Most words in the English language have multiple meanings. Early in my courses I point out how using a word one way and then another in the same line of reasoning can lead to faulty conclusions. Orwell’s idea of doublethink in his novel, 1984, gave birth to a related idea, doublespeak, political speech, where words come completely unhinged from their original meaning, and sometimes come to mean the exact opposite.
We see politicians urging fairness to promote what is unfair. “Sensible” solutions are urged that are not only nonsense, but make problems worse instead of solving any problem. And we see politicians hiding behind their transparency.
In 2010, the Affordable Care Act, aka ObamaCare, became law, a push toward universal health coverage. Universal health care and health insurance coverage have been debated for many years in the U.S. In this 1999 talk before the Physicians for a National Health Program, Karen Palmer outlines the history of efforts to establish universal health coverage in the U.S. and traces the efforts back to the late 1800s.
While the roots are deep, the modern debate in the U.S. is linked to Hillary Clinton’s advocacy for universal health coverage in 1993, after 12 consecutive years of Republican control of the White House and a decade of health care prices rising much more rapidly than other prices and two decades of great turbulence in the job market, leading to uncertainty in health insurance coverage.
Since the passage of Medicare covering the elderly and Medicaid covering the non-elderly poor in the mid 1960s, the debate over universal coverage focused on the problem of the high costs of health care made it difficult for the middle class to afford health insurance. We should understand that the very programs that subsidized the health care insurance the elderly and the poor, both increased total demand for health care and made these health care consumers less careful about their own health care costs, pushing health care costs up rapidly for everyone in the 1970s and even more in the 1980s as our population became older. The promise of universal health care thus was led by a promise to control rising costs.
Though government cutting spending sounds like a somewhat facetious joke, there are three main ways in which the rise in health care spending might be brought down: by some limit on health care prices and the prices of health care inputs; by limiting access to some treatments and procedures; by reducing the barriers to entry into medical professions and by even more rapid technological advances in health care.
Of course, instead of increasing the technological development, the Affordable Care Act is likely to impede technological advances by placing heavy taxes on some health care devices, reducing the profitability of such devices, cutting incentives to develop them.
For many of the insurance companies to be selected to offer insurance on these state “exchanges,” their prices had to be low. To get their prices low, they set low rates of reimbursement for doctors and other providers. Many doctors and hospitals chose not to be providers. In California, though, a major plan listed almost 1000 doctors who never agreed to be providers, leading to a great deal of confusion by consumers.
To make matters worse, though, many of the patients in California who have ObamaCare coverage are beginning to find out the hard way that having health care insurance is not at all the same thing as having access to health care. What these partients are discovering is that most doctors have all of the patients that they can handle and are no longer taking more patients and patients just cannot find a doctor. In other words, there is a shortage of doctors with the California ObamaCare system.
The shortage of health care providers was something I anticipated when national health insurance was brought up in 1992 during the Clinton and Bush campaign for president as you can see in this column I wrote for the Thibodaux Chamber of Commerce Magazine. (Sorry for the crazy symbols in the file—these were added by changes in versions of servers that we have for the Nicholls website.)
In that column, I suggested one of the few things we can really do to reduce the rate of increase in health care costs: reduce the barriers to entry into health care professions by prying the control of health care professional school accreditation away from the professionals they educate. In just about any line of business, including health care, people want to have no extra barriers to entry into the field while trying to get in. Once in, just about everyone wants to close off the business off to newcomers, to new competition.
From my column on health insurance, you can see that by trying to keep the pay to doctors down, some people are denied care. Of course, my students will note that these price controls, this time by the insurance companies, have brought on shortages and these shortages have brought on very high search costs as people try to find doctors that just are not there. The combined costs of looking and looking for doctors who are not there and of waiting to see a doctor once you find one along with the jacked up premiums for ObamaCare to cover treatment you are not interested in to subsidize someone else, and the higher tax bills to cover subsidies and expanded Medicaid enrollments will surely be higher than what we had before.
Welcome to the new meaning of “affordable.”