The Great Obamacare Divide

piggybankThe Affordable Care Act did not create the divide between the healthy and the unhealthy, it drove the wedge deeper. The healthy have always paid for the unhealthy but the costs have been spirally out of control for the last thirty years. Out of control health care costs was and still is the primary reason for health care reform. The Affordable Care Act took a different tack to fixing the health care problem. It decided that the only health care reform issue that was going to be addressed was an expansion of our chronic care system and this expansion would be accomplished by increased cost shifting. The key cost shifting policies implemented by the Affordable Care Act were to ban pre-existing conditions, use community rating to level out insurance premiums between age groups, to expand Medicaid, and to use a one size fits all approach to health insurance plans. As long as third party payer system remained intact and paying for the expansion, the goals of the Affordable Care Act were safe. When the healthy people realized that their insurance premiums were going up or their health insurance was being dropped because they were the people paying for expanded benefits, the results were predictable. According to a recent Fox News poll 56% of the people believe that they had a better health care plan before the Affordable Care Act reforms. The Affordable Care Act reforms drove a big enough wedge between the healthy against the unhealthy that the healthy noticed.

The majority of the people in this country are healthy. They are also likely to be skeptical of the argument that cost shifting policies will reduce future health insurance increases. Like most people they do not like to think about health care until it is necessary. Unlike the unhealthy group they are willing to evaluate their health insurance with the same cost to benefit lens they use to evaluate their auto or house insurance if it will save them money. They have concluded that the health care system has failed to fix their problem for twenty years and it is unlikely that the Affordable Care Act will fix it. The unhealthy and poor really do not have a choice about their health care so their attitude to health care is completely different than the healthy. They do not care who pays for the health care as long as they get the health care they want. So we have a group of healthy people who reluctantly care about health care costs and an unhealthy group that does not care at all. It is not surprising that a Rasmussen poll found out that 59% of the people would trade a less expensive health insurance plan for a bigger paycheck.

If they had a choice, 59% of Likely U.S. Voters would choose a less expensive health insurance plan that covered only major medical expenses and a bigger paycheck.

The healthy majority are willing to embrace “common sense” changes and the unhealthy minority do not care. The healthy want more choices that result in lower costs.  If they continue to be healthy, they reason that they should be able to use “their savings” for other high priority items in the family budget. It is their money. The Affordable Care supporters believe these savings belong to society and should be used to expand health care for those unhealthy people who have no choice. Solving this health care issue for the unhealthy is a major part of their world view of the “greater good” for society. In reality they have entered into a shell game with the insurance companies and health care providers to change the source of funds for the chronic care and uninsured patients. It is not surprising that the healthy people group view the “greater good” argument with skepticism. They understand the “greater good” talk, they do not see the “greater good” walk. To the healthy we have a health care cost problem and the problem with the unhealthy will not be solved by throwing more money at it. It will require a different type of health care reform than the Affordable Care Act. This health care reform has to be smarter about the health cost games being played by insurance companies and health care providers, increasing health care competition, and less focused on raising revenue. It is a regulatory environment that looks like it lends itself more to the state control than the federal control. This leaves the Affordable Care Act supporters with the “Jerry Maguire” dilemma if they want the Affordable Care Act to survive. Do you continue to argue that Affordable Care Act reforms are part of the “greater good” for society despite being significantly more expensive for the healthy or do you embrace your job as agent to the people and start showing them some results they can see in their wallet? Show me the money!