A Dinosaur's Thoughts on the ACA So Far

Now that the ACA or "Obamacare" has kicked in, this simple lizard has a few thoughts to put out on how it's going.  First, it occurs to me that while there have been plenty of complaints from humans of the right-wingety variety, few if any have latched onto something that really is quite radical about the otherwise middle-of-the-road initiative.  I'm referring to that little bid'niss of doing away with the "pre-existing conditions" screening procedure.  Know why that's che-sexy radical?  Well, THE BASIC PREMISE of insurance is that you must set up your client-parameters with certain exclusions in mind, ones that allow you to turn a profit by the actuarial tables.  I'll bet you're still trying to wrap your mind around the fact that a walnut-brained Jurassic dinosaur just used a fancy phrase like "actuarial tables" and actually seems to have understood what it meant, but let's get back to the subject at hand.  What I'm suggesting is that Obumuhcare messes with the very concept that makes insurance insurance.

Here's a f'rinstance: if a guy is standing on top of a tall building and threatening to jump, you don't sell him a million-dollar life-insurance policy that takes effect immediately and carries no exclusionary language against suicide.  But that's close to what Obamacare does, isn't it?  If I have three life-threatening diseases at the same time, I get to sign up for a policy and you can't exclude me on that basis.  You also don't get to charge me more, if I understand the law correctly.  (Except that the insurers can still charge more for older people.  Because not doing that would be no fun at all.)  What that requirement does is transform the for-profit insurer into an entity that in at least one regard has to behave rather like a gub'mint agency.  You get Medicare when you turn 65.  They don't turn you away because you're sick or old, not even with an unctuous smile.

Now, I'm not complaining about this new development – far from it.  If I've got it right, it's a good move on the Administration's part.  It's even admirably insidious of them, no?  People are so busy complaining about a few curve balls that they've missed the soshulist spitball fluttering right past them and into the catcher's mitt.  So there's that.  Big Insurers who used to make Cruella De Vil (you know, the novel and cartoon character who grinned maniacally whilst shooting dalmations from a helicopter – okay, I made that last part up) look like a major benefactor to the ASPCA must now behave like halfway decent corporate citizens. 

But then there's everything else.  I've read that a lot of very poor folk have been able to sign up for Medicaid, CHIP, etc. and that a lot of people have indeed been able to get policies with help from Uncle Sam.  That's great.  What's not so great is that in a fair number of cases, middle-classers are finding that those "affordable" new ACA-compliant policies are priced beyond financial reach, and no help is available.  Somehow, when the Democrats say "rich bastard," they always seem to mean, "Bill Gates, Warren Buffet and all those other caviar-eating mother-truckers who make more than $25,000 per annum."  Yup, O ye rich 'uns, your Prada-shod hoof shall slide in due time; your days of living it up with your ill-gotten venti-cinque mille k's are fast coming to the ignominious end they deserve.  Yes, that's right, you -- and ….  Well, you get the idea.

That’s a problem with the ACA, I think – it fails up to now to make provision for the fact that a lot of perfectly ordinary Americans are getting squeezed by the provisions of a law intended to help ordinary Americans.  Because of course how could people who preside over a capitalist economy possibly be expected to bethink themselves five minutes in advance and realize what's bound to happen when they tell insurers to start offering something like "access to necessary health care" instead of the snake-oil & small-print gobs of bunkum they've so often been guilty of offering in the past?  Think ahead?  "Who does that?" as the saying goes.  Who, indeed.  Why, if you thought they should have made allowance for this kind of behavior, you're just the sort of unreasonable individual who thinks that when you know your website is going to get 3.8 million hits per day, you ought to design it not to crash when more than five people log on at once.  And there's just no talking to an unreasonable lot like you.  I give up, I really do.

Put these two things together – one, that Obamacare radically and (I think) admirably transforms the health insurance market in terms of how it assesses eligibility for access to care, and two, a lot of people don't perceive "unaffordably higher premiums for somewhat better policies" to be particularly beneficial to them.  Then I think you can see what needs to happen.  No, not the "Repeal Maobamacare" mantra of the Right, but rather a determination to iron out whatever needs ironing out in the ACA and a recognition (forced on us partly by the ACA itself) that yes, health care is often pretty good in this country but it's also pretty expensive and almost nobody can really afford the true cost of it, so the market is a VERY imperfect vehicle for making things right.  All that means extending the premium subsidies to people who make more than the amounts that currently trigger subsidies.  (And yes, my $25,000 figure was only intended as satire, it isn't even close to the correct figure.)  Extending the subsidies or tax breaks would move the ACA much closer to being a law that recasts health-care access as a basic right, a necessity, rather than as a privilege or a hassle. 

As things stand, I think the ACA only goes about halfway in that direction, and that's why the public perception of it (aside from enough right-wing propaganda to choke up the infernal rivers Phlegethon and Cocytus together) isn't very positive right now.  It's the half-measure we were able to get given the political landscape during President Obama's first term, and therein lies the problem.  Apparently, so many of us here in the "US & A" despise government so much that even when we try to get it to do something good, we do things in a muddled, overly complex and yet half-bum way and we end up creating as many problems as we solve.  What I think needs to be done would cost us all somewhat more as taxpayers, but at least it would be fair and it would stop all the grumbling about the unintended consequences of a major and mostly beneficial law.