It occasionally happens that a fringe groups, often religious, will confidently predict the end of the world, and when the deadline passes and The End does not come, they have to deal with it. Some admit they were wrong. Some are confused and don’t know what to think. A lot of True Believers manage to convince themselves that they just got the date wrong, or that God gave them a brief reprieve perhaps as a reward for their own faithfulness, or even that The End really came after all, despite appearances, but just hasn’t fully manifested itself yet.
In an article published on the New York magazine website back on April 2 (link), Jonathan Chait likens some opponents of the Affordable Care Act (Obamacare) to the members of a failed doomsday cult who won’t give up.
His main example is a piece by Michael Tanner for National Review (link) that was published, appropriately enough, on April Fool’s Day. Not everything Tanner says is wrong, but a lost is at the very least seriously misleading.
For example, it’s true that some people ended up with more expensive policies than they had, and some people lost policies that they wanted to keep. But Tanner greatly overstates the number of people who lost coverage as a result of the ACA, and of course the net number of uninsured is today much smaller. He also neglects to note that the main reason some people are paying more is that they’re getting much better health insurance. Under the Affordable Care Act, insurance companies can no longer refuse to cover pre-existing conditions or arbitrarily cancel coverage for people who get something expensive to treat. Nor can they refuse to cover costs over a certain amount. It’s the customer whose out-of-pocket expenses are limited.
Moreover, many working people with individual health insurance are seeing both better coverage and lower prices thanks to subsidies for both health insurance premiums and, for lower-income people, help paying the uninsured part of their medical bills.
Tanner assumes that ACA has raised the cost of healthcare for employers and the government, but Chait points out that overall healthcare costs are in fact growing much more slowly than they had been doing prior to the ACA,. Indeed, the federal government has in fact ended up spending less on healthcare than it was projected to before the ACA was passed.
On the broader economic front, Tanner claims that higher costs have hurt economic growth, despite the fact that 2014, when the main provisions of the ACA first came into full effect, saw the fastest growth in the U.S. economy since 1999. Tanner also assumes that the ACA has led employers to push more workers into part-time jobs. It appears he’s relying on a predicted result of a provision that hasn’t actually taken effect yet, and in reality the share of part-time workers has gone down.
Tanner complains, “The potential impact on the quality of care remains troubling.” Maybe it is to him. Perhaps he’s worried that the ACA will prove so successful as to damage the Republican Party. I hope he doesn’t rate political advantage above healthcare, but some certainly have done so, as witness the statements quoted in this earlier post.)
In any case, there’s evidence the ACA is improving the quality of care. Since more people are insured and still more have better coverage, fewer are delaying care for financial reasons. In addition, improvements in hospital care promoted by a little-known part of the ACA have saved tens of thousands of lives (see this other recent post).
The ACA isn’t perfect and could be improved. For example, given that Medicare works pretty well and is rated higher than private insurance by those who have it, we could simply expand Medicare to cover everybody. Or we could adopt the Australian system or the Dutch one or the German one. By objective measures, many other developed countries have healthcare outcomes as good as or better than ours, and yet they spend a smaller total amount of money from all sources — businesses, individuals, and the government — than does the government alone in the U.S.
But given our political gridlock (and the complete failure of the Republicans to offer any alternative to the Affordable Care Act), the ACA seems to be for now the best we’re going to get.