s been a lot going on at that hospital — money problems and more — it’s been in the press — and I wonder if that invoice isn’t an error. They say no.:( I will pay them $10 a month. I am getting the idea the invoice is likely an error; the ER is outsourced; why are you people seinding me an invoice from the hospital itself??? they say “We’re supposed to”.

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