The best thing opponents of Obamacare have going for them is Obamacare. The implementation glitches and the ensuing delays have created a perverse system: Individuals must purchase insurance with no out-of-pocket cost cap while employers are under no obligation to provide insurance. Aside from the gross unfairness and the difficulty in rolling out the plans (e.g. exchanges aren’t set up, there is no guarantee personal information will be protected, the centrality of a corrupted IRS) Obamacare’s debut is bringing home several unpleasant realities.
First, as Yuval Levin points out:
In January, a study by Kurt Giesa and Chris Carlson in the magazine of the American Academy of Actuaries estimated that 80 percent of Americans below the age of 30 in the individual market would find themselves with higher premiums next year than this year, even after subsidies. Early data from the states suggest this estimate may not be far off the mark. . . .The young and healthy are expected to enable that system to function in two ways: They will pay significantly higher rates than they do now, and more of them will buy coverage. But there is an obvious contradiction between these two expectations. If the cost of something goes up, why would more people buy it?
Obamacare’s promise of universal, affordable health-care insurance is illusory; it will be neither universal nor affordable.
Second, young and healthy voters will be getting a raw deal and they know it. If they behave rationally and take up Supreme Court Chief Justice John Roberts offer — don’t insure and just pay the tax — the system will collapse. The pool of covered people in the exchanges will be older (although Medicare remains in place for those 65 years and over) and sicker, the costs will increase, and the alternative will be to squeeze care (i.e. ration) or hugely increase taxes. Levin sums up: “Its mistreatment of the young and healthy is therefore actually a huge problem for the law, and points to the core of the new system’s economic irrationality, or rather to its failure to contend with how people understand their economic options.”
The other adverse consequences (stifling medical device companies, over-pricing the cost of labor, increases in part-time work) will also be felt as Obamacare works its will on the economy by taxes, mandates and more taxes.
It is a misnomer then to call the problems ones of “implementation.” Even if states get their exchanges up and even if the government prevails in laws challenging the obligations of religious-based employers and even if the exchanges manage to secure personal data, the underlying assumptions on which Obamacare rests — young and healthy people can be corralled into the system to subsidize old and sick people is illogical. If you are under 26 years old then you likely stay on your parents’ plan. If you’re over 26 and are making little income you probably qualify for expanded Medicaid insurance. And if you are over 26 and have an income but no employer-based coverage you probably pay the fine and sign up for subsidized care when and if you get very ill or seriously injured. Besides all that, you’d still have the impact on hiring and the part-time work boom.
Republicans should stop diverting attention from these real problems for Democrats too an unpopular stance for Republicans (shutting down the government). They must make Democrats own the Obamacare debacle and make the case to voters that they should be fired for foisting and then refusing to delay or modify the deeply flawed plan.