When the Bad Guys Win

It's an unjust world.  The Democrats got pummeled in the mid-term elections, partly because of the Affordable Care Act passed over a strong and united Republican opposition.  The Act benefits a vast majority of Americans yet more than half dislike it, and even now are evenly divided about repealing it.

The Republicans' criticism is mainly on three counts, of which the first is misplaced given the rationale and experience of other countries, and the other two are a consequence of their own obstructionism.  These three are:

(a) The expanded role of government.  Every other advanced country has an even more pronounced public payer model, with much lower costs, and better outcomes on average than the US in OECD tracked measures like life expectancy and infant mortality.  Even (sane) capitalists recognize that some functions like defense, police and fire fighting are better performed by a public agency.  Why should anyone blindly assume that health care coverage does not fall into this category?  Or that the job is most efficiently performed by profit maximizing private insurers needing a 25% overhead on top of payouts to providers for meeting their own administrative costs and earnings goals?  Now a WSJ story on Nov. 16 describes how China's successful "State Capitalism" is upsetting the adage of the supremacy of market competition in a broader economic context.

(b) The mandate for obtaining or providing health insurance, especially for employers who otherwise pay a fee.  This mandate for employers and individuals would have been unnecessary if we had a tax funded single payer system.  This "single payer" term is widely misunderstood, and  Howard Dean and Congressman Anthony Wiener wisely used the term "Medicare for All" which Americans grasp much better.  But they didn't get enough air time to get their message through, and Obama never picked up on their cue.  

"Single payer" does not necessarily preclude private insurers - they are allowed to operate in West Europe, but less than 15% of the population opts for them.  So US insurers were right in fearing they'd be cut to a third of their size if something like that happened here.  Their opposition and disinformation aided by their largely Republican allies ensured the timid Obama administration didn't even try for single payer.  Then mandating coverage for all became the only way to viably force private insurers to accept those with pre-existing conditions.  Americans largely fail to understand the connection, and hence Republicans have been able to beat Democrats over the head about these unpopular mandates.

(c) Reforms hardly address the high cost of health care.  This again is ironical since it is Republicans who have strenuously opposed most measures to bring health care prices down, like single payer or even a strong public option, or Medicare directly negotiating drug or device prices.  In their own time they turned a blind eye to provider shortages and increasing hospital market power through consolidations.  They are right though, to raise the issue of tort or malpractice reforms, even as Democrats argue this is not a big factor.

Overall, the wrongful obstruction and opposition by cynical Republican lawmakers of much needed health care reforms has been rewarded by victories at the hustings.  I prefer the endings in typical Bollywood films where the villains get their just desserts and the good guys win out.

Special interests aside there are actually effective ways to drastically cut down health costs while maintaining quality, achieving universal coverage and keeping most Americans happy.  More on that in my next post.