Nov. 6th, 2013

pktechgirlbackup: (pktechgirl)
[reminder: I've been against Obamacare since it was proposed]

I always knew Obama's promise that no one who liked their health insurance would have to change it, that everyone could keep their doctor, was bullshit. It would have been bullshit even if the law didn't expressly forbid some existing forms of insurance, because even if everything was technically legal, Obamacare changed the incentives and people respond to incentives. I knew that what he meant was "we're not instituting the NHS, your choice of doctor will still be between you and your insurance company." Nothing in the law *demanded* providers shrink their networks, but it would be criminally negligent if no one crafting the bill thought of that as a possible thing insurers would do when faced with a demand to provide more care for less money. So yes, Obama either lied or is so profoundly stupid it's amazing we're not giving farm subsidies to water crops with Gatorade.

That said, I think the insistence that Obamacare be a Pareto improvement over the status quo led to a lot of the worst parts of the bill. They reinforced the link between employment and insurance. Let me repeat that: THEY REINFORCED THE LINK BETWEEN INSURANCE AND EMPLOYMENT.

I have just about the shiniest, most employer provided insurance you could have. And I use it. I would definitely suffer financially if the link between employment and insurance was weakened. And I still think it's a travesty they didn't. I can't even use words to describe this, just more My Little Pony gifs

If they had been willing to let some people suffer temporarily, they could have ended up with a much better bill. One that, say, taxed insurance as regular income and thus removed the incentive to pay people in the form of health care, which they then overconsume. Or at least didn't reinforce the link between insurance and employment.

Speaking of employment and insurance and taxes, let's talk about the Cadillac Tax. Rather than, say, tax the cost of the insurance as income, thus weakening the link between employment and insurance, they have this weird excise tax that is higher than the top marginal rate for income tax (although to be fair, not quite the top marginal income tax rate + payroll tax), based on some weird moralism that person A having really amazing insurance is prima facia hurting person B. I had naively assumed that a plan was considered Cadillac because it had a low deductible or co-pay. This turns out to be wrong. It is considered a Cadillac plan if it costs more than a certain amount. Since premiums vary based on demographics, health status, and risk factors like smoking, this is essentially a tax on being high-risk.

Or at least, it should be. Another problem with Obamacare is that it limits the spread between what young people and old people pay, to a ratio far lower than the expected cost for each group. And it bans considering health status entirely. The explicit goal is to have the young and healthy subsidize the old and sick. Government action making one class of people give money to help another is called a tax, except it's going through a private company and is obfuscated by semi-enforcable demands to purchase a product. I hate taxes as much as the next puppy-kicking neocon, but given that we're going to pay them, I would at least like to pay them to the government. Involving a theoretically unlimited number of private companies to collect the tax and distribute the benefits is a gross violation of every reasonable set of principles I can think of.

It's like someone looked around the country and realized that we pay farmersing conglomerates a lot of money to not grow crops, and the return we do get is less and less like real food every year, and trying to fix it by giving the farming conglomerates more money and forcing everyone to pay a portion of their income to their choice of McDonalds, Wendys, or Burger King. And then claiming all the problems are solved because Consumer Choice.


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