Obamacare may work, but I doubt it

obamacare-500The Affordable Care Act does good things.  It extends health insurance to many (but not all) of the uninsured.  It forbids denying people health insurance because of a pre-existing condition.  Young people can be covered by their parents’ health insurance for longer periods of time.

The big problem with the law is its complexity.  Generally speaking, government is a good mechanism for doing simple, clear-cut things, and a bad mechanism for doing complicated things.

Obamacare is hard to implement, as is seen in all the delays and exemptions in rolling out implementation.

And it is easy to sabotage.  The U.S. Supreme Court opened the door for sabotage by striking down a provision requiring expansion of Medicaid, the government health care program for the poor.  (I don’t get this.  How is it that the Medicaid law is constitutional, but expansion of Medicaid is unconstitutional?)

As a candidate, Barack Obama proposed a simple, workable public option.  A public option would be a self-financing government health insurance system that people could join if they couldn’t get private insurance or weren’t satisfied with their current insurance.  It didn’t require micro-managing the whole U.S. health care system.  But that would have been a threat to the for-profit health insurance industry.  For whatever reason, Obama quickly abandoned his plan when he was sworn in as President.

Obamacare does nothing to address the reasons Americans pay so much more for medical care than foreigners do.  It disallows the government negotiating with drug companies for lower drug prices, as foreign governments do.  It locks in for-profit health insurance, which would play no useful role in a universal health care system.  And it does not address the fact that physicians and other specialists have much higher incomes than in foreign countries.  As with some of the President’s other initiatives, it leaves me in doubt as to which side he is on.

I agree that some of the reasons for opposing Obamacare are bogus.  Employers blame the Affordable Care Act for layoffs and downgrading jobs from full-time to part-time, but I think most of that would be happening without the law.

The best result for Obamacare would be that it results in a net improvement, with the possibility of further piecemeal improvement.  The worst is that it would leave many people worse off than before, and discredit the whole idea of universal health care.

I fear Obamacare will be a big unwieldy mess, which ordinary people won’t understand and which the insurance, drug and medical industries can manipulate to their own advantage.  But I’m not sure I’m right about this, and I hope I’m wrong.


Here are some of the problems with Obamacare.

Untangling Obamacare: Shopping the insurance exchanges by Trudy Lieberman for Columbia Journalism Review.  The Affordable Care Act is difficult even for experienced journalists to understand and explain.

Obamacare: One blow after another by Jennifer Haberkom and Carrie Budoff Brown for Politico.  This is a good roundup of the unexpected setbacks in implementing the Affordable Care Act.

Obamacare Subsidies Act Like an Effective Marginal Tax of About 15 Percent As Your Income Goes Up by Kevin Drum for Mother Jones.  In terms of incentives, declining subsidies are the same as a tax.

Most uninsured Americans live in states that won’t run their own Obamacare exchanges by Pew Research Center.

Here are reasons to hope the law just might work.

Swapping COBRA for Obamacare Likely to be a Windfall for Big Business by Jay Hancock for Kaiser Health News.

Obamacare premiums will be cheaper than CBO projected by Matthew Yglesias for Slate’s Moneybox.

But there are better alternatives.

Canadians don’t understand Ted Cruz’s health care battle by Matt Miller for the Washington Post. (Hat tip to Jack Clontz)

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2 Responses to “Obamacare may work, but I doubt it”

  1. Chico Says:

    Doubt is not a pleasant condition, but certainty is absurd.


  2. philebersole Says:


    The fundamental fallacy which is committed by almost everyone is this: “A and B hate each other, therefore one is good and the other is bad.”
    ==Bertrand Russell to Sidney Hook in 1958 1956.

    I think the main thing that President Obama has going for him is the craziness and irresponsibility of opponents such as Ted Cruz.


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