Code Red: Two Economists Examine the U.S. Healthcare System

October 6, 2013

Dr. Strangelaw, or, How I Learned to Stop Worrying and Love Obamacare

Filed under: Uncategorized — David Dranove and Craig Garthwaite (from Oct 11, 2013) @ 4:38 pm

There is an ancient Arabic proverb: “The enemy of my enemy is my friend.” With this in mind, I can’t help but think that whatever Senator and leading Tea Party blowhard Ted Cruz opposes must be good. When Cruz decided to try to shut down America because he opposes Obamacare , well that sealed the deal for me. I say “Obamacare forever.”

Readers of my blog know that I think Obamacare has too many rules that create problems for payers and providers alike, and relies on some questionable practices for funding. I don’t like the rush to form ACOs or the lack of serious cost-effectiveness analysis (admittedly a concession to Republicans.) But Obamacare beats the hell (sorry Ted) out of Cruzcare, which, as far as I can tell, goes something like this: “Didn’t put aside enough money for that life-saving operation? Here is a prayer that might help.”

I used to sort of be a Republican. I voted for Bush (I won’t say which one in order to avoid embarrassment) and voted against Obama more than once (living in Illinois I had several opportunities.) And I hate that Obama is playing at President like someone playing poker with a winning hand. This isn’t supposed to be about which politician claims the biggest pot for himself. But I will take a selfish and somewhat scornful Obama over Ted Cruz and the Tea Cozies any and every day of the week. And I will work to find the best Democratic leaders if all the Republicans can offer is Cruz and his TCs.

Shut down the government to finally fund Medicare and Social Security? Maybe. Shut down the government to achieve a rational tax code? Sure. Shut down the government to balance the budget? Now we are talking. But shut down the government to block the opening of the health insurance exchanges? How absurd! This may be the most pro-market thing to emerge from this administration. Maybe the Tea Cozies think that if God had wanted exchanges He would have given CMS sufficient computer capacity to handle the opening rush of enrollees. More likely the TCs are afraid that the exchanges might work. (Speaking of computers, I can’t help but wonder if some savvy TC programmer – an oxymoron? – is sabotaging the open enrollment period.)

The shame of it is that there are plenty of ways to tweak Obamacare for the better. Changes to enhance market forces and promote alternative delivery systems would please everyone to the left of the TCs; i.e., most Americans. But thanks to Cruz and the TCs, any chance for debating how to improve Obamacare has been lost, at least for now.

Obamacare is not going away. I admit that I have gotten used to the idea and think it might not be such a bad thing after all. With luck, many of the TCs are going away; I am actually rooting for the Democrats to retake the House. When they do, I hope that Congress tries its hand at Obamacare 2.0 and takes this flawed but promising program to the next level.

2 Comments

  1. Knowing the stressful nature of an IT implementation, I can’t help but feel for the army of implementers charged with the roll-out of healthcare.gov. I signed up on the website approximately 1 hour after it opened, and I had only a few difficulties registering. A few times the site timed out, and the data entry portions were sometimes a little silly (I had to enter in my address twice in a row, and it could not verify my identity). I did find the website easy to use, and it was apparent that a great deal of thought had been given to making an interface easy to use.

    Given that millions of people (possibly click-happy, uninsured twenty-somethings myself!) probably accessed the website on the first few days, I was not surprised that the site frequently become inaccessible–such breakdowns are common in the roll-out of any nationwide software.

    As an outsider to the political system, I can’t help but worry that the rise of Machiavellianism in the Tea Party will result in default, either now or in the future. It certainly seems like the Republicans (at least, a substantial number of TC’ers) are willing to risk this sort of economic apocalypse. I wonder what kind of precedent this sets for a democracy, especially if Obama makes some sort of concession, perhaps delaying the financial penalties, in order to avoid the default. Is this brinkmanship going to remain the trend? I also fear how foreign policy, already somewhat weak at this point, may fare as our country grows increasingly financially and politically unstable. We already saw our credit rating drop–what’s next?

    Comment by Justin — October 8, 2013 @ 10:02 am

  2. Lots to agree with in your post, David. Apologies for asking, but have you set out your assessment of ObamaCare in any academic (or least in-depth) articles? Also, what would you recommend for someone who wanted to read about it and understand what works/what doesn’t (or likely won’t) work in it? In other words, what are your ‘must reads’ on this? All the best, Henry

    Comment by Henry Ergas — October 9, 2013 @ 2:42 pm


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