Monday, August 07, 2017

Navigating health insurance adds jobs, unwanted jobs


I find myself in the unexpected position of thinking Paul Krugman has overemphasized, or perhaps misplaced, the potency of white supremacy in the Republican crusade to destroy Obamacare. The economist and columnist attributes the rage against Obamacare to mobilized racial resentment, which he soft pedals as "identity politics".

Why did the prospect of health reform produce so much popular rage in 2009 and 2010? ... there was plenty of genuine popular rage, stoked by misinformation and outright lies from the usual suspects: Fox News, talk radio and so on. For example, around 40 percent of the public believed that Obamacare would create “death panels” depriving senior citizens of care.

The question then becomes why so many people believed these lies. The answer, I believe, comes down to a combination of identity politics and affinity fraud.

Whenever I see someone castigating liberals for engaging in identity politics, I wonder what such people imagine the right has been doing all these years. For generations, conservatives have conditioned many Americans to believe that safety-net programs are all about taking things away from white people and giving stuff to minorities.

And those who stoked Obamacare rage were believed because they seemed to some Americans like their kind of people — that is, white people defending them against you-know-who.

All that is true; it was mostly the Making America White Again set who drove the noisy clamor against the Affordable Care Act.

But that is added on top of the widely felt underlying grievance against the U.S. health care non-system: it fails to provide what people actually want from the government in relation to health care -- that is, it fails make medical care easy to access, uncomplicated, and as close to possible to free (or perhaps paid for through taxes.) People don't want access to a profit-driven insurance product: to normal human beings, our insurance system means premiums that always seem to be going up, co-pays, deductibles, ever-changing lists covered doctors and services to navigate, and much more. Using insurance is a job. Most people only have insurance because they have a job already. They resent being asked to do another job in order to get their pains diagnosed.

Sarah Kliff, Vox's lead health care reporter, was stunned in field interviews to learn what many people really want:

Medicaid is *way* more popular than marketplace plans. No deductibles or co-pays!

In fact, she reports, among Trump voters in Tennessee, people who used the Obamacare market places to buy insurance expressed "Medicaid envy" at their poorer neighbors who qualified for the cheaper, simple government plan.

Of course I'm glad that Republicans have not corralled the votes to wrench health care away from millions of people -- but the rumblings of discontent will only continue so long as insurers, hospitals, and doctors are allowed to organize provision of medical care to skim off vast profits from themselves. No wonder people are pissed off and stay that way.

H/t to expostfactoid for pulling data on the yearning and the possibility for Medicaid for All together.

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