Last night I attended a meeting of an organization with which I have been involved for over 25 years — one, in fact, that I helped to start. It has nothing to do with health care, but after the end of the meeting I got into a political discussion with the one perrson who is actually an employee of the organization, a woman who, in the course of the discussion, said that it was good that President Obama manipulated the Congress through parliamentary tricks in order to pass Obamacare after Scott Brown was specifically elected on a promise to prevent it — because she liked Obamacare.
At this point, we started discusssing Obamacare. Now in fact, I never said what I actually approved of in Obamacare; the only thing I was discussing was what was bad, and we had to leave the building so I never finished the discussion. But I would like to complete it here (and I intend to tell her to look at it!)
My main opposition to Obamacare as it was finally passed is to the mandatory features. I think it is a good thing to make it easier fo people to get health insurance — the facts that insurance companies cannot deny coverage for pre-existing conditions, and that they have to keep children on parents' policies longer, are good. But instead of requiring people to have coverage and fining them if they do not, what should have been done is perhaps to subsidize its purchase (the insurance exchanges might well be a good thing if they are implemented correctly), and such things as to allow purchase of plans across state lines. It might even be that it should be detached from the employer contribution way it is mostly financed, so that you do not lose coverage when you leave a job, whether voluntarily or involuntarily.
The thing I cannot accept is that you are not permitted to decide, on your own, whether you want coverage, and even what kind of coverage you can get. When it was decided that you must have health insurance, it was also decided that a Government official would decide what kind of coverage you need. If a single male wants to buy a policy that does not cover the costs of childbirth, he cannot. It's not just its requrements on the employer side — the requirement to cover contraception that Catholic institutions are protesting — the insured person has no freedom to determine the best policy for his own needs.
If it were up to me, a plan that would have made more sense would have been to require insurance companies to cover everyone who applied (no denial of coverage for pre-existing conditions, as in the actual Obamacare plan), but arrange things that all employers paid the money they now put up for health insurance into a pool similar to the one they pay for unemployment insurance, and use this money to subsidize health insurance so that policies become affordable by people who cannot afford to buy it now. If a person does not want to buy health insurance, he should be able to self-insure. If he wants to buy a policy with no coverage for conditions he expects never to need, let him. The insurance companies, in turn, need to be able to price policies like life insurance policies, based on actuarial considerations, so that younger people who do not need as much medical care can get their insurance more cheaply. The fear has been spread that the young will opt out and leave the insurance companies with only the older and sicker people, raising their costs. If young people are required to pay less, however, they will be encouraged to join. Younger people do buy life insurance, so this idea works.
The other thing people have clamed would be a problem is that if you ban denial of coverage for pre-existing conditions, but allow people to start coverage at any time instead of requiring it at the beginning, they will first buy insurance when they are sick. The cure for that is to make it like the Medicare drug plan — if you can enroll but you don't, then when you do enroll it costs more than it otherwise would. Thai seems to work in the Medicare case — it would seem to work here as well.
Those are my thoughts.
