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ObamaCare Staggers Toward the October 1 Finish Line, Part III & IV

Lambert Strether continues his analysis of the Affordable Healthcare Act and explains why this legislation is detrimental to our health as citizens.

Part III

Yes, ObamaCare, even if it has been driven off the front page by the NSA and Syria, is still lurching along; there are 23 days ’til open enrollment begins, even if October 1 has been very conveniently redefined as a “soft launch” that doesn’t really matter, the only date that really matters being January 1, 2014, when you can actually purchase the ObamaCare product, because Jeebus, who wants to make huge household budget decisions that could affect your 2013 1040 in 2013? (But can’t somebody tell HHS that October 1 doesn’t matter? Because it’s all over their site.)

The administration, as it is wont to do when faced with a tough sell, has deployed The Big Dog. The Times called Clinton’s speech “wonkish,” but, alas (rather, necessarily) it was filled with evasions and half-truths. Selecting one:

“This does give us the best chance we have to achieve nearly universal coverage, provide higher quality health care and lower the rate of cost increases, which we have got to do in a competitive global economy,” he said.

Well, “nearly universal” is what I’d call lawyerly parsing. Of the approximately 50 million uninsured, ObamaCare projects to cover only 7 million of these in its first year, and 30 million of those uninsured uncovered when fully implemented. So how “nearly” is that? I’d say not very. I’d also say that any American deserves health care just as much as any other American — we are all equal in suffering — yet this thought somehow never occurs to ObamaCare apologists like former President Clinton, who, like Obama and the rest of the political class, is ever comfortable throwing millions under the bus.

And for those who are covered, coverage is, basically, random. Luck of the draw. As the launch date, soft or not, approaches, we’re getting more detail:

Residents in Seattle and Portland, Ore., will pay $213 and $165 monthly respectively for the same lowest-cost Bronze plan, which will cost $308 in New York City and $336 in Burlington, Vt.

First, look at the sleight of hand in the phrase “the same … plan”; the benefits in the plans are the same on paper (or on the website), but “words are wind,” as they say in Game of Thrones. The plans will have different networks, different definitions for services, different delivery of services. Anybody who’s had to cobble together health care from different providers knows this; and Kaiser did a study that proves there are “substantial variations among plans,” even when insurance actuaries are given the same set of definitions for plan benefits.

So now we’ve got ObamaCare being random in two dimensions: Random because the price depends on where you live; in California, it depends on what county you live in. And random because you really can’t compare individual plans on the Exchanges, as ObamaCare promises, like flat-screen TVs: The plans are incommensurate! So Beltway triumphalism — “Get. Excited.” — that we finally have some notion of what ObamaCare will cost the average citizen — is completely misplaced: We’ve got a price, but we don’t have a product, and the price of the (incommensurable) product varies whimsically by our location. If the Post Office worked like ObamaCare, every zip code would have a stamp with a different price on it!

And why is the ObamaCare product random? And why are the prices random? Because for all the bluster about ObamaCare being universal — as we have seen, it isn’t — ObamaCare makes no commitment to universal coverage, and does not treat health care as a right, unlike single payer Medicare for All. That’s because ObamaCare is in its essence a market state solution, a splendid example of cognitive regulatory capture, where the government — using the word “consumer” instead of the word “citizen” is the tell here — adopts the private health insurer mindset, and actually forces people to buy a product, while all the while turning over the profits to corporation whose markets it made!

Perhaps that’s why, when a Democratic loyalist blog finally decides to do some education on ObamaCare, it doesn’t start with the actual benefits ObamaCare will deliver*, and certainly doesn’t mention let alone advocate for proven programs, like single payer Medicare for all, that could actually deliver the services ObamaCare claims to. No. What do they do? They begin a series that will explain the arcana of private health insurance. Good call, because that’s what ObamaCare is.** Balloon Juice:

I’m a bureaucrat at a health insurance company which most of you have never and will never hear about. My job is to be a subject matter expert on a fairly arcane set of knowledge. I have seen some posts and some great comment threads at Balloon Juice where great questions are being asked and basic mechanical knowledge would be very useful. I will be writing a series of posts over the next couple of weeks/months that attempts to explain why a profit seeking insurance company does what it does.

A project which struck me, as it struck others more tactful, as the final collapse of the “progressive” Obama supporter into whimpering irrelevance (if constitutional scholar Obama’s gutting of the Fourth Amendment with the NSA scandals and peace candidate Obama’s warmongering on Syria had not already achieved that). If we’d passed single payer Medicare for All in 2010, we would already have saved a trillion dollars and a lot of grief. So why is a putatively progressive blog explaining how the completely parasitical, rentier-driven business of private health insurance works, instead of trying to abolish it? If you’ve got a tapeworm in your gut, you don’t try mitigate it, or “tweak” it, or have a talk with it, to persuade it to devour less of your substance: You get treatment and kill it!

Finally, I’ve been saying for awhile that the ObamaCare rollout feels like a political campaign because it is a political campaign. The rollout, remember, does not target the sick who actually need care. Nor does it treat all citizens equally; instead, market segmentation is used, and only those likely to respond to marketing are targeted. And who is targeted? Well, youth — we are told that the not-yet-old must subsidize the no-longer-young*** — Blacks, and Hispanics, especially in important Democratic states like CA. At this point, a suspicious mind might notice that these demographics are suspiciously close to Obama’s demographics as a candidate. And a suspicious mind did. The LA Times:

Administration officials are also working directly with key constituent groups including Latinos and African Americans to encourage them to sign up for coverage.

So that cat’s out of the bag now.**** Maybe if I have the energy I can get to how ObamaCare is also throwing walking around money to Democratic front groups for ill-defined services, but that will have to wait for another day.

Meanwhile, just think: If we had single payer Medicare for All, maybe Breaking Bad’s Walter White — who had health insurance, after all — would have remained a prideful, resentful, ego-driven sociopath chemistry teacher, instead of becoming a drug lord. It’s a funny old world.

NOTE * Ritual caveat: A program as huge as ObamaCare will undoubtedly deliver benefits to some. However, it cannot and will not deliver benefits to all, equitably. It’s not designed to do that.

NOTE ** Which would be why Medicaid and Medicare are both left as entirely separate systems. Eh?

NOTE *** Note privatized actuarial logic, so distant from a sense of “provide for the common welfare.”

NOTE **** One does not need to assume that ObamaCare will provide real benefit even if Obama is trying to sell it (or, in this case, upsell it, his 2008 and 2012 elections having been the initial sale).

Part IV

Tonight I want to focus on only two topics: First, ObamaCare apologists, Democratic operatives, and career “progressives” have been peddling the Big Lie that ObamaCare is universal. WaPo’s Sarah Kliff has a story today: Left behind: Stories from Obamacare’s 31 million uninsured; I’ve been saying 30 million, but heck, who’s counting? Enough with the “universal,” already! At least for these United States. Because anybody who’s been paying attention to the heath care reform debates knows that there’s already a truly universal, proven system, on this very continent, in a country with a culture and a political system very much like our own, and called, amazingly enough, Medicare:

The Canadian single payer system.

We also know that although Obama did verbally support single payer in 2003, he was already backing off by 2006. We know that In the 2008 campaign, Obama ran “Harry & Louise”-style ads attacking Clinton for supporting the individual mandate, which Krugman called him out on. (This matters because if you accept the premise that people should be forced to buy a health insurance, even though it’s a defective product, then the mandate is the only way to achieve universal coverage; universality, therefore, has never been Obama’s priority.) We know that once elected, Obama and his administration dissed single payer at every opportunity, including mocking its advocates, censoring Town Hall coverage, and cancelling his own family doctor’s appearance at a forum after it became known that he was going to advocate single payer. Kathleen Sebelius says Obama’s goal is to block single payer permanently. So when you hear ObamaCare apologists, Democratic operatives, and career “progressives” say they want ObamaCare to evolve in the direction of universal coverage, take that with a dose of salts, because they will not advocate, and hate to even mention, a proven system that achieves that goal. Based on their track record — and I know this will come as a surprise to you — they’re lying.

But there’s an even simpler way to tell that universal coverage is not a priority for Obama, or the Democrats:

You know how the Democratic nomenklatura is always whining that the Republicans keep introducing bills to repeal ObamaCare (40 at last count), even though they don’t have a hope of passing them in the Senate? How they’re grandstanding and throwing red meat to the base? Well, how come turnabout isn’t fair play on this? How come Nancy Pelosi hasn’t thrown her own base some red meat by putting John Conyers’ single payer bill, HR676, on the floor 40 times? And so what if the Republicans suppress it, or vote it down? And how about the Senate? Bernie Sanders had a single payer bill, S703, in 2009; so why not at least do a little grandstanding for the base and introduce that bill on the Senate floor? And if 40 times is too much for the stately processes of The World’s Greatest Deliberative Body, then how about once? Or if Harry Reid wants to take some luster from the Kennedy name, how about he re-introduces Kennedy’s bill to reform Medicare by progressively lowering the eligibility by five years, every year, ’til all are covered? Just once? Or if the Democrats just have to have a poorly architected, complex, and Rube Goldberg-esque health care proposal, why not write another 2000 pages of bug fixes for a bill that really does guarantee universal coverage, and put that on the floor 40 times?

The simple answer: Priorities. The Congressional Democrats — or at least Obama’s rump faction of that party — don’t introduce any bills to guarantee universal coverage because that’s not their priority; once they’ve serviced their constituents and handed out the walking around money, their interest is at an end. And the Congressional Democrats don’t introduce single payer bills because that’s not their priority: Like Obama, they hate it. That’s because they’re owned by the health insurance companies, and their priority is to preserve the health insurance industry by guaranteeing them a market. If you get coverage from that effort, that’s a happy side effect and not the goal.

Second, I’d like to focus on the idea of ObamaCare as an experiment. From an article by Henry J. Aaron and Kevin W. Lucia (credentials omitted) in this month’s New England Journal of Medicine:

[T]he ACA has set in motion a large number of pilot programs, experiments, and demonstration projects involving new methods of paying for care and organizing providers. These innovations include bundled payments and accountable care organizations. Not all these innovations will succeed. But if some do, the exchanges will be in a position to encourage or require their adoption. And if exchanges cover a sizable fraction of the insured population, they will have the clout to change the delivery system.

The authors say “experiment” and “innovation” like those are good things. And I suppose, if you are funded to do them, they must be good. However, if we’re designing an entire health care system, we don’t need to experiment, because the Canadians already did that for us. Take a look at this chart (originally from Ian Welsh):

Notice how US and Canadian costs are similar until 1970, and then diverge? That’s when the Canadians adopted their single payer system. Looking at the same data, Yglesias writes:

This is the chart that I think ought to dominate the conversation about public-sector health care spending in the United States, and yet it is curiously [BWA-HA-HA-HA!!!] ignored. The data show government health care spending per capita in the United States and Canada. The United States spends more. And that’s not more per person who gets government health insurance, it’s more per resident. And yet Canada covers all its citizens, and we don’t. That should be considered shocking stuff, and yet I rarely hear it mentioned.

Even odder [BWA-HA-HA-HA!!!] is that the most recent time I heard it mentioned was Valerie Ramey talking at the American Economics Association conference in San Diego and her conclusion was that this showed U.S. health care needs free-market reforms. The more straightforward interpretation, I would think, is that the U.S. needs to make its system more like Canada’s. It’s important to note that the example here is Canada. Not some radically different society. Not some far-off distant land. And the gap is actually growing. …

Canada’s public-sector health care system—conveniently called “Medicare”—is available to people of all ages, and thus has even more bulk purchasing power than its American analogue. That allows it to obtain services at a much lower price, which reduces spending.

Again, we don’t need to experiment. (I don’t want to say that Aaron and Lucia are running a scam, but feel free to think it.) The Canadians have run the experiment, and we have the results. Unfortunately, the political class suppressed them, at the behest of the health insurance companies.

Now, the medical profession is very well aware of the word for experiments that are performed on people without their informed consent. That word is unethical. And ObamaCare is an experiment; Aaron and Lucia admit as much (and give several other reasons in their article besides the passage I quoted). Have the American people given their informed consent to this experiment, which will affect not only their personal economies, but their health and even their lives? No. Obama and the Democrats mock, censor, and suppress single payer advocates (see paragraph three, above), and refuse to seriously legislate for it, or even grandstand for it, exactly in order to deny Americans informed consent. That makes them, in medical terms, unethical. “First, do no harm.” How does advocating for experimental solutions while keeping silent on proven solutions comport with the words of Hippocrates?

Summing up, I’ve been trying to work up an ethical critique of ObamaCare (and, necessarily, of its advocates). Here goes:

1. ObamaCare purports to be universal, but is not. This is unfair.*

2. ObamaCare coverage depends on “the luck of the draw.” This is unfair. People are equal in their suffering, and should have access to care that eases their suffering equally.

3. ObamaCare is an experiment performed on the health of the American people without their informed consent. This is unethical.

NOTE * Also too, lying is bad, and Big Lies are worse.

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