The Affordable Care Act, aka Obamacare, is a policy Rube Goldberg device — instead of doing the simple, obvious thing, which would just be to insure everyone, it basically relies on a combination of regulations and subsidies to rope, coddle, and nudge us into a rough approximation of a single-payer system. There were reasons for this, of course, mainly political: a complete displacement of the existing system would have been both too destructive of powerful interests and too radical for voters.
Still, the question is whether this cobbled-together system will work, and there have been many conservatives rubbing their hands with glee over the prospect of failure.
We won’t really know how Obamacare works until it has been in operation for a while; but we do know that essentially the same system has been running in Massachusetts since 2006, and is doing pretty well. The question, then, is whether other states that don’t have MA’s initial advantages — especially an already low uninsurance rate and an already operating system of community rating — can make this thing work. The big fear has been of sharply rising premiums as insurers are required to cover people with preexisting conditions. And the biggest test case was always going to be California.
Well, the preliminary numbers for CA are in — and they’re looking very good, with costs coming in below expectations. At this point, it looks as if this thing is indeed going to work.
And think about the political dynamics. Because the Supreme Court decided to let states opt out of the Medicaid expansion, some states — notably Texas — will have a pretty dysfunctional version of Obamacare in 2014, although even those systems will provide significant benefits to many people. Still, the whole political calculus was supposed to be that Republicans in red states could point to the horrors of Obamacare and ride them to political victory. Instead, it looks as if we’re going to see blue-state residents reaping the benefits of a functional health care system, while red-state residents are denied many of those benefits, for what looks like no better reason than mean-spirited spite — because what’s going on is, indeed, mean-spirited spite.
Predictions that Obamacare will be a big political issue are probably right — but not in the way gleeful conservatives imagined.
Source: The New York Times
Article by Paul Krugman