Thursday, October 4, 2012

A real debate on Obamacare

The Obamacare debate may be the most egregiously dishonest thing I've seen in some time.

Consider this Reuter's poll from June: people dislike Obamacare, but they like it's provision.

All this really means is that when the program is described accurately, it rates well, but typically it's misrepresented as a socialist government takeover. This false debate point on Obamacare (looking at you Mitt) is dangerous and insulting.

Normally I find similar misrepresentations mildly annoying, but I've always felt that the health care issues should be treated with more respect. Health care is serious for obvious economic and moral reasons, so let's treat it as such.

Despite his opposition, Romney's Massachusetts administration is arguably the architect of Obamacare. Not surprisingly then, Romney appears to like many of the provisions:

  • Eliminating lifetime maximums
  • Eliminating bans on those with pre-existing conditions
  • Allowing kids to stay on their parents plan until age 26
In last night's debate, I heard no real objection from Romney concerning the individual mandate either, which is arguably both the linchpin of the program and its most hotly contested and least popular aspect. Just ask John Roberts.

Romney criticized Obamacare on two main points. The first is that it "put in place a board that can tell people ultimately what treatments they're going to receive." This statement is simply untrue. The Independent Payment Advisory board to which Romney refers does not have to power to ration health care as he implies.

The second point is that Obamacare drives the cost of insurance up resulting in job loss. This claim is also shaky. Premiums have gone up, but benefits have as well. Moreover, large group plans have seen almost no change in premiums and small group plans have seen only modest change. Obamacare is not a likely job killer because of added premium cost.

However, so long as insurance operates as a for-profit industry -- which I believe is immoral -- insurance companies have a moral responsibility to generate returns for shareholders. Adding new people to the insurance coffers probably means adding the sickest among us who had no access to health care before, and those added payouts will change how insurance is provided in order to maintain profit.

My guess is that the trend in recent years of replacing PPOs and HMOs with high-deductible plans will continue. In short, you'll be covered and get group rates, but if you need to be hospitalized for any reason, count on dropping around $2,500+ out of pocket in addition to your premium.

If you want to attack Obamacare honestly, this cost shift is where you do it.

Still, regardless of the election result I don't see repeal as likely. And frankly I welcome a large scale shift to high-deductible plans because it will finally force us to a fundamental decision about health care: Should insurance be a private good for corporate profit?

If the answer is yes, then our choice will likely be between high-deductible plans for all or dropping the chronically ill from coverage in order to maintain private profit at public expense. After all, that's what these cost shifts represent.

If the answer is no, then we will likely face a more progressive public-sector approach to health care reform as opposed to the conservative private-sector approach of Obamacare.

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