Monday, September 23, 2013

The long game of Obamacare

Many of you will remember the great debate that happened on the left as Obamacare worked its way through the Senate. Far too many people prioritized only one thing...the public option. Today I'm convinced that many of them never really knew what the public option was - the requirement that all state health care exchanges include at least one public insurance option - and instead equated it with a single payer system. President Obama has consistently been criticized on the left for failing to support single payer and that critique got equated with the simple idea of a public option on the exchanges.

But lets go back to 2008 and listen to what then-Senator Barack Obama said about single payer.



In addition to worrying about job losses during the great recession, President Obama talked about the fact that so many people rely on their employer for health insurance. Any move towards single payer would have to de-couple health insurance from employment.

As we move towards the unveiling of the state health care exchanges on October 1st, it is with that in mind that I read stories like this.
Home Depot Inc. said today that it would drop medical plans for part-time workers and direct them to the government-sponsored insurance websites scheduled to open next year as part of the health law...

Detroit and Chicago have proposed ending health plans for current or retired municipal workers, since they’ll be able to buy subsidized coverage through the health-care law...

Last week, Trader Joe’s Co., the closely held supermarket chain, said it would end health benefits next year for part-time workers. Employees will get a $500 payment and be sent to the public exchanges. With federal tax credits available there, most workers will get a better deal than the company could offer, Trader Joe’s said in a statement.

By offering other insurance options, “Obamacare has taken the moral imperative away for employers to continue offering coverage,” said Laszewski, the industry consultant. “The days of your father’s health insurance are over.”
Republicans will use this as an example of the havoc they envision coming from Obamacare and I've already seen too many liberals light their hair on fire about it as well. Whether or not employers will provide a subsidy in pay that is the equivalent of what they have been spending to purchase insurance is - of course - a concern.

But what I see in all of this is the extremely effective long game that is so typical of President Obama. He knew at the outset that if he championed the cause of single payer, he would never get it through Congress. And so instead he put in place a system that not only addresses significant immediate concerns, it will slowly but surely move us in the direction of decoupling health insurance from employment - opening up a whole range of possibilities.

Hang onto your hats, folks. This whole Obamacare thing is just getting started! It might be a bumpy ride. But I like where things are headed.

24 comments:

  1. My best friend is HR Vice President for an American (yes - American) manufacturing company. She thinks the best thing to happen to health insurance in this country is to de-couple it from employers. How much insurance you get, who pays what, etc. is far more dependent on how much that company spends for widgets, or transportation to get the widgets to market, etc. than it does how an employer feels about your health care. Many decisions go into the (few) options you are given by your employer and they have precious little to do with the health of employees.

    She thought ACA was a completely reasonable 'first step' that would eventually lead to single payer (as a good progressive, that is her preference). In many ways, the scary headlines that Republicans point to are actually the steps that put health insurance in the hands of the individual, without relying on the whims of your employer or the uncertainties of the job market.

    The ride will be bumpy. That used to be acceptable, but now becomes politically perilous. I have my fears. Smartypants rightly points to whether or not an employer will pocket what it would have paid in premiums (a real concern) when, in fact, insurance is part of your compensation for your job. Subsidies are what make this work - what kind of taxes will eventually need to be implemented to fund growing 'subsidies' until the single-payer breaking point is reached?

    It's a long game, to be sure. If Democrats and Democratic-leaning voters would vote in sufficient numbers, we can return Congress and other state legislatures to some sanity and fix this stuff. Social security and Medicare didn't offer nearly what they offer now when first implemented. We got our foot in the door and worked to improve the system. That this fact is lost on such Big Brains like Katrina van den Heuvel and other self-styled brilliant progressives, is a dirty, rotten disgrace.

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  2. And now - the final frontier of worker's freedom: Your Retirement.

    While we (in the Netherlands, but this is the same throughout Europe) enjoy a "state pension" it is normally augmented (i.e., beyond just above starving levels) by your retirement fund; which is coupled to your employer :-(

    Imagine if you could just cling to your retirement savings while switching employers ...

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    1. As long ago as 1971, the Builders Laborers Union in New South Wales, Australia, was organizing for this. Since most of the workers were essentially temporary, the scheme involved employers paying into a central fund. It came to a strike (I happened to be there, working as an unskilled laborer), and we won, almost immediately! I don't know how this has since evolved, or even if it worked in practice, but the principle of employer-funded pension benefits that are decoupled from the employer is not hard to implement. Meantime, a large raise in Social Security payments (and minimum wage) would be good.

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  3. The de-coupling is not only essential from a structural point of view, but just from a wage/compensation perspective. As health insurance premiums were rising, real wages were stagnant. Although "total compensation" might have risen due to the increase in premiums cost, wages weren't rising. Its a bit of "chicken or the egg", but in the long run it will be best for the workers to focus solely on wages (which includes vacation/holiday wages), instead of getting bogged down in health insurance premiums. Which raises my concern regarding Unions. I don't pay dues any longer, but my first "grown up" job was a Union job represented by United Steelworkers as a metal fabricator. I support Unions, but some of the leadership seem to be too dependent on negotiating health insurance. In the aggregate, it would be an easy way to show increases in the value of negotiations in millions of dollars over and above any inflation-based adjustments. Does that explain their opposition to the ACA? Certainly not the whole story, but while I support Unions I also think they need new leadership with new ideas.

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  4. Whenever I heard the word "public option" I tuned out. I figured that there would be adjustments to the bill over time. I don't see anything wrong with being critical, criticism has to be useful.

    Vic78

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  5. It took 30 years for Canada to evolve their system -- yet when I routinely pointed this out to the Hair-on-Firebagger Brigade during the ACA fight, I was sneered at as an "Obama apologist." (Hell, at least I knew how to count to 60.) Yeah -- never really have felt the urge to apologize, oddly. ;)

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  6. President Obama's successes are fairly incredible in the face of Vitriol, Naked Hatred and the desire of Republicans to sabotage the Nation so they can demonize him for the next century.

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  7. O/T
    Hi Smartypants. Checking in daily since you told us your mother passed on, I notice you have been 'away'. I hope you are okay - as okay as it's possible for you to be under the circumstances. Take care of yourself. VC

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  8. Ms Smartypants, hope you are well.

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  9. Hope all is well with you. Missing my daily dose of sanity.

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  10. Smartypants,

    saw at another blog that you were going through difficult times. Having been in your situation, you have my prayers.

    come back to us when the time is right and know that there are those of us who are keeping you in our thoughts and prayers.

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  11. I heard some folks on the radio stressing out about the possibility that ACA will "trick" people into moving in the direction of a single-payer system. They were dreadfully afraid that it might work, and crowd out what they called "good Conservative free-market solutions", whatever the hell those might be.

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  12. My condolences to you and your family.

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  13. Does anyone have any news on Smartypants?

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  14. Blessings to you, Smartypants.

    pamelabrown

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  15. Am concerned about smartypants and sending her love and blessings.

    pamelabrown

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  16. 3 Chics sends condolences to you, Ms. SmartyPants and your family. We MISS your wisdom. Wishing you much peace, rest, and love.

    Ametia

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  17. Miss you and concerned about you. Think about you every day, smartypants. Really miss your smarts!!

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  18. My condolences to you on your loss, Smartypants. So sorry to hear this.

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  19. Dear Smartypants, I miss your posts very much. I pray for all to be well with you.
    Mary Lynne

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  20. Looks like smarty pants has moved to beautiful mess things on tumblr

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