The Affordable Care Act — as compared to what? by Caroline Poplin

Reproduced here for fair use and discussion purposes. My comments in bold.

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(This column might just be a candidate for "Leftist Regurgitation of the Year" contest. In this one column is every talking point, every misrepresentation, every unthinking, unblinking True Believer bumper sticker slogan in existence, all contained in one handy 44 ounce to-go cup.

I mean, this is truly astonishing. And it's even more astonishing considering that this is a national column. Piled on top like a cherry on a sewage milkshake is the fact that she is an actual doctor. It is hard for me to believe that this is not satire, but apparently Doctor Poplin is dead serious.

Read on:

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 Republicans can hardly believe their good luck. The Obama administration has once again snatched defeat from the jaws of victory. (Once again? This is curious. What other defeats has President Obama suffered? I can't think of a single one. He has gotten everything he wanted, and thanks to a complicit media, has rarely, if ever, gotten any criticism or scrutiny at all.) After successfully holding off Republican efforts to destroy Obamacare by shutting down the government and threatening default, (The Republicans never threatened default. It was a common bogeyman offered by the Left, however.) the administration badly bungled the rollout of the crown jewel of health reform: the insurance exchanges. (No surprise to those of us who wrestle with computers daily.) (No surprise? Doctor Poplin was expecting this? It doesn't bother her that the lynchpin of obamacare, the website, was so badly executed? This is astonishing.)

Somehow administration leaders also failed to anticipate the predictable response of insurance companies to a perfect opportunity to raise premiums wholesale, while blaming someone else. (Here we have the obligatory potshot at eeeevil insurance companies being blamed for reacting to the fact that they are required to include more coverage in the health insurance they sell. Apparently Doctor Poplin believes this stuff should be free.)

Nevertheless, we need to keep in mind that even as they gleefully tear into the ACA, Republicans have not offered an alternative. (False. This persistent leftist trope appears time and again in various guises. I googled "republican alternatives health care," without the quotes, and the first hit was this, right on the GOP website.  The search took .002 seconds, which apparently was too much time for Doctor Poplin to waste on actual research.) 

On reflection, however, this is no surprise. Republicans don’t see a problem with health care in America. (Now Doctor Poplin begins to riff on her false premise. I would be very surprised indeed if Doctor Poplin could locate a single Republican at any level who has said there is nothing wrong with the healthcare system. But because she started with a falsehood, everything she builds upon it will be false as well.) Insurers can sell what they choose to whom they choose; (False. Insurance policies are heavily regulated, with nearly every word in them litigated. And who can be insured under what circumstances is also extensively controlled by law.) people can select policies they like and can afford,  (Whoa. quite a swerve. Does she think this is a bad thing? Obviously, since obamacare eliminates choice and competition.) or save their money for other things. (Apparently she doesn't like this either. It is certainly a leftist perspective that people ought not be able to spend there own money as they choose.) This is how markets work. The only change Republicans would make is deregulation, (Wait a second. Didn't Doctor Poplin just tell us that "Republicans have not offered an alternative?" This sounds like an alternative. And if you follow the link I supplied above, it isn't the "only change." We are starting to see that the truth is a stranger to Doctor Poplin.) so insurers and good prospects can find one another more easily across state lines.

As Ronald Reagan said: “Government is not the solution to the problem, government (in this case, the ACA) is the problem.” (Reagan's prescient words come back to haunt us. As usual, he was right.)

For conservatives, health insurance and health care are ordinary commodities to be traded in the marketplace, just like automobile insurance and automobiles. (Yes, quite true. But we have not seen the marketplace dictate health care for decades. We have reams of government regulations, laws, and court dictates impinging on the marketplace. We have government itself spending $.47 of every health care dollar. We have mandates, interference, and cost shifting up the yin-yang. The free market, for all practical purposes, has not been tried.)

But health care is not just another item in the shopping cart. As the African-American spiritual observed, “If living were something that money could buy, the rich would live and the poor would die.” (Well, actually, it's a Negro spiritual, and the words go like this:

All my trials Lord, soon be over.

I've got a little book that was given to me
And every page spells liberty
All my trials, Lord, soon be over

The river of Jordan is muddy and cold
When it chills the body but not the soul
All my trials Lord, soon be over

Too late, my brothers
Too late, but never mind
All my trials, Lord, soon be over

If living were a thing that money could buy
The rich would live and the poor would die
All my trials, Lord, soon be over

There grows a tree in Paradise
And the pilgrims call it the Tree of Life
All my trials, Lord, soon be over
All my trials Lord, soon be over.

As is typical for the Left, Dr. Poplin can't even get the religion right. The writer of this spiritual is revealing a profound truth of the faith, that even with all the trouble this life brings, death cannot win, because there is freedom, victory, and life. But notice the verse Dr. Poplin quoted, and consider its context. The song explains it's the tree of life, eternal life, life in the by and by, that's what cannot be purchased by the rich. This is quite different than how Doctor Poplin tried to represent it.)

And that is where we are in the 21st century. Health care is a matter of life and death. Our medicine is highly effective. Today, we can cure, or treat, diseases that were once fatal — heart attacks, many cancers, even HIV. That is, if you have the money. Today rich Americans live, on average, five years longer than poor citizens. (It just isn't fair! I think we need to kill more rich people. That'll even things up...)

Nor is health insurance an ordinary insurance product.

Illness today is not evenly distributed across the population. Some 10 percent of people are responsible for 60 percent of health-care costs in the United States. Because most illness continues for many years after diagnosis, these people are easy to identify: patients with multiple sclerosis, congestive heart failure, lymphoma. (So people with diseases cost the most? This is a revelation for Doctor Poplin, I guess.)

No one wants to pay for the sick people — not the insurance companies (particularly if they cannot recover their costs by charging the sick higher premiums) and not healthy customers. (There are lots of people who want to pay for the sick people. Out of their compassion, voluntarily and generously, they give of their time, resources, and prayers to help the sick. Hundreds, even thousands, of hospitals receive billions of dollars of donations, volunteer help, and other kinds of service. Individuals pay for other peoples' health needs every day. 

And insurance itself by design causes people to pay for the sick by spreading the risk of sickness. Doctor Poplin literally does not know what she's talking about.) We hear this now, as single men and older people complain that to comply with the ACA, they have to pay for maternity benefits that they will never use. (This mandate, along with many others, is additional coverage not offered on many health policies before. Going back to a prior point, apparently Doctor Poplin thinks that health insurance premiums should not go up when more coverage is mandated. Then she's surprised when people complain. Truly amazing.)

A free market with lots of choices among multiple insurers, risk pools, policies with all sorts of benefits and price structures, allows insurers and healthy individuals to avoid the sick. (As we have just seen, the sick are not being avoided. But more to the point, apparently Doctor Poplin wants fewer insurers, no risk pools, and policies with few benefits and limited prices structures. Whaa?) The less affluent healthy can gamble on inexpensive policies with spotty coverage (That damn free choice. Oh how she hates it that people don't do what she thinks they should do.) (useless to the chronically ill): since most people are healthy most of the time, few of them will ever need to test their insurance. (Or they can join large groups of other healthy people working for large employers who provide insurance.) Insurers can charge sick people thousands of dollars a month to cover the cost of their claims, and then some.

The result? The people who need health care the most have the most difficulty getting insurance that covers it. Doesn’t this defeat the whole purpose of the exercise? (Hasn't Doctor Poplin ever heard of state risk pools? Medicaid? But beyond that, if people gain the ability to get health insurance when they are already sick, we have moved from insurance to welfare. A risk with a 100% chance of loss is not insurable. I wonder, does Doctor Poplin think people ought to be able to buy car insurance to cover a wreck that has already happened?)

That, however, is the Republican alternative to the ACA. (Again she admits the Republicans have an alternative after claiming they did not.) And remember, even before the ACA, things were not stable, but deteriorating: as health costs rose, premiums, co-pays and deductibles were going up, employers were cutting back. (Why, Doctor Poplin? As mentioned previously, government is heavily involved in the health insurance marketplace. Things kept getting worse. Now that we have obamacare, surprise, things keep getting worse.) Without the ACA, those trends will continue.(There is no evidence whatsoever that obamacare with reverse these trends. On the contrary, it is clear that just the opposite is already happening. Reports are coming in regarding people losing their "non-compliant" policies. They're being forced into the exchanges at markedly higher rates. Obamacare is a catastrophe on every level.)

The ACA was an effort to preserve a private health insurance market, using regulation to achieve a better result. As we see, this is very complicated. (Cop out. And also, this is not an effort to preserve the private health market. That's been on its way out for decades as government has muscled in with one ill-advised intervention after another. "It's complicated" is the warrior cry of the bureaucrat. That's why we have tens of thousands of pages in the tax code. Complexity, thy name is government.) 

There is a third option. If everyone is in the same, large, pool, everything medically necessary is covered, insurers are paid merely to process claims, and premiums are scaled to income, there is enough money to cover everyone at reasonable cost without elaborate, expensive, error-prone computer programs and geniuses to run them. People will be able to choose their doctors and hospitals. (And the rich can always buy more if they want.)

A crazy, wild-eyed socialist nightmare? No, (Yes.) this is Medicare, a familiar, popular, competently-run public insurance system that everyone’s parents or grandparents rely on. (Um, they have no choice. They are forced to rely on it, since government made it illegal to compete with it in the private marketplace.) Person-for-person, disease-for-disease, Medicare is the cheapest, most efficient health insurance program in the country. (Astoundingly false. This program is bankrupt.) (There is virtue in simplicity.) (So why do people have to buy medicare supplements?) Medicare already controls health care costs better than private insurers, and with a few tweaks, could do much more, forcing prices down to the level citizens of every other advanced democracy pay, with no sacrifice in quality. (Gawd, this woman must be an idiot. Medicare does not operate in a vacuum. It forces prices down, which results in cost-shifting, making everyone else's health care more expensive. Medicare unbalances the market place, and because government is the 800 pound gorilla in the room, the rest of the health care market is thrown into a tailspin. Medicare is CAUSING the problem!)

Given the alternatives, maybe Medicare-for-all deserves a second look.

Caroline Poplin is a physician, attorney and policy analyst in Bethesda, Md. She wrote this column for McClatchy-Tribune News Service.