Wednesday, November 26, 2014

How to Prepare for a Thanksgiving Day “Obamacare” Rant

You might as well be ready for it, especially if you, like me, support the Affordable Care Act and work in a field related to healthcare: Obamacare will be brought up over Thanksgiving Dinner by one of your relatives, particularly if they are convinced by watching Fox News that it is the worst thing ever.

You can hope, of course, that they won’t, because it will probably just lead to mutual bad feelings and indigestion. You could try to shift the conversation away from Obamacare to something less controversial, like whether the Washington Redskins football team should change its name (okay, not a good alternative topic!), or immigration (okay, another bad alternative—maybe there just aren’t any topical subjects out there that won’t make someone mad).  You could try to ignore their Obamacare rants, but I haven’t found that to be terribly effective in my own Irish-American extended family. (Irish-Americans are drawn to a good argument like a moth is drawn to flame, often with similarly calamitous results).  

Or you could try to answer with a reasoned discussion of why you support Obamacare—while recognizing that some of your relative’s objections to the law may be supported by their own personal experiences and personal philosophy.

You are almost certainly going to hear about Jonathan Gruber, the MIT economist and so-called Obamacare “architect” who was recorded on video as implying that Obamacare was passed by taking advantage of the “stupidity” of the American voter.  I personally wouldn’t try to rise to Mr. Gruber’s defense about these particular remarks—calling the voters stupid was, well, stupid.  But it might be helpful for you to know that although Mr. Gruber provided advice to the administration, mainly by creating a statistical model to simulate its impact, he was not the “architect” of the Affordable Care Act in any real sense of the word, as Politico documents in a well-researched story.

The substantive point that Mr. Gruber was evidently trying to make, as a private citizen to an academic audience, is that Obamacare works by transferring money—through higher health insurance premiums and taxes, from the well-off and the well, to help pay for health insurance for the less well-off and the less well, and that the administration wasn’t particularly transparent about it. (Medicare, which is highly popular, does the same—those who are younger, healthier and working subsidize care for older and sicker retirees). It is probably true that many Americans do not understand that Obamacare, and Medicare for that matter, transfer dollars from those who are healthier and wealthier to those who are less healthy and wealthy, but that hardly makes them stupid. And it is also true that the Obama administration and congressional Democrats downplayed the redistributive aspects of the ACA when trying to sell it to the voters—although in my near 36 years of experience in the political process, I have found that all politicians, of all political stripes, promote their ideas by emphasizing the things the voters want to hear, not the parts that will upset them.

And Gruber’s remarks were hardly a smoking gun revelation about Obamacare’s redistributive impact. Conservative critics of Obamacare have been well aware that the subsidies the law offers to sicker and poorer people to help them afford insurance comes from healthier and wealthier persons—which is precisely the reason that many have been philosophically opposed all along! For instance, The Wall Street Journal made exactly this point in an editorial published just a few months after the law’s enactment).

Now, if you try to explain all of the above about Jonathan Gruber to your upset relative, you probably won’t have a particularly pleasant Thanksgiving dinner. So it might be best just to acknowledge that whatever Mr. Gruber meant to say, and no matter what his role in Obamacare was and was not, his “stupidity” remarks were offensive and wrong.

But what is worthy of philosophical debate, independent of Gruber’s controversial comments, is the fundamental question of whether every American should have access to health insurance coverage, no matter how sick they are, where they work and live, or how much or how little they earn. If your answer is yes, then you would have to acknowledge, and be willing to try to persuade others, that the only way that this can be accomplished is by redistributing dollars, through higher premiums and taxes, from those who are fortunate enough to be healthier and wealthier and have insurance, to those who are less healthy, less wealthy, and can’t afford to buy health insurance on their own.

If you philosophically oppose such redistribution, maybe at least in part because you are in the category of people who are paying more under Obamacare to help the less fortunate afford health insurance, then you have to be willing to acknowledge if the Affordable Care Act were to be repealed, the result will be millions more people will have to go without health insurance coverage. (Studies show that many of them will be sicker and die younger as a consequence). Is that an acceptable outcome to you? If not, what would you propose instead?

This is a debate worth having, because it is the fundamental dividing line between those of us who support the Affordable Care Act as a just and moral way to help those who are less fortunate have access to health care, even if some of us who are more fortunate have to pay more, and those who believe it is unjust and immoral for the government to collect money from some to subsidize healthcare for others.

This is a worthy debate to have, although having it over Thanksgiving dinner might still not be the best idea. Not if you don’t want to have mashed potatoes hurled in your general direction, that is!

Happy Thanksgiving!

Today’s question: What will you say if Obamacare is brought up by a relative or guest at your Thanksgiving dinner?


Harrison said...

I will say:
"How about those Packers, huh?"

That's what I'll say.
And I'll say the same if they bring up Ebola, ISIS, Ferguson, Immigration, Benghazi, Hillary Clinton, Midterm Election results,...
There is a pretty long list of Fox News talking points to avoid.

It isn't that the facts are on the Fox News side.
It is that Fox News repeats things in unshakeable ways.

It isn't about stupid. It is about listening to conversations that fit a pattern of beliefs.

So...."How about those Packers,huh?"


ryanjo said...

I'll just skip all the Fox News talking points that seem to infuriate you thin-skinned Obamacare apologists. Instead I'll quote the recent NY Times report "Private Oncologists Being Forced Out, Leaving Patients to Face Higher Bills" ( To wit: "Christian Downs, executive director of the Association of Community Cancer Centers, said that although there are no good data yet, he expected the Affordable Care Act was accelerating the trend." Big corporate medicine is loving feeding at the ACA trough. How does that jive with all those warm & fuzzy Obamacare dreams we read on the ACP blog? And how did the NY Times scoop Fox News about this ?

gleannfia said...

In answer to your question, I just do not engage with Tea Party types who are rude and self-righteous. You just cannot reason with them. Interesting to note, many of them are getting govt "handout" via Medicare and other programs, but somehow always feel entitled than their fellow Americans.

Harrison said...


When was any health care reorganization not going to be a battle between big money players?
The ACA legislation was round one.
And the insurers won.
They took the ball and still control it.
Oncologists are a cost to insurers.
In what world do we expect that an expense is not going to face cuts from a payer?

What system would you contrive that would not pit big money interests against big money interests?

Oncologists already took a financial hit.
Gov't regulations hit them before the ACA did by cutting remunerations from chemo agent kickbacks.

And now you are quoting speculation from an industry representative as if it is fact.
He plays the role of a lobbyist.
He wants public support.

Round one is over.
We are well into round 2, or probably even later rounds.
The ACO battles are ongoing. The Pioneer ACO project is nearly dead. It is dead here in California. I know that for sure because I'm part of the biggest CA IPA that was in it and we backed out.

That was a war between payers and providers. Payers, in this case Medicare, didn't bend and so the battle ended with providers cutting losses.
Of course with an IPA it isn't just a pure battle because IPA's are a tool of insurance companies too.

Single payer advocates think that they have the solution.
But they don't.
Single payer has to be implemented using the infrastructure we have, which is administered through private sector organizations.
That will be far from wonderful.

I don't know the answer.
But battle after battle is going to happen.

Thanksgiving dinner conversations, and too often our discussions here, including mine, try to simplify this.

We have a President who has always been unafraid of detail.
When he wanted to give the public a stimulus he did not do it with a one time payment or tax rebate. That would have looked cute and would have bumped his political standing, but it was economically wrong.
Instead finding a way to give workers a little with each paycheck is what he chose.
Hard to tell it was even there, but it was a little bit of money spread out over time that was used to improve purchase power.
And it worked.
Consumer confidence is up.

The economy is better now in many ways.
Our health care system is healthier now than it was in 2008.

I disagree with a lot that this President has done, but he has done a lot right too.

Every President is a mix. I disagreed with President Bush, but he did a lot to fight AIDS in Africa. A lot.
He is to be commended for that.

It is a position with great power.
It will always be a mixed bag.