A paranoid friend of mind e-mailed me the following quote from Michael Gerson about the ACA taken from an article in the Washington Post:
“On the evidence of the article, Obama and his closest advisers are in denial about the structural failures of the [ACA] — the stingy coverage, narrow provider networks, high deductibles and adverse-selection spirals already underway in several states.”
Which Mr Gerson actually, for the most part, reused from an article (with the addition of the awareness that the Bronze plan costs a lot) he had written in October 2013 while wondering why the ACA wasn’t working as well as Amazon:
“If they don’t get the necessary volume and demographic mix in the exchanges,” Yuval Levin of National Affairs told me, “it could set off a catastrophic adverse-selection spiral that would not only render the exchanges inoperable but badly damage our large health care systems.”
Yuval Levin turns out wrote an article of his own containing the word “death spiral.” If you Google the word “death spiral” you will get a lot of speculation regarding the fate of the Affordable Care Act that can almost all be traced back to this one article in October, 2013. And they say we don’t communicate well…
I sent my paranoid friend links to Ezra Klein’s recent article, the analysis prepared by the Center for Economic and Policy Research, and an article posted on Pacific Standard based on an article posted by ProPublica. My hope is that now my friend will sleep better for at least a couple of nights.
In the process of spending way too much time getting to the bottom of this, I ran across Avik Roy’s latest on the conservative case for universal coverage. Avik posits that if the Republican dog catches the ACA bus, they will need to figure out what to do with it. He points out that the bones of the ACA are compatible conservative thinking. He even, using Singapore and Switzerland, identifies ways in which through modest changes the law could be effective “from a conservative point of view.” Not anything that progressives are unaware of, I might add.
He closes with the following:
To credibly advance this approach, conservatives must make one change to their stance: They have to agree that universal coverage is a morally worthy goal. No conservative politicians oppose universal public education; instead, we champion reforms that improve the quality of public education that poor Americans receive. Ensuring that every American has access to quality health coverage is a legitimate goal of public policy, and it can be done in a way that expands freedom and reduces the burden on American taxpayers.
Reading the comments, loyal readers of the Washington Examiner are not happy. They are incensed that one of theirs has disregarded the constitutional ban on healthcare as a right, looked to another country for answers, and mostly for implying that since we are providing the care anyway we might as well do it right.
I, on the other hand, will take a different approach. If offered the opportunity I will say “Mr Roy, I have never thought of it that way. Why, you are right, if those poor people are going to access the system anyway, we DO need to make sure that we are being good stewards of our resources. Thank you for pointing this out.”