Making the Unaffordable Affordable and Affordable Unaffordable

This week marks the sixth anniversary of the Patient Protection and Affordable Care Act (ACA). But it’s hardly anything to celebrate. The ACA was intended to make health coverage affordable using an age-old strategy referred to as OPM (other peoples’ money). For instance, ACA regulations require insurers to accept all applicants — including unprofitable ones — at rates not adjusted for their health risk. Premiums can vary somewhat based on age, but not health status. A plethora of new taxes (mostly on medical care and health insurance) are supposed to somehow make coverage more affordable. Other funding mechanisms include draconian cuts to Medicare and higher deficits to expand Medicaid.

Devon Herrick, PhD, Senior Health Care Economist,  National Center for Policy Analysis, “The Unaffordable Care Act Turns 6, “ March 23, 2016, The Health Care Blog

What Doctor Herrick went on to say was that when you make health insurance affordable for  those who previously found health insurance unaffordable-  the 12 million who signed up for the ACA health exchanges and the 22 million new Medicaid enrollees, most of whom are sicker than the general run of the population, 220 million or so, you often make previously affordable health insurance unaffordable  for  the general population, i.e. the health young and middleclass, because they must spend  their taxpayer money  on higher premiums and deductibles  to make health care insurance affordable for those who previously found that insurance unaffordable,  i.e., they no longer find  affordable  the unaffordable higher premiums and unaffordable deductibles for routine care.

Enough word play.    According to President Obama,  in a recent statement in Argentina to a group of students,   this redistribution of income makes no difference and depends on what you think is necessary to advance what kind of social goal you are trying to achieve and what kind of society you want to live in.  It depends on whether you want social justice with a slow growth socialist economy or if you want social inequities with a faster growing economy.  It depends on what is practical and what works.

It depends, in short on your experience.

As poet Ogden Nash said.

For sterile wearience and drearience,

Depend, my boy, on experience.

Here is the President’s statement to students.

"So often in the past there has been a division between left and right, between capitalists and communists or socialists, and especially in the Americas, that’s been a big debate. Oh, you know, you're a capitalist Yankee dog, and oh, you know, you're some crazy communist that's going to take away everybody's property."

"Those are interesting intellectual arguments, but I think for your generation, you should be practical and just choose from what works. You don’t have to worry about whether it really fits into socialist theory or capitalist theory. You should just decide what works," he added. "And I said this to President Castro in Cuba."

“I guess to make a broader point, so often in the past there's been a sharp division between left and right, between capitalist and communist or socialist. And especially in the Americas, that's been a big debate, right? Oh, you know, you're a capitalist Yankee dog, and oh, you know, you're some crazy communist that's going to take away everybody's property. And I mean, those are interesting intellectual arguments, but I think for your generation, you should be practical and just choose from what works. You don't have to worry about whether it neatly fits into socialist theory or capitalist theory -- you should just decide what works.”

“And I said this to President Castro in Cuba. I said, look, you've made great progress in educating young people. Every child in Cuba gets a basic education -- that's a huge improvement from where it was. Medical care -- the life expectancy of Cubans is equivalent to the United States, despite it being a very poor country, because they have access to health care. That's a huge achievement. They should be congratulated. But you drive around Havana and you say this economy is not working. It looks like it did in the 1950s. And so you have to be practical in asking yourself how can you achieve the goals of equality and inclusion, but also recognize that the market system produces a lot of wealth and goods and services. And it also gives individuals freedom because they have initiative.”

“And so you don't have to be rigid in saying it’s either this or that, you can say -- depending on the problem you're trying to solve, depending on the social issues that you're trying to address what works. And I think that what you’ll find is that the most successful societies, the most successful economies are ones that are rooted in a market-based system, but also recognize that a market does not work by itself. It has to have a social and moral and ethical and community basis, and there has to be inclusion. Otherwise it’s not stable. “

“And it’s up to you -- whether you're in business or in academia or the nonprofit sector, whatever you're doing -- to create new forms that are adapted to the new conditions that we live in today.”