Oh my G-d, have I written about the Affordable Care Act aka Obamacare! More than 700 posts, and almost 10% mention the Affordable Care Act or Obamacare. Here are a few of my favorites:
The game ends on September 30, 2017, at midnight, Eastern Daylight Time. Senate reconciliation rules—obtuse to the nth—mandate that the Senate pass a new law by September 30, or not at all in 2017. (Not clear? Whether the House of Representatives must pass the same bill by 9/30, or if it can simply adopt the same bill before the Senate adjourns sine die.)
I wrote Dirty Rotten Scoundrels, and the Promise on July 28. And the “Promise” has returned. Here’s Senator Charles Grassley (R-Iowa):
You know, I could maybe give you 10 reasons why this bill shouldn’t be considered, but Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.
No sir, it’s not as much of a reason. In fact, it’s no reason at all. None!
Clearly, we cannot expect fresh thinking—or, for that matter, any thinking—about health care from the majority party. They simply don’t care! And no, I don’t offer that judgment because Obamacare rocks. Issues abound, but these people don’t want to solve problems. Instead, they want to focus on so-called principles: Freedom; Free markets; yah-da, yah-da!!!
So let us meet this crew on its own turf, and talk about freedom and free markets. In particular, let’s focus on the free market for labor and employment.
Most American adults must work. Employment feeds families, among many other basic needs. It also offers most people a benefit package which includes health insurance.
Accidents Of History Created U.S. Health System, a 2009 NPR piece, explains how employer-based health insurance came into existence. Add offering insurance benefits during WWII to attract workers, and tax advantages which the IRS and Congress offered up in 1943 and 1954. Voilà. Group health insurance and, with it, health care payment and delivery systems.
We can argue employer-based health insurance, good or bad. But facts are facts—and no, Kellyanne C., alternative facts are not facts—and most Americans have employer-based health insurance. And, for most Americans, health insurance matters. Few among us can withstand the economic consequences of an unexpected health crisis. Further, in such a situation, money not be a driver.
For sure, most health dollars get spent on routine matters. (“Big deal stuff” costs lots, but the law of large numbers makes “everyday stuff” for tens of millions cost lots more.) And the system—from patients to providers to insurers to the government—benefits from a structure which incentivizes routine care. Why? Routine care helps keep people healthy, which makes them more productive, and helps avoids “big ticket” procedures and treatments. (Duh concepts for regular people; not so much for our elected R public servants.) And facts are facts. For right now most people have insurance which covers most of their health care costs.
So, if most people get their coverage at work, and most people want and need insurance, what happens when a job change arises? Ideally, health insurance should matter not at all. But, as we all know, it matters completely in many cases. Especially, it matters when an employee chooses the “start a new business” route. For example, take a late-50s professional, uninsurable before Obamacare (because of a pre-existing condition), who wants to start his own professional practice. Choices? Stay, for insurance, or go bare and hope for the best.
In a free market, the professional makes his choice without major hindrances. Is a lack of health insurance a major hindrance? For me it was, in 2009, when it looked like Obamacare was not happening? And in 2015, when I—the exemplar—started my own professional practice? Never would have happened, without Obamacare.
Who cares, when politicians promised repeal, stupidly, when they knew their promise mattered not all. Read The Importance of Young Firms for Economic Growth, from the Ewing Marion Kauffman Foundation. Or Research Review: Who Creates Jobs? Start-up Firms and New Businesses, from The Heritage Foundation. We can make me an outlier—the one guy for whom having health insurance mattered—and claim health insurance impacts job growth not at all. Or, we can live in the real world, and acknowledge the fact that without a solid, stable insurance market which makes affordable health insurance available for everyone, we don’t have a free market for labor and employment. And that, without free markets for labor and employment, job growth suffers.
If your people in Washington belong to the R Party, call or email them. Bad policy here!