Homeland Security Watch

News and analysis of critical issues in homeland security

October 7, 2013

Obamacare and Resilience, Ctd.

Filed under: General Homeland Security — by Arnold Bogis on October 7, 2013

Via Andrew Sullivan of The Dish, here is a Vanity Fair piece by Kurt Eichenwald on how Obamacare benefits those who already have insurance. In a nutshell:

In fact—if you have insurance—the more uninsured who live in your community, the lower the quality of care you receive. Again—if more people in your community are uninsured, your care will be worse. In other words, if you want to go to the places with the worst medical care, hightail it to states like Texas that are fighting Obamacare, making it difficult for their residents to figure out how to use the Obamacare insurance exchanges, and refusing to expand Medicaid. The insured folks in that state will get worse care than one with more people insured.

Before quoting anyone on that, follow the logic. Hospitals don’t have poverty wards; if a patient comes in the door in bad shape, they don’t do a wallet biopsy before deciding what care that person should receive—everyone at a hospital receives the same quality. But if a community has a higher number of uninsured, that means the latest and greatest technology and treatments will drive up the amounts of unreimbursed care. In essence, hospitals that provide the best, most modern, and most expensive treatments in an area with lots of uninsured will be forced to pass unsustainable amounts of cost to their prices. Insurance companies won’t pay it, local governments won’t finance it, and the hospitals will go out of business.

The only option then? Don’t provide the top-quality care to anyone—insured or not. That keeps the cost of uncompensated care down and lets the hospital stay in business.

I’ll be honest.  I have no problem with Obamacare.  I lived for many years in Massachusetts under “RomneyCare,” upon which it was based on.  I never felt my healthcare coverage was unduly affected, nor felt my personal rights were under attack (likely because I always maintained my employer-provided insurance and the only added burden was filling in one line of my Massachusetts tax return with the number of my health insurance plan).

However, the case I’m building for resilience is not based on the particulars of Obamacare.  Instead, it is the community benefit provided by expanded insurance coverage.  For this, I don’t care if aliens come down from Mars, win Powerball, and then buy everyone insurance.  The end result will remain the same: increased insurance coverage = decreased stress on the health care system = increased community health resiliency.

Resiliency is such a big, overarching issue.  It involves everything from critical infrastructure to supply chains to social capital to ______ (fill in the blank).  In one particular area of this issue, increasing the number of medically insured members of our communities will only add to the common good.  Getting more people to not take their health for granted, to learn about their own and their loved ones’ medical vulnerabilities, and potentially care for themselves and others during an emergency can only INCREASE our overall resiliency.

The road taken in this journey matters less then the taking the journey itself.  If responsible policymakers do not like the road Obamacare takes us down, I sincerely hope they provide a plausible alternate route.

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Comment by William R. Cumming

October 8, 2013 @ 2:32 am

Arnold! That is exactly the point. Those opposing Obamacare have no alternatives to propose! They are nihilists!

Comment by Solomon King

October 9, 2013 @ 3:59 am

ni·hil·ism [nahy-uh-liz-uhm, nee-]

total rejection of established laws and institutions.
anarchy, terrorism, or other revolutionary activity.
total and absolute destructiveness, especially toward the world at large and including oneself: the power-mad nihilism that marked Hitler’s last years.
Philosophy .
an extreme form of skepticism: the denial of all real existence or the possibility of an objective basis for truth.
nothingness or nonexistence.
( sometimes initial capital letter ) the principles of a Russian revolutionary group, active in the latter half of the 19th century, holding that existing social and political institutions must be destroyed in order to clear the way for a new state of society and employing extreme measures, including terrorism and assassination.

Comment by John Plodinec

October 10, 2013 @ 7:54 am

I’m afraid I have to disagree. You are arguing for the “promise” of universal health care insurance. However, the “practice” of Obamacare is very different. There are several practical problems with the ACA.

• It has already harmed the economy because of its ill-considered definition of full-time work. Our economic recovery is weaker because people who want full-time jobs can only find part-time work.

• Independent estimates (e.g., by the renowned Cleveland Clinic) are that hospitals will be able to recover only about 2/3 of what they have previously. Guess what? That means less maintenance, and eventually less care.

• We are already seeing doctors refusing to take new Medicare patients, and some refusing to take any Medicare patients. Reimbursements are too low, and going lower. Remember, the CBO estimates that the ACA will result in a decrease of $716 billion (that’s right – with a B) in Medicare to pay for the ACA.

• The ACA did nothing about about one of the largest components of health care costs – lawsuits.

• Finally, and perhaps most significant, as a nation we will be significantly LESS resilient: health care will be much more highly correlated with the rest of the economy because of the massive increase in government involvement.

Alternatives were proposed. For example, Cong. Ryan proposed means testing and a phaseout of traditional Medicare for those under 50, and was savaged by the President. A year later, he proposed a “softer” alternative.

By no means do I agree with the stupid tactics espoused by Sen. Cruz. However, I disagree just as strongly with people who confuse the promise with the practice. The ACA is a bad law that makes an unsustainable system even more so. For the good of the country, and for a more resilient nation, it needs to be changed.

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