Obamacare and its Critics (whose pants appear to be on fire)

The right has been seeking to overturn the Affordable Care Act ever since its passage in early 2010. As the most significant regulatory overhaul of the U.S. healthcare system since the 60s (Medicare and Medicaid), it fundamentally challenges notions about what the government can and should do. There have been several approaches used by conservatives to turn the public against it, including the erstwhile fallacious argument about “death panels,” the equally questionable argument that healthcare rates will go up, calling it “socialist,” shutting down the government to attain their goal through ransom (holding the country hostage actually seeming to me a relatively accurate portrayal of the failed attempt), decrying the state of socialized medicine in other countries and most recently by denouncing the problems with the website (the only valid critique) and with an absurd attack on the notion that people without children should have to pay for kids with children. In this blog post, I will explore the majority of these claims, providing strong counterarguments to each. I will ignore the “death panel” and ransom strategies, as the former is patently absurd (see The Daily Show takedown here: You Tube) and the latter was covered in a previous entry.

Let’s start with the general critique of any active government role for making the healthcare market more equitable and access more widespread. As with any attempt in this regard, the charge is often that this is “socialism” and thus against the American way. Since Obamacare does not meet any of the criteria for socialism, meaning the public ownership or government control over a public good, I will forgo any deeper analysis of this. But let’s look at three facts that undermine the commonly-held notion that markets are always better than government: 1. Americans have among the lowest life expectancy of any industrialized country in the world, even as the richest country in the world (Common Dreams or Wiki), 2. America has the highest infant mortality rate of any industrialized country in the world (CIA World Factbook) and 3. Americans pay more for healthcare than any other industrialized country in the world (Graphs from Washington Post). Thus the leading indicators of the “quality” or price of the system show us that it is far inferior to countries that fully embrace socialized medicine and that the most important statistic of all – life expectancy – leaves us right alongside countries that are developing rather than fully developed.

Second is the related argument that people in countries with socialized medicine get worse service. The above-mentioned statistics undermine this argument quite profoundly, but we can go beyond this to look at countries with socialized healthcare (which includes most of the advanced economies in the world) and explore statistics on their effectiveness. First, I again turn to the Washington Post, which has a short article outlining many of the fallacies sold to the U.S. public by conservatives and the medical establishment (or check out this piece from Huff Post about the underlying fallacies of the ideological argument itself, or a call to embrace socialized medicine here). Among the fallacies is the idea of high costs, long waiting times, the lack of choice and the inability to secure additional services if one wants to pay more. But the statistics are clear here, with the U.S. paying more for worse, and often unnecessary, healthcare services: see this PBS series, this Common Wealth Fund report using OECD data or How Stuff Works, with even the Daily Mail providing evidence of our comparative weakness in comparison to other wealthy nations.

Third, let’s look at the fallacy that Obamacare will lead to an increase in insurance premiums. While that might be the case in the short term, as people are forced to buy better plans than those offered previously, simple economic logic dictates that, over time, premiums should go down. Why, you ask?  Well, insurance companies base premiums on their expected risk (and costs) versus the money they receive in premiums from the whole pool of the insured. Healthy candidates at the same age and with the same demographic information as unhealthy candidates generally pay the same rate – and thus healthy people subsidize the unhealthy, at least in the short run. If an insurance company can create a big enough pool of the insured, they can balance the risk across many people who will pay more than they use. This lowers the overall cost to the company, increases profits and allows for lower rates. Since many of the uninsured are young, they should actually balance the risk factor of total insured people by a particular company down, thus allowing a decline in rates. Overall, this should reduce rates over time. On top of this, the increase in choice and information available to consumers, increases competitive pressure and tends to decrease prices over time – particularly if collusion is taken out of the formula by government regulators and the potential for new entrants into the insurance market. Thus the second major argument against Obamacare is based on a fallacy and misreading of simple economics – or a rhetorical/propaganda device used by the right given the realization that lower rates reduce profits for their corporate sponsors (the biggest insurance companies).

Finally, is the recent surreal argument that people without children, or who don’t want children, shouldn’t have to pay for people who are having them (and thus the childcare costs associated with that rather common activity) – as if reproduction of the species is some woebegone aim that no longer exists in the spectacle society, digital age and knowledge economy of the 21^st century ('GOP's Newest Demented Crusade: War on Mothers"). Is it really so long ago and far away that LBJ thought the country could end poverty and racial discrimination? Have we moved so far away from the most basic of social contract ideals that people are really only responsible for themselves and their individual, self-interested needs, wants and desires? Has faith in government collapsed so far that we are to be left to the whims of the market, corporations and the power elites? And can a society survive if it does nothing to create, cultivate and support a shared sense of community and associated living? These are all questions the new GOP answers with a resounding “no,” so loud that many in the media can’t seem to even think of what “yes” might look like. Is it really plausible to allow insurance companies to refuse payment for pregnancy and associated child care costs? Are we hoping to approach the Afghanistan level of infant mortality? Or are we simply saying that poor people shouldn’t have children at all? If so, what are the provisions for staffing all the crappy, low-skilled jobs that the American economy now banks on for the still rising corporate profits? This argument is so absurd I shall spend no longer criticizing it.

The reality is quite simple. The American healthcare system is overpriced, under regulated, inefficient and of questionable quality (when measuring silly things like saving lives). Obamacare does not go far enough to address this national travesty, but at least it provides a partial and temporary solution that can serve the goals of equal access and equal treatment, at least at a baseline level. The middle class and rich can still pay for better plans. The insurance companies can still overcharge, though the market should now punish them for doing so. Doctors can still order unnecessary procedures. And the system can still focus on palliatives and cures, rather than prevention. But the critiques of Obamacare, beyond its failed website, are unfounded and, as is so often the case in American politics, obfuscate the real debates around the issue. One hopes the media can at least tacitly acknowledge this reality in their future coverage. And I heard pigs are banding together to start a new, low-cost airline service.