I’m busy today with a school paper, but you should absolutely read these two pieces today.
The first is about the individual mandate and the possibility of a “death spiral” — too many sick individuals signing up for insurance in the exchanges without enough healthy folks to subsidize costs to keep premiums sustainable — from delaying that provision due to current website problems for the federally-administered insurance exchanges. Adrianna McIntyre writes:
Can we all calm down about death spirals? Yes, recent HealthCare.gov news has been dismal at best. Yes, the administration is statutorily locked in to the open enrollment period. And yes, if glitches persist, they may opt to delay the individual mandate through the hardship exemption. This is less disastrous than it sounds.
I’ve argued in the past that delaying the individual mandate for a year wouldn’t provoke a full death spiral; it would be an uncomfortable hiccup, but it’s not enough time for the whole market to unravel. More importantly, there are deep-in-the-weeds protections baked into the Affordable Care Act: risk adjustment, reinsurance, and risk corridors.
The second represents a continued conversation on the debate over liberalism and the Affordable Care Act.
Conservative columnist Ross Douthat in the New York Times writes an excellent essay that attempts to get down to the “ideological bedrock” between right and left on health care reform:
And this is where we start to really get down to ideological bedrock, because conservatives and libertarians (and a few liberals) then look at the European/Canadian model and say, Surely there’s a better way than that. Yes, we concede, the strictly socialized systems do seem to save money relative to our mixed, kludge-y, public-private mess. But we also think that Americans really do get something for all the extra money that we spend: Specifically, a system that appears to drive a leonine share of global health care innovation, creating the drugs and procedures and life-extending technologies that then ripple outward, improving health and life expectancy in the developed and developing world alike. And the great fear on the right is that if we, too, end up controlling costs from the top down the way other countries do, then we won’t just squeeze waste out of the system, we’ll squeeze out innovation and drive out talent as well … and worse, we won’t even know it, because we’ll just assume that the innovations that we get are the only ones there could have been.
This is an incredibly rare, and fair, conservative attitude towards the debate. Yet that’s emblematic of the problem, isn’t it? While the broader issues he raises are very much worth debating, it requires a certain orientation towards being proactive on health care reform that simply doesn’t exist for the vast majority of conservatives. As I wrote previously there are plenty of avenues for constructive compromise over the status quo in a post-ACA health care system in America — like Arkansas attempting to cover the working poor in the private exchanges. However, that is not a position that most of the Republican party on any level holds right now. Nor is that anywhere close to where conservative activism is concentrating their efforts to change health care policy. In both of those cases the overwhelming imperative for the right is to ensure that low-income Americans don’t have health insurance next year. This isn’t hyperbole, it is an observation I wish was untrue.
Given what I’ve read of Douthat he knows this fact and desires it to be otherwise as well. Nevertheless, the conservative vision of health care reform he portrays wouldn’t be a product of self-directed initiative on the right but inevitably a compromise with liberals and Democrats. But the latter isn’t even possible (even if it was something like universal catastrophic coverage) when one side in any and all instances wants to spend less on the poor.