Just a few weeks ago on September 30 I did a review of the current status of Obamacare, and now just last week the New York Times takes its own stab at the subject. The Times' treatment, that appeared in the print version on October 27, was headlined "Is the Affordable Care Act Working?" It consists of a small teaser on page A1, followed by two full interior pages of text, divided into seven articles, on pages A16 and A17. Once again we illustrate that there are just two ways of looking at the world.
In the Times, the first question they ask is "Has the percentage of uninsured people been reduced?" Fair question, and it is indeed the issue on which Obamacare was sold to the public. So the Times carefully cherry-picks some data to get the answer they want: "The Number of Americans Without Health Insurance Is Down by About 25 Percent." Really? They base that on what they call "five key surveys" recently taken, from Rand, Commonwealth Fund, Gallup, Urban Institute, and CDC. Hmmm, only one of them is from the government, and that one is CDC rather than the Census. What happened to the Census? No mention here in the Times article that the Census has changed its methodology to make its numbers on percent uninsured no longer comparable to prior data. Next, all five surveys only compare this year (2014) to last year (2013). The CDC survey only shows the percent uninsured down from 20% to 18% -- that's only a 10% decline, not 25%. In the four other surveys cited, the current percent uninsured is said to be 16%, 15%, 13% and 14%. Should we dare to ask what the percent uninsured was back, say, just before Obamacare was passed, late in the GW Bush administration, or maybe back in the Clinton administration? When I researched those questions for the September 30 article, the answer (according to Census data) was that the percent uninsured was 15.4% in 2008, and 13.7% in 2000. (When I attempt to confirm those numbers on the Census website today, I get a message that the data are "corrupted" and can't be displayed. Should we be suspicious?) The decline in uninsured from those numbers is little or nothing. So is there an actual meaningful decline that can be attributed to Obamacare, or is this just the result of an improving economy, or is it the case of a store owner who conveniently raised his prices just prior to declaring a "sale"? The Times doesn't choose to address that issue.
Well, assume that there has been a decline in the "uninsured" by something in the range of 10 - 25%. How much of that represents people who are paying for it, and how much represents people who have newly been given "insurance" for free? (Pardon my skepticism, but it's not clear to me why entitlement to free medical care qualifies as "insurance," other than that somebody wants to declare victory by having a statistic that the number of "uninsured" has gone down.) It turns out again that the Times won't give us an answer to the question. However, they give enough information to give strong reason to believe that most of the decline in "uninsured" comes from the Medicaid expansion.
But a few trends are clear. Most notably, Medicaid expansion really mattered. States that expanded their programs saw a substantially larger reduction in their uninsured population than states that did not expand.
Or to put it another way, if you give away free medical care, people will take it. Surely, you didn't need this 2000 page law if that was all it was going to accomplish.
Moving on, the Times' next question is "Has insurance under the law been affordable?" And the answer is, "For now, dire warnings that the law would cause premiums for most people to rise sharply have proved unfounded." Read the article, though, and you quickly realize that the Times measures the costs and benefits of the law by looking only at prices faced by consumers and treating government money as completely free and not part of the equation. There's no mention at all of how much the government is paying out for the exchange subsidies and Medicaid expansion. But lots of people get benefits of cheaper coverage!
Eighty-five percent of those who signed up during the enrollment period qualified for federal subsidies to help pay premiums. For those who qualified for subsidies through the federal exchange, the subsidies lowered the cost by 76 percent on average, according to the Obama administration.
So, did the law actually make the insurance less expensive, or did it just hide the cost somewhere in your taxes where you can't see it and quantify it? In this whole huge report on the ACA, there's no mention, as Bloomberg News found back in September, "that "federal spending on Obamacare and related legislation has far exceeded anyone's estimates (or imaginations)."
Turning to the part of the market where people actually pay for their insurance, the Times finds a mixed bag: some prices up, some down, some markets with lots of competition, some without, some additional coverages but some increased deductibles. Oh, it's just all so complicated! Or another way of looking at it is that it's not really complicated at all. We know from the government's efforts in higher education what happens when the government puts lots of money in subsidies into a market in order to make it "affordable" for all. It took about 30 years for the higher education business to gradually progress to a situation where almost nobody can afford college and an entire generation is crushed by a trillion dollars of outstanding debt. Betting that a comparable fate will eventually happen with Obamacare is like betting that the sun will rise tomorrow in the East. But the process does take many years to play out.
To summarize, despite great efforts to make this appear like a reasonable, carefully weighed evaluation, it's just the usual Times spin. Thousands of pages of a massively complex government takeover of a sixth of the economy, and it boils down to, some more people (but not many more) have insurance because now the government pays most or all of the cost for them. The large majority who previously were uninsured still are. Before, it was a crisis. Now it is not. Why? Because to point that out would be to jeopardize our guys' hold on power.