Andrew Sullivan: How Obama's Long Game Will Outsmart His Critics

[eridani]

54. Health care reform helped to cost us the 2010 election

Not as policy per se, but because of the utterly stupid tactics used to defend it. I quit going to OFA's useless strategy sessions when all they were able to come up with was silly pissy little lists of microconstituencies who benefitted from PPACA, as if the general voting public actually gave a flying fuck about charts and graphs. The tactic amounted to rowing a couple of boats out to rescue 100 drowing people, having one boat take 10 of them on board, and the other one featuring a guy with a bullhorn bragging to the remaining 90 about how wonderful he was to save 10 people. What most people noticed about PPACA was that insurance companies continued to screw them, with premiums skyrocketing and benefits decreasing.

Those things were bad enough, but what really destroyed us was allowing the Republicans to successfully attack PPACA as cutting Medicare. That this was a lie (it only cut subsidies to private Medicare Advantage plans) was irrelevant. What was relevant was that Obama and Democrats in gereral absolutely refused to defend the more successful GOVERNMENT traditional Medicare and point out that if the private plans could do it better and cheaper, why would they need subsidies? This refusal led to devastating losses in the more reliable senior demographic.

To be sure, it's pretty near impossible to defend PPACA on a foundation of basic values, because the value it is based on is one of our most disgusting and despicable ones--namely that people deserve health care on the basis of how much money they have. Instead of just Americans, there are now Platinum, Gold, Silver and Bronze Americans, in descending order of worth. Not to mention the Lead category for people 50-64 who are privileged to pay three times as much at any level. 23-26 year olds whose parents have insurance and can afford to add them deserve health care; those whose parents can't, don't. Affluent sick people who can afford the outrageous premiums of the high risk pools for those with pre-existing conditions deserve heatlh care; those who can't, don't.

Massachusetts gives us a clue about the disaster that is going to be visited on older sick people not poor enough to qualify for Medicaid. The MA reform is actually popular, but only among the 85% majority who haven't yet been expensively sick. (In every age group, 5% of the population accounts for 50% of all health care costs and 15% account for 85% of costs.) The healthy folks can afford to be delusional, their opinions about how good their coverage is being worth about what their opinions about how good their fire extinguishers are--that is to say not much.

What is happening to the sick you can judge from the before and after medical bankruptcy data. Before reform, 59% of bankruptcies in MA were related to health care; now 50% are. The crappy high deductible insurance that is the only kind older lower income people can afford actively prevents people from getting health care. After you pay the insurance company for essentially nothing (in the absence of catastrophic illness), you have nothing left to pay for a doctor visit. What we can look forward to with the implementation of PPACA is the continued bankrupting and killing of sick people, only at a lower level.

Sure, it "bends the cost curve," but only for the government. It does so by taking the savings out of the hides of sick people. Sullivan's defense of this is utterly clueless.