There is a new report out from the Congressional Budget Office (CBO) titled “The Slow Recovery of the Labor Market”, and as its title implies, it predicts a slow recovery from a labor perspective. Among other things, the CBO report is now making headlines in the political game of Obamacare because it forecasts a 2.5 million job reduction by 2024 due to the effects of the health care law. You should read the report itself (it’s not very long and it has lots of pictures), because it is practically impossible to find objective coverage of its contents in today’s media, which is full of ideology driven experts and completely devoid of old school reporters. I don’t know about you, but I for one am growing tired of the incessant drumroll crediting or blaming Obamacare for everything from the price of gas at the pump to the demise of penguins in Argentina, so let’s show some magnanimity and absolve Obamacare from, at least, the following 10 naturally occurring phenomena.
10. The CBO labor forecasts – Starting with the most recent development, we should observe that the CBO report is not stating that Obamacare will create a shortage of jobs or increase unemployment, which will remain high independent of Obamacare. These 2.5 million jobs are projected to be voluntarily forgone by people, or as the White House press secretary put it, “Americans would no longer be trapped in a job just to provide coverage for their families, and would have the opportunity to pursue their dreams”. And for 2.5 million able bodied folks, those dreams are projected by the CBO to include no work. Instead of having to toil from dawn to dusk in large offices or start small businesses of their own, Americans now have a choice, and we should rejoice in utter disbelief that in a country where one in five children is living in poverty and unemployment is rampant, citizens finally have the liberty to earn no income.
9. Health insurance cancellations – Much ado about nothing was made of millions of insurance cancellations sent in bulk to those who purchased health insurance on the individual market. In case you weren’t aware of it, this type of mass turnover has been occurring in this hapless segment of the market since the beginning of time. Every year, all insurance companies rescinded all policies for all their customers. If your experience is different, then you are definitely an outlier. Besides, it is a well-known fact that individual market policies, as opposed to those issued by benevolent employers, such as Walmart or McDonald’s, were pure garbage before Obamacare, as any retired executive, or middle class family can tell you.
8. Health insurance premium hikes – Seriously? We wouldn’t be having Obamacare if insurance premiums wouldn’t have crippled our economy, impoverished the nation and rendered Apple and Google incapable of competing in the global markets. It is true that Obamacare is forcing insurers to pay out a fixed share of revenues to doctors and hospitals, but Obamacare is also delivering millions of fully subsidized customers to private insurers, allowing revenues to grow through volume in addition to the customary growth in unit margin. This should help avoid wanton increases in premiums beyond originally projected ones.
7. Price of Care – Yes, prices for medical services are exceedingly high in the U.S., but Obamacare was obviously not the catalyst for those. The hospitals started this trend many years ago, and private insurers who like any honest enterprise, get to keep a percent of their revenues, had little incentive to curb the hospitals’ enthusiasm. It is true that Obamacare is providing incentives to hospitals to consolidate into price gauging monopolies, but aren’t monopolies the natural outcome of a free market? The cost of health care in the U.S. was almost double its nearest European competitor before Obamacare, and it still is, and Obamacare had absolutely no ill effects, or any other effects, on that sad statistic.
6. Narrow networks – It seems that people signing up for new Obamacare plans are having trouble getting to see their old doctors, because health insurance companies have concluded (based on extensive and nonexistent research) that folks prefer cheap insurance over actual medical care. Thus, all consumer centered benefit designs include less doctors, less hospitals (particularly popular ones), less of what consumers don’t need or want, and more insurance stuff, such as peace of mind. This cost containment strategy has been initiated long before Obamacare was even contemplated (remember the nineties?), and it worked exceedingly well when combined with #8 above. All Obamacare did, was to create the healthy transparency needed for us to observe this highly beneficial trend towards value for our most esteemed citizens, such as AARP and United Healthcare.
5. Shortage of doctors – Ah, the scare tactics of the rabid right are at work again. Supposedly, Obamacare and its millions of uninsured will be flooding doctors and hospitals, squeezing paying customers out of their place in line. Nothing could be farther from the truth. First, as any Obamacare advocate can tell you, we’ve been having a shortage of doctors long before Obamacare kicked in a month ago, so this has nothing to do with the health care law. Second, Obamacare contains many provisions aimed at finding ways to liberate doctors from the practice of medicine, and to liberate medicine from practicing physicians, so consumers can avail themselves of health care uninhibited by ancient guilds. Also, when insurance plans are firing doctors from their networks by the thousands (see #6 above), how can any free-marketer in his right mind suggest that there is a shortage of doctors?
4. The insurance gap – This is the bleak spectrum of folks who are not poor enough, old enough, young enough, or otherwise demographically endowed enough, to enjoy the opportunity of pursuing their dreams of not working while having the peace of mind that comes with an insurance card. Obamacare tried its hardest to liberate these folks, but a conservative Supreme Court and recalcitrant Governors in red States have come together to obstruct the expanded Obamacare subsidies in many States. It looks like the Governors are beginning to soften their stance though, so we should see more Medicaid cards issued soon. Either way, Obamacare did not cause folks to be in this category to start with, and if you must blame someone, blame the Governor or the judicial branch of government.
3. The Website – We’re talking about a website, a minor technical detail that has absolutely nothing to do with the essence of Obamacare. Yes, Healthcare.gov and several other local health insurance exchanges have been a good example of how not to build and deploy software. It was a learning experience for the nation, and there is clear value in that. As any entrepreneur can recite in his sleep, failing early and failing often is the only way to achieve success. And the website seems to have accomplished that, at the modest cost of less than half of what it would cost to build, say, a new Space Shuttle.
2. Redistribution of wealth – Yes, Obamacare is providing subsidized insurance to the poor, and yes, Obamacare is forcing the young and healthy to pay more so that the old and sick can be charged less, and if you look at the chart published by the Brookings Institute, your heart will sing with joy at the sight of two huge positive columns of gains for the very poor, and the tiny loss columns for everybody else. Until you read the full report, that is. Those huge income gains for the poor, you see, include the money paid by the government on their behalf to insurance companies, and as Brookings wisely shifts the terminology, these are gains in “well-being”, not cash in your pocket. We could use similar logic to divvy up what the government pays defense contractors, agribusinesses, all foreign aid, government salaries, and pretty much the entire federal budget, and show a vast increase in “well-being” for the poor. The President’s recent lukewarm inequality rhetoric notwithstanding, rest assured that Obamacare is not even remotely trying to alter the Darwinian redistribution of wealth in use today.
1. Dysfunctional government – Obamacare, although the most hotly debated federal undertaking in recent memory, cannot be blamed for the present impotence of our federal government, no matter what they tell you from the right or left side of the aisle, or the TV. If President Truman were alive today, he could write volumes on his own “Do Nothing” Congress. Obamacare is actually the one rare incident where a significant law has been passed in the five years following the election of President Obama. It is testimony that Congress can indeed legislate, and it is proof that our government is working as redesigned by an invisible hand. Sure, Obamacare has been the favorite football for the biggest exhibition game on earth right now, but you don’t usually blame the football if your team just doesn’t show up in New Jersey.
Margalit writes regularly about intersection of healthcare & technology on her site: On Health Care Technology