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ObamaCare’s Shameful and Lethal Three-year History — and Future

letsgetitdone's picture


Joseph M. Firestone and Lambert Strether


Many people, and especially Obama supporters, characterize the ACA (ObamaCare) as just starting or a work in progress and then go on to urge that the program will have glitches, needs to be tweaked, isn't yet fully implemented, and so forth. We think it's a mistake to see the ACA as just starting. We also think it's a mistake not to weigh the costs of ObamaCare's stately three-year progress toward partial coverage for the the American people, and just as important to weigh the opportunity costs.

The ACA was passed in March 2010, incorporating many features designed to meet Republican objections to the Bill. Yet, in the end, Democrats never put Medicare for All on the table, abandoned the public option and many other features, and did not get a single Republican vote in either chamber.

The Democrats even saw to it that the bill was fiscally neutral over a 10 year projection at a time when the tanked economy needed more deficit spending and the jobs that would have brought. And to do that, they postponed implementation of most of the bill for more than three years, until now, allowing people to go without care, to die, to divorce, and to lose their homes or go bankrupt due to medical bills, just so they could argue that the bill was fiscally neutral. In gauging the record of the bill, these 3 to 3.5 years of waiting for its implementation and their real costs to the people of the United States must be taken into account.

It also must be taken into account that in the year before the ACA was passed there were some 45 million Americans uninsured, and they were dying at the rate of 1,000 more for every million than in the general population. That is, lack of insurance was causing more than 45,000 fatalities per year. (The cost of those deaths in money terms: $1.38 trillion).

When the ACA was passed it was estimated by its proponents that it would cover 35 million more people than before. Now these same proponents are using the figure 31 million new people covered instead. Meanwhile the population of the United States has grown by 9 million people, and due to the effect of the crash of 2008, millions of people who were insured before the crash are now uninsured. So, though there are no hard figures on this it is likely that estimates of 30 million still uninsured are on the low side. And when we consider that HHS, today, for actuarial reasons, is marketing to the young and healthy, and not the vulnerable and disengaged, it seems quite possible that the 45,000 fatalities per year will not decrease significantly, if at all.

Even if the projection of 31 million new people covered is accurate by say 2017, we will still have as many (assuming further population growth) as 28 million uncovered people then, because the Democrats chose to pass the ACA rather than the Conyers/Kucinich enhanced Medicare for All bill, HR 676. So, 9 years after the effort to pass universal health care started in 2009, we would still have 28,000 fatalities per year to cope with and 28 million going to emergency rooms for care that is too little and often too late (assuming that regulations and laws are not changed to tighten up or eliminate ER access, using the ACA as a pretext).

Furthermore, it's perfectly possible that the current 31 million new coverage projection is still too optimistic about the future. Many states are still fighting the ACA and will not implement its Medicaid provisions. Some 17 million out of the 31 million new people covered were going to go into the expanded Medicaid program. But with State Governors in Southern and some Western Red States refusing to allow that Medicaid expansion to occur, we may end up with only 9 million new Medicaid enrollees nationwide. Many others will try to game the system because they are willing to accept the risk of mandate violations and fines rather than pay the cost of the lousy insurance offered for basic plans in the ACA.

All in all, that 31 million may well turn into 17 million or so before all this is done. And then we would have taken 9 years of passage, waiting, and implementation and would still have as many as 40 million people uncovered in 2017, and 40,000 annual fatalities.

That is the measure of the possible failure of the ACA.

Is that better than nothing? Sure, but but a fair evaluation also must take into account the opportunity cost of what was done in 2009 to work towards and then pass the ACA in 2010. What if the Democrats had ignored the Republicans in 2009, and used reconciliation, or elimination of the filibuster, and their big majorities in both Houses to try to ram through HR 676?

I think they would have succeeded because Nancy Pelosi had full control of the House, and with elimination of the filibuster and even reconciliation they would have needed only 50 votes + 1 (the VP) in the Senate to have passed that bill in the Spring of 2009, and implemented it by January 2010. Then there would have been no rise of the Tea Party, no sabotaging of the ACA, and full coverage for everyone with no co-pays.

That's what we've lost by not trying to pass HR 676 and by trying instead to take a bipartisan insurance company conciliation approach to passing the ACA. This post, gives the total for the anticipated opportunity cost by comparing Romney's 2012 alternative to the ACA, the baseline of no reform at all, the ACA, and Medicare for All over the period 2010 - 2022. Bottom line: the ACA is projected to cost 286,500 lives through 2022, assuming no change. That's a lot better than the baseline and a lot better than Romney's 2012 alternative. But it's still terrible compared to what we might have had if we had a President who really represented people rather than Wall Street.


What if an effort to pass HR 676 had failed in 2009 because too many Democrats in the Senate defected to pass it? Well, I think this would have been very unlikely with the very large Democratic majority and the popularity of the president at its height, but even if it would have failed, then the Democrats could still have compromised with members of their party to pass enhanced Medicare for All for everyone under 26 and over 45, or under 26 and over 50, or whatever compromise would have moved those wayward Democrats up to the 50 vote mark. Such a compromise bill would still have lowered the fatalities substantially by providing insurance for those who needed it most and by enhancing the Medicare program for seniors (full coverage and no co-pays). It would also have been something Democrats could have run on and built upon in each successive election year, rather than having to defend the sorry ACA with its package of inadequate goodies, silly mandate, IRS enforcement, high cost for lousy coverage, and Rube Goldberg eligibility determination. Again there would have been no Tea Party, because Tea Partiers like Medicare, and there would have been no Republican nationwide sweep in 2010, no gerrymandering, no voter suppression, no anti-woman bills, and none of all the rest of the nonsense we've seen because the Democrats did what they did.

Average: 5 (1 vote)


Cujo359's picture
Submitted by Cujo359 on

but even if it would have failed, then the Democrats could still have compromised with members of their party to pass enhanced Medicare for All for everyone under 26 and over 45, or under 26 and over 50, or whatever compromise would have moved those wayward Democrats up to the 50 vote mark.

Yep, just like when you're discussing how much a used car is worth with the salesman, but tell him a value that's at least a little less, you don't start from the compromised position and expect that's what you'll end up with. W/o a serious campaign for either Medicare for all or some other program that would cut the insurance companies out altogether, they ended up with what the insurance companies wanted.

Well, yes, I know that was the Obama Administration wanted all along, but real negotiations wouldn't have gone the way these did.

letsgetitdone's picture
Submitted by letsgetitdone on

I think it's the media, the money, and the Dem third way/Obamabot establishment. If we want someone else, we have to organize and take over the Party by the end of 2015.

Alexa's picture
Submitted by Alexa on

a little bit of clarification?

How on earth, since ALL of today's Dem Leadership are sold-out corporatists (Third Way/DLC-types, if not actual "card-holding members") are we, the marginalized true left, supposed to "take over" the Party? [and this is not intended to be snarky--it's an earnest question.]

Somehow, I can't see the likes of Buffet or Soros or Big Business funding an actual lefty Presidential candidate (if there were such a thing).

Anymore, I tend to look for a "third party" candidate, because I see no way working within the Dem Party.

What am I missing?


BTW, did you notice that Harry Reid said that Dems are willing to "negotiate" on the Repubs "demands," if they want to come to the table during the "budget process."

IOW, "Give us a clean CR, and we'll give you a Grand Bargain, LOL!"

Talk about cynical . . .

Alexa's picture
Submitted by Alexa on

if a corporatist (Centrist) looks like they will get the Democratic Party's nomination.

I have little hope that a "real lefty" would challenge either VP Biden, FS Clinton, Booker (sorry, don't remember his title--is he or was he the NJ Governor?), etc.

Chances are the top-down Dem Party could obstruct a challenge at all (like they did in 2012).

But, if they do allow someone to pose a challenge, it would probably be a DLCer like incumbent Maryland Governor Martin O'Malley (or maybe even Booker) or Montana's Governor Brian Schweitzer, in order to "introduce them to the national stage" for the next election.

[That's OK--I've got my DLC "New Dem Of The Week" Photos ready if they should, LOL!]

At any rate, they would be as toxic as the potential candidates mentioned above (Third Way, DLC, No Labels, etc.--not a "personal swipe" at any of the aforementioned).

Frankly, if the ACA is as disastrous as I think that it will be, it really may not matter who the Democratic Party puts up. The full effects on the tens of millions of "Group Health Plan" beneficiaries will not be fully felt by the midterms.

And probably not "fully felt" by 2016.

However, I do believe that by then, many more millions of Americans will realize how much the implementation of the ACA has cost them in terms of their own (formerly decent, if not very good) group health insurance plans and premiums.


We've finally been notified of "teleconferences" commencing next week regarding what Mr. A's corporation plans are for health insurance next year.

I would not be surprised if we were to be thrown either into the public Health Exchange(s), or, if there is a company benefit to the "private" exchanges--like Sears is going to use next year--possibly even just dumped into one of them.


Alexa's picture
Submitted by Alexa on

on Employer-Sponsored Group Health Plans.

I'm too pushed to elaborate a great deal right now, so here's a brief summary of what I'm referencing.

Mr. A's employer attributes the almost quadrupling of our annual deductible, and the tripling of our overall group health insurance costs, to the ACA.

Whether or not this is an "excuse," is frankly neither here nor there--the result is still "disastrous."

For example, within the past decade, the annual deductible was only $250. And it did go up before the ACA was passed into law--first $500, then $750, and then to $1000.

Since the passage of the ACA, it has shot up to just under $3800.

But wait--that's not the worst of it, LOL!

We NOW (as of 2013) have a "two-track" system for out-of-pocket costs or expenses.

Our total ANNUAL liability, including our health insurance premiums, if we must file claims for in- and out-of-network--is just under $25,000!

Heck, this company is so aggressive on holding down costs, that they implemented the practice of NOT COVERING "working spouses," immediately after the ACA was passed! [meaning the next "plan year"]

I could be wrong, but I believe that the negative effects that the ACA has (and will have) on the group health market, will cost Dems greatly at the polls--in time.

BTW, apologize for the "garbled" comment above. Hopefully this comment clarifies my previous comment. ;-)

beowulf's picture
Submitted by beowulf on

Good piece guys. The country loses in two ways. 1. The cost of the real death tax (using EPA value per statistical life is $9 million X number of deaths caused by inadequate medical coverage) and 2. the wasteful medical spending tax (unnecessary spending that's be eliminated with a Medicare for All system).

Combined the two are the equivalent of assessing a tax to collect at least 5% of GDP ($800B) and burning the proceeds, every year. However since the CBO doesn't account for either of these, the Obama Admin's goal to keep Obamacare's 10 yr budgetary cost under $1 trillion ignored this $8 trillion hole in the economy.

Submitted by lambert on

I think this post and the rights post I did encapsulate a lot of excellent talking points....

letsgetitdone's picture
Submitted by letsgetitdone on

good to get your perspective Carlos. BTW, did you see this comment by bmaz on Beowolf "scams?"

katiebird's picture
Submitted by katiebird on

Wow. Reporter just asked Sibelius if she could imagine that some families can't afford a $5000 deductible. And she grinned (GRINNED) and said families are capable of managing their budgets and if they can't afford that level deductible then they'll choose a plan with a lower deductible. There. Wasn't THAT easy?

Rainbow Girl's picture
Submitted by Rainbow Girl on

Where did you see/hear this?

A few more statements like that and the whole nasty edifice may implode faster than anybody hoped or expected.

katiebird's picture
Submitted by katiebird on

And the interview cut off right there without a followup. I don't know if they'll be showing a complete interview with her.