“I’m for it, but what is the reality of it?”

h/t Wonkblog, from the NYT:
With Affordable Care Act, Canceled Policies for New York Professionals

The article describes how many New York independent professionals, most of them proud liberals, are shocked, shocked I tell you, and dismayed that their premiums and out-of-pocket costs are going up and provider options going down.

I can understand missing the latter point. It was never clear to me how we would supposedly provide adequate healthcare coverage to tens of millions of additional people without adding healthcare providers, facilities, or efficiency. But like those in the article, I didn’t understand the mechanisms and incentives that would lead to one’s existing providers suddenly not being “in-network” and thus practically unavailable. I think we can add capacity and efficiency and reduce costs, but that will take time and the right incentives.

Perhaps on the cost issue these folks thought the new taxes on higher income people would cover everyone. My understanding was always that those funds pay to subsidize lower income people. However, premiums had to go up for previously covered people for two simple reasons:

        1) Sick people, some of them very sick, are now in your plan. The costs to pay for their coverage far exceeds the insurance premiums collected. That loss gets translated into higher premiums and out-of-pocket costs for existing plan members.
        2) You may now pay for many coverages you cannot use. For example, pediatric dental is required on all plans regardless of whether the plans include children. If you’ve got little kids, you can thank your childless neighbors for pitching in on the braces.


I can sympathize. I’ve long thought the U.S. needed to make major reforms to healthcare, move away from an employer-centric model, ensure basic coverage, and reduce waste, fraud, and abuse. When Obama came along I accepted the Frankenstein ACA and criticized the Republicans for having failed to do anything when they had the majorities. I still do. But there are reasons for my Single Payer or Mad Max post and my agreement with Druckenmiller about just simplifying things instead of further convoluting them and, well, calling taxes taxes.

Anyway, following is the sad reaction of some of these surprised people (emphasis added):

It is not lost on many of the professionals that they are exactly the sort of people – liberal, concerned with social justice – who supported the Obama health plan in the first place. Ms. Meinwald, the lawyer, said she was a lifelong Democrat who still supported better health care for all, but had she known what was in store for her, she would have voted for Mitt Romney.

It is an uncomfortable position for many members of the creative classes to be in. “We are the Obama people,” said Camille Sweeney, a New York writer and member of the Authors Guild. Her insurance is being canceled, and she is dismayed that neither her pediatrician nor her general practitioner appears to be on the exchange plans. What to do has become a hot topic on Facebook and at dinner parties frequented by her fellow writers and artists.

I’m for it,” she said. “But what is the reality of it?

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