Obamacare Is a Disaster, Just as Expected

The right’s warnings about Obamacare proved prescient, yet Democrats keep doubling down on a failing system they refuse to admit they broke.

Just over 15 years ago, when the Democrat-controlled House and the Democrat-controlled Senate were debating the healthcare proposals offered by the Democrat president, nearly everyone on the political right was unified in opposition. It may well have been the last time the right was united on anything, but it was indeed unified and resolute.

Congresswoman Michelle Bachmann (MN) warned that “This monstrosity of a bill will not only destroy the private healthcare market, it will lead to massive increases in premiums and rationed care.” Congressman (and eventual vice-presidential nominee and Speaker of the House) Paul Ryan (WI) complained that “This bill is a fiscal Frankenstein. It’s a government takeover that will explode costs and kill jobs.” Senator (and Republican Leader) Mitch McConnell (KY) insisted that Americans “want reforms that lower costs, not a trillion-dollar government experiment.”

Right-leaning commentators like George Will and Charles Krauthammer agreed, not only with each other but with Republicans in Congress as well. Krauthammer, in particular, argued that President Obama’s promise to “bend the cost curve” down was pure, unadulterated, and extensively documented fantasy. National Review, much maligned among Trump supporters these days, dedicated most of an issue to exposing and forecasting Obamacare’s fiscal absurdities and the likelihood that it would result in lower quality of care, increased taxes, and exploding insurance premiums. Even the Heritage Foundation—in the news lately for purportedly exacerbating rifts in the conservative coalition—likewise agreed with everyone in the movement, insisting that Obamacare was a disaster waiting to happen and would keep none of the promises that it made, all while destroying what was good and valuable in the private insurance market.

More than a decade later, when it was clear that the system was in trouble and that only greater government intervention and spending could save it, Heritage (in the form of Robert Moffit, Edmund Haislmaier, and Nina Owcharenko Schaefer) took something of a victory lap, detailing Obamacare’s manifest failures and arguing that it was long past time to scrap the whole experiment. “The facts,” the Heritage analysts noted, “are in.”

The ACA dramatically increased health insurance premiums and cost-sharing in the individual market….

The ACA failed to meet official enrollment targets in the individual markets….

The ACA expanded government coverage while wrecking the private individual health insurance market….

The ACA compromised access to care for persons—including those with preexisting medical conditions—enrolled in the nation’s individual markets….

The ACA failed—and failed miserably—to attract young people into the exchange insurance pools….

The ACA Medicaid expansion prioritizes able-bodied adults, many of whom are working, over the elderly, the disabled, and poor women and children….

The ACA did not, as predicted, “bend the curve” of America’s healthcare spending….

Everything Republicans warned would happen did happen. And the Democrats’ response was to offer a massive “temporary” increase in subsidies to help paper over the failures. Again, every sentient person in the country insisted that doing so would be a disaster, that the subsidies would only increase costs, and that they would not be temporary.

The Democrats didn’t listen, however. They didn’t listen in 2009 and 2010 when Congress initially debated and then passed Obamacare—without a single Republican vote in either house. They didn’t listen in 2020, when they insisted they needed expanded subsidies to address the financial hardships created by COVID-19. They didn’t listen in 2023, when they extended the COVID-era subsidies as part of the inaptly named Inflation Reduction Act, at a cost of $64 billion. And they’re still not listening now. Indeed, they just engineered the longest shutdown in American government history because they have no intention of ever listening or ever admitting that perhaps the right was absolutely spot-on in its predictions about Obamacare.

Worse still, in addition to sticking their fingers in their ears and ignoring the experiences of the last decade and a half, the Democrats are actually blaming the Republicans for all of the healthcare system’s problems, insisting that the GOP is somehow responsible for their delusions. As Senator Bernie Sanders, the ideological spirit animal of today’s Democrats, put it, “This government shutdown is all about whether Republicans will get away with raising healthcare premiums by 75% for 20 million Americans and throwing 15 million people off their healthcare.”

Over the years, countless conservative commentators have played upon the famous line in the movie “Love Story,” arguing that “being a liberal means never having to say you’re sorry.” More accurately, they would note that being a liberal/leftist/statist means never having to say you were wrong or admit that your utopian dreams were, in reality, nightmares. This is a feature, not a bug, of leftism. Just as today’s young leftists insist that communism can work, despite its many high-profile and bloody failures, because “real communism has never been tried,” so the Democrats insist that Obamacare can work if it’s tweaked and adjusted in just the right ways.

Although Jean-Jacques Rousseau shares the title “father of the modern left” with many of his Enlightenment contemporaries, he clearly did more than most to undermine and destroy the existing social and political orders and to discombobulate the West. As Nietzsche argued, Rousseau was “the greatest revolutionizing force of the modern era.”

Rousseau did not believe in the concept of Original Sin and insisted that the very idea was invented to keep man oppressed, silenced, and miserable under the thumb of society’s imperfect institutions. “Everything is good as it comes from the hands of the creator,” he wrote in the opening pages of Emile, but “everything degenerates in the hands of man.”

As a result, Rousseau and his followers saw society’s institutions as the foremost threat to man’s freedom and happiness. If man is good by nature, yet he behaves poorly under the direction and guidance of specific institutions, then the institutions, by definition, must be corrupt. They are clearly the cause of the aberrant behavior and must, therefore, be reformed—as thoroughly and as frequently as necessary to enable man to live as he should in a collective society. As the historian Paul Johnson noted in his Intellectuals, to Rousseau, society or “culture” was an “evolving, artificial construct….” But it nevertheless “dictated man’s behavior,” meaning that “you could improve, indeed totally transform, his behavior by changing the culture and the competitive forces, which produced it…” In short, according to Rousseau, one can change the world by successfully changing its institutions—over and over and over again, until you get it right, without ever having to say you’re sorry for getting it wrong.

Normal people, of course, think that the institutions created by Obamacare are destructive, costly, and ultimately ineffective. And we know they believe this because so many of them said so before the system was ever put in place. The Democrats disagree, and they will not be dissuaded from their course by any appeals to theory or experience. They want to keep the institutions and keep reforming them until they inevitably find the right formula.

[I’m not sure this is entirely correct as it is complex.]

This is a possible reinsurance model PPACA replacement scheme:

US citizens and lawfully present persons of a US resident household shall be eligible for coverage as per the PPACA.

The federally subsidy eligible expenses of each eligible issued policy shall be:
1. 85% of Medicare Part A scope coverage provider payouts,
2. 80% of Medicare Part B scope coverage provider payouts, plus
3. 80% of prescription drug coverage provider payouts on a policy.

Uncle Sam shall pay a share of the federally subsidy eligible expenses of each eligible policy equal to 30%,
plus 1/6th of each policyholders’ household premium calculation percentage below 400% of FPL that is above 40%.

[The 30% is to mainly cover the costs of chronic condition people.]

A policyholders’ premium calculation percentage shall be the lesser of 100% or 25 times:
their statutorily expected household monthly income,
less the HUD fair market rent for a two-bedroom apartment,
less vehicle loan obligations when computed on a monthly or 30-day basis,
less vehicle insurance obligations when computed on a monthly or 30-day basis,
less court-ordered obligations due, including child support, fines and costs, when computed on a 28-day, 30-day or monthly basis,
less expected student loan repayment expenses when computed on a monthly or 30-day basis,
less other amounts the coverage issuer justly deems reasonable and specific for college attendance when averaged to a proper extent by the month over an appropriate time period,
less other monthly or corresponding amounts the coverage issuer reasonably deems to be mandatory,
divided by 1/12th the annual FPL amount for the covered household size.

The statutorily expected household monthly income shall be the sum,
for each person of the household at least 19 years of age,
excluding the primary caregiver in the household for the under full-time school age children of the household,
the:
1. the hourly computational wage rate for the household’s state*100[what can be expected from working retail],
reduced by two-thirds if a full-time college student
and a photocopy of the student’s college ID or proof of tuition payment is on file with the coverage issuer,
2. if higher, the person’s income last stated by the policy purchaser, or person,
3. if lower, the person’s net income stated reasonably accurately not more than 70 days ago by the policy purchaser, or person,
for no more than four months of the policy year.

Hourly computational wage rates for 2026 shall be assumed to be as follows:
1. AK, HI, WA, CA, OR, NJ, NY, MD, MA, RI, DC - $16/hour
2. CO, AZ, IL, NB - $15/hour
3. ME, VT, VA, UT, FL - $14/hour
4. GA, MI - $13/hour
5. NM - $12/hour
6. AL, MS - $10/hour
7. other states $11/hour.

[States with severe winter weather may be given a lower rate than their statutory minimum wage rate.]

Extractable profit to not exceed:
1. 1% of the Medicare amount, plus $100, for each inpatient episode paid within 30 days of initial correct provider billing and within 60 days of initial provider billing,
2. 1% of the Medicare amount, plus $8, for each other provider bill paid to the contracted amount within 30 days of initial correct provider billing and within 60 days of initial provider billing,
3. $1 for each off-patent drug prescription paid for, $3 if for 90 days,
4. $5 for each patented drug prescription paid for within 30 days of the policy year, $15 if for 90 days, and
5. $20 for each recombinant drug provision paid for within 30 days of the policy year.

Administrative related and in-house care costs shall not exceed the extractable profit limit, any applicable reasonable state law limit, or any policy limit. All issued policies shall have a reasonable percentage of premium limit stated within the first 1000 characters of any initial normal course of access policy specific marketing page.

Insurers may, with reasonable 30-days online posted notice, raise premiums of a PPACA policy type to reasonably expect to reach the extractable profit level based on actual and reasonably forecast expenses during the calendar year, subject to a 5% monthly premium rise cap.

Any funds left over after claims on PPACA policies have been paid for the calendar year and profit extracted shall be paid over to Uncle Sam.

There shall be a customer premium payment grace period, to 11:59PM of the third Friday of each month, for the third and fourth full coverage months of the policy.

There shall be a customer premium payment grace period, to 11:59PM of the fourth Friday of each month, for the remaining months of a policy.

An operation takes place in a room.

There is a surgeon. He has gown on. He will refer to an imaging display device.

This is a nurse with a gown on and a cart with a set of scalpels, some hand tools such as clamps, some suture material and sometimes a stapling device and staples. She also has a suctioning device.

There is an anesthesiologist. He has an anesthesia machine, a heart monitoring machine, some gas tanks and tubing, and a mask. He will also have a syringe and a tube with a pre-induction drug. He will have a few other syringes and off-patent drugs in case there is a problem.

Sometimes, there will be a heart bypass machine and a nurse to man it.

The patient is placed on a bed and draped.

It might take about 15 manhours for these people to do their work on the patient, on average.

The patient might have worked 80,000 manhours.

“Are you planning to repeal EMTALA, and pass a Federal law to prevent enforcement of existing State laws which forbid denial of care for nonpayment?”

My Latest Suggested EMTALA (and Medicaid ER) Reform

FOR CARESEEKERS

To get care under the EMTALA or Medicaid for yourself or custodial child, the hospital might require you to
1. pay $100 in cash or by financial organization card accepted at the emergency care facility,
2. hand over your valid SNAP card and tender a matching valid domestic governmental picture ID,
3. hand over your valid domestic driver’s license,
4. hand over your valid US passport,
5. hand over your operable Apple or Samsung cellphone model listed by a current regulation issued by a Secretary of HHS, or
6. hand over a valid domestic governmental picture ID of yours and
a tender matching financial institution statement less than 70 days old showing a domestic governmental or employer direct deposit of at least $150, both for hospital photocopying and recordkeeping.

States might be allowed to authorize emergency care facilities to contemporaneously debit SNAP cards for EMTALA incidents.

Items handed over may be retained by the emergency care facility until retrieved within one month by the responsible party by paying $100, or more, for the care, plus a retrieval fee not exceeding $20 in a manner the facility accepts. Items not timely retrieved may be disposed of in a legally allowable manner.

NOTE: People can get the care they need, but only by paying $100, forfeiting an expensive cellphone, or going through the hassle of replacing a SNAP card or government picture ID.

FOR HOSPITALS

I would allow hospitals collect up to $1,000 per incident of EMTALA service from employers, with payment not in excess of $50 per week per employee concerned being due to any and all EMTALA providers and not for more than 100 weeks after service. Such payments on behalf of an employee would be considered to be a debt of the employee to the employer. Employers could collect back from employees and ex-employees (and require EMTALA incident employees to participate in an employer plan).

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