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ACA Fail Fractal
Juicing The Numbers to Score An ACA Victory

The Obama administration announced to much fanfare yesterday that over six million people have signed up for insurance in the federal Affordable Care Act exchange. Last year, the Congressional Budget Office estimated that seven million would get coverage by the end of the open enrollment period, which ends on March 31. Earlier this year, it revised it’s estimate down to six million. Nevertheless, it seems the administration has finally met one of its goals—and in advance of the March 31st deadline!

The WSJ has more:

AltaMed Health Services Corp., a nonprofit with more than 40 clinics in southern California serving largely Hispanic patients, is operating two enrollment centers and has been running ads on radio and elsewhere. Its weekly call volume mounted to around 1,700 last week, then shot up to around 2,000 each day on Monday and Tuesday, said Cástulo de la Rocha, AltaMed’s chief executive. “The rush is huge,” he said, and he expects it to grow in the final days.

…On Monday and Tuesday, processed more than 100,000 enrollments each day, said one person familiar with its performance. The site was also averaging about 40,000 simultaneous users, up from about 20,000 users two weeks ago, said the person.

So should the White House be popping the corks on their bottles of bubbly? Perhaps not quite yet. The stated goal of Obamacare was to expand access to the uninsured. The law’s success or failure, then, depends on how many of those six million were previously uninsured. The truth is, we just don’t know what the actual percentage of the six million are new enrollees. The White House itself has admitted that they’re not collecting this data in any systematic way.

What little data we do have does not look very promising, however. Many of those six million may have already had insurance and lost it due to ACA plan cancellations. Until we get the data we really need, announcements like the one the administration released yesterday should be counted more as PR coup than as a useful metric for evaluating the success or failure of the ACA.

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  • DiogenesDespairs

    This Administration will take whatever is the biggest number they can gin up and, whatever it is, no matter how large or small, declare it a great victory. How do I know this? Because they’ve already begun. Happy April Fool’s Day.

    And by the way, the purpose of this misbegotten law is NOT to insure the previously uninsured – that is merely part of its cover story. Its purpose is gradually to undermine the existing health care system until there is a genuine crisis, a few years down the road, so the federal government can rush in and rescue us all from the crisis it has created with a government “single-payer” system, meaning effective government control over the entire medical and health sector of the economy. In that respect Obamacare is not failing at all; it is working as intended.

    • Thirdsyphon

      Assuming you’re right (and you might be), undermining our existing dysfunctional for-profit health insurance system and replacing it with Medicare for all is still a plan to insure the previously uninsured.

      Also, single-payer doesn’t equate to “effective government control over the entire medical and health sector of the economy,” let alone “socialized medicine.” The only Western country that I’m aware of with that kind of system is the United Kingdom, which tightly controls the practice of medicine through their National Health Service.

      • DiogenesDespairs

        A “single-payer” system would necessarily mean the monopsonist payer would decide what gets paid for, who gets paid for it, and how much it will pay them. “Who pays the piper calls the tune.”

        As for your other point, Canada is a western nation, and under its system, the entire medical profession is employed by the government and Canadians are not permitted to have health insurance or to pay for medical care outside the system. In practice, routine care is “free,” i.e. paid with tax dollars, but Canadians with the means and ability to travel flock across the border to pay full freight in the US for care that either is simply not made available to them in the Canadian system, or has a prohibitively long waiting list. (There is also a medical black market in some, maybe all, provinces served by moonlighting doctors and nurses that the government ignores because of the political “optics” that would be generated in arresting and fining or jailing people for healing the sick on their own time or seeking to be treated in cases where the government can’t or won’t.) At least in the UK people can pay for additional medical care over and above what the government provides privately. France also has a single-payer system, but I am not familiar enough with it to express an opinion about it.

        • Thirdsyphon

          In practice, wealthy people with the means to pay out-of-pocket for treatments not covered by their insurance (whether it’s from the government or a private insurer) will always have that option. And in practice, nobody else ever will. The question isn’t how to preserve access to concierge medicine for the wealthy (since they’ll always have it) or to provide that access to the general public (since that will always be impossible).

          Rather, the social policy challenge is how to obtain the best result for the 99% of people who lack the means to pay for the kind of exotic, expensive treatments that insurance doesn’t cover, and who were therefore never going to benefit from those treatments in any event.

          How, in other words, can we as a society ensure that normal people get the best possible access to the kind of normal medical care that insurance actually does cover?

          By that standard, compared to other wealthy industrialized nations, we’re doing a terrible job. Since most of the countries that have implemented single payer get better health outcomes for their citizens than we do while paying less. . . isn’t it time to consider adopting their methods?

          • DiogenesDespairs

            Your assertion is false. Even the poorest get excellent care – when they show up for it. It is not the delivery of health care that is a problem, it is the methods of paying for it, and there are plenty of remedies for that that were not even considered when Obamacare was rammed through and are still not to this day. I suspect you are echoing a UN study from over a decade ago that was long ago discredited and disavowed even by the UN. If you still think you get better health outcomes under government medical monopolies, I suggest you Google the following: UK hospital abuse – and get an education.

          • Jim__L

            We get people exotic treatments by giving them to rich people (who pay an arm and a leg) first, and then develop ways to bring down their costs to the point that they can be mass-marketed.

            China has made huge strides under its “some get rich first” policy. America’s medical miracle factories have made huge strides under our “some get cured first” policy.

            This is something of a careless generalization, it’s true… access to exotic treatments isn’t entirely limited to “the rich”. It’s just more likely for “the rich” to get them.

            Ironically, if you eliminate “Cadillac” health plans, the whole miracle works may grind to a halt. It’s hard to say whether this would be a good thing or a bad thing from a fiscal point of view; but if your goal is to grow humanity’s medical capabilities over time and pursue the policy that would get the 99% of 2030 / 2050 / 2070 the best care possible, bringing in Eurosocialist practices is probably a mistake.

      • Andrew Allison

        Most OECD countries offer government provided single-payer healthcare. Note that such systems do not exclude private insurance for those that want it.

  • Joseph Blieu

    The government’s greatest power is to prevent something from happening, it is much worse at creating and providing services. It’s role in health care should be in regulating out bad drugs and bad people. Government style health care is like the Veterans Admin hospitlas, good to the degree that kind hearted individuals work to help others, but bad in overall incentive to provide for the clients, government union caregivers are the ones who demand the best care (I have seen in detail how state institutions are really run, $800,000 per year prison psychcologists anyone?, Full time TV watchers anyone?). But to the point, if government is the insurer they have complete control of health worker salary and payment. Canada probably does this OK but very variably by province. I know a Canadian Doc who took a week to re-roof his own house instead of hiring someone because a weeks pay in the ER is less than the cost of paying a roofer, Docs make less and staff makes more so incentive to move to US or not go to med school is high. Canada has only a minimal amount of the core unemployed poor and is separated from land imigration by the US. What you see in Canada or UK will not be affordable in the land of Detroit, Chicago and LA. But still it is undeniable that in Canada people get less advanced care and have longer delays that make them want to go to the US and pay, I know many large companies had additional insurance for their employees to do this, when I was last doing business in Canada, perhaps it is now outlawed? Examples such as the celeberty who hit her head skiing and could not get a lifesaving MRI are well reported.
    So if single payer is adopted there will not be enough money in the GDP to spend an amount giving existing middle class treatment to the 350MM approx people in the US. There will be more staff needed at lower salaries, less capital for lifesaving equipment, less payoff to create new drugs due to price restricitons and everyone will be equally poory served, by what magic could it be different?

  • Jim__L

    Step 1: Cause problem.
    Step 2: Solve part of problem.
    Step 3: Declare victory!

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