The Real Beneficiaries and Victims of Obamacare

The success or failure of Obamacare is often looked at in terms of "winners" versus "losers."

For example, in Thomas B. Edsall's analysis of Obamacare in the New York Times, Drew Altman, president of the Henry J. Kaiser Family Foundation, is quoted as stating:

I think the bottom line here is that the "winners" greatly outnumber the "losers" in general and in the individual market in Obamacare, but the media and political math is different from the actual math. A significant minority of "losers" or self-perceived losers and a few high profile bad outcomes...are more than enough to cause real political problems.

Kaiser is an organization that does research on health policy issues, but I would wager that even the learned people at Kaiser have no real idea at this point whether there will actually end up being more "winners" than "losers" under Obamacare compared to the health insurance system that preceded it, much less that the winners will "greatly outnumber" the losers. With Obamacare, there are just too many known unknowns as well as unknown unknowns.

But let's just stipulate, for the sake of argument, that Altman knows a great deal about number crunching and health insurance. What he may not know so much about is how people might feel about having been lied to by the president, even if some of them might have ended up as "winners" paying lower premiums. He may also not know how some people feel who used to be economically independent but who now need the government subsidies in order to afford their compulsory health insurance: are they "winners" too, or do some perceive the change as a blow to their self-respect? Do some "winners" get angry on behalf of their friends and relatives who are "losers," through no fault of their own, or does everyone only react to his/her own situation? And how might "winners" who are paying a little less money for premiums factor that against losing their trusted doctors and their favorite hospitals as part of the bargain?

When Obamacare was just a gleam in its advocates' eyes, there was already a system of health insurance in place that had been cobbled together over the years. It was admittedly imperfect, although it had been tweaked repeatedly to try to improve it. It was set by the states and overseen and regulated by state insurance departments and commissioners. Obama and liberal Democrats, and even some conservatives, have consistently pointed out what they perceive as unfair discrimination and/or inequities on the part of insurance companies under that system, although there were all sorts of laws in many states to help remedy the situation: limits on what restrictions could be placed on covering pre-existing conditions, laws forbidding the cancellation of policies when someone became sick unless fraud had been involved on the part of the patient, the establishment of high-risk pools, the provision of Medicaid for the poor, and prohibiting hospitals from turning away indigent patients.

Did those rules make the system completely fair? Of course not. But the inequities that remained in health insurance were a subset of the more general inequities of life -- such as the reality that some people are wealthier than others, and the wealthier can afford more -- combined with the fact that insurance is a profit-making business. For example, allowing people to sign up with pre-existing conditions without charging them significantly more would tend to reduce profits and could even make that business go out of business rather rapidly. In sum, the unfairness was mostly understandable and not arbitrary, whether people thought it needed remediation or not.