Truth, Lies, and Healthcare
Truth, Lies, and Healthcare
The Affordable Care Act (ACA, or Obamacare, if you prefer) is not a perfect system. It is easy to find actual flaws in the new healthcare law if the standard of measurement is a “perfect” system. However it is a vastly superior system to the system we had before the ACA, contrary to what opponents are fighting very hard and spending huge sums of money on misinformation campaigns to convince you of. The ACA has already improved the lives of millions of Americans, including those who don’t even know they have benefited and those who don’t even have a need to “sign up” for it. It could help even more people in more ways, if more people would learn the truth and act in their own best interests instead of acting according to the way those who are trying to undermine the system want them to act. This issue is personal for me, because my family has benefited tremendously from the new law. For my family, and millions of other Americans, this is literally a life-and-death issue. I will be glad to explain to you how my family has benefited, if you care enough about the truth to ask.
The truth is readily available. It is difficult for many people to determine the truth, however, because the truth is being presented alongside so much misinformation, blame-shifting, and deliberate falsehoods. One standard tactic used by those whose intent is to deliberately mislead America is the logical fallacy known as argumentum ad nauseam. This means that the same lies are repeated so often that a large number of people assume that they must be true.
Political advocates with an agenda are not motivated to present the truth. They are simply motivated to get you to agree with their positions. You won’t find the truth if you choose to listen only to advocates whose positions you can pre-assume that you will agree with. Confirmation bias is not truth.
Widespread use of misinformation and falsehoods has been successful in making mainstream media an unreliable source for separating the truth from the false and the irrelevant. The media have not been able to, or have chosen not to, present the truth without misinformation from political activists. Many people want the truth, but find it difficult to determine. I have had conversations with people who don’t understand the details, but they make assumptions based on what they have been told repeatedly. Often, this results in a “giving up” attitude, which means that misplaced blame leads to action or inaction that is inconsistent with individuals’ best interests.
How can I convince people of the truth? Like I said above, this is personal for me, but it is also something that affects the personal lives and livelihoods of millions of Americans. I have learned a lot about this from personal experience, from my studies of economic issues, and from knowing how to ask the “right” questions of those affected and those inside the process. My goal all along has been to separate the truth from the misinformation, and then to support the truth. If this sounds like a position arrived at from my political biases, it is not. I am only biased towards the truth. The truth does not always reside where people want it to, and it doesn’t always reside straight down the middle of any political spectrum.
This is complicated. Healthcare itself is complicated, but this is made more so due to the widespread use of misinformation and falsehoods. How should I approach this? A very short report would not do the issue justice. If it is too short, it would probably confuse the issue even more. That is not my intention, and I hope I do better than that with this article. If, on the other hand, I try to include all of the details, with examples, then this would be a much longer article. My experience tells me that longer reports are read by fewer people. I could publish a book on the subject; but that not only would be longer, it also would take time to get a book written, edited, and published. It also would have costs involved. I hope this compromise will encourage more people to read what I have to say. It is probably longer than many people would want to read, but much shorter than it would have been if I had included all of the details. This is basically a summary, from number one through number ten.
Please read and share.
Healthcare involves real people, and is a life-and-death issue. This is serious business. Healthcare reform should never be treated as a political game in which you pick a side in the debates based on what certain political advocates want you to support. You don’t “win” if your side wins the political debate, not if you have any sense of humanity at all. If you have already steadfastly chosen to support repeal of the Affordable Care Act because that is the position of “your side” in politics, or because you have chosen to oppose anything that President Obama supports, then you have already rejected the truth. You have already decided that the lives of millions of Americans are not important to you; clearly not as important as a “victory” for your side in the political game. However, if you honestly support repeal because of what you have been told by the media and by your friends and family, then continue reading this post for some important truths.
Any healthcare system has a cost, and the ACA is no exception. There is a cost involved with everything, so opposing the ACA because it has a cost is not a valid argument. Comparing all costs and all benefits, including social costs and benefits, and arriving at a net balance, is valid. The difference between competing systems is the net benefit of one system compared to others that are on the table in policy options. It is not a valid argument to pick out a specific cost and ignore the benefits. The true cost of any system is the benefits of another system on the table that you don’t get if you don’t implement that alternative system. Also, it is not a valid argument to argue for a system that is not on the table. If you oppose the Affordable Care Act because it is not a single-payer system, then it is irrational to want the ACA repealed. A repeal of Obamacare would not give us a single-payer system; it would give us the old system we had before the ACA, and all of that system’s problems.
The ACA is not a government take-over of the healthcare system. It is not “government control of one-sixth of the economy”. If you want an example of what government-run health insurance looks like, just take a look at Medicare. When Medicare was proposed in the 1960s, it was attacked with the same talking points that are now being used against the ACA. While Medicare is government-administered healthcare, the ACA is a market-based system designed to make health insurance available and affordable for more Americans. Getting more people insured is the public goal, and both the private and social benefits of doing so must be factored into any valid arguments. The fact that healthcare now adds up to about one-sixth of the economy is a symptom of the out-of-control costs that are a feature of the old healthcare system. The rate of growth in overall healthcare costs has decreased significantly under the ACA, something that had not happened under any other U.S. healthcare policy. The individual mandate is the feature that has come under the most fire. People don’t like the idea that they are being “forced” to buy something if they don’t want it. Never mind that the individual mandate is originally a conservative idea based on conservative principles. It was first proposed by the Heritage Foundation. For details and the conservative principles involved with an individual mandate, check out “The Heritage Lectures: Assuring Affordable Health Care for All Americans”, 1989. The mandate was added due to the nature of private sector insurance. Without it, insurance and healthcare are much more expensive. If you oppose a mandate for general principles, think of it this way: the individual mandate is a mandate that replaces a different mandate that we have always had, which is a mandate that those who take the personal responsibility to purchase health insurance must pay for those who don’t take that responsibility. This includes higher insurance costs as well as higher prices from healthcare providers whose costs are increased due to providing services that do not get reimbursed. When more people take this personal responsibility, the costs for everybody go down, including costs for doctors, hospitals, and pharmaceutical companies. Without the individual mandate, the costs are much higher.
Healthcare reform was not rushed through the legislative process, and was not forced upon Americans without input from different points of view. I’m surprised that so many people have fallen for the kind of rhetoric that says otherwise. There is a very long historical record leading up to the ACA, and this historical record did not occur without significant press coverage and public debate. The process, including many significant details in the eventual law, involved the input of ideas from Republican legislators. Much of Obamacare is actually the result of Republican ideas that were not included in the original proposal from President Obama. These ideas were implemented as a result of public statements by some Republicans explaining why they would not vote for the ACA. The proposal was changed in order to eliminate these public points of opposition. This despite the fact that Republican lawmakers refused to participate in the committees created for this purpose. The fact that every single Republican in Congress voted against it, even after their ideas were included, is a result of organized Republican obstruction of anything that Obama supported. It is not a result of Republicans not being included in the process.
The ACA is more than just the federal healthcare exchanges. Many Americans with no need to sign up for healthcare coverage through the exchanges have already benefited from the ACA without even knowing it. Some of the benefits outside the exchanges are: coverage cannot be refused for pre-existing conditions; lower prescription drug costs for senior citizens; coverage for children up to age 26; insurance company price increases justified and limited to costs of providing benefits; a more affordable option for workers to remain covered while switching jobs, giving individuals more control over their personal lives; more gender equality in costs and coverage; wellness physicals and preventative services for seniors on Medicare; and expanded Medicaid to provide better coverage for more people.
Medicaid expansion is a key feature of the ACA, and those who gain coverage through Medicaid expansion are benefiting from the ACA in the same manner that those who sign up through the federal exchanges are. But Medicaid expansion is under state control. States are allowed to accept or decline Medicaid expansion for the ACA, and each state that does expand Medicaid can choose its own method for handling it. Most of the well-publicized criticisms of the ACA, the “Obamacare horror stories”, are not national features of the ACA but rather are features of state policies. This is especially true in states whose Republican governors have been publicly opposed to the ACA. The number of options available, and their costs, varies from state to state, largely due to state politics. Some states have leaders who publicly discourage people from signing up through the exchanges, negatively affecting the marketplace. State politics is leaving more people uninsured in states whose leaders are publicly opposed to the ACA. For this reason, the “success” of the initial sign-up period in terms of the number of additional people insured will best be measured through state by state statistics, including Medicaid, and not through the national statistics. Beware of blame-shifting due to these state differences. Time will expose this truth to more people.
The ACA is not a system that is designed to replace the employer-based system of the past. A single-payer system would do that. We still have an employer-based system, and the vast majority of employees under this system are not going to have their coverage changed by the ACA. Insurance companies are still at the center of the system. The ACA actually expands that system. It provides financial incentives for employers to provide adequate coverage, and requires such coverage for large employers (although the vast majority of large employers already offer such benefits). The government does not provide medical care. Except for expanded Medicaid and some enhancements to Medicare, the government does not provide health insurance coverage through the ACA; healthcare is still a market-based system. There are no government “death panels”, but the government does put limits on some such decisions made by insurance companies. What the ACA does is provide options for people who would not have access to affordable coverage under the old system. It is designed to benefit those individuals who would fall through the cracks of the old system, and lower overall rates through the pooling of individual policy-holders. People without employer-based coverage include: individuals who don’t have jobs; people who are self-employed (unless they maintain and pay for group insurance for their employees); people whose employers do not offer health insurance benefits; people who are between jobs; and people who are in an initial probation period (often 90 days) of a new job. These features mean that, under the old system, many people would have to forfeit the freedom to change jobs, start a business, or pursue other dreams. Either that, or lose health insurance. People who would go 90 days without coverage under the old system (and those who cannot provide written proof of previous coverage that was in effect within 90 days) would be subject to denial of coverage due to pre-existing conditions.
Due to the comprehensiveness of healthcare reform, combined with the complexity of our economy and our society, there are going to be people who don’t fit neatly into the categories that the main features of the ACA deal with. These are people, a small minority, who are “caught in the margin”. This is something common to any major, comprehensive piece of legislation. The common sense approach is to deal with these situations one at a time as they become known. Marginal issues, which can be dealt with separately, are not a rational reason to scrap an entire system that benefits a much larger segment of the population. Even those caught in the margin of one feature of the ACA likely will benefit from other features.
The comprehensive nature of the Affordable Care Act is the reason different features of the law have different dates of implementation, and different deadlines. This is also a design feature, not a side effect. Due to the complexity of society, once the implementation process began, it became apparent that it would make sense to adjust some of these dates, which in most cases were set down years before implementation. Adjusting dates to improve the process is not a negative feature, and is not a sign that the entire system is fatally flawed. This is completely different from advocating for changing dates in order to undermine the system. Opponents have expressed a desire to have it both ways – criticizing changes that improve the system because changes “prove” the system should be scrapped, while at the same time criticizing the fact that changes which would undermine the system are not being made.
The “Obamacare victims” being aired by media and political candidates opposed to the ACA are all either fake stories, or the real source of their problems lies elsewhere (perhaps it is because of how their state has designed the system in opposition to the ACA, or perhaps the “victims” have not even applied through the exchanges and viewed their options but instead were simply told by a previous provider that their rates were going up). Keep this in mind when you look at an attack ad on TV featuring a “victim” of Obamacare – that ad is deliberately misleading. It doesn’t matter which ad; there have been several and every single one has been debunked. If the rhetoric about the “horrors” of the ACA were really true, they would have no trouble finding real victims. But they have found none, so they put out false accounts. Do you consider yourself to be a “victim”, or do you personally know somebody who is? If so, then it is a near certainty that either the “victims” haven’t actually gone through the necessary channels to find out their best options, or the source of their “victimhood” is in the way their Republican state government is choosing to handle the new healthcare law. If the same rhetoric were true, then people all over the world would want to get a healthcare system similar to our old system. Many opponents of the ACA continue the rhetorical line that the old U.S. healthcare system “is the best healthcare in the world”. That line is demonstrably false, by any measurable standard, yet many still believe it due to argumentum ad nauseam. No country wants that kind of system; there are no movements or advocates for such a system in any other country. People in other countries prefer their own healthcare systems to ours. In fact, the world has long considered the U.S. healthcare system to be a joke. The Affordable Care Act, while imperfect, is a major step in changing the reality as well as the perception.