Detailed non-entertainment polls continue to show the same results as they have every year since 2010, that most Americans actually support the Affordable Care Act if you dig down further than simplistic support/oppose questions.
If you only ask the topline question, you’ll keep finding the same thing: most people “oppose” the ACA. But if you ask what people want done with it, most want it either left alone (25%), or expanded (22%). The repeal and replace (13%) crowd is small, probably because the Republican Party hasn’t said what they would replace the ACA with. Only 24% want it repealed with no replacement.
Even 18% of Republicans want Obamacare left alone or expanded, more than the 11% of Democrats that want it repealed and/or replaced (the latter with single payer, which could easily fall under “expand”).
Add it up: 47% want the law left alone or expanded, 37% want it gone and/or replaced. Obamacare is not a train wreck or a disaster and it’s a law that most Americans favor.
There’s lots to be said about what’s going on, what we should take away from all of this, and then what should be done about it. Republicans are hammering the exchange roll out failure but they’re essentially shooting at themselves.
The health insurance exchanges are a market-based solution to high premiums that were supposed create competition. If premiums aren’t where we expected them to be, or want them to be, then it’s not a failure of government, it’s a failure of the private markets to compete with each other even with softly forced to do so.
The actual Big Government solution to health care would have been replacing Medicare with Medicaid and opening it to everyone based on income, or replacing the for-profit insurance industry entirely.
Instead, we got the “small government” solution to the inefficiencies of the free market which prioritizes profit rather than affordable health outcomes.
There are only two insurance companies providing plans in North Carolina on the federal exchange and one of the two is only covering half the counties in the state. Short of the government becoming even more interventionist by forcing insurance companies to cover territories that they don’t want to, that is a failure of inspired private competition. It’s only about the millionth lesson we’ve learned from health care in this country that market-based solutions are inefficient.
That lesson dictates that steps taken towards an even more market-based approach would be doomed to failure, and that the solution actually is more government, not less. That shouldn’t surprise anyone who has spent serious time looking at how other countries handle health care. Some governments directly regulate the price of procedures, some regulate what doctors get paid, while others don’t have a private insurance market at all. All of them spend less on health care than America does and many have similar if not better affordable health outcomes than we do.
Given the problems that private IT companies have had creating functional exchange websites, it probably would have been better in retrospect not to have state-based exchanges at all.
The conservative idea of allowing insurance companies to compete across state lines was bad because without strict federal regulation, they’d all flee to states with the least regulation and that would be bad for consumers. But it’s not an inherently bad idea, it just needs work. Allowing — or even forcing — insurance companies to compete across state lines would probably promote consolidation of the insurance market into a handful of large mega-corps, which isn’t ideal, but then they’d all be large enough to be national providers that would operate only on a federally-run exchange. That would do more to promote competition, ironically, than what we have now.
From the PR side of things, the administration should have done more to warn people with free-riding plans that cover basically nothing that they were going to lose what they had, because they didn’t have something worth having to begin with. All the people losing plans in October through policy cancellation had coverage that didn’t cap deductibles and capped payouts, which is now prohibited.
People who felt cheated by that do so because they’ve never actually had to use their shitty $90/mo plan and so never discovered the hard way that $90 is probably about all they’d ever get out of it when they got sick. Some of the plans going away only covered two doctor visits and the rest were 100 percent out-of-pocket. That’s not allowed anymore, either.
Exchange plans cost more than the canceled policies precisely because they offer more comprehensive coverage, and that should have been explained at every possible opportunity. Some people will pay more in monthly premiums but once they get sick, they’ll save a ton of money, guaranteed.
The true scale of the obsolete policy issue also should have been explained much earlier. A couple million people having obsolete and awful-anyway policies canceled is nothing compared to the 80% of people who get insurance through their employer, and those plans aren’t going away. The inadvisable promise by President Obama that people would get to keep what they already have was true for 80% of the market, which is pretty damn good.
More on this topic later…