We Brits are bemused by the Obamacare saga in the USA.
The overwhelming mass of Brits (including me) have no idea at all how the national health service actually works. All we know is that the State has taken on the responsibility to fix us if something goes wrong. It may all be increasingly bedraggled in some places to the point of killing you through neglect or incompetence, and more and more taxpayers' money intended to pay for medicine and doctors seems to be siphoned off into medical negligence compensation fees for lawyers. But it is at least there, day and night, and you don't have to think about paying anything for it directly.
Over in the USA there is simply a different way of looking at healthcare. It is YOUR responsibility to make provision for it through assorted private insurance schemes, augmented with different state-backed schemes for those in need. Hence Obamacare - a sprawling impossibly complicated way to solve two problems: not enough people are paying enough money into the US health pot to pay for growing healthcare costs, plus many people can not get or afford insurance cover at all.
If there are in principle clear advantages of the Obamacare model over the current system, the Obama team have done a good job of not selling them. Previous major US healthcare reforms have been passed (and repealed) with varying degrees of bipartisan support. The ginormous Obamacare law was passed with no Republican votes at all. This might show that the Republicans are all evil uncaring monsters. Or it might show that the Democrats were greedy and vain, bent on lurching all US healthcare towards something more resembling a 'European' model eventually and prepared to take bold if not reckless political risks to achieve that.
Anyway, the sheer complexity of what the new law tried to do appears to be causing it to crash. If Americans in large numbers do not sign up to the new system, it will be hopelessly unbalanced and enter a 'death spiral' - it will be paying out for people with chronic and expensive conditions, but not taking in lots of money from people who currently are in goodish shape. The core website needed to launch it all has been a spectacular disaster, and Democrats up for election next year are starting to panic as they try to fend off Republican 'we warned you this would happen' arguments that look pretty darn good.
Meanwhile millions of Americans are receiving letters telling them that because of Obamacare their insurance policies are no longer valid. This flies in the face of repeated explicit assurances by President Obama that anyone who wanted to keep their insuance scheme and their existing doctor would be able to do so. Ghastly, horrible lies? Or as the main bastion of Obama media supporters desperately call it at the New York Times, merely an 'incorrect promise'?
National Review has a lively round up of conservative critiques of Obamacare. Try this practical one by one by Deroy Murdock:
Imagine if Obama simply had offered vouchers, or Health Stamps, to America’s uninsured. Let’s say each needy individual without coverage received $5,000 to purchase insurance. Those with severe conditions could receive additional support. They then would have been encouraged to visit ehealthinsurance.com and similar websites. The uninsured could compare prices and buy whatever plans suited their circumstances. So post-menopausal women need not purchase birth control and maternity coverage, as Obamacare mandates. Childless male 23-year-olds would not be forced to buy pediatric dental insurance, as Obamacare requires.
At roughly 29 percent of Obamacare’s cost, this rational approach would have fulfilled Obama’s promise to cover the uninsured. Conservatives would have been pleased to see freedom and choice central to this arrangement. Those who liked their health-care plans could have kept their health-care plans. Period. And ehealthinsurance.com would have let America avoid the humiliation of launching an unworkable website as the whole world was watching.
Obama could have enjoyed all of this. Instead, and ironically, his massive, statist scheme has soiled the reputation of big-government liberalism — perhaps for decades.
But the prize goes to Jonah Goldberg whose Obamacare Schadenfreudarama piece is a masterpiece of modern sustained political polemic - and all the more devastating for being learned and witty:
In every tale of hubris, the transgressor is eventually slapped across the face with the semi-frozen flounder of reality.
The Greeks had a god, Nemesis, whose scythe performed the same function. It was Nemesis who lured Narcissus to the pool where he fell in love with his own reflection. Admittedly, most of Nemesis’s walk-on roles were in the Greek tragedies, but in the modern era, comeuppance-for-the-arrogant is more often found in comedies, and the “rollout” of Healthcare.gov has been downright hilarious. (I put quotation marks around “rollout” because the term implies actual rolling, and this thing has moved as gracefully as a grand piano in a peat bog.)
But, as the president says, “it’s more than a website.” Indeed, the whole law is coming apart like a papier-mâché yacht in rough waters. The media feeding frenzy it has triggered from so many journalistic lapdogs has been both so funny and so poignant, it reminds me of nothing more than the climax of the classic film Air Bud, when the lovable basketball-playing golden retriever finally decides to maul the dog-abusing clown...
... The other possibility is that he is such an incompetent manager, who has cultivated such a culture of yes-men, that he was completely in the dark about the problems. That’s the reigning storyline right now from the White House. Obama was betrayed. “If I had known,” he told his staff, “we could have delayed the website.”
This is how you know we’re in the political sweet spot: when the only plausible excuses for the administration are equally disastrous indictments.
Read the whole thing.
Jonah then piles it on in a new piece on the latest Obama press-conference:
The president did his level best to explain that he was as in the dark as anybody about the problems with his signature legislation.
He explained that he was not “informed directly” that the Healthcare.gov website was about as ready to run as a three-legged horse at the Preakness Stakes. Apparently, the old saw that the “buck stops” with the president never took into account the possibility that the buck could get lost in interoffice mail.
...
The law is really quite clear. It was so clear that the Congressional Budget Office — their own in-house think tank — said that millions would lose their health-care plans. Obama even said so with the Democratic leadership in the room.
More to the point, the law was intended to cause millions of people to lose their existing plans so they would enter the exchanges.
Now the same people who literally wrote the law feel betrayed when the law does exactly what they intended. That’s like getting mad at a remote-control car when you crash it. Yes, the website’s failures make the panic more acute, but the fact remains that the Affordable Care Act is doing precisely what it’s supposed to do.
Maybe the Democrats will somehow survive this mega-debacle and slowly but surely the new Obamacare insurance regime will get enough people to make it just about viable.
But in the meantime the law has done a startling job in creating a vast crowd of annoyed Americans who need to steer 100% of their vexation at any Democrat running for election. Precisely because it is so vast and inflexible a 'reform', it is open to a terrible - and growing - barrage of angry sniping from both unhappy friend and unrelenting foe alike.
Broader lesson?
The way the Democrats tried to reform healthcare through such a massive, complicated, top-heavy law was precisely the wrong way to go in modern circumstances. Smart networked effects of far smaller less controversial reforms (letting insurance companies sell across state borders, tort reform, encouraging crowd-sourced techniological health care and remote treatment modes and so on) would have been much wiser.
As it is, President Obama is sinking fast in public esteem. Good. It all goes back to his winner-takes-all style attitude immediately after his first election:
In a meeting with the president, Mr. Cantor—then the No. 2 Republican in the House—discussed the economic recovery plans that the post-2008 GOP remnant favored. “Elections have consequences,” the president responded, “and Eric, I won.” The White House promptly leaked the remark to the media.
Yes, Mr President, you did win. So now you 100% own the grim consequences of divisively ramming through Obamacare despite many well-founded objections to it.
