July 02, 2013

#Obamacare just fell flat on its fucking face

For those of us true liberals, not neoliberals, who wanted Dear Leader to present, or at least seriously and honestly consider, a single-payer healthcare plan, we at least hoped (at least on the surface) that what he actually got passed would be a reasonable substitute.

We held our collective breath wondering how the Supreme Court would rule on the individual mandate. We accepted the ruling that it was a tax, even as many of us recognized that Chief Justice John Roberts had just inserted a T. Rex-sized Trojan horse into large chunks of the modern federal regulatory state and the Commerce Clause.

And, since then, we've watched a royal clusterfuck.

First, reports that electronic patient records were, if not saving much money (or time) for patients and hospitals, generating plenty of dinero for companies that wrote the software for them.

While proponents say new record-keeping technologies will one day reduce costs and improve care, profits and sales are soaring now across the records industry. At Allscripts, annual sales have more than doubled from $548 million in 2009 to an estimated $1.44 billion last year.

Gee, what a shock.

"Shock" No. 2 — how this happened, including the revolving government-industry door of "the most transparent administration in history.

None of that would have happened without the health records legislation that was included in the 2009 economic stimulus bill — and the lobbying that helped produce it. Along the way, the records industry made hundreds of thousands of dollars of political contributions to both Democrats and Republicans. In some cases, the ties went deeper. Glen E. Tullman, until recently the chief executive of Allscripts, was health technology adviser to the 2008 Obama campaign. As C.E.O. of Allscripts, he visited the White House no fewer than seven times after President Obama took office in 2009, according to White House records.  
So, as more and more of Obamacare gets implemented, let's be prepared for more and more real shocks of how it doesn't save so much money after all, and more and more fake "shocks" of how that came to be.  Second, we saw Dear Leader rewrite, and rewrite, and rewrite, the birth control coverage portion of the employer mandate on levels of coverage, shrinking more and more each time what was required, to the point that that portion of the law has become highly vulnerable to legal challenge.

Result? Hobby Lobby is "beating the rap" on fines, and the appellate course hearing the case says the whole provision could be junked.

And, now, we have the breaking point.

Dear Leader has pushed back the actual employer mandate — cover your employees or pay fines — until 2015. Shock me that that can-kicking goes past the 2014 midterm elections. Here's the explainer:
“We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark J. Mazur, an assistant Treasury secretary, wrote on the department’s Web site in disclosing the delay. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so.” 
And, here's the problem behind the problem: those magical, mythical exchanges:
The change does not affect other central provisions of the law, in particular those establishing health care marketplaces in the states — known as exchanges — where individual Americans without health insurance can shop from a menu of insurance policies. Under those provisions, subsidies are available for lower-income individuals who qualify. 

However, without being able to confirm whether employers are offering insurance to their employees, it will be difficult for the exchanges to know who is entitled to subsidies to help pay for insurance. Enrollment in the exchanges is to begin Oct. 1, and they are to take effect on Jan. 1. 
Yes, yes, I know wingnuts in Congress have fought tooth and claw funding to educate Americans about these exchanges. But, as I said in another blogpost, isn't this what Organizing for Action, the rebranding of Organizing for America, is for? Or do we need to be more nakedly honest about how it's for Obama shaking down neoliberal donors to help preserve his "legacy"?

There's other issues beyond that, though, that Dear Leader won't tell you.

First is, as Doug Henwood stated, that many businesses were going to opt out. The penalties were cheaper than the insurance coverage. A lot cheaper.

The $2,000 per employee penalty is less than half their annual per-employee cost for their share of health insurance, on average.
Ah, vindication. Financial Times has has a front-page piece (“US business hits out at ‘Obamacare’ costs”) confirming the central point of the (2011) McKinsey survey: for many employers, it will be much cheaper to pay the penalties than cover full-time workers, and cut the hours for others so they fall under the definition of full-time and then don’t have to be covered. Retailers and fast-food chains are the most likely to do that, but there’s no reason that many other employers wouldn’t join in.
CEOs of Kroger, Dunkin Donuts and other companies go on the record about this and more. Henwood, though he's not gloating now, predicted this outcome nearly two full years ago.

Next issue with the exchanges? Their complexity, and how, even with Dear Leader having "insurance whisperers" to try to explain this all to currently uninsured, how major insurers (and contributors to Obama's campaigns) were going to use this to snow people with paperwork, as CJR reported.

That's the same insurance industry that's the hassle from hell, post-event, even for well-educated people. Even for newspaper editors who can write about it.

There's yet more problems.

Here's another: Some families may not be able to afford employer-based care, depending on co-pay levels, but may not qualify for subsidies on the exchanges, either.

Doesn't a lot of this sound like the same problems that were voices about "Hillarycare" 20 years ago? Absolutely so, in my book. And, folks, that's just from 10 minutes of going through my blog archive and looking at previous posts with the Obamacare tag.

And, yes, many of those people 20 years ago were conservatives, despite the outlines of this type of program being supported at that time, as well all know, by Newt Gingrich and the Heritage Foundation. In foresight, let alone hindsight, that's probably about the best reason in the world any non-neoliberal true liberal should have run from hell from something like this.

And, this last straw is is the bottom-line example on how poorly this law was written, how poorly it was thought out, how poorly its unfolding has been planned, and ultimately, "legacy" aside, how poorly Obama himself has handled all of this. I don't want to hear a lot of naysayers talking about Republican obstructionism on implementation. Obama could have dodged a fair amount of that. And, he could have dodged ALL of that with a single-payer system.

Nor do I want to hear from Obamiacs that this is the best that could be done. Given that Obama let Max Baucus write this bill, and in highly dilatory fashion until Scott Brown won the Senate special election in Massachusetts to replace Ted Kennedy, I've only scratched the surface of his political and legislative mismanagement. Anybody who's read my glowing review of Ron Suskind's book, which offers more detail on that, knows that.

At what point are we going to go beyond saying Obama is "nonconfrontational," too? At what point are we even going to go beyond repackaging Teddy Roosevelt's comment about William McKinley that "he has the backbone of a chocolate eclair"?

At what point are more people going to be more honest about how much Obama is a neoliberal sellout to hypercapitalism, with a certain amount of political cowardice on top?

That's also why it's either stupidity or naïvete to claim that Obamacare has a "bomb" of some sort that will radically change how private insurers are forced to operate.

And, I've only started with what's wrong with Obamacare. Here's one other one, that I've repeatedly noted: the lack of a federal bureau for insurance regulation. Given how toothless state ones are, the fact that Obamacare didn't even address this is another big black mark.

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