Eric Zuesse, originally posted at strategic-culture.org
To Republicans, good news about Obamacare (the American President’s ‘legacy’ healthcare-reform program, called officially “The Affordable Care Act”) is bad news about Obamacare (for all Americans) — and, now, they’ve got more of it to crow about than they did before.
First of all, on Friday, September 16th, the U.S. Bureau of Labor Statistics reported that the two categories of consumer products and services whose prices rose by far the most, during both the past year, and the latest month, were “Medical care services” and “Medical care commodities.” President Obama had promised that his Obamacare would end healthcare-cost inflation, not supercharge it.
In addition to that, House Republicans (the House Energy and Commerce Committee) issued on September 13th, their own ‘good news’ about Obamacare, in a research study that they did, titled “Implementing Obamacare: A Review of CMS’ Management of the State-Based Exchanges”. It reports that U.S. taxpayers (the CMS or Centers for Medicare and Medicaid Services) have paid $4.6 billion to 16 states to set up state-based insurance “exchanges” or marketing-sites for the insurance companies’ plans, and that four (25%) of them have already failed, and one more will close by the end of 2017. (More could fall subsequently.) Furthermore, with all of that $4.6B spending, every one of these exchanges was supposed to be self-sustaining by the end of 2014, but none of them yet is, nearly two years after the deadline; and, consequently, their economic drain to the country continues, and the federal expenditures will keep rising for Obamacare’s state exchanges (if and as long as any of them continue to exist).
Here are the Committee’s main “Findings”:
CMS is not confident that the remaining SBEs will be sustainable in the long term.
As of September 2016, every SBE still relies upon federal establishment grant funds — 20 months after SBEs were to be self-sustaining by law.
Only one SBE — Kentucky — complied with PPACA’s requirement that all SBEs publish the costs associated with operating its exchange on the internet, including monies lost to waste, fraud, and abuse.
CMS prohibits pay-per-enrollee schemes in federally facilitated exchange states, but permits the same problematic scheme in SBEs, in order to increase enrollment numbers.
The HHS Inspector General found that Maryland and Nevada violated federal rules and used federal Medicaid dollars to pay for unpermitted SBE expenses.
CMS failed to enforce its own rules on Medicaid allocations, and did not recover the misspent dollars identified by the HHS Inspector General.
CMS has recovered only $1.6 million in misspent federal funds from three SBEs. Nearly $1 million was for impermissible construction costs that went undetected by CMS for over a year.
The Government Accountability Office issued two reports on CMS oversight of the SBEs. All six of the recommendations for how CMS can improve its oversight of the SBEs remain “open,” indicating that CMS has not implemented a single one.
CMS eased the transition for failed SBEs to join healthcare.gov by allowing them to keep user fees collected by insurance carriers intended to pay for the use of healthcare.gov.
Starting in 2017, CMS will offer failed SBEs a “reduced” rate of 1.5 percent to use healthcare.gov, at the expense of federal taxpayers.
According to CMS, SBEs have “a right to change their mind” if a state decides it no longer wants to operate an exchange.
However, these are actually small problems compared to broader issues of Obamacare — especially: healthcare cost, universality, and quality, in the United States, as compared to other countries. After Obamacare’s having been in effect now for two years, there is no indication whatsoever that it has at all improved the competitive standing of the U.S. in healthcare, but some evidence exists that the U.S. — already twice the per-capita healthcare cost as compared to healthcare in other countries — experienced the highest percentage increase in that cost of any country, soaring from $8,713 per-capita in 2013 (pre-Obamacare), up 9.3% to $9,523 Obamacare in 2014, the latest-reported year. Obama had promised the opposite (though, like nearly all of his ‘promises’, only in vague terms).
Senator Obama, when he was selling Obamacare, back on 23 June 2007, early in his Democratic primary campaign against Senators Hillary Clinton and John Edwards, promised that if he became President, “I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family’s premium by up to $2,500 a year.”
The results turned out to be this: Obamacare started in October 2013 (not “by the end of my first term”) and so its first year of operation was 2014. Obama there promised in terms of insurance-costs per family, not per person. The closest statistically measured standard term for that word “family” is the U.S. Census’s “household.” The Census’s “Number of people per household” has been stable near its current number, 2.54, ever since 2001. So: Obama’s promise was to lower the average American’s annual insurance premium by “up to” $1,000 per year (which actually means anything less than $1,000 per year). No clear data have been published regarding whether that promise (such as it was — meaningless, but that’s the way he won the Presidency, by seeming to say things that actually meant almost nothing) was fulfilled. However, the Kaiser Family Foundation issued a report on 21 May 2015, when the first results were in for the year 2014 (Obamacare’s first year), and found that, when individual insurance plans’ enrollees (both Obamacare and traditional) were asked “Do you feel well-protected by your health insurance plan, or do you feel vulnerable to high medical bills?” 38% of Obamacare enrollees said “Feel vulnerable to high medical bills” but only 34% of non-Obamacare individual health insurance enrollees did; and this fact suggests that the deductibles and other exclusions were worrying people more in Obamacare than in the pre-existing (traditional) insurance plans. In other words: though Obama was promising to lower health-insurance premiums by “up to” $1,000 per person, he wasn’t promising to lower healthcare costs for anyone. There are lots of healthcare costs that insurance doesn’t cover. Obama’s promise was thus meaningless, especially because there seems to be some evidence that the Obamacare plans have higher deductibles etc. — out-of-pocket uncovered costs — than pre-Obamacare plans.
What’s not meaningless is total annual healthcare expenses (which include health-insurance premiums) per person in the United States. And those figures do exist, and here they are:
The total annual health expenditure per person in the United States was $8,454 in 2012, $8,713 in 2013 (the last pre-Obamacare year), and a whopping $9,523 during Obamacare’s first year, 2014; and it hasn’t yet been published for 2015, though we’re already nine months into 2016. Regardless of whether Obama’s promise to reduce annual premiums by “up to” $1,000 per year per person ever becomes fulfilled, per-capita healthcare costs seem to be increasing sharply under Obamacare, not decreasing, but the government (and thus the press) aren’t publishing recent-enough data for that to be firmly established yet. The 2015 costs, when published, will provide a crucial early indication of whether there’s any net benefit from Obamacare at all — or maybe even lots of net harm. (In any case, the first year’s results on healthcare costs were deplorable.)
Another key variable by which to judge Obamacare is the universality of health insurance; and, until Obama came into office, 85.4% of Americans had health insurance, 14.6% did not. The latest figures are 89% have insurance, 11% do not. Candidate Obama promised “universal” coverage, and that it “will cover every American,” but increasing the coverage-rate from 85.4%, up to 89%, doesn’t even come close to achieving that (100%). All other advanced nations already have 100% coverage — in every one, healthcare is a right, not a privilege that’s available only to people who can afford it. Coverage is universal, and therefore people get diagnosis and treatment early enough in a disease so as to be able to extend their health and life-spans. That’s the way to keep healthcare costs down, not twice the international average as is the case in the corrupt United States. The only people who benefit from the American system are investors — including the people who invest in politicians: including Republican politicians, which is why they can’t criticize Obamacare on these factors (cost and universality) without being total hypocrites.
Another key variable is quality of care; and the U.S. quality of care is low in comparison to other advanced nations, (as one should expect where the cost is high and the universality is low), and there exist as-of-yet, no solid data indicating whether quality of care has improved under Obamacare. To be satisfied with Obamacare is to be satisfied with America’s being at the very bottom, in what America gets for what America pays on healthcare. Even if Obamacare might help the investors who actually hired him and the other politicians to produce it, Obamacare might harm America. No evidence yet exists that it has helped America.
Near the very end of Obama’s eight years in office, his promises (to the extent that any were clear and important) about what he would achieve regarding healthcare in the U.S. if elected President, still remain to be fulfilled, and America still (and even increasingly) continues to lag the other advanced nations regarding healthcare.
Obama rammed through the healthcare plan that he wanted, and he continues to rave about the plan that he got, but even near the end of his Presidency, we don’t know whether it had any real merit, at all.
In fact, the entire speech from which that quotation of his, promising “$2,500 a year” premium-reductions per “family” was taken, was loaded with assertions that seem outright phony in retrospect. Even the immediately surrounding context of that quotation exemplifies this: “I have made a solemn pledge that I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family’s premiums by up to $2500 a year. That’s not simply a matter of policy or ideology — it’s a moral commitment.” Would he acknowledge, now, at the end of his Presidency, that his deception of the public there, was a “moral failure”? It was, indeed, profoundly corrupt: Obama didn’t choose to write the bill Senator Ted Kennedy, who had endorsed Obama against Hillary Clinton and wanted and expected to get that assignment, and who favored the public option and many other progressive features that candidate Obama had said he wanted; but instead Obama selected the conservative Senator Max Baucus, who opposed all those things. And Baucus then engaged the health-insurance-company lobbyist Elizabeth Fowler to draft the bill. After it passed, Obama hired Fowler into his Administration to administer Obamacare’s implementation. And after that was finished, Fowler went right back into lobbying — this time for yet another healthcare industry that had worked with Fowler to draft Obamacare and that expected to (and did) profit from it: pharmaceuticals. On 5 December 2012, Britain’s Guardian headlined “Obamacare architect leaves White House for pharmaceutical industry job”.
If Obama is going to leave a positive legacy, Obamacare certainly won’t be it. That’s lots of good news for Republicans, but lots of lousy news for Americans. And it’s the reality about Obamacare, and about the extraordinarily corrupt nation, America, which stands out for high costs and low quality, in healthcare. Nothing that Republicans recommend on healthcare is any better. But the fact that Obamacare is a bust, is good news to their ears, and so they trumpet the minor points of its failure, while ignoring the major ones, where their own recommendations are even worse than what Democrats gave us.
Is this a country in decline? The answer to that question is more than economic. It is everything, including moral. But if America is to catch up with the rest of the industrialized world, it can’t proceed any further in its becoming increasingly corrupt. That certainly won’t do the job. It cannot work. The ‘change’ candidate in a corrupt America, has brought us just more of the same, but worse — even if it’s not bad enough to satisfy Republicans.
Investigative historian Eric Zuesse is the author, most recently, of They’re Not Even Close: The Democratic vs. Republican Economic Records, 1910-2010, and of CHRIST’S VENTRILOQUISTS: The Event that Created Christianity.