Obamacare Will Hurt the Poor and the Elderly
John Boehner says Obamacare is the law of the land, and he's right. At this point, there is no reasonable prospect that it will be repealed before its full implementation in 2014. At that point, there will be huge additional classes of people dependent on federal subsidies to either (A) be covered by Medicaid or (B) buy health insurance in government-organized markets.
If it is an unpopular program now, in 2014 it will become much more popular with the folks receiving these subsidies. Like Social Security and Medicare, Obamacare clients will come to view it as a right or an entitlement. Anyone who argues for its repeal will be portrayed as a heartless ogre. This is a political reality and Boehner is smart to come to terms with it.
That said, there is one key, politically salient difference between Obamacare and the New Deal/Great Society entitlements: Obamacare creates losers who will be politically impossible to ignore for both Democrats and Republicans alike. This is a complicated subject, but here I'll focus on two groups of people that will be harmed.
1. The elderly will be hurt -- Obamacare cuts a substantial amount of money out of future Medicare expenditures. This is the famous $700 billion cut that go so much attention during the election season. The main way that cuts will be made will be through the newly created Independent Payment Advisory Board (IPAB). Given the constraints that body faces, the most likely strategies they will employ include cutting Medicare Advantage and sharply cutting payments to doctors. For the elderly, the latter will mean that Medicare will become more like Medicaid (the government health insurance program for the poor), as fewer doctors will agree to see Medicare patients.
2. The poor will be hurt -- People who are currently insured through Medicaid often cannot find a doctor who will see them. Even if they can find a doctor who takes Medicaid, they face long waits for scheduled care. This is one of the reasons that emergency rooms are so often crowded -- they are the only place where Medicaid patients can be guaranteed to see a doctor. Obamacare will greatly expand Medicaid enrollment (by 20+ million people) to the near-poor, but it will do nothing to expand the supply of doctors caring for those patients. This will make it even harder for the poor to find care.
There are others who will be hurt -- federal taxpayers and small business owners for instance -- but this post is already too long. Democrats will pretend the elderly won't be hurt. They will respond to the harm to the poor by pushing for expanded funding for Medicaid. Republicans have had mixed success with pointing out the harm to the elderly. Can they make a politically effective, conservative argument about the harm caused to the poor?
- Comment (32)
- · Quote
- · UnfollowFollow (5)
- Pages:
- 1
- 2
Comments:
Aug '12
Re: Obamacare Will Hurt the Poor and the Elderly
Mark
[Making sure you're comparing apples to apples, and controlling for differences. For example, one reason a country might spend more on something is because they buy more of it, which might be because they want more or need more.]
Or can afford more. But we are comparing two very rich countries (the US and Australia), with similar populations. Not a rich country with an old population and a poor country with a young one. I think it is apples to apples.
[So if Americans have bad eating and exercise habits, or if our ethnic makeup is one that results in genetically higher levels of obesity and heart disease]
I wish with all my heart that Australians all looked like Crocodile Dundee/Female equivalent, but the truth is that we are in direct competition with the US for MONIW (most obese nation in the world). We're fatties too.
[What needs to be shown is whether the extra money we spend on healthcare is unreasonable.]
I don't think it's unreasonable to buy what you do, but you're paying too much for it. Looks like market failure.
Rgds
Aug '12
Re: Obamacare Will Hurt the Poor and the Elderly
Mendel:
I think it is perfectly plausible to say that the Australian single-payer plan provides equal or better overall care at less expense than U.S. healthcare, but that a truly free market in healthcare in the U.S. could be even more efficient. · 23 minutes ago
Could be? And also could not be, right? So far it's hypothetical.
But looking at systems in comparable countries around the world:
Are there any free markets in health care that provide a similar or better level of health coverage to Australia's for a lower proportion of GDP? (<9%. I can't think of any. Switzerland has an Obamacare like system which costs them 10.8% of GDP according to that Pearl of Truth wikipedia fwiw.)
Are there any single payer systems in the world which provide a similar or better level of health coverage to the US' for a lower proportion of GDP? (<18%. Yes: Australia, Canada, Israel...)
I guess I don't understand the need to to re-invent the wheel wrt health care in the US. There are so many other existing systems - compare, contrast, pick one - they all work better.
What am I missing?
May '10
Re: Obamacare Will Hurt the Poor and the Elderly
Zafar, how do you determine "a similar or better level of health coverage to the US' "? For example, there is the often-cited stat that Pittsburgh has more MRI machines than all of Canada. It's also frequently noted that average (average!) emergency room wait times in parts of Quebec are upwards of 20 hours, and this is not unusual throughout Canada. And there are also the figures on the many months wait times for elective surgeries. Correct me if I'm wrong on these.
If you compare cancer survival rates, the US tops the charts.
Mar '11
Re: Obamacare Will Hurt the Poor and the Elderly
Zafar
Mendel:
I think it is perfectly plausible to say that the Australian single-payer plan provides equal or better overall care at less expense than U.S. healthcare, but that a truly free market in healthcare in the U.S. could be even more efficient.
Could be? And also could not be, right? So far it's hypothetical.
But looking at systems in comparable countries around the world:
Are there any free markets in health care that provide a similar or better level of health coverage to Australia's for a lower proportion of GDP?
Before we can answer that, we have to ask the question: are there any free markets in general healthcare at all in the developed world?
And the answer is no. So your comparisons mean little, since there is no reference point on the other side. The question is indeed only hypothetical.
Mar '11
Re: Obamacare Will Hurt the Poor and the Elderly
Of course, we all know that Medicare pays per service, not per outcome - maybe Pittsburgh has far too many MRI machines than necessary for a healthy populace because of distorted incentives.
In general, I don't see why we should defend our current system. Yes, it delivers a number of superior outcomes. It also delivers a number of subpar outcomes in many categories, and is incredibly expensive and wasteful to boot. It's also not a free-market system by any honest appraisal - and I have no problem saying that it sucks.
Aug '12
Re: Obamacare Will Hurt the Poor and the Elderly
Mark - Quality is determined by the health and life outcomes. Is spending 9% of GDP instead of 18% on healthcare worth longer waits in emergency rooms for conditions that allow it? I say yes.
Wrt statistics
http://www.factcheck.org/2009/08/cancer-rates-and-unjustified-conclusions/
From which:
...the United States boasts a higher five-year relative survival rate than the European average, according to a 2008 study in the British medical journal Lancet. ...
But survival rates also differ within the United States, between insured and uninsured populations....
...survival rates in Canada, Japan, Australia and Cuba were all comparable to or higher than U.S. survival rates on all types of cancer that the Lancet study examined, except for prostate cancer. Those countries all have some form of government-provided health care coverage....
aggressive screening common in the U.S. turns up both early cases [of prostate cancer] and cases that would never need intervention. This leads to an inflated survival rate in the U.S., where asymptomatic patients are more likely to be diagnosed. [and to be alive five years after diagnosis.]
[Statistics] don’t really present any obvious conclusions when used to compare different populations.
?
Aug '12
Re: Obamacare Will Hurt the Poor and the Elderly
Mendel
[Before we can answer that, we have to ask the question: are there any free markets in general healthcare at all in the developed world?
And the answer is no. So your comparisons mean little, since there is no reference point on the other side. The question is indeed only hypothetical.]
So if we stick to comparing apples to apples, how about free markets in general healthcare in the developing world? Are there any? How do they compare wrt outcomes with single payer/centrally provided healthcare systems in countries at a similar level of development?
And more fundamentally, why do countries seem start regulating health care provision as soon as their societies start aspiring to have the entire population covered?
I think it is unfair to blame markets for doing what untrammelled markets do: maximise individual profit. In most cases this does grow wealth and benefit the whole of society.
Wrt health care provision, however, profit maximisation can be perfectly consistent with a certain level of deprivation in society. Universal health care is not automatically consistent with maximising profit (ie efficiency) from health care provision. Why does it make sense to expect the market to automatically deliver it?
Regards
Aug '12
Re: Obamacare Will Hurt the Poor and the Elderly
[In general, I don't see why we should defend our current system. Yes, it delivers a number of superior outcomes. It also delivers a number of subpar outcomes in many categories, and is incredibly expensive and wasteful to boot. It's also not a free-market system by any honest appraisal - and I have no problem saying that it sucks.]
To clarify: I will say that health care technology (and health care itself, perhaps) IS recognised as excellent in the US. When my father needed a bypass lo those many years ago we took him from India straight to Houston.
Any questions I (an outsider) have about the system are about getting that health care to the people - it isn't an attack on the quality of that care at all.
Edited on November 10, 2012 at 5:37amNov '11
Re: Obamacare Will Hurt the Poor and the Elderly
If we are to have a public option, by all means let us have the politicians offer this and get it passed. This business of having the CMS bureaucracy micromanage the enormous private payer bureaucracy, and pretend that this will "reduce overhead" and "increase efficiency through economies of scale" or whatever buzzwords they are dazzling the masses with, is utter bollocks. Government option with well-defined limits, paid for via taxes, with a robust private insurance market that isn't micromanaged into subservience by the government, to give people that can afford it better coverage? By all means, let us have that, if the people want it.
Nov '11
Re: Obamacare Will Hurt the Poor and the Elderly
It's a shame these discussions never get beyond the most superficial of copy-pasting links to factcheck.org level. Does anyone here actually have to work with CMS on a regular basis? I do. It's a terrible bureaucracy. Does anyone here know about the new readmission penalty?
Nov '11
Re: Obamacare Will Hurt the Poor and the Elderly
More here. Also:
Nov '11
Re: Obamacare Will Hurt the Poor and the Elderly
I know I've linked to this before, but I'll go ahead and link to it again. The reasons why the USA spends more money on healthcare are complex. If you want to point at percentages of GDP, or average life expectancy, and sneer and sneer away about how Cuba has better healthcare than we do, go ahead, you're not being serious.