Friday, November 22, 2013

135.2 - Some random comments about Obamacare

Some random comments about Obamacare

Okay, I have a few random, sort of disjointed, comments on the recent brouhaha around the Affordable Care Act, aka Obamacare, the first of which sort of relates to what I was just talking about, which is legislation regarding women's health and pregnancy.

I find it amusing - but not the least bit surprising - that the same sort of people who are so dead-set against abortion, the same sort of people who will screech to the skies their concern for "unborn children" - and by the way, I repeat: there is no such thing as an "unborn child"; a fetus is no more an "unborn child" than a caterpillar is an "unborn butterfly" - but the people who will screech to the skies their concern for "unborn children" and the health of pregnant women are also dead set against government assistance for maternity and newborn care.

As a result, they are tying themselves in philosophical and rhetorical knots trying to justify their outrate, their outrage I tell you, over the fact that Obamacare requires that basic insurance policies cover those services.

For example, Rep. Renee Ellmers, the chairwoman of the House GOP Women’s Policy Committee, asked Health and Human Services Secretary Kathleen Sebelius “Has a man ever delivered a baby?” The proper answer to which is "No. Has a woman ever had prostate cancer?" Because if we're not going to cover the one because otherwise it's somehow "unfair" to men who won't use the service, shouldn't we also not cover the other on the equivalent grounds?

Here's another one: Greg Mankiw, who chaired President Shrub's Council of Economic Advisors, argued that, quoting him:
But having children is more a choice than a random act of nature. People who drive a new Porsche pay more for car insurance than those who drive an old Chevy. We consider that fair because which car you drive is a choice. Why isn’t having children viewed in the same way?
Beyond the fact that calling having children a "choice" allows for both birth control - which, yes, some on the right are against - and abortions, and beyond the creepy comparison of having a child with buying a car, I wonder what sort of women Mankiw thinks are having Porsche pregnancies and which are having "old Chevy" pregnancies - but I think we can make a good guess.

Next, the wave of policy cancellations across the country are driven by the same thing that has driven the cost of medical insurance for the past several decades: The desire of the insurance industry to maximize profits at the expense of the health of its policyholders and the general public. The purpose is to dump their most expensive customers onto the public rolls, letting the taxpayers pick up the bill, while keeping only those customers they think are least likely to ever use the products the companies are selling.

They used to do it with pre-existing conditions and recissions but they can't do that any more, so they have come up with new ways such as trying to force their more expensive consumers either into much more expensive plans or onto the exchanges - where several of the largest insurers have refused to take part. In fact, in 23 states plus the District of Columbia, there are fewer than four carriers in the individual exchange market. Its all just more ways to avoid having to cover people who might actually use their insurance. Same game, but different rules so different tactics.

Which we all should have seen coming. What, did you expect them to behave any differently? I'm not surprised by corporations trying to game the system to their own benefit; it's what they do. What I am surprised at is the surprise. Didn't any of these people hear the tale of the scorpion and the turtle?

But speaking of those cancellations, rather than caving, this is what I wish our prez, The Amazing Mr. O, had said about the "if you like your plan you can keep it" business:

"Yes, I said that and yes, I meant it. Because it didn't occur to me that someone paying for insurance that essentially covers little of anything while sticking them with sky-high deductibles for what it does cover would rather keep that plan than take advantage of the opportunity get an affordable plan that actually covers them for health and medical expenses they actually have. The only reasons people have one of those plans is either that it's cheap and it's the only thing they can afford or because they were rejected from other insurance because of pre-existing conditions so it's the only kind of insurance they could get. As a result of the ACA, those people can do better for themselves. And I admit it: It just didn't occur to me that any significant number of people might not want to do that.

"It's like someone with a '65 Nova being told of a program by which they could afford a 2010 Camry - and please, no cracks about why I didn't use an American car; it's just for the illustration - someone with a '65 Nova being offered a way to afford a 2010 Camry and saying no, they want to keep the Nova. I suppose it's possible but frankly it didn't occur to me that someone would want to do that."

Finally: When the debate over what became the ACA was going on, I was one of those people who opposed the bill because it was too weak, too favorable to the insurance industry, would leave too many people uncovered even after it was fully in force, and actually wasn't about access to health care but access to health insurance, which is clearly not the same thing.

The response came in three types: One simply denied the shortcomings existed. Another was the shrug of "it's what will pass" as if the proper starting point for a political negotiation is the minimum you think you can get rather than the maximum that you want. The third was those who admitted the problems but insisted "This is a starting point. Next year we'll come back to make it better."

I told those latter folks "No you won't; you'll spend your time and energy trying to keep what you've got against attacks from the right." To those people, I'm going to take the opportunity to say "I told you so. Next time, listen."


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