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“The Free Market Failed”: Here’s Some More Good News About Obamacare. Too Bad It Won’t Dent The Debate

Whenever a health insurer announces that it will be requesting significant premium increases in the coming year, it’s guaranteed to generate news stories that are waved triumphantly by conservatives as proof that the Affordable Care Act is a failure and, just as they predicted, premiums are skyrocketing because the government is messing around in health care.

When a story like this one comes along, on the other hand, it seems to generate much less attention:

California’s Obamacare exchange negotiated a 4% average rate increase for the second year in a row, defying dire predictions about health insurance sticker shock across the country.

The modest price increases for 2016 may be welcome news for many of the 1.3 million Californians who buy individual policies through the state marketplace, known as Covered California.

California’s rates are a key barometer of how the Affordable Care Act is working nationwide, and the results indicate that industry giants Anthem and Kaiser Permanente are eager to compete for customers in the nation’s biggest Obamacare market.

Leading up to Monday’s announcement there had been a steady drumbeat of news about major insurers outside California seeking hefty rate hikes of 20% to 40% for Obamacare open enrollment this fall.

Keep in mind that before the ACA went into effect, annual premium increases of 10 percent or so had become the norm. California is only one state, and when you go across the country the picture is complicated — in some states premiums are rising more slowly than they did before the law; in other states they’ve jumped; and in some places they’ve declined. There are many reasons why. But what’s important to understand is that the predictions of the law’s critics — that both overall health spending and premiums would explode — were completely wrong.

The key word in this story comes in the first paragraph: “negotiated.” California is one of the states where officials running the health care exchange negotiate with insurers over rates, and when you have a negotiation, you can get better terms for the people you represent. Yet incredibly, we’re still arguing over whether what the health insurance market needs is less government involvement and more of that free market magic.

So for the millionth time: the reason we have the world’s most expensive health care system is precisely because the free market failed.

If conservatives were right and government is the problem, then in all the world’s other advanced nations, where there is much more government regulation of health care than we have, they’d be paying more for their health care than we do. But they spend far less, often with better health outcomes and usually with virtually no uninsured. And after watching this debate for the better part of a decade, I’ve yet to hear a single conservative explain why that’s the case, and how it squares with their beliefs about government and markets. How can it possibly be that government-heavy systems — whether you’re talking about a completely socialized one like Great Britain’s or a system like France’s that combines a basic government plan with heavily regulated private supplemental insurance — work so much better and cost so much less than ours? If you have a religious belief that markets are always right and government is always wrong, it’s just impossible to reconcile.

The point isn’t that the ACA is a perfect piece of legislation that has solved all our problems, because it isn’t and it hasn’t. The ACA is a gigantic kludge layered on top of what was already a terribly dysfunctional system. Health insurance in America remains incredibly complicated — for instance, if you’re on an exchange, in order to get the best rate you may have to shop around every year. Unfortunately, Republicans have made it impossible to fix the law’s weaknesses as we used to do with complex legislation, because they’ve fed their constituents a lie that any day now they’re going to repeal the whole thing, so there’s no point in trying to make it work better (and that doing so would be a compromise with evil, of course).

Fifty years ago this Thursday, Lyndon Johnson signed Medicare into law. At the time, Republicans predicted not only that the program would be a failure, but that it would send America hurtling toward a socialist nightmare of oppression. Ronald Reagan famously said that if the law passed, “we 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.” Yet this big-government, single-payer health insurance program for seniors turned out to be one of the most successful and popular pieces of legislation in American history. Not only that, due in part to the Affordable Care Act, the projected future cost of Medicare keeps going down — another conservative prediction about the ACA that has proven wrong by 180 degrees.

And today, Republicans pretend they love Medicare and only want to preserve it, while they present plans that would eliminate its guarantee of coverage and turn it into a voucher program, on the failed theory that whatever the private sector does in health care must be superior. These efforts always fail, because the program is just too popular.

The ACA isn’t politically bulletproof in the same way, in large part because it’s so many different things. No one “has” Obamacare in the way you have Medicare, with a card in your wallet; in fact, tens of millions of people are affected by the ACA, usually in positive ways, without ever realizing it. But here’s a crazy idea: What if we looked at where the law is succeeding and tried to build on that success, and looked at where it isn’t and tried to correct those shortcomings, doing it all with the best understanding of the actual facts we can gain?

Oh, who am I kidding.


By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, July 28, 2015

July 29, 2015 - Posted by | Affordable Care Act, Conservatives, Health Insurance Premiums | , , , , , ,

1 Comment »

  1. The ACA, while imperfect, is working pretty well. Per Kaiser Family Health Foundation, eleven major markets are seeing increases like those noted in CA. The press prints the higher increases which are occurring in some markets with fewer members and less competition, but they may be the outliers. This is all without Medicaid expansion in twenty states. If that was done, we would see even more reduction in uninsureds.


    Comment by btg5885 | July 29, 2015 | Reply

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