Weatherdem's Weblog

Bridging climate science, citizens, and policy

Obamacare’s ‘Cadillac Tax’ Exposes Policy Weaknesses

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In 2009 and 2010, I had many discussions with people about the Affordable Care Act (Obamacare).  At the outset let me explain that health care reform would have been expanding Medicare to every American.  It has the lowest overhead of any service and would have resulted in providing health care to everybody regardless of income or any other metric.  My fallback position was a Medicare opt-in as part of state-based or national-based health exchanges.  Let the private for-profit corporations compete against Medicare in the free market.  As conservatives usually say (but ran away from in this instance), let the market decide.  Well, we all know how non-free the market is.  Conservatives and Libertarians love to pick winners: as long as they’re winning.

Instead, President Obama spent two years’ worth of political capital on a search for his First Grand Bargain.  And make no mistake: he got exactly what he wanted.  Instead of health care reform, Americans were saddled with a health insurance giveaway.  Millions of Americans won’t be allowed to make a choice in the market; they will be forced to buy something.  That is a disgusting development in our country’s history.

Here is an anecdote that demonstrates the fundamental weakness of the “reform”: “While it might reduce health care spending, for many people it doesn’t reduce the cost of care.”  If you’re healthy, things will be great because you’ll receive free or cheap preventative care.  If you’re really sick, things will get worse because you’ll pay more and more for the same care you’ve been receiving.  Oops.  As Joan says, “if you have a serious health issue and were previously uninsured because of your pre-existing condition, you can at least get insurance now.”  Note the critical missing piece in that sentence: you won’t get quality care; you’ll get insurance.  Which, depending on your socioeconomic status, means you could get good care or crappy care.  That is the big reform as part of the President’s Grand Bargain.

Joan goes on to say, “The actual health care they receive needs to be made less expensive. That’s where the next steps in reform have to be made.”

Um, duh.  But just when we make those next reform steps?  That was the elephant in the room in my 2009-2010 discussions with Obamacare zealots.  Nobody was willing to say how they would make those next steps … or when.  The only thing they would say was it would eventually happen because incrementalism was the proper strategic political choice.  It became clear to me later that incrementalism works for folks in the establishment.  It keeps them employed for years and decades as tiny steps are taken every decade or two.  Meanwhile, Abbey and Casey Bruce’s bills will double in cost.  How many millions of Americans face higher medical bills in 2014 because the establishment folks decided incremental steps are the best?  President Obama and a bunch of other folks were reelected in 2012.  Are they pushing additional health care reform?  No and they won’t either.  They did health care reform.  We’ll have to wait until some undetermined point in the future to try for true health care reform again.

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