Obamacare myths

The New York Times’ Bill Keller had a nice little piece debunking five “Obamacare” myths.  Quite usefully, he particularly takes on the canards how Republicans would repeal health care reform:

THE UNFETTERED MARKETPLACE IS A BETTER SOLUTION. To the extent there is a profound difference of principle anywhere in this debate, it lies here. Conservatives contend that if you give consumers a voucher or a tax credit and set them loose in the marketplace they will do a better job than government at finding the services — schools, retirement portfolios, or in this case health insurance policies — that fit their needs.

I’m a pretty devout capitalist, and I see that in some cases individual responsibility helps contain wasteful spending on health care. If you have to share the cost of that extra M.R.I. or elective surgery, you’ll think hard about whether you really need it. But I’m deeply suspicious of the claim that a health care system dominated by powerful vested interests and mystifying in its complexity can be tamed by consumers who are strapped for time, often poor, sometimes uneducated, confused and afraid.  [emphasis mine]

“Ten percent of the population accounts for 60 percent of the health outlays,” said Davis. “They are the very sick, and they are not really in a position to make cost-conscious choices.”

Exactly, you are not exactly going to comparison shop based on price when you have a broken arm or a serious liver disease.  Also:

LEAVE IT TO THE STATES. THEY’LL FIX IT. The Republican alternative to Obamacare consists in large part of letting each state do its own thing. Presumably the best ideas will go viral.

States do have a long history of pioneering new ideas, sometimes enlightened (Oregon’s vote-by-mail comes to mind) and sometimes less benign (see Florida’s loopy gun laws). Obamacare actually underwrites pilot programs to reduce costs, and gives states freedom — some would argue too much freedom — in designing insurance-buying exchanges. But the best ideas don’t spread spontaneously. Some states are too poor to adopt worthwhile reforms. Some are intransigent, or held captive by lobbies.

You’ve heard a lot about the Massachusetts law. You may not have heard about the seven other states that passed laws requiring insurers to offer coverage to all. They were dismal failures because they failed to mandate that everyone, including the young and healthy, buy in. Massachusetts — fairly progressive, relatively affluent, with an abundance of health providers — included a mandate and became the successful exception. To expand that program beyond Massachusetts required … Barack Obama.

And, of course, he doesn’t even bring up the lowest common denominator of regulation example, i.e., all are credit card companies are incorporated in Delaware and South Dakota where they have bought the rights from those state legislators to completely screw us.  There’s surely be a race to the bottom that would take advantage of many people by selling very poor and poorly regulated insurance across state lines.

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