We were all given a (kind of cruel) three-day reprieve from losing Obamacare when the Supreme Court decided it liked all the attention and postponed their big announcement until Thursday. Such drama queens on the bench. Anyway, I thought I would be writing a post about what they just took away, and the senselessness of it all, but instead I’m writing about what they might take away. It still might not happen, obviously, and I’m not making a prediction because no one really knows, but I have absolutely no hope whatsoever that it will survive.
It’s almost a cliche that when talking about the Affordable Care Act (which I have and will continue to call Obamacare in the past and from this point on, because we should be proud of it, and thank you to Republicans for the handy nickname) the talking heads on TV will say something like, “most people don’t even know what’s in the bill.” They will then blame this lack of public awareness on Democrats or maybe on President Obama himself and I will have to fight very hard not to throw the remote at the TV.
Hmmmm. Is there another institution other than the Democratic Party that is charged with the responsibility of informing the public about important issues and legislation that might affect their lives? Could a complete lack of knowledge by Americans about Obamacare, the single most important piece of healthcare legislation since Medicare, be anyone else’s fault beside the president and his party? It sure seems to me that we as a country could use some sort of industry or companies that would, like, you know, tell us about new stuff that is happening. New stuff is important. We could call the industry “new stuff,” or maybe just “news” for short. Crazy, I know.
Eclectablog has a pretty good rundown of 18 reasons to like Obamacare. I would pay particularly close attention to number 3.
For the first time, health insurers are required to spend 80 to 85 percent of customers’ premiums on actual care. More than $1.3 billion in overcharges will be returned to consumers and employers this year.
That’s the Medical Loss Ratio part of the bill and it’s a key component to improving the care that we receive for our insurance money. I highlight it specifically because in a conversation with my very conservative brother a couple of months ago, he wasn’t even aware that it existed. I blame Obama, obviously.
The MLR has gone into effect and people should be starting to receive refund checks from insurance companies that didn’t quite spend as much on actual, you know, healthcare as the law dictates. What’s interesting about this is the $1.3 billion is an estimate from last year; the newest estimate is about $1.1 billion, which means that the law was actually working: companies are starting to spend more money on actual care instead of denying coverage. If (or when) SCOTUS kills Obamacare on Thursday (depending on the extent of the damage) those checks might never go out.
Much has been written about the fact that Republicans and conservatives were the original creators of the individual mandate that they now insist is unconstitutional. Obviously it’s not hard to see the nihilism at play that would allow them to so easily change their position on what used to be a key component to so many of their own plans. They want to defeat President Obama, regardless of the cost, and they aren’t really all that embarrassed to pretend that things they firmly believed two years ago are now tyranny. It’s a kind of talent, really.
What is less clear is the Republican end-game. If Obamacare is destroyed, what’s the Republican plan for achieving universal coverage? Despite the conspiracy theories of many conservatives who will show out-of-context YouTube clips as evidence that Obamacare is a precursor to Single Payer Kenyan Atheistic Islamic Socialism, no sane person could look at the key provisions of Obamacare and conclude that it is a convenient stepping stone towards Single Payer. Obamacare bends over backwards to preserve private insurance companies, mandating that people buy their products and subsidizing their ability to do so. The mental gymnastics required to turn Obamacare into a Single Payer Trojan Horse (Kenyan Horse?) should be a medal event in London this year. It’s the reason that polls show so many people are unhappy with the bill: liberals don’t like it because it is in many ways a Republican plan and doesn’t get us closer to Single Payer; conservatives don’t like it because a Democrat signed it.
Ronald Reagan signed the Emergency Medical Treatment and Active Labor Act in 1986 which created the Emergency Room form of universal coverage we have now. It’s an unsustainable system because people can (rationally) opt to not buy insurance and then show up in emergency rooms and get care when something unexpected happens. These “Free Riders” are the main reason that the rest of us pay so much for our care. Someone has to pay for them.
There simply is no way to solve the Free Riders problem in healthcare without bringing as many people as possible into the system. Either you can do that with a Single Payer system where everybody is included by law and the government taxes everyone and pays for all care, or you can do it by mandating that people buy insurance. There is absolutely no way around one of those two options. Republicans have been pushing for an individual mandate for over 20 years. President Obama’s great sin was to give them what they wanted.
So I can tell you what the Republicans want SCOTUS to take from you on Thursday. (Or rather, I can point you to blogs that are telling you. Seriously, go read that link. Okay, here it is again so you don’t have to scroll up. Geez.) What I can’t really do is tell you why. I can guess (and have) but only conservatives can really answer the question.
I suspect that what it might actually come down to is this: conservatives aren’t really interested in providing universal coverage. It’s just not that important to them. They don’t think that access to health care should be considered a right. I think maybe they wish the Gipper hadn’t signed that law back in 1986. I can’t say for sure, but that’s my working theory.