Why I support Obamacare

No, this isn’t tech related, so feel free to skip it if you don’t care or don’t want to read it. I’m leaving comments on, but stupid, abusive, or unhelpful comments will be deleted. You can disagree—that’s fine!—but be nice.

A conservative friend of mine asked me on Facebook why I support Obamacare. I wrote up this very long reply (almost 2000 words!) as an answer. Because I intended it as a casual reply—at least up until the first 500 or so words!—I didn’t provide citations & links for most of the facts I cite. Nonetheless, it should be easy to search for any of them & find my sources. Oh, & I don’t think there are, but if you find a few unquoted sentences in here from Wikipedia, I apologize in advance for my sloppiness.

This is a very long answer, because you asked a serious question. However, before I start, let me say that while I support Obamacare, I see it as a half measure at best. I was, & I still am, in favor of a single-payer healthcare system (for instance, making Medicare available to everyone), like virtually every other industrialized nation. That to me will be the only solution to the problems that Obamacare is trying to solve (detailed below).

Further, to me, Obamacare is mostly insurance company reform. That’s really what it is. That’s a good thing, as insurance companies have made billions of dollars screwing over a lot of people. Obamacare is still not the real comprehensive reform I would have liked, but it was the best we could get right now, so I’m happy we have it, even if I don’t think it goes nearly far enough.

How the US healthcare system (very) generally works

In order to answer your question, let’s first review how the US does things. Most of the population under 67 is insured by an employer (either theirs or a family member’s), some buy health insurance on their own, & the remainder are uninsured (~16% of the population). Health insurance for public sector employees (including the military) is primarily provided by the government.

The basic idea, though, is that you are insured by your employer (an outgrowth of World War II, by the way, when employers, seeking a way to provide benefits to employees during a time of wage & price control limitations, started offering to pay for health care costs instead; the government had offered to cover health care costs, but unions & others protested, as they wanted the benefits—it seemed to make sense at the time.). This system is an outlier among other industrialized nations, however, as virtually all others guarantee access to medical care for its citizens through public, government-backed systems.

How are we doing compared to other industrialized nations?

• Life expectancy: 50th among 221 nations, & 27th out of 34 industrialized countries
• Infant mortality: 39th
• Adult female mortality: 43rd
• Adult male mortality: 42nd
• & on & on

Not so great. Not nearly as great as we should be doing.

Problems in the US healthcare system

Now let’s look at the problems Obamacare is trying to solve.

1. 45 million people had no type of health insurance in 2012. Sure, they could go the emergency room, but then they either get a bill that bankrupts them (see below) or the outrageously high costs get passed along to everyone else.

2. Many of those who had insurance had “bad” insurance that didn’t cover very much.

3. Health insurance has often been discriminatory: women paid more than men, for example, or insurers wouldn’t cover someone who was sick. This often lead to destroyed finances (62% of filers for bankruptcies claim high medical expenses; 25% of all senior citizens declare bankruptcy due to medical expenses, & 43% are forced to mortgage or sell their primary residence).

4. Healthcare costs in the US are the highest in the world (yet we’re only ranked 46th in the world for efficiency by Bloomberg & 17th out of 17 in a report by the National Research Council & the Institute of Medicine; other reports are similar). The expenditure per person in the U.S. is ~$8000, while the total amount of GDP spent on health care is ~17%—also the highest of any country in the world.

5. Figuring out what your healthcare plan does & does not cover is at best extremely difficult & at worst impossible. The “fine print” is often used by insurance companies to screw consumers.

Those are all real, painful issues for virtually every American using the healthcare system—which means every American!

What Obamacare does

So, what does Obamacare DO to fix these problems?

• Obamacare requires insurance companies to cover all applicants within new minimum standards. In other words, you can’t be offered an el cheapo plan that sounds great (“Only $50 a month! Sure!”) but doesn’t actually cover anything. And all plans must include prescription drugs, maternity care, mental health, physical rehabilitation, laboratory services, preventive care, chronic disease management, ambulances, hospitalization (that one screwed a lot of people), & pediatric services—all things that were often left out of the “cheap” plans. Even better, insurance companies can’t impose annual or lifetime coverage caps, so you can count on those things being available.

• Obamacare requires that insurance plans eliminate co-pays & deductibles for childhood immunizations, adult vaccinations, medical screenings, mammograms, colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STD counseling, HIV screening & counseling, FDA-approved contraceptive methods, breastfeeding support & supplies, & domestic violence screening & counseling.

• Obamacare requires that the out-of-pocket maximum deductible you have to pay is limited to $6,350 for an individual. Again, this is because the “cheap” plans would often have sky-high deductibles, which lead to bankruptcies or sickness & death due to an inability to pay.

• Obamacare requires insurance companies to offer the same rates regardless of pre-existing conditions. A lot of people have gotten screwed by the insurance companies by their failure to cover pre-existing conditions, so it’s great that this is no longer the case.

• Obamacare requires insurance companies to offer the same rates regardless of sex. Women won’t pay more than men.

• Obamacare will lower both future deficits and Medicare spending, according to Congressional Budget Office projections.

• Obamacare will reduce the number of uninsured by 27 million between now and 2023; unfortunately, it will still leave approximately 26 million Americans uninsured (Who’s still going to be uninsured? Illegal immigrants [1/3 of that uninsured group], citizens who fail to enroll in Medicaid even though they could, citizens who opt to pay the annual penalty instead of purchasing insurance, & citizens who live in states that opt out of the Medicaid expansion and who don’t qualify for existing Medicaid coverage or subsidized coverage). That’s far better than the current situation. Among the non-elderly, 83% are currently insured (although a lot of those policies are pretty bad); under Obamacare, that will jump to 94% (& the plans all have to adhere to a minimum standard, so no more crappy plans). It’s not universal, but it’s far better.

• Obamacare will reduce medical bankruptcies & prevent job lock (when someone can’t leave their current job because then they’ll lose their health insurance).

• Obamacare will help control costs by reducing the number of people who have to go to the emergency room because that’s their only option & also by increasing the size of the insurance risk pool, which should help to distribute costs.

• Obamacare allows children to remain on their parents’ plans until age 26, which will reduce the number of uninsured young adults.

• Obamacare increases Medicaid eligibility to 16 million individuals with incomes below 133% of the federal poverty level.

• Obamacare removes the Medicare “donut hole” (after someone under Medicare runs through the initial coverage of prescription drugs, they have to pay for those prescription drugs [at a higher cost], until they reach the catastrophic-coverage threshold, at which point Medicare takes over coverage again).

• Obamacare establishes four tiers of coverage: bronze, silver, gold, & platinum. All of these categories offer the same essential benefits, outlined above; the different tiers tell you what your premiums & out-of-pocket costs are going to be. Basically, the percentage of care covered through premiums (as opposed to out-of-pocket costs) are roughly 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum). This makes things simpler for the consumer.

• Obamacare requires insurance companies spend at least 80–85% of premium dollars on health costs & claims instead of administrative costs & profits; if this is violated, they must issue rebates to policyholders.

Whew!

I think all of that is great. I mean, seriously great. I find it very hard to understand how someone could be against it, frankly. Is it perfect? Hell no. But it’s better than what we had.

Some examples

Are some premiums going to go up? Well, kind of, but in many cases, not really. Here’s an example: if you’re 27 & live in Fort Lauderdale, Florida, the least expensive plan is around $66 before Obamacare. Under Obamacare, it’s $128. “That’s double!”, you say. Hold on.

First of all, that plan sucks. It’s comes with a very high deductible—$10,000—& doesn’t cover mental health, brand-name drugs, or pre-natal care. On top of that, your out-of-pocket limit is $12,500. Egad! And, of course, if you have pre-existing conditions, you’re looking at a LOT more.

Under Obamacare, the $128 plan must include basic health benefits, like mental health, prescription drugs, & maternity care. Your deductible/out-of-pocket is limited to $6,350. That’s a far better plan!

“But it’s still $128!”, you say. Hold on. Under Obamacare, if you’re single & earn less than $46k a year, you are eligible for federal subsidies to help defray premium costs, with the size of the subsidy based on age, income, & residence. That means that the young single person in Fort Lauderdale ends up paying … wait for it … $74 a month. A whopping $8 more, for a far better plan, & you can’t get screwed by the insurance companies!

And here’s another example, this one from a close friend of mine. On October 1, 2013, when the Obamacare exchanges opened, my friend Bill got on the website & finally got decent health insurance. Here’s his brief story:

One data point: as a self-employed, relatively healthy 47 year old (I just hit my personal best in the squat rack), I was ‘uninsurable’ to any of the companies out there because of being diagnosed with sleep apnea 10 years ago (I have no other pre-existing conditions). I have since lost 35lbs and the apnea went away, but still no company wants to insure me - so I had to buy through MO’s ‘high risk’ pool. $508/mo for a $5K deductible - no vision, no dental, etc. - catastrophic coverage only. Just checked the new health insurance exchange web site today - $200/mo for better coverage…

That is exactly what Obamacare is supposed to do.

Some myths

In the list of things Obamacare does that I provided above, note the items that were not listed, because Obamacare does not do them:

• You do not have to change your doctor.
• You do not have to change your insurance.
• You do not have to use a government healthcare system.
• You do not have to use an exchange.
• Businesses do not have to use the exchanges (insurance offered to employees must meet federal minimum standards, however).

In fact, for most people, not a lot will change, except that your insurance will be better. As Michael Tanner, senior fellow at the CATO Institute (a noted libertarian think tank), put it: “The vast majority of people will continue to get insurance the same way they do today”.

By the way, I’d also like to address the statement that the President & Congress are somehow exempt from Obamacare. Actually, Obamacare requires that members of Congress (& other federal employees) obtain health insurance either through an exchange or approved program (Medicare, for example), instead of using the current government program (the Federal Employees Health Benefits Program). However, the federal government will, like large private employers, continue contributing to the new health insurance plans of federal employees.

And besides, remember how our system works, by & large: the employer pays for the employee’s health care. The President & Congress & the military & other government employees are employed by the federal government, so why shouldn’t it contribute to, & provide, their health care?

The past informs the future

To wrap up this long reply, I’d like to forecast the future by looking at the past. Every time there has been an expansion of social services & rights for people in this country, the right wing has pulled a Chicken Little & screamed that the US was doomed (note I said “right wing” & not “Republicans”). Here are just a few examples; believe me, there are many more.

• Social Security Act (1935). John Taber, a GOP House member from New York: “Never in the history of the world has any measure been brought here so insidiously designed as to prevent business recovery, to enslave workers.”
• Fair Labor Standards Act (1938), which set a national minimum wage, guaranteed time-and-a-half for overtime in certain jobs, & banned child labor: “Opponents of the bill charged that [it] was ‘a bad bill badly drawn’ which would lead the country to a ‘tyrannical industrial dictatorship.’ They said New Deal rhetoric, like ‘the smoke screen of the cuttle fish,’ diverted attention from what amounted to socialist planning.” (http://www.dol.gov/oasam/programs/history/flsa1938.htm)
• Medicare & Medicaid (1965). Ronald Reagain in 1961: “[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

And now Obamacare:

• Louisiana Rep. John Fleming: “Obamacare is the most dangerous piece of legislation ever passed in Congress.”
• Minnesota Rep. Michele Bachmann: “Repeal this failure before it literally kills women, kills children, kills senior citizens.”
• New Hampshire state Rep. Bill O’Brien: Obamacare is “a law as destructive to personal and individual liberty as the Fugitive Slave Act of 1850.”

And the best of all (& voted by Politifact as “Lie of the Year” for 2009!; see http://chnsa.ws/f5):

• Sarah Palin: “The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”

The right wing freaked out about the Social Security Act in 1935; now it’s an established part of our country. The right wing freaked out about the Fair Labor Standards Act in 1938; who would abolish the minimum wage or allow child labor now? The right wing freaked out about Medicare & Medicaid in 1965; now millions of people depend on those programs for their health & lives.

The right wing is freaking out about Obamacare now; in ten years, no one is going to care. The benefits Obamacare provides society will be accepted, & most people will wonder how we ever lived without them. The sky won’t fall, but millions of people will be insured, & will be able to live healthier lives without worrying that they’ll go bankrupt or die because they can’t afford or get health insurance.

That’s why I support Obamacare.