Healthcare and the Midterms

One of the most often repeated arguments in the closing stages of the 2018 midterm election cycle is the fact that healthcare is the most important issue to voters, according to polling. This is pushed by the various flavors of Status Quo Proponent, despite the fact that the reasoning for that healthcare concern is an indictment of the Status Quo.

Consider this discussion on MSNBC’s Morning Joe from last week. About halfway through, after the panel had exhausted its shots at the Trump administration, Willie Giest decided to ask a substantive question about whether Obamacare was possibly at the root of this. The expert panelist answered as follows:

The Affordable Care Act was wildly successful in many ways. It provided 20 million people with coverage, largely under the Medicare Expansion. Through the exchanges, roughly 8 or 9 million get their insurance. Most of those people get federal subsidies for their insurance. So they end up paying almost nothing…for those people, the law is working great.

 

But there is a large chunk of middle income America that doesn’t qualify for those federal subsidies, and they’re subject to these 55% premium increases, the fact that deductibles have tripled over 10 years – tripled! – and that has far surpassed wages. So when we talk about basic pocketbook issues for middle income American families, healthcare IS the issue.

Before continuing, it’s important to discuss a harsh reality. Healthcare is a good, and like all goods, at any given moment it is finite. This underpins the uncomfortable truth that, in terms of insurance coverage, those who will be likely to consume more health care services (namely the sick and the elderly), are going to be more expensive to insure.

So when you mandate, as Obamacare did, that insurance cover anyone, even those with a pre-existing condition, you are going to see the cost of insuring people rise. Additionally if you add some 20 to 30 million people, who are at the very least heavily subsidized, premiums are going to have to rise on the un-subsidized pool of insurance consumers to make up the difference.

And those premiums have risen, in spades. As our expert (among others) points out, the middle class has been hit like a ton of bricks. They are too ‘wealthy’ to qualify for subsidies, and not wealthy enough for substantial increases in healthcare premiums not to take a huge bite out of their standard of living.

This is where the concern stems from, with regard to the midterms. Yet those who are focusing on healthcare, the Democrats and other ‘conservative’ Status Quo defenders, talk as though it is Trump who is the source of the problem.

Part of this is due to the ‘genius’ in the implementation of the ACA, in that some of the meatier provisions did not kick in until 2014, four years after it was signed into law. This meant that the sustained pain for most middle class families hasn’t been felt until recently. And when you look up and see there is a new guy in charge, it is easy to pin the blame on him.

The main issue, however, is how healthcare is viewed in general, within the context of politics. I’ll return to the television discussion I referenced earlier. At the start of it, our expert explains some of the contradictions in Trumps messaging.

…After Trump’s tweet, there was this outpouring of Democratic candidates saying Hey, how do you reconcile that tweet with the Trump administration filing a court filing on June in Texas asking to specifically get rid of the protections for pre-existing conditions in the ACA.

 

[…]

 

He says I’ll always protect this and doesn’t then reconcile that with his administrations’ full frontal attack on precisely those provisions in the ACA. And i think voters are left in this middle ground trying to figure out who is going to protect our healthcare, who is going to protect our premiums.

She is right on one level, in that you cant say you want to repeal Obamacare and then at the same time say you want to mandate people with preexisting conditions are covered. But Trump has to say the latter for political purposes, because his ‘conservative’ predecessors lost the argument.

Obamacare essentially codified the erroneous idea that healthcare goods and services are human rights. Note how our expert uses the terms ‘ACA’ and ‘healthcare’ interchangeably, describing the Trump administration’s efforts to strike down some of the ACA provisions in very stark terms. It is as though Obamacare invented healthcare, such that its repeal would be an existential crisis for humanity.

This is the mountainous messaging battle one has to wage in order to roll the ACA back. Yet, the reality is that the bill is catastrophic for most people. The bottom line is that the ACA did nothing to improve healthcare, in terms of the quality and quantity of doctors, medicine, hospitals, equipment, technology, etc. It merely changed the nature of who paid, how much was paid, who consumed and how much was consumed.

Its proponents love to tout the 20 million figure our expert cited, in terms of new people who were covered. What is less regarded is the fact that probably three times that figure are currently being swamped in premium increases to pay for those 20 million. That’s the hard truth.

What is truly astounding is that proponents, like our expert, never even think to link the issues middle class voters are having with Obamacare itself. The ideological purity of the wealth distribution inherent in Obamacare won’t let them. The premium costs to her are just a thing that happened, but if Obamacare was taken away, she reasons, it might all be worse! On top of this, these people don’t think Obamacare goes far enough. They would like to extend this madness to the entirety of the healthcare system with a Medicare For All proposal. The “logic” there is apparently that having seen healthcare premiums explode with a half measure, going the full distance will…decrease costs.

That they retain such a dominant position in framing the discussion  light of that is ominous. Despite Trump’s reputation as a political bull in a china shop, the nature of the health care discussion and the resounding political defeat suffered when Obamacare was signed probably resigns those who understand the disaster that it is to waiting for it to succumb under its own weight. Which means further pain for the middle class.