So, it turns out that insuring lots of additional people who have pre-existing conditions and no money to pay premiums actually costs a LOT more than before.
This in spite of the claim that ACA would actually SAVE money.
Now, it may be possible to argue that "we" (whoever that is) are saving money overall, because the costs of untreated health problems are externalities imposed on all of us in the form of lost productivity and desperate families. And it may be that universal coverage is a good thing, just in terms of basic fairness.
But that was not the argument. The argument was that ACA would straight up save money, and make insurance cheaper. There was never any chance that this was actually true, and its' not true. I love the way the craven, hypocritical WaPo puts: Funds run low... Well, yeah, that's what "giant budget-busting spending" does. I guess Ms. Pelosi should have said, "Let's pass this bill and later we can figure out [how to pay for] what's in it."
This in spite of the claim that ACA would actually SAVE money.
Now, it may be possible to argue that "we" (whoever that is) are saving money overall, because the costs of untreated health problems are externalities imposed on all of us in the form of lost productivity and desperate families. And it may be that universal coverage is a good thing, just in terms of basic fairness.
But that was not the argument. The argument was that ACA would straight up save money, and make insurance cheaper. There was never any chance that this was actually true, and its' not true. I love the way the craven, hypocritical WaPo puts: Funds run low... Well, yeah, that's what "giant budget-busting spending" does. I guess Ms. Pelosi should have said, "Let's pass this bill and later we can figure out [how to pay for] what's in it."
11 comments:
Did you actually read the article?
"The program, which was launched in summer 2010, was always intended as a temporary bridge for the uninsured. But it was supposed to last until 2014. At that point, the health-care law will bar insurers from rejecting or otherwise discriminating against people who are already sick, enabling such people to buy plans through the private market.
From the start, analysts questioned whether the $5 billion that Congress appropriated for the Pre-Existing Condition Insurance Plan — as the program is called — was sufficient.
Initial fears that as many as 375,000 sick people would swamp the pools and bankrupt them by 2012 did not pan out. This is largely because, even though the pools must charge premiums comparable to those for healthy people, the plans sold through them are often expensive."
So firstly, whether this one component of ACA, which is less than a third of one percent of gross ACA spending over the ten-year window, works as intended is irrelevant to the question of whether ACA's primary mechanisms for insuring the unemployed - subsidized, regulated exchanges + Medicaid expansion - works as intended.
And whether those will work as intended is a really good question! But the high-risk pools are not some central component of ACA, they were just a holdover to give some people some health care between when the bill got passed and when it goes into full effect.
And your characterizations of what ACA would do - "straight up save money, and make insurance cheaper" - are incorrect. ACA is supposed to reduce the budget deficit, which is conceptually distinct from saving money, and it is supposed to reduce health-care cost growth as a share of GDP, which is very conceptually distinct from making insurance cheaper, whatever that means.
There are plenty of good arguments to be had about PPACA and how to best provide healthcare, etc. I would prefer single-payer, as you would:
http://mungowitzend.blogspot.com/2012/06/single-payer.html
But we can at least try to grapple with what ACA does honestly and coherently.
Shouldn't we be calling it the "so-called 'Affordable' Health Care Act"?
Squarely Rooted,
Hard to keep up with the twists and turns in your post, which is in keeping with the obfuscation with which this law was jammed through.
The ACA was intended to address rising health insurance rates and increasing healthcare costs. To claim the financial promise was to "reduce the deficit" is nonsense. A trillion dollar program to hand out Rolex watches can be called a deficit reduction program if you couple it with a two trillion dollar tax increase.
And to say it was only supposed to "reduce health-care cost growth as a share of GDP," meaning ACA could be completely successful if healthcare costs continued rising indefinitely, is either a mischaracterization of the intent, or an expose of the deception. Was the law intended to disrupt the entire process of health care and insurance in this country only to tweak the continued upward tilt of the cost curve?
Lastly, the comment that the high-risk pool was "just a holdover to give some people some health care" until the law went into effect is either sloppy or, again, typical of the artifice that conflates having health insurance with receiving health care. Everyone in this country who is suffering from a condition gets health care, regardless of whether they have health insurance. You claim to seek precision; is this a slip or is it deliberate on your part?
What Pelsmin said.
Pelsmin,
Let me address what you said point-by-point:
"The ACA was intended to address rising health insurance rates and increasing healthcare costs."
This is true, except that it neglects that it was also intended to provide health insurance to those who lacked it.
"A trillion dollar program to hand out Rolex watches can be called a deficit reduction program if you couple it with a two trillion dollar tax increase."
This is, of course, true. It is a good example of why a purportedly technocratic focus on "deficit reduction" fails to meaningfully address questions people actually care about.
"And to say it was only supposed to "reduce health-care cost growth as a share of GDP," meaning ACA could be completely successful if healthcare costs continued rising indefinitely, is either a mischaracterization of the intent, or an expose of the deception. Was the law intended to disrupt the entire process of health care and insurance in this country only to tweak the continued upward tilt of the cost curve?"
I could have been more precise here - the purpose is probably better phrased as "stabilizing the health care expenditure:GDP ratio." Therefore, if health care cost growth slowed, ACA could be considered only a partial success. This is, of course, to the extent you credit ACA with said reductions; the recent slowdown http://www.nytimes.com/2013/02/12/us/politics/sharp-slowdown-in-us-health-care-costs.html?hp&_r=0 is probably only somewhat creditable to ACA at best.
Of course, health care costs are in-and-of-themselves a difficult thing to target. You could make surgery and CAT scans illegal and health care costs would probably drop drastically. To the extent that increased spending on health care is resulting in increased health then "health care cost growth" isn't really a problem. So the real question is about health care efficiency, ie, increased health produced per dollar spent. This is a fantastically hard thing to measure, and it is unsurprising that governments, non-profit organizations, academia and private companies and institutions alike all have difficulty in providing health care efficiently or evaluating the performance of health care institutions and practices.
"Lastly, the comment that the high-risk pool was "just a holdover to give some people some health care" until the law went into effect is either sloppy or, again, typical of the artifice that conflates having health insurance with receiving health care. Everyone in this country who is suffering from a condition gets health care, regardless of whether they have health insurance. You claim to seek precision; is this a slip or is it deliberate on your part?"
I claim to seek precision, but I will rarely claim to have obtained it, as you accurately note here. Health insurance indeed is not mutually inclusive with health care, and I shouldn't have said as much. But as the host's post which I linked to noted, waiting until a condition becomes life-threatening then treating it in the ER is the stupidest, most inefficient way of providing health care imaginable. Therefore, I should have said that high-risk pools were a way to give people insurance, not health care, as a holdover function, with the idea that they may receive more efficient care than they otherwise were. And perhaps they are! All we know is that the cost of providing them care through high-risk insurance pools is more expensive than what Congress allowed for, which is something many analysts predicted at the time.
Anyway, I'm trying to engage in good faith here, so please don't accuse me of "obfuscation." The verdict is far from out as to whether ACA, on the whole, was a net-positive for American healthcare, and the question is likely to never be truly answered conclusively. In fact, even if health outcomes drastically improve at the same time that costs stabilize or even decrease, there shouldn't be any automatic presumption that ACA is responsible. I admit that my first comment was a bit snarkier than it had to be.
Squarely Rooted,
It's clear from your response that you are, in fact, addressing this in good faith. Gotta tell you, the debate wasn't carried out that way in front of the American People, or in the congress.
And for those who say "This is too nuanced to be grasped by the public at large -- we needed to 'simplify and modify' some of the points to make them more digestible," I would say that kind of paternalism violates the principles of American government. If the laws are too complex and subtle for Americans to understand, there's something wrong with the laws. First time in history of the country that a transformational law was passed in a harshly partisan, strategically-maneuvered fashion like this.
The system is broken, as you point out. Major reform is needed, designed by smart people who understand the power of free markets and who respect individuals' ability and obligation to look after themselves. I don't think we got anything like that with ACA.
Pelsmin,
I want to take issue with one thing you said:
"Major reform is needed, designed by smart people who understand the power of free markets..."
http://www.forbes.com/sites/aroy/2011/10/11/how-mitt-romneys-health-care-experts-helped-design-obamacare/
Here is how the Democratic Party and liberal-leaning individuals see the timeline of health reform in the United States:
BEGIN: Health care in the United States sucks.
1993: A new Democratic administration proposes a health care reform plan that is universally panned and reviled. Republicans (and some Democrats) propose an alternative based on a mandate/subsidize/exchange model which is at least intended to use market forces to improve health care.
http://www.kaiserhealthnews.org/stories/2010/february/23/gop-1993-health-reform-bill.aspx
2006 - The Republican governor of Massachussets shepherds a mandate/subsidize/exchange plan into law.
2008- Democrats campaign on a mandate/subsidize/exchange platform and win.
2009 - Every Republican who ever supported mandate/subsidize/exchange now claims it is socialism, including said GOP Mass Gov. Democrats pass it anyway and take an electoral schellacking in 2010.
This is seperate from the merits of ACA, but the idea was that, by adopting the more conservative, market-oriented alternative to past top-down plans to reform health care, Democrats and the left were making major concessions to conservative ideas in order to secure universal health insurance. So you can see why many among them feel bait-and-switched by the fact that the plan that used to be the market-oriented alternative, designed by a MIT economist, is now a disaster that should be replaced by "major reform...designed by smart people who understand the power of free markets..." They thought the law they just passed WAS "major reform...designed by smart people who understand the power of free markets..."
Again, seperate from the merits of ACA, but I think that's why many on the left who felt they were made an offer - give up on single-payer and other publically-provided plans and embrace this market-oriented GOP-originating plan because it's politically viable - feel like the goalposts shifted.
Tyler Cowen would say this is all about mood affiliation.
Square Root,
Off base on several accounts. The little ones first: Romney never renounced ACA as socialism. He weakly objected to it as anti-federalism, in effect claiming it was a great idea, but should be done by each state. Left-leaning liberal "Republican." That mealy-mouthed view helped him lose. (BTW, his plan was a disaster in MA. In-state Democratic friends tell me the media never covered how it was turning out because it was an indictment of the ACA model).
More importantly, you can't possibly call ACA a market-oriented GOP-originated plan. I keep hearing that claim, which is laughable and obviously false. Up there with "Reagan actually RAISED taxes and GREW government," and "Obama has slowed federal growth more than anyone since Ike." Patently false, can't be supported, just not true. When you look into the claim that the Heritage foundation supported the concepts of ACA you see the lie.
Romney didn't call Obama a socialist, but he came damn close:
http://2012.talkingpointsmemo.com/2011/12/romney-attacks-obama-for-being-a-socialist-without-calling-him-a-socialist.php
Also, Heritage absolutely advocated for an individual mandate:
http://usatoday30.usatoday.com/news/opinion/forum/story/2012-02-03/health-individual-mandate-reform-heritage/52951140/1
http://blog.heritage.org/wp-content/uploads/Heritage-Foundation-Amicus-Brief-05-11-11.pdf
They can qualify and hedge their past support all they want, and they have every right to change their position, but it's silly to deny that, in the late 80s and early 90s, the GOP/conservative institutional position on healthcare was in favor of individual mandates. And here's Politifact on exchanges:
http://www.politifact.com/truth-o-meter/statements/2010/apr/01/barack-obama/obama-says-heritage-foundation-source-health-excha/
Also, I can't let you call something I blogged just a week ago "patently false" without some response!
http://squarelyrooted.wordpress.com/2013/02/12/krugman-is-underselling-austerity/
That's what the data says.
I know this thread has been kaput for weeks (or, in internet-time, several eternities) but I couldn't resist:
http://thinkprogress.org/health/2013/03/13/1710231/paul-ryan-makes-big-admission-republicans-helped-write-obamacare/
RYAN: Look, exchanges at the state level is something we have always been talking about. Tom Coburn and I had a bill. I think they have kind of messed up the idea of exchanges but the idea from conservative standpoint is a revived idea that can work. The other thing is high risk pools. They screwed the high risk pools and didn’t work in Obamacare but a way of making them work from our minds to make sure that people with preexisting conditions can get considerable health insurance. We think some in that law were destroyed but revive those things in an effort to replacing the law.
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