Ezekiel Emanuel (yes Rahm’s brother) was the true architect of Obamacare, not Jonathan Gruber (who merely did some economics and made some admissions against interest.)
Don’t believe me? Let’s look at Wikipedia since I’m too tired to reread and summarize his work myself.
In articles and in his book Healthcare, Guaranteed, Emanuel said that universal health care could be guaranteed by replacing employer paid health care insurance, Medicaid and Medicare with health care vouchers funded by a value-added tax.
Ok, it’s not a value added tax and it didn’t affect Medicaid and Medicare, but does that sound familiar? Maybe it’s not close enough.
In the article Why Tie Health Insurance to a Job?, Emanuel said that employer based health insurance should be replaced by state or regional insurance exchanges that pool individuals and small groups to pay the same lower prices charged to larger employers.
Exchanges you say?
He suggested that a federal agency be created to test the effectiveness of new health care technology.
Let’s set aside the fact that the FDA already exists. This is a Wikipedia way of glossing over the IPAB, which colloquially goes down as “death panel” but is more of large scale rationing board. (“Effectiveness” testing suggests we’re going to test to see if it works. What Emanuel really wants is “cost effectiveness” testing, which is just one gigantic value judgment.)
Now, via Misanthropic Humanitarian we have Zeke trying desperately to rescue his baby from the cold depths of failure. Go watch the video, I’ll wait.
You back? Cool.
I want to address a few random things Zeke says because although Varney goes after him pretty hard, there are finder points which would cause a normal man to curl into a fetal position and cry, but Zeke is no mere mortal, he’s an Emanuel, immune from shame. Nevertheless let’s look at those.
- “We’ve Covered 20 million people!”
Zeke always resorts to talking points an flippant responses, it’s a trademark of his writing in my field too. Honestly, if I wrote papers for peer reviewed journals the way he does I’d be blackballed, but he’s special.
Yes, a higher number of people have been “covered,” although depending on how you define that “covered” can mean anything from merely enrolling in an exchange (even if you had insurance previously) to getting coverage under Medicaid expansion. Actual numbers do show a drop in the number of uninsured, but also a steady uptick in Medicaid. So if our goal is to get people off government plans into private plans, I’d say we’re at best at a wash. Meanwhile, Medicaid expansion is sinking state budgets! So…yeah, not exactly great or stable. I’m also going to be intrigued to see what 2017 brings in terms of numbers as insurers drop out of the exchanges. I think this drop in uninsured will reverse in the next few years as prices increase and people decided to take the risk.
Also KFF puts the number of uninsured at 32 million soon, which I guess is “less than 30 million” using Chicago voting math.
- “I never wanted to control costs, just costs increases.”
Really? Wow you lie worse than Hillary Clinton. Let’s use your own words against you:
Most important, such measures would improve efficiency and provide cost control for the health-care system. Eliminating employers’ vetting of insurance companies and all associated costs would save tens of billions of dollars
(Emphasis added. Source) Glad to see you can’t even remember your own bullshit man.
- “Conservatives love high deductible plans.”
Yeah Zeke, you can shove this one up your ass. I’m a proponent of high deductible plans as an option for people, I think it would lower costs if they were part of a host of market solutions. The problem is the ACA made these the worst type of high deductible plans. They allow the consumer no choice in what is actually covered, mandate a bunch of things consumers might not want, causing massive price increases. So you get no benefits of the lower premium costs of a traditional high deductible plan. Additionally, we’ve taken 0 steps towards price transparency in the health care market. So the idea that market principles can lower costs simply will not work under these conditions.
Also, Zeke, I’m a fan of choice in the market first, and Obamacare eliminated that. People should be able to choose their own level of risk aversion based on a ton of factors personal to them. The Obamacare model explicitly prevents that, leading to basically everyone getting a shitty high priced/high deductible plan.
- “We’re better off than we were before.”
Hardly? Before the system was broken, although had a certain level if inertial stability to it. Now the system is broken and lacks stability. This is the classic “politician’s fallacy” although a bit out of order. Just because something was broken and we did something to “fix” it (although I’m not sure that was ever the goal anyway) does not mean we’re better off. Even if you take a rose colored glasses view on where we are currently and say that’s better (it’s not) it’s so unstable we’ll be far worse off in just a few years.
- “I don’t want single payer.”
Well this much is true I guess, Zeke rejects single payer mostly because he thinks it won’t fly in the US with that whole liberty thing we love. But he really wants command and control style healthcare where it’s not technically single payer, but the government has total control over what can be offered, how much it costs, and who can sell it. Oh and you want it paid for by vouchers funded by taxes. I mean in the most technical sense it’s not single payer, but that’s some real hair splitting there.
By the by, Zeke suggests we should all want to die at the age of 75. Let’s ask him in 15 years how he feels about that. My guess is you’ll find him with a cushy insurance plan milking it for everything it’ll cover.