Affordable Care Act – Some Sifting and Winnowing

The Affordable Care Act can be viewed as the most noteworthy achievement of Obama’s tenure as President, or as others would have it, a huge, costly mistake which should be repealed as quickly as possible.  Check back with me in 10 years for a better assessment, but for now I will try to sort out some of the issues and likelihoods from information I have garnered from various sources.

English: Official photo cropped of United Stat...

Senator and Minority Leader Mitch McConnell (R-KY) (Photo credit: Wikipedia)

First is the curious situation of the ACA being, from a Dem perspective, the greatest achievement of Obama’s term, but not pushed hard in his reelection campaign.   A problem they created in passing the act was that most of the benefits do not begin until 2014, so few have experienced its benefits and most don’t know what they are.   This has made it easy for the Republicans to portray the ACA as something nobody wants (*1).

But let’s move on to an actual shortcoming in the plan.  The ACA will not greatly alter our ever rising costs of healthcare, in which we pay 2, 3, or 4 times what other advanced nations pay for similar services.   The passage of the ACA required making concessions to many interest groups,  such as drug and insurance companies and individual Democratic Senators.  As such, the overall problem of increasing healthcare costs was not really addressed in the act, one more reason not to herald it as an achievement.

What the ACA will provide, however, is insurance coverage to some 30 million or so who do not have it now.   In contrast, the Republican have no plan to do that.  They say they do, but health care expert Stuart Altman describes it as “little dibbles and dabbles”.   And that “plan” would at best provide additional insurance coverage to three million people, not 30 million.

What is less clear is what will be the costs of the ACA over time.  Again, according to Stuart Altman, about 100o pages of the 2700 page document deal with ways to save money to counterbalance added expenses, so it can be argued it will pay for itself.    However, we all know the tendency of costs to overrun estimates, even when one plans to remodel one’s house.

One big question percolating is the additional costs that states will have to pay with the expansion of Medicaid by the ACA.   Initially, in 2014 the Fed Gov will pay 100% of those costs but that will change over time, so the question is how much it might change.  I will table that issue until my next post.

While the Obama people don’t stress the ACA in their campaign, neither does the Romney team (other than vowing to repeal it).  Trashing the act in detail would remind everyone that it was largely based on  Mitt’s own plan as Governor of Massachusetts.   The big deal made of the individual mandate –  prompting everyone to buy insurance  – decided in favor by the Supreme Court recently, was no big deal when Romney was pushing his insurance plan in MA.

The mandate idea was developed by the Heritage Foundation, a conservative think tank, reflecting this Republican value:   Reduce the number of “free riders” allowed to live off  the efforts of others.   Romney portrayed those not willing to do their share by buying insurance as “free riders” clogging hospital emergency rooms.

However, the “free rider” aversion was later trumped by another aversion of the right,  big  government oppression of individuals.  When the Obama team came to embrace the mandate, it became even more clear to Republicans that it was a bad idea, even unconstitutionally so.

Amidst all of the political spinning and dodging, this much is clear:   Expanding health care insurance is important to the Democrats and not to the Republicans, as Senate minority leader Mitch McConnell made clear on the Fox News  Sunday, July 1.   Given my center/left bias it might surprise that I consider FOX’s Chris Wallace the toughest political interviewer on TV.  He’s  a chip off the  old block Mike, of 60 Minutes fame.

Since the Republicans promise to repeal what they like to call Obamacare if given the chance, Wallace asked McConnell what they had in mind to expand coverage to the 30 million.  McConnell tried to dodge the question a few times by saying things like “we already have the best healthcare system in the world”, but like a junkyard dog, Wallace dug his teeth into the issue and wouldn’t let go.  Finally, an irritated McConnell said “That is not the issue. The question is how you can go step by step to improve the American health care system.”

And Wallace responded:  “You don’t think the 30 million people who are uninsured is an issue? ”  And McConnell rejoined:   “Let me tell you what we’re not going to do. We’re not going to turn the American health care system into a western European system.”

Tough luck, 30 million.

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(*1)  It seems the Democrats did not want the plan to cost more than a trillion over 10 years,  which was easier to achieve if little was spent until 2014.

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