Sunday, November 17, 2013

Did the Dems F*ck Up Universal Health Coverage?

It's looking like a strong possibility. The first major contributor to this fuck-up was the disastrous website rollout. This fuck-up was completely avoidable and unforgivably stupid. This wasn't cutting edge software since a bunch of states already had health insurance exchanges. No, this was a fuck-up and a whopping huge data point in the argument that the federal government shouldn't be trusted to manage healthcare.

The second major contributor were all the decisions to maximize coverage. These decisions have been made all along the way, so they have preceded that website debacle and could be considered the single major contributor to the Obamacare failure if it happens. The decision to maximize coverage lead to higher policy costs, higher subsidies, and more people deciding to flout the law and go without insurance. Maximizing coverage has its strong points too, but they don't matter if the strategy collapses universal coverage.

If you want to provide universal coverage, doesn't it make sense to do so at an attainable level? If you're going to invite the entire neighborhood to a cookout, you may have to settle for serving hot dogs and hamburgers, not filet mignon and king salmon.

Maybe Obamacare will work out, and in a year or two we'll have settled into it, have some minor grumbles, but generally be satisfied. But the risks were underestimated by the administration. They should have been more careful and, ahem, more conservative because universal coverage is a big fucking deal, and a major step forward in fairness. But Dems aren't careful like that, which is one reason I rarely admit my party affiliation anymore.

If Obamacare sinks, I'll give most of the blame to the Dems. The GOP of course will deserve some for constantly barraging or undermining the program instead of helping improve it. But it will be the Dems who sank their own ship.



Dangerous said...

Frankly, MP, I'm disappointed at your lack of intellectual rigor in reaching such a dramatic conclusion!!

"If you want to provide universal coverage, doesn't it make sense to do so at an attainable level?"

How, for example, do you balance "universal" and "attainable"? Do you through out mental health coverage to make it more "attainable"? Is the measure you're using for success and failure what percentage of the population chooses to risk their financial health to avoid paying premiums? Or to lay them off on us?

The media is bad enough for its oversimplifications of a very complex undertaking involving nearly 20% of our country's GDP. The notion that "the federal government shouldn't be trusted to manage healthcare" because its hastily-constructed web site didn't work perfectly on day one is a vast overreach.

Let's not forget -- nobody doesn't have healthcare or healthcare insurance because of Obamacare's exchange web site woes. Coverage would not begin until 1/1/14 anyway. This isn't like Katrina or Iraq. Nobody is dying or suffering because the web site was a problem. As of today, anyone can go on the web site and shop for plans, compare premiums and benefits, take their best guess at what will work best for them, and place their bets with the insurance company.

What you seem to have forgotten about healthcare and health insurance is that insurance companies couldn't be trusteed to manage healthcare. Apart from their obvious conflict of interest, they bought of state insurance boards and so many politicians of both parties that we had the following:

* Rapidly rising premiums year-in year-out.
* Companies dropping or reducing coverage due to cost, and/or eating employee raises to pay higher healthcare costs.
* Lots of people going bankrupt anyway.
* Lots of people losing coverage when they needed it most.
* Insurance companies dropping policies as soon as they proved unprofitable.
* 50 million people with no insurance coverage at all.
* Many people forgoing treatment because they couldn't afford it, or using the emergency room thus passing the highest cost on to the entire system for others to pay.

So I ask you, which of these pre-existing conditions in the healthcare system will you "blame" on the Democrats for their attempts to fix it? Sire, the GOP will love to play the you-break-it-you-bought-it card, but it was already broke so I'd expect a self-described "moderate" to see past that.

ModeratePoli said...

@dangerous, I haven't reached any conclusion. However, it's a reasonable question to be asking, which is why I ask it. You don't answer that question--you just go into full-on defense mode.

The lack of coverage was definitely a problem. But the mistakes in the rollout, and the mistakes that only become apparent now, can convince people that: 1) it was too big a problem to fix, or 2) the Dems are the wrong people to try to fix the problem.

The general opinion could easily shift that way. That's what I'm saying.

I still support universal coverage, but there is more than one way to get there. There are also goals short of universal coverage that might seem reasonable to a lot of people, including me. The worse the rollout goes, the less attainable universal coverage feels to people.

If you think that perception won't take hold, or that all the facts are still on the side of universal coverage, think again.

Dangerous said...

Already, stories are appearing that reflect a more thorough review of both the website rollout's improvements (or which there are many) and the paucity of claims that cancelled policies disadvantaged the people who "liked them and wanted to keep them".

The first issue is a technical story involving an untestable (at least at full scale) web-based software application. Rather than diving into the problems and explaining each one, the media and most pundits simply declared it a "debacle" and left it at that. That was the narrative, true or false. had been up for months prior to Oct. 1 and ran fine. You could do lots of stuff on it. But open enrollment was a fresh set of challenges at high volume on the first day. The cracks appeared only then, no matter what CYAers want to allege now. States websites had similar problems.

So I'm not going to say that the technical stuff was botched, just the combination of expectation settings and narrative control: politics. That is, the website problems were frustrating but nobody lost a thing. Coverage wouldn't start until 1/1/14 anyway.

They made some mistakes in design and deployment but I'm not going to judge them that harshly on either the politics or technical aspects. The media whores saw easy ratings via their favored means: exaggeration. The truth is that the website woes are an inconvenience at most for a small percentage of the public. The media reported it like the storm of the century, paralyzing the entire country.

The other parallel story -- cancellations and sticker shock for replacement policies -- is a complex actuarial narrative the media far oversimplified with a few partial anecdotes and a whole lot of "I told you so" hype from ACA opponents. The truth is the everyone is better off under ACA including every simple person who received a cancellation notice, whether they have to pay more or not. And the reason for that is simple: their health insurance future is far more secure than before ACA. Many may have already received that benefit but didn't get to realize it or its associated cost until ACA's 2014 provisions. That resulted in cancellation of a policy that the insurer could cancel or change later for just about any reason, leaving the policyholder high and dry. Beginning 1/1/14, they can't do that, so policies they priced on the basis of being able to reduce their liability later are cancelled.

Sure, it's easy to focus on the NOW price; my policy premium today versus my new policy options. But health insurance doesn't work like that and it's just lazy media truth.

ModeratePoli said...


You're making two very strong points.

1) It's a definite good to have statutory access to health coverage. (I hope it isn't lost due to ACA costs/mistakes/etc.)

2) Pricing of policies was affected by the company's ability to cancel--a very nasty advantage that saves money for many while royally screwing the unlucky.