Wednesday, November 13, 2013

So Here's My Question

Every news broadcast and many, many articles in my feeds bemoan the disaster that is Obamacare.  Listening to the cacophony is fairly depressing, and over the last few days it has really got me thinking.  My impression was that most of the law hadn't even kicked in yet and that for many of the parts of the law that had begun things were just swell.  So if that's true, who is complaining and what are they complaining about?

Think about it.  Just what is going wrong?

No denial for previous conditions: working.
Insurance company spending directed toward health care spending: working.
Preventive care included with all insurance: working.
Mental health care included with all insurance: working.
No dropping coverage because you get sick: working.
Adult children can stay on their parents' policies longer: working.
No annual or lifetime spending caps: working.
Oh, and millions of people previously ineligible for insurance now eligible:  working.

Those are just the ones I know off the top of my head and I'm not a policy wonk.  But I know it isn't all good... mostly not working.
"If you like your coverage, you can keep your coverage.": mostly not working.

So there are some things that aren't going well, but looking even a little bit closer is it really that big a deal?  Off the top, we're only talking about people that had no insurance before or were in the individual market.  For people who are the former things are unfortunate, but no worse off than they were before.  For people who are the latter things are also unfortunate, but weren't we told that only 5% on insurance moves through the individual market?  Right, so whatever is going wrong it doesn't impact somewhere in the world of 95% of the public.

However terrible things have rolled out, at most they are terrible for less than 5% of folks that already had insurance.

With that in mind let's recap the things that aren't working.  The website isn't fully functional.  Leaving aside that for some people is working, and leaving aside that there's a telephone alternate (which admittedly is also only partially up to speed), and leaving aside that you can still - just like before - go direct to the insurance company, the federal website is only in play for people that live in states that didn't set up their own exchanges.

In California, Kentucky, Oregon and the other states that didn't leave things to the federal government things are working peachy.  Of the whole of the group vulnerable to this particular issue let's assume that maybe half of them live in states dependent on  Put a pin in that.

Then there's the promise: "If you like your coverage, you can keep your coverage."  Part of me wants to fall back on what I said about this during the campaign:  there simply isn't anyone that likes their coverage.  I just always assumed that anyone that liked their coverage either hadn't had to use it or was ignorant of the mechanics in some way.  I thought that promise was hollow to begin with.

But let's assume there actually were people that were happy with their coverage and let's assume that the list of global improvements above is somehow not enough to make the change worth it for them.  From what I've heard maybe 1/3 of these people are actually untouched by the program at this time - they're just either "sure" or terrified something bad is going to happen, but as of yet the fear or the certainty is unsupported.  Another 1/3 of these folks, once they find what their new coverage will be find that they are getting more for less.  And then yes, the remaining 1/3 are a little bit getting screwed for the rest of the country.

Who does that leave with a legitimate beef?  From 1/3 to 1/2 of 5%  Between 1.5 to 2.5% of the population and THAT is only with the caveat that they are totally unmoved by the improvement for the whole.

Why is there so much noise over 2%?

There are going to be things that need to be changed.  There are going to be things that are not going to have the exact consequence when they come into play.  We will need to have frank conversation about those things when they happen.

But can everyone please turn down the volume until there's really something substantive to yammer about?

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