Sunday, March 23, 2014

Obamacare's Birthday

This weekend marks 4 years since the passage of the Affordable Care Act. The GOP re-branded it as "Obamacare," in hopes that those who hate Obama would similarly hate "his" healthcare plan. There are at least 3 flaws with that: 1) he didn't write the bill 2) some Obama haters directly benefit from this plan and 3) the GOP has given the Dems a great marketing tool here: there are now over 10,000,000 people who are fans of Obamacare because it has given them the health insurance they wanted and couldn't get previously. Ask P&G about the marketing power of 10,000,000 consumers who are out there saying "I just bought this product and it's really helping me and my family."

There's not much point reviewing the law and how it's been rolled out, as that is a well-documented and over-analyzed debacle. I find the IT issues particularly embarrassing as I work in that industry and it reads like a classic case of how NOT to run a large IT project. Because I work in that industry though, I'm also aware of how notorious the government is for NOT being able to manage IT contractors, being difficult to work with, and changing requirements on the fly without adjusting timelines or budgets appropriately. This example just happened to get a ton more media attention than others, and rightfully so, but rest assured there are several hundred other IT initiatives that Uncle Sam is screwing up at this very moment. In short though, adoption has been less than expected, a majority of Americans "disapprove" of Obamacare although I'm certain a majority of Americans don't understand it either (who does?), and the true costs of this thing will not be known for years.

Is Obamacare bad for America? I don't know. It's certainly ugly, and poorly executed, but is there a net benefit to it at the end of the day? What's the point of comparison? Obamacare is awful compared to what - doing nothing? Compared to the national health care systems that a VAST majority of advanced industrialized nations have successfully deployed with better outcomes, lower costs, and none of the rationing & death panels the GOP desperately wants you to believe exist? That's the system I want, by the way, and there is overwhelming, conclusive evidence that national health care systems work AMAZINGLY well if the standard of comparison is the health care "system" we had in place before Obamacare. I'd love to see every insurance company put out of business, because I believe they're the root of the problem, and the doctors and hospitals have simply evolved & adapted to maximize their own outcomes because of how they have to deal with the insurance companies. No rational person can look at this system which has:

  • An annual enrollment process (what's the cost to our economy of the lost productivity when we all have to do that crap each year?) 
  • Denial of coverage to the sick and/or pregnant 
  • The artificial inflation of and wide regional variations in the costs of care due to the absurd relationships between insurers, providers, and hospital systems 
  • Having to get permission from insurance companies before you get treatment
  • Coverage that is often tied to your employer, which completely skews labor force participation and job mobility...
and say "yes, that's an awesome system, I want that!" I've lived in the UK. I've done long term IT projects in Sweden and France. And I'm here to tell you those systems work well. Are they perfectly efficient and without flaws? Nope. There is bureaucracy, there is corruption, and those things will be true for ANY system that tries to provide healthcare for millions of people - some of the exact problems we see in Medicare here in the US. But I'm here to tell you that the GOP is full of crap when they want you to believe that you get poor quality care or that it's difficult to see a doctor. That's just simply not true. Anyone who gives the "they pay way higher taxes than we do" doesn't understand the big picture either. First off most of us already pay 40% in taxes, we just don't get healthcare thrown in with it. Then consider the insanely higher cost of care in the US, which WE ALL PAY FOR ANYWAY, just not in the form of direct taxes. You cannot analyze the big picture and come to any conclusion other than to say that most national health care systems provide better care at a lower net cost, full stop. 

But today I want to talk about elections and call out the GOP for pulling a classic "I hate your idea but I'm not actually proposing a viable alternative" move. You know, the kind that your mom called you out for as a kid, and your colleague calls you out for today. This is yet another dimension of where the GOP has completely alienated its TRUE base - moderates like me. There are literally millions of us, Reagan Republicans who know full well that Reagan wouldn't take the time to spit on John Boehner's shoes, that compromise is not a sign of weakness, it's how you get things done in Washington. Back to my point #1 about why the GOP was stupid to paint Obamacare as Obama's law, this law was written by the Dems in Congress, the GOP had a chance to participate and shape things, but they chose not to. I'll be the first guy to admit that Nancy Pelosi is useless, so why on Earth would anyone let her craft such an important piece of legislation? 

The answer is simple politics. The GOP, "led" by Mitch McConnell, openly stated that their goal was for Obamacare to fail, NOT because they had a better plan, but PURELY because if it failed big time that would help them win elections. That motive must be used to frame anything and everything they try to tell us about Obamacare and/or their alternative proposals, if they ever come up with one. They could have collaborated with the Dems in writing this thing, they chose not to.

If you're a true conservative and you want to get rid of government waste and improve our economy, the healthcare sector is a perfect place to start. Our nation spends way too much on it, it's crippling our economy, and it should be a prime target for reform. But today's GOP big shots aren't leaders, they're self-centered jerks who care far more about winning the next election and sticking it to the Dems than actually giving this country what it needs: healthcare reform, entitlement reform, a simplified tax code. They are absolutely owned by big pharma and the big insurance companies & hospitals, the exact organizations that have the most to lose from a more efficient health care system. 

The strongest evidence of this is that, four years on, they have yet to propose a viable alternative. They've wasted 50 votes in the House to repeal Obamacare. These jerks can't pass anything meaningful, but the notion that Congress can't pass a bill is nonsense. If they can find time for 50 symbolic votes that get them nothing more than a sound byte for the next election cycle, they could find time for more meaningful debate if they wanted to. They don't. All they care about is being able to say "we tried to repeal it over 50 times, it's the Dems that stopped us so blame them." Well, the reason the Dems stopped you is because they outnumber you, because you guys ran on a "repeal Obamacare" platform in 2012 and that failed to win you the majority you'd need in Congress to actually DO that. My favorite part of this dimension of the story is that many of my GOP friend now deny that the 2012 cycle was a referendum on Obamacare; that instead it's the upcoming 2014 mid-terms that will be the referendum. This is because they figured 2012 would be a landslide for the GOP and it wasn't. They lost 2 seats in the Senate and 6 seats in the house. 

So where does this leave the GOP for 2014? I think they're actually in a really bad spot. True, more people disapprove of Obamacare today than 2 years ago, but there's another pesky statistic that I think offsets that: we've now got 10,000,000 Americans who just GOT coverage through Obamacare that didn't have it previously. In states that setup their own exchanges, the participation rates are staggeringly high and the percentage of the population who's uninsured has dropped dramatically. In Kentucky, our uninsured population has dropped by 75% and half of the newly insured are under 35 years old. 

One of the GOP's best talking points is that there are a few million people who lost coverage, in particular Obama's failure to deliver on his promise that "if you like your coverage you can keep it." Well, the truth is that a lot of people had terrible coverage that is no longer legal, but this is America and if you want to pay for an insurance product that doesn't even cover basic preventive care, that's your "right." Here's the rub: if your key argument is that Obamacare is bad because people lost coverage from it, you can't repeal it today because you'd be killing coverage for 10,000,000 Americans! All the GOP can feasibly do in terms of reforming it is to further Frankenstein a law that's already ridiculously complex. The GOP knows this, and I'm betting they also know it's not worth the fight this year to try to pass an alternative. Much easier to stick with the current strategy of just throwing stones at it. The smart voters already know that the GOP isn't actually proposing any alternatives, and the dumb voters don't care, they vote based on sound bytes anyway.


  1. Jeremy, Where do I start?

    1) The 50 votes to repeal is not true. That is a talking point fabricated by the Left (and it seems to be working). Byron York of the Washington Examiner lists all 54 votes to repeal or amend the ACA ( Now I grant you that the Washington Examiner is certainly a right-leaning paper, but he seems to have his facts in order. Note that only six votes were full repeal. The remaining 48 are ideas on how to fix the law. So, certainly the Right has ideas on how to make the law better (Maybe better should be in quotes ...). I don't see Harry Reid scrambling to debate any of the bills passed by the House, lest Obama be put in a position where he has to either 1) modify his law, admitting that there are some serious flaws in the law or 2) veto what would be a bipartisan change to the law. Please don't rest this at the feet of McConnell ... but, please don't consider me a McConnell fan, either.

    I disagree that the GOP is in a bad spot. They have a great shot at winning the Senate back, assuming the states in play have nominated someone outside of the Lets-stick-our-foot-in-our-mouth Tea Party Candidates (Richard Mourdock, anyone?). Should they win the Senate, (and because the senate has done away with the 60-vote rule for cloture) it could put Obama in some embarrasing spots when it comes to vetoing legislation.

    The real travesty in all of this is the implementation. HHS has unilaterally ignored or rewritten the law. This is, at best, shameful and, at worst, unconstitutional. The executive branch does not get the power to pick and choose which parts of the law it wants to enforce.

    We do need heath care reform. We need some market-based solutions to drive down costs. We need consumers to be more directly connected to the costs they are incurring. We need insurance to be portable and to protect them where there is something catastrophic (whether it happen in an instant or over 20 years).

  2. OK, I'll agree that not all 54 House votes were for full repeal, but let's be honest about what they were: 1) they were absolutely NOT viable alternatives and 2) they actually look very much like the same piecemeal repeal/revise approach that you rightly criticize the administration for taking. Many of those GOP votes were attempts to modify the law by de-funding portions of it. Hard to argue that's any different than Obama's executive orders to selectively enforce it, some of which, by the way, were giving the business community exactly what they asked for. Obama being responsive to the business community ruins the dominant narrative though, so let's brush that aside and just paint it as tyranny.

    Votes #3 - #11 on the list were complete horse shit. Six of the votes were later passed by the Senate and signed by Obama, so let's not pretend Reid has a full blockade going here either. None of them proposed a complete alternative, and even York doesn't suggest this.

    The GOP has a 60% chance of taking back a majority in the Senate, this according to Nate Silver who quite accurately predicted the 2012 outcome. ( Cloture aside, it still takes a super-majority to override a veto and that exists only in the dreams of a putz named Reince Priebus.

    The ACA provides real help to a huge number of people. It costs a lot, it's not pretty, but the GOP has yet to offer a viable alternative. TPM is pretty neutral on this stuff. And if you don't like them, take Cantor's own word for it. He admits that they've not yet proposed an alternative when he made his January speech saying "we promise to develop and pass one this year." He also admits it's not a priority when his February and March messages to the GOP caucus fail to mention ACA reform, at all. I stick by my theory that their only aim is to continue poking fun at it and make sound bytes from it, rather than actually replace it with a viable alternative.