Stories by Arthur Greene

Arthur Greene is the pseudonym of a Washington policy analyst.

Riding Obamacare to Victory in November

March 29th, 2010 at 12:46 am 48 Comments

Republicans counting on Obamacare’s unpopularity to deliver them a win in November seem likely to face disappointment. An honest look at the package shows it’s masterfully designed to deliver a lot of meaningful favors to groups likely to reward Democrats at the polls in November. In particular, senior citizens and middle class families all get immediate benefits while the important costs and externalities resulting from the package won’t take place for some time. Democrats are right to think that people will like the package.

Let’s begin with the well-organized senior-citizen population. Seniors taking advantage of the Medicare drug benefit get an immediate and tangible handout thanks to Obamacare: $250 as a cash rebate to help pay drug costs. Combined with some pharmaceutical industry price cuts and an ongoing generic drug price war that Wal-Mart sparked, seniors’ already falling out-of-pocket drug costs will fall even more before November.  And at least some people will vote for Democrats as a result.

Middle class families get even more. In fact, the plan’s new rules relating to children’s coverage and lifetime maximum benefits will instantly alleviate many anxieties that most middle-class families feel about healthcare.  By letting children stay on their parents’ healthcare plans until age 26, hardly anyone with children will have to worry about his or her new college graduate getting healthcare. Rules that forbid healthcare providers from excluding children with pre-existing conditions will impact only a few but they will produce a lot of heart-warming stories about children whose families no longer have to worry about potentially bankrupting medical costs.  The immediate elimination of lifetime coverage maximums, likewise, means that almost no seriously ill person with employer-provided family health insurance will have to worry about exhausting benefits.  Finally, new high risk pools — a temporary measure until exchanges begin operating in 2014 — will make coverage a lot easier to get for sick people with decent incomes.

Republicans can’t legitimately call for the repeal of any of this: nearly all of the immediate changes are consensus measures that they incorporated into their own healthcare plans. Even better for Democrats, very few will have short term costs. Higher taxes, the potential of waiting lists, and some employers’ decision to drop coverage and the like won’t happen until 2014 or after. The one immediate tax from the plan — a 10 percent levy on indoor sun-tanning — seems unlikely to cause much public anger since, obviously, the tanning industry and its customers didn’t mount an effective campaign against its imposition.

None of this means that Obamacare is good policy. The program is still a big government takeover of the healthcare industry that may diminish the quality of healthcare. I’ll benefit but others may lose. The short term changes, furthermore, seem calculated to get votes by catering to get them from people who have anxiety about medical costs rather than helping those — lower-income single people, small business owners, laid-off workers in their 50s — who have the fewest options under the current system.

Politically, however, the Democrats are right. Once people understand the plan, many Americans will like it.

Why This Republican is Praying for Obamacare

March 15th, 2010 at 12:25 am 81 Comments

I’m a healthy (haven’t missed a day of work in 4 years), click well-off (if things go well, doctor I could make $200, thumb 000 this year), thirty-something Republican policy wonk. I donated to John McCain’s Presidential campaign. Good friends of mine held prominent positions in the Bush White House. I worked at a senior level for a big-name Republican politician. The last few months, I’ve helped several clients (Republican pols and trade associations you’ve heard of) try and throw cold water on President Obama’s health care plan. Indeed, large parts of the plan — subsidies for the middle class, greatly increased regulation of the private economy, and the genuine threat of health care rationing — offend my political beliefs. But, personally, I’d like to see Obamacare become law.

I’ll cut to the chase: I couldn’t ever handle my wife’s current health problems without insurance and the current precarious state of my own health coverage causes me tremendous anxiety and leads me to personally support the Democratic agenda for health care reform. As a result of chronic severe life-long asthma, a heart condition, and a lifetime of terrible medical luck — a broken arm that developed a bone infection in her 20s — she’s a physical wreck, entirely unable to work. I’m quite sure that no individual insurer would (or should) ever write an individual policy that includes her unless obligated to by law.

Even with a pretty good income of my own and the resources of our families we’d have enormous difficulty paying anything close to the medical bills my wife has run up without very comprehensive insurance. One stay she had at a major hospital cost over $130,000 and afterwards my then-employer’s HR director all but accused her of raising health insurance premiums for everyone in the office. (She was right.) A recent visit to the emergency room that included an MRI cost over $10,000. And I haven’t even seen the tab for her most recent 3-day hospital stay.

For now, largely thanks to President Obama’s policies, none of this is a major problem even though my co-pays and deductibles can exceed $500 a month (and our health insurance is, by all accounts, a very solid PPO plan). The federal government picks up about half of the health premium from the job my wife held before she got too sick to work — I made too much to qualify for the full 65 percent subsidy now available — but even this won’t last forever. We have about 7 months left on the subsidy and another few after COBRA runs out altogether.

After that, the options aren’t that good. I’ve made an agreement with one of my larger clients to add me to its payroll and health insurance plan if I ask them. The problem is, I’ll feel like crap if the company does this for me: it’s a small business with about 15 employees and my wife’ s health problems will probably raise premiums for everyone enough to have a material effect on the company’s bottom line and cut take home pay for all employees. Likewise, my wife, who can’t work, has put in an application for Social Security disability and, if it’s approved, will eventually qualify for Medicare. But, despite having worked to help craft Medicare policy on the national level, I didn’t know that she’ll have to wait two years to enroll. (Frankly, she probably could have qualified a year ago but, largely out of a mutual “we don’t need welfare” attitude, we didn’t apply then.)  And, after COBRA runs out, even one hospital stay would cause serious problems unless I rely on my client’s willingness to put me on its plan. The state I live in offers a “last resort” health care plan and, I could also create a “small group” consisting of myself and my secretary, who already has insurance through her husband, but either of these options would give us a very high monthly premium and even higher co-insurance every time my wife goes to the hospital.

We’d be better off (and I think society would too) under something like Obamacare. In a “public option” or community-rated individual market plan offered through an exchange I’d have no problem paying a premium and the costs of any subsidy we paid would be distributed across the entire exchange rather than focused narrowly. This seems a lot fairer than putting us on a heavily subsidized community-rated national health care plan largely intended for the elderly or, worse yet, forcing every employee of a small business to pick up a portion of our health care costs.

And I can’t see any other way to get through. No developed country, not even ours, requires the very sick to pay their own hospital bills in full. Through group plans, community rating, and public coverage, someone else will always pay a portion of the bills for the truly sick.  After all, my wife exercises when she’s healthy enough to, keeps her weight within recommended guidelines, gets all preventative care doctors say she should, takes her medications, eats right, has never smoked, and drinks only once in a while.  Her conditions result entirely from genetics and bad luck. It is one thing to say she should be responsible (she is) and another to say that my family deserves enormous financial hardship because of things entirely beyond our control.

In fact, the total level of subsidy would probably go down under Obamacare. Right now, we get a COBRA subsidy I don’t deserve. Without some serious reform, it’s likely that my wife will ultimately end up on Medicare with taxpayers picking up a large portion of her bills in any case.  What makes sense is a policy that would give us sturdy health insurance covering all of her preexisting conditions with predictable, if high, premiums and enough benefits that we won’t owe thousands of dollars out-of-pocket after a single hospital stay. It seems pretty simple but, absent sweeping health care reform, no such option exists or will exist.

Such an option includes the (modified) community rating and guaranteed issue provisions of Obamacare. Making these things work, in turn, requires something similar to an individual mandate to purchase health insurance. Without that, people will buy insurance only when they get sick. (New Jersey has tried that.) A mandate, in turn, would require some subsidies for lower income individuals to purchase health insurance. And, with that, one basically has Obamacare.  In this context I’m not even sure that a pure “public option” is a bad idea largely because, managed properly, it would skim off people like my wife and might actually moderate premiums in a privately managed individual market.

My interest, I must admit, is selfish. I’m never going to end up on the streets as a result of my wife’s medical bills and my wife is never going to go without needed medical care. I’m grateful that she can see all kinds of specialists without waiting for them and get high-tech diagnostics anytime a doctor thinks it might help. I wouldn’t wish any other nation’s medical system on her and understand that some of these things could well get worse under an Obamacare-like agenda. But, for now, it seems like the best option.