My post of a few days ago addressed what is to me one of the oddest features of the progressive project, namely that existing government programs that were supposed to solve some social problem, but then utterly failed, just get completely forgotten — even as spending on those programs continues and indeed generally increases forever on autopilot. Meanwhile, the underlying social problem persists, and the response of the progressive politician is to cease all mention of the prior programs (and certainly never to acknowledge their failure), and instead to propose yet another new program and yet additional new spending to solve the same problem. Surely, this newly-proposed program is going to be the one that will finally work.
That prior post specifically addressed government job training programs. There were 47 of them (by one count) in 2014, when then-VP Joe Biden got the task from President Obama of finally solving the problem of inadequately-trained workers. Of course, Biden never acknowledged the disaster of the existing 47 failed programs, and instead proposed another new federal job training program and $600 million of new spending (sorry, “investments”).
And the job training situation is of course only a microcosm of the broader federal “anti-poverty” effort, where scores of programs and nearly a trillion dollars in annual federal spending never make the slightest dent in the problem of “poverty” as defined. Yet somehow polite discussion of how to address ongoing poverty must never mention the failure of these prior efforts, and instead must always move on to the newly proposed programs that supposedly are now going to work. Recent examples in the “anti-poverty” arena include universal pre-K, free college, and affordable housing.
But surely the most striking example of this phenomenon is in the healthcare area. There, all the talk among the current Democratic candidates is of finally bringing “universal healthcare” to America. Among those who have specifically expressed a view, a clear majority have explicitly endorsed the Bernie Sanders proposal of “Medicare for all” (whatever that may mean). Others have been even less specific, but have still indicated that they see a clear need for some massive new program (or programs) to accomplish the goal of universal healthcare access. Examples: Amy Klobuchar (“Single-payer health care ‘could be a possibility in the future,’ but ‘I’m just looking at something that will work now,’ Klobuchar said.”); Cory Booker (“[Booker] explained that ‘Medicare for All is great, but if we can’t get that, but if we can extend Medicare down to age 55 ... that’s going to create such an effect on the whole system that’s going to make it better.’”); Kamala Harris (“‘The idea is that everyone gets access to medical care, and you don’t have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require,’ Harris said in a CNN town hall event. . . .”).
But wait a minute. Whatever happened to Obamacare? Wasn’t that the be-all-and-end-all program that was supposed to bring “everyone access to medical care”? This was 1000+ pages of untold complexity, put together by certified geniuses like Jonathan Gruber and Zeke Emanuel. Every possible contingency was anticipated and provided for. No stone was left unturned. If we could just enact this one, the problem of inadequate access to medical care would surely be solved once and for all. And Obamacare was in fact enacted, and has survived all efforts to repeal it. So now, are you telling me that despite this incredible accomplishment of progressive government, the problem of “universal access to medical care” has somehow avoided being solved? How could that even be possible? And, if that problem has not been solved, isn’t the discussion we should be having a conversation about what went wrong? If we don’t understand what went wrong with Obamacare, how could we possibly already be thinking about adding on the next program?
Undoubtedly, you remember President Obama’s big speech to Congress on September 9, 2009, that kicked off the push that culminated in the enactment of Obamacare in early 2010. In the September 2009 address, Obama described the basic features of the plan that ultimately got enacted:
The plan I'm announcing tonight . . . will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. . . . Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. . . . Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices.
And then there was my favorite line from that speech:
I am not the first President to take up this cause [of universal health care], but I am determined to be the last.
I guess all the Democratic candidates have forgotten that line! So let’s put together a little report card for Obamacare:
Approximately 17 million new enrolled Medicaid beneficiaries are in the “expansion group” defined by Obamacare, according to the Kaiser Family Foundation.
The number of people covered by policies purchase on Obamacare exchanges for 2018 was 8.8 million.
Cost? Bloomberg in May 2018 estimated annual Obamacare spending for individual and insurance company subsidies at $55 billion per year. Add to that the portion of Medicaid spending that results from the Obamacare expansion. Since the 17 million new enrollees are approximately 23% of Medicaid beneficiaries, therefore about 23% of Medicaid spending, or .23 x $296 billion = $68 billion is attributable to Obamacare. The total of these two numbers is $123 billion per year.
According to Census data, by 2017, some 28.5 million people, or 8.8% of the population, continued to not have “health insurance.”
The average price of a policy on the HealthCare.gov exchanges more than doubled from when the exchanges opened in 2013 through the 2018 open enrollment period.
Life expectancy in the U.S. began a decline in 2014, which continued through 2017 (latest data). It’s only 0.3 years total (from 78.9 to 78.6), but still rather shocking given all the additional government spending on “healthcare.”
In short, Obamacare didn’t come anywhere close to accomplishing its goals. Indeed, if you think (as I do) that the most important metrics are health outcomes (best proxy being life expectancy) and cost, then Obamacare has been a disaster. You spent a lot more money on your health and you died younger. How is it possible to spin that as something even remotely positive? Hey — but you were slightly more likely to have “coverage.” I am unmoved.
So of course, it’s the usual. In the current debate over healthcare, mostly taking place among the many Democratic presidential hopefuls, Obamacare is almost completely unmentioned. The program remains in place, and the spending continues, out of sight, out of mind. We’re on to the next program, and this time it’s really, really going to work.
I guess I understand why no Democratic candidate wants to discuss this situation. It’s enormous spending for very dubious gains. 20 or so million additional “insured” might seem like something positive only if you think that just having health “insurance” has intrinsic value irrespective of how much it costs, of whether actual health outcomes are better or worse, and of whether additional people have been made dependent on government handouts. Meanwhile, it sure looks like close to 30 million ordinary Americans are just refusing to do as they are told by their rulers, and are not making the purchase of health insurance the number one priority in their lives. Why should they?
Whatever program comes next, be it “Medicare for All” or some cut-rate facsimile, is sure to be another 1000+ page behemoth, again full of infinite complexity touted as being the final solution to the problem of “universal access” to healthcare. How long — and how many trillions of dollars — before it fails and we’re on to the next one that will really, really work this time?