The Occupy Tea Party Platform, Part II: Obamacare

Health care reform and universal health insurance is one of those issues that has popped up time and again in American politics for decades, dating back to Lyndon Johnson’s Great Society and the enactment of Medicare and Medicaid, if not further. Both Richard Nixon and Bill Clinton tried and failed to enact their own reforms. In that context, love him or hate him (or his plan), the fact that Barack Obama was able to pass anything, in the most polarized political climate since at least the Civil War, is nothing short of astounding.

The spiraling costs of health care pose such a threat to the long-term viability of the federal government, especially as the baby boomers retire, that this should be an issue that both sides of the aisle can agree on. In practice, a lot of people, especially on the right, seem to be unclear as to what the issue actually is, seeing the health care debate as being less about health care and more about the role of government in our lives, and there’s a lot of disagreement over where to fix the problem. (It doesn’t help that “Obamacare” has become a bogeyman that has arguably overshadowed the actual contents of the bill.) A lot of Democrats made insurance companies into the scapegoat, calling for the government to institute a public option to force insurance companies to keep premiums down and stop discriminating against people with pre-existing conditions (the people who most need it) in the name of profit, if not take over the health insurance system entirely and adopt a single-payer system.

While I’m sympathetic to the Democrats’ stance, I’m still not convinced that repealing the health insurance industry’s anti-trust exemption wouldn’t have done a lot to solve those problems even on its own, without further government intervention in the marketplace. Ultimately, Obama wasn’t able to pass any form of public option, and the bill’s ultimate solution to the problem of the insurance industry could be seen as an adoption of my viewpoint. Perhaps the centerpiece of the bill is the establishment of an “exchange” with which individuals and businesses could compare and contrast various health plans. But this was coupled with numerous requirements for qualifying health plans and a universal coverage mandate. During the debate on the bill, while watching C-SPAN I saw Republican lawmakers denounce the “exchange” as sufficient to constitute a “government takeover” of health care, raising the specter of the government deciding which insurance plans you’ll have a “choice” from. The “exchange” comes across to me as more of a shadow free market than an actual one, one the Democrats didn’t have enough confidence in not to include instructions to insurance companies on what to do and what not to do on top of it.

I can see why the individual mandate, probably the most controversial specific provision, was included. Most young, healthy people consider themselves invulnerable and don’t think they’ll need health insurance for anything. Requiring them to get health insurance means they’re covered if they turn out to be wrong, while their healthiness makes them the insurance companies’ ideal customer and makes it easier for them to cover more marginal customers for less, possibly having the result of lowering insurance costs overall. Republicans have been most vocal in decrying the mandate, but even Keith Olbermann, then still with MSNBC, called for the mandate to be stripped after the public option died, claiming that with the mandate but no public option the bill amounted to a massive gift to the insurance companies. I suspect that betrays his lack of faith in capitalism and the free market more than anything else, but in any case I can definitely see a scenario where requiring everyone to get health insurance causes high and inelastic demand, theoretically allowing insurance companies to drive prices to the moon.

At any rate, all the emphasis on insurance may be at least slightly misguided anyway. A larger problem may involve the quality of care itself and how it’s delivered to patients. There’s little research on what treatments offer the best bang for the buck; doctors are presently paid based on how often they’re used, not with a constant salary, encouraging overtreatment; and there needs to be effort to encourage healthier lifestyles so people aren’t so reliant on the health care system in the first place. (This last may come up in later entries in this series.) Republicans would rather focus on tort reform, claiming that fear of malpractice suits is what drives up costs; I’m not convinced by Wikipedia’s analysis which focuses on the effect of the actual rather than perceived risk of malpractice. And we’re running the risk of shortages in doctors and nurses in the future. The health care legislation does confront many of these problems, though they’re clearly in the background compared to insurance reform.

This is too complex an issue for me to figure out what the best approach is, so I may revisit it later. My impression is that the health care bill is superior to the status quo ante, and any better reform would need to build off at least some of its provisions, and if the Republicans repeal it without providing some sort of replacement there may be some people who feel a bit betrayed. But I can’t help but wonder what might have happened if we had instituted a true free market, rather than one imposed by the government. As it stands, it may well turn out that the health care legislation will give more power to both government and business, and while I’d like to see how it plays out before making any rash decisions, if it does end up repealed we should insist that it be replaced with a bill that empowers patients first and foremost by encouraging, rather than stifling, innovation in all areas of health care. Perhaps it includes an individual mandate, perhaps not, but if it includes it it does so only if it’s been established that, combined with other reforms, it will improve health care costs and quality of health for all Americans, rather than serving as a giveaway to insurance companies.

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