Keller: Republicans Should Be Cheering The “Affordable” Care Act

by William Teach | October 14, 2013 9:33 am

Here’s the NY Times’ Bill Keller with The Rest Of The Story[1]

Unless you’ve been bamboozled by the frantic fictions of the right wing, you know that the Affordable Care Act, familiarly known as Obamacare, has begun to accomplish its first goal: enrolling millions of uninsured Americans, many of whom have been living one medical emergency away from the poorhouse. You realize those computer failures that have hampered sign-ups in the early days – to the smug delight of the critics – confirm that there is enormous popular demand. You have probably figured out that the real mission of the Republican extortionists and their big-money backers was to scuttle the law before most Americans recognized it as a godsend and rendered it politically untouchable.

Just because people access a website doesn’t mean they’re going to purchase the product. And, they aren’t really purchasing the product. The Miami Herald has upgrade enrollees to “urban legand[2]“. Yes, eventually people will sign up. They really do not have a choice. They’ll pay a fine/tax, otherwise. We do want people with health insurance, so that the rest of us aren’t paying for them. What they’re finding out is that it’s not particularly affordable.

What you may not know is that the Affordable Care Act is also beginning, with little fanfare, to accomplish its second great goal: to promote reforms to our overpriced, underperforming health care system. Irony of ironies, the people who ought to be most vigorously applauding this success story are Republicans, because it is being done not by government decree but almost entirely with market incentives.

Did Bill miss the point that these “market incentives” derive from government mandates and requirements? Sure looks like it. That’s not free market in the least.

Using mainly the marketplace clout of Medicare and some seed money, the new law has spurred innovation and efficiency. And while those new insurance exchanges that are now lurching into business will touch roughly 1 in 10 Americans (the rest of us are already covered by private employer plans or by government programs like Medicare), these systemic reforms potentially touch every patient, every taxpayer.

After telling us that we should be applauding these “market incentives”, which derive from government, he tells us that these “market incentive” actually derive from government and will touch virtually every single American. Why wouldn’t Conservatives love that?

Since the Affordable Care Act was signed three years ago, more than 370 innovative medical practices, called accountable care organizations, have sprung up across the country, with 150 more in the works. At these centers, Medicare or private insurers reward doctors financially when their patients require fewer hospital stays, emergency room visits and surgeries – exactly the opposite of what doctors have traditionally been paid to do. The more money the organization saves, the more money its participating providers share. And the best way to save costs (which is, happily, also the best way to keep patients alive) is to catch problems before they explode into emergencies.

There’s a lot of discourse regarding these ACOs, and whether they will work or not. Some say yes, some say no. Some say they will lead to substandard care, and cause people who should be referred to be left without the care they need. Time will tell. What this does do is insinuate The Government into more of our personal health care choices, meaning the decision is between the doctor and the government, not the doctor and the patient.

There’s no doubt that reducing ER visits can reduce health insurance costs. But people who should be heading to the hospitals may not be sent. That is dangerous. And based on Government interference. Anyhow, sure, there are some good parts to Obamacare. They’re the tasty pretzel bun covering the guano-patty. Said guano-patty is the Governmental interference in our lives, the increased control of our health care by Government, the increased costs, etc, you know the hit list. Just obtaining health insurance through the Exchanges involves a huge smattering[3] of governmental agencies. Hugely complicated just to sign up.

One reason you may not have heard much about this part of the Obamacare story is that it is numbingly complicated.

The hell you say!

But I suspect another reason is partisan spite. The Democrats were passionately in favor of enrolling the uninsured, but many would have preferred a government-run program, or at least a public option. What Obamacare has wrought is the kind of market-driven reformation that Republicans pretend to believe in. Which makes you wonder how much of their opposition rests on the merits, and how much is just a loathing for anything associated with Barack Obama.

Got that? Liberal Bill Keller thinks a government driven program that’s incredibly complicated and involves a huge amount of government agencies enforcing a huge amount of government mandates is “free market.” But, we don’t like it cause of Obama. Right. Here’s free market principles in action

In order to fully appreciate that chart, you have to see it in full. Check at Rep. Kevin Brady’s[4] website, where that is enlarged to 9000 x 7000. Yes, that big in order to understand all the connections. Which looked like this[5] before passage of the ACA.

BTW, if Keller thinks the way the ACOs operate is great, having incentives to reduce costs, why don’t we try and do that for Government itself?

Crossed at Pirate’s Cove[6]. Follow me on Twitter @WilliamTeach[7].