A healthy debate: was Obamacare designed to fail?

Point: Obamacare's failures could be a design to promote single-payer

By Howard J. Peterson

Democratic socialist progressives, hard to know what term to use these days, unabashedly embrace single payer healthcare for the United States.  The Affordable Care Act (Obamacare) was passed by Congress with no Republican votes in 2010.  It didn't achieve single payer.  However, an examination of how Obamacare has evolved might lead to the conclusion that it was designed to fail as a way to, ultimately, force a single payer system.

The only material success of Obamacare has been the expansion of Medicaid.  14M new people have been added to the Medicaid roles in states that adopted Medicaid expansion.  According to the Kaiser Family Foundation, the number of uninsured citizens as of June 2015 has only declined by 10 million. So, if you add the growth of the population since 2014 (6M) to the decline in uninsured (10M) (6+10=16) and then subtract the 14M new Medicaid enrollees, the result is that only 2M people who were previously uninsured have gotten insurance through the federal and state exchanges.

The exchanges have produced no material benefit.  Therefore, one might conclude that these exchanges were simply established to destroy commercial insurance markets. The exchanges have required minimum benefits some of which make little sense (64 year-old women being required to carry OB coverage), dramatically increased co-payments and deductibles, increased overall insurance plans rates rather than reduce them by the promised $2,500, escalated taxes/penalties for not participating and driven insurance companies out of the exchanges given their mounting losses and severed the ability for many people to see your own doctor.

So, if one were a conspiracy theorist it would go something like this: the Democrats knew there would be growth in Medicare driven by the aging population. Obamacare focused on the expansion of Medicaid with a plan to increase dependency on federal funding.  The exchanges only purpose was the destruction of the commercial insurance market.  Given these factors and the growing national debt due to Obamacare and the fact that 32M U.S. citizens still remain uninsured a compelling case could be made to move to a single payer system as the only and obvious solution.  Great, the VA for everybody.

Democratic socialist progressives, I believe, would applaud the shift of the entire healthcare sector (17% of our economy) to federal government control.  Combine that with a carbon tax and existing social programs and this positions the federal government to define pretty much all of how we live our lives.

Contrary to this direction, we have enough money currently within healthcare to pay for the clinical needs of our entire population.  The real problem is not cost; its utilization.  The United States provides most healthcare services at two times the rate of other countries (MRIs, orthopedic implants, tonsillectomies).  We do this because of the flawed incentives of our payment system.  We could fix this by changing payment incentives and preserving a commercial insurance market.   But those who crafted Obamacare may be more interested in controlling the citizens than solving the problem.

Counterpoint: Obamacare is doing just fine

By Robert I. Field

If the Affordable Care Act was designed it to fail, its architects did a terrible job. In the face of relentless obstruction, it has been a remarkable success.

Since the law took full effect in 2014, the percent of Americans without health insurance has fallen by more than one-third to the lowest level ever recorded.  Millions of people with preexisting conditions who would not have been able to find coverage previously now have insurance.

A study by the Rand Corporation found that as of February 2015, 16.9 million Americans had gained health insurance under the Act. And somewhat surprisingly, the largest portion of them, 9.6 million, found coverage not through the insurance exchanges or Medicaid but through an employer plan. Many of them were young adults who benefitted from the law's provision that they remain eligible for their parents' coverage until age 26.

Contrary to predictions of the law's opponents, few employers have dropped coverage. Nor have they cut back on hiring. Job creation has been proceeding at its fastest pace since the 1990s. Nor is there evidence of significant shifts of workers to part-time status to avoid the law's coverage requirement.

None of the opponents' other dire warnings have materialized, either. Health care costs have not skyrocketed but instead have risen at the lowest rate in years.

The law has not contributed to a dramatic rise in federal debt. In fact, the deficit has been declining at the fastest pace since World War II, falling by two-thirds since 2009.

And the law has not destroyed commercial insurance markets - it has created new ones. Before Obamacare, individual policies were unobtainable at any price for many with preexisting conditions, and for those who were able to buy insurance, the coverage was often meager and subject to cancellation when they filed their first claim.

Thanks to Obamacare, Americans are now guaranteed the right to obtain health insurance on an exchange regardless of their health status - a lifesaver for many.

To be sure, Obamacare has produced less of a reduction in uninsurance than its supporters had hoped. It would be fair to question the pace of its success. However, the law was never projected to cover everyone, and its slow progress in expanding coverage is still better than anything we have seen before.

It is also true that customers on the exchanges face the burden of shopping around each year to find the best plan and to avoid the possibility of a large premium increase. This can be time-consuming and confusing.

Of course, there is a name for such a system in which consumers must make difficult decisions between competing products. It is called the free market. We are still waiting after six years for an alternative free market plan that Republicans keep promising to come up with.

I do agree that there is enough money already in the system to expand coverage, if we could change the payment incentives.

Guess where you can find a set of initiatives to make a start at doing just that? Obamacare is filled with them.

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