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Hullabaloo


Saturday, December 14, 2013

 
Bipartisan Hypocrisy

by digby

Ezra Klein wonders how Republicans can be such hypocrites about health care when Obamacare turns out to be exactly what they wanted all along:
Republicans have zeroed in on two things that people really will hate about insurance under Obamacare: The high deductibles and the limited networks.

"As consumers dig into the details," Robert Pear reports in the linked article, "they are finding that the deductibles and other out-of-pocket costs are often much higher than what is typical in employer-sponsored health plans."

What's confusing about this line of attack is that high-deductible health-care plans -- more commonly known as "health savings accounts" -- were, before Obamacare, a core tenet of Republican health-care policy thinking. In fact, one of the major criticisms of Obamacare was that it would somehow kill those plans off. "Obamacare may be fatal for your HSA," warned the Heritage Foundation on 2010. "Health Savings Accounts Under Attack" blared Red State.'

When Republicans were forced to come up with alternatives for Obamacare, high-deductible plans were core to those proposals. "Conservatives have suggested deregulating Obamacare’s exchanges to make it easier to provide policies with high deductibles," wrote Ramesh Ponnuru. One of those conservatives was right-wing darling Dr. Ben Carson. "In order to right the ship, we need to return the responsibility for good health care to the patient and the health care provider," he said. "One of the best ways to do this is through health savings accounts, which patients can control."
This always baffled Obamacare's supporters. "The minimal, or bronze, insurance option allows out-of-pocket spending of up to $12,500 for a family of four," wrote Jonathan Cohn. "Those are some pretty high deductibles!"

Now that those high deductibles are here, Republicans have decided that they are, if anything, too high. Just one more broken promise.

Obama's pledge that "if you like your doctor, you can keep your doctor" is also under fire. The issue here is that insurers entering the competitive health marketplaces are tightening their networks in order to cut costs and improve quality. It's worked: Premiums in the marketplaces are far lower than was expected when Obamacare passed.

This, too, is a success for a longtime conservative health-policy idea. Insurance exchanges have been in every major Republican health-care bill since the early 1990s. They were in Paul Ryan's 2009 health-care proposal. They're the basis of the GOP's plan for Medicare reform.

Yes, Republicans are hypocrites. And if you give them an inch they'll take a mile. News at 11.

But what about the Democrats? Are they not hypocrites as well? Here's an example of how they used to characterize the high deductible (HSA) concept:
Health savings accounts by definition favor the wealthy and/or the healthy. For those that never go to the doctor, or who can afford the high out-of-pocket costs incurred when using health savings accounts (you need to pay $1,050 as an individual or $2,100 for a family before your insurance will cover the rest), health savings accounts are great. Wealthy and/or healthy individuals can put a bit of money away, tax free, into their health savings account and then draw from it to pay their astronomical out-of-pocket costs when they decide to go see a doctor. If you're healthy, the doctor's visit doesn't happen very often. If you're wealthy, who cares if it happens very often, you can afford it.
And as for the smaller network issue, I think we all know that Obamacare proponents, starting with the president, didn't exactly sell it as a cost savings device based on narrowing your choice of doctors. In fact, Democrats condemned Republicans for trying to deny Americans access to whatever doctors they wanted to see --- or making them shop around for cheaper health care in general.

Now, I'm not saying that Republican caterwauling isn't far worse. It is. The Democrats adopted the Heritage Foundation plan and they're still screaming. This is how they move the country right. It's very effective. But Democrats appropriating Republican ideas and defending them is also a form of hypocrisy, particularly when they then scold their own voters for being upset with aspects of the end result.

What's done is done and perhaps this was always the best we could do in this profit fetishizing culture of ours. But with the GOP shrieking about Obamacare being akin to a communist takeover, I can't help but wonder where the Democrats will draw the line. Will they continue to appease them as they have so far? After all, we just came through a very close call with Social Security cuts and raising the Medicare age, both of which were, for the first time proposed by a Democratic administration in budget negotiations. That Rubicon has been crossed. Why won't Obamacare be subject to the same dynamic as the New Deal programs which have been fully woven into the fabric of American life?

The lesson for progressives is that you have to accept that the Republicans will never, ever raise a white flag and admit that you have won. They just keep shamelessly pushing the envelope. But the Democrats, on the other hand, are always looking for a deal. Any deal. And that's how we have become the inequality capital of the first world. Let's not pretend that this happened only because of Republican hypocrisy.

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