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The Obamacare We Deserve - How to Make it Better

Obamacare was conceived at the Heritage Foundation, and birthed in Massachusetts by Mitt Romney. Obama took Romneycare, a program designed to keep the private insurance industry intact, and improved some of its provisions. In deciding what course, the question for the new administration, which successfully ran a campaign with a large plank to make major changes to the health care delivery system, try to go around the existing insurance industry or through it?

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Nurses demonstrate for universal healthcare, May 2008., pbs.org - Bill Moyers Journal

The Obamacare We Deserve

By Michael Moore

December 31, 2013
New York Times Op-Ed

Today marks the beginning of health care coverage under the Affordable Care Act's new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president's enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president's Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

I believe Obamacare's rocky start - clueless planning, a lousy website, insurance companies raising rates, and the president's telling people they could keep their coverage when, in fact, not all could - is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics "expose" the fact that President Obama endorsed a single-payer system before 2004, they're actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney's car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they'll use some of that to try to privatize Medicare.

For many people, the "affordable" part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet - I would be remiss if I didn't say this - Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter's spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won't be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.
 

Let's not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year - money that would be going to hospitals and treatment.

In blue states, let's lobby for a public option on the insurance exchange - a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients' health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)
 

All eyes are on Vermont's plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That's why corporate money will soon flood into Vermont to crush it. The legislators who'll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let's get started. Obamacare can't be fixed by its namesake. It's up to us to make it happen.

[Michael Moore is a documentary filmmaker whose 2007 film "Sicko" examined the American health care industry.]

A version of this op-ed appears in print on January 1, 2014, on page A19 of the New York edition with the headline: The Obamacare We Deserve.


ACA Coverage Begins, and Michael Moore Has Mixed Feelings About It

By Jared Bernstein

January 1, 2014
On the Economy - Jared Bernstein Blog

Hey, Happy New Year from all of us at OTE!

OK -back to work.

I sort of enjoyed Michael Moore's oped in today's NYT about both the shortcomings and attributes of the Affordable Care Act, on the day its coverage officially begins to kick in.  By "sort of," I mean that I think he gets the politics wrong but he gets the policy right in important ways.

Moore argues that Obamacare is "awful," born of conservative ideology to protect the existing private insurer infrastructure.
 

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney's car. And we knew it.
 

Now, putting aside "awful," which Obamacare is definitely not -Moore himself calls the reform a "godsend" a few sentence later -he's right about a lot of the above.

Political scientists will write tomes on this, I'm sure, but as someone who was there at the time, the relevant question was: do we, a new administration that successfully ran a campaign with a large plank to make major changes to the health care delivery system, try to go around the existing insurance industry or through it?  While Moore and many progressives may believe that either path was viable, many others were justifiably convinced that there was no political path around the insurance industry that Congress would support.

That's Congress.  What about the general public?  As Ezra Klein points out, if a small minority -about 5% of the population -was deeply upset about not being able to keep their existing plan, why would it have been OK if pretty much everyone now in the private market faced that same transition?

There's no question that to an extent, an administration makes its own bed in these fights.  Their assumptions about what's possible determine what's possible.  But having been inside that machine for a few years, I think this is a much more conservative country -in the sense of resisting change and being suspicious of government -than a lot of people think.

Meanwhile, the ACA is rolling along, with a couple of million signed up for coverage in the exchanges and millions more signing up for the Medicaid expansion,* the latter of which is reaching folks higher up the income scale than it has in the past.

Other benefits of the new coverage kicking in today:
 

Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations. And they cannot set dollar limits on what they spend on "essential health benefits" for a policyholder.

Moore argues that progressives can plot a course from the ACA to something closer to single payer, by, for example, trying to get an option for publicly-provided coverage (like Medicare for all) in the state exchanges and supporting the single-payer system that's supposed to start in Vermont in a few years.

I don't see why not, and if so, that looks more like the incremental path that our political economy usually dictates.  As a friend pointed out to me the other day, such progress happens one funeral at a time and the death in this case is a very important one: it is the demise of the notion that the ACA can be repealed.  That notion is not dead yet, but it is dying, as each day of increased coverage -however bumpy (and there are more bumps to come) -worsens its condition.

And no, it is not covered under Obamacare.

*The NYT says "hundreds of thousands" have signed up for Medicaid under the ACA expansion; the WaPo says 3.9 million. My CBPP colleagues tell me that, in fact, this number is not knowable yet, though stuff I've seen leads me to believe it's in the millions, not the hundreds of thousands.

[Jared Bernstein joined the Center on Budget and Policy Priorities in May 2011 as a Senior Fellow.  From 2009 to 2011, Bernstein was the Chief Economist and Economic Adviser to Vice President Joe Biden, executive director of the White House Task Force on the Middle Class, and a member of President Obama's economic team. Bernstein's areas of expertise include federal and state economic and fiscal policies, income inequality and mobility, trends in employment and earnings, international comparisons, and the analysis of financial and housing markets. Prior to joining the Obama administration, Bernstein was a senior economist and the director of the Living Standards Program at the Economic Policy Institute in Washington, D.C. Between 1995 and 1996, he held the post of deputy chief economist at the U.S. Department of Labor.]