Real stories of Obamacare

Obamacare has been in the news so much this week because of the looming deadline, it got me to thinking more about the real people who are impacted by it directly. Living in the mid-west (sorry kids, Kentucky ain't the South), and having grown up in a very nice whitey-McWhitey-pants suburb, it's not surprising that I have a lot of conservative friends. To clarify, when I use conservative I mean it in the true sense, not the Fox News idiot sense (although I have some friends in that category too). I mean people who don't like big government, and people who generally support free and open markets. If you think the government should be involved in banning gay marriage or protecting religious bigotry, you're not a conservative (but there's a good chance you're a jerk).

Anyway this means I have a lot of friends who hate Obama, and also hate Obamacare. I have a generally favorable opinion of both, though I fully recognize they're not without their flaws (see my recent post on why I prefer national health care). I didn't vote for Obama because I think he walks on water (as some Democrats do), and I know the ACA represents massive government interference in one of the biggest sectors of our economy, it'll cost a ton of money and we won't know if it's achieving its goals for several years. But we desperately needed something, and I think this particular something is better than nothing.

Sure, lots of people lost their coverage and/or couldn't keep it due to Obamacare's new minimum standards for insurance. And Obama was an idiot to promise that "if you like your insurance you can keep it," which we all now know was a lie. A lot of Americans were paying for insurance policies that covered almost nothing. They fall into three groups:

1. Some percentage of those Americans knew what they had, and are rightfully upset that they can't keep their crappy coverage. I argue that those Americans are not much better than the ones who choose to not carry insurance at all - both groups are likely to end up receiving free care when something bad happens. If you, like me, believe that we have a problem with a lack of individuals taking responsibility for themselves and their own actions in this country, and if you know the statistics about how much free care doctors and hospitals give out in this country and how that "free" care translates into the higher premiums the rest of us pay, then you almost have to agree with me that those people are freeloaders. Conservatives hate freeloaders. 
2. Some percentage of those people with crappy plans had no idea that they were buying crappy insurance, and are right now a) mad at the company who sold them the snake oil policy and b) signing up for Obamacare because they want actual coverage for wacky things like preventative care.
3. Some percentage of those Americans knew what they had but also knew that there were no viable alternatives to them. They lost their policy but they're NOT mad about it because now they have a viable option for real insurance. These people are also singing up for Obamacare.

Remember, 70% of the country gets health insurance from their employer or the government (Medicare/Medicaid/Veterans Administration). So we're really only talking about the 30% who don't. There was an argument that tons of employers would stop offering coverage because of Obamacare; that they'd simply pay the fine for not offering coverage and dump their employees off onto the public exchanges. This has not happened. There was an argument that small businesses would go bankrupt from being forced to offer coverage. This has not happened, largely because there are massive tax incentives to offer coverage and any small business operator with two brain cells will take advantage of an opportunity to 1) attract & retain employees while simultaneously 2) lowering her tax burden. 

Now let's go to the polls. Americans hate Obamacare. More than half of them say they "don't want it." But from what frame of reference are they looking at Obamacare? 45% of Americans get coverage from their employer. Do they get to complain about Obamacare? I suppose so, because they are also tax payers and it's an expensive program. But these people don't need the coverage Obamacare offers to people who previously had no alternative, and I think that's important to bear in mind. If you're only looking at the federal and state budget implications of Obamacare, it's easy to hate. 

25% of Americans get their healthcare from the government anyway. Do they get to claim that this is wasteful government spending? I think not, since that would be pretty hypocritical. Yes, the burden on state and federal health care programs will go up, but there is a very real chance that Obamacare will achieve its other goals of improving outcomes and lowering costs. Part of the goal of this legislation was to address the very real skyrocketing costs of healthcare by getting more people preventative care options AND by holding providers responsible for outcomes, and taking insurance companies to task for inflating administrative costs. 

The 30% of the country that's not insured through their employers or the government is either uninsured, or falls into one of the 3 categories of "I previously had lousy insurance that is now illegal." Some percentage of the uninsured are now quite happy to sign up for something. There are some compelling stories about this compiled in a nice marketing piece by HHS. Contrary to the Romney narrative, most people in this country do not like handouts and want to provide for themselves and their families. They simply had no good options for affordable care prior to Obamacare. Now that they have options, they're signing up to the tune of 5,000,000 plus.

Remember, just because it's marketing doesn't make it imaginary - these are real people. I also am friends with a number of artists on facebook who write glowing reviews of their experience, in particular some of the New Orleans musicians I miss so much. Oddly enough, when you play on street corners and in bars, those gigs don't offer good health coverage, yet these musicians do want to take better care of themselves and they recognize the risk they have been taking by not having coverage. It was just truly un-affordable to them. There are still some freeloaders out there, but there always will be. 

I think the approval rating of the ACA today should be determined by the uninsured who want coverage, and groups #2 and #3 from the "I previously had lousy insurance that is now illegal" crowd. Those are the people for whom the ACA has the greatest short term impact. If you still get coverage from your employer or uncle same, your opinion on the sign up phase is irrelevant. You can weigh in a couple years from now when we have some real evidence as to whether this thing lowers the cost of care and improves patient outcomes. By then we'll know if it's worth the tax burden or not.