For once in my life, I actually agree with Megan McArdle. It is much more likely that a relatively successful ObamaCare will lead to a single-payer system than it is that a major failure of the law will lead us there. The main obstacle to single-payer is, as Ms. McArdle correctly agues, that most people have employer-provided health insurance that is working fairly well for them. Many of the problems they were having with their insurance have been fixed as part of the Affordable Care Act‘s reforms. People don’t want to give up what they have.
But, over time, a successful individual market that provides good prices will destroy the logic of employer-provided health care. A greater share of the population will get their insurance for themselves. And then the political pressure will be to improve the individual market, which would always be cheaper for the consumer of the government ran it than for-profit corporations.
We may never get a true single-payer system, but it becomes more likely if the individual market works and grows.
that most people have employer-provided health insurance that is working fairly well for them
Most?
Where is this fantasy land?
General polling on the subject shows people are generally satisfied with their insurance, if even they know the system has problems and sucks.
Plus, McMegan’s other point tells the tale: even if people know what they have sucks, they’re generally not keen on losing what they have to get something that (in their mind) might not even be better.
In fact, the whole piece is actually fairly good. It could be the first piece by McMegan that wasn’t riddled with total bullshit. I’m sure some is there if I re-read it tho.
I agree, here in MN, one of the best insurance reformed states in the nation outside of MA, employer provided insurance is basically collapsing in on itself. The costs skyrocketed in the last several years, and although I anticipate slower growth in premium and benefit cuts this year in part due to the ACA, the place where we’ve landed is untenable.
World of difference between small employer and large employer coverage. I worked for a small firm that changed insurers every couple years, and deductibles went from $250> $2000> $5000. I went on my wife’s insurance – she works for a WA state related firm that has coverage with no deductible. It has taken many years to get the changes now in place. The success of the ACA and the policies of future administrations will determine the evolution of the health care system. But I suspect any changes that are radically different will be many, many years from now.
Sometimes I wonder what would happen if we made it illegal to run certain kinds of enterprises for profit. Health insurance and education would be at the top of my list. All these for-profit colleges are a scourge on our nation, and when you’re pooling money to provide for people’s medical needs, it’s just unconscionable to siphon off any part of that just to fatten up someone’s bank account. You can make plenty as a top executive in a non-profit anyway.
My opinion on this is significantly a function of teaching at a leading business school. Millennials are so far to the left on almost every issue compared to their parents. Even MBAs are progressive compared to people my age (early 40s), including on health policy: many of them see Big Pharma as greedy bastards. The votes have not been there for a single payer system but they will be in 10-20 years.
I would also argue that while the ACA has included provisions (like staying longer on your parents’ plan) that soften the impact of our currently dysfunctional health system, the system will remain dysfunctional unless the exchanges work. If they fail, it’s single payer here we come. I think the medical industry, broadly defined, sees it the same way. They will very hard to make the ACA work.
The trends that have to change for the neoliberals to avoid single-payer health care (Medicare-for-all) or socialist health care (VA-for-all) are:
Under Obamacare, it is unlikely that all three of these are unlikely to persist. The dumping of employees onto the individual market by employers right now looks the likeliest to be the one creating political pressure for single payer. But providers not being able to contain their prices is a close second if only because it is the insurance companies that got highly regulated in the Affordable Care Act.
Insurance company pricing of employer coverage might be a factor driving the shedding of employer plans. Indeed the extra time allowed before they come under Obamacare might turn out to be less of an avoidance of price increases than employers thought.
Notice that all three of these have to do with the private part of the public-private neoliberal formula for providing services.
The medical loss ration should control 2 & 3 on your list, the most likely thing to happen is companies dump people onto the exchanges and just pay the fines.
The medical loss ratio requirement in the ACA fixes 2 only to the extent that 3 doesn’t increase. The “best practices” monitoring and independent board to set Medicare pricing is expected to deal with 3, but you know the politics of the “doc fix” is not going to go away easily.
Nice post Booman. It will be interesting to watch the Republicans start calling for delaying the mandate as opposed to extending the filing deadline. Will the Republicans help the Democrats fix the problem like when the Medicare Part D system needed fixing? Not very likely. I haven’t thought this through completely, but I’m wondering about how a delay of the mandate could be tailored to make it punitive if you delay, sort of like Medicare Part D. (If you don’t apply when eligible, you pay a premium.) Add to that the caveat that if you do sign up after eligibility, you also have to pay the yearly mandate penalty back to day one. Furthermore, insist that if Republicans wish to allow individuals to delay enrollment, they (Republicans) agree to pay the costs associated with the enrollments. You have to opt out by registering. This will insure that a record exists of who didn’t enroll when eligible. OK, fire away and blow this idea full of holes.
Already we’re seeing significant cost containment as a result of Obamacare. Hospitals have incentives to prevent readmission (rather than the old system which rewarded them for botched work by giving them more money to fix it). There’s still lots of low hanging fruit. The main thing that could get in the way of healthcare reform is sabotage, which is what the Republicans have been attempting in large ways and small. This is why we must work hard to keep them from those dangerous levers of power, which should never be left within reach of children, nincompoops, facists, frauds or hucksters.
Here’s a thought. What if, instead of pushing Medicare Part D, GW Bush (and his brain, KR) had pushed Obamacare. Well, it would have been BushRoveCheneycare but you get the idea.
Rove was onto something. Had he been able to get Republicans on the right side of this issue and the right side of immigration reform, they wouldn’t be facing political realignment at the national level. They could have sold their small government line of bullshit on scores of other issues while containing and minimizing the “socialistic” element of health care reform.
The Republicans having lost a lot of credibility on this issue, I predict that over the next 20 to 30 years we’ll see movement in the direction of national health insurance (such as a public option or expansion of Medicare although not likely national delivery of health care).
what has happened to Ezra Klein? His whole wonk blog has turned into one big wank fest against the website. He is complaining about the lack of call hold music? Come on. He has turned into David Broder. It is disappointing.
He always was David Broder, you just hadn’t noticed yet. He annoys me even more than his buddy Yglesias does. Remember, during the mercifully brief Paul-Ryan-is-a budget-genius boomlet a couple of years ago, he was one of the biggest cheerleaders on the so-called “left”.
I hate to rely on Sullivan, but can anyone talk me through this:
http://dish.andrewsullivan.com/2013/10/25/coverage-you-cant-keep/
I have been looking all over the place for some kind of detailed information on this issue since my dad told me last week he was losing 6 of the 7 specialists he has been seeing, some for over 20 years, because United Health Care was simply dropping about 20% of the physicians who service Medicare customers. Apparently, in early October, there was a huge purge by most all of the major providers, with no explanation. Letters to doctors, some of whom had just negotiated their next year’s contract, simply arrived in the mail informing them that “due to changes in the health care environment, they were making changes to improve service to their existing customers”. And by that, the meant they were purging those who they felt didn’t fit well within their business model.
I would appreciate any information people might have on this. My father, of course, is laying the blame squarely at the feet of Obamacare. And I have nothing as far as factual information to even relate. My father’s doctors seem as shocked as he was that they were being cut loose. I find the timing quite suspicious. And the fact that there is simply no explanation given makes it even more maddening.
I did find where Connecticut state legislators were demanding answers, but apparently there are none forthcoming from UHC.
I’ve been telling people that there’s no question about them keeping their old insurance, if they want. Apparently I’ve been lying.
Good luck with your dad.
My understanding of this- which is limited- is that these likely were policies that didn’t meet the law’s (not all that high) standards. Meaning that they were crap policies, and the policyholders were getting ripped off, paying good money for pretty worthless “coverage”.
That might well be the case, Steve. Though he was very satisfied with the doctors and the treatment he was getting. But that doesn’t mean he was getting a good deal. I understand after talking to my mom last night that he has switched over to Humana this week, and most of his doctors will be in that plan. I will have to find out if maybe he got a better deal. It will probably take a while for me to unwind this, though. His kneejerk reaction is always glass-half-empty when it comes to “the gubmint”. And he hates the President with a passion, so everything is always going to be wrapped up in that emotion.
Digby adresses these Insurance company letters here
http://digbysblog.blogspot.com/2013/10/right-wing-scare-tactic-674-cancelling.html
http://digbysblog.blogspot.com/2013/09/your-helpful-insurance-company.html
Thanks! This helps me a lot. I knew something was out there.
Awesome. Thanks.
Exactly. Junk insurance is no longer allowed, because in many ways it can be as bad for everyone as no insurance at all.
ACA says you have to have REAL insurance.
There just seems to be a dearth of information on what is happening here. But it is going viral on the right and among the Tea Party crowd. And I have ZERO with which to counter it.
I have been saying the same thing to people as you have about people keeping their insurance. Hell, I have phone-banked about it many times. When this was first thrown in my face last week, I thought that surely there would be some kind of explanation that would help me understand it. But as far as I can tell, it has been CRICKETS everywhere, except from the right.
I just find it remarkable that something like this would simply fly under the radar for this long. Whether or not it has anything to do with the ACA, people are all being told by their physicians that there is a direct relationship. And that is a hard thing to refute.
By the way, he had also gotten the rate increase notices. And after looking at what he received, I have to say that some of them were pretty substantial. Again, it is impossible for me to even try to explain this to him. It has only served to increase the rage level at this whole ACA thing and specifically the President and Democrats. I’m at a loss as to how to mitigate this whole thing with him, not that it would probably do any good.
Which is really unfortunate, because the way for him to get a better deal is in fact to shop on the exchange.
That would be the worst possible scenario for him. His Tea Party side conflicting with a deep desire to get a “deal”.
But it might be kind of interesting to watch the battle with himself.
Mike, is your dad not on Medicare?